Morphological identification and genetic characterization of Anopheles stephensi in Somaliland

Seasonal plasticity in daily timing of flight activity in Anopheles stephensi is driven by temperature modulation of dawn entrainment

The Asian malaria vector Anopheles stephensi is invading Africa, requiring it to adapt to novel climates and ecosystems. In part, this may be facilitated by An. stephensi's poorly understood seasonal behavioural plasticity in flight timing, leading to earlier biting activity in cold Asian winters and later biting times in the warm summer. Changes in behavioural timing could be directly imposed by seasonal variation in ambient light and temperature levels or result from altered entrainment of intrinsically expressed circadian rhythms by these factors. We demonstrate that An. stephensi entrained flight activity timing is phase-locked to dawn and is not affected by constant ambient temperature, which cannot explain earlier biting activity in colder winters with later dawn. Instead, we show that where night temperatures are the colder part of daily temperature cycle; the entrained phase-angle between dawn and flight activity is altered, hereby increasingly colder, winter-like nights progressively advance flight activity onset. We propose that seasonal timing plasticity optimizes behaviour to warmer daytime in winter, and colder nights in summer, providing protection against both heat-desiccation and cold immobility. The adaptive advantage of this plasticity could be relevant to the successful invasion and survival of An. stephensi in African climates, and changing climate worldwide.This article is part of the Theo Murphy meeting issue, 'Circadian rhythms in infection and immunity'.

Sequencing confirms Anopheles stephensi distribution across southern Yemen

The invasion of Anopheles stephensi in Africa warrants investigation of neighboring countries. In this study, genetic analysis was applied to determine the status of An. stephensi in southern Yemen. Cytochrome c oxidase subunit I (COI) and internal transcribed spacer 2 (ITS2) were sequenced in An. stephensi collected in Dar Sa'ad (Aden City), Tuban, Rodoom, Al Mukalla, and Sayhut, and phylogenetic analysis confirmed An. stephensi identity. Our analyses revealed that the ITS2 sequences were identical in all An. stephensi, while COI analysis revealed two haplotypes, one previously reported in northern Horn of Africa and one identified in this study for the first time. Overall, these findings revealed low levels of mitochondrial DNA diversity, which is consistent with a more recent population introduction in parts of southern Yemen relative to the Horn of Africa. Further, whole genomic analysis is needed to elucidate the original connection with invasive populations of An. stephensi in the Horn of Africa.

Global Health Priority Box─Proactive Pandemic Preparedness

The coronavirus pandemic outbreak of 2019 highlighted the critical importance of preparedness for current and future public health threats (https://www.mmv.org/mmv-open/global-health-priority-box/about-global-health-priority-box). While the main attention for the past few years has been on COVID-19 research, this focus has reduced global resources on research in other areas, including malaria and neglected tropical diseases (NTDs). Such a shift in focus puts at risk the hard-earned progress in global health achieved over the past two decades (https://www.who.int/news-room/spotlight/10-global-health-issues-to-track-in-2021). To address the urgent need for new drugs to combat drug-resistant malaria, emerging zoonotic diseases, and vector control, Medicines for Malaria Venture (MMV) and Innovative Vector Control Consortium (IVCC) assembled a collection of 240 compounds and, in August 2022, launched the Global Health Priority Box (GHPB). This collection of compounds has confirmed activity against emerging pathogens or vectors and is available free of charge. This valuable tool enables researchers worldwide to build on each other's work and save precious time and resources by providing a starting point for the further development of treatments and insecticides. Furthermore, this open access box aligns with two of the many priorities outlined by the World Health Organization (WHO) (https://www.who.int/news-room/spotlight/10-global-health-issues-to-track-in-2021).

A quantitative and systematic analysis of Anopheles stephensi bionomics and control approaches

Anopheles stephensi is a mosquito endemic to South Asia and the Arabian Peninsula that has recently been detected in eight African countries, posing a significant threat to global malaria control efforts. A challenge with An. stephensi is that it requires unique surveillance and control tools when compared to other malaria vectors. Through a systematic literature review, we investigated the efficacy of trapping methods and controls for An. stephensi mosquitoes, with a focus on studies of its behavior and biology. Data from 83 articles (native range: Afghanistan, India, Iran, Iraq, Pakistan, and Qatar; invasive range: Djibouti, Ethiopia, Sri Lanka, Saudi Arabia, and Sudan) met our study inclusion criteria. Data from these studies revealed that using host-seeking animal baited traps increased the number of mosquitoes collected per trap per day in the native range when compared to host-seeking human baited traps. However, these differences were not present in data collection rate assessments from the invasive range. We also found that An. stephensi equally used a large variety of breeding habitats in the native range, but that it tended to prefer water reservoirs and wastewater in the invasive range. Finally, we found that temephos, fenthion, Bacillus thuringiensis israelensis, and Beauveri bassiana were more effective at reducing larvae in their native range compared to the approaches found in our systematic literature search, but the relative effectiveness of these approaches in the invasive range was less clear. Understanding proven historical surveillance and control approaches is essential to the advancement of invasive An. stephensi mitigation efforts, but continued investigations in the invasive range are critical to reducing the impacts of malaria morbidity and mortality.

