Evidence for a role of Anopheles stephensi in the spread of drug and diagnosis-resistant malaria in Africa

Emiru, Tadele and Getachew, Dejene and Murphy, Maxwell and Sedda, Luigi and Ejigu, Legesse Alamerie and Bulto, Mikiyas Gebremichael and Byrne, Isabel and Demisse, Mulugeta and Abdo, Melat and Chali, Wakweya and Elliott, Aaron and Vickers, Eric Neubauer and Aranda-Díaz, Andrés and Alemayehu, Lina and Behaksera, Sinknesh W. and Jebessa, Gutema and Dinka, Hunduma and Tsegaye, Tizita and Teka, Hiwot and Chibsa, Sheleme and Mumba, Peter and Girma, Samuel and Hwang, Jimee and Yoshimizu, Melissa and Sutcliffe, Alice and Taffese, Hiwot Solomon and Bayissa, Gudissa Aseffa and Zohdy, Sarah and Tongren, Jon Eric and Drakeley, Chris and Greenhouse, Bryan and Bousema, Teun and Tadesse, Fitsum G. (2023) Evidence for a role of Anopheles stephensi in the spread of drug and diagnosis-resistant malaria in Africa. Nature Medicine. ISSN 1078-8956

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Abstract

Anopheles stephensi, an Asian malaria vector, continues to expand across Africa. The vector is now firmly established in urban settings in the Horn of Africa. Its presence in areas where malaria resurged suggested a possible role in causing malaria outbreaks. Using a prospective case control design, we investigated the role of An. stephensi in transmission following a malaria outbreak in Dire Dawa, Ethiopia in April-July 2022. Screening contacts of malaria patients and febrile controls revealed spatial clustering of P. falciparum infections around malaria patients in strong association with An. stephensi presence in the household vicinity. Plasmodium sporozoites were detected in these mosquitoes. This outbreak involved clonal propagation of parasites with molecular signatures of artemisinin and diagnostic resistance. This study provides the strongest evidence to date for a role of An. stephensi in driving an urban malaria outbreak in Africa, highlighting the major public health threat this fast-spreading mosquito poses.