Accepted Manuscript
Title: First detection of Anopheles stephensi Liston, 1901
(Diptera: Culicidae) in Ethiopia using molecular and
morphological approaches
Authors: Tamar E. Carter, Solomon Yared, Araya
Gebresilassie, Victoria Bonnell, Lambodhar Damodaran,
Karen Lopez, Mohammed Ibrahim, Seid Mohammed, Daniel
Janies
PII:
DOI:
Reference:
S0001-706X(18)30561-8
https://doi.org/10.1016/j.actatropica.2018.09.001
ACTROP 4774
To appear in:
Acta Tropica
Received date:
Revised date:
Accepted date:
14-5-2018
1-9-2018
1-9-2018
Please cite this article as: Carter TE, Yared S, Gebresilassie A, Bonnell V, Damodaran
L, Lopez K, Ibrahim M, Mohammed S, Janies D, First detection of Anopheles stephensi
Liston, 1901 (Diptera: Culicidae) in Ethiopia using molecular and morphological
approaches, Acta Tropica (2018), https://doi.org/10.1016/j.actatropica.2018.09.001
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First detection of Anopheles stephensi Liston, 1901 (Diptera: Culicidae) in Ethiopia using
molecular and morphological approaches.
Tamar E. Carter1,2*+ Solomon Yared3*, Araya Gebresilassie3, Victoria Bonnell1, Lambodhar
Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9201
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Damodaran1, Karen Lopez1, Mohammed Ibrahim4, Seid Mohammed5, Daniel Janies1
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University City Blvd, Charlotte, NC, 28223, USA
Department of Biology, Baylor University, Waco, TX, 76798, USA
Department of Biology, Jigjiga University, Jigjiga, Ethiopia,
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College of Veterinary Medicine, Jigjiga University, Ethiopia
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Department of Animal and Range Science, Jigjiga University, Jigjiga, Ethiopia
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SY: solyar2005@yahoo.com
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TC: tamar_carter@baylor.edu
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AG: arayagh2006@yahoo.com
TB: vab18@psu.edu
LD: ldamodar@uncc.edu
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KL: klopez1@uncc.edu
MI: fahmi32@hotmail.com
SM: seid514@gmail.com
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DJ: djanies@uncc.edu
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*Authors contributed equally.
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+ Corresponding author
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Abstract
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Malaria is a major public health concern in Ethiopia. With the increase in malaria cases in
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the Somali Region of Ethiopia, understanding the distribution and identifying the species of
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malaria vectors is vital to public health. Here we report the first detection of Anopheles
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stephensi in Ethiopia, a malaria vector typically found in the Middle East, the Indian
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subcontinent, and China, but recently found in Djibouti.
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An entomological investigation was conducted during November to December 2016 in
Kebri Dehar town of the Ethiopian Somali Regional State as ancillary work for Anopheles spp.
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surveillance. Mosquito larvae were collected from water reservoirs. Larvae were reared in the
laboratory to the adult stage and identified morphologically. PCR and sequencing of cytochrome
oxidase 1 (COI) and internal transcribed spacer 2 (ITS2) loci were performed. Basic Local
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Alignment Search Tool (BLAST) was used to compare sample sequences to sequences in the
NCBI nucleotide database for species identification. To further analyze the relationship between
the specimen we collected in Kebri Dehar and other Anopheles samples available in Genbank,
phylogenetic analysis was performed using a maximum likelihood approach.
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Molecular and morphological results confirm specimens were An. stephensi. The closest
high scoring hit was for all specimens was for the An. stephensi sequence. Independent
phylogenetic analyses of COI and ITS2 sequences revealed in both cases strong bootstrap (100)
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support for our sequence forming a clade with other An. stephensi sequences to the exclusion of
any other species of Anopheles. In conclusion, Anopheles stephensi is present in Kebri Dehar
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town in Ethiopia. These findings highlight the need for additional research to examine the role of
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An. stephensi in malaria transmission in Ethiopia.
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Keywords: Malaria, Anopheles stephensi, Kebri Dehar, phylogenetics, Horn of Africa
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1. Background
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Malaria is a serious public health threat in Ethiopia, where over 68% of the population is
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at risk for infection and an average of 2.5 million cases are reported each year (World Malaria
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Report, 2017). Malaria transmission exhibits a seasonal and unstable pattern in Ethiopia, with
transmission varying with altitude and rainfall (Alemu et al., 2011). The highest levels of malaria
transmission are observed in the north, west, and eastern lowlands of Ethiopia (World Malaria
Report, 2017). In the eastern lowlands such as Afar and Ethiopian Somali Regional State
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(ESRS), malaria is endemic along the rivers where small-scale irrigation activities are practiced
for agricultural purposes (Malaria programme review - Aide Memoire, 2011).
