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Martiniano R, Haber M, Almarri MA, Mattiangeli V, Kuijpers MCM, Chamel B, Breslin EM, Littleton J, Almahari S, Aloraifi F, Bradley DG, Lombard P, Durbin R. Ancient genomes illuminate Eastern Arabian population history and adaptation against malaria. CELL GENOMICS 2024; 4:100507. [PMID: 38417441 PMCID: PMC10943591 DOI: 10.1016/j.xgen.2024.100507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/01/2023] [Accepted: 01/31/2024] [Indexed: 03/01/2024]
Abstract
The harsh climate of Arabia has posed challenges in generating ancient DNA from the region, hindering the direct examination of ancient genomes for understanding the demographic processes that shaped Arabian populations. In this study, we report whole-genome sequence data obtained from four Tylos-period individuals from Bahrain. Their genetic ancestry can be modeled as a mixture of sources from ancient Anatolia, Levant, and Iran/Caucasus, with variation between individuals suggesting population heterogeneity in Bahrain before the onset of Islam. We identify the G6PD Mediterranean mutation associated with malaria resistance in three out of four ancient Bahraini samples and estimate that it rose in frequency in Eastern Arabia from 5 to 6 kya onward, around the time agriculture appeared in the region. Our study characterizes the genetic composition of ancient Arabians, shedding light on the population history of Bahrain and demonstrating the feasibility of studies of ancient DNA in the region.
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Affiliation(s)
- Rui Martiniano
- School of Biological and Environmental Sciences, Liverpool John Moores University, L3 3AF Liverpool, UK.
| | - Marc Haber
- Institute of Cancer and Genomic Sciences, University of Birmingham Dubai, Dubai, United Arab Emirates
| | - Mohamed A Almarri
- Department of Forensic Science and Criminology, Dubai Police GHQ, Dubai, United Arab Emirates; College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | | | - Mirte C M Kuijpers
- Department of Ecology, Behavior and Evolution, School of Biological Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Berenice Chamel
- Institut Français du Proche-Orient (MEAE/CNRS), Beirut, Lebanon
| | - Emily M Breslin
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin 2, Ireland
| | - Judith Littleton
- School of Social Sciences, University of Auckland, Auckland, New Zealand
| | - Salman Almahari
- Bahrain Authority for Culture and Antiquities, Manama, Kingdom of Bahrain
| | - Fatima Aloraifi
- Mersey and West Lancashire Teaching Hospitals NHS Trust, Whiston Hospital, Warrington Road, Prescot, L35 5DR Liverpool, UK
| | - Daniel G Bradley
- Smurfit Institute of Genetics, Trinity College Dublin, Dublin 2, Ireland
| | - Pierre Lombard
- Bahrain Authority for Culture and Antiquities, Manama, Kingdom of Bahrain; Archéorient UMR 5133, CNRS, Université Lyon 2, Maison de l'Orient et de la Méditerranée - Jean Pouilloux, Lyon, France
| | - Richard Durbin
- Department of Genetics, University of Cambridge, CB2 3EH Cambridge, UK.
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Elagali A, Shubayr M, Noureldin E, Alene KA, Elagali A. Spatiotemporal Distribution of Malaria in the Kingdom of Saudi Arabia. Trop Med Infect Dis 2024; 9:16. [PMID: 38251213 PMCID: PMC10820690 DOI: 10.3390/tropicalmed9010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Malaria is a significant public health concern in the Kingdom of Saudi Arabia (KSA). This study aimed to investigate the spatiotemporal distribution of malaria in the KSA between 2017 and 2021. METHODS A spatial analysis was conducted using data for malaria cases stratified by Plasmodium species reported by the Ministry of Health for the period 2017-2021. Covariate data such as environmental, socioeconomic, and demographic factors were assembled from different publicly available sources. RESULTS A total of 13,852 cases were reported from 20 regions in the KSA during the study period. The study indicated a decline in the overall number of reported cases from 2715 in 2017 to 2616 in 2021, primarily driven by a decrease in Plasmodium falciparum infections. However, the number of Plasmodium vivax cases increased in 2021. Southern regions of the KSA remained at higher risk due to imported cases from neighboring Yemen. Socioeconomic and demographic factors, such as access to healthcare and education, were found to affect malaria transmission. Environmental factors, such as temperature and rainfall, were also identified as determinants of malaria risk. CONCLUSIONS This study showed significant spatial variation in malaria cases in the KSA that was related to underlying socioeconomic status and environmental factors. The findings of this study highlight the need for continued efforts to control and eliminate malaria in the KSA, particularly in regions with higher risk of malaria.
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Affiliation(s)
- Ahmed Elagali
- School of Biological Sciences, University of Western Australia, Perth, WA 6009, Australia
- Department of Zoology, Omdurman Islamic University, Al Khartoum 14415, Sudan;
| | - Mosa Shubayr
- Department of Preventive Dental Sciences, Jazan University, Jazan 45142, Saudi Arabia
| | | | | | - Asmaa Elagali
- Department of Zoology, Omdurman Islamic University, Al Khartoum 14415, Sudan;
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Alhaddad MJ, Alsaeed A, Alkhalifah RH, Alkhalaf MA, Altriki MY, Almousa AA, Alqassim MJ, Alibrahim F. A Surge in Malaria Cases in the Eastern Health Region of Saudi Arabia During the COVID-19 Pandemic. Cureus 2023; 15:e37740. [PMID: 37213951 PMCID: PMC10192777 DOI: 10.7759/cureus.37740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/23/2023] Open
Abstract
Background Malaria transmission was stopped on most of the vast area of the Kingdom of Saudi Arabia. However, the pandemic of coronavirus disease (COVID-19) has negatively affected the efforts to control malaria. For instance, COVID-19 was reported to induce a relapse of malaria that is caused by Plasmodium vivax. Furthermore, physicians' attention toward COVID-19 can only result in neglect and delayed diagnosis of complicated malaria cases. These factors, among others, might have contributed to an increase of malaria cases in Dammam, Saudi Arabia. Thus, this study was conducted to examine the effects of COVID-19 on malarial cases. Methods The medical records of all patients who were treated at Dammam Medical Complex for malaria between July 1, 2018, and June 30, 2022, were reviewed. Malaria cases were compared between the pre-COVID-19 period (between July 1, 2018, and June 30, 2020) and the COVID-19 period (between July 1, 2020, and June 30, 2022). Results A total of 92 malaria cases occurred in the total study period. There were 60 cases of malaria in the COVID-19 period as opposed to only 32 cases in the pre-COVID-19 period. All the cases were imported from the endemic Saudi southern areas or from outside the country. Eighty-two patients (89.1%) were males. Most of them were Sundaneses (39 patients, 42.4%), Saudis (21 patients, 22.8%), and tribal peoples (14 patients, 15.2%). Fifty-four patients (58.7%) were infected with Plasmodium falciparum. Seventeen patients (18.5%) were infected with Plasmodium vivax. Another 17 patients (18.5%) had a mixed infection with both Plasmodium falciparum and Plasmodium vivax. A trend toward more infected stateless tribal patients was observed in the COVID-19 period compared to the pre-COVID-19 period (21.7% vs 3.1%). A similar trend was noticed for mixed malarial infections with both Plasmodium falciparum and Plasmodium vivax (29.8% vs 0%) with a P value of less than 0.01. Conclusion Malaria cases were almost doubled during the COVID-19 pandemic as compared to the pre-pandemic era signifying the negative effects of the pandemic on malaria epidemiology. The cases increased for a variety of causes that include alternation of health-seeking behaviors, changes in healthcare structures and regulations, and the interruption of malaria preventive services. Future research is needed to study the long-term effects of the changes imposed by the COVID-19 pandemic and to mitigate the effects of any future pandemic on malaria control. As two patients from our cohort were diagnosed with malaria based on blood smears, although they had negative rapid detection tests (RDTs), we recommend testing all the patients who are suspected to have malaria with both RDTs and peripheral blood smears.
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Affiliation(s)
- Mousa J Alhaddad
- Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | - Ali Alsaeed
- Department of Internal Medicine, Infectious Disease Division, Dammam Medical Complex, Dammam, SAU
| | | | - Makarem A Alkhalaf
- College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | | | - Arif A Almousa
- Department of Internal Medicine, Dammam Medical Complex, Dammam, SAU
| | | | - Fatimah Alibrahim
- Department of Internal Medicine, Infectious Disease Division, Dammam Medical Complex, Dammam, SAU
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4
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Rawson T, Doohan P, Hauck K, Murray KA, Ferguson N. Climate change and communicable diseases in the Gulf Cooperation Council (GCC) countries. Epidemics 2023; 42:100667. [PMID: 36652872 DOI: 10.1016/j.epidem.2023.100667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 12/05/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
A review of the extant literature reveals the extent to which the spread of communicable diseases will be significantly impacted by climate change. Specific research into how this will likely be observed in the countries of the Gulf Cooperation Council (GCC) is, however, greatly lacking. This report summarises the unique public health challenges faced by the GCC countries in the coming century, and outlines the need for greater investment in public health research and disease surveillance to better forecast the imminent epidemiological landscape. Significant data gaps currently exist regarding vector occurrence, spatial climate measures, and communicable disease case counts in the GCC - presenting an immediate research priority for the region. We outline policy work necessary to strengthen public health interventions, and to facilitate evidence-driven mitigation strategies. Such research will require a transdisciplinary approach, utilising existing cross-border public health initiatives, to ensure that such investigations are well-targeted and effectively communicated.
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Affiliation(s)
- Thomas Rawson
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK.
| | - Patrick Doohan
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Katharina Hauck
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Kris A Murray
- Centre on Climate Change and Planetary Health, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia
| | - Neil Ferguson
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
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5
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Abdalal SA, Yukich J, Andrinopoulos K, Alghanmi M, Wakid MH, Zawawi A, Harakeh S, Altwaim SA, Gattan H, Baakdah F, Gaddoury MA, Niyazi HA, Mokhtar JA, Alruhaili MH, Alsaady I, Alhabbab R, Alfaleh M, Hashem AM, Alahmadey ZZ, Keating J. Livelihood activities, human mobility, and risk of malaria infection in elimination settings: a case-control study. Malar J 2023; 22:53. [PMID: 36782234 PMCID: PMC9926773 DOI: 10.1186/s12936-023-04470-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Livelihood activities and human movements participate in the epidemiology of vector-borne diseases and influence malaria risk in elimination settings. In Saudi Arabia, where malaria transmission intensity varies geographically, it is vital to understand the components driving transmission within specific areas. In addition, shared social, behavioural, and occupational characteristics within communities may provoke the risk of malaria infection. This study aims to understand the relationship between human mobility, livelihood activities, and the risk of malaria infection in the border region of Jazan to facilitate further strategic malaria interventions. In addition, the study will complement and reinforce the existing efforts to eliminate malaria on the Saudi and Yemen border by providing a deeper understanding of human movement and livelihood activities. METHODS An unmatched case-control study was conducted. A total of 261 participants were recruited for the study, including 81 cases of confirmed malaria through rapid diagnostic tests (RDTs) and microscopy and 180 controls in the Baish Governorate in Jazan Provinces, Saudi Arabia. Individuals who received malaria tests were interviewed regarding their livelihood activities and recent movement (travel history). A questionnaire was administered, and the data was captured electronically. STATA software version 16 was used to analyse the data. Bivariate and multivariate analyses were conducted to determine if engaging in agricultural activities such as farming and animal husbandry, recent travel history outside of the home village within the last 30 days and participating in spiritual gatherings were related to malaria infection status. RESULTS A logistical regression model was used to investigate components associated with malaria infection. After adjusting several confounding factors, individuals who reported travelling away from their home village in the last 30 days OR 11.5 (95% CI 4.43-29.9), and those who attended a seasonal night spiritual gathering OR 3.04 (95% CI 1.10-8.42), involved in animal husbandry OR 2.52 (95% CI 1.10-5.82), and identified as male OR 4.57 (95% CI 1.43-14.7), were more likely to test positive for malaria infection. CONCLUSION Human movement and livelihood activities, especially at nighttime, should be considered malaria risk factors in malaria elimination settings, mainly when the targeted area is limited to a confined borderland area.
