Infectivity of Chronic Malaria Infections and Its Consequences for Control and Elimination.

Assessing the importance of targeting the chronic Plasmodium falciparum malaria reservoir is pivotal as the world moves toward malaria eradication. Through the lens of a mathematical model, we show how, for a given malaria prevalence, the relative infectivity of chronic individuals determines what intervention tools are predicted be the most effective. Crucially, in a large part of the parameter space where elimination is theoretically possible, it can be achieved solely through improved case management. However, there are a significant number of settings where malaria elimination requires not only good vector control but also a mass drug administration campaign. Quantifying the relative infectiousness of chronic malaria across a range of epidemiological settings would provide essential information for the design of effective malaria elimination strategies. Given the difficulties obtaining this information, we also provide a set of epidemiological metrics that can be used to guide policy in the absence of such data.