Over the past few years, malaria has become a growing public health threat in multiple
zones and districts in Eastern Ethiopia (Bekele, 2016; Mohammed, 2015). Environmental
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changes are believed to be contributing with increased flooding being reported (Simane et al.,
2016). With the migration of people in search of fertile land for crop production and livestock
rearing along the river basin, there is concern that malaria transmission may continue to increase
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in and outside the region (Simane et al., 2016).
In addition to human movement, there are questions about the role of the mosquito vector
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population in the recent increase of malaria cases. Plans for malaria intervention and policy
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benefit from the knowledge of the specific malaria vector(s), in different regions of Ethiopia.
Various species of Anopheles exhibit different feeding and breeding patterns which in turn
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dictate malaria transmission timing and seasonality (Gone et al., 2014; Massebo et al., 2015).
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Thus, determining the species and their role in malaria transmission across Ethiopia are crucial
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for planning of malaria control efforts.
To date, forty-four species and subspecies of anopheline mosquitoes have been
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documented in Ethiopia (Systematic Catalog of Culicidae). The predominant malaria vector
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species in Ethiopia is Anopheles arabiensis (Massebo et al., 2013; Taye et al., 2006). Other
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common vectors include An. funestus, An. pharoensis, and An. nili (Krafsur, 1977; Lelisa et al.,
2017; Taye et al., 2006). These species vary in breeding preferences and feeding behaviors. An.
arabiensis is reported to feed both outdoors and indoors, is mostly zoophilic, and has exhibited
both indoor and outdoor resting behavior (Gone et al., 2014; Kenea et al., 2016; Massebo et al.,
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2015). An. arabiensis larvae have been found in seasonal habits of both natural and manmade
sources (Kenea et al., 2011). An. funestus has demonstrated both endophilic and exophilic
behaviors and has shown to be zoophilic in certain settings (Gone et al., 2014) and breed in
agricultural related puddles (Kibret et al., 2014). An. pharoensis has exhibited exophagic
behavior (Taye et al., 2006) and larvae have been detected in swamps and sand mining pools
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(Kenea et al., 2011). Most studies on malaria vectors in Ethiopia have focused on the west,
northern, and southern regions. However, entomological data on the Anopheles species
composition and vector role in the eastern portion of Ethiopia are sparse. The limited mosquito
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surveys and molecular studies are due to remoteness and security challenges of the region.
Accordingly, an entomological survey was undertaken with the aim of determining the
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bionomics of Anopheles mosquitoes in ESRS. Here we report the results of a study of Anopheles
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mosquitoes in ESRS in which we found Anopheles stephensi, a species primarily observed east
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of the Red Sea.
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2. Methods
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2.1. Description of study area
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The current study was undertaken in Kebri Dehar, in the ESRS in eastern Ethiopia
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(Figure 1). Kebri Dehar is located 1035 km from Addis Ababa. The topography of the study
area is predominantly lowland plain with an average altitude of 493 meters above sea level with
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a few foothills of higher altitude. The study area has a latitude and longitude of 6°44’25’’N, 44°
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16’38’’E, respectively. The area has sparse shrubs and trees, including different species of
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Figure 1. Map of study site Kebri Dehar.
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Acacia and incense trees.
The climate of Kebri Dehar is characterized as tropical semiarid. The region's
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temperature ranges from 23-30 °C. The area has bimodal rainfall pattern. The first and main
rainy season ‘Gu’ occurs from mid-April to the end of June. A secondary rainy season known as
‘Deyr’ occurs from early October to late December. Overall the annual precipitation averages
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200 mm. Despite these patterns, the rainfall pattern is variable making the area prone to recurrent
droughts that can last several months.
The inhabitants of the district are largely pastoralists, who raise cattle, camels, sheep and
goats. Sorghum and maize are the main staple food crops in the area. Based on figures from the
Ethiopian Central Statistical Agency in 2007, Kebri Dehar has an estimated population of
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100,191 of whom 51,327 are men and 48,864 are women (Central Statistical Agency of Ethiopia,
2007). Typically, each house contains a cement tank used as a water reservoir. The type of house
in the study area is mainly rectangular with a corrugated iron roof and cement walls. The study
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area was selected as a sentinel site of malaria and is sprayed with carbamate insecticides during
active malaria season in collaboration with the Federal Ministry of Health (FMOH) and the
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Regional Health Bureau.
