Addressing the challenges of implementing evidence-based prioritisation in global health.

Global health requires evidence-based approaches to improve health and decrease inequalities. In a roundtable discussion between health practitioners, funders, academics and policy-makers, we recognised key areas for improvement to deliver better-informed, sustainable and equitable global health practices. These focus on considering information-sharing mechanisms and developing evidence-based frameworks that take an adaptive function-based approach, grounded in the ability to perform and respond to prioritised needs. Increasing social engagement as well as sector and participant diversity in whole-of-society decision-making, and collaborating with and optimising on hyperlocal and global regional entities, will improve prioritisation of global health capabilities. Since the skills required to navigate drivers of pandemics, and the challenges in prioritising, capacity building and response do not sit squarely in the health sector, it is essential to integrate expertise from a broad range of fields to maximise on available knowledge during decision-making and system development. Here, we review the current assessment tools and provide seven discussion points for how improvements to implementation of evidence-based prioritisation can improve global health.

Mosquito Communities and Avian Malaria Prevalence in Silvereyes (Zosterops lateralis) Within Forest Edge and Interior Habitats in a New Zealand Regional Park.

Forest fragmentation and agricultural development are important anthropogenic landscape alterations affecting the disease dynamics of malarial parasites (Plasmodium spp.), largely through their effects on vector communities. We compared vector abundance and species composition at two forest edge sites abutting pastureland and two forest interior sites in New Zealand, while simultaneously assessing avian malaria prevalence in silvereyes (Zosterops lateralis). Twenty-two of 240 (9.2%) individual silvereyes captured across all sites tested positive for avian malaria, and Plasmodium prevalence was nearly identical in edge and interior habitats. A total of 580 mosquito specimens were trapped across all sites. These comprised five different species: the introduced Aedes notoscriptus and Culex quinquefasciatus; the native A. antipodeus, C. asteliae and C. pervigilans. The known avian malaria vector C. quinquefasciatus was only recorded in the forest edge (mostly at ground level). In contrast, the probable vector C. pervigilans was abundant and widespread in both edge and interior sites. Although frequently caught in ground traps, more C. pervigilans specimens were captured in the canopy. This study shows that avian malaria prevalence among silvereyes appeared to be unaffected by forest fragmentation, at least at the scale assessed. Introduced mosquito species were almost completely absent from the forest interior, and thus our study provides further circumstantial evidence that native mosquito species (in particular C. pervigilans) play an important role in avian malaria transmission in New Zealand.

Patterns in avian malaria at founder and source populations of an endemic New Zealand passerine.

Significant progress in our understanding of disease transmission in the wild can be made by examining variation in host-parasite-vector interactions after founder events of the host. This study is the first to document patterns in avian malaria, Plasmodium spp., infecting an endemic New Zealand passerine, Anthornis melanura, at multiple-host subpopulations simultaneously. We assess the Beaudoin hypothesis of bimodal seasonality and use AIC model selection to determine host factors associated with disease prevalence. We had the rare opportunity to test the enemy release hypothesis (ERH) after a recent colonisation event of the bellbird host. Four Plasmodium species were found to infect bellbirds. Temporal patterns of three exotic parasite lineages, including GRW06 Plasmodium (Huffia) elongatum, SYAT05 Plasmodium (Novyella) vaughani and a Plasmodium (Haemamoeba) relictum, were sporadic with low prevalence year round. The fourth species was an endemic parasite, an unresolved Plasmodium (Novyella) sp. here called ANME01, which exhibited a strong winter peak at the source subpopulations possibly indicating greater immune stressors at the densely populated source site. At the colonies, we observed bimodal seasonality in the prevalence of ANME01 with autumn and spring peaks. These infection peaks were male-biased, and the amplitude of sex bias was more pronounced at the newer colony perhaps due to increased seasonal competition resulting from territory instability. We observed a decrease in parasite species diversity and increase in body condition from source to founder sites, but statistical differences in the direct relationship between body condition and malaria prevalence between source and colony were weak and significant only during winter. Though our data did not strongly support the ERH, we highlight the benefits of 'conspecific release' associated with decreased population density and food competition. Our findings contribute to the identification of ecological and environmental drivers of variability in malaria transmission, which is valuable for predicting the consequences of both natural range expansions, as well as host re-introductions resulting from intensive conservation practices.

Malaria parasites (Plasmodium spp.) infecting introduced, native and endemic New Zealand birds.