Insecticide resistance and population structure of the invasive malaria vector, Anopheles stephensi, from Fiq, Ethiopia

Anopheles stephensi invasion in Ethiopia poses a risk of increased malaria disease burden in the region. Thus, understanding the insecticide resistance profile and population structure of the recently detected An. stephensi population in Fiq, Ethiopia, is critical to inform vector control to stop the spread of this invasive malaria species in the country. Following entomological surveillance for An. stephensi in Fiq, Somali region, Ethiopia, we confirmed the presence of An. stephensi morphologically and molecularly in Fiq. Characterization of larval habitats and insecticide susceptibility tests revealed that Fiq An. stephensi is most often found in artificial containers and is resistant to most adult insecticides tested (organophosphates, carbamates, pyrethroids) except for pirimiphos-methyl and PBO-pyrethroids. However, the immature larval stage was susceptible to temephos. Further comparative genomic analyses with previous An. stephensi populations from Ethiopia using 1704 biallelic SNPs revealed genetic relatedness between Fiq An. stephensi and east-central Ethiopia An. stephensi populations, particularly Jigjiga An. stephensi. Our findings of the insecticide resistance profile, coupled with the likely source population of Fiq An. stephensi, can inform vector control strategies against this malaria vector in Fiq and Jigjiga to limit further spread out of these two locations to other parts of the country and continent.

Update on antimicrobial resistance in Somalia: Current status, challenges, opportunities, and future perspectives

Antimicrobial resistance (AMR) is a critical global health challenge, and Somalia is no exception. This update examines the current status of AMR in Somalia, highlighting the prevalent patterns of resistance, contributing factors, and significant health impacts. Despite limited surveillance data, evidence suggests rising resistance to key antibiotics, exacerbated by inadequate healthcare infrastructure, overuse of antimicrobials, and lack of regulatory oversight. The review identifies key challenges, including insufficient diagnostic capabilities, poor infection control practices, and a need for robust stewardship programs. Opportunities for addressing AMR in Somalia are discussed, including strengthening surveillance systems, improving healthcare access, and fostering international collaboration. Future perspectives emphasize the importance of integrating AMR strategies into broader health policies, enhancing public awareness, and investing in research to develop new treatments and prevention methods. Addressing these issues is crucial for mitigating the impact of AMR and improving health outcomes in Somalia.

Invasive Anopheles stephensi in Africa: insights from Asia

Anopheles stephensi is a highly competent urban malaria vector species, endemic in South Asia and the Persian Gulf, which has colonised eight countries in sub-Saharan Africa (SSA) since 2013 and is now spreading uncontrollably. In urban areas of Africa, where malaria transmission has previously been low or non-existent, the invasion of An. stephensi represents a significant problem, particularly to immunologically naïve populations. Despite this rapidly advancing threat, there is a paucity of information regarding the bionomics of An. stephensi in SSA. Here, we offer a critical synthesis of literature from An. stephensi's native range, focusing on the future of An. stephensi in a rapidly urbanising Africa, and highlighting key questions that warrant prioritisation by the global malaria vector control community.

A decade of invasive Anopheles stephensi sequence-based identification: toward a global standard

Anopheles stephensi is an invasive malaria vector in Africa that has been implicated in malaria outbreaks in the Horn of Africa. In 10 years, it has been detected as far east as Djibouti and as far west as Ghana. Early detections were mostly incidental, but now active surveillance in Africa has been updated to include An. stephensi. Morphological identification of An. stephensi from native vectors can be challenging, thus, sequence-based assays have been used to confirm identification during initial detections. Methods of sequence-based identification of An. stephensi have varied across initial detections to date. Here, we summarize initial detections, make suggestions that could provide a standardized approach, and discuss how sequences can inform additional genomic studies beyond species identification.

