DURHAM, N.C. – A Duke University-led initiative to predict and prevent malaria outbreaks in the Amazon has received a $3.4 million grant from the National Institute of Allergy and Infectious Diseases (NIAID).

The grant will support the research team’s efforts to develop new and more reliable methods to forecast where and when a malaria outbreak will occur, weeks or even months in advance, and identify which intervention strategy will best control its spread.

Since 2010, Amazon-basin countries have experienced a 600% increase in malaria cases, the most rapid rise in confirmed cases in any region worldwide, yet international aid to fund malaria control programs there has plummeted.

A key part of the Duke-led, NIAID-funded research will be adapting a Malaria Early Warning System (MEWS) the research team has developed and successfully tested in Peru so that it can be used in the Brazilian and Ecuadorian Amazon, too.

The system uses statistical models to predict the probability of a malaria outbreak at sites across a region, based on analysis of satellite-generated data on local temperatures, precipitation, land use, human population density, extent of forest cover, and other factors that can promote disease transmission.

The system can also identify which intervention strategies will best control malaria’s spread under local conditions at the time of the outbreak.

 Duke students learn how to identify different species of mosquitos.
Duke students learn how to identify different species of mosquitos. Photo credit: William Pan, Duke University

In Peru, MEWS has demonstrated greater than 90% sensitivity and specificity in predicting outbreaks up to 12 weeks in advance across small regions, said William Pan, associate professor of global environmental health, who leads the initiative.

“That’s a huge improvement over conventional surveillance used for decision-making, which relies on confirmed-case data that can be four weeks old by the time it reaches public health agencies,” Pan said. “MEWS gives local officials time to respond proactively rather than reactively.”

In addition to supporting the team’s work to adapt MEWS for use in malaria-prone regions of Ecuador and Brazil, the NIAID grant will enable Pan and his colleagues to investigate how interactions between human communities clustered along many international borders in Amazonia contribute to large-scale patterns of malaria transmission.

Locals cross these borders regularly to buy and sell goods, seek medical care or other services, attend events, or visit friends and family on the other side, Pan explained. Their movements can help malaria spread across national jurisdictions and complicate efforts to track and control its transmission. The new research aims to identify which control strategies will work best in these trans-governmental social networks.

“Malaria remains a major problem in Latin America, yet it is the only region of the world where investments from global malaria donors are declining,” Pan said. “Given the relatively strong health infrastructure there compared to other malaria endemic regions of the world, we have a real opportunity to eliminate malaria from the western hemisphere and the MEWS system is one step towards that shared goal. Our vision is not just a technical fix, but a bottom-up approach that engages stakeholders from the community to national and international levels.”

Duke’s partners in the initiative are Johns Hopkins University; Universidad Peruana Cayetano-Heredia; Pontificia Universidad Católica del Perú; Universidad San Francisco de Quito; Universidad Federal Minas Gerais; the Oswaldo Cruz Foundation; Peru’s Ministry of Health; and Ecuador’s Ministry of Health.