{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T10:27:22Z","timestamp":1784629642376,"version":"3.55.0"},"reference-count":62,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2_Suppl","license":[{"start":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:00:00Z","timestamp":1770076800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,3]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    A malaria outbreak occurred in Farafangana District, Madagascar, in 2018, shortly after the implementation of insecticide-treated bed net distribution and indoor residual spraying campaigns. Entomological and epidemiological investigations were conducted to characterize disease transmission in six villages in three communes. Mosquitoes were collected using human landing catches, light traps, and pyrethrum spray catches. Vector biting behavior was described, and sporozoite indices were determined. To describe demographic and risk data, questionnaires were administered to individuals from randomly selected households, and rapid diagnostic tests (RDTs) were performed on consenting household members.\n                    <jats:italic>Anopheles coustani<\/jats:italic>\n                    (\n                    <jats:italic>An. coustani<\/jats:italic>\n                    ),\n                    <jats:italic>Anopheles gambiae<\/jats:italic>\n                    s.s. (\n                    <jats:italic>An. gambiae<\/jats:italic>\n                    s.s.),\n                    <jats:italic>Anopheles funestus<\/jats:italic>\n                    (\n                    <jats:italic>An. funestus<\/jats:italic>\n                    ), and\n                    <jats:italic>Anopheles mascarensis<\/jats:italic>\n                    (\n                    <jats:italic>An. mascarensis<\/jats:italic>\n                    ) were the most frequently captured malaria vector species. Outdoor biting was common for all predominant\n                    <jats:italic>Anopheles<\/jats:italic>\n                    species collected (exophagy rates varied from 59.8% for\n                    <jats:italic>An. gambiae<\/jats:italic>\n                    s.s. to 100.0% for\n                    <jats:italic>An. coustani<\/jats:italic>\n                    ), except for\n                    <jats:italic>An. funestus<\/jats:italic>\n                    , which exhibited an exophagy rate of less than 47.0%. Of 1,488\n                    <jats:italic>Anopheles<\/jats:italic>\n                    mosquitoes collected, 25 (1.7%) had\n                    <jats:italic>Plasmodium falciparum<\/jats:italic>\n                    sporozoites, only one of which was collected indoors. The remaining 24 were collected outdoors, 13 (54.2%) of which were\n                    <jats:italic>An. coustani<\/jats:italic>\n                    . The other 12 specimens were\n                    <jats:italic>An. funestus<\/jats:italic>\n                    ,\n                    <jats:italic>Anopheles squamosus<\/jats:italic>\n                    ,\n                    <jats:italic>An. gambiae<\/jats:italic>\n                    s.s., and\n                    <jats:italic>An. mascarensis<\/jats:italic>\n                    . Of 226 individuals tested using RDTs, 71 (31.4%) had positive results. A total of 61 (85.9%) of these individuals were asymptomatic, most of whom were children. Highly infected secondary malaria vectors, in addition to primary vectors, combined with a predominance of exophagy, contributed to parasite transmission in the Farafangana District, where indoor-targeted vector control measures had been implemented. A high proportion of asymptomatic infections likely sustained transmission. Control strategies for outdoor biting should be explored.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.24-0834","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T15:52:28Z","timestamp":1761234748000},"page":"52-60","source":"Crossref","is-referenced-by-count":1,"title":["Malaria Outbreak in Farafangana District, Southeast Madagascar, 2018: Are Secondary Vectors a Threat to Current Malaria Control Approaches?"],"prefix":"10.4269","volume":"114","author":[{"given":"Thiery","family":"Nepomichene","sequence":"first","affiliation":[{"name":"Institut Pasteur de Madagascar, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aina","family":"Harimanana","sequence":"additional","affiliation":[{"name":"Institut Pasteur de Madagascar, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fenomiaranjara","family":"Randrianaivo","sequence":"additional","affiliation":[{"name":"Institut Pasteur de Madagascar, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rico","family":"Randrenjarison","sequence":"additional","affiliation":[{"name":"Institut Pasteur de