Design of a novel intelligent computing framework for predictive solutions of malaria propagation model

The paper presents an innovative computational framework for predictive solutions for simulating the spread of malaria. The structure incorporates sophisticated computing methods to improve the reliability of predicting malaria outbreaks. The study strives to provide a strong and effective tool for forecasting the propagation of malaria via the use of an AI-based recurrent neural network (RNN). The model is classified into two groups, consisting of humans and mosquitoes. To develop the model, the traditional Ross-Macdonald model is expanded upon, allowing for a more comprehensive analysis of the intricate dynamics at play. To gain a deeper understanding of the extended Ross model, we employ RNN, treating it as an initial value problem involving a system of first-order ordinary differential equations, each representing one of the seven profiles. This method enables us to obtain valuable insights and elucidate the complexities inherent in the propagation of malaria. Mosquitoes and humans constitute the two cohorts encompassed within the exposition of the mathematical dynamical model. Human dynamics are comprised of individuals who are susceptible, exposed, infectious, and in recovery. The mosquito population, on the other hand, is divided into three categories: susceptible, exposed, and infected. For RNN, we used the input of 0 to 300 days with an interval length of 3 days. The evaluation of the precision and accuracy of the methodology is conducted by superimposing the estimated solution onto the numerical solution. In addition, the outcomes obtained from the RNN are examined, including regression analysis, assessment of error autocorrelation, examination of time series response plots, mean square error, error histogram, and absolute error. A reduced mean square error signifies that the model's estimates are more accurate. The result is consistent with acquiring an approximate absolute error close to zero, revealing the efficacy of the suggested strategy. This research presents a novel approach to solving the malaria propagation model using recurrent neural networks. Additionally, it examines the behavior of various profiles under varying initial conditions of the malaria propagation model, which consists of a system of ordinary differential equations.

Spatiotemporal distribution and bionomics of Anopheles stephensi in different eco-epidemiological settings in Ethiopia

BACKGROUND

Malaria is a major public health concern in Ethiopia, and its incidence could worsen with the spread of the invasive mosquito species Anopheles stephensi in the country. This study aimed to provide updates on the distribution of An. stephensi and likely household exposure in Ethiopia.

METHODS

Entomological surveillance was performed in 26 urban settings in Ethiopia from 2021 to 2023. A kilometer-by-kilometer quadrant was established per town, and approximately 20 structures per quadrant were surveyed every 3 months. Additional extensive sampling was conducted in 50 randomly selected structures in four urban centers in 2022 and 2023 to assess households' exposure to An. stephensi. Prokopack aspirators and CDC light traps were used to collect adult mosquitoes, and standard dippers were used to collect immature stages. The collected mosquitoes were identified to species level by morphological keys and molecular methods. PCR assays were used to assess Plasmodium infection and mosquito blood meal source.

RESULTS

Catches of adult An. stephensi were generally low (mean: 0.15 per trap), with eight positive sites among the 26 surveyed. This mosquito species was reported for the first time in Assosa, western Ethiopia. Anopheles stephensi was the predominant species in four of the eight positive sites, accounting for 75-100% relative abundance of the adult Anopheles catches. Household-level exposure, defined as the percentage of households with a peridomestic presence of An. stephensi, ranged from 18% in Metehara to 30% in Danan. Anopheles arabiensis was the predominant species in 20 of the 26 sites, accounting for 42.9-100% of the Anopheles catches. Bovine blood index, ovine blood index and human blood index values were 69.2%, 32.3% and 24.6%, respectively, for An. stephensi, and 65.4%, 46.7% and 35.8%, respectively, for An. arabiensis. None of the 197 An. stephensi mosquitoes assayed tested positive for Plasmodium sporozoite, while of the 1434 An. arabiensis mosquitoes assayed, 62 were positive for Plasmodium (10 for P. falciparum and 52 for P. vivax).

CONCLUSIONS

This study shows that the geographical range of An. stephensi has expanded to western Ethiopia. Strongly zoophagic behavior coupled with low adult catches might explain the absence of Plasmodium infection. The level of household exposure to An. stephensi in this study varied across positive sites. Further research is needed to better understand the bionomics and contribution of An. stephensi to malaria transmission.

Possible potential spread of Anopheles stephensi, the Asian malaria vector

BACKGROUND

Anopheles stephensi is native to Southeast Asia and the Arabian Peninsula and has emerged as an effective and invasive malaria vector. Since invasion was reported in Djibouti in 2012, the global invasion range of An. stephensi has been expanding, and its high adaptability to the environment and the ongoing development of drug resistance have created new challenges for malaria control. Climate change is an important factor affecting the distribution and transfer of species, and understanding the distribution of An. stephensi is an important part of malaria control measures, including vector control.