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2.2. Larval sampling and morphology
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Mosquito larvae and pupae were collected from the water reservoirs between November
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to December 2016 (Figure 2). We selected 10 larval sites based on the presence and density of
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larvae and pupae, and optimal time in the area. Dipping was done following WHO guidelines
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and standard operating procedures for entomological surveillance techniques (World Health
Organization, 1992). The anopheline larvae collected were recorded according to their stage of
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development as either first to second instars (early) or third to fourth (late) instars. The larvae
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and pupae were transported to the field laboratory with jars and put in enamel trays. Larvae and
pupae were reared at the field lab to adulthood in Kebri Dehar and they were maintained at 28 ±
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20C and 70 ± 10% relative humidity. The pupae were sorted and transferred with pipettes from
the enamel trays to beakers with small amounts of water. Each beaker was placed inside a cage
for rearing. Pupae were provided with 10% sugar in the cage. After two to three days the pupae
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emerged to adults and the cages were put in safe place protected from contamination, ants, and
other insects. The adults were collected using an aspirator, transferred to paper cups, and killed
using chloroform for further species identification using morphological keys.
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Figure 2. Collection of larvae from breeding habitats (water reservoirs) in Kebri Dehar town.
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Emerged adults were identified to species level using dissecting microscope and
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magnifying lenses at 10x magnification. Mosquitoes were identified to species based on
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morphological characters of their palps, wings, abdomen and legs using standard identification
keys (Gillies and Coetzee, 1987; Glick and Walter Reed Biosystemsatics Unit, 1992). Following
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the identification of species based on morphological characters, 529 adult mosquito specimens
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were shipped to the University of North Carolina at Charlotte for molecular analysis.
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2.3. DNA extraction, amplification, and sequencing
DNA was extracted from the head and thorax of the mosquitos using the DNeasy Blood
and Tissue Kit (Qiagen, Valencia, CA). The polymerase chain reaction (PCR) was performed
for each individual mosquito, targeting the mitochondrial cytochrome c oxidase subunit 1 gene
(COI) and the nuclear internal transcribed spacer 2 (ITS2) region. The reagent components and
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concentrations for the PCR assays were 1x Promega HotStart Master Mix (Promega, Madison,
WI) and 0.4mM or 0.5mM for each primer of COI and ITS2, respectively, plus 1µl of isolated
DNA template. For the COI assay, universal primers that amplifies a portion of the gene was
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utilized using previously published protocols (Folmer et al., 1994; Saeung et al., 2007), with
expected amplicons between 658 to 710 bp. The PCR protocol was as follows: 95°C 1 min; 30
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cycles of 95°C 30 sec, 48°C 30 sec, 72°C 1 min; 72°C 10 min. For the ITS2 assay, a 650 bp
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region including the gene was PCR amplified using universal primers previously detailed in
Djadid et al. (2006). PCR temperature protocol consisted of 95°C for 2 min, 30 cycles of 95°C
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for 30 s, 50°C for 30 s, and 72°C for 1 min; followed by 72°C for 5 min. All primers used are
Sequence
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Primer
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listed in Table 1.
GGTCAACAAATCATAAAGATATTGG
COI
5.8S
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ATGCTTAAATTTAGGGGGTAGTC
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28S
ATCACTCGGCTCGTGGATCG
Folmer et al.
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1994
TAAACTTCAGGGTGACCAAAAAATCA COI
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HCO2198R
Annealing
Temperature
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LCO1490F
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Name
Locus Reference
Folmer et al.
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1994
ITS2
Djadid et al.
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2006
ITS2
Djadid et al.
50
2006
Table 1. Primers used for PCR amplification.
PCR products were cleaned using ExoSAP. Amplicons were sequenced using Sanger
technology with ABI BigDyeTM Terminator v3.1 chemistry (Thermofisher, Santa Clara, CA)
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according to manufacturer recommendations and run on a 3130 Genetic Analyzer (Thermo
Fisher, Santa Clara, CA). Sequences were analyzed using Codon Code Aligner Program V. 6.0.2
(CodonCode Corporation, Centerville, MA). Sequences from Anopheles from Ethiopia were
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submitted to the National Center for Biotechnology Information's (NCBI) Basic Local
Alignment Search Tool (BLAST) (Altschul et al., 1990) against the nucleotide collection in
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Genbank to find other Anopheles sequences that formed high scoring similarity pairs (HSP) at
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the NCBI web server using these values (i.e. max hsp 500, expect threshold 10, word size 28).
