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In spite of significant progress towards malaria control and elimination achieved in South America in the 2000s, this mosquito-transmitted tropical disease remains an important public health concern in the region. Most malaria cases in South America come from Amazon rain forest areas in northern countries, where more than half of malaria is caused by Plasmodium vivax, while Plasmodium falciparum malaria incidence has decreased in recent years. This review discusses current malaria data, policies and challenges in four South American Amazon countries: Brazil, Colombia, Peru and the Bolivarian Republic of Venezuela. Challenges to continuing efforts to further decrease malaria incidence in this region include: a significant increase in malaria cases in recent years in Venezuela, evidence of submicroscopic and asymptomatic infections, peri-urban malaria, gold mining-related malaria, malaria in pregnancy, glucose-6-phosphate dehydrogenase (G6PD) deficiency and primaquine use, and possible under-detection of Plas-modium malariae. Some of these challenges underscore the need to implement appropriate tools and procedures in specific regions, such as a field-compatible molecular malaria test, a P. malariae-specific test, malaria diagnosis and appropriate treatment as part of regular antenatal care visits, G6PD test before primaquine administration for P. vivax cases (with weekly primaquine regimen for G6PD deficient individuals), single low dose of primaquine for P. falcipa-rum malaria in Colombia, and national and regional efforts to contain malaria spread in Venezuela urgently needed especially in mining areas. Joint efforts and commitment towards malaria control and elimination should be strate-gized based on examples of successful regional malaria fighting initiatives, such as PAMAFRO and RAVREDA/AMI.
Challenges and opportunities for pursuing malaria elimination in Peru
2018
Recent history suggests that malaria can be eliminated in low-endemic countries, and there is a growing interest among key stakeholders from Peru to plan accordingly and achieve malaria elimination with a comprehensive programmatic goal. In support of this interest, this dissertation integrates a course of studies to inform and support such goal, by accounting for the two most important malaria transmission patterns that currently characterize Peru, the one affecting the Peruvian north coast and the other affecting the Peruvian Amazon basin. The first study will determine the impact of reactive case detection with focal mass drug administration (RCD/FMDA) as compared to passive case detection on reducing the regional annual parasite incidence in Tumbes, Peru (Paper 1). The second study will determine the impact of the malaria elimination program implemented in Tumbes on interrupting the transmission of malaria beyond the intervention area and along the Peruvian north coast (Paper 2). And the third study will determine whether further understanding the patterns of malaria incidence in Loreto, the main human malaria reservoir in Peru, may offer a variety of strategical targets for the malaria elimination program that was launched in Loreto, influencing as well the nearby regions at the Peruvian Amazon basin in 2017 (Paper 3). It has been observed that the malaria elimination program implemented in Tumbes, which was based on replacing passive case detection with RCD/FMDA strategy, had a significant effect on reducing the regional annual parasite incidence in Tumbes within the intervention areas (2/13 districts) during the first two years of the program (pilot project). When the strategy was scaled up across the entire Tumbes region, malaria transmission was halted with no endogenous cases for the following three years. Additionally, data suggest that the Tumbes intervention indirectly helped to interrupt malaria transmission in the nearby region of Piura. During the intervention in
Accelerating to Zero: Strategies to Eliminate Malaria in the Peruvian Amazon
In February 2014, the Malaria Elimination Working Group, in partnership with the Peruvian Ministry of Health (MoH), hosted its first international conference on malaria elimination in Iquitos, Peru. The 2-day meeting gathered 85 malaria experts, including 18 international panelists, 23 stakeholders from different malaria-endemic regions of Peru, and 11 MoH authorities. The main outcome was consensus that implementing a malaria elimination project in the Amazon region is achievable, but would require: 1) a comprehensive strategic plan, 2) the altering of current pro-grammatic guidelines from control toward elimination by including symptomatic as well as asymptomatic individuals for antimalarial therapy and transmission-blocking interventions, and 3) the prioritization of community-based active case detection with proper rapid diagnostic tests to interrupt transmission. Elimination efforts must involve key stakeholders and experts at every level of government and include integrated research activities to evaluate, implement, and tailor sustainable interventions appropriate to the region.
Meeting Report Accelerating to Zero: Strategies to Eliminate Malaria in the Peruvian Amazon
Am. J. Trop. Med. Hyg., 2016
In February 2014, the Malaria Elimination Working Group, in partnership with the Peruvian Ministry of Health (MoH), hosted its first international conference on malaria elimination in Iquitos, Peru. The 2-day meeting gathered 85 malaria experts, including 18 international panelists, 23 stakeholders from different malaria-endemic regions of Peru, and 11 MoH authorities. The main outcome was consensus that implementing a malaria elimination project in the Amazon region is achievable, but would require: 1) a comprehensive strategic plan, 2) the altering of current pro-grammatic guidelines from control toward elimination by including symptomatic as well as asymptomatic individuals for antimalarial therapy and transmission-blocking interventions, and 3) the prioritization of community-based active case detection with proper rapid diagnostic tests to interrupt transmission. Elimination efforts must involve key stakeholders and experts at every level of government and include integrated research activities to evaluate, implement, and tailor sustainable interventions appropriate to the region.