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Affiliation(s)
- Shaymaa A. Abdalal
- grid.412125.10000 0001 0619 1117Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Joshua Yukich
- grid.265219.b0000 0001 2217 8588School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA USA
| | - Katherine Andrinopoulos
- grid.265219.b0000 0001 2217 8588School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA USA
| | - Maimonah Alghanmi
- grid.412125.10000 0001 0619 1117Vaccines and Immunotherapy Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Majed H. Wakid
- grid.412125.10000 0001 0619 1117Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Special Infectious Agents Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ayat Zawawi
- grid.412125.10000 0001 0619 1117Vaccines and Immunotherapy Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Steve Harakeh
- grid.412125.10000 0001 0619 1117King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sarah A. Altwaim
- grid.412125.10000 0001 0619 1117Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Special Infectious Agents Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hattan Gattan
- grid.412125.10000 0001 0619 1117Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Special Infectious Agents Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fadi Baakdah
- grid.412125.10000 0001 0619 1117Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Special Infectious Agents Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mahmoud A. Gaddoury
- grid.412125.10000 0001 0619 1117Department of Community Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hatoon A. Niyazi
- grid.412125.10000 0001 0619 1117Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jawahir A. Mokhtar
- grid.412125.10000 0001 0619 1117Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed H. Alruhaili
- grid.412125.10000 0001 0619 1117Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Special Infectious Agents Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Isra Alsaady
- grid.412125.10000 0001 0619 1117Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Special Infectious Agents Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rowa Alhabbab
- grid.412125.10000 0001 0619 1117Vaccines and Immunotherapy Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohamed Alfaleh
- grid.412125.10000 0001 0619 1117Vaccines and Immunotherapy Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah, 21589 Saudi Arabia
| | - Anwar M. Hashem
- grid.412125.10000 0001 0619 1117Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia ,grid.412125.10000 0001 0619 1117Vaccines and Immunotherapy Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ziab Zakey Alahmadey
- grid.415696.90000 0004 0573 9824Microbiology and Serology Departments, Al-Ansar Hospital, Ministry of Health, Medina, Saudi Arabia
| | - Joseph Keating
- grid.265219.b0000 0001 2217 8588School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA USA
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6
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Abdalal SA, Yukich J, Andrinoplous K, Harakeh S, Altwaim SA, Gattan H, Carter B, Shammaky M, Niyazi HA, Alruhaili MH, Keating J. An insight to better understanding cross border malaria in Saudi Arabia. Malar J 2023; 22:37. [PMID: 36732819 PMCID: PMC9893606 DOI: 10.1186/s12936-023-04467-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 01/23/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Border malaria is a major obstacle for the malaria elimination in Saudi Arabia. Today, the southern border of Saudi Arabia is a region where malaria cases are resurging, and malaria control is dwindling mainly due to the humanitarian crisis and the conflict in Yemen. This study analyses the current border malaria epidemiology along the southern border of Saudi Arabia from 2015 to 2018. METHODS All reported cases maintained by the malaria elimination centres in Aledabi and Baish, Jazan Province, Saudi Arabia, from 2015 to 2018 were analysed to examine the epidemiological changes over time. Pearson's Chi-Square test of differences was utilized to assess differences between the characteristics of imported and local causes and between border cases. A logistic regression model was used to predict imported status was related to living along side of the border area. RESULTS A total of 3210 malaria cases were reported in Baish and Aledabi malaria centres between 2015 and 2018, of which 170 were classified as local cases and 3040 were classified as imported cases. Reported malaria cases were mainly among males, within the imported cases 61.5% (1868/3039) were residents of the border areas. CONCLUSIONS Given the complexity of cross-border malaria, creating a malaria buffer zone that covers a certain margin from both sides of the border would allow for a joint force, cross-border malaria elimination programme. To initiate a malaria elimination activity and cases reported as belonging to this zone, rather than being pushed from one country to the other, would allow malaria elimination staff to work collaboratively with local borderland residents and other stakeholders to come up with innovative solutions to combat malaria and reach malaria-free borders.
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Affiliation(s)
- Shaymaa A. Abdalal
- grid.412126.20000 0004 0607 9688Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Joshua Yukich
- grid.265219.b0000 0001 2217 8588Tulane University School of Public Health and Tropical Medicine, New Orleans, LA USA
| | - Katherine Andrinoplous
- grid.265219.b0000 0001 2217 8588Tulane University School of Public Health and Tropical Medicine, New Orleans, LA USA
| | - Steve Harakeh
- Saudi Arabia Ministry of Health, Jazan, Saudi Arabia
| | - Sarah A. Altwaim
- grid.412126.20000 0004 0607 9688Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Hattan Gattan
- grid.412125.10000 0001 0619 1117Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Brendan Carter
- grid.265219.b0000 0001 2217 8588Tulane University School of Public Health and Tropical Medicine, New Orleans, LA USA
| | | | - Hatoon A. Niyazi
- grid.412126.20000 0004 0607 9688Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Mohammed H. Alruhaili
- grid.412126.20000 0004 0607 9688Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Joseph Keating
- grid.265219.b0000 0001 2217 8588Tulane University School of Public Health and Tropical Medicine, New Orleans, LA USA
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7
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Bin Dajem SM, Ahmed MA, Alghnnam FF, Alghannam SF, Deshmukh GY, Zaidi RH, Bohol MFF, Salam SS, Wazid SW, Shafeai MI, Rudiny FH, Motaen AM, Morsy K, Al-Qahtani AA. Genetic Diversity and Population Genetic Analysis of Plasmodium falciparum Thrombospondin Related Anonymous Protein (TRAP) in Clinical Samples from Saudi Arabia. Genes (Basel) 2022; 13:genes13071149. [PMID: 35885932 PMCID: PMC9319867 DOI: 10.3390/genes13071149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 02/01/2023] Open
Abstract
The thrombospondin related anonymous protein (TRAP) is considered one of the most important pre-erythrocytic vaccine targets. Earlier population genetic studies revealed the TRAP gene to be under strong balancing natural selection. This study is the first attempt to analyze genetic diversity, natural selection, phylogeography and population structure in 199 clinical samples from Saudi Arabia using the full-length PfTRAP gene. We found the rate of nonsynonymous substitutions to be significantly higher than that of synonymous substitutions in the clinical samples, indicating a strong positive or diversifying selection for the full-length gene and the Von Willebrand factor (VWF). The nucleotide diversity was found to be π~0.00789 for the full-length gene; however, higher nucleotide diversity was observed for the VWF compared to the thrombospondin repeat region (TSP). Deduction of the amino acid sequence alignment of the PNP repeat region in the Saudi samples revealed six genotypes characterized by tripeptide repeat motifs (PNP, ANP, ENP and SNP). Haplotype network, population structure and population differentiation analyses indicated four distinct sub-populations in spite of the low geographical distance between the sampling sites. Our results suggest the likeliness of independent parasite evolution, creating opportunities for further adaptation, including host transition, and making malaria control even more challenging.
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Affiliation(s)
- Saad M. Bin Dajem
- Department of Biology, College of Science, King Khalid University, Abha 61413, Saudi Arabia; (S.M.B.D.); (K.M.)
| | - Md Atique Ahmed
- ICMR-Regional Medical Research Center, Dibrugarh 786010, Assam, India;
| | - Fatimah F. Alghnnam
- Department of Infection and Immunity, Research Centre, King Faisal Specialist Hospital Research Centre, Riyadh 11211, Saudi Arabia; (F.F.A.); (S.F.A.); (M.F.F.B.)
| | - Shouq F. Alghannam
- Department of Infection and Immunity, Research Centre, King Faisal Specialist Hospital Research Centre, Riyadh 11211, Saudi Arabia; (F.F.A.); (S.F.A.); (M.F.F.B.)
| | - Gauspasha Yusuf Deshmukh
- Department of Biotechnology and Microbiology, National College, Tiruchirapalli 620001, Tamil Nadu, India; (G.Y.D.); (R.H.Z.)
| | - Rehan Haider Zaidi
- Department of Biotechnology and Microbiology, National College, Tiruchirapalli 620001, Tamil Nadu, India; (G.Y.D.); (R.H.Z.)
| | - Marie Fe F. Bohol
- Department of Infection and Immunity, Research Centre, King Faisal Specialist Hospital Research Centre, Riyadh 11211, Saudi Arabia; (F.F.A.); (S.F.A.); (M.F.F.B.)
| | - Syeda Sabiha Salam
- Department of Life Sciences, Dibrugarh University, Dibrugarh 786004, Assam, India;
| | - Syeda Wasfeea Wazid
- Arogya Society of Health, Welfare and Support (ASHWAS), Dinsugia 785640, Assam, India;
| | - Mohammed I. Shafeai
- Sabya General Hospital, Sabya 85534, Saudi Arabia; (M.I.S.); (F.H.R.); (A.M.M.)
| | - Fuad H. Rudiny
- Sabya General Hospital, Sabya 85534, Saudi Arabia; (M.I.S.); (F.H.R.); (A.M.M.)
| | - Ali M. Motaen
- Sabya General Hospital, Sabya 85534, Saudi Arabia; (M.I.S.); (F.H.R.); (A.M.M.)
| | - Kareem Morsy
- Department of Biology, College of Science, King Khalid University, Abha 61413, Saudi Arabia; (S.M.B.D.); (K.M.)
| | - Ahmed A. Al-Qahtani
- Department of Infection and Immunity, Research Centre, King Faisal Specialist Hospital Research Centre, Riyadh 11211, Saudi Arabia; (F.F.A.); (S.F.A.); (M.F.F.B.)
- Department of Microbiology and Immunology, College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Correspondence:
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8
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Oyegoke OO, Maharaj L, Akoniyon OP, Kwoji I, Roux AT, Adewumi TS, Maharaj R, Oyebola BT, Adeleke MA, Okpeku M. Malaria diagnostic methods with the elimination goal in view. Parasitol Res 2022; 121:1867-1885. [PMID: 35460369 PMCID: PMC9033523 DOI: 10.1007/s00436-022-07512-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 04/01/2022] [Indexed: 01/08/2023]
Abstract
Malaria control measures have been in use for years but have not completely curbed the spread of infection. Ultimately, global elimination is the goal. A major playmaker in the various approaches to reaching the goal is the issue of proper diagnosis. Various diagnostic techniques were adopted in different regions and geographical locations over the decades, and these have invariably produced diverse outcomes. In this review, we looked at the various approaches used in malaria diagnostics with a focus on methods favorably used during pre-elimination and elimination phases as well as in endemic regions. Microscopy, rapid diagnostic testing (RDT), loop-mediated isothermal amplification (LAMP), and polymerase chain reaction (PCR) are common methods applied depending on prevailing factors, each with its strengths and limitations. As the drive toward the elimination goal intensifies, the search for ideal, simple, fast, and reliable point-of-care diagnostic tools is needed more than ever before to be used in conjunction with a functional surveillance system supported by the ideal vaccine.
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Affiliation(s)
- Olukunle O Oyegoke
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Leah Maharaj
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Oluwasegun P Akoniyon
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Illiya Kwoji
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Alexandra T Roux
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Taiye S Adewumi
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Rajendra Maharaj
- Office of Malaria Research, Medical Research Council, Durban, South Africa
| | | | - Matthew A Adeleke
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Moses Okpeku
- Discipline of Genetics School of Life Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa.
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9
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Madkhali AM, Abdulhaq AA, Atroosh WM, Ghzwani AH, Zain KA, Ghailan KY, Hamali HA, Mobarki AA, Eisa ZM, Lau YL, Al-Mekhlafi HM. The return of chloroquine-sensitive Plasmodium falciparum parasites in Jazan region, southwestern Saudi Arabia over a decade after the adoption of artemisinin-based combination therapy: analysis of genetic mutations in the pfcrt gene. Parasitol Res 2021; 120:3771-3781. [PMID: 34561749 DOI: 10.1007/s00436-021-07323-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/15/2021] [Indexed: 11/25/2022]
Abstract
This study investigated the polymorphism in the P. falciparum chloroquine resistance transporter (pfcrt) gene 11 years after chloroquine (CQ) cessation in Jazan region, southwestern Saudi Arabia. Two hundred and thirty-five P. falciparum isolates were amplified to detect mutations in the pfcrt gene. The pfcrt 76 T molecular marker for CQ resistance was detected in 66.4% (156/235) of the isolates, while the K76 CQ-sensitive wild type was detected in 33.6%. The pfcrt 74I and pfcrt 75E point mutations were each found to be present in 56.2% of isolates, while only four isolates (1.7%) were found to carry the pfcrt 72S mutation. Moreover, four pfcrt haplotypes were identified as follows: the CVIET triple-allele (56.2%), SVMET double-allele (1.7%) and CVMNT single-allele (8.5%) mutant haplotypes and the CVMNK wild haplotype (33.6%). The analysis also revealed significant associations between the prevalence of mutant pfcrt alleles and haplotypes and the age group, governorate and nationality of the patients as well as the parasitaemia level (p < 0.05). The findings provide evidence of the potential re-emergence of CQ-susceptible P. falciparum strains in Jazan region over a decade after CQ discontinuation, with about one third of the isolates analysed carrying the pfcrt K76 CQ-sensitive wild allele and the CVMNK ancestral wild haplotype. Although the reintroduction of CQ cannot be recommended at present in Saudi Arabia, these findings support the rationale for a potential future role for CQ in malaria treatment. Therefore, continuous molecular and in vitro monitoring mutations of pfcrt polymorphism in Jazan region is highly recommended.
