Patterns of change in vector-borne diseases

Malaria Transmission around the Memve'ele Hydroelectric Dam in South Cameroon: A Combined Retrospective and Prospective Study, 2000⁻2016

Dam constructions are considered a great concern for public health. The current study aimed to investigate malaria transmission in the Nyabessan village around the Memve'ele dam in South Cameroon. Adult mosquitoes were captured by human landing catches in Nyabessan before and during dam construction in 2000-2006 and 2014-2016 respectively, as well as in the Olama village, which was selected as a control. Malaria vectors were morphologically identified and analyzed for Plasmodium falciparum circumsporozoite protein detection and molecular identification of Anopheles (A.) gambiae species. Overall, ten malaria vector species were identified among 12,189 Anopheles specimens from Nyabessan (N = 6127) and Olama (N = 6062), including A. gambiae Giles (1902), A. coluzzii Coetzee (2013), A. moucheti Evans (1925), A. ovengensis Awono (2004), A. nili Theobald (1903), A. paludis Theobald (1900), A. zieanni, A. marshallii Theobald (1903), A. coustani Laveran (1900), and A. obscurus Grünberg (1905). In Nyabessan, A. moucheti and A. ovengensis were the main vector species before dam construction (16-50 bites/person/night-b/p/n, 0.26-0.71 infective bites/person/night-ib/p/n) that experienced a reduction of their role in disease transmission in 2016 (3-35 b/p/n, 0-0.5 ib/p/n) (p < 0.005). By contrast, the role of A. gambiae s.l. and A. paludis increased (11-38 b/p/n, 0.75-1.2 ib/p/n) (p < 0.01). In Olama, A. moucheti remained the main malaria vector species throughout the study period (p = 0.5). These findings highlight the need for a strong vector-borne disease surveillance and control system around the Memve'ele dam.

The effects of urbanization on global Plasmodium vivax malaria transmission

Background

Many recent studies have examined the impact of urbanization on Plasmodium falciparum malaria endemicity and found a general trend of reduced transmission in urban areas. However, none has examined the effect of urbanization on Plasmodium vivax malaria, which is the most widely distributed malaria species and can also cause severe clinical syndromes in humans. In this study, a set of 10,003 community-based P. vivax parasite rate (PvPR) surveys are used to explore the relationships between PvPR in urban and rural settings.

Methods

The PvPR surveys were overlaid onto a map of global urban extents to derive an urban/rural assignment. The differences in PvPR values between urban and rural areas were then examined. Groups of PvPR surveys inside individual city extents (urban) and surrounding areas (rural) were identified to examine the local variations in PvPR values. Finally, the relationships of PvPR between urban and rural areas within the ranges of 41 dominant Anopheles vectors were examined.

Results

Significantly higher PvPR values in rural areas were found globally. The relationship was consistent at continental scales when focusing on Africa and Asia only, but in the Americas, significantly lower values of PvPR in rural areas were found, though the numbers of surveys were small. Moreover, except for the countries in the Americas, the same trends were found at national scales in African and Asian countries, with significantly lower values of PvPR in urban areas. However, the patterns at city scales among 20 specific cities where sufficient data were available were less clear, with seven cities having significantly lower PvPR values in urban areas and two cities showing significantly lower PvPR in rural areas. The urban–rural PvPR differences within the ranges of the dominant Anopheles vectors were generally, in agreement with the regional patterns found.

Conclusions

Except for the Americas, the patterns of significantly lower P. vivax transmission in urban areas have been found globally, regionally, nationally and by dominant vector species here, following trends observed previously for P. falciparum. To further understand these patterns, more epidemiological, entomological and parasitological analyses of the disease at smaller spatial scales are needed.

A history of chagas disease transmission, control, and re-emergence in peri-rural La Joya, Peru

Background

The history of Chagas disease control in Peru and many other nations is marked by scattered and poorly documented vector control campaigns. The complexities of human migration and sporadic control campaigns complicate evaluation of the burden of Chagas disease and dynamics of Trypanosoma cruzi transmission.