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2.4. Phylogenetic Analysis
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Phylogenetic analysis was performed with the sequence data collected from the
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Anopheles specimens isolated in Ethiopia and closely related within the Anopheles genus found
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in Genbank’s nucleotide database ( https://www.ncbi.nlm.nih.gov/nuccore) for both the COI and
ITS2 sequences separately. Alignments were created with MAFFT version 7 (Katoh and
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Standley, 2013) and were trimmed using MEGA version 7 (Kumar et al., 2016). Phylogenetic
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relationships between the Ethiopian samples we created and samples accessed via Genbank
sequences were inferred using a maximum likelihood approach with RAxML (Stamatakis,
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2014). We applied the GTRGAMMA option that uses GTR model of nucleotide substitution
with gamma model of rate of heterogeneity. A total 100 runs were completed with a strategy to
identify the heuristically-best-scoring tree under the maximum likelihood criterion and rapid
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bootstrap analysis in one run. Outgroups were chosen based on availability of data in Genbank
and reported relatedness from previous studies (Alam et al., 2008; Harbach and Kitching, 2016).
Anopheles implexus and Anopheles sawadwongporni were assigned as the outgroup for COI
analysis and ITS2 respectively. RAxML output was viewed in FigTree (Rambaut, 2007), rooted
on the outgroup, and a final phylogenetic tree image was created.
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3. Results
Both molecular and morphological data confirmed the larvae were Anopheles stephensi
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based on the following analyses:
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3.1. Morphological analysis
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In total, 535 larval samples were collected and reared to adulthood. Each adult mosquito
emerged from the pupa was identified to species level using morphological characters under a
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dissecting microscope, two days of post emergence. The following characteristics were
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observed: the palps were smooth with three distinct pale bands and pale spots were also present
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in the maxillary palps, the palpomere four is white at the base and apex, and the palpomere five
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was completely pale. The legs femora and tibiae were speckled with pale scales. The abdominal
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terga II-VIII and sterna V-VIII were covered with pale scales. The wing anal vein had 3 dark
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3.2. Genetic analysis
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spots and its scutal fossa was covered with scattered pale scales.
Thirty-six samples were selected at random for genetic analysis. Each specimen had
identical COI and ITS2 sequences. BLAST of Genbank nucleotide collection under default
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settings with COI and ITS2 from the Kebri Dehar samples as query sequences matched to An.
stephensi sequences with 99% identity and 100% identity for COI and ITS2 sequences,
respectively. Sequences from Kebri Dehar were deposited in Genbank (MH650999 for ITS2,
and MH651000 for COI).
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Phylogenetic analyses were performed for COI and ITS2 separately to confirm the
species identified through BLAST search. COI phylogenetic analysis included 129 top highscoring segment pair (HSP) sequences retrieved from Genbank via Nucleotide BLAST (Altschul
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et al., 1990) analysis from background specimens that had sufficient geographic metadata
(Supplemental File 1). Sequences were collected from the following species: An. annularis, An.
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arabiensis, An. argyritarsis, An. azaniae, An. coluzzii, An. culicifacies, An. dthali, An. gambiae,
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An. implexus, An. intermedius, An. jeyporiensis, An. lepidotus, An. minimus, An. minimus C, An.
nr. dravidicus YML2012, An. pampanai, An. sawyeri, An. splendidus, An. stephensi, and An.
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varuna. An. stephensi sequences were collected from Pakistan, India, Djibouti, Sri Lanka, Iran,
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and Saudi Arabia. The final alignment was trimmed to 618 base pairs (Supplemental File 2). In
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total, 175 variable sites were identified across all taxa. Within the 44 An. stephensi sequences, 65
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variables sites were identified. Phylogenetic analysis of the alignment revealed strong bootstrap
support for the sequence from the Ethiopian sample forming a monophyletic clade with all other
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An. stephensi sequences. The bootstrap value for the key clade was 100% (see arrow in Fig. 3).
