Serological evidence of vector and parasite exposure in Southern Ghana: the dynamics of malaria transmission intensity.

BACKGROUND: Seroepidemiology provides robust estimates for tracking malaria transmission when intensity is low and useful when there is no baseline entomological data. Serological evidence of exposure to malaria vectors and parasite contribute to our understanding of the risk of pathogen transmission, and facilitates implementation of targeted interventions. Ab to Anopheles gambiae salivary peptide (gSG6-P1) and merozoite surface protein one (MSP-1(19)) reflect human exposure to malaria vectors and parasites. This study estimated malaria transmission dynamics using serological evidence of vector and parasite exposure in southern Ghana. METHODS: Total IgG responses to both antigens in an age stratified cohort (14) were measured from South-eastern Ghana. 295 randomly selected sera were analyzed from archived samples belonging to a cohort study that were followed at 3 consecutive survey months (n = 885); February, May and August 2009. Temporal variations in seroprevalence of both antigens as well as differences between the age-stratified cohorts were determined by χ (2) test with p < 0.05 statistically significant. Non-parametric repeated ANOVA - Friedman's test was used to test differences in antibody levels. Seroprevalence data were fitted to reversible catalytic model to estimate sero-conversion rates. RESULTS: Whereas parasite prevalence was generally low 2.4%, 2.7% and 2.4% with no apparent trends with season, seroprevalence to both gSG6-P1 and MSP1(19) were high (59%, 50.9%, 52.2%) and 57.6%, 52.3% and 43.6% in respective order from Feb. to August. Repeated measures ANOVA showed differences in median antibody levels across surveys with specific significant differences between February and May but not August by post hoc Dunn's multiple comparison tests for gSG6-P1. For MSP1(19), no differences were observed in antibody levels between February and May but a significant decline was observed from May to August. Seroconversion rates for gSG6-P1 increased by 1.5 folds from February to August and 3 folds for MSP1(19). CONCLUSION: Data suggests exposure to infectious bites may be declining whereas mosquito bites remains high. Sustained malaria control efforts and surveillance are needed to drive malaria further down and to prevent catastrophic rebound. Operational factors for scaling up have been discussed

Indoor residual spraying with a non-pyrethroid insecticide reduces the reservoir of <i>Plasmodium falciparum</i> in a high-transmission area in northern Ghana

High-malaria burden countries in sub-Saharan Africa are shifting from malaria control towards elimination. Hence, there is need to gain a contemporary understanding of how indoor residual spraying (IRS) with non-pyrethroid insecticides when combined with long-lasting insecticidal nets (LLINs) impregnated with pyrethroid insecticides, contribute to the efforts of National Malaria Control Programmes to interrupt transmission and reduce the reservoir of Plasmodium falciparum infections across all ages. Using an interrupted time-series study design, four age-stratified malariometric surveys, each of ~2,000 participants, were undertaken pre- and post-IRS in Bongo District, Ghana. Following the application of three-rounds of IRS, P. falciparum transmission intensity declined, as measured by a >90% reduction in the monthly entomological inoculation rate. This decline was accompanied by reductions in parasitological parameters, with participants of all ages being significantly less likely to harbor P. falciparum infections at the end of the wet season post-IRS (aOR = 0.22 [95% CI: 0.19–0.26], p-value < 0.001). In addition, multiplicity of infection (MOIvar) was measured using a parasite fingerprinting tool, designed to capture within-host genome diversity. At the end of the wet season post-IRS, the prevalence of multi-genome infections declined from 75.6% to 54.1%. This study demonstrates that in areas characterized by high seasonal malaria transmission, IRS in combination with LLINs can significantly reduce the reservoir of P. falciparum infection. Nonetheless despite this success, 41.6% of the population, especially older children and adolescents, still harboured multi-genome infections. Given the persistence of this diverse reservoir across all ages, these data highlight the importance of sustaining vector control in combination with targeted chemotherapy to move high-transmission settings towards pre-elimination. This study also points to the benefits of molecular surveillance to ensure that incremental achievements are not lost and that the goals advocated for in the WHO’s High Burden to High Impact strategy are realized

<it>Mansonia africana</it> and <it>Mansonia uniformis</it> are Vectors in the transmission of <it>Wuchereria bancrofti</it> lymphatic filariasis in Ghana

