Human-to-mosquito transmission efficiency increases as malaria is controlled

The efficiency of malaria transmission between human and mosquito has been shown to be influenced by many factors in the laboratory, although their impact in the field and how this changes with disease endemicity are unknown. Here we estimate how human–mosquito transmission changed as malaria was controlled in Dielmo, Senegal. Mathematical models were fit to data collected between 1990 and the start of vector control in 2008. Results show that asexual parasite slide prevalence in humans has reduced from 70 to 20%, but that the proportion of infectious mosquitoes has remained roughly constant. Evidence suggests that this is due to an increase in transmission efficiency caused by a rise in gametocyte densities, although the uneven distribution of mosquito bites between hosts could also contribute. The resilience of mosquito infection to changes in endemicity will have important implications for planning disease control, and the development and deployment of transmission-reducing interventions.