Abstract
► Malaria elimination is best achieved by targeting vector control to areas of high transmission. ► Annual case incidence and prevalence are not adequate metrics for understanding transmission. ► The entomological inoculation rate (EIR) is a flexible and accurate metric of malaria transmission. ► Malaria elimination can only be achieved if annual EIRs are reduced to less than one bite per person. ► National Malaria Control Programs aiming at elimination should measure EIRs to target efforts.
Roll Back Malaria's ambitious goals for global malaria reduction by 2015 represent a dilemma for National Malaria Control Programs (NMCPs) that are still far from malaria elimination. Current vector control efforts by NMCPs generally fall short of their potential, leaving many NMCPs wondering how much vector control it will take to achieve malaria elimination. We believe the answer is detailed in the relationships between the entomological inoculation rate (EIR) and four epidemiological measures of malaria in humans. To achieve adequate vector control, NMCPs must evaluate EIRs to identify problematic foci of transmission and reduce annual EIRs to less than one infectious bite per person.
