Seasonal Distribution and Trend Analysis of Urban Malaria Prevalence in a Malaria Clinic, South Delhi, India, between 2012 and 2019.

It is important to study the recent malaria incidence trends in urban areas resulting from rapid urbanization that can lead to changes in environmental conditions for malaria. This retrospective study assessed trends in malaria patients, their distribution according to parasite species, patient demographics, and weather data for the past 8 years at a malaria clinic in the National Institute of Malaria Research, New Delhi, India. We overlaid the effects of environmental factors such as rainfall, relative humidity, and temperature on malaria incidence. The malaria data were digitized for a period spanning 2012 to 2019, during which 36,892 patients with fever attended the clinic. Of these, 865 (2.3%) were diagnosed with malaria microscopically. Plasmodium vivax was predominant (96.2%), and very few patients were of Plasmodium falciparum (3.5%) or mixed infections (0.3%). The patients with malaria were within a 10-km radius of the clinic. Males (70.9%) were more commonly affected than females (29.1%). Of the total malaria patients, a majority (∼78%) belonged to the > 15-year age group. A total of 593 malaria patients (68.6%) received primaquine. These patients were most commonly diagnosed in April through October. Furthermore, there was a lag of 1 month between the rainfall peak and the malaria case peak. The peak in malaria cases corresponded to a mean temperature of 25 to 30°C and a relative humidity of 60% to 80%. This analysis will be useful for policymakers in evaluating current interventions and in accelerating malaria control further in urban areas of India.

Polymerase Chain Reaction-Based Malaria Diagnosis Can Be Increasingly Adopted during Current Phase of Malaria Elimination in India.

Despite commendable progress in the control of malaria in India and other countries, there are hidden reservoirs of parasites in human hosts that continually feed malaria transmission. Submicroscopic infections are known to be a significant proportion in low-endemic settings like India and these infections do possess transmission potential. Hence, these reservoirs of infection add to the existing roadblocks for malaria elimination. It is crucial that this submerged burden of malaria is detected and treated to curtail further transmission. The currently used diagnostic tools including the so-called "gold standard" of microscopy are incapable of detecting these submicroscopic infections and thus are suboptimal. It is an opportune time to usher in more sensitive molecular tools like polymerase chain reaction (PCR) for routine diagnosis at all levels of healthcare as an additional diagnostic tool in routine settings. Polymerase chain reaction assays have been developed into user-friendly formats for field diagnostics and are near point of care. In India, because of the COVID-19 pandemic, these are being used rampantly across the country. The facilities created for COVID-19 diagnosis can easily be co-opted and harnessed for malaria diagnosis to augment surveillance by the inclusion of molecular techniques like PCR in the routine national malaria control program.

Ivermectin as an endectocide may boost control of malaria vectors in India and contribute to elimination.

Malaria constitutes one of the largest public health burdens faced by humanity. Malaria control has to be an efficient balance between diagnosis, treatment and vector control strategies. The World Health Organization currently recommends indoor residual spraying and impregnated bed nets as two malaria vector control methods that have shown robust and persistent results against endophilic and anthropophilic mosquito species. The Indian government launched the National Framework for Malaria Elimination in 2016 with the aim to achieve the elimination of malaria in a phased and strategic manner and to sustain a nation-wide malaria-free status by 2030. India is currently in a crucial phase of malaria elimination and novel vector control strategies maybe helpful in dealing with various challenges, such as vector behavioural adaptations and increasing insecticide resistance among the Anopheles populations of India. Ivermectin can be one such new tool as it is the first endectocide to be approved in both animals and humans. Trials of ivermectin have been conducted in endemic areas of Africa with promising results. In this review, we assess available data on ivermectin as an endectocide and propose that this endectocide should be explored as a vector control tool for malaria in India.

Malaria Epidemiology Along the Indian Districts Bordering Bhutan and Implications for Malaria Elimination in the Region.

It is important for malaria-endemic countries to address malaria control across international borders, and in particular to prioritize appropriate rapid diagnosis, treatment and surveillance. Bhutan and India aim to achieve malaria elimination by 2023 and 2030 respectively. Malaria elimination along the Indo-Bhutan border is of common concern. We delineated malaria epidemiology along the border to provide a blueprint for focusing malaria control efforts in key foci within this region. Epidemiological data from 2015 to 2019 were analyzed, as the most drastic reductions in malaria burden across most parts of India were witnessed in this time frame. Several areas of concern include low surveillance in most border districts, favorable climatic conditions for perennial malaria transmission, and movement of potential parasite carriers because of the porous borders. India and Bhutan need to control the importation/exportation of malaria cases. We highlight the foci of concern for which implementing tailor-made malaria control strategies may benefit both countries.