Methodology/Principal Findings

We conducted a cross-sectional serological and entomological study to evaluate temporal and spatial patterns of T. cruzi transmission in a peri-rural region of La Joya, Peru. We use a multivariate catalytic model and Bayesian methods to estimate incidence of infection over time and thereby elucidate the complex history of transmission in the area. Of 1,333 study participants, 101 (7.6%; 95% CI: 6.2–9.0%) were confirmed T. cruzi seropositive. Spatial clustering of parasitic infection was found in vector insects, but not in human cases. Expanded catalytic models suggest that transmission was interrupted in the study area in 1996 (95% credible interval: 1991–2000), with a resultant decline in the average annual incidence of infection from 0.9% (95% credible interval: 0.6–1.3%) to 0.1% (95% credible interval: 0.005–0.3%). Through a search of archival newspaper reports, we uncovered documentation of a 1995 vector control campaign, and thereby independently validated the model estimates.

Conclusions/Significance

High levels of T. cruzi transmission had been ongoing in peri-rural La Joya prior to interruption of parasite transmission through a little-documented vector control campaign in 1995. Despite the efficacy of the 1995 control campaign, T. cruzi was rapidly reemerging in vector populations in La Joya, emphasizing the need for continuing surveillance and control at the rural-urban interface.

The historically rural problem of Chagas disease is increasing in urban areas in Latin America. Peri-rural development may play a critical role in the urbanization of Chagas disease and other parasitic infections. We conducted a cross-sectional study in an urbanizing rural area in southern Peru, and we encountered a complex history of Chagas disease in this peri-rural environment. Specifically, we discovered: (1) long-standing parasite transmission leading to substantial burden of infection; (2) interruption in parasite transmission resulting from an undocumented insecticide application campaign; (3) relatively rapid re-emergence of parasite-infected vector insects resulting from an unsustained control campaign; (4) extensive migration among peri-rural inhabitants. Long-standing parasite infection in peri-rural areas with highly mobile populations provides a plausible mechanism for the expansion of parasite transmission to nearby urban centers. Lack of commitment to control campaigns in peri-rural areas may have unforeseen and undesired consequences for nearby urban centers. Novel methods and perspectives are needed to address the complexities of human migration and erratic interventions.

Climate change effects on trematodiases, with emphasis on zoonotic fascioliasis and schistosomiasis

The capacity of climatic conditions to modulate the extent and intensity of parasitism is well known since long ago. Concerning helminths, among the numerous environmental modifications giving rise to changes in infections, climate variables appear as those showing a greater influence, so that climate change may be expected to have an important impact on the diseases they cause. However, the confirmation of the impact of climate change on helminthiases has been reached very recently. Only shortly before, helminthiases were still noted as infectious diseases scarcely affected by climate change, when compared to diseases caused by microorganisms in general (viruses, bacteriae, protozoans). The aim of the present paper is to review the impact of climate change on helminthiases transmitted by snails, invertebrates which are pronouncedly affected by meteorological factors, by focusing on trematodiases. First, the knowledge on the effects of climate change on trematodiases in general is reviewed, including aspects such as influence of temperature on cercarial output, cercarial production variability in trematode species, influences of magnitude of cercarial production and snail host size, cercarial quality, duration of cercarial production increase and host mortality, influence of latitude, and global-warming-induced impact of trematodes. Secondly, important zoonotic diseases such as fascioliasis, schistosomiasis and cercarial dermatitis are analysed from the point of view of their relationships with meteorological factors. Emphasis is given to data which indicate that climate change influences the characteristics of these trematodiases in concrete areas where these diseases are emerging in recent years. The present review shows that trematodes, similarly as other helminths presenting larval stages living freely in the environment and/or larval stages parasitic in invertebrates easily affected by climate change as arthropods and molluscs as intermediate hosts, may be largely more susceptible to climate change impact than those helminths in whose life cycle such phases are absent or reduced to a minimum. Although helminths also appear to be affected by climate change, their main difference with microparasites lies on the usually longer life cycles of helminths, with longer generation times, slower population growth rates and longer time period needed for the response in the definitive host to become evident. Consequently, after a pronounced climate change in a local area, modifications in helminth populations need more time to be obvious or detectable than modifications in microparasite populations. Similarly, the relation of changes in a helminthiasis with climatic factor changes, as extreme events elapsed relatively long time ago, may be overlooked if not concretely searched for. All indicates that this phenomenon has been the reason for previous analyses to conclude that helminthiases do not constitute priority targets in climate change impact studies.

