**3. Conclusions and issues to watch for**

The importance of basic knowledge on mosquito vector behavior and ecology for the development of tailor-made vector control strategies is considered key in the recent WHO Health and Environment Linkages Initiative (HELI), highlighting its importance for sustainable longterm mosquito control actions [106–111].

Recently, an updated research agenda for malaria elimination and eradication (malERA) was published [26, 112–114]. It comprises a multidisciplinary approach to the most important challenges of controlling malaria. Several factors significantly impact the dynamics of malaria transmission. Specifically, shifts in mosquito ecology and behavior caused by anthropogenic alterations in the environment have a major impact on the effectiveness of control strategies. These alterations include, but not limited to, urbanization, human movement, availability of breeding containers and water bodies, hosts for blood feeding and availability of sugar sources and resting places. Moreover, mosquito insecticide resistance, behavioral avoidance, high vector biodiversity, competitive and food web interactions, mosquito population dynamics and dispersion also play a major role in the complex scenario comprising the dynamics of malaria transmission [17, 115, 116].

> of mosquito surveillance for the development of guidelines and models of the risk of disease transmission (**Figure 3**); (3) development of effective and environmentally friendly strategies to reduce malaria and other vector-borne disease transmission, following the recommendations by VCAG and considering the increase of insecticide resistance [100, 102]. To our understanding, traditional insecticide-based control efforts, such as IRS and LLIN, should be used in combination with novel eco-friendly tools, such as "eave tubes technology," ATSB methods, and even the employment of the ectendocide ivermectin [40, 44, 76]. These new mosquito control tools should be accompanied by (4) an evaluation of their effectiveness, assessment of their usefulness and impact through randomized controlled trials with entomological and epidemiological outcomes (**Figure 3**), this has been done for traditional control strategies such as LLINs and IRS; (5) the monitoring of man-made alteration in the environment and its impact in the dynamics of malaria vectors; and (6) the establishment of a multi-disciplinary team with different areas of expertise (**Figure 3**) [100, 102, 120]. Indeed, the transdisciplinary cooperation among professionals is important for ensuring adequate evaluation of the epidemiological impact triggered by

Newer Approaches for Malaria Vector Control and Challenges of Outdoor Transmission

http://dx.doi.org/10.5772/intechopen.75513

393

**Figure 3.** Main challenges and trends in current malaria vector control research (adapted and modified from [120]).

Here we illustrate the complex scenario comprising the epidemiology of malaria and how anthropogenic selective pressures are modulating the ecology and behavior of vector mosquitoes. To our understanding, there is no other choice rather to use rigorous, science-driven

This study was supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number R01AI100968. The content is solely the responsibility of the authors and does not necessarily represent the official views of the

novel mosquito vector control strategies.

**Acknowledgements**

strategies for controlling vector mosquito populations.

The development of reliable and effective mosquito control strategies is no easy task, and several challenges must be overcome to achieve a long-term sustainable reduction of mosquito populations. Most of the new strategies and tools developed for controlling vector mosquito populations are not rigorously tested, and most of the time, their real epidemiological impact is not properly assessed rendering the deployment of ineffective mosquito control strategies with limited result on the prevalence of vector-borne diseases [117]. These challenges can be classified as systemic, structural, informational, environmental, human movement, political and financial ones [13]. Key core issues have to be addressed in order to decrease the prevalence of malaria, such as (1) vector surveillance is often neglected or insufficient in most countries at risk of mosquito-borne diseases, rendering control efforts ineffective; (2) malaria endemic countries are often endemic for more than one major mosquito-borne disease depleting the availability of resources; (3) there is a lack of scientific evidence to guide the efforts for mosquito control; (4) anthropogenic alterations in the environment and global warming are responsible for driving the abundance of vector mosquitoes, directly affecting the effectiveness of control strategies; (5) the increase in the human population and movement of people is associated with the dispersion of vector mosquitoes, exposing non-immune populations to new diseases; and (6) funds for vector surveillance are negligible and even though financial support has been made available for LLINs and IRS for controlling *Anopheles* mosquitoes, other vector-borne diseases are largely neglected [13, 17, 118, 119].

