Nucleic Acid surveillance and malaria elimination.

Sixty years ago, the WHO launched the Global Malaria Eradication Program (GMEP) (1955–1969). The GMEP was successful in eliminating malaria from numerous regions in temperate climates (including parts of southern Europe, the United States, the former Soviet Union, the Middle East, Southeast Asia, India, Sri Lanka, Mexico, Venezuela, and the Caribbean Islands) (2 ). Operationally, the GMEP was largely equipped with insecticides—dichloro-diphenyl-trichloroethane (DDT) with residual longevity was central to the mission (3 )— and motivated by evidence for interruption of malaria transmission from a control campaign in Greece and additional success in interrupting malaria and yellow fever transmission during construction of the Panama Canal (2, 3 ). Unfortunately, numerous biological (mosquito insecticide resistance and parasite drug resistance), socioeconomic, and political factors conspired against the GMEP, and the global effort to eradicate malaria fell well short of its goals (2, 3 ). Additionally, resurgence of disease has been well documented in numerous countries where malaria transmission had reached or was approaching elimination (4 ). Thus, whereas some campaigns against malaria have been durable and long-lived, others were very fragile. The effort to eliminate malaria was rejuvenated beginning with the 1997 International Conference on Malaria in Africa: Challenges and Opportunities Cooperation, held in Dakar, Senegal (5 ). At that time, malaria was killing an estimated 1.5–2.7 million people annually (3–5 people per min), insecticide resistance was being observed in many of the Anopheles species vectors (2, 6 ), and parasite resistance to chloroquine had swept across Africa. Resistance to chloroquine had been demonstrated as directly linked to substantial increases in malaria mortality throughout Africa, and malaria experts around the world were signaling a “malaria disaster” there (7 ). This threat prompted participation in the Dakar meeting from leadership of the NIH, the UK Wellcome Trust, Institut Pasteur (Paris), WHO Tropical Disease Research Program, and the World Bank (5 ). Numerous malaria elimination initiatives can track their origins to this meeting, including the Multilateral Initiative on Malaria and ultimately the Global Fund to Fight AIDS, Tuberculosis, and Malaria (8, 9 ). By 1997, substantial changes had occurred to increase technological capacities for malaria laboratory and epidemiological studies. It had become possible to culture Plasmodium falciparum, among the most important human malaria parasites (10 ). Recombinant DNA technology made it possible to clone genes and express proteins that could be used to develop diagnostic assays (11 ) and vaccines (12 ). Furthermore, the PCR had revolutionized the ability to detect sequences specific to each of the human malaria parasite species, and with the development of highly sensitive molecular diagnostic assays, researchers were poised to transform perspectives regarding malaria epidemiology (13). The current global effort against malaria is focused by regional goals to turn back transmission of this disease and a recognition that it will be important to couple control and elimination efforts with research and a strong appreciation of the heterogeneous characteristics of the disease in different climates and ecological settings. In the past 5 years, the Malaria Eradication Research Agenda (malERA) has published several articles reviewing successes and failures of the GMEP and reminding the community about definitions (Fig. 1), strategies, and tools to eradicate malaria (14 ). As malERA has stated, there must be a “[s]ustained commitment from local communities, civil society, policy leaders, and the scientific community, together with a massive effort to build a strong base of researchers from the endemic areas” for this new agenda to succeed (14 ). Primary components of the malaria elimination toolkit include existing long-lasting 1 International Health, Genetics, and Biology, The Center for Global Health & Diseases, Case Western Reserve University, Cleveland, OH. * Address correspondence to the author at: International Health, Genetics, and Biology, The Center for Global Health & Diseases, Case Western Reserve University, Biomedical Research Bldg, Rm426, 2109 Adelbert Road, Cleveland, OH44106-4983. Fax 216-3684825; e-mail [email protected]. Received April 8, 2015; accepted April 9, 2015. Previously published online at DOI: 10.1373/clinchem.2015.240705 © 2015 American Association for Clinical Chemistry 2 Nonstandard abbreviations: CLIP-PCR, capture and ligation probe-PCR; GMEP, Global Malaria Eradication Program; DDT, dichloro-diphenyl-trichloroethane; malERA, Malaria Eradication Research Agenda; LLIN, long-lasting insecticide-treated bed net; RDT, rapid diagnostic test; LOD, limit of detection; rRNA, ribosomal RNA. Clinical Chemistry 61:6 789–791 (2015) Editorials