Malaria in India: The Center for the Study of Complex Malaria in India

Malaria is a major public health problem in India and one which contributes significantly to the overall malaria burden in Southeast Asia. The National Vector Borne Disease Control Program of India reported ∼1.6 million cases and ∼1100 malaria deaths in 2009. Some experts argue that this is a serious underestimation and that the actual number of malaria cases per year is likely between 9 and 50 times greater, with an approximate 13-fold underestimation of malaria-related mortality. The difficulty in making these estimations is further exacerbated by (i) highly variable malaria eco-epidemiological profiles, (ii) the transmission and overlap of multiple Plasmodium species and Anopheles vectors, (iii) increasing antimalarial drug resistance and insecticide resistance, and (iv) the impact of climate change on each of these variables. Simply stated, the burden of malaria in India is complex. Here we describe plans for a Center for the Study of Complex Malaria in India (CSCMi), one of ten International Centers of Excellence in Malaria Research (ICEMRs) located in malarious regions of the world recently funded by the National Institute of Allergy and Infectious Diseases, National Institutes of Health. The CSCMi is a close partnership between Indian and United States scientists, and aims to address major gaps in our understanding of the complexity of malaria in India, including changing patterns of epidemiology, vector biology and control, drug resistance, and parasite genomics. We hope that such a multidisciplinary approach that integrates clinical and field studies with laboratory, molecular, and genomic methods will provide a powerful combination for malaria control and prevention in India.

Graphical abstractWe present plans for a Center for the Study of Complex Malaria in India (CSCMi), a partnership between Indian and United States scientists, made possible through funding from the National Institutes of Health and their commitment to establish International Centers of Excellence in Malaria Research. Through the CSCMi, we will work to develop knowledge, tools, and evidence-based strategies to help support intervention and control programs of the Indian government. We are also committed to building research capacity in India by helping to train the next generation of malaria and mosquito vector biologists. Among our research projects is a comprehensive epidemiological surveillance study of the malaria burden in diverse ecological sites, which will help improve the accuracy of the current estimations. Malaria endemicity in India. State boundaries are color-coded according to total malaria endemicity (see key). Data taken from the National Vector Borne Disease Control Programme (http://www.nvbdcp.gov.in/) for year 2010. NIMR field stations are indicated as red dots. The three NIMR field stations incorporated as part of the CSCMi are: Nadiad (Gujarat), Rourkela (Odisha) and Chennai (Tamil Nadu), each with different eco-epidemiological profiles as shown. EIR: entomological inoculation rate; API: annual parasite incidence.Figure optionsDownload full-size imageDownload as PowerPoint slideHighlights► Malaria is a significant public health problem in India. ► Malaria in India is ‘complex’ involving multiple Plasmodium species and vectors. ► Improved knowledge, tools, and evidence-based strategies are needed to support Indian control programs. ► Determining the ecological and evolutionary determinants of malaria transmission is key. ► New genomics technology can be used to propel investigation of malaria mixed species and mixed genotypes.