Priorities in vector control should be defined by the national vector-borne disease control program and studies designed and performed in consultation with national and international experts in the relevant field. The plan should consider a list of strategic key areas necessary to implement vector control in a given country, followed by research guidance from academic institutes and companies [27]. The most important topics to be considered that are also in agreement with the WHO criteria, comprise: (1) assessment of the health system limitations to improve processes and methods aiming for the improvement in efficacy of vector control; (2) implementation Newer Approaches for Malaria Vector Control and Challenges of Outdoor Transmission http://dx.doi.org/10.5772/intechopen.75513 393

**Figure 3.** Main challenges and trends in current malaria vector control research (adapted and modified from [120]).

of mosquito surveillance for the development of guidelines and models of the risk of disease transmission (**Figure 3**); (3) development of effective and environmentally friendly strategies to reduce malaria and other vector-borne disease transmission, following the recommendations by VCAG and considering the increase of insecticide resistance [100, 102]. To our understanding, traditional insecticide-based control efforts, such as IRS and LLIN, should be used in combination with novel eco-friendly tools, such as "eave tubes technology," ATSB methods, and even the employment of the ectendocide ivermectin [40, 44, 76]. These new mosquito control tools should be accompanied by (4) an evaluation of their effectiveness, assessment of their usefulness and impact through randomized controlled trials with entomological and epidemiological outcomes (**Figure 3**), this has been done for traditional control strategies such as LLINs and IRS; (5) the monitoring of man-made alteration in the environment and its impact in the dynamics of malaria vectors; and (6) the establishment of a multi-disciplinary team with different areas of expertise (**Figure 3**) [100, 102, 120]. Indeed, the transdisciplinary cooperation among professionals is important for ensuring adequate evaluation of the epidemiological impact triggered by novel mosquito vector control strategies.

Here we illustrate the complex scenario comprising the epidemiology of malaria and how anthropogenic selective pressures are modulating the ecology and behavior of vector mosquitoes. To our understanding, there is no other choice rather to use rigorous, science-driven strategies for controlling vector mosquito populations.

#### **Acknowledgements**

**3. Conclusions and issues to watch for**

term mosquito control actions [106–111].

392 Towards Malaria Elimination - A Leap Forward

malaria transmission [17, 115, 116].

The importance of basic knowledge on mosquito vector behavior and ecology for the development of tailor-made vector control strategies is considered key in the recent WHO Health and Environment Linkages Initiative (HELI), highlighting its importance for sustainable long-

Recently, an updated research agenda for malaria elimination and eradication (malERA) was published [26, 112–114]. It comprises a multidisciplinary approach to the most important challenges of controlling malaria. Several factors significantly impact the dynamics of malaria transmission. Specifically, shifts in mosquito ecology and behavior caused by anthropogenic alterations in the environment have a major impact on the effectiveness of control strategies. These alterations include, but not limited to, urbanization, human movement, availability of breeding containers and water bodies, hosts for blood feeding and availability of sugar sources and resting places. Moreover, mosquito insecticide resistance, behavioral avoidance, high vector biodiversity, competitive and food web interactions, mosquito population dynamics and dispersion also play a major role in the complex scenario comprising the dynamics of

The development of reliable and effective mosquito control strategies is no easy task, and several challenges must be overcome to achieve a long-term sustainable reduction of mosquito populations. Most of the new strategies and tools developed for controlling vector mosquito populations are not rigorously tested, and most of the time, their real epidemiological impact is not properly assessed rendering the deployment of ineffective mosquito control strategies with limited result on the prevalence of vector-borne diseases [117]. These challenges can be classified as systemic, structural, informational, environmental, human movement, political and financial ones [13]. Key core issues have to be addressed in order to decrease the prevalence of malaria, such as (1) vector surveillance is often neglected or insufficient in most countries at risk of mosquito-borne diseases, rendering control efforts ineffective; (2) malaria endemic countries are often endemic for more than one major mosquito-borne disease depleting the availability of resources; (3) there is a lack of scientific evidence to guide the efforts for mosquito control; (4) anthropogenic alterations in the environment and global warming are responsible for driving the abundance of vector mosquitoes, directly affecting the effectiveness of control strategies; (5) the increase in the human population and movement of people is associated with the dispersion of vector mosquitoes, exposing non-immune populations to new diseases; and (6) funds for vector surveillance are negligible and even though financial support has been made available for LLINs and IRS for controlling *Anopheles* mosquitoes,

Priorities in vector control should be defined by the national vector-borne disease control program and studies designed and performed in consultation with national and international experts in the relevant field. The plan should consider a list of strategic key areas necessary to implement vector control in a given country, followed by research guidance from academic institutes and companies [27]. The most important topics to be considered that are also in agreement with the WHO criteria, comprise: (1) assessment of the health system limitations to improve processes and methods aiming for the improvement in efficacy of vector control; (2) implementation

other vector-borne diseases are largely neglected [13, 17, 118, 119].

This study was supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number R01AI100968. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This research was also supported by CDC (https://www.cdc. gov/) grant 1U01CK000510-01: Southeastern Regional Center of Excellence in Vector-Borne Diseases: The Gateway Program.

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