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Affiliation(s)
- Aymen M Madkhali
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia.,Medical Research Centre, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Ahmed A Abdulhaq
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Wahib M Atroosh
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.,Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen
| | | | - Khalid Ammash Zain
- Medical Research Centre, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Khalid Y Ghailan
- Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Hassan A Hamali
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Abdullah A Mobarki
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Zaki M Eisa
- Saudi Centre for Disease Prevention and Control, Ministry of Health, Jazan, Kingdom of Saudi Arabia
| | - Yee-Ling Lau
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Hesham M Al-Mekhlafi
- Medical Research Centre, Jazan University, Jazan, Kingdom of Saudi Arabia. .,Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. .,Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
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10
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AlRuwaisan AU, Al-Anazi MR, Shafeai MI, Rudiny FH, Motaen AM, Bin Dajem SM, Alothaid H, Morsy K, Alkahtani S, Al-Qahtani AA. Associations of Single Nucleotide Polymorphisms in IL-18 Gene with Plasmodium falciparum-Associated Malaria. J Inflamm Res 2021; 14:3587-3619. [PMID: 34345179 PMCID: PMC8323861 DOI: 10.2147/jir.s314638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Interleukin-18 (IL-18) is a pro-inflammatory cytokine, reported to be involved in the initial immune responses against malaria. Genetic variations in the host are an important factor that influences the etiology of malaria at several disease levels. Polymorphisms within the IL-18 gene are associated with susceptibility and clinical outcome of several diseases. Methods We genotyped single nucleotide polymorphisms (SNPs) in IL-18 of patients infected with Plasmodium falciparum with varying extent of parasitemia and different age groups. Results SNPs rs5744292 (OR = 70.446; 95% CI = 4.318-1149.323; p<0.0001) and rs544354 (OR = 1.498; 95% CI = 1.088-2.063; p=0.013) were found to be significantly associated with parasitemia in P. falciparum-infected patients when compared with healthy control subjects. SNP rs5744292 (OR = 7.597; 95% CI=1.028-56.156; p=0.019) was associated with increased parasite density in infected patients. SNPs rs544354 (OR 0.407; 95% CI=0.204-0.812; p = 0.009) and rs360714 (OR of 0.256; 95% CI=0.119-0.554; p = 0.001) were significantly associated with parasite density in an age-dependent manner, with the risk alleles present more frequently among the younger (1-9 years) patients. Several haplotypes were found to have a significant association with parasitemia. In-vitro expression analysis using luciferase reporter assay showed that SNPs rs1946518 and rs187238 in the IL-18 gene promoter region and rs360728 and rs5744292 in the 3'-untranslated region of the IL-18 gene were associated with enhanced transcriptional activity. Conclusion Our results suggest that polymorphisms within the IL-18 gene are associated with the susceptibility to P. falciparum infection and related parasitemia among groups with different parasite density and across various age groups.
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Affiliation(s)
- Alaa U AlRuwaisan
- Zoology Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Mashael R Al-Anazi
- Department of Infection and Immunity, Research Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | | | | | - Saad M Bin Dajem
- Department of Biology, College of Science, King Khalid University, Abha, Saudi Arabia
| | - Hani Alothaid
- Department of Basic Sciences, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi Arabia
| | - Kareem Morsy
- Department of Biology, College of Science, King Khalid University, Abha, Saudi Arabia.,Zoology Department, Faculty of Science, Cairo University, Cairo, Egypt
| | - Saad Alkahtani
- Zoology Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed A Al-Qahtani
- Department of Infection and Immunity, Research Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.,Department of Microbiology and Immunology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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11
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Al-Mekhlafi HM, Madkhali AM, Ghailan KY, Abdulhaq AA, Ghzwani AH, Zain KA, Atroosh WM, Alshabi A, Khadashi HA, Darraj MA, Eisa ZM. Residual malaria in Jazan region, southwestern Saudi Arabia: the situation, challenges and climatic drivers of autochthonous malaria. Malar J 2021; 20:315. [PMID: 34256757 PMCID: PMC8276496 DOI: 10.1186/s12936-021-03846-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 07/06/2021] [Indexed: 01/23/2023] Open
Abstract
Background Saudi Arabia and Yemen are the only two countries in the Arabian Peninsula that are yet to achieve malaria elimination. Over the past two decades, the malaria control programme in Saudi Arabia has successfully reduced the annual number of malaria cases, with the lowest incidence rate across the country reported in 2014. This study aims to investigate the distribution of residual malaria in Jazan region and to identify potential climatic drivers of autochthonous malaria cases in the region. Methods A cross-sectional study was carried out from 1 April 2018 to 31 January 2019 in Jazan region, southwestern Saudi Arabia, which targeted febrile individuals attending hospitals and primary healthcare centres. Participants’ demographic data were collected, including age, gender, nationality, and residence. Moreover, association of climatic variables with the monthly autochthonous malaria cases reported during the period of 2010–2017 was retrospectively analysed. Results A total of 1124 febrile subjects were found to be positive for malaria during the study period. Among them, 94.3 and 5.7% were infected with Plasmodium falciparum and Plasmodium vivax, respectively. In general, subjects aged 18–30 years and those aged over 50 years had the highest (42.7%) and lowest (5.9%) percentages of malaria cases. Similarly, the percentage of malaria-positive cases was higher among males than females (86.2 vs 13.8%), among non-Saudi compared to Saudi subjects (70.6 vs 29.4%), and among patients residing in rural rather than in urban areas (89.8 vs 10.2%). A total of 407 autochthonous malaria cases were reported in Jazan region between 2010 and 2017. Results of zero-inflated negative binomial regression analysis showed that monthly average temperature and relative humidity were the significant climatic determinants of autochthonous malaria in the region. Conclusion Malaria remains a public health problem in most governorates of Jazan region. The identification and monitoring of malaria transmission hotspots and predictors would enable control efforts to be intensified and focused on specific areas and therefore expedite the elimination of residual malaria from the whole region. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03846-4.
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Affiliation(s)
- Hesham M Al-Mekhlafi
- Medical Research Centre, Jazan University, Jazan, Kingdom of Saudi Arabia. .,Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. .,Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
| | - Aymen M Madkhali
- Medical Research Centre, Jazan University, Jazan, Kingdom of Saudi Arabia.,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Khalid Y Ghailan
- Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
| | - Ahmed A Abdulhaq
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | | | - Khalid Ammash Zain
- Medical Research Centre, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Wahib M Atroosh
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.,Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen
| | - Alkhansa Alshabi
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Hussein A Khadashi
- Medical Research Centre, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Majid A Darraj
- Department of Internal Medicine, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Zaki M Eisa
- Saudi Centre for Disease Prevention and Control, Ministry of Health, Jazan, Kingdom of Saudi Arabia
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12
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Current Epidemiological Characteristics of Imported Malaria, Vector Control Status and Malaria Elimination Prospects in the Gulf Cooperation Council (GCC) Countries. Microorganisms 2021; 9:microorganisms9071431. [PMID: 34361867 PMCID: PMC8307262 DOI: 10.3390/microorganisms9071431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 11/23/2022] Open
Abstract
Malaria is the most common vector-borne parasitic infection causing significant human morbidity and mortality in nearly 90 tropical/sub-tropical countries worldwide. Significant differences exist in the incidence of malaria cases, dominant Plasmodium species, drug-resistant strains and mortality rates in different countries. Six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Qatar, Oman, Saudi Arabia and United Arab Emirates, UAE) in the Middle East region with similar climates, population demographics and economic prosperity are aiming to achieve malaria elimination. In this narrative review, all studies indexed in PubMed describing epidemiological characteristics of indigenous and imported malaria cases, vector control status and how malaria infections can be controlled to achieve malaria elimination in GCC countries were reviewed and discussed. These studies have shown that indigenous malaria cases are absent in Bahrain, Kuwait, Qatar and UAE and have progressively declined in Oman and Saudi Arabia. However, imported malaria cases continue to occur as GCC countries have large expatriate populations originating from malaria-endemic countries. Various malaria control and prevention strategies adopted by GCC countries including more stringent measures to reduce the likelihood of importing malaria cases by prior screening of newly arriving expatriates and vector elimination programs are likely to lead to malaria elimination in this region.
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13
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Iqbal J, Al-Awadhi M, Ahmad S. Decreasing trend of imported malaria cases but increasing influx of mixed P. falciparum and P. vivax infections in malaria-free Kuwait. PLoS One 2020; 15:e0243617. [PMID: 33306727 PMCID: PMC7732060 DOI: 10.1371/journal.pone.0243617] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/20/2020] [Indexed: 01/22/2023] Open
Abstract
Malaria still continues to be the most important parasitic disease worldwide, affecting 228 million people and causing 405,000 deaths each year. In this retrospective study during 2013 to 2018, we documented the incidence of imported malaria infection and evaluated the impact of malaria preventive measures in Kuwait, a non-endemic country. The epidemiologic and demographic data of all malaria cases was collected from the Infectious Diseases Hospital, Kuwait where all suspected cases of malaria are referred for confirmation and therapeutic intervention. The diagnosis of malaria infection was done by microscopy of Giemsa stained blood films. Selected samples were retested with BinaxNOW® Malaria rapid test and molecular assay to reconfirm the Plasmodium spp. or mixed infection. Overall, 1913 (25.9%) malaria cases were detected, 81.5% of which were among male subjects. Male subjects had higher incidence of P. vivax malaria (113; 91.1%) and mixed infection with P. falciparum and P. vivax (1245; 90.0%) compared to females who had higher rate of P. falciparum infection (52.4%). An overwhelming majority of malaria cases (1895; 99.1%) were detected among expatriates from malaria-endemic countries; India (1012; 52.9%), Pakistan (390; 20.4%), Afghanistan (94; 4.9%) and African countries (313; 16.3%). Only 18 cases involved Kuwaiti nationals, all with a history of travel to African countries. The majority of malaria cases were detected during the summer and fall months (May-October). Our data showed that the incidence rate of imported malaria cases was stable during 2013 to 2018, however, the incidence of total malaria cases showed a declining trend over the years. This study confirms that the preventive program has been successful in reducing the incidence of imported malaria infections in Kuwait. The most striking finding of this study was high incidence of mixed infection with P. falciparum and P. vivax, with almost all (97%) cases among workers from India.
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Affiliation(s)
- Jamshaid Iqbal
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
- * E-mail:
| | - Mohammad Al-Awadhi
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
| | - Suhail Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
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14
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Madkhali AM, Al-Mekhlafi HM, Atroosh WM, Ghzwani AH, Zain KA, Abdulhaq AA, Ghailan KY, Anwar AA, Eisa ZM. Increased prevalence of pfdhfr and pfdhps mutations associated with sulfadoxine-pyrimethamine resistance in Plasmodium falciparum isolates from Jazan Region, Southwestern Saudi Arabia: important implications for malaria treatment policy. Malar J 2020; 19:446. [PMID: 33267841 PMCID: PMC7709338 DOI: 10.1186/s12936-020-03524-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/25/2020] [Indexed: 11/10/2022] Open
Abstract
Background Despite significant progress in eliminating malaria from the Kingdom of Saudi Arabia, the disease is still endemic in the southwestern region of the country. Artesunate plus sulfadoxine–pyrimethamine (AS + SP) has been used in Saudi Arabia since 2007 as a first-line treatment for uncomplicated Plasmodium falciparum malaria. This study aimed to investigate the prevalence of mutations associated with resistance to artemisinin and sulfadoxine–pyrimethamine (SP) resistance in P. falciparum parasites circulating in Jazan region, southwestern Saudi Arabia. Methods A total of 151 P. falciparum isolates were collected between April 2018 and March 2019 from 12 of the governorates in Jazan region. Genomic DNA was extracted from dried blood spots and amplified using nested PCR. Polymorphisms in the propeller domain of the P. falciparum k13 (pfkelch13) gene and point mutations in the P. falciparum dihydrofolate reductase (pfdhfr) and dihydropteroate synthase (pfdhps) genes were identified by sequencing. Results No mutations in the pfkelch13 propeller domain were found in any of the 151 isolates. However, point mutations in the pfdhfr and pfdhps genes were detected in 90.7% (137/151) of the isolates. The pfdhfr double mutations N51I + S108N (i.e. ACICNI haplotype) and triple mutations N51I + C59R + S108N (i.e. ACIRNI haplotype) were detected in 47% and 37.8% of the isolates, respectively. Moreover, the pfdhps single mutation at codon A437G and double mutations A437G + K540E (i.e. SGEAAI haplotype) were observed in 4.6% and 51.7% of the isolates, respectively. Interestingly, 23.8%, 25.1 and 12.6% of the isolates had quintuple, quadruple and triple mutated combined pfdhfr–pfdhps genotypes, respectively. Furthermore, significant associations were found between the prevalence of mutant haplotypes and the age, gender and nationality of the patients (P < 0.05). Conclusion This study revealed a high prevalence of point mutations in the pfdhfr and pfdhps genes of P. falciparum isolates from Jazan region, with quintuple and quadruple mutant pfdhfr–pfdhps genotypes reported for the first time in Saudi Arabia and the Arabian Peninsula. Despite the absence of the pfkelch13 mutation in the isolates examined, the pfdhfr and pfdhps mutations undermine the efficacy of SP partner drug, thereby threatening the main falciparum malaria treatment policy in Saudi Arabia, i.e. the use of AS + SP. Therefore, the continuous molecular and in-vivo monitoring of ACT efficacy in Jazan region is highly recommended.
