The potential impact of integrated malaria transmission control on entomologic inoculation rate in highly endemic areas

We have used a relatively simple but accurate model for predicting the impa ct of integrated transmission control on the malaria entomologic inoculatio n rate (EIR) at four endemic sites from across sub-Saharan Africa and the s outhwest Pacific. The simulated campaign incorporated modestly effective va ccine coverage, bed net use, and larval control. The results indicate that such campaigns would reduce EIRs at all four sites by 30- to 50-fold. Even without the vaccine, 15- to 25-fold reductions of EIR were predicted, imply ing that integrated control with a few modestly effective tools can meaning fully reduce malaria transmission in a range of endemic settings. The model accurately predicts the effects of bed nets and indoor spraying and demons trates that they are the most effective tools available for reducing EIR. H owever, the impact of domestic adult vector control is amplified by measure s for reducing the rate of emergence of vectors or the level of infectiousn ess of the human reservoir. We conclude that available tools, including cur rently neglected methods for larval control, can reduce malaria transmissio n intensity enough to alleviate mortality. Integrated control programs shou ld be implemented to the fullest extent possible, even in areas of intense transmission, using simple models as decision-making tools. However, we als o conclude that to eliminate malaria in many areas of intense transmission is beyond the scope of methods which developing nations can currently affor d. New, cost-effective, practical tools are needed if malaria is ever to be eliminated from highly endemic areas.