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Figure 3. Phylogeny of COI sequence from Anopheles isolates. Bootstrap values >70 for notable species clades
shown at nodes. Nodes without numbers had a value <70. Ethiopian sequenced isolated denoted with arrow. Final
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ML Optimization Likelihood: -3549.017267. Sequences with no country listed or country incorrectly listed in
Genbank are labeled as NCL.
Figure 4. Phylogeny of COI sequence from Anopheles stephensi isolates. Bootstrap values >70 shown at nodes.
Nodes without numbers had a value <70. Final ML Optimization Likelihood: -1252.592081. Ethiopian sequenced
isolated denoted with arrow.
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To better investigate the relationship with the Ethiopian An. stephensi sequenced isolate with
sequenced isolates from other countries, phylogenetic analysis was performed with only An.
stephensi COI sequences that contained accurate location details using An. maculatus as the
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outgroup (Figure 4, Supplemental File 3). Our results show the Ethiopian isolate is sister to the
clade that contains
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isolates from Pakistan, India, Iran, Sri Lanka, and Djibouti. The bootstrap value of the key clade
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is 100 percent (see arrow in Fig. 4). The analysis also indicated that the Ethiopian An. stephensi
is most closely related to a Pakistan sequenced isolate.
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Similar results were observed for the ITS2 phylogenetic analysis. ITS2 phylogenetic
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analysis included 35 sequences from NCBI (Supplemental File 4) that formed HSPs with the
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sequence from the Ethiopian sample forming in the BLAST search and had sufficient geographic
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metadata. The following species were included in the analysis: An. stephensi, An. willmori, An.
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maculipalpus, An. maculatus, and An. sawadwongporni. The final alignment was trimmed to 350
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base pairs. In total, 112 variable sites were identified across taxa. All An. stephensi sequences
were identical except for one (HQ703001) which had 40 variables sites compared the other An.
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stephensi sequences. The ITS2 alignment included multiple gaps and a microsatellite region. As
with COI, the Ethiopian ITS2 sequence shared a clade with other An. stephensi isolates to the
exclusion of other species with a bootstrap value of 100 percent for the key clade (see arrow in
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Fig. 5).
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Figure 5. Phylogeny of ITS2 sequence from Anopheles stephensi isolates. Bootstrap values >70 shown at nodes.
Nodes without numbers had a value <70. Final ML Optimization Likelihood: -1104.708501. Ethiopian sequenced
isolated denoted with arrow.
4. Discussion
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Here we illustrate for the first time the presence of Anopheles stephensi in Ethiopia with
both molecular and morphological evidence. Both COI and ITS2 phylogenetic analysis confirm
the monophyly of Ethiopian An. stephensi specimens with other An. stephensi specimens to the
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exclusion of other species of Anopheles. The differentiation of An. stephensi isolates from
Anopheles gambiae complex isolates, including An. arabiensis, is consistent with previous
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phylogenetic studies (Hao et al., 2017; Jiang et al., 2014). While COI showed more sequence
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diversity across the Anopheles species, ITS2 is more conserved. The morphological data also
support the identification of An. stephensi. Morphology of the specimen resembled the features
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for the An. stephensi reported in Sri Lanka (Gayan Dharmasiri et al., 2017).
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The finding of An. stephensi in Ethiopia is unexpected. Previous sources describe An.
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stephensi's range being restricted to east of the Red Sea (Gaffigan; Sinka et al., 2011). One recent
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exception is the detection of An. stephensi in Djibouti in 2013 during a malaria outbreak (Faulde
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et al., 2014). The authors of the Djibouti report speculate that the source of the outbreak was host
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migration from Ethiopia. While host movement likely plays a role in cross transmission of
malaria, it will be very important to investigate how vector movement may also contribute to
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transmission across political borders. In our An. stephensi species phylogenetic analysis (Figure
4), the Djibouti sequenced isolate is in a distinct clade to the clade containing the isolate from
Ethiopia suggesting different introductions to the Horn of Africa. Interestingly, the sister isolate
for Anopheles stephensi in Ethiopia was from Pakistan. Additional genetic analysis of samples
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from the Horn of Africa, the Middle East, and other regions within An. stephensi’s range can
provide needed information on the origin and movement of An. stephensi.
We establish some working hypotheses about the arrival of the Ethiopian An. stephensi in
Ethiopia. Some competing scenarios are possible: 1) An. stephensi was recently introduced into
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Ethiopia. The COI data currently shows that the Ethiopian isolate is most closely related to a
Pakistani isolate. Further analysis of mosquitoes from South Asia, the Middle East, and the
Arabian Peninsula can provide more granular information about the timing and source of An.