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Affiliation(s)
- Aymen M Madkhali
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia. .,Medical Research Centre, Jazan University, Jazan, Kingdom of Saudi Arabia.
| | - Hesham M Al-Mekhlafi
- Medical Research Centre, Jazan University, Jazan, Kingdom of Saudi Arabia. .,Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. .,Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
| | - Wahib M Atroosh
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.,Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen
| | | | - Khalid Ammash Zain
- Medical Research Centre, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Ahmed A Abdulhaq
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Khalid Y Ghailan
- Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Alkhansa A Anwar
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Zaki M Eisa
- Saudi Centre for Disease Prevention and Control, Ministry of Health, Jazan, Kingdom of Saudi Arabia
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15
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Kam YW, Ahmed MY, Amrun SN, Lee B, Refaie T, Elgizouli K, Fong SW, Renia L, Ng LF. Systematic analysis of disease-specific immunological signatures in patients with febrile illness from Saudi Arabia. Clin Transl Immunology 2020; 9:e1163. [PMID: 32864128 PMCID: PMC7443187 DOI: 10.1002/cti2.1163] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/09/2020] [Accepted: 07/06/2020] [Indexed: 01/24/2023] Open
Abstract
Objectives Little is known about the prevalence of febrile illness in the Arabian region as clinical, laboratory and immunological profiling remains largely uncharacterised. Methods A total of 2018 febrile patients from Jazan, Saudi Arabia, were recruited between 2014 and 2017. Patients were screened for dengue and chikungunya virus, Plasmodium, Brucella, Neisseria meningitidis, group A streptococcus and Leptospira. Clinical history and biochemical parameters from blood tests were collected. Patient sera of selected disease-confirmed infections were quantified for immune mediators by multiplex microbead-based immunoassays. Results Approximately 20% of febrile patients were tested positive for one of the pathogens, and they presented overlapping clinical and laboratory parameters. Nonetheless, eight disease-specific immune mediators were identified as potential biomarkers for dengue (MIP-1α, MCP-1), malaria (TNF-α), streptococcal and meningococcal (eotaxin, GRO-α, RANTES, SDF-1α and PIGF-1) infections, with high specificity and sensitivity profiles. Notably, based on the conditional inference model, six of these mediators (MIP-1α, TNF-α, GRO-α, RANTES, SDF-1α and PIGF-1) were revealed to be 68.4% accurate in diagnosing different febrile infections, including those of unknown diseases. Conclusions This study is the first extensive characterisation of the clinical analysis and immune biomarkers of several clinically important febrile infections in Saudi Arabia. Importantly, an immune signature with robust accuracy, specificity and sensitivity in differentiating several febrile infections was identified, providing useful insights into patient disease management in the Arabian Peninsula.
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Affiliation(s)
- Yiu-Wing Kam
- Singapore Immunology Network Agency for Science, Technology and Research (ASTAR) Singapore
| | - Mohamed Yousif Ahmed
- Singapore Immunology Network Agency for Science, Technology and Research (ASTAR) Singapore.,Department of Infectious Diseases Clinic and Medical Microbiology King Fahad Central Hospital Jazan Saudi Arabia
| | - Siti Naqiah Amrun
- Singapore Immunology Network Agency for Science, Technology and Research (ASTAR) Singapore.,Infectious Diseases Horizontal Technology Centre (ID HTC) Agency for Science, Technology and Research (ASTAR) Singapore
| | - Bernett Lee
- Singapore Immunology Network Agency for Science, Technology and Research (ASTAR) Singapore
| | - Tarik Refaie
- Department of Infectious Diseases Clinic and Medical Microbiology King Fahad Central Hospital Jazan Saudi Arabia
| | - Kamla Elgizouli
- Department of Infectious Diseases Clinic and Medical Microbiology King Fahad Central Hospital Jazan Saudi Arabia
| | - Siew-Wai Fong
- Singapore Immunology Network Agency for Science, Technology and Research (ASTAR) Singapore.,Infectious Diseases Horizontal Technology Centre (ID HTC) Agency for Science, Technology and Research (ASTAR) Singapore.,Department of Biological Sciences National University of Singapore Singapore
| | - Laurent Renia
- Singapore Immunology Network Agency for Science, Technology and Research (ASTAR) Singapore.,Infectious Diseases Horizontal Technology Centre (ID HTC) Agency for Science, Technology and Research (ASTAR) Singapore
| | - Lisa Fp Ng
- Singapore Immunology Network Agency for Science, Technology and Research (ASTAR) Singapore.,Infectious Diseases Horizontal Technology Centre (ID HTC) Agency for Science, Technology and Research (ASTAR) Singapore.,National Institute of Health Research Health Protection Research Unit in Emerging and Zoonotic Infections University of Liverpool Liverpool UK.,Institute of Infection, Veterinary and Ecological Sciences University of Liverpool Liverpool UK.,Department of Biochemistry Yong Loo Lin School of Medicine National University of Singapore Singapore
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16
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Munawar K, Saleh A, Afzal M, Qasim M, Khan KA, Zafar MI, Khater EI. Molecular characterization and phylogenetic analysis of anopheline (Anophelinae: Culicidae) mosquitoes of the Oriental and Afrotropical Zoogeographic zones in Saudi Arabia. Acta Trop 2020; 207:105494. [PMID: 32330453 DOI: 10.1016/j.actatropica.2020.105494] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
The Kingdom of Saudi Arabia (KSA) has a diverse fauna due to its peculiar position bordering the Afrotropical, Oriental and Palaearctic zoogeographic zones. The present study reports the phylogenetics of five mosquito species belonging to five series of Anopheles (Cellia) . We collected mosquito larvae from eastern, western and southwestern regions of KSA. The sampled mosquitoes were morphologically identified using the pictorial keys of mosquitoes and characterized by using single and multi-locus analysis of -internal transcribed spacer 2 (ITS2) region and cytochrome oxidase c subunit I (COI). Based on the morphological and molecular data, five species were recognized, like An. stephensi (Neocellia) (Oriental), An. arabiensis (Pyretophorus) (Afrotropical), An. dthali (Myzomyia) (Oriental and Palaearctic), An. cinereus (Paramyzomyia) and An. rhodesiensis rupicola (Neomyzomyia) (Oriental and Palaearctic). The phylogenetic analysis showed that An. stephensi is a monophyletic species with different ecotypes found in different geographic regions. Comprehensive phylogenetics and population genetics studies are crucial for a better understanding of the role of these five mosquito species in malarial transmission across various zoogeographic zones of different ecological and demographic characteristics.
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17
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Al-Rumhi A, Al-Hashami Z, Al-Hamidhi S, Gadalla A, Naeem R, Ranford-Cartwright L, Pain A, Sultan AA, Babiker HA. Influx of diverse, drug resistant and transmissible Plasmodium falciparum into a malaria-free setting in Qatar. BMC Infect Dis 2020; 20:413. [PMID: 32539801 PMCID: PMC7296620 DOI: 10.1186/s12879-020-05111-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/20/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Successful control programs have impeded local malaria transmission in almost all Gulf Cooperation Council (GCC) countries: Qatar, Bahrain, Kuwait, Oman, the United Arab Emirates (UAE) and Saudi Arabia. Nevertheless, a prodigious influx of imported malaria via migrant workers sustains the threat of local transmission. Here we examine the origin of imported malaria in Qatar, assess genetic diversity and the prevalence of drug resistance genes in imported Plasmodium falciparum, and finally, address the potential for the reintroduction of local transmission. METHODS This study examined imported malaria cases reported in Qatar, between 2013 and 2016. We focused on P. falciparum infections and estimated both total parasite and gametocyte density, using qPCR and qRT-PCR, respectively. We also examined ten neutral microsatellites and four genes associated with drug resistance, Pfmrp1, Pfcrt, Pfmdr1, and Pfkelch13, to assess the genetic diversity of imported P. falciparum strains, and the potential for propagating drug resistance genotypes respectively. RESULTS The majority of imported malaria cases were P. vivax, while P. falciparum and mixed species infections (P. falciparum / P. vivax) were less frequent. The primary origin of P. vivax infection was the Indian subcontinent, while P. falciparum was mostly presented by African expatriates. Imported P. falciparum strains were highly diverse, carrying multiple genotypes, and infections also presented with early- and late-stage gametocytes. We observed a high prevalence of mutations implicated in drug resistance among these strains, including novel SNPs in Pfkelch13. CONCLUSIONS The influx of genetically diverse P. falciparum, with multiple drug resistance markers and a high capacity for gametocyte production, represents a threat for the reestablishment of drug-resistant malaria into GCC countries. This scenario highlights the impact of mass international migration on the reintroduction of malaria to areas with absent or limited local transmission.
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Affiliation(s)
- Abir Al-Rumhi
- Department of Biochemistry, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Zainab Al-Hashami
- Department of Biochemistry, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Salama Al-Hamidhi
- Department of Biochemistry, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Amal Gadalla
- Department of Biochemistry, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Raeece Naeem
- Biological and Environmental Sciences and Engineering Division, King Abdulla University for Science and Technology (KAUST), Thuwal, Kingdom of Saudi Arabia
| | - Lisa Ranford-Cartwright
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, Scotland, UK
| | - Arnab Pain
- Biological and Environmental Sciences and Engineering Division, King Abdulla University for Science and Technology (KAUST), Thuwal, Kingdom of Saudi Arabia
- Research Centre for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, N20 W10 Kita-ku, Sapporo, Japan
- Nuffield Division of Clinical Laboratory Sciences (NDCLS), The John Radcliffe Hospital, University of Oxford, Headington, Oxford, OX3 9DU, UK
| | - Ali A Sultan
- Department of Microbiology and Immunology, Weill Cornell Medicine - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Hamza A Babiker
- Department of Biochemistry, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
- Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, UK.
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18
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Gao B, Saralamba S, Lubell Y, White LJ, Dondorp AM, Aguas R. Determinants of MDA impact and designing MDAs towards malaria elimination. eLife 2020; 9:e51773. [PMID: 32293559 PMCID: PMC7185997 DOI: 10.7554/elife.51773] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 04/12/2020] [Indexed: 11/13/2022] Open
Abstract
Malaria remains at the forefront of scientific research and global political and funding agendas. Malaria models have consistently oversimplified how mass interventions are implemented. Here, we present an individual based, spatially explicit model of P. falciparum malaria transmission that includes all the programmatic implementation details of mass drug administration (MDA) campaigns. We uncover how the impact of MDA campaigns is determined by the interaction between implementation logistics, patterns of human mobility and how transmission risk is distributed over space. Our results indicate that malaria elimination is only realistically achievable in settings with very low prevalence and can be hindered by spatial heterogeneities in risk. In highly mobile populations, accelerating MDA implementation increases likelihood of elimination; if populations are more static, deploying less teams would be cost optimal. We conclude that mass drug interventions can be an invaluable tool towards malaria elimination in low endemicity areas, specifically when paired with effective vector control.
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Affiliation(s)
- Bo Gao
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Sompob Saralamba
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
| | - Yoel Lubell
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
| | - Lisa J White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
| | - Arjen M Dondorp
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
| | - Ricardo Aguas
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
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19
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Bansal D, Bharti PK, Acharya A, Abdelraheem MH, Patel P, Elmalik A, Abosalah S, Khan FY, ElKhalifa M, Kaur H, Farag E, Sarmah NP, Mohapatra PK, Sehgal R, Mahanta J, Sultan AA. Molecular surveillance of putative drug resistance markers of antifolate and artemisinin among imported Plasmodium falciparum in Qatar. Pathog Glob Health 2019; 113:158-166. [PMID: 31296112 PMCID: PMC6758627 DOI: 10.1080/20477724.2019.1639018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Malaria remains a significant public health challenge and is of global importance. Imported malaria is a growing problem in non-endemic areas throughout the world and also in Qatar due to a massive influx of migrants from endemic countries. Antimalarial drug resistance is an important deterrent in our fight against malaria today. Molecular markers mirror intrinsic antimalarial drug resistance and their changes precede clinical resistance. Thus, in the present study, molecular markers of sulphadoxine-pyrimethamine (Pfdhfr and Pfdhps) and artemisinin (PfATPase6 and Pfk13) were sequenced to determine the drug resistance genotypes among 118 imported P. falciparum isolates in Qatar, between 2013 and 2016. All the isolates had mutant Pfdhfr alleles, with either double mutant (51I/108N) (59.3%) or triple mutant (51I, 59R and 108N) (30.6%) genotypes. I164L substitution was not found in this study. In case of Pfdhps, majority of the samples were carriers of either single (S436A/ A437G/ K540E) mutant (47.2%) or double (S436A/K540E, A437G/K540E, K540E/A581G) mutant (39.8%). A single novel point mutation (431V) was observed in the samples originated from Nigeria and Ghana. Polymorphisms in PfATPase6 were absent and only one non-synonymous mutation in Pfk13 was found at codon G453A from a sample of Kenyan origin. High levels of sulphadoxine-pyrimethamine resistance in the present study provide potential information about the spread of antimalarial drug resistance and will be beneficial for the treatment of imported malaria cases in Qatar.