Madagascar, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rogelin","family":"Raherinjafy","sequence":"additional","affiliation":[{"name":"Ministry of Public Health, National Malaria Control Program, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Marius","family":"Rakotondramanga","sequence":"additional","affiliation":[{"name":"Institut Pasteur de Madagascar, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Zohdy","sequence":"additional","affiliation":[{"name":"Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Solofo","family":"Razakamiadana","sequence":"additional","affiliation":[{"name":"US President\u2019s Malaria Initiative, Antananarivo, Madagascar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Kapesa","sequence":"additional","affiliation":[{"name":"US President\u2019s Malaria Initiative, Antananarivo, Madagascar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauricette Nambinisoa","family":"Andriamananjara","sequence":"additional","affiliation":[{"name":"Ministry of Public Health, National Malaria Control Program, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence","family":"Baril","sequence":"additional","affiliation":[{"name":"Institut Pasteur de Madagascar, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rindra","family":"Randremanana","sequence":"additional","affiliation":[{"name":"Institut Pasteur de Madagascar, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence","family":"Randrianasolo","sequence":"additional","affiliation":[{"name":"Institut Pasteur de Madagascar, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine M.","family":"Dentinger","sequence":"additional","affiliation":[{"name":"Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia;"},{"name":"US President\u2019s Malaria Initiative, Antananarivo, Madagascar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain","family":"Girod","sequence":"additional","affiliation":[{"name":"Institut Pasteur de Madagascar, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Sci Rep","first-page":"18129","article-title":"Spatiotemporal mapping of malaria prevalence in Madagascar using routine surveillance and health survey data","volume":"10","author":"Arambepola","year":"2020"},{"key":"b2","series-title":"Malar J","first-page":"57","article-title":"Multiple causes of an unexpected malaria outbreak in a high-transmission area in Madagascar","volume":"15","author":"Kesteman","year":"2016"},{"key":"b3","article-title":"ICF. Demographic and Health Survey, Madagascar (DHS-V) 2021.","year":"2021"},{"key":"b4","article-title":"Monographie R\u00e9gion Atsimo Atsinanana.","year":"2013"},{"key":"b5","series-title":"Am J Trop Med Hyg","first-page":"169","article-title":"Malaria transmission in urban sub-Saharan Africa","volume":"68","author":"Robert","year":"2003"},{"key":"b6","series-title":"Malar J","first-page":"114","article-title":"Small-scale land-use variability affects Anopheles spp. distribution and concomitant Plasmodium infection in humans and mosquito vectors in southeastern Madagascar","volume":"15","author":"Zohdy","year":"2016"},{"key":"b7","series-title":"Acta Trop","first-page":"193","article-title":"Malaria transmission in Southern Madagascar: Influence of the environment and hydro-agricultural works in sub-arid and humid regions: Part 1. Entomological investigations","volume":"89","author":"Marrama","year":"2004"},{"key":"b8","series-title":"Insectes Dipteres Culicidae Anophelinae","author":"Grjebine","year":"1966"},{"key":"b9","series-title":"Malar J","first-page":"58","article-title":"Spatial and temporal dynamics of malaria in Madagascar","volume":"17","author":"Ihantamalala","year":"2018"},{"key":"b10","article-title":"The PMI VectorLink Madagascar 2018 End of Spray Report (Eosr).","year":"2018"},{"key":"b11","series-title":"Am J Trop Med Hyg","first-page":"520","article-title":"Identification of single specimens of the Anopheles gambiae complex by the polymerase chain reaction","volume":"49","author":"Scott","year":"1993"},{"key":"b12","series-title":"Methods in Malaria Research","author":"Ljungstr\u00f6m","year":"2008"},{"key":"b13","series-title":"Malar J","first-page":"405","article-title":"An innovative tool for moving malaria PCR detection of parasite reservoir into the field","volume":"12","author":"Canier","year":"2013"},{"key":"b14","article-title":"WHO Guidelines for Malaria: Treatment for Severe Disease.","year":"2025"},{"key":"b15","series-title":"J Biomed Inform","first-page":"377","article-title":"Research electronic data capture (REDCap)\u2014A metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009"},{"key":"b16","series-title":"J Biomed Inform","first-page":"103208","article-title":"The REDCap consortium: Building an international community of software platform partners","volume":"95","author":"Harris","year":"2019"},{"key":"b17","series-title":"Malar J","first-page":"422","article-title":"Baseline malaria