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

Abstract

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. 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 malaria patients and febrile controls revealed spatial clustering of P. falciparum infections around malaria patients in strong association with An. stephensi presence 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. This study provides the strongest evidence to date for a role of An. stephensi in driving an urban malaria outbreak in Africa, highlighting the major public health threat this fast-spreading mosquito poses