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Affiliation(s)
- Devendra Bansal
- Department of Microbiology and Immunology, Weill Cornell Medicine - Qatar, Cornell University, Qatar Foundation - Education City , Doha , Qatar
| | - Praveen K Bharti
- National Institute for Research in Tribal Health, Indian Council of Medical Research , Jabalpur , India
| | - Anushree Acharya
- Department of Microbiology and Immunology, Weill Cornell Medicine - Qatar, Cornell University, Qatar Foundation - Education City , Doha , Qatar
| | - Mohamed H Abdelraheem
- Department of Microbiology & Immunology, Faculty of Medicine and Health Sciences, Sultan Qaboos University , Muscat , Oman
| | - Priyanka Patel
- National Institute for Research in Tribal Health, Indian Council of Medical Research , Jabalpur , India
| | - Ashraf Elmalik
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation , Doha , Qatar
| | - Salem Abosalah
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation , Doha , Qatar
| | - Fahmi Y Khan
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation , Doha , Qatar
| | - Mohamed ElKhalifa
- Department of Laboratory Medicine and Pathology, Hamad General Hospital, Hamad Medical Corporation , Doha , Qatar
| | - Hargobinder Kaur
- Department of Parasitology, Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | | | - Nilanju P Sarmah
- Regional Medical Research Centre, NE, Indian Council of Medical Research , Dibrugarh , India
| | - Pradyumna K Mohapatra
- Regional Medical Research Centre, NE, Indian Council of Medical Research , Dibrugarh , India
| | - Rakesh Sehgal
- Department of Parasitology, Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Jagadish Mahanta
- Regional Medical Research Centre, NE, Indian Council of Medical Research , Dibrugarh , India
| | - Ali A Sultan
- Department of Microbiology and Immunology, Weill Cornell Medicine - Qatar, Cornell University, Qatar Foundation - Education City , Doha , Qatar
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20
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Fernandes V, Brucato N, Ferreira JC, Pedro N, Cavadas B, Ricaut FX, Alshamali F, Pereira L. Genome-Wide Characterization of Arabian Peninsula Populations: Shedding Light on the History of a Fundamental Bridge between Continents. Mol Biol Evol 2019; 36:575-586. [PMID: 30649405 DOI: 10.1093/molbev/msz005] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The Arabian Peninsula (AP) was an important crossroad between Africa, Asia, and Europe, being the cradle of the structure defining these main human population groups, and a continuing path for their admixture. The screening of 741,000 variants in 420 Arabians and 80 Iranians allowed us to quantify the dominant sub-Saharan African admixture in the west of the peninsula, whereas South Asian and Levantine/European influence was stronger in the east, leading to a rift between western and eastern sides of the Peninsula. Dating of the admixture events indicated that Indian Ocean slave trade and Islamization periods were important moments in the genetic makeup of the region. The western-eastern axis was also observable in terms of positive selection of diversity conferring lactose tolerance, with the West AP developing local adaptation and the East AP acquiring the derived allele selected in European populations and existing in South Asia. African selected malaria resistance through the DARC gene was enriched in all Arabian genomes, especially in the western part. Clear European influences associated with skin and eye color were equally frequent across the Peninsula.
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Affiliation(s)
- Veronica Fernandes
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal
| | - Nicolas Brucato
- Laboratoire Évolution & Diversité Biologique (EDB UMR 5174), Université de Toulouse Midi-Pyrénées, CNRS, IRD, UPS. 118 route de Narbonne, Bat 4R1, 31062 Toulouse cedex 9, France
| | - Joana C Ferreira
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Nicole Pedro
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal
| | - Bruno Cavadas
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal
| | - François-Xavier Ricaut
- Laboratoire Évolution & Diversité Biologique (EDB UMR 5174), Université de Toulouse Midi-Pyrénées, CNRS, IRD, UPS. 118 route de Narbonne, Bat 4R1, 31062 Toulouse cedex 9, France
| | - Farida Alshamali
- Department of Forensic Sciences and Criminology, Dubai Police General Headquarters, Dubai, United Arab Emirates
| | - Luisa Pereira
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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21
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Alshahrani AM, Abdelgader TM, Mohya M, Jubran S, Abdoon AMO, Daffalla AA, Babiker A, Kyalo D, Noor AM, Al-Zahrani MH, Snow RW. Risk Associated with Malaria Infection in Tihama Qahtan, Aseer Region, Kingdom of Saudi Arabia: 2006-2007. MALARIA CONTROL & ELIMINATION 2019; 5:144. [PMID: 31286096 PMCID: PMC6614030 DOI: 10.4172/2470-6965/1000144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Since 2004, the Kingdom of Saudi Arabia has pursued a policy of malaria elimination. The distribution of malaria at this time was constrained to regions located in the South Western part of the country. The present study aimed to understand the risk of malaria infection and factors associated with these events between March 2006 and August 2007 in one part of Aseer region. METHODS The study was carried out in Tihama Qahtan area in the far southeastern part of Aseer, historically the most malaria endemic area of this region. The area covers 54 villages served by three primary health care centres (Wadi Alhayah, Alfarsha and Albuqaa). Malaria cases were detected using passive case detection (PCD) at the three health centres for 18 months from March 2006, each positive case was investigated using patient and household level enquiries. In addition, four cross-sectional surveys in 12 villages were undertaken using rapid diagnostic tests within the catchments of each health centre coinciding with malaria transmission seasons. RESULTS Among 1840 individuals examined in the PCD survey, 49 (2.7%) were positive for malaria, most were Plasmodium falciparum cases and one was a P. vivax case. The majority of these infections were likely to have been acquired outside of the area and represent imported cases, including those from the neighboring region of Jazan. Among the 18 locally acquired cases, the majority were adult males who slept outdoors. 3623 individuals were screened during the cross-sectional surveys, 16 (0.44%) were positive and infections only detected during peak, potential transmission periods. CONCLUSION There was evidence of local malaria transmission in the Tihama Qahtan area in 2006-2007, however prevalence and incidence of new infections was very low, making the future ambitions of elimination biologically feasible. The constant source of imported infections must be considered in the area's elimination ambitions, alongside strong behavioural community messages about sleeping outdoors unprotected and travel to malaria endemic areas outside the region.
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Affiliation(s)
- AM Alshahrani
- Vector Control Administration, Aseer Health Affairs Directorate,
Abha, Kingdom of Saudi Arabia
- Aseer General Directorate of Health Affairs, Abha, Kingdom of Saudi
Arabia
| | - TM Abdelgader
- Vector Control Administration, Aseer Health Affairs Directorate,
Abha, Kingdom of Saudi Arabia
- Aseer General Directorate of Health Affairs, Abha, Kingdom of Saudi
Arabia
| | - M Mohya
- Aseer General Directorate of Health Affairs, Abha, Kingdom of Saudi
Arabia
| | - S Jubran
- Vector Control Administration, Aseer Health Affairs Directorate,
Abha, Kingdom of Saudi Arabia
| | - AMO Abdoon
- Public Health Directorate, Ministry of Health, Riyadh, Kingdom of
Saudi Arabia
| | - AA Daffalla
- Deanship of Scientific Research, Jazan University, Kingdom of Saudi
Arabia
| | - A Babiker
- Tropical Medicine Research Institute, National Centre for Research,
Sudan
| | - D Kyalo
- Spatial Health Metrics Group, Kenya Medical Research
Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - AM Noor
- Spatial Health Metrics Group, Kenya Medical Research
Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield
Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - MH Al-Zahrani
- National Malaria Control Programme, Ministry of Health, Riyadh,
Kingdom of Saudi Arabia
| | - RW Snow
- Spatial Health Metrics Group, Kenya Medical Research
Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield
Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
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22
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Epidemiology of Malaria in the State of Qatar, 2008-2015. Mediterr J Hematol Infect Dis 2018; 10:e2018050. [PMID: 30210743 PMCID: PMC6131099 DOI: 10.4084/mjhid.2018.050] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/03/2018] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives Imported malaria poses a serious public health problem in Qatar because its population is “naïve” to such infection; where local transmission might lead to serious, life-threatening infection and might even trigger epidemics. Methods This study is a retrospective review of the imported malaria cases in Qatar reported by the malaria surveillance program at the Ministry of Public Health (MoPH), during the period between January 2008 and December 2015. All cases were imported and underwent parasitological confirmation through microscopy. Results A total of 4092 malaria cases were reported during 2008–2015 in Qatar. The demographic features of the imported cases show that the majority of cases were males (93%), non-Qatari (99.6%), and aged 15 to 44 years (82.1%). Moreover, P. vivax was found to be the main etiologic agent accounting for more than three-quarters (78.7%) of the imported cases. In addition, almost a third (33.1%) of the cases were reported during the months of July, August, and September. Conclusions Imported malaria in Qatar has witnessed an increase during the past seven years, despite a long period of constant reduction; where the people most affected were adult male migrants from endemic countries. Many challenges need to be overcome to prevent the reintroduction of malaria into the country.
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23
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Soliman RH, Garcia-Aranda P, Elzagawy SM, Hussein BES, Mayah WW, Martin Ramirez A, Ta-Tang TH, Rubio JM. Imported and autochthonous malaria in West Saudi Arabia: results from a reference hospital. Malar J 2018; 17:286. [PMID: 30086757 PMCID: PMC6081858 DOI: 10.1186/s12936-018-2438-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/01/2018] [Indexed: 01/12/2023] Open
Abstract
Background The Kingdom of Saudi Arabia is seeking malaria eradication. Malaria transmission has been very low over the last few years. Discovered cases of Plasmodium falciparum infection are assigned a treatment protocol of artemisinin-based combination therapy, which consists of artesunate in addition to sulfadoxine-pyrimethamine rather than the traditional chloroquine, which has high resistance rates worldwide. This study aims to investigate the presence of different gene mutations concerning anti-malarial drug resistance (pfdhfr, pfdhps, pfmdr1, pfcrt, pfcytb, pfketch13) to identify whether drug-resistant alleles are present in this area of the Kingdom and whether the country’s treatment protocol is still suitable for Plasmodium bearing a resistance mutation. Methods Blood samples were collected from patients suffering from symptoms suggesting malaria coming to King Faisal Hospital, Taif, from February to August 2016. Diagnosis was performed by Giemsa-stained thin and thick blood films, rapid diagnostic test and PCR. Positive P. falciparum samples were further subjected to series of PCR amplification reactions targeting genes related with drug resistance (pfdhfr, pfdhps, pfmdr1, pfcrt, pfcytb, pfketch13). Results Twenty-six cases were positives, 13 infected with P. falciparum, of those, 4 cases were autochthonous, and 13 with Plasmodium vivax. The results of the gene mutation detection confirmed that there was no mutation related to resistance to artemisinin or atovaquone, on the other hand chloroquine resistance alleles were detected in 31% of samples. Moreover, point mutations in the pfdhfr and pfdhps genes, related resistance to antifolate drugs, were detected in all characterized samples. Conclusions Haplotypes of P. falciparum in the western region of the Kingdom of Saudi Arabia exhibit high resistance against antifolate drugs. These results should be extensively discussed when planning to modify anti-malarial drug protocols in the future.
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Affiliation(s)
- Rasha Hassan Soliman
- Microbiology Department, Faculty of Medicine, Taif University, Al Hawiyah, Taif, Kingdom of Saudi Arabia.,Parasitology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Patricia Garcia-Aranda
- Malaria and Emerging Parasitic Diseases Laboratory, National Microbiology Centre, Instituto de Salud Carlos III, Madrid, Spain
| | - Sherine Mohamed Elzagawy
- Parasitology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.,Princes Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Boshra El-Sayed Hussein
- Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt.,King Faisal Medical Complex, Taif, Kingdom of Saudi Arabia
| | - Wael Wahid Mayah
- Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt.,Faculty of Dentisary, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Alexandra Martin Ramirez
- Malaria and Emerging Parasitic Diseases Laboratory, National Microbiology Centre, Instituto de Salud Carlos III, Madrid, Spain
| | - Thuy-Huong Ta-Tang
- Malaria and Emerging Parasitic Diseases Laboratory, National Microbiology Centre, Instituto de Salud Carlos III, Madrid, Spain
| | - José Miguel Rubio
- Malaria and Emerging Parasitic Diseases Laboratory, National Microbiology Centre, Instituto de Salud Carlos III, Madrid, Spain.
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24
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Al Zahrani MH, Omar AI, Abdoon AMO, Ibrahim AA, Alhogail A, Elmubarak M, Elamin YE, AlHelal MA, Alshahrani AM, Abdelgader TM, Saeed I, El Gamri TB, Alattas MS, Dahlan AA, Assiri AM, Maina J, Li XH, Snow RW. Cross-border movement, economic development and malaria elimination in the Kingdom of Saudi Arabia. BMC Med 2018; 16:98. [PMID: 29940950 PMCID: PMC6019222 DOI: 10.1186/s12916-018-1081-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/21/2018] [Indexed: 11/17/2022] Open
Abstract
Malaria at international borders presents particular challenges with regards to elimination. International borders share common malaria ecologies, yet neighboring countries are often at different stages of the control-to-elimination pathway. Herein, we present a case study on malaria, and its control, at the border between Saudi Arabia and Yemen. Malaria program activity reports, case data, and ancillary information have been assembled from national health information systems, archives, and other related sources. Information was analyzed as a semi-quantitative time series, between 2000 and 2017, to provide a plausibility framework to understand the possible contributions of factors related to control activities, conflict, economic development, migration, and climate. The malaria recession in the Yemeni border regions of Saudi Arabia is a likely consequence of multiple, coincidental factors, including scaled elimination activities, cross-border vector control, periods of low rainfall, and economic development. The temporal alignment of many of these factors suggests that economic development may have changed the receptivity to the extent that it mitigated against surges in vulnerability posed by imported malaria from its endemic neighbor Yemen. In many border areas of the world, malaria is likely to be sustained through a complex congruence of factors, including poverty, conflict, and migration.