<p>Abstract</p> <p>Background</p> <p>Recent data from Ghana indicates that after seven rounds of annual mass drug administration (MDA) there is still sustained transmission albeit at low levels in certain areas where <it>Anopheles melas</it>, <it>An. gambiae</it> s.s., <it>Mansonia</it> and <it>Culex</it> species are the main biting mosquitoes. <it>Anopheles gambiae</it> s.l. and <it>An. funestus</it> are the known vectors in Ghana and a recent report indicated that <it>An. melas</it> could transmit at low level microfilaraemia. However, because <it>An. melas</it> is not found everywhere there was the need to determine whether any of the other culicine species could also be playing a role in the transmission of LF.</p> <p>Methods</p> <p>Indoor mosquitoes collected once a month for three months using pyrethrum spray catches in six communities within the Kommenda-Edina-Eguafo-Abirem (KEEA) District, Central Region of Ghana were morphologically identified, dissected and examined for the presence of <it>W. bancrofti</it>. Additionally, stored mosquito samples collected during previous years in 8 communities from the Gomoa District also in the Central Region were similarly processed. The identities of all <it>W. bancrofti</it> parasites found were confirmed using an established PCR method.</p> <p>Results</p> <p>A total of 825 indoor resting mosquitoes comprising of 501 <it>Anopheles</it> species, 239 <it>Mansonia</it> species, 84 <it>Culex</it> species and 1 <it>Aedes</it> species were dissected and examined for the presence of <it>W. bancrofti</it>. <it>Mansonia africana</it> had infection and infectivity rates of 2.5<it>%</it>. and 2.1% respectively. <it>Anopheles gambiae</it> s.l. had an infection rate of 0.4% and a similar infectivity rate. None of the <it>Culex</it> sp. and <it>Aedes</it> sp were found with infection. From the stored mosquitoes the infection and infectivity rates for <it>M. africana</it> were 7.6% (N = 144) and 2.8% respectively whilst the corresponding rates for <it>M. uniformis</it> were 2.9% (N = 244) and 0.8%.</p> <p>Conclusions</p> <p>This is the first report of <it>Mansonia</it> species as vectors of lymphatic filariasis (LF) in Ghana and in West Africa since that of 1958 in Guinea. The revelation of a hitherto unrecognised vector which is possibly more efficient in transmission than the recognised ones has a profound implication for elimination of lymphatic filariasis programmes in the sub-region.</p

Transmission indices and microfilariae prevalence in human population prior to mass drug administration with ivermectin and albendazole in the Gomoa District of Ghana

Abstract Background The Lymphatic Filariasis Elimination Programme in Ghana involves annual mass drug administration (MDA) of ivermectin and albendazole to persons living in endemic areas. This is repeated annually for 4–6 years to span across the reproductive lifespan of adult worms. In order to stimulate participation of community members in the MDA programme, this study was carried out to understand local views on transmission, management and prevention of the disease. The study also presents baseline transmission indices and microfilariae prevalence in the human population in eight endemic communities of coastal Ghana prior to the MDA. Methods A descriptive survey was carried out to explore perceptions on causes, treatment and prevention of lymphatic filariasis. Perceptions on community participation in disease control programmes were also assessed. After participants were selected by cluster sampling and 100 μl of blood sampled from each individual and examined for mf microfilariae. A similar volume of blood was used to determine the presence of circulating filarial antigen. Mosquitoes were collected simultaneously at all sites by human landing catches for 4 days per month over a six-month period. All Anopheles mosquitoes were dissected and examined for the larval stages of the parasite following which molecular identification of both vector and parasite was done. Results Eight hundred and four persons were interviewed, of which 284 (32.9 %; CI 31.1–34.5) acknowledged elephantiasis and hydrocoele as health related issues in the communities. Thirty-three people (3.8 %; CI 2.1–5.5) thought sleeping under bed net could help prevent elephantiasis. Microfilariae prevalence was 4.6 % (43/941) whiles 8.7 % (75/861) were positive for circulating filarial antigen. A total of 17,784 mosquitoes were collected, majority (55.8 %) of which were Anopheles followed by Culex species (40 %). Monthly biting rates ranged between 311 and 6116 bites/person for all the eight communities together. Annual transmission potential values for An. gambiae s.s. and An. funestus were 311.35 and 153.50 respectively. Conclusion Even though the highest mf density among inhabitants was recorded in a community that had the lowest Anopheles density with Culex species constituting 95 % of all mosquitoes collected, Anopheles gambiae s.s. and An. funestus remained the main vectors