Malaria Elimination

1
Malaria Elimination

• Dr A.Kondrachine

2
Development of Concept of Disease/Infection
Elimination
3
WHO Concepts of Disease/InfectionEliminati
on
4
Elimination as Public Health Problem
5
Elimination as a Public Health Problem and
Interruption of Transmission

• Chagas disease (1998)- in all endemic countries
  of Latin America
• Lymphatic filariasis (1997)
• Onchocerciasis in the Americas (1991)- in 6
  countries
• Dracunculiasis (2002 2005) eradication
  country-by-country certification of elimination
  of transmission by International Commission

6
Concept of Malaria Elimination

• Practical eradication of malaria malaria
  incidence reached in NMCP the level of less 0.1
  per 100 000 population (USSR, China, North
  Vietnam during 1960s)
• In the NMEPs, malaria elimination status roughly
  corresponded to the last year(s) of consolidation
  phase
• In Europe, USA, Australia, malaria eradication
  was achieved in the course of implementation of
  malaria control in a staged manner, initially by
  elimination malaria as a public health problem
  and then by interruption of malaria transmission

7
Concepts by Agencies outside WHO

• Elimination of communicable disease connotes the
  reduction of case transmission to a predetermined
  very low level (Last, JM 2001)
• Elimination of disease is a reduction to zero of
  the incidence of a specified disease in a defined
  geographical area as a result of deliberate
  efforts. Continued intervention measures are
  required (ITFDE, cited by Molyneux et al, 2004)
• Elimination is a local reduction to zero of the
  incidence of infection because infection can be
  imported from other areas that are still endemic,
  permanent intervention is required to maintain
  elimination as a stable state of the trivial
  equilibrium (Duerr et al,2005)

8
CONCLUSION

• WHO concept of disease/infection elimination
  applicable to malaria
• Elimination of malaria is a logical transition
  from effective control to malaria eradication
• The eventual goal of malaria eradication may be
  achieved firstly through the elimination of
  disease as public health problem with subsequent
  interruption of local transmission
• Concept of malaria eradication needs
  re-assessment by WHO

9
Malaria Elimination in WHO EMROTargets

• Elimination of Local Transmission Egypt, Syria,
  Morocco
• Elimination as Public Health Problem and
  Interruption of Local Transmission Islamic
  Republic of Iran, Saudi Arabia
• Maintenance of Malaria Free Status- Jordan,
  Qatar, Bahrein, Kuweit, Oman, United Arab
  Emirates, Lebanon

10

• Strategies for Elimination of Residual Malaria
  Foci

11
Concept of Malaria Focus

• Malaria focus a defined and circumscribed
  locality situated in a currently or formerly
  malarious area and containing the continuous or
  intermittent epidemiological factors necessary
  for malaria transmission (WHO, 1963)
• A focus of infection is an integration of the
  interactive populations of the parasite,hosts and
  vectors that support its existence (Beklemishev,
  1970)

12
Commitments

• Political Commitment
• Resource Allocation
• RBM Partnership

13
Preparatory Stage

• Needs assessment exercise
• Meeting of requirements
• Training of personnel (specialized service,
• Basic health service, private sector)
• Collection and analysis of information on malaria
  foci
• General information

14
Preparatory stage (cont.)

• Physiography
• Entomology and related information
• GIS, GPS
• Meteorology
• Population characteristics
• Malaria season, details of malaria transmission
• Assessment of feasibility of malaria elimination

15
Preparatory stage (cont.)

• Epidemiological investigation and classification
  of cases
• - induced case by contaminated blood
• - imported case contracted outside
• - relapsing case
• - introduced case contracted locally
• from imported
• - indigenous case- contracted locally from
• any other case

16
Preparatory stage (cont.)

• Operational classification of foci
• - Duration of existence residual or
• new
  
• - Current malaria transmission non-
• active, active, potential

17
Types of Malaria Foci

• Residual foci
• - non-active (transmission interrupted no
  indigenous
• possible occurrence of relapsing cases)
• - active ( transmission not interrupted)
• New foci
• - potential (presence of imported cases no
  evidence of transmission, but renewal possible)
• - active ( renewed transmission)

18
Attack Stage

• Selection of anti-malaria measures
• Plan of Action developed
• Detection, diagnosis and treatment
• Mass fever and mass drug administration
• Chemoprophylaxis

19
Vector Control

• Integrated Vector Control
• Anti-larval measures
• Indoor residual spraying
• Space spraying
• Personal protection measures
• Bio-environmental management

20
Role of Different Partners

• General Health Services
• Specialized Health Services
• Private sector
• Intersectoral cooperation
• International cooperation
• Cooperation in border areas

21
Evaluation and Monitoring

• Integrated Information system
• Integrated Surveillance system
• Use of Indicators
• Exchange of Information
• Verification of Interruption of Transmission

22
Prevention of Malaria Reintroduction
23
CHALLENGES

• Inadequate availability of international
  information on malaria status in different areas
• Inadequate cooperation between malaria countries,
  especially in border areas
• Risk of introduction of multi-resistant
  P.falciparum
• Difficulties to trace imported cases
• Inadequacies in malaria vigilance
• Lack of awareness of malaria re-introduction into
  malaria free areas among GHS staff
• Inadequacies in malaria training

24
Role of Malaria Surveillance

• Malaria surveillance as a part of General
  Surveillance
• Information collection, analysis, exchange,
  dissemination
• Epidemiological investigation of foci, cases,
  analysis of malariogenic potential
• Monitoring and assessment of preventive measures

25
Prevention and Control of Re-introduced Malaria

• Sustained surveillance of fever cases by various
  diagnostic measures
• Availability of reagents, antimalarials,
  materials, equipment
• Training and re-training of personnel
• Epidemiological Malaria Early Warning System
• - forecasts average seasons weather
• - increase in mosquitoes density and
  survival
• - Vector dynamics (entomological
  inoculation
• rate)

26
Prevention (cont.)

• Monitoring and use of indicators
• Diagnosis and treatment of introduced cases
• Emergency preparedness
• Training of personnel
• Operational research
• Role of different health services
• Role of Ministry of Health