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Affiliation(s)
- Mohammed H. Al Zahrani
- National Malaria Elimination Programme, Public Health Agency, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Abdiasiis I. Omar
- National Malaria Elimination Programme, Public Health Agency, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Abdelmohsin M. O. Abdoon
- National Malaria Elimination Programme, Public Health Agency, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Ali Adam Ibrahim
- National Malaria Elimination Programme, Public Health Agency, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah Alhogail
- National Malaria Elimination Programme, Public Health Agency, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Mohamed Elmubarak
- National Malaria Elimination Programme, Public Health Agency, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Yousif Eldirdiry Elamin
- National Malaria Elimination Programme, Public Health Agency, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed A. AlHelal
- National Malaria Elimination Programme, Public Health Agency, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Ali M. Alshahrani
- Malaria Elimination Programme, Aseer Health Affairs Directorate, Abha, Kingdom of Saudi Arabia
| | - Tarig M. Abdelgader
- Malaria Elimination Programme, Aseer Health Affairs Directorate, Abha, Kingdom of Saudi Arabia
| | - Ibrahim Saeed
- Malaria Elimination Programme, Aseer Health Affairs Directorate, Abha, Kingdom of Saudi Arabia
| | - Tageddin B. El Gamri
- Malaria Elimination Programme, Jazan Health Affairs Directorate, Jazan, Kingdom of Saudi Arabia
| | - Mohammed S. Alattas
- Malaria Elimination Programme, Jazan Health Affairs Directorate, Jazan, Kingdom of Saudi Arabia
| | - Abdu A. Dahlan
- Malaria Elimination Programme, Jazan Health Affairs Directorate, Jazan, Kingdom of Saudi Arabia
| | - Abdullah M. Assiri
- Directorate of Public Health, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Joseph Maina
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Xiao Hong Li
- Malaria Elimination Unit, Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Robert W. Snow
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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25
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Genetic diversity and transmissibility of imported Plasmodium vivax in Qatar and three countries of origin. Sci Rep 2018; 8:8870. [PMID: 29891983 PMCID: PMC5995916 DOI: 10.1038/s41598-018-27229-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/29/2018] [Indexed: 12/02/2022] Open
Abstract
Malaria control program in the Arabian Peninsula, backed by adequate logistical support, has interrupted transmission with exception of limited sites in Saudi Arabia and sporadic outbreaks in Oman. However, sustained influx of imported malaria represents a direct threat to the above success. Here we examined the extent of genetic diversity among imported P. vivax in Qatar, and its ability to produce gametocytes, compared to parasites in main sites of imported cases, the Indian subcontinent (india) and East Africa (Sudan and Ethiopia). High diversity was seen among imported P. vivax in Qatar, comparable to parasites in the Indian subcontinent and East Africa. Limited genetic differentiation was seen among imported P. vivax, which overlapped with parasites in India, but differentiated from that in Sudan and Ethiopia. Parasite density among imported cases, ranged widely between 26.25–7985934.1 Pv18S rRNA copies/µl blood, with a high prevalence of infections carried gametocytes detectable by qRT-PCR. Parasitaemia was a stronger predictor for P. vivax gametocytes density (r = 0.211, P = 0.04). The extensive diversity of imported P. vivax and its ability to produce gametocytes represent a major threat for re-introduction of malaria in Qatar. The genetic relatedness between P. vivax reported in Qatar and those in India suggest that elimination strategy should target flow and dispersal of imported malaria into the region.
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Lover AA, Harvard KE, Lindawson AE, Smith Gueye C, Shretta R, Gosling R, Feachem R. Regional initiatives for malaria elimination: Building and maintaining partnerships. PLoS Med 2017; 14:e1002401. [PMID: 28981506 PMCID: PMC5628788 DOI: 10.1371/journal.pmed.1002401] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Andrew Lover and colleagues discuss regional malaria initiatives, the strengths and challenges.
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Affiliation(s)
- Andrew A. Lover
- Malaria Elimination Initiative, Global Health Group at the University of California, San Francisco, San Francisco, California, United States of America
- * E-mail: ,
| | - Kelly E. Harvard
- Malaria Elimination Initiative, Global Health Group at the University of California, San Francisco, San Francisco, California, United States of America
| | - Alistair E. Lindawson
- Malaria Elimination Initiative, Global Health Group at the University of California, San Francisco, San Francisco, California, United States of America
| | - Cara Smith Gueye
- Malaria Elimination Initiative, Global Health Group at the University of California, San Francisco, San Francisco, California, United States of America
| | - Rima Shretta
- Malaria Elimination Initiative, Global Health Group at the University of California, San Francisco, San Francisco, California, United States of America
| | - Roly Gosling
- Malaria Elimination Initiative, Global Health Group at the University of California, San Francisco, San Francisco, California, United States of America
| | - Richard Feachem
- Malaria Elimination Initiative, Global Health Group at the University of California, San Francisco, San Francisco, California, United States of America
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Hassan KS. World Malaria Day: Our story with malaria in Oman. Sultan Qaboos Univ Med J 2017; 17:e133-e134. [PMID: 28690883 DOI: 10.18295/squmj.2016.17.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 05/23/2017] [Accepted: 05/25/2017] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kowthar S Hassan
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
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Access to and use of long-lasting insecticidal nets and factors associated with non-use among communities in malaria-endemic areas of Al Hudaydah governorate in the Tihama region, west of Yemen. Malar J 2017; 16:244. [PMID: 28599666 PMCID: PMC5466721 DOI: 10.1186/s12936-017-1894-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 06/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background Universal coverage of the targeted malaria-endemic areas with long-lasting insecticidal nets (LLINs) is implemented as one of the key interventions for malaria control and elimination in Yemen. In 2013, through a mass campaign, LLINs were distributed to the targeted communities in Al Hudaydah governorate. This study aimed to assess the ownership of, access to, and use of LLINs. It also aimed to identify factors associated with not using LLINs in malaria-endemic areas of Al Hudaydah in the Tihama region, west of Yemen. Methods A cross-sectional survey was conducted in four districts (Ad Durayhimi, Al Marawi’ah, Al Mansuriyah and Bayt Al Faqiah) in Al Hudaydah during February 2016. A total of 701 households were included in this study. Data on socio-demographic characteristics and availability of LLINs were collected by interview and observation. Four indicators for malaria prevention using LLINs; proportion of households with at least one LLIN, proportion of households with at least one LLIN for every two people, proportion of population with access to LLINs in the surveyed households and proportion of population who slept under LLINs the previous night of the survey were calculated as indicated by Roll Back Malaria Monitoring and Evaluation Reference Group. Use to access ratio was assessed. Factors associated with not using LLINs among people with access were also investigated. Results Of 701 households with 4900 de facto population, ownership of at least one LLIN was 90.6%, while 24.1% owned at least one for every two people during the survey in 2016. The overall proportion of people with access to LLINs was 51.5% (95% CI 50.1–52.9). Only 19.0% (95% CI 17.9–20.1) slept under LLINs the night before the survey and the overall use to access ratio was 0.37. The proportions of children under 5 years of age with access to and use of LLINs were 13.7 and 42.5%, respectively. On the other hand, the proportions of pregnant women with access to and use of LLINs were 16.4 and 20.0%, respectively. Multivariable analysis identified that people living in Al Mansuriyah district [adjusted odds ratio (AOR) = 3.29, 95% confidence interval (CI) 1.35–8.01; P = 0.009)], having three or more damaged LLINs in the house (AOR = 2.76, 95% CI 1.79–4.25; P < 0.001), aged between 16 and 45 years old (AOR = 2.17, 95% CI 1.26–3.75; P = 0.005) or older (AOR = 2.17, 95% CI 1.09–4.29; P = 0.026) and living in huts (AOR = 1.59, 95% CI 1.09–2.32; P = 0.015) were significantly less likely to use LLINs. Conclusions This study shows a low LLIN access rate among local communities targeted for universal LLIN coverage in Al Hudaydah, a malaria-endemic area of high transmission. This finding necessitates additional distribution channels following mass campaigns to maintain the universal coverage. Reduced use of LLINs among people with access in these communities together with the identified risks of non-use highlight the importance of conducting behaviour change communication campaigns to enhance using LLINs in areas with universal coverage.
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Killeen GF, Kiware SS, Okumu FO, Sinka ME, Moyes CL, Massey NC, Gething PW, Marshall JM, Chaccour CJ, Tusting LS. Going beyond personal protection against mosquito bites to eliminate malaria transmission: population suppression of malaria vectors that exploit both human and animal blood. BMJ Glob Health 2017; 2:e000198. [PMID: 28589015 PMCID: PMC5444054 DOI: 10.1136/bmjgh-2016-000198] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/09/2016] [Accepted: 11/13/2016] [Indexed: 11/03/2022] Open
Abstract
Protecting individuals and households against mosquito bites with long-lasting insecticidal nets (LLINs) or indoor residual spraying (IRS) can suppress entire populations of unusually efficient malaria vector species that predominantly feed indoors on humans. Mosquitoes which usually feed on animals are less reliant on human blood, so they are far less vulnerable to population suppression effects of such human-targeted insecticidal measures. Fortunately, the dozens of mosquito species which primarily feed on animals are also relatively inefficient vectors of malaria, so personal protection against mosquito bites may be sufficient to eliminate transmission. However, a handful of mosquito species are particularly problematic vectors of residual malaria transmission, because they feed readily on both humans and animals. These unusual vectors feed often enough on humans to be potent malaria vectors, but also often enough on animals to evade population control with LLINs, IRS or any other insecticidal personal protection measure targeted only to humans. Anopheles arabiensis and A. coluzzii in Africa, A. darlingi in South America and A. farauti in Oceania, as well as A. culicifacies species E, A. fluviatilis species S, A. lesteri and A. minimus in Asia, all feed readily on either humans or animals and collectively mediate residual malaria transmission across most of the tropics. Eliminating malaria transmission by vectors exhibiting such dual host preferences will require aggressive mosquito population abatement, rather than just personal protection of humans. Population suppression of even these particularly troublesome vectors is achievable with a variety of existing vector control technologies that remain underdeveloped or underexploited.
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Affiliation(s)
- Gerry F Killeen
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Samson S Kiware
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Fredros O Okumu
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Catherine L Moyes
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | | | - Peter W Gething
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - John M Marshall
- Divisions of Biostatistics and Epidemiology, School of Public Health, University of California, Berkeley, California, USA
| | - Carlos J Chaccour
- Instituto de Salud Global, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Instituto de Salud Tropical, Universidad de Navarra, Pamplona, Spain
| | - Lucy S Tusting
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
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Alshahrani AM, Abdelgader TM, Saeed I, Al-Akhshami A, Al-Ghamdi M, Al-Zahrani MH, El Hassan I, Kyalo D, Snow RW. The changing malaria landscape in Aseer region, Kingdom of Saudi Arabia: 2000-2015. Malar J 2016; 15:538. [PMID: 27821186 PMCID: PMC5100269 DOI: 10.1186/s12936-016-1581-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/28/2016] [Indexed: 12/02/2022] Open
Abstract
Background In 2004, a revised action plan was developed, supported by the World Health Organization, to eliminate malaria from Saudi Arabia by preventing re-introduction of malaria into regions since declared malaria free, eliminating foci of transmission in the Mecca and Medina areas
and a concerted effort of foci surveillance and control, to eliminate malaria from the regions of Jazan and Aseer. This paper provides the context, activities, progress, and possible contributions toward malaria elimination in the Aseer region since 2000, with a more detailed analysis of the spatial location of locally acquired case incidence since 2012. Methods This is a descriptive study of all available Ministry of Health surveillance data and process reports since 2000, with higher spatial resolution analysis of data between 2012 and 2015. Results In 2000, there were 511 cases of Plasmodium falciparum locally acquired infection. The following 4 years witnessed a dramatic decline in cases to only 18 locally acquired infections reported in 2005. A resurgence in local infections was reported in 2006 (93) and 2007 (165), thereafter (2008–2014) local cases continued to decline to fewer than 40 per year across the region. However, in 2015, a small rise was noted (51). All locally acquired infections were P. falciparum. There has been a constant flow of imported infections into Aseer since 2000, mostly among immigrant labour from Pakistan, India, Sudan, and Yemen. Imported infections have included both Plasmodium vivax and P. falciparum. The spatial extent of malaria appears to be changing, but there remain two intractable areas Sarat Abeda and Dhran Aljanub, where risks per reporting centre have changed little since 2001, remaining above 0.5 per 10,000 population. Only seven villages contributed 55% of all locally acquired infection since 2012. Discussion Aseer has reached a state of very low incidence of locally acquired infections, despite a constant source of imported infections from outside the country. How many of the local infections are F2 generations from imported infections or how many are a result of residual active transmission between asymptomatic carriers of infections transmitted by pockets of existing Anopheles arabiensis populations remains unknown. A more detailed investigation of the spatial and temporal patterns of infected hosts, parasites and vectors would help define whether this region has managed to effectively prevent local transmission of new infections.
