Converging Human and Malaria Vector Diagnostics with Data Management towards an Integrated Holistic One Health Approach

Abstract

Monitoring malaria prevalence in humans, as well as vector populations, for the presence of Plasmodium, is an integral component of effective malaria control, and eventually, elimination. In the field of human diagnostics, a major challenge is the ability to define, precisely, the causative agent of fever, thereby differentiating among several candidate (also non-malaria) febrile diseases. This requires genetic-based pathogen identification and multiplexed analysis, which, in combination, are hardly provided by the current gold standard diagnostic tools. In the field of vectors, an essential component of control programs is the detection of Plasmodium species within its mosquito vectors, particularly in the salivary glands, where the infective sporozoites reside. In addition, the identification of species composition and insecticide resistance alleles within vector populations is a primary task in routine monitoring activities, aiming to support control efforts. In this context, the use of converging diagnostics is highly desirable for providing comprehensive information, including differential fever diagnosis in humans, and mosquito species composition, infection status, and resistance to insecticides of vectors. Nevertheless, the two fields of human diagnostics and vector control are rarely combined, both at the diagnostic and at the data management end, resulting in fragmented data and mis- or non-communication between various stakeholders. To this direction, molecular technologies, their integration in automated platforms, and the co-assessment of data from multiple diagnostic sources through information and communication technologies are possible pathways towards a unified human vector approach.

Keywords: One Health; diagnostics (Dx); epidemics; information and communication technologies (ICT); insecticide resistance; malaria; vector-borne diseases.

Figure 1

Molecular assays could represent a converging factor between human and vector diagnostics (common methodology for pathogen detection) and within vector diagnostics (common methodology for pathogen detection, vector species identification, insecticide resistance determination). “MS-MS” stands for tandem mass spectrometry. Source: K. Mavridis, FORTH.

Figure 2

The “triangle” assays–cartridge–instrument lies in the heart of automated point-of-need platforms (here point-of-“need” is used as a more general term to include the mosquito diagnostics instead of point-of-“care” that is typically used for human diagnostics). This structure is common for any platform-oriented approach, and the concept of unified human and mosquito diagnostics can build upon this configuration. Source: K. Mitsakakis, Hahn-Schickard.

Figure 3

Aspects of information and communication technologies (ICT) related to the fields of human diagnostics and vector control. Source: K. Mitsakakis, Hahn-Schickard.

Figure 4

Schematic representation of the interconnection between human and vector diagnostics through the three pathways described in this review (topics within the dashed line). Further related topics of direct relevance, such as treatment (related to vaccines, medicines) and vector control (related to insecticides) are also indicated (outside the dashed line) as components towards the complete One Health approach. Source: K. Mitsakakis, Hahn-Schickard and J. Vontas, FORTH.