Building boom boosts malaria-carrying, invasive mosquito in Ethiopia

Malaria annually kills around 620,000 people globally, mostly in Africa, according to the World Health Organization.

Stephensi, long a major vector of malaria in Asia, was first identified in Africa in the port city of Djibouti in 2012. It has since been detected in Ethiopia, Somalia, Kenya, Nigeria and Ghana. The insect has already sparked several urban outbreaks of malaria in Africa, including in Dire Dawa, Ethiopia’s second-largest city.

The invader brings a challenging new twist to malaria-eradication efforts on the continent, where malaria is overwhelmingly a rural disease, spread by other species of mosquitos that are adapted to live in rural areas. African public health officials have made great strides controlling the disease, using methods targeting the unique behaviors of these rural mosquitos and the lifestyles of people in the countryside.

Stephensi, however, is a game changer. This species of mosquito can live in rural environments but also thrives in urban areas. It’s resistant to insecticides and adept at surviving dry seasons. Its arrival in Africa poses a serious potential threat to millions of city dwellers who have little or no immunity from repeated prior exposure to malaria.

“Different methods of surveillance and control than those used in the countryside will be needed to combat malaria spread by Anopheles stephensi,” Vazquez-Prokopec says.

Indoor spraying and the use of bed nets impregnated with insecticide, for instance, are malaria interventions in rural areas. That’s because night is the peak biting time for the two mosquito species that are currently the primary malaria vectors in Africa.

Stephenesi, however, tends to bite outside and at dusk before people have gone to bed.

For more than 15 years, Vazquez-Prokopec has traced outbreaks of viral diseases spread by another urban mosquito, Aedes aegypti, including dengue fever, Zika and chikungunya. His research in South America and Mexico considers the interactions of mosquitos, pathogens and people.  

The goal is to zero in on the most effective ways for cash-strapped public health officials to control outbreaks of these mosquito-borne diseases in sprawling, densely packed cities where many people live in substandard housing.

Dengue fever alone sickens nearly 100 million people a year globally, although its annual death toll of around 40,000 people is far less than that of malaria.

After identifying the man-made construction pits as the primary habitats for the stephensi larvae, the researchers entered their GPS coordinates into Google Earth to visualize their locations. It became apparent that the sites provided a unique spectral signature —  demarcated by size, color contrast and the presence of water — that allowed the researchers to easily identify other construction pits throughout Jigjiga.

Historical data archived by Google Earth gave the researchers a view into how the pattern of the construction sites evolved in relation to the rapid development of the city since 2016. Google Earth maps also reveal the gradient of population density as the semirural outskirts gradually become absorbed by urban development.

“It may be possible to use Google Earth like a time machine as one tool to understand the dynamics of how stephensi exploits human habitats to survive and to expand its range,” Vazquez-Prokopec says.

Funded by a $270,000 grant from the CDC, Vazquez-Prokopec and his colleagues are now expanding their research into stephensi in Jigjiga along with several other Ethiopian cities.

They will use satellite data to explore urban-rural gradients across these cities, from the fully developed centers to the outskirts where there is less development but a greater presence of domesticated animals such as cattle and sheep.

“We want to understand how different habitats across this developmental gradient influence the presence of stephensi,” Vazquez-Prokopec says. “We want to answer questions such as whether the mosquitos are reproducing faster in one area or another and the factors that may be influencing these differences.”

Better understanding the behaviors of the mosquitos within different ecologies will allow the researchers to develop a suite of tools to control stephensi.

“The goal is to provide tools and guidance that enables public health officials to control these mosquitos as effectively as possible, so that their limited resources are not wasted,” Vazquez-Prokopec says. “Detecting patterns can enable public health workers to predict where hotspots may occur. That gives them an opportunity to prevent, or at least mitigate, an outbreak.”

The dengue-virus-carrying Aedes aegypti mosquito is also present in African cities, Vazquez-Prokopec notes, along with other species of the insect that have adapted to urban environments.

Working to control urban malaria outbreaks spread by stephensi may simultaneously help to control some other urban mosquito-borne diseases, although each disease and mosquito species presents unique challenges.

Aedes aegypti, for instance, only bites humans and lives almost exclusively in urban areas. Stephensi, however, also bites cattle and other animals and can get established in rural environments.

“Whenever possible, we will look for opportunities to synergize control methods across species of mosquitos,” Vazquez-Prokopec says.

Djibouti, the first place in Africa that stephensi was identified, had made such gains in controlling malaria that it appeared the disease might be eliminated in the country. Since the arrival of stephensi, however, malaria exploded in Djibouti, rising from just 27 cases in 2012 to 70,000 cases in 2020, mostly in Djibouti City.

It is not clear whether urban malaria will follow a similar pattern as stephensi spreads across Africa. But it is important to realize the growing potential for malaria outbreaks in African cities, Vazquez-Prokopec says.

“Even if urban malaria only contributes to a small percentage of the disease burden in Africa, it could still take a tremendous toll,” he says. “It’s important to learn everything we can about the disease ecology of stephensi as it enters new habitats so we can give public health officials effective tools to reduce its impact on people.”

Story by Carol Clark