The changing epidemiology of malaria elimination: new strategies for new challenges - PubMed (original) (raw)

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The changing epidemiology of malaria elimination: new strategies for new challenges

Chris Cotter et al. Lancet. 2013.

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Abstract

Malaria-eliminating countries achieved remarkable success in reducing their malaria burdens between 2000 and 2010. As a result, the epidemiology of malaria in these settings has become more complex. Malaria is increasingly imported, caused by Plasmodium vivax in settings outside sub-Saharan Africa, and clustered in small geographical areas or clustered demographically into subpopulations, which are often predominantly adult men, with shared social, behavioural, and geographical risk characteristics. The shift in the populations most at risk of malaria raises important questions for malaria-eliminating countries, since traditional control interventions are likely to be less effective. Approaches to elimination need to be aligned with these changes through the development and adoption of novel strategies and methods. Knowledge of the changing epidemiological trends of malaria in the eliminating countries will ensure improved targeting of interventions to continue to shrink the malaria map.

Copyright © 2013 Elsevier Ltd. All rights reserved.

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Conflict of interest statement

Conflicts of interest

All authors work at the Global Health Group of the University of California, San Francisco, CA, USA. The Global Health Group exists in part to support global, regional, and country efforts to achieve evidence-based malaria elimination. JH works for the Centers for Disease Control and Prevention (CDC) supporting the President’s Malaria Initiative. MSH, AAP, JH, RDG, and RGAF serve as members of the Malaria Elimination Group. RGAF cochairs the Asia Pacific Malaria Elimination Network and the Global Health Group is the cosecretariat of the Network. The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of their employing organisations or of the sources of funding.

Figures

Figure 1:

Figure 1:. Categorisation of countries as malaria free, eliminating malaria, or controlling malaria, 2012

Adapted with permission from authors and publisher. See panel 1 for discussion.

Figure 2:

Figure 2:. Percentage reduction in annual parasite incidence (API) in the 34 malaria-eliminating countries, 2000–10

The Dominican Republic is the only country with increasing malaria incidence during this time.

Figure 3:

Figure 3:. The changing epidemiology of malaria in Sabah state, Malaysia, 1994–2011 (A); and in Sri Lanka, 1999–2011 (B)

Note logarithmic scale for the total confirmed malaria cases in figure 3B. Adapted with permission from the authors.,

Figure 4:

Figure 4:. Imported malaria in Saudi Arabia, 1999–2010

Imported malaria due to cross-border movement between Saudi Arabia and Yemen, mainly by migrant workers, poses the biggest risk to Saudi Arabia’s elimination goal. Saudi Arabia has reduced total malaria cases (indigenous and imported) by 85% from more than 13 000 cases in 1999, to fewer than 2000 in 2010. At the same time, the percentage of imported cases rose sharply, comprising less than 25% of total cases in 1999, and more than 99% in 2010.

Figure 5:

Figure 5:. Increasing importance of Plasmodium vivax in the Solomon Islands, 2001–11

Adapted with permission from authors.

Comment in

References

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