Bionomics of malaria vectors and relationship with malaria transmission and epidemiology in three physiographic zones in the Senegal River Basin

Following the implementation of two dams in the Senegal River, entomological and parasitological studies were conducted in three different ecological zones in the Senegal River Basin (the low valley of Senegal River, the Guiers Lake area and the low valley of Ferlo) every 3 month in June 2004, September 2004, December 2004 and March 2005. The objective of this work was to study the influence of environmental heterogeneities on vector bionomics and malaria epidemiology. Mosquitoes were collected when landing on human volunteers and by pyrethrum spray catches. In the parasitological survey, blood samples were taken from a cohort of schoolchildren under 9 years during each entomology survey. Seven anopheline species were collected: Anopheles arabiensis, Anopheles gambiae M form, Anopheles funestus, Anopheles pharoensis, Anopheles coustani, Anopheles wellcomei and Anopheles rufipes. A. arabiensis, A. funestus and A. pharoensis were predominant in the low valley of the Senegal River, A. funestus in the Guiers Lake area and A. arabiensis in the low valley of Ferlo. Mosquito populations' dynamics varied temporally depending on the rainy season for each zone. The anthropophilic rates varied between 6 and 76% for A. gambiae s.l. and 23 and 80% for A. funestus. Only 4/396 A. pharoensis and 1/3076 A. funestus tested carried Plasmodium falciparum CS antigen. These results suggest the implication of A. pharoensis in malaria transmission. The related entomological inoculation rates were estimated to 10.44 in Mbilor and 3 infected bites in Gankette Balla and were due, respectively, to A. pharoensis and A. funestus. Overall, 1636 thick blood smears were tested from blood samples taken from schoolchildren with, respectively, a parasite and gametocyte average prevalence of 9 and 0.9%. The parasite prevalence was uniformly low in Mbilor and Gankette Balla whereas; it increased in September (16%) and then remained stable in December and March (22%) in Mboula where malaria transmission was not perceptible. However, significant differences were observed over time for parasite prevalence in Mbilor and Mboula villages whereas; it was only in Gankette Balla village where gametocyte prevalence was significantly different over time. Our study demonstrates the influence of ecological changes resulted from dams implementation in the Senegal River on the composition of vectorial system, malaria transmission and epidemiology. Such changes should be thoroughly surveyed in order to prevent any possible malaria outbreak in the Senegal River Basin.

Infectious Disease in the Age of Globalization

This chapter explores the links between globalization and infectious diseases in relation to changes in four major spheres—economic, environmental, political and demographic, and technological. It highlights areas where the evidence suggests that processes of globalization have led to changes in the distribution, transmission rate, and, in some cases, management of infectious diseases.

Are New World leishmaniases becoming anthroponoses?

In the New World, leishmaniases are originally wild exoanthropic zoonoses developing in sylvatic ecotopes. For a long time, Leishmania parasites have shown a remarkable plasticity to face modifications in their environment. Now, both geographical extension and numerical increase of leishmaniasis cases in the New World are giving cause for concern. These circumstances might have been provoked by the simple invasion of zoonotic foci by humans. However, dramatic evolutionary mechanisms are also at work in the New World: (i) the reduction of biodiversity associated with anthropogenic environmental changes (deforestation and urbanization); and (ii) the subsequent adaptations and interactions of new vectors and reservoir hosts at the interface with humans. This paper considers that these processes could result in new pathogenic complexes tending to synanthropic zoonoses, if not anthroponoses. Increasing man-made risk factors could thus possibly make leishmaniases a growing public health concern in the New World.