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stephensi in the Horn of Africa. 2) An alternative hypothesis is that An. stephensi has been
present in Ethiopia for a long time but undetected. There are some morphological similarities
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between An. stephensi and An. arabiensis, which is considered the dominant vector in most of
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Ethiopia. Therefore, it is possible that An. stephensi has been overlooked or misidentified over
the years and came from the other side of the Red Sea a long time ago. Our findings highlight the
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need for wider survey of the malaria vectors in Ethiopia. Here we show that sequence-based
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methods are particularly useful for differentiating the species that may be morphologically
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similar.
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Finding An. stephensi in Ethiopia has important public health implications. An. stephensi,
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like An. arabiensis, has demonstrated both indoor and outdoor behaviors but is most often
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endophagic (Manouchehri et al., 1976; Tirados et al., 2006). If the same endophagic behavior
patterns are observed in Ethiopia, different malaria control strategies may need to be
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implemented. Additionally, more studies are needed to determine the vector compentency of An.
stephensi in Ethiopia for Plasmodium spp. Wild-caught mosquitoes will be surveyed to confirm
the transmission of Plasmodium in the region and to identify which parasite species is being
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transmitted. Ethiopia is one of the few countries in Africa where P. vivax and P. falciparum are
both actively transmitted (Carter et al., 2018; Tadesse et al., 2018; World Health Organization,
1992). In the Somali Region, P. falciparum is believed to the be the primary species. An.
stephensi’s ability to carry both Plasmodium falciparum and Plasmodium vivax, as observed in
other areas (e.g. India and Djibouti) (Balabaskaran Nina et al., 2017; Faulde et al., 2014; Thomas
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et al., 2017), makes it a public health concern for this region. In addition to studies of behavior,
range, and vector competence for An. stephensi, studies on An. stephensi's sensitivity or
resistance to insecticides will provide important information on the type of vector control
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interventions to implement.
To gain better insight into the geographic range of An. stephensi, the next step is to
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conduct mosquito surveys in multiple locations throughout Ethiopia. Much of the effort should
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center on the eastern portion where information on malaria vectors in general is scarce. Both
rural and urban surveys are needed, particularly to investigate the role that livestock presence
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plays in An. stephensi abundance. All target sites should include both larvae and adult
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collections. Sampling ten additional study sites with two sample collection time points will
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provide preliminary information on the temporal, epidemiological, geographic, and climatic
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design a long-term surveillance study.
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variation of the distribution Anopheles population in Ethiopia. This information will be used to
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In conclusion, this study describes the first confirmed report of An. stephensi in Ethiopia.
The identification of An. stephensi in Ethiopia has important implications for understanding
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malaria transmission in Ethiopia. The results of this study contribute the broader understanding
of malaria vector composition in the ESRS and in Ethiopia as a whole.
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Abbreviations
BLAST: Basic Local Alignment Search Tool
COI: Cytochrome c oxidase subunit 1 gene
DNA: Deoxyribonucleic Acid
ESRS: Ethiopian Somali Regional State
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FMOH: Federal Ministry of Health
ITS2: Internal transcribed spacer 2 region
NCBI: National Center of Biotechnology Information
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PCR: Polymerase chain reaction
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Declarations
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Competing interests
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published before or submitted elsewhere for publication.
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The authors declare that they have no competing interest exist and the manuscript has not been
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Availability of data and material
The datasets supporting the conclusions of this article are included within the article and its
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Funding
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supplemental files. Sequences have been submitted to NCBI Genbank database.
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This study was financially supported by Jigjiga University. This project was partially funded by
the University of North Carolina at Charlotte Multicultural Postdoctoral Fellowship.
Acknowledgements
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Our gratitude goes to Mr. Negib Abdi and Habtamu Atlaw for their facilitating financial and
arranging the car for the field work. It is our great pleasure to thank Mr. Geleta Bekele for his
technical support in rearing mosquito at field laboratory. The authors would also like to thank
Dr. Ronald Clouse for his helpful suggestions. We acknowledge the University of North
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Carolina at Charlotte and entities within (i.e. the Department of Bioinformatics and Genomics,
The College of Computing and Informatics, Academic Affairs, and the Graduate School) for
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salary and logistical support.
National Statistics. 2007. http://www.csa.gov.et/
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World Malaria Report. World Health Organization. 2017.
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Malaria programme review - Aide Memoire. Ministry of Health 2011.
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