title: Characterization of the infectious reservoir of malaria with an agent-based model calibrated to age-stratified parasite densities and infectiousness.
abstract: BACKGROUND
  Elimination of malaria can only be achieved through removal of all vectors or complete depletion of the infectious reservoir in humans. Mechanistic models can be built to synthesize diverse observations from the field collected under a variety of conditions and subsequently used to query the infectious reservoir in great detail.
  
  
  METHODS
  The EMOD model of malaria transmission was calibrated to prevalence, incidence, asexual parasite density, gametocyte density, infection duration, and infectiousness data from nine study sites. The infectious reservoir was characterized by age and parasite detectability with diagnostics of varying sensitivity over a range of transmission intensities with and without case management and vector control. Mass screen-and-treat drug campaigns were tested for likelihood of achieving elimination.
  
  
  RESULTS
  The composition of the infectious reservoir is similar over a range of transmission intensities, and higher intensity settings are biased towards infections in children. Recent ramp-ups in case management and use of insecticide-treated bed nets (ITNs) reduce the infectious reservoir and shift the composition towards sub-microscopic infections. Mass campaigns with anti-malarial drugs are highly effective at interrupting transmission if deployed shortly after ITN campaigns.
  
  
  CONCLUSIONS
  Low-density infections comprise a substantial portion of the infectious reservoir. Proper timing of vector control, seasonal variation in transmission intensity and mass drug campaigns allows lingering population immunity to help drive a region towards elimination.
authors.affiliation: Institute for Disease Modeling, Intellectual Ventures, 1555 132nd Ave NE, Bellevue, WA, 98005, USA. jgerardin@intven.com.
authors.forename: Jaline
authors.initials: J
authors.lastname: Gerardin
authors.affiliation: Institute for Disease Modeling, Intellectual Ventures, 1555 132nd Ave NE, Bellevue, WA, 98005, USA. aouedraogo@intven.com.|Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso. aouedraogo@intven.com.
authors.forename: André Lin
authors.initials: AL
authors.lastname: Ouédraogo
authors.affiliation: Institute for Disease Modeling, Intellectual Ventures, 1555 132nd Ave NE, Bellevue, WA, 98005, USA. kmccarthy@intven.com.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: McCarthy
authors.affiliation: Institute for Disease Modeling, Intellectual Ventures, 1555 132nd Ave NE, Bellevue, WA, 98005, USA. peckhoff@intven.com.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Eckhoff
authors.affiliation: Institute for Disease Modeling, Intellectual Ventures, 1555 132nd Ave NE, Bellevue, WA, 98005, USA. ewenger@intven.com.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Wenger
mesh_terms: D000293:Adolescent; D000328:Adult; D000354:Africa, Western; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D009033:Culicidae / Q000469:parasitology; D004197:Disease Reservoirs / Q000469:parasitology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D057148:Insecticide-Treated Bednets; D016778:Malaria, Falciparum / Q000453:epidemiology / Q000469:parasitology / Q000517:prevention & control* / Q000635:transmission*; D008403:Mass Screening; D008875:Middle Aged; D008954:Models, Biological; D010963:Plasmodium falciparum / Q000502:physiology; D015995:Prevalence; D013636:Tanzania
chemical_list: D000962:Antimalarials