Control of Human Parasitic Diseases: Context and Overview

The control of parasitic diseases of humans has been undertaken since the aetiology and natural history of the infections was recognized and the deleterious effects on human health and well-being appreciated by policy makers, medical practitioners and public health specialists. However, while some parasitic infections such as malaria have proved difficult to control, as defined by a sustained reduction in incidence, others, particularly helminth infections can be effectively controlled. The different approaches to control from diagnosis, to treatment and cure of the clinically sick patient, to control the transmission within the community by preventative chemotherapy and vector control are outlined. The concepts of eradication, elimination and control are defined and examples of success summarized. Overviews of the health policy and financing environment in which programmes to control or eliminate parasitic diseases are positioned and the development of public-private partnerships as vehicles for product development or access to drugs for parasite disease control are discussed. Failure to sustain control of parasites may be due to development of drug resistance or the failure to implement proven strategies as a result of decreased resources within the health system, decentralization of health management through health-sector reform and the lack of financial and human resources in settings where per capita government expenditure on health may be less than $US 5 per year. However, success has been achieved in several large-scale programmes through sustained national government investment and/or committed donor support. It is also widely accepted that the level of investment in drug development for the parasitic diseases of poor populations is an unattractive option for pharmaceutical companies. The development of partnerships to specifically address this need provides some hope that the intractable problems of the treatment regimens for the trypanosomiases and leishmaniases can be solved in the not too distant future. However, it will be difficult to implement and sustain such interventions in fragile health services often in settings where resources are limited but also in unstable, conflict-affected or post-conflict countries. Emphasis is placed on the importance of co-endemicity and polyparasitism and the opportunity to control parasites susceptible to cost-effective and proven chemotherapeutic interventions for a package of diseases which can be implemented at low cost and which would benefit the poorest and most marginalized groups. The ecology of parasitic diseases is discussed in the context of changing ecology, environment, sociopolitical developments and climate change. These drivers of global change will affect the epidemiology of parasites over the coming decades, while in many of the most endemic and impoverished countries parasitic infections will be accorded lower priority as resourced stressed health systems cope with the burden of the higher-profile killing diseases viz., HIV/AIDS, TB and malaria. There is a need for more holistic thinking about the interactions between parasites and other infections. It is clear that as the prevalence and awareness of HIV has increased, there is a growing recognition of a host of complex interactions that determine disease outcome in individual patients. The competition for resources in the health as well as other social sectors will be a continuing challenge; effective parasite control will be dependent on how such resources are accessed and deployed to effectively address well-defined problems some of which are readily amenable to successful interventions with proven methods. In the health sector, the problems of the HIV/AIDS and TB pandemics and the problem of the emerging burden of chronic non-communicable diseases will be significant competitors for these limited resources as parasitic infections aside from malaria tend to be chronic disabling problems of the poorest who have limited access to scarce health services and are representative of the poorest quintile. Prioritization and advocacy for parasite control in the national and international political environments is the challenge.

Common themes in changing vector-borne disease scenarios

The impact of climate change on disease patterns is controversial. However, global burden of disease studies suggest that infectious diseases will contribute a proportionately smaller burden of disease over the next 2 decades as non-communicable diseases emerge as public health problems. However, infectious diseases contribute proportionately more in the poorest quintile of the population. Notwithstanding the different views of the impact of global warming on vector-borne infections this paper reviews the conditions which drive the changing epidemiology of these infections and suggests that such change is linked by common themes including interactions of generalist vectors and reservoir hosts at interfaces with humans, reduced biodiversity associated with anthropogenic environmental changes, increases in Plasmodium falciparum: P. vivax ratios and well-described land use changes such as hydrological, urbanization, agricultural, mining and forest-associated impacts (extractive activities, road building, deforestation and migration) which are seen on a global scale.

Global change and human vulnerability to vector-borne diseases

Global change includes climate change and climate variability, land use, water storage and irrigation, human population growth and urbanization, trade and travel, and chemical pollution. Impacts on vector-borne diseases, including malaria, dengue fever, infections by other arboviruses, schistosomiasis, trypanosomiasis, onchocerciasis, and leishmaniasis are reviewed. While climate change is global in nature and poses unknown future risks to humans and natural ecosystems, other local changes are occurring more rapidly on a global scale and are having significant effects on vector-borne diseases. History is invaluable as a pointer to future risks, but direct extrapolation is no longer possible because the climate is changing. Researchers are therefore embracing computer simulation models and global change scenarios to explore the risks. Credible ranking of the extent to which different vector-borne diseases will be affected awaits a rigorous analysis. Adaptation to the changes is threatened by the ongoing loss of drugs and pesticides due to the selection of resistant strains of pathogens and vectors. The vulnerability of communities to the changes in impacts depends on their adaptive capacity, which requires both appropriate technology and responsive public health systems. The availability of resources in turn depends on social stability, economic wealth, and priority allocation of resources to public health.

