Tracking progress towards malaria elimination in China: estimates of reproduction numbers and their spatiotemporal variation

Isobel Routledge; Shengjie Lai; Katherine E Battle; Azra C Ghani; Manuel Gomez-Rodriguez; Kyle B Gustafson; Swapnil Mishra; Joshua L Proctor; Andrew J Tatem; Zhongjie Li; Samir Bhatt

There are several limitations to our study. Firstly, there is a limitation in the classification of local and 176 imported cases used in this study. For instance, the definition of importation used in case 177 classification is defined by travel to any malaria-endemic areas outside China in the month prior to 178 illness onset. This definition might include people who travelled abroad within the week prior to 179 illness onset, but biologically their infection could not have been obtained during that time given the 180 incubation period. However, in the absence of alternative information, travel history may provide a 181 better indication of the likely importation status of a case than attempting to infer importation 182 without this information, however there could be scope in future work to allow for incorrect travel 183 history. As certification of elimination is now tolerant of introduced (first generation imported-to-184 local transmission) but not indigenous (second generation local-to-local transmission) cases, being 185 . CC-BY-NC-ND 4.0 International license is made available under a The copyright holder for this preprint (which was not peer-reviewed) is the author/funder. It . https://doi.org/10.1101/628842 doi: bioRxiv preprint able to differentiate between the two, and understanding how much transmission is indigenous 186 versus imported or introduced is an important area of focus for future work. 187