American Journal of Tropical Medicine and Hygiene – May 2015

American Journal of Tropical Medicine and Hygiene
May 2015; 92 (5)

Malaria Control: Tortoises and Hares
Steven R. Meshnick*
Author Affiliations
Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
How long will it take to effectively control and then eliminate malaria in sub-Saharan Africa? Is it a sprint to the finish line or a crawl? Will the tortoise or hare win the malaria race?

Malaria Transmission, Infection, and Disease at Three Sites with Varied Transmission Intensity in Uganda: Implications for Malaria Control
Moses R. Kamya, Emmanuel Arinaitwe, Humphrey Wanzira, Agaba Katureebe, Chris Barusya,
Simon P. Kigozi, Maxwell Kilama, Andrew J. Tatem, Philip J. Rosenthal, Chris Drakeley, Steve W. Lindsay, Sarah G. Staedke, David L. Smith, Bryan Greenhouse, and Grant Dorsey
Am J Trop Med Hyg 2015 92:903-912; Published online March 16, 2015, doi:10.4269/ajtmh.14-0312
The intensification of control interventions has led to marked reductions in malaria burden in some settings, but not others. To provide a comprehensive description of malaria epidemiology in Uganda, we conducted surveillance studies over 24 months in 100 houses randomly selected from each of three subcounties: Walukuba (peri-urban), Kihihi (rural), and Nagongera (rural). Annual entomological inoculation rate (aEIR) was estimated from monthly Centers for Disease Control and Prevention (CDC) light trap mosquito collections. Children aged 0.5–10 years were provided long-lasting insecticidal nets (LLINs) and followed for measures of parasite prevalence, anemia and malaria incidence. Estimates of aEIR were 2.8, 32.0, and 310 infectious bites per year, and estimates of parasite prevalence 7.4%, 9.3%, and 28.7% for Walukuba, Kihihi, and Nagongera, respectively. Over the 2-year study, malaria incidence per person-years decreased in Walukuba (0.51 versus 0.31, P = 0.001) and increased in Kihihi (0.97 versus 1.93, P < 0.001) and Nagongera (2.33 versus 3.30, P < 0.001). Of 2,582 episodes of malaria, only 8 (0.3%) met criteria for severe disease. The prevalence of anemia was low and not associated with transmission intensity. In our cohorts, where LLINs and prompt effective treatment were provided, the risk of complicated malaria and anemia was extremely low. However, malaria incidence was high and increased over time at the two rural sites, suggesting improved community-wide coverage of LLIN and additional malaria control interventions are needed in Uganda.

Rotavirus Seasonal Distribution and Prevalence Before and After the Introduction of Rotavirus Vaccine in a Peri-Urban Community of Lima, Peru
Millie R. Chang, Grace Velapatiño, Miguel Campos, Elsa Chea-Woo, Nelly Baiocchi, Thomas G. Cleary and Theresa J. Ochoa*
Author Affiliations
Universidad Peruana Cayetano Heredia, Lima, Peru; Instituto de Medicina Tropical, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Mathematics, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Pediatrics, Universidad Peruana Cayetano Heredia, Lima, Peru; Center for Infectious Diseases, University of Texas School of Public Health, Houston, Texas
We evaluated the monthly distribution of rotavirus diarrhea in a cohort of children 12–24 months of age followed as part of a diarrhea clinical trial in a peri-urban community of Lima. We observed a peak of rotavirus diarrhea in the winter months and a decrease in rotavirus prevalence after the introduction of the rotavirus vaccine in Peru.