Linking field-based ecological data with remotely sensed data using a geographic information system in two malaria endemic urban areas of Kenya

Background

Remote sensing technology provides detailed spectral and thermal images of the earth's surface from which surrogate ecological indicators of complex processes can be measured.

Methods

Remote sensing data were overlaid onto georeferenced entomological and human ecological data randomly sampled during April and May 2001 in the cities of Kisumu (population ≈ 320,000) and Malindi (population ≈ 81,000), Kenya. Grid cells of 270 meters × 270 meters were used to generate spatial sampling units for each city for the collection of entomological and human ecological field-based data. Multispectral Thermal Imager (MTI) satellite data in the visible spectrum at five meter resolution were acquired for Kisumu and Malindi during February and March 2001, respectively. The MTI data were fit and aggregated to the 270 meter × 270 meter grid cells used in field-based sampling using a geographic information system. The normalized difference vegetation index (NDVI) was calculated and scaled from MTI data for selected grid cells. Regression analysis was used to assess associations between NDVI values and entomological and human ecological variables at the grid cell level.

Results

Multivariate linear regression showed that as household density increased, mean grid cell NDVI decreased (global F-test = 9.81, df 3,72, P-value = <0.01; adjusted R² = 0.26). Given household density, the number of potential anopheline larval habitats per grid cell also increased with increasing values of mean grid cell NDVI (global F-test = 14.29, df 3,36, P-value = <0.01; adjusted R² = 0.51).

Conclusions

NDVI values obtained from MTI data were successfully overlaid onto georeferenced entomological and human ecological data spatially sampled at a scale of 270 meters × 270 meters. Results demonstrate that NDVI at such a scale was sufficient to describe variations in entomological and human ecological parameters across both cities.

Synthesis and in vitro anti-protozoal activity of a series of benzotropolone derivatives incorporating endocyclic hydrazines

The preparation and evaluation as potential anti-protozoal agents of molecules bearing an endocyclic hydrazine moiety is presented. The synthetic route to this new series of compounds is straightforward, involving a hetero Diels-Alder reaction between different benzotropolone esters and diethyl azodicarboxylate (DEAD). While they show limited or no in vitro activity against Leishmania donovani, Plasmodium falciparum and Trypanosoma brucei rhodesiense, several of the compounds have activities against Trypanosoma cruzi in the 15.8-41.0 microM range. These activities are comparable to that of benznidazole (IC50 6.0 microM), the main chemotherapy employed in the treatment of T. cruzi infections. In addition, all but one of the new bicyclic hydrazine esters are virtually non-toxic, one of the most important drawbacks of currently available trypanocidal drugs.

Water-related disease patterns before and after the construction of the Diama dam in northern Senegal

The ecological changes caused by projects for the development of water resources are known to affect the epidemiology of water-related diseases. The effects of the construction of the Diama dam (completed in 1986) in the Senegal River on the epidemiology of malaria, urinary and intestinal schistosomiasis, diarrhoea and dysentery were investigated in four districts in northern Senegal. To make allowance for any general trend in reported morbidity (caused by changes in demography or the healthcare system), the numbers of cases of these illnesses reported by the basic healthcare facilities before and after the completion of the dam were compared with those of respiratory disease. Prior to the construction of the dam, malaria was the most encountered water-related disease in the medical records of all districts, followed by diarrhoea, dysentery and urinary schistosomiasis. This order remained the same after the completion of the dam. Despite the optimism of health-assessment reports prepared prior to the construction of the Diama dam, the unexpected appearance and spread of intestinal schistosomiasis as well as an increase in the incidence of urinary schistosomiasis have aggravated public health in the Senegal River basin. It remains to be judged whether the economic benefits of the dam will counterbalance its adverse effects.

