A micro-epidemiological analysis of febrile malaria in Coastal Kenya showing hotspots within hotspots.
Malaria transmission is spatially heterogeneous. This reduces the efficacy of control strategies, but focusing control strategies on clusters or 'hotspots' of transmission may be highly effective. Among 1500 homesteads in coastal Kenya we calculated (a) the fraction of febrile children with positive malaria smears per homestead, and (b) the mean age of children with malaria per homestead. These two measures were inversely correlated, indicating that children in homesteads at higher transmission acquire immunity more rapidly. This inverse correlation increased gradually with increasing spatial scale of analysis, and hotspots of febrile malaria were identified at every scale. We found hotspots within hotspots, down to the level of an individual homestead. Febrile malaria hotspots were temporally unstable, but 4 km radius hotspots could be targeted for 1 month following 1 month periods of surveillance.DOI: http://dx.doi.org/10.7554/eLife.02130.001.
KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, United Kingdom pbejon@kemri-wellcome.org.
Philip
P
Bejon
KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya Imperial College London, London, United Kingdom.
Thomas N
TN
Williams
KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
Christopher
C
Nyundo
Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom.
Simon I
SI
Hay
Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom.
David
D
Benz
Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom.
Peter W
PW
Gething
KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
Mark
M
Otiende
KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
Judy
J
Peshu
KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
Mahfudh
M
Bashraheil
Department of Medicine, University of California, San Francisco, San Francisco, United States.
Bryan
B
Greenhouse
Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands London School of Hygiene and Tropical Medicine, London, United Kingdom.
Teun
T
Bousema
KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
Evasius
E
Bauni
KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, United Kingdom.
Kevin
K
Marsh
John Hopkins Malaria Research Institute, Baltimore, United States.
David L
DL
Smith
KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya Institute for Tropical Medicine, University of Tübingen, Germany German Centre for Infection Research, Tübingen, Germany.
Steffen
S
Borrmann
D002648:Child; D005334:Fever / Q000150:complications*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000150:complications / Q000453:epidemiology* / Q000276:immunology; D012307:Risk Factors
falciparum; hotspot; malaria control; spatial epidemiology