METHODS

In this study, we collected existing distribution data for An. stephensi, and based on the SSP1-2.6 future climate data, we used the Biomod2 package in R Studio through the use of multiple different model methods such as maximum entropy models (MAXENT) and random forest (RF) in this study to map the predicted global An. stephensi climatically suitable areas.

RESULTS

According to the predictions of this study, some areas where there are no current records of An. stephensi, showed significant areas of climatically suitable for An. stephensi. In addition, the global climatically suitability areas for An. stephensi are expanding with global climate change, with some areas changing from unsuitable to suitable, suggesting a greater risk of invasion of An. stephensi in these areas, with the attendant possibility of a resurgence of malaria, as has been the case in Djibouti.

CONCLUSIONS

This study provides evidence for the possible invasion and expansion of An. stephensi and serves as a reference for the optimization of targeted monitoring and control strategies for this malaria vector in potential invasion risk areas.

Building the vector in: construction practices and the invasion and persistence of Anopheles stephensi in Jigjiga, Ethiopia

Anopheles stephensi is a major vector of malaria in Asia and the Arabian Peninsula, and its recent invasion into Africa poses a major threat to malaria control and elimination efforts on the continent. The mosquito is well adapted to urban environments, and its presence in Africa could potentially lead to an increase in malaria transmission in cities. Most of the knowledge about An stephensi ecology in Africa has been generated from studies conducted during the rainy season, when vectors are most abundant. Here, we provide evidence from the peak of the dry season in the city of Jigjiga in Ethiopia, and report An stephensi immature stages infesting predominantly in water reservoirs made to support construction operations (ie, in construction sites or associated with brick-manufacturing businesses). Political and economic changes in Ethiopia (particularly the Somali Region) have fuelled an unprecedented construction boom since 2018 that, in our opinion, has been instrumental in the establishment, persistence, and propagation of An stephensi via the year-round availability of perennial larval habitats associated with construction. We argue that larval source management during the dry season might provide a unique opportunity for focused control of An stephensi in Jigjiga and similar areas.

Evidence for a role of Anopheles stephensi in the spread of drug- and diagnosis-resistant malaria in Africa

Anopheles stephensi, an Asian malaria vector, continues to expand across Africa. The vector is now firmly established in urban settings in the Horn of Africa. Its presence in areas where malaria resurged suggested a possible role in causing malaria outbreaks. Here, using a prospective case-control design, we investigated the role of An. stephensi in transmission following a malaria outbreak in Dire Dawa, Ethiopia in April-July 2022. Screening contacts of patients with malaria and febrile controls revealed spatial clustering of Plasmodium falciparum infections around patients with malaria in strong association with the presence of An. stephensi in the household vicinity. Plasmodium sporozoites were detected in these mosquitoes. This outbreak involved clonal propagation of parasites with molecular signatures of artemisinin and diagnostic resistance. To our knowledge, this study provides the strongest evidence so far for a role of An. stephensi in driving an urban malaria outbreak in Africa, highlighting the major public health threat posed by this fast-spreading mosquito.

Public health impact of the spread of Anopheles stephensi in the WHO Eastern Mediterranean Region countries in Horn of Africa and Yemen: need for integrated vector surveillance and control

BACKGROUND

Anopheles stephensi is an efficient vector of both Plasmodium falciparum and Plasmodium vivax in South Asia and the Middle East. The spread of An. stephensi to countries within the Horn of Africa threatens progress in malaria control in this region as well as the rest of sub-Saharan Africa.

METHODS

The available malaria data and the timeline for the detection of An. stephensi was reviewed to analyse the role of An. stephensi in malaria transmission in Horn of Africa of the Eastern Mediterranean Region (EMR) in Djibouti, Somalia, Sudan and Yemen.

RESULTS

Malaria incidence in Horn of Africa of EMR and Yemen, increased from 41.6 in 2015 to 61.5 cases per 1000 in 2020. The four countries from this region, Djibouti, Somalia, Sudan and Yemen had reported the detection of An. stephensi as of 2021. In Djibouti City, following its detection in 2012, the estimated incidence increased from 2.5 cases per 1000 in 2013 to 97.6 cases per 1000 in 2020. However, its contribution to malaria transmission in other major cities and in other countries, is unclear because of other factors, quality of the urban malaria data, human mobility, uncertainty about the actual arrival time of An. stephensi and poor entomological surveillance.

