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TARGETING MALARIA HOTSPOTS

Sunday, 10th of June 2012

• TARGETING MALARIA HOTSPOTS

Full text is at http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001165

• Heterogeneity is a common facet of infectious diseases, whereby infection and disease are concentrated in a small proportion of individuals.
• In malaria, heterogeneity is manifested as small groups of households, or hotspots, that are at a substantially increased risk of malaria transmission.
• These hotspots exist in all transmission settings but are less easily detected at high transmission intensity.
• Hotspots maintain transmission in low transmission seasons and fuel transmission in the high transmission seasons.
• Targeting hotspots is a highly efficient way to reduce malaria transmission at all levels of transmission intensity.

Malaria hotspots appear to maintain malaria transmission in low transmission seasons and are the driving force for transmission in the high transmission season. Targeting the hotspots would mean the most infected and most diseased households would be prioritized with the added benefits of reducing transmission to the whole community. Identifying the hotspots is possible by mapping asymptomatic carriers or using serological tools. Treating hotspots by ensuring high coverage of interventions for a few households is likely to be easier and much more efficient, and may allow for more complicated interventions than using untargeted approaches. The recent successes of scaling up interventions for impact on malaria have revealed the policy gap of what to do afterwards when coverage is good yet malaria transmission continues. In this paper we have argued that the next evidence-based step is to tackle malaria hotspots. Although knowledge gaps exist, we argue that hotspot-targeted interventions should take place at all transmission levels where resources are sufficient and rapid reductions in malaria transmission will be seen.