Diverse Malaria Presentations across National Institutes of Health South Asia International Center for Excellence in Malaria Research Sites in India

Abstract

The Malaria Evolution in South Asia (MESA) International Center for Excellence in Malaria Research (ICEMR) was established by the US National Institutes of Health (US NIH) as one of 10 malaria research centers in endemic countries. In 10 years of hospital-based and field-based work in India, the MESA-ICEMR has documented the changing epidemiology and transmission of malaria in four different parts of India. Malaria Evolution in South Asia-ICEMR activities, in collaboration with Indian partners, are carried out in the broad thematic areas of malaria case surveillance, vector biology and transmission, antimalarial resistance, pathogenesis, and host response. The program integrates insights from surveillance and field studies with novel basic science studies. This is a two-pronged approach determining the biology behind the disease patterns seen in the field, and generating new relevant biological questions about malaria to be tested in the field. Malaria Evolution in South Asia-ICEMR activities inform local and international stakeholders on the current status of malaria transmission in select parts of South Asia including updates on regional vectors of transmission of local parasites. The community surveys and new laboratory tools help monitor ongoing efforts to control and eliminate malaria in key regions of South Asia including the state of evolving antimalarial resistance in different parts of India, new host biomarkers of recent infection, and molecular markers of pathogenesis from uncomplicated and severe malaria.

Figure 1.

(A) Malaria Evolution in South Asia (MESA) International Center for Excellence in Malaria Research (ICEMR) sites in India. Location of the four sites at 1) Goa Medical College (GMC), North Goa district, Goa state, 2) Jawaharlal Nehru Medical College and Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha district, Maharashtra state, 3) Shalini Memorial Hospitals, Krishi Gram Vikas Kendra (KGVK), Ranchi district, Jharkhand state, and 4) Assam Medical College and Regional Medical Research Center—Northeast (RMRC-NE), Dibrugarh district, Assam state. The study states are marked in gray and the study districts are marked in dark gray. (B) Plasmodium falciparum:P. vivax ratio in states where the study sites are located. Cases include both uncomplicated and complicated malaria. (C) Categorization of Indian states on the Annual Parasite Index (API) based transmission continuum according to malaria transmission data reported by National Vector Borne Disease Control Program (NVBDCP) (now called National Center for Vector Borne Disease Control NCVBDC). Category 1 contains states with API less than one and all the districts in the state are with API less than one. Category 2 contains states having API less than one and one or more districts reporting API more than one. Category 3 contains states with API more than one. MESA site Goa is in Category 1, Assam and Maharashtra are Category 2 states while Jharkhand is a Category 3 state. GA = Goa; AS = Assam; MH = Maharashtra; JH = Jharkhand. Other state names also follow the two-letter code (alpha-2) according to the ISO 3166-1 standard (https://www.iso.org/obp/ui/#iso:code:3166:IN). * Till October 2021.

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The multidisciplinary integrated research of MESA-ICEMR is capable of delivering on the research and development challenges identified by the WHO in achieving GTS 2016–2030 goals. The MESA-ICEMR basic sciences research with clinical samples can lead to improvement of current malaria health products or lead to the development of novel products in these categories.