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Open Access Highly Accessed Case study

Ivermectin to reduce malaria transmission: a research agenda for a promising new tool for elimination

Carlos J Chaccour12*, Kevin C Kobylinski3, Quique Bassat45, Teun Bousema67, Chris Drakeley6, Pedro Alonso45 and Brian D Foy8*

Author Affiliations

1 Internal Medicine Department, Clínica Universidad de Navarra, Av. Pio XII 36, Pamplona 31008, Spain

2 Instituto de Salud Tropical, Universidad de Navarra, Pamplona, Spain

3 Entomology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA

4 Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain

5 Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique

6 Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK

7 Department of Medical Microbiology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands

8 Arthropod-borne and Infectious Diseases Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University, 1692 Campus Delivery, Fort Collins, Colorado 80523-1692, USA

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Malaria Journal 2013, 12:153  doi:10.1186/1475-2875-12-153

Published: 7 May 2013

Abstract

Background

The heterogeneity of malaria transmission makes widespread elimination a difficult goal to achieve. Most of the current vector control measures insufficiently target outdoor transmission. Also, insecticide resistance threatens to diminish the efficacy of the most prevalent measures, indoor residual spray and insecticide treated nets. Innovative approaches are needed. The use of endectocides, such as ivermectin, could be an important new addition to the toolbox of anti-malarial measures. Ivermectin effectively targets outdoor transmission, has a novel mechanism of action that could circumvent resistance and might be distributed over the channels already in place for the control of onchocerciasis and lymphatic filariasis.

Methods

The previous works involving ivermectin and Anopheles vectors are reviewed and summarized. A review of ivermectin’s safety profile is also provided. Finally three definitive clinical trials are described in detail and proposed as the evidence needed for implementation. Several smaller and specific supportive studies are also proposed.

Conclusions

The use of ivermectin solves many challenges identified for future vector control strategies. It is an effective and safe endectocide that was approved for human use more than 25 years ago. Recent studies suggest it might become an effective and complementary strategy in malaria elimination and eradication efforts; however, intensive research will be needed to make this a reality.

Keywords:
Malaria elimination; Ivermectin; Endectocides; Vector control