Human and Vector Drivers of Transmission and Enhanced Surveillance for Early Outbreak Detection and Monitoring Progress Toward Elimination

ABSTRACT Malaria control and elimination are stymied by incompletely understood drivers of transmission by both the human reservoir and vector mosquitoes. Although the specifics of these drivers and the barriers they present are not uniform across transmission settings, there are common gaps in knowledge that, if filled, could lead to more effective control strategies and surveillance systems. The first of these fundamental gaps is the spatiotemporal risk of malaria transmission created by interaction of the anopheline vector and human host. We will address this at the household level by assessing when and where mosquito and human behaviors enable the interaction between parasites, vectors, and humans. The second gap is in understanding who is most at risk. Individuals differ not only in their risk behaviors but also by how attractive they are to mosquitoes. Lastly, where malaria transmission is low and nearing elimination, surveillance strategies based on detection of parasite-positive vectors or gametocytes in human hosts are not efficient for targeting hotspots. Different metrics and tools are needed to achieve and sustain malaria elimination. Serological surveillance of residual blood at rural health facilities coupled with a near real-time data visualization dashboard could guide malaria elimination interventions at fine spatial scales. 1