Insecticide susceptibility status of malaria vectors in Himachal Pradesh, India

Background & objectives: The state of Himachal Pradesh is one of the hilly forested states of India. Warming of climate has been evidenced in the state due to the ongoing climate change which may cause the upsurge/introduction of mosquito-borne diseases. To curb disease transmission, an effective vector control strategy will be required. Methods: Insecticide susceptibility status of available malaria vectors was determined using the standard WHO method in six districts Kangra, Una, Mandi, Bilaspur, Solan and Mandi of the state. An. culicifacies and An. fluviatilis were tested against DDT (4%), malathion (5%) and deltamethrin (0.05%) using WHO insecticide susceptibility kits. Results: Overall, An. culicifacies was found resistant to DDT in all the six districts, susceptible to malathion in all districts except Bilaspur and Solan where it showed possible resistance. It was susceptible to deltamethrin in all the study districts. An. fluviatilis was resistant to DDT and susceptible to malathion and deltamethrin in Kangra and Una districts. Interpretation & conclusion: At present, indoor residual spraying (IRS) is not being undertaken in Himachal Pradesh. However, with the information generated through the present study, the state government can plan evidence-based IRS at least for focal spray in limited foci reporting malaria incidence.

Validation of micro-chip based PCR assays for diagnosis of both Plasmodium falciparum and Plasmodium vivax

Background & objectives: Microscopy is considered as the gold standard for malaria diagnosis, however sub-microscopic infections can only be detected by Polymerase chain reaction, which demands high cost and elaborate laboratory setup. The Micro-chip PCR based Truenat Malaria Pv-Pf and Pf assay is a portable solution for detection of sub-microscopic/asymptomatic cases of malaria in the field, three lots of which were evaluated for P. falciparum and P. vivax malaria. Methods: Three lots of Truenat® Malaria Pv-Pf and Pf assay (kits) were assessed using blood samples of P. vivax and P. falciparum as well as malaria negative blood samples. DNA was extracted from the blood samples using the Trueprep Auto v2 Universal Cartridge based sample prep device and real time qPCR was performed using Truelab DUO micro PCR Analyzer with three lots of Truenat® Malaria Pv-Pf and Pf Assays. Mean, Standard deviation and one-way analysis of variance (ANOVA) was used to assess the significance of inter-lot variability in Cycle threshold values. Results: The Truenat® Malaria Pv-Pf and Pf assays identified the malaria parasites with 100% accuracy. Based on the test for variance (ANOVA) the inter-lot variability in cycle threshold values were not significant, indicating a high degree of precision. Interpretation & conclusion: Based on high accuracy and precision between different lots, the Truenat® Malaria Pv-Pf and Pf assays were found to be suitable for the diagnosis of sub-microscopic infections in field conditions to provide support in elimination of malaria.

Laboratory evaluation of the efficacy of boric acid containing toxic sugar baits against Anopheles culicifacies, An. stephensi and Aedes aegypti mosquitoes

Background & objectives: Attractive toxic sugar baits (ATSB) is a novel tool which employs mosquito sugar feeding behaviour to kill them. The potential of ATSB against mosquito vectors has been demonstrated in limited scope around the world including Israel, some of the African countries and USA. But their efficacy against mosquito vectors of India is yet to be ascertained. Therefore, current study was planned to evaluate the efficacy of TSB (without attractant) against two important malaria vectors Anopheles culicifacies and An. stephensi along with major dengue vector Aedes aegypti. Methods: TSB solution was prepared by dissolving different concentrations of boric acid in glucose and tested against each of the mosquito species. Another experiment was done by spraying this boric acid sugar solution on to Calendula officinalis plant. It served as a sole source of mosquito feed and mortality of mosquitoes was counted after 24 hours. Results: The TSB resulted in 100% mortality of Ae. aegypti and An. stephensi at 4% concentration of boric acid while in An. culicifacies 100% mortality was achieved at 3% concentration TSB solution. TSB solution with 2% boric acid, resulted in 99.1% mortality in An. culicifacies while ~95 % mortality of An. stephensi and Ae. aegypti. When TSB solution with 2% boric acid was sprayed on plant, ~89-94% mortality was observed in both An. stephensi and An. culicifacies. Interpretation & conclusion: Based on the results, boric acid based toxic sugar bait solution could be a promising tool for vector control. Further studies are needed to find out its toxicity of TSB against non-target organisms and residual efficacy in field trials in different ecotypes.

Intricacies of using temperature of different niches for assessing impact on malaria transmission.

Background & objectives: The influence of temperature on the life cycle of mosquitoes as well as on development of malaria parasite in mosquitoes is well studied. Most of the studies use outdoor temperature for understanding the transmission dynamics and providing projections of malaria. As the mosquitoes breed in water and rest usually indoors, it is logical to relate the transmission dynamics with temperature of micro-niche. The present study was, therefore, undertaken to understand the influence of different formats of temperature of different micro-niches on transmission of malaria for providing more realistic projections. Methods: The study was conducted in one village each of Assam and Uttarakhand States of India. Temperatures recorded from outdoor (air) as well as indoor habitats (resting place of mosquito) were averaged into daily, fortnightly and monthly and were used for determination of transmission windows (TWs) for Plasmodium vivax (Pv) and P. falciparum (Pf) based on minimum temperature threshold required for transmission. Results: The daily temperature was found more useful for calculation of sporogony than fortnightly and monthly temperatures. Monthly TWs were further refined using fortnightly temperature, keeping in view the completion of more than one life cycle of malaria vectors and sporogony of malaria parasite in a month. A linear regression equation was generated to find out the relationship between outdoor and indoor temperatures and R2 to predict the percentage of variation in indoor temperature as a function of outdoor temperature at both localities. Interpretation & conclusions: The study revealed that the indoor temperature was more than outdoors in stable malarious area (Assam) but fluctuating in low endemic area like Uttarakhand. Transmission windows of malaria should be determined by transforming outdoor data to indoor and preferably at fortnightly interval. With daily recorded temperature, sporogonic and gonotrophic cycles can also be calculated which is otherwise not possible with monthly data. The study highlights that the projections made for malaria in view of climate change need to be seen with limitation of difference in outdoor and indoor temperatures at different locations, highlighting the need for local data generation at least at sub-district level.

Climate change and human health: Indian context.

The article reviews the issue of climate change and health in the Indian context. The importance of climate change leading to estimated loss of above 2.5 million DALYs in southeast Asia, mortality due to heat waves, and the importance of air quality related respiratory diseases, disasters due to excessive floods, malnutrition due to reduction in rice, maize and sorghum crops etc. Latest work undertaken in India, vis-a-vis current scenario and need for further work has been discussed. There is felt need of further studies on assessing the impact on dengue and chikungunya as the transmission dynamics of these diseases involve water availability, storage and life style, etc. Uncertainties and knowledge gaps identified in the studies undertaken so far have also been highlighted. As regards to vector borne diseases, there is a need to concentrate in the areas which are presently free from malaria and with use of best available tools of interventions in already disease endemic areas like northeastern states, the risk of climate change impacts can be minimized.