Detecting imported malaria infections in endemic settings using molecular surveillance: current state and challenges

The Global Technical Strategy for Malaria 2016 to 2030 targets eliminating malaria from at least 35 countries and reducing case incidence by 90% globally. The importation of parasites due to human mobilization presents a significant challenge to achieve elimination as it can undermine local interventions. A thorough understanding of importation is necessary to support efforts to control and further lead to elimination. Parasite genetic data is extensively deployed to investigate the space-time spread of imported infections. In this matter, this systematic review aimed to aggregate evidence on the use of parasite genetic data for mapping imported malaria and the statistical analytical methods. We discuss the advantages and limitations of the deployed genetic approaches and propose a suitable type of genetic data and statistical framework to discriminate imported malaria infections from local infections. The findings provide actionable insights for national control programs, helping them select the most suitable methods for detecting imported cases while supporting the evaluation of elimination program performance, particularly in low transmission settings.