A continental risk map for malaria mosquito (Diptera: Culicidae) vectors in Europe

Although malaria was officially declared eradicated from Europe in 1975, its former vectors, mainly members of the Anopheles maculipennis (Meigen) complex, are still distributed throughout the continent. The present situation of Anophelism without malaria indicates that current socio-economic and environmental conditions maintain the basic case reproduction number, Ro, below 1. Recently, it has been speculated that predicted climate changes may increase anopheline abundance and biting rates (as well as reduce the Plasmodium parasite extrinsic incubation period), allowing the reemergence of malaria transmission in Europe. As a preliminary step toward predicting future scenarios, we have constructed models to test whether the current distribution of the five former European malaria vectors [An. atroparvus (Van Thiel),An. labranchiae (Falleroni), An. messeae (Swellengrebel & De Buck), An. sacharovi (Favr) and An. superpictus (Grassi)] can be explained by environmental parameters, including climate. Multivariate logistic regression models using climate surfaces derived from interpolation of meteorological station data (resolution 0.5 x 0.5 degrees) and remotely sensed land cover (resolution 1 x 1 km) were fitted to 1,833 reported observations of the presence and absence of each species across Europe. These relatively crude statistical models predicted presence and absence with a sensitivity of 74-85.7% and specificity of 73.4-98.1% (with climate a significantly better predictor than land cover type). A geographically independent validation of the models gave a sensitivity of 72.9-88.5% and a specificity of 72.7-99.6%. This allowed us to generate risk maps for each species across Europe. Assuming that high risk equates with the potential for high abundance, these models should permit the development of risk maps for European mosquitoes under future climate scenarios. These techniques would be equally useful for estimating the risk of reemergence in other nonendemic areas such as the United States and Australia, as well as changes to risk within endemic areas.

Environmental, cultural and social changes and their influence on parasite infections

The changes taking place within the societies, cultures and the environments in which we live are massive and complex. By referring to simple epidemiological models it is possible to build an objective framework with which to look at these changes in terms of their likely impact on the epidemiology of parasitic diseases within human communities. These parameters are listed for hosts and both micro- and macroparasites, as are epidemiologically significant cultural, social and environmental variables. Changes in these variables may be either detrimental or beneficial to human health and may, in addition, interact in complex ways. Examples of the complexity of changes which can influence epidemiology are provided for a cultural template of the population living in the north-east of Thailand.

A simplified model for predicting malaria entomologic inoculation rates based on entomologic and parasitologic parameters relevant to control

Malaria transmission intensity is modeled from the starting perspective of individual vector mosquitoes and is expressed directly as the entomologic inoculation rate (EIR). The potential of individual mosquitoes to transmit malaria during their lifetime is presented graphically as a function of their feeding cycle length and survival, human biting preferences, and the parasite sporogonic incubation period. The EIR is then calculated as the product of 1) the potential of individual vectors to transmit malaria during their lifetime, 2) vector emergence rate relative to human population size, and 3) the infectiousness of the human population to vectors. Thus, impacts on more than one of these parameters will amplify each other's effects. The EIRs transmitted by the dominant vector species at four malaria-endemic sites from Papua New Guinea, Tanzania, and Nigeria were predicted using field measurements of these characteristics together with human biting rate and human reservoir infectiousness. This model predicted EIRs (+/- SD) that are 1.13 +/- 0.37 (range = 0.84-1.59) times those measured in the field. For these four sites, mosquito emergence rate and lifetime transmission potential were more important determinants of the EIR than human reservoir infectiousness. This model and the input parameters from the four sites allow the potential impacts of various control measures on malaria transmission intensity to be tested under a range of endemic conditions. The model has potential applications for the development and implementation of transmission control measures and for public health education.

Chagas' disease and the autoimmunity hypothesis

The notion that the pathology of Chagas' disease has an autoimmune component was initially based on the finding of circulating antibodies binding heart tissue antigens in patients and mice chronically infected with Trypanosoma cruzi. Later, T lymphocytes reactive with heart or nerve tissue antigens were found in chagasic mice and patients, extending the concept to include cell-mediated immunity. However, there is disagreement about whether the observed immunologic autoreactivities are triggered by T. cruzi epitopes and then affect host tissue antigens by virtue of molecular mimicry or are elicited by host antigens exposed to lymphocytes after tissue damage caused by the parasite. There is also disagreement about the relevance of immunologic autoreactivities to the pathogenesis of Chagas' disease because of the lack of reproducibility of some key reports supporting the autoimmunity hypothesis, conflicting data from independent laboratories, conclusions invalidated by advances in our understanding of the immunologic mechanisms underlying cell lysis, and, last but not least, a lack of direct, incontrovertible evidence that cross-reacting antibodies or autoreactive cells mediate the typical pathologic changes associated with human Chagas' disease. The data and views backing and questioning the autoimmunity hypothesis for Chagas' disease are summarized in this review.