**4. Conclusions and recommendations**

these species in earlier publications, because distributions of *Ny. nuneztovari* and *Ny. goeldii*

**Figure 6.** Distribution of the Nuneztovari Complex (denoted by white dots). Map made in Google Earth Pro [83] using

In Colombia, *Ny. nuneztovari* is an important malaria vector on both sides of the Andes presenting morphological, behavioral, and genetic heterogeneity throughout the country [151, 152]. In northwestern Colombia, it was found to be the most prevalent species, confirming an earlier study [58], and showed endo and exophagic behavior [152]. It was naturally infected by *P. vivax* VK247 [60, 87], positive for *P. vivax* VK210, and VK247 in the Pacific Coast [103]. In eastern Colombia, there are no recent reports of *Ny. nuneztovari* infected with *Plasmodium*, but more importantly, there is a lack of investigation of malaria outbreaks along the frontier with Venezuela with no record of species identification and vector incrimination. Because of the humanitarian crisis in Venezuela, the numbers of malaria cases have increased dramatically since 2010 [1, 153]. In the most recent study of Colombian *Ny. nuneztovari*, it was reported to be abundant and dominant in localities where anthropogenic activities such as livestock, fishfarming, and small to medium-scale agriculture were common, attributed to its adaptability to environmentally impacted habitats [152]. Common larval habitats were artificial fishponds

Regionally, this species shows the highest biting activity after 20:00 h, which suggests high transmission risk when people are at home, but not necessarily under nets. ITNs could be one component of an effective vector control intervention. In a locality in the northeast, Tibú,

overlap, as do those of *Ny. goeldii* and *Ny*. *dunhami* [149, 150].

data from the Malaria Atlas Project [84, 85].

296 Towards Malaria Elimination - A Leap Forward

and wetlands, particularly in the west and northwest [58, 152].

As discussed by Packard [37], for sustainable malaria control, focusing on decreasing incidence towards elimination, effective measures need to be considered, including those related to human ecology. Examples include a significant improvement in living and housing conditions, redesigning of anthropogenic landscapes from those that favor mosquito vectors to a remodeled landscape that is both adequate for humans and inadequate for vector mosquitoes. The sustainability and success of a malaria control program depends on a combination of diagnosis of human infection, treatment with anti-malarial drugs, and vector control. Moreover, proposed changes will need to be maintained such that the malaria baseline will not be affected by either interruption or disruption of a control program [1]. It would be sensible to include malaria control in the One Health Program, to align it with the elimination of extreme poverty, a goal of the global sustainable development program.

The recent elimination of malaria on the Peru-Ecuador border was a successful strategy and included strengthening surveillance and treatment, resource sharing, the use of operational research to inform policy, and novel interventions [135]. The current program depends on prompt, effective diagnosis and treatment with no charge, community personnel trained to collect blood smears from febrile persons within their communities, case reporting to a national surveillance system that includes a five-category case definition (indigenous, imported, introduced, induced, and cryptic), active foci and case investigations, mapping and elimination of larval habitats, and the use of ITNs and LLINs. This could serve as a model for the current situation along the Venezuelan border with its neighbors, Colombia and Brazil. One very important aspect of this program is that it took 20 years to achieve its goals [135].

Worldwide, some of the innovations adopted for prevention, control, and eventual elimination of malaria transmission during the past ~10 years have included the development and deployment of LLINs [158, 159], the completion and exploration of many mosquito and parasite genomes [160–163], major progress on genome editing in vector mosquitoes [164–166], new interventions such as house eaves [167] and push-pull systems [168], and better evaluation of larval source management (LSM) as a potential component of integrated control management systems [169]. Global policies and recommendations provide a useful framework and roadmap guided by the Global Technical Strategy of Malaria Control and Elimination (2016–2025), a reconsideration of the vectorial capacity formula for elimination [170] and the Plan for Elimination of Malaria in Brazil (UN/OMS 2015; [4]).

NY, USA for creating the maps. Financial support was provided by US National Institutes of Health (NIH) NIH grant R01 AI110112 to JEC and ICEMR grant U19 AI089681 to J.M. Vinetz, COLCIENCIAS Colombia (Project code No. 596-2013) and Estrategia para la Sostenibilidad de Grupos de Investigación 2016–2107, Universidad de Antioquia, code No. ES84160123 to MMC, and FAPESP Grant no. 2014/26229-7 to MAMS. MEG thanks the Council for International Exchange of Scholars (US Department of State) for a Fulbright Scholar Fellowship to visit the

Malaria Transmission in South America—Present Status and Prospects for Elimination

http://dx.doi.org/10.5772/intechopen.69750

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Wadsworth Center, NYS Department of Health, Albany, NY, USA.

ACT artemisinin-based combination therapy

DDT dichlorodiphenyltrichloroethane EIR entomological inoculation rate

ENSO El Niño-Southern oscillation

HBI human blood index

IRS indoor residual spraying ITN insecticide-treated net

ITS2 internal transcribed spacer 2

LSM larval source management

PCR polymerase chain reaction

WHO World Health Organization

MOH Ministry of Health

LLIN long-lasting insecticide-treated net

PAHO Pan American Health Organization

RAPD random amplified polymorphic DNA

IR infection rate

ELISA enzyme-linked immunosorbent assay

**Conflict of interest**

**List of abbreviations**

The authors declare no conflict of interest.

API annual parasite index COI cytochrome c oxidase I

During the same 10-year timeframe, several novel tools and strategies have been envisaged that focus on the Neotropical malaria control and eradication landscape: (1) successful colonization of the main malaria vector *Ny. darlingi* [171, 172]; (2) development of predictive models on climate change scenarios for Neotropical malaria vectors and *Plasmodium* [18, 19]; and (3) collection of baseline larval habitat characteristics in malaria endemic regions that can guide larval source reduction [29, 48, 58, 173] and may prove effective as part of a broader array of vector interventions in certain landscape types such as abandoned gold mining pools [174] and possibly commercial fish ponds [31].

The most serious challenge to malaria eradication in South America from the viewpoint of vector control is that most vector species are primarily exophilic, often exophagic, and frequently bite early in the evening. Therefore, it is essential to determine and monitor the local biting behavior of a mosquito vector species.

Identified gaps in vector interventions throughout South American endemic areas are:

