October 17, 2022
Announcing the Outbreak:
- From January to August 2022, more than 3.4 million suspected malaria cases were reported in Pakistan compared to 2.6 million in 2021.
- More than 170,000 laboratory-confirmed cases, most of them due to Plasmodium vivax parasite.
- 78% of the confirmed cases were in Balochistan and Sindh provinces after devastating floods in mid-June 2022.
Malaria:
It is an infectious parasitic disease caused by a parasite called (Plasmodium), transmitted by mosquitoes and infiltrates red blood cells in human body, causing a group of symptoms, the most important of which are fever, anemia, and spleen enlargement. There are two types of malaria: Benign and Malignant. Benign malaria is less serious and more responsive to treatment, unlike malignant malaria. If the case is suspected to be infected with malignant malaria health care must be provided as soon as possible.
Disease Transmission:
- This disease is transmitted through more than one method, the most important of which is mosquitoes, which multiply after rain, especially in areas of poor healthy drainage of rainwater and sewage. Since this disease is a deadly disease, World Health Organization has recommended travelers thereto to