prevalence and care-seeking behaviours in rural Madagascar prior to a trial to expand malaria community case management to all ages","volume":"20","author":"Sayre","year":"2021"},{"key":"b18","series-title":"Expert Rev Anti Infect Ther","first-page":"623","article-title":"The silent threat: Asymptomatic parasitemia and malaria transmission","volume":"11","author":"Lindblade","year":"2013"},{"key":"b19","series-title":"Malar J","first-page":"475","article-title":"Malaria case in Madagascar, probable implication of a new vector, Anopheles coustani.","volume":"14","author":"Nepomichene","year":"2015"},{"key":"b20","series-title":"Parasit Vectors","first-page":"430","article-title":"Differential contribution of Anopheles coustani and Anopheles arabiensis to the transmission of Plasmodium falciparum and Plasmodium vivax in two neighbouring villages of Madagascar","volume":"13","author":"Goupeyou-Youmsi","year":"2020"},{"key":"b21","series-title":"Malar J","first-page":"25","article-title":"Widespread zoophagy and detection of Plasmodium spp. in Anopheles mosquitoes in southeastern Madagascar","volume":"20","author":"Finney","year":"2021"},{"key":"b22","article-title":"PMI Africa IRS (AIRS) Project MADAGASCAR 2016\u20132017 Final Entomological Monitoring Report.","year":"2017"},{"key":"b23","year":"2026"},{"key":"b24","article-title":"Social Vulnerability of Children Aged 5 to 15 Years to Malaria in Madagascar: 3 Anthropological Studies LLIN Use.","author":"Njatosoa","year":"2021"},{"key":"b25","series-title":"PloS Negl Trop Dis","first-page":"e0007176","article-title":"Anopheles mosquito surveillance in Madagascar reveals multiple blood feeding behavior and Plasmodium infection","volume":"13","author":"Tedrow","year":"2019"},{"key":"b26","series-title":"BMJ Glob Health","first-page":"e003647","article-title":"District-level health system strengthening for universal health coverage: Evidence from a longitudinal cohort study in rural Madagascar, 2014\u20132018","volume":"5","author":"Garchitorena","year":"2020"},{"key":"b27","series-title":"BMC Med","first-page":"322","article-title":"Proactive community case management decreased malaria prevalence in rural Madagascar: Results from a cluster 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USA","first-page":"e2104282119","article-title":"Diurnal biting of malaria mosquitoes in the Central African Republic indicates residual transmission may be \u201cout of control\u201d","volume":"119","author":"Sangbakembi-Ngounou","year":"2022"},{"key":"b1","series-title":"Sci Rep","first-page":"18129","article-title":"Spatiotemporal mapping of malaria prevalence in Madagascar using routine surveillance and health survey data","volume":"10","author":"Arambepola","year":"2020"},{"key":"b2","series-title":"Malar J","first-page":"57","article-title":"Multiple causes of an unexpected malaria outbreak in a high-transmission area in Madagascar","volume":"15","author":"Kesteman","year":"2016"},{"key":"b3","article-title":"ICF. Demographic and Health Survey, Madagascar (DHS-V) 2021.","year":"2021"},{"key":"b4","article-title":"Monographie R\u00e9gion Atsimo Atsinanana.","year":"2013"},{"key":"b5","series-title":"Am J Trop Med Hyg","first-page":"169","article-title":"Malaria transmission in urban sub-Saharan Africa","volume":"68","author":"Robert","year":"2003"},{"key":"b6","series-title":"Malar J","first-page":"114","article-title":"Small-scale land-use variability affects Anopheles spp. distribution and concomitant Plasmodium infection in humans and mosquito vectors in southeastern Madagascar","volume":"15","author":"Zohdy","year":"2016"},{"key":"b7","series-title":"Acta Trop","first-page":"193","article-title":"Malaria transmission in Southern Madagascar: Influence of the environment and hydro-agricultural works in sub-arid and humid regions: Part 1. Entomological investigations","volume":"89","author":"Marrama","year":"2004"},{"key":"b8","series-title":"Insectes Dipteres Culicidae Anophelinae","author":"Grjebine","year":"1966"},{"key":"b9","series-title":"Malar J","first-page":"58","article-title":"Spatial and temporal dynamics of malaria in Madagascar","volume":"17","author":"Ihantamalala","year":"2018"},{"key":"b10","article-title":"The PMI VectorLink Madagascar 2018 End of Spray Report (Eosr).","year":"2018"},{"key":"b11","series-title":"Am J Trop Med Hyg","first-page":"520","article-title":"Identification of single specimens of the Anopheles gambiae complex by the polymerase chain reaction","volume":"49","author":"Scott","year":"1993"},{"key":"b12","series-title":"Methods in Malaria Research","author":"Ljungstr\u00f6m","year":"2008"},{"key":"b13","series-title":"Malar J","first-page":"405","article-title":"An innovative tool for moving malaria PCR detection of parasite reservoir into the 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