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Affiliation(s)
- Ali Mohamed Alshahrani
- Vector Control Administration, Aseer Health Affairs Directorate, Abha, Kingdom of Saudi Arabia. .,Aseer General Directorate of Health Affairs, Abha, Kingdom of Saudi Arabia.
| | - Tarig M Abdelgader
- Vector Control Administration, Aseer Health Affairs Directorate, Abha, Kingdom of Saudi Arabia.,Aseer General Directorate of Health Affairs, Abha, Kingdom of Saudi Arabia
| | - Ibrahim Saeed
- Vector Control Administration, Aseer Health Affairs Directorate, Abha, Kingdom of Saudi Arabia.,Aseer General Directorate of Health Affairs, Abha, Kingdom of Saudi Arabia
| | - AbdulRhman Al-Akhshami
- Vector Control Administration, Aseer Health Affairs Directorate, Abha, Kingdom of Saudi Arabia.,Aseer General Directorate of Health Affairs, Abha, Kingdom of Saudi Arabia
| | - Mohamed Al-Ghamdi
- Aseer General Directorate of Health Affairs, Abha, Kingdom of Saudi Arabia
| | | | - Ibrahim El Hassan
- Public Health and Tropical Medicine, University of Jazan, Jazan, Kingdom of Saudi Arabia
| | - David Kyalo
- Spatial Health Metrics Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Robert W Snow
- Spatial Health Metrics Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.,Nuffield Department of Clinical Medicine, Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
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Atroosh WM, Al-Mekhlafi HM, Snounou G, Al-Jasari A, Sady H, Nasr NA, Lau YL, Surin J. Sustained efficacy of artesunate-sulfadoxine-pyrimethamine against Plasmodium falciparum in Yemen and a renewed call for an adjunct single dose primaquine to clear gametocytes. Malar J 2016; 15:295. [PMID: 27234587 PMCID: PMC4882835 DOI: 10.1186/s12936-016-1344-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 05/13/2016] [Indexed: 01/03/2023] Open
Abstract
Background In Yemen, artesunate plus sulfadoxine-pyrimethamine (AS + SP) has been used as first-line treatment for uncomplicated falciparum malaria, which accounts for about 99 % of malaria cases. There is evidence that resistance to SP is increasing, with potential negative impact on efficacy, and in particular on curbing transmission. This study aims: (a) to evaluate the therapeutic efficacy of AS + SP treatment for uncomplicated falciparum malaria in Yemen; (b) to investigate the frequency of mutations in Plasmodium falciparum genes associated with resistance to AS (Kelch 13 propeller domain, pfK13) and SP (dihydrofolate reductase, pfdhfr, and dihydropteroate synthase, pfdhps); and (c) to assess the adequacy of this ACT to clear gametocytes. Methods A 28-day in vivo evaluation of the clinical and parasitological response to three-day course of AS + SP was carried out in two areas of high endemicity (Hodeidah and Al-Mahwit provinces, Tehama region) in Yemen according to standard WHO protocol 2009. Clinical and parasitological indices were monitored over a 28-day follow-up, and the outcome was PCR-corrected. The frequencies of mutations in the pfdhfr, pfdhps, and pfK13 genes were obtained by sequencing following amplification. Results Eighty-six patients completed the study, with a cure rate of 96.5 % (94.2 % PCR-uncorrected). Whereas four (4.7 %) patients still showed parasitaemia on day 2 post-treatment, all were found negative for asexual malaria stages on days 3 and 7. The efficacy of gametocyte clearance was poor (14.5, 42.5 and 86.0 % on days 7, 14 and 28, respectively), with gametocytes persisting throughout the study in some patients. All the isolates sequenced had the pfk13 propeller domain wild-type allele, and mutations associated with SP failure were observed only for pfdhfr with the double mutation (S108N + N51I) found in 65.4 % of the isolates sequenced. Conclusion In Yemen, AS + SP therapy remains effective for the treatment of uncomplicated falciparum malaria. Mutations were not detected in pfk13 or pfdhps, though double mutations were observed for pfdhfr. The observed persistent gametocytaemia re-enforces calls to add a single dose primaquine to this ACT in order to minimizes the potential for transmission and enhance regional efforts to eliminate malaria. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1344-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wahib M Atroosh
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.,Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen
| | - Hesham M Al-Mekhlafi
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. .,Endemic and Tropical Diseases Unit, Medical Research Center, Jazan University, Jazan, Kingdom of Saudi Arabia. .,Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
| | - Georges Snounou
- UPMC Université Paris 06, Inserm (Institut National de la Santé et de la Recherche Medicale), Centre d'Immunologie et des Maladies Infectieuses (Cimi-Paris), UMR 1135, ERL CNRS 8255 (Centre National de la Recherche Scientifique), Sorbonne Universités, 91 Boulevard de l'Hôpital, F-75013, Paris, France.
| | - Adel Al-Jasari
- National Malaria Control Programme, Ministry of Public Health and Population, Sana'a, Yemen
| | - Hany Sady
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nabil A Nasr
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yee-Ling Lau
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Johari Surin
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.,Centre for Research and Innovation, Taylor's University, 47500, Subang Jaya, Selangor, Malaysia
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Cook J, Grignard L, Al-Eryani S, Al-Selwei M, Mnzava A, Al-Yarie H, Rand A, Kleinschmidt I, Drakeley C. High heterogeneity of malaria transmission and a large sub-patent and diverse reservoir of infection in Wusab As Safil district, Republic of Yemen. Malar J 2016; 15:193. [PMID: 27059182 PMCID: PMC4826523 DOI: 10.1186/s12936-016-1249-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 03/30/2016] [Indexed: 11/10/2022] Open
Abstract
Background Yemen remains the country with the highest malaria transmission within the Arabian Peninsula and a source of imported cases to neighbouring countries. Methods This study collected samples from individuals resident in a valley in Western Yemen as a baseline to examine infection prevalence for a future trial. As well as rapid diagnostic test (RDT) and microscopy, a filter paper blood spot was collected for molecular and serological analyses. Results Samples were collected from 2261 individuals from 12 clusters across a study area of approximately 100 km2. Plasmodium falciparum infection prevalence was 12.4, 11.1 and 19.6 % by RDT, microscopy and polymerase chain reaction (PCR), respectively. RDT and microscopy did not detect 45 % of infections present, suggesting many infections were low-density. Infection prevalence and seroprevalence were highly heterogeneous between clusters, with evidence of higher exposure in clusters close to the wadi. The mean multiplicity of infection (MOI) was 2.3 and high heterozygosity and allelic richness were detected. Conclusions This highly diverse parasite population suggests a high degree of transmissibility and coupled with the substantial proportion of low-density infections, may pose challenges for malaria control and elimination efforts. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1249-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jackie Cook
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.
| | - Lynn Grignard
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Samira Al-Eryani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Mustafa Al-Selwei
- Malaria Control Programme, Ministry of Public Health and Population, Sana'a, Yemen
| | - Abraham Mnzava
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Hafed Al-Yarie
- Malaria Control Programme, Ministry of Public Health and Population, Sana'a, Yemen
| | - Alison Rand
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Immo Kleinschmidt
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Chris Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Al-Eryani SMA, Kelly-Hope L, Harbach RE, Briscoe AG, Barnish G, Azazy A, McCall PJ. Entomological aspects and the role of human behaviour in malaria transmission in a highland region of the Republic of Yemen. Malar J 2016; 15:130. [PMID: 26932794 PMCID: PMC4774125 DOI: 10.1186/s12936-016-1179-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/17/2016] [Indexed: 11/25/2022] Open
Abstract
Background The Republic of Yemen has the highest incidence of malaria in the Arabian Peninsula, yet little is known of its vectors or transmission dynamics. Methods A 24-month study of the vectors and related epidemiological aspects of malaria transmission was conducted in two villages in the Taiz region in 2004–2005. Results Cross-sectional blood film surveys recorded an overall malaria infection rate of 15.3 % (250/1638), with highest rates exceeding 30 % in one village in May and December 2005. With one exception, Plasmodium malariae, all infections were P.falciparum. Seven Anopheles species were identified among 3407 anophelines collected indoors using light traps (LT) and pyrethrum knockdown catches (PKD): Anopheles arabiensis (86.9 %), An. sergentii (9 %), An. azaniae, An. dthali, An. pretoriensis, An. coustani and An. algeriensis. Sequences for the standard barcode region of the mitochondrial COI gene confirmed the presence of two morphological forms of An. azaniae, the typical form and a previously unrecognized form not immediately identifiable as An. azaniae. ELISA detected Plasmodium sporozoites in 0.9 % of 2921 An. arabiensis (23 P. falciparum, two P. vivax) confirming this species as the primary malaria vector in Yemen. Plasmodium falciparum sporozoites were detected in An. sergentii (2/295) and a single female of An. algeriensis, incriminating both species as malaria vectors for the first time in Yemen. A vector in both wet and dry seasons, An. arabiensis was predominantly anthropophilic (human blood index = 0.86) with an entomological inoculation rate of 1.58 infective bites/person/year. Anopheles sergentii fed on cattle (67.3 %) and humans (48.3; 20.7 % mixed both species), but only 14.7 % were found in PKDs, indicating predominantly exophilic behaviour. A GIS analysis of geographic and socio-economic parameters revealed that An. arabiensis were significantly higher (P < 0.001) in houses with televisions, most likely due to the popular evening habit of viewing television collectively in houses with open doors and windows. Conclusions The predominantly indoor human biting vectors recorded in this study could be targeted effectively with LLINs, indoor residual spraying and/or insecticide-treated window/door curtains reinforced by education to instil a perception that effective and affordable malaria prevention is achievable. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1179-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samira M A Al-Eryani
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK. .,Department of Medical Parasitology, Faculty of Medicine and Health Sciences, University of Yemen, Sana'a, Yemen.
| | - Louise Kelly-Hope
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK.
| | - Ralph E Harbach
- Department of Life Sciences, Natural History Museum, Cromwell Road, London, UK.
| | - Andrew G Briscoe
- Department of Life Sciences, Natural History Museum, Cromwell Road, London, UK.
| | - Guy Barnish
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK.
| | - Ahmed Azazy
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, University of Yemen, Sana'a, Yemen.
| | - Philip J McCall
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK.
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Adeel AA, Saeed NA, Aljasari A, Almohager AM, Galab MH, AlMahdi A, Mahammed MH, AlDarsi M, Salaeah YA, Atta H, Zamani G, Warsame M, Barrette A, Mohammady HE, Nada RA. High efficacy of two artemisinin-based combinations: artesunate + sulfadoxine-pyrimethamine and artemether-lumefantrine for falciparum malaria in Yemen. Malar J 2015; 14:449. [PMID: 26573814 PMCID: PMC4647513 DOI: 10.1186/s12936-015-0970-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 10/27/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Artesunate + sulfadoxine-pyrimethamine (AS + SP) has been the first-line treatment and artemether-lumefantrine (AL) the second-line treatment for uncomplicated falciparum malaria in Yemen since 2005. This paper reports the results of studies conducted to monitor therapeutic efficacy of these two drugs in sentinel sites in Yemen. METHODS Eight therapeutic efficacy studies were conducted in six sentinel sites during the period 2009-2013 in Yemen. Five studies were for the evaluation of AS + SP (total of 465 patients) and three studies (total of 268 patients) for the evaluation of AL. The studies were done according to standard WHO protocol 2009 with 28-day follow-up. RESULTS In the evaluation of AS + SP, the PCR-corrected cure rate was 98 % (95 % CI 92.2-99.5 %) in one site and 100 % in all of the other four sites. In the sites where AL was evaluated, the PCR-corrected cure rate was 100 % in all the sites. All patients were negative for asexual parasitaemia on day 3 in both the AS + SP and the AL groups. There was a higher rate of clearance of gametocytaemia in the AL-treated group when compared with the AS + SP groups from day 7 onwards. CONCLUSION AS + SP remains the effective drug for uncomplicated falciparum malaria in Yemen. AL is also highly effective and can be an appropriate alternative to AS + SP for the treatment of falciparum malaria. AL demonstrated a higher efficacy in clearing microscopic gametocytaemia than AS + SP. TRIAL REGISTRATION Trial registration number ACTRN12610000696099.
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Affiliation(s)
- Ahmed A Adeel
- College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Niaz Abdo Saeed
- The National Malaria Control Programme, Ministry of Public Health and Population, Sanaa, Yemen.
| | - Adel Aljasari
- The National Malaria Control Programme, Ministry of Public Health and Population, Sanaa, Yemen.
| | | | | | - Amar AlMahdi
- Ministry of Public Health and Population, Sanaa, Yemen.
| | | | | | | | - Hoda Atta
- Malaria Control and Elimination, Division of Communicable Diseases Control, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt.
| | - Ghasem Zamani
- Malaria Control and Elimination, Division of Communicable Diseases Control, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt.
| | - Marian Warsame
- Global Malaria Programme, World Health Organization, Geneva, Switzerland.
| | - Amy Barrette
- Global Malaria Programme, World Health Organization, Geneva, Switzerland.