Avian malaria is caused by intracellular mosquito-transmitted protist parasites in the order Haemosporida, genus Plasmodium. Although Plasmodium species have been diagnosed as causing death in several threatened species in New Zealand, little is known about their ecology and epidemiology. In this study, we examined the presence, microscopic characterization and sequence homology of Plasmodium spp. isolates collected from a small number of New Zealand introduced, native and endemic bird species. We identified 14 Plasmodium spp. isolates from 90 blood or tissue samples. The host range included four species of passerines (two endemic, one native, one introduced), one species of endemic pigeon and two species of endemic kiwi. The isolates were associated into at least four distinct clusters including Plasmodium (Huffia) elongatum, a subgroup of Plasmodium elongatum, Plasmodium relictum and Plasmodium (Noyvella) spp. The infected birds presented a low level of peripheral parasitemia consistent with chronic infection (11/15 blood smears examined). In addition, we report death due to overwhelming parasitemia in a blackbird, a great spotted kiwi and a hihi. These deaths were attributed to infections with either Plasmodium spp. lineage LINN1 or P. relictum lineage GRW4. To the authors' knowledge, this is the first published report of Plasmodium spp. infection in great spotted and brown kiwi, kereru and kokako. Currently, we are only able to speculate on the origin of these 14 isolates but consideration must be made as to the impact they may have on threatened endemic species, particularly due to the examples of mortality.

Presence and seasonal prevalence of Plasmodium spp. in a rare endemic New Zealand passerine (tieke or Saddleback, Philesturnus carunculatus).

The conservation and management of Saddlebacks (Philesturnus carunculatus) and other New Zealand birds, currently relies on the translocation of individuals to predator-free sites. Avian malaria has been identified as one of the diseases to be tested for prior to translocations in New Zealand, with the aim of translocating disease-free individuals. We describe avian malaria lineages and their seasonal prevalence in 2007-2008 in Saddlebacks from Mokoia Island, a source of birds for translocations, and investigate their pathogenicity. Three lineages of avian malaria were found at low prevalence (≤10.6%) and parasitemia (all but one infection were below 1/10,000 erythrocytes), typical of chronic infections. Two lineages clustered with previously identified lineages of Plasmodium relictum and one with a lineage of Plasmodium (Huffia) elongatum. Prevalence of malaria infection was higher in the spring with no significant difference in prevalence between juvenile and adult birds. We found no effect of stress on infections or any indication of pathogenicity.

A new blood parasite within the relict endemic New Zealand gecko Hoplodactylus duvaucelii.

Duvaucel geckos (Hoplodactylus duvaucelii) are large endemic lizards that have been extirpated from the New Zealand mainland due to introduced mammalian predators. This species has subsequently become the subject of species translocation conservation management in an endeavour to increase the number of populations and as a part of island ecological restoration. Blood sampling of a captive adult male after tail autotomy led to the discovery of a Rickettsia-like organism within this gecko's erythrocytes. We conclude that this infection was acquired at the gecko's source location, a remote island closed to the general public and lacking potential invasive parasite reservoir reptiles. The likely vector is the native mite Geckobia naultina. This finding represents valuable new baseline information about the health parameters of this threatened species. Particularly in the light of the paucity of reported blood parasitism in New Zealand reptiles, the conservation management of this species through relocation and captive-breeding, and the on-going concerns regarding the introduction of novel parasites to New Zealand.

Attraction between sexes: male-female gametocyte behaviour within a Leucocytozoon toddi (Haemosporida).

Understanding the breeding systems of Plasmodium, and the closely related Haemoproteus and Leucocytozoon (Apicomplexa: Haemosporida), is fundamental to virulence and transmission research. We report an unusual binding behaviour between gametocytes of Leucocytozoon toddi. This aggregative behaviour was notably characterised by a disparity in the likelihood of clustering by female and male gametocytes. Thus, indicating a possible difference in the 'stickiness' of gametocytes per sex. Overall, 12% of gametocytes in this high-parasitaemia infection (0.269 gametocytes per 100 red blood cells (RBCs)) were incorporated into aggregations involving substantial contact. The gametocyte sexual combinations within aggregations varied significantly from expected according to the background 0.49 sex ratio within this sample, with female-female contacts occurring more and male-male contacts occurring less frequently than expected. A second L. toddi (identical for 709 bp of the cyt b mitochondrial gene) with lower parasitemia (0.035 gametocytes per 100 RBCs) showed no significant binding. Interestingly, the ratios of male gametocytes in both of these parasites were greater than expected under sex-ratio theory and similar to the 50% observed in species with syzygy breeding strategies. We discuss the ramifications of this observation in terms of sex-ratio theory and breeding strategies and provide speculative explanations for this unusual gametocyte behaviour.