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After almost a decade of sustained decline, in 2016 and 2017, malaria cases have increased in many countries of the region. PAHO recommends strengthening detection, treatment and surveillance actions to control the disease.
Washington, D.C., February 2nd, 2018 (PAHO/WHO).- A new epidemiological update of the Pan American Health Organization (PAHO), issued on January 30th, recommends that countries of the Americas strengthen malaria surveillance and control actions given the rise in the number of cases in several countries of the region in 2016 and 2017.
This recommendation has been issued after almost a decade (2005–2014) of sustained decline in the number of malaria cases in the region, a trend that has now reversed. In 2016, nine countries (Colombia, Ecuador, El Salvador, Guyana, Haiti, Honduras, Nicaragua, Panama and Venezuela) reported an increase in the number of cases, and five countries (Brazil, Ecuador, Mexico, Nicaragua and Venezuela) did it last year.
In Venezuela, the National Focal Point for the International Health Regulations notified to PAHO that 319,765 malaria cases had been reported between the 1st and the 42nd week of 2017, which represents an increase with respect to the 240,613 cases reported in 2016.
Brazil notified 174,522 malaria cases between January and November 2017 in the Amazon region, which represents an increase compared to the 117,832 cases reported in 2016. In Mesoamerica, there was an increase in the number of cases in Nicaragua, where reported cases went from 6,209 in 2016 to 10,846 in 2017.
The update, which focuses on countries which experienced an increase during the past year, does not mention the situation in other countries which normally report a significant number of malaria cases. Colombia’s Pacific coast and Peru’s Amazon region are among the areas with the highest malaria transmission levels in the region, and they pose challenges for controlling the disease.
At the beginning of 2017, PAHO warned countries of the region about the risk of outbreaks, increase in the number of cases and deaths in endemic areas, as well as about the possible reestablishment of the disease in areas where transmission had been interrupted. For this reason, the update also draws attention to countries which, despite being malaria-free or having very few cases, have reported indigenous malaria transmission last year. Cuba and Costa Rica notified indigenous cases in 2017 and Honduras notified cases in an area where they had not been reported recently. Countries such as Ecuador and Mexico are also mentioned. There, transmission has decreased significantly over the past few years, but the number of cases increased in 2017. 1,279 cases were reported in Ecuador last year and 926 in 2016, while 704 cases where reported in Mexico in 2017 and 514 in the previous year.
PAHO warns that achievements made towards eliminating the disease could be compromised if surveillance and control actions are not maintained or strengthened. “Although PAHO member States have made efforts in response to that alert, the increase in cases during 2017 indicates the persistence of the constraints and gaps in the response,” points out the organization in the epidemiological update.
The existence of conditions of vulnerability and poverty in populations living in areas where the vector is present and the disease is transmitted, the prevalence of work and economic activities which increase the risk of exposure to vectors (e.g., mining, extraction of natural products and agriculture), as well as unplanned occupancy of lands are some of the factors behind the increase in cases. Mobile and migrant populations are particularly vulnerable due to their housing conditions and lack of social protection.
Recommendations
The WHO Regional Office for the Americas, PAHO, urges countries to strengthen actions for the surveillance and control of the disease, mainly measures related to early detection of cases, the timely diagnosis and the immediate initiation of treatment.
According to the update, the main action to control malaria transmission is to shorten the time period between the onset of symptoms and the treatment of the case, as well as its investigation and response.
PAHO also recommends providing diagnosis and complete treatment with antimalarials much closer to the communities at risk. It also urges to carry out complementary vector control activities, as well as to ensure the quality of the parasitological diagnosis and avoid the shortage of medicines.
Likewise, PAHO recommends countries of Central America, Hispaniola or malaria-free Caribbean territories to consider the risk of the importation of malaria cases due to chloroquine-resistant P. falciparum strains from countries of the Amazon region or other continents.
Links
– Epidemiological Update Increase of malaria in the Americas
– PAHO/WHO: Malaria
– Report on the Situation of Malaria in the Americas
– World Malaria Report