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Progress toward malaria elimination in Jazan Province, Kingdom of Saudi Arabia: 2000-2014. Malar J 2015; 14:444. [PMID: 26552387 PMCID: PMC4640236 DOI: 10.1186/s12936-015-0858-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 08/22/2015] [Indexed: 11/11/2022] Open
Abstract
Background The draft Global Technical Strategy for malaria aims to eliminate malaria from at least 10 countries by 2020. Yemen and Saudi Arabia remain the last two countries on the Arabian Peninsula yet to achieve elimination. Over the last 50 years, systematic efforts to control malaria in the Kingdom of Saudi Arabia has successfully reduced malaria cases to a point where malaria is now constrained largely to Jazan Province, the most south-western area along the Red Sea. The progress toward elimination in this province is reviewed between 2000 and 2014. Methods Data were obtained from the Ministry of Health case-reporting systems, activity reports, unpublished consultants reports, and relevant scientific published papers. Sub-provincial population data were obtained the national household censuses undertaken in 2004 and 2010. Rainfall data were obtained from the Meteorological Department in Jazan. Results Between 2000 and 2014 there were 5522 locally acquired cases of malaria and 9936 cases of imported malaria. A significant reduction in locally acquired malaria cases was observed from 2000 to 2014, resulting in an average annual incidence (2010–2014) of 0.3 cases per 10,000 population. Conversely imported cases, since 2000, remain consistent and higher than locally acquired cases, averaging between 250 and 830 cases per year. The incidence of locally acquired cases is heterogeneous across the Province, with only a few health districts contributing the majority of the cases. The overall decline in malaria case incidence can be attributed to coincidental expansion of control efforts and periods of exceptionally low rainfall. Conclusions Jazan province is poised to achieve malaria elimination. There is a need to change from a policy of passive case detection to reactively and proactively detecting infectious reservoirs that require new approaches to surveillance. These should be combined with advanced epidemiological tools to improve the definitions of epidemiological receptive and hotspot malaria risk mapping. The single largest threat currently remains the risks posed by imported infections from Yemen.
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Kraemer MUG, Hay SI, Pigott DM, Smith DL, Wint GRW, Golding N. Progress and Challenges in Infectious Disease Cartography. Trends Parasitol 2015; 32:19-29. [PMID: 26604163 DOI: 10.1016/j.pt.2015.09.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/30/2015] [Accepted: 09/17/2015] [Indexed: 02/02/2023]
Abstract
Quantitatively mapping the spatial distributions of infectious diseases is key to both investigating their epidemiology and identifying populations at risk of infection. Important advances in data quality and methodologies have allowed for better investigation of disease risk and its association with environmental factors. However, incorporating dynamic human behavioural processes in disease mapping remains challenging. For example, connectivity among human populations, a key driver of pathogen dispersal, has increased sharply over the past century, along with the availability of data derived from mobile phones and other dynamic data sources. Future work must be targeted towards the rapid updating and dissemination of appropriately designed disease maps to guide the public health community in reducing the global burden of infectious disease.
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Affiliation(s)
- Moritz U G Kraemer
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, OX1 3PS, UK.
| | - Simon I Hay
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA; Fogarty International Center, National Institutes of Health, Bethesda, MD 20892-2220, USA
| | - David M Pigott
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, OX1 3PS, UK; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - David L Smith
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, OX1 3PS, UK; Fogarty International Center, National Institutes of Health, Bethesda, MD 20892-2220, USA; Sanaria Institute for Global Health and Tropical Medicine, Rockville, MD 20850, USA
| | - G R William Wint
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, OX1 3PS, UK; Environmental Research Group Oxford (ERGO), Department of Zoology, University of Oxford, Oxford, OX1 3PS, UK
| | - Nick Golding
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
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Coleman M, Al-Zahrani MH, Coleman M, Hemingway J, Omar A, Stanton MC, Thomsen EK, Alsheikh AA, Alhakeem RF, McCall PJ, Rabeeah AAA, Memish ZA. A country on the verge of malaria elimination--the Kingdom of Saudi Arabia. PLoS One 2014; 9:e105980. [PMID: 25250619 PMCID: PMC4175080 DOI: 10.1371/journal.pone.0105980] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 07/28/2014] [Indexed: 11/29/2022] Open
Abstract
Significant headway has been made in the global fight against malaria in the past decade and as more countries enter the elimination phase, attention is now focused on identifying effective strategies to shrink the malaria map. Saudi Arabia experienced an outbreak of malaria in 1998, but is now on the brink of malaria elimination, with just 82 autochthonous cases reported in 2012. A review of published and grey literature was performed to identify the control strategies that have contributed to this achievement. The number of autochthonous malaria cases in Saudi Arabia decreased by 99.8% between 1998 and 2012. The initial steep decline in malaria cases coincided with a rapid scaling up of vector control measures. Incidence continued to be reported at low levels (between 0.01 and 0.1 per 1,000 of the population) until the adoption of artesunate plus sulfadoxine-pyrimethamine as first line treatment and the establishment of a regional partnership for a malaria-free Arabian Peninsula, both of which occurred in 2007. Since 2007, incidence has decreased by nearly an order of magnitude. Malaria incidence is now very low, but a high proportion of imported cases, continued potential for autochthonous transmission, and an increased proportion of cases attributable to Plasmodium vivax all present challenges to Saudi Arabia as they work toward elimination by 2015.
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Affiliation(s)
- Michael Coleman
- Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
| | | | - Marlize Coleman
- Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Janet Hemingway
- Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Abdiasiis Omar
- Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Michelle C. Stanton
- Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Eddie K. Thomsen
- Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Adel A. Alsheikh
- Public Health Directorate, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Raafat F. Alhakeem
- Public Health Directorate, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Phillip J. McCall
- Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Abdullah A. Al Rabeeah
- Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Public Health Directorate, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Ziad A. Memish
- Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Public Health Directorate, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
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Al-Hamidhi S, Mahdy MAK, Idris MA, Bin Dajem SM, Al-Sheikh AAH, Al-Qahtani A, Al-Hashami Z, Al-Farsi H, Al-Mekhlafi AM, Saif-Ali R, Beja-Pereira A, Babiker HA. The prospect of malaria elimination in the Arabian Peninsula: a population genetic approach. INFECTION GENETICS AND EVOLUTION 2014; 27:25-31. [PMID: 24981966 DOI: 10.1016/j.meegid.2014.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 03/21/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND In the Arabian Peninsula malaria control is progressing steadily, backed by adequate logistic and political support. As a result, transmission has been interrupted throughout the region, with exception of limited sites in Yemen and Saudi Arabia. Here we examined Plasmodium falciparum parasites in these sites to assess if the above success has limited diversity and gene flow. METHODS We examined 108 P. falciparum isolates in three sites in Yemen (Taiz, Dhamar and Hodeidah) and 91 isolates from Saudi Arabia (Jazan). Nine microsatellites were analyzed for allelic diversity, multi-locus haplotype and inter-population differentiation. RESULTS Diversity at each locus (unbiased heterozygosity [H]) was relatively lower in Yemen; (Hodeidah, H=0.615, Taiz, H=0.66, Dhamar, H=0.481), compared to Saudi Arabia (Jazan, H=0.76). Microsatellites were distributed widely and private alleles, detected in a single population, were rare. Pairwise comparisons revealed that parasites population in Dhamar was relatively distanced (FST=0.19). However, Taiz (Yemen) (FST=0.065) and Hodeidah (FST=0.107) populations were closer to that in Jazan (Saudi Arabia). Nonetheless, parasites in the four sites can be considered as one population. CONCLUSION Although malaria risk in Saudi Arabia has been cut considerably, the extent of diversity and parasite genetic structure are indicative of a large population size. Elimination strategy should target demographic factors that favor parasite dispersal and flow of imported malaria.
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Affiliation(s)
- Salama Al-Hamidhi
- Department of Biochemistry, Faculty of Medicine and Health Sciences, Sultan Qaboos University, Oman
| | - Mohammed A K Mahdy
- Research Department, University of Science and Technology, Sana'a, Yemen; Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Mohamed Ahmed Idris
- Department of Microbiology and Immunology, Faculty of Medicine and Health Sciences, Sultan Qaboos University, Oman
| | - Saad M Bin Dajem
- Biology Department, College of Science, King Khalid University, Abha, Saudi Arabia
| | | | - Ahmed Al-Qahtani
- Medical Research, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Zainab Al-Hashami
- Department of Biochemistry, Faculty of Medicine and Health Sciences, Sultan Qaboos University, Oman
| | - Hissa Al-Farsi
- Department of Biochemistry, Faculty of Medicine and Health Sciences, Sultan Qaboos University, Oman
| | - Abdulsalam M Al-Mekhlafi
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Riyadh Saif-Ali
- Biochemistry Department, Faculty of Medicine, Sana'a University, Yemen
| | - Albano Beja-Pereira
- Research Centre in Biodiversity and Genetic Resources (CIBIO), University of Porto, Rua Padre Armando Quintas 7, Vairão 4485-661, Portugal
| | - Hamza A Babiker
- Department of Biochemistry, Faculty of Medicine and Health Sciences, Sultan Qaboos University, Oman.
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Memish ZA, Zumla A, Alhakeem RF, Assiri A, Turkestani A, Al Harby KD, Alyemni M, Dhafar K, Gautret P, Barbeschi M, McCloskey B, Heymann D, Al Rabeeah AA, Al-Tawfiq JA. Hajj: infectious disease surveillance and control. Lancet 2014; 383:2073-2082. [PMID: 24857703 PMCID: PMC7137990 DOI: 10.1016/s0140-6736(14)60381-0] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Religious festivals attract a large number of pilgrims from worldwide and are a potential risk for the transmission of infectious diseases between pilgrims, and to the indigenous population. The gathering of a large number of pilgrims could compromise the health system of the host country. The threat to global health security posed by infectious diseases with epidemic potential shows the importance of advanced planning of public health surveillance and response at these religious events. Saudi Arabia has extensive experience of providing health care at mass gatherings acquired through decades of managing millions of pilgrims at the Hajj. In this report, we describe the extensive public health planning, surveillance systems used to monitor public health risks, and health services provided and accessed during Hajj 2012 and Hajj 2013 that together attracted more than 5 million pilgrims from 184 countries. We also describe the recent establishment of the Global Center for Mass Gathering Medicine, a Saudi Government partnership with the WHO Collaborating Centre for Mass Gatherings Medicine, Gulf Co-operation Council states, UK universities, and public health institutions globally.
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Affiliation(s)
- Ziad A Memish
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; WHO Collaborating Centre for Mass Gatherings Medicine, Riyadh, Saudi Arabia; Al-Faisal University, Riyadh, Saudi Arabia; Ministry of Health, Riyadh, Saudi Arabia.
| | - Alimuddin Zumla
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; Division of Infection and Immunity, University College London, London, UK; University College London Hospitals NHS Foundation Trust, London, UK
| | - Rafat F Alhakeem
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; Ministry of Health, Riyadh, Saudi Arabia
| | | | | | | | | | | | - Philippe Gautret
- Aix Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Inserm, and Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Maurizio Barbeschi
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; Preparedness, Surveillance and Response, Global Capacity Alert and Response, World Health Organization, Geneva, Switzerland
| | - Brian McCloskey
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; WHO Collaborating Centre on Mass Gatherings and High Visibility/High Consequence Events, London, UK
| | - David Heymann
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; Chatham House, London, UK; London School of Hygiene & Tropical Medicine, London, UK
| | - Abdullah A Al Rabeeah
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; Ministry of Health, Riyadh, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Saudi Aramco Medical Services Organization, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA
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Pindolia DK, Garcia AJ, Huang Z, Fik T, Smith DL, Tatem AJ. Quantifying cross-border movements and migrations for guiding the strategic planning of malaria control and elimination. Malar J 2014; 13:169. [PMID: 24886389 PMCID: PMC4057586 DOI: 10.1186/1475-2875-13-169] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 03/28/2014] [Indexed: 11/15/2022] Open
Abstract
Background Identifying human and malaria parasite movements is important for control planning across all transmission intensities. Imported infections can reintroduce infections into areas previously free of infection, maintain ‘hotspots’ of transmission and import drug resistant strains, challenging national control programmes at a variety of temporal and spatial scales. Recent analyses based on mobile phone usage data have provided valuable insights into population and likely parasite movements within countries, but these data are restricted to sub-national analyses, leaving important cross-border movements neglected. Methods National census data were used to analyse and model cross-border migration and movement, using East Africa as an example. ‘Hotspots’ of origin-specific immigrants from neighbouring countries were identified for Kenya, Tanzania and Uganda. Populations of origin-specific migrants were compared to distance from origin country borders and population size at destination, and regression models were developed to quantify and compare differences in migration patterns. Migration data were then combined with existing spatially-referenced malaria data to compare the relative propensity for cross-border malaria movement in the region. Results The spatial patterns and processes for immigration were different between each origin and destination country pair. Hotspots of immigration, for example, were concentrated close to origin country borders for most immigrants to Tanzania, but for Kenya, a similar pattern was only seen for Tanzanian and Ugandan immigrants. Regression model fits also differed between specific migrant groups, with some migration patterns more dependent on population size at destination and distance travelled than others. With these differences between immigration patterns and processes, and heterogeneous transmission risk in East Africa and the surrounding region, propensities to import malaria infections also likely show substantial variations. Conclusion This was a first attempt to quantify and model cross-border movements relevant to malaria transmission and control. With national census available worldwide, this approach can be translated to construct a cross-border human and malaria movement evidence base for other malaria endemic countries. The outcomes of this study will feed into wider efforts to quantify and model human and malaria movements in endemic regions to facilitate improved intervention planning, resource allocation and collaborative policy decisions.
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Affiliation(s)
- Deepa K Pindolia
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA.
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