High Plasmodium Infection Rate and Reduced Bed Net Efficacy in Multiple Insecticide-Resistant Malaria Vectors in Kinshasa, Democratic Republic of Congo

High and multiple resistance to insecticides are recorded in the 2 main malaria vectors in the Democratic Republic of the Congo, leading to a significant loss of efficacy of conventional bed nets in the presence of alarmingly high Plasmodium infection rate, suggesting high malaria transmission. Abstract Accounting for approximately 11% of all malaria cases, the Democratic Republic of the Congo (DRC) is central to malaria elimination efforts. To support vector control interventions in DRC, we characterized the dynamics and impact of insecticide resistance in major malaria vectors in 2015. High Plasmodium infection rates were recorded in Anopheles gambiae and Anopheles funestus , with Plasmodium falciparum predominant over Plasmodium malariae . Both mosquito species exhibited high and multiple resistance to major public health insecticide classes. The extremely high resistance to permethrin and DDT (dichlorodiphenyltrichloroethane) in An. gambiae (low mortalities after 6 hours exposure) is worrisome, and is supported by a reduced insecticidal effect of bed nets against both mosquito species in laboratory tests. Metabolic and target site insensitivity mechanisms are driving this resistance in An. gambiae , but only the former was observed in An. funestus . These findings highlight the urgent need for actions to prolong the effectiveness of insecticide-based interventions in DRC.