CONCLUSIONS

While An. stephensi may explain a resurgence of malaria in Djibouti, further investigations are needed to understand its interpretation trends in urban malaria across the greater region. More investment for multisectoral approach and integrated surveillance and control should target all vectors particularly malaria and dengue vectors to guide interventions in urban areas.

Seasonal dynamics of Anopheles stephensi and its implications for mosquito detection and emergent malaria control in the Horn of Africa

Invasion of the malaria vector Anopheles stephensi across the Horn of Africa threatens control efforts across the continent, particularly in urban settings where the vector is able to proliferate. Malaria transmission is primarily determined by the abundance of dominant vectors, which often varies seasonally with rainfall. However, it remains unclear how An. stephensi abundance changes throughout the year, despite this being a crucial input to surveillance and control activities. We collate longitudinal catch data from across its endemic range to better understand the vector's seasonal dynamics and explore the implications of this seasonality for malaria surveillance and control across the Horn of Africa. Our analyses reveal pronounced variation in seasonal dynamics, the timing and nature of which are poorly predicted by rainfall patterns. Instead, they are associated with temperature and patterns of land use; frequently differing between rural and urban settings. Our results show that timing entomological surveys to coincide with rainy periods is unlikely to improve the likelihood of detecting An. stephensi. Integrating these results into a malaria transmission model, we show that timing indoor residual spraying campaigns to coincide with peak rainfall offers little improvement in reducing disease burden compared to starting in a random month. Our results suggest that unlike other malaria vectors in Africa, rainfall may be a poor guide to predicting the timing of peaks in An. stephensi-driven malaria transmission. This highlights the urgent need for longitudinal entomological monitoring of the vector in its new environments given recent invasion and potential spread across the continent.

Confirmation of the presence of Anopheles stephensi among internally displaced people's camps and host communities in Aden city, Yemen

BACKGROUND

Declines in global malaria cases and deaths since the millennium are currently challenged by multiple factors including funding limitations, limits of, and resistance to vector control tools, and also recent spread of the invasive vector species, Anopheles stephensi-especially into novel urban settings where malaria rates are typically low. Coupled with general increases in urbanization and escalations in the number of conflicts creating rapid and unplanned population displacement into temporary shelter camps within host urban areas, particularly in the Middle East and sub-Saharan Africa, increased urban malaria is a major threat to control and elimination.

METHODS

Entomological monitoring surveys (targeting Aedes aegypti) of water containers across urban areas hosting internally displaced people (IDP) communities in Aden city, Yemen, were performed by The MENTOR Initiative, a non-governmental organisation. As part of these surveys in 2021 23 larvae collected and raised to adults were morphologically identified as An. stephensi. Twelve of the samples were sent to Liverpool School of Tropical Medicine for independent morphological assessment and genetic analysis by sequencing the ribosomal ITS2 region and the mitochondrial COI gene.

RESULTS

All twelve samples were confirmed morphologically and by sequence comparison of the single ITS2 and COI haplotype detected to the NCBI BLAST database as An. stephensi. Phylogenetic analysis with comparable COI sequences indicated close relationship to haplotypes found in Djibouti and Ethiopia.

CONCLUSION

The study results confirm the presence of An. stephensi in Yemen. Confirmation of the species in multiple urban communities hosting thousands of IDPs living in temporary shelters with widescale dependency on open water containers is of particular concern due to the vulnerability of the population and abundance of favourable breeding sites for the vector. Proactive monitoring and targeted integrated vector management are required to limit impacts in this area of typically low malaria transmission, and to prevent further the spread of An. stephensi within the region.

What sounds like Aedes, acts like Aedes, but is not Aedes? Lessons from dengue virus control for the management of invasive Anopheles

Aedes mosquitoes are responsible for transmission of dengue, chikungunya, Zika, and yellow fever viruses. Aedes mosquitoes are the pathfinders of invasive urban-living mosquitoes, and have spread into 129 countries over the past five decades. In the past 10 years Anopheles stephensi has been identified within densely populated cities in Yemen and across the Horn of Africa and as far west as Nigeria. A stephensi's aggressive spread is closely linked to increases in population movement due to migration, conflict, and climate change; rapid unplanned urbanisation; and resulting poor water quality, sanitation, waste container removal, and hygiene systems. As a highly invasive vector that is adept at transmitting malarial pathogens (eg, Plasmodium vivax and Plasmodium falciparum), A stephensi's spread holds huge implications for increasing malaria morbidity and mortality. Both vectors (ie, Aedes species and A stephensi) thrive in the same urban environments, and urgent action is needed to seize the opportunity to integrate disease control resources and generate innovative vector-control tools for urban populations, to protect the many millions at risk.