The American Society of Tropical Medicine and Hygiene’s (ASTMH) Annual Meeting, Nov. 9-13 in Toronto, Ontario, Canada, drew approximately 4,900 global health professionals from around the world. Investigators from the IDEEL Lab contributed new insights to the global conversation, drawing attention to a defining crossroads in East Africa’s malaria response.
Multiple IDEEL studies documented the resurgence of cases and the spread of drug resistance. In Ethiopia, over 7 million cases in 2024 coincided with high prevalence of artemisinin partial resistance (ART-R) mutations in the kelch13 gene, particularly 622I in Tigray, alongside pfhrp2/3 deletions that compromise rapid diagnostic tests, while new in vitro culture systems and ex vivo assays were established to monitor resistance locally. Zanzibar’s resurgence moved beyond recent travelers to mainland Tanzania, with reactive case detection uncovering low-density parasitemias invisible to RDTs, underscoring the role of human mobility. In Tanzania’s Kagera region, ART-R mutations (561H, 164L) and antifolate resistance remained widespread, while Rwanda’s deep genomic surveillance revealed rising prevalence of R561H and A675V mutations, plus diverse emerging variants with strong geographic heterogeneity. Uganda reported a novel locus associated with reduced susceptibility to lumefantrine and artemisinin, expanding the genetic landscape of resistance. Transmission biology studies in Tanzania showed that asymptomatic carriers, especially children during the peak rainfall months, can efficiently infect mosquitoes, with a small subset of individuals driving most transmission. Collectively, IDEEL’s findings emphasized that rising drug resistance, diagnostic challenges, imported cases, and hidden reservoirs threaten malaria elimination, while new laboratory and genomic tools provide critical opportunities for surveillance and targeted interventions. Following is a list of contributions from faculty investigators and students.
One Health 1: The Interface of Humans, Ecosystems, and Animal Health
- Associations Between Animal Ownership and Malaria Prevalence Over Space and Time in Sub-Saharan Africa using Cross-Sectional National Demographic and Health Surveys – Hillary Topazian, Camille Morgan, Varun Goel
- Measuring the transmissibility of recurrent parasitemias that arise following artemisinin-based combination therapy – Claudia Gaither, Lucia Mulei, Jonathan Juliano, Jessica Lin
- Plasmodium ovale species in sub-Saharan Africa: curiosity or emerging threat? – Jessica Lin, Zachary Popkin Hall, Kelly Carey-Ewend, Wenqiao He, Jonthan Juliano, Jonathan Parr
Malaria – Genetics, Genomics and Evolution
- Molecular Investigation of Malaria Resurgence in Ethiopia – Jonathan J. Juliano, Jonathan B. Parr, Ashenafi Assefa
- Imported Malaria and Local Transmission Hotspots in Zanzibar: Findings from Reactive Case Detection – Julia Muller, Jonathan Juliano, Jessica Lin
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Zach Popkin-Hall, PhD, and Wenqiao He, PhD Successful establishment of continuous P. falciparum in vitro culturing and ex vivo ring-stage survival assays for national antimalarial drug resistance surveillance in Ethiopia – Jonathan Parr, Jon Juliano, Ashenafi Assefa
- Assessing the Functional Roles of K13 Mutations and Pfhrp2/3 Deletions on P. falciparum Partial Artemisinin Resistance in Ethiopia – Jonathan Parr, Jon Juliano, Ashenafi Assefa
- Increasing prevalence of artemisinin partial resistance and high level antifolate resistance in Kagera Tanzania from 2021 to 2023 – Jon Juliano, Zachary Popkin Hall
- Baseline long-lasting insecticidal net coverage and malaria prevalence among children living in flood-prone areas of rural southwestern Uganda prior to implementation of a chemoprevention intervention – Sara Albanna, Dana A. Giandomenico, Ross M. Boyce
- Surveillance in Rwanda reveals increasing validated Plasmodium falciparum kelch13 mutations and complex patterns of recent emergence and spread 2022-2024 – Jon Juliano, Jenna Zuromski
Mulu Berihun, working with Drs. Assefa, Parr, and Juliano on malaria studies in Ethiopia.
Late-breakers in Malaria I
- Identification of a novel locus associated with decreased susceptibility of Plasmodium falciparum to lumefantrine and artemisinin in Uganda – Jon Juliano, Karaoke Niare
- Advances in the Diagnosis and Treatment of Congenital Chagas Disease – Natalie Bowman
Malaria – Parasite Transmission Biology
- Determinants of human-to-mosquito transmission from the asymptomatic malaria reservoir in Bagamoyo, Tanzania – Jessica Lin, Claudia Gaither, Srijana Chhetri, Jonathan Juliano, Feng-Chang Lin
Late-breakers in Clinical/Applied Sciences II
Epidemiology of La Crosse Neuroinvasive Disease Among Hospitalized Children in Western North Carolina – Shruti Sagar, Dana A. Giandomenico, Ross M. Boyce
Fellowship Award
Robert (RJ) Williams, MD, a second year infectious diseases fellow, was awarded the Burroughs Wellcome Fund/ASTMH Postdoctoral fellowship in tropical infectious diseases. Funding will support his project in Zambia studying the pathogenesis of severe malaria.
About the IDEEL Lab
Formed in 2015, the Infectious Disease Epidemiology and Ecology Lab (IDEEL) started with a group of UNC investigators who shared a vision for improving the health of the world’s poorest populations by understanding the infectious diseases that impact them most. Today, the lab, in collaboration with Brown University and Imperial College, is an interdisciplinary research community of infectious disease physicians, epidemiologists, molecular parasitologists, cell biologists, geneticists and geographers, exploring how pathogens interact with human hosts.