Transmission dynamics of residual and reemerging malaria in the Amazon: Defining a roadmap to malaria elimination

Over the past decade, malaria transmission has declined dramatically across most of the Amazon Basin. Malaria elimination in the Amazon remains an important priority for Ministries of Health. Our long-term goal is to provide scientific evidence that can be translated into effective public health interventions for malaria control and elimination in the Amazon. More immediately we seek to understand the basis for two contrasting malaria epidemiological situations in Amazon: residual malaria with continuing hypoendemicity and hotspots of transmission. Our short-term goal is to test the hypothesis that asymptomatic parasite carriage and human mobility across areas with different levels of endemicity are major contributors to residual malaria transmission in selected Amazonian settings. Our specific aims are:1. Longitudinally determine malaria dynamics and geographic micro-heterogeneity in contrasting settings of malaria transmission in Brazil and Peru.2. Prospectively identify genome-level population changes in P. vivax and P. falciparum to detect reintroductions, and to estimate parasite population complexity at baseline and potentially after interventions.3. Use mathematical models to describe changing dynamics of malaria incidence and parasitemia prevalence over time, and to assess potential effects of combinations of interventions on malaria control and elimination.