  Background Elimination of malaria can only be achieved through removal of all
vectors or complete depletion of the infectious reservoir in humans.
Mechanistic models can be built to synthesize diverse observations from the
field collected under a variety of conditions and subsequently used to query
the infectious reservoir in great detail. Methods The EMOD model of malaria
transmission was calibrated to prevalence, incidence, asexual parasite density,
gametocyte density, infection duration, and infectiousness data from 9 study
sites. The infectious reservoir was characterized by diagnostic detection limit
and age group over a range of transmission intensities with and without case
management and vector control. Mass screen-and-treat drug campaigns were tested
for likelihood of achieving elimination. Results The composition of the
infectious reservoir by diagnostic threshold is similar over a range of
transmission intensities, and higher intensity settings are biased toward
infections in children. Recent ramp-ups in case management and use of
insecticide-treated bednets reduce the infectious reservoir and shift the
composition toward submicroscopic infections. Mass campaigns with antimalarial
drugs are highly effective at interrupting transmission if deployed shortly
after ITN campaigns. Conclusions Low density infections comprise a substantial
portion of the infectious reservoir. Proper timing of vector control, seasonal
variation in transmission intensity, and mass drug campaigns allows lingering
population immunity to help drive a region toward elimination.
