Águas, Ricardo, White, L. J., Snow, Robert W. and Gomes, M. Gabriela M. (2008) Prospects for malaria eradication in sub-Saharan Africa. PL o S One, Vol.3 (No.3). doi:10.1371/journal.pone.0001767

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Abstract

Background: A characteristic of Plasmodium falciparum infections is the gradual acquisition of clinical immunity resulting
from repeated exposures to the parasite. While the molecular basis of protection against clinical malaria remains
unresolved, its effects on epidemiological patterns are well recognized. Accumulating epidemiological data constitute a
valuable resource that must be intensively explored and interpreted as to effectively inform control planning.
Methodology/Principal Finding: Here we apply a mathematical model to clinical data from eight endemic regions in sub-
Saharan Africa. The model provides a quantitative framework within which differences in age distribution of clinical disease
are assessed in terms of the parameters underlying transmission. The shorter infectious periods estimated for clinical
infections induce a regime of bistability of endemic and malaria-free states in regions of mesoendemic transmission. The
two epidemiological states are separated by a threshold that provides a convenient measure for intervention design.
Scenarios of eradication and resurgence are simulated.
Conclusions/Significance: In regions that support mesoendemic transmission, intervention success depends critically on
reducing prevalence below a threshold which separates endemic and malaria-free regimes.

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine
Divisions:	Faculty of Science > Life Sciences (2010- ) > Biological Sciences ( -2010)
Library of Congress Subject Headings (LCSH):	Plasmodium falciparum, Malaria -- Immunological aspects, Malaria -- Africa, Sub-Saharan -- Mathematical models
Journal or Publication Title:	PL o S One
Publisher:	Public Library of Science
ISSN:	1932-6203
Official Date:	12 March 2008
Dates:	Date Event 12 March 2008 Published
Volume:	Vol.3
Number:	No.3
DOI:	10.1371/journal.pone.0001767
Status:	Peer Reviewed
Access rights to Published version:	Open Access
Funder:	Fundação para a Ciência e a Tecnologia (FCT), European Commission (EC), Wellcome Trust (London, England)
Grant number:	SFRH/BD/23900/2005 (FCT), MEXT-CT-2004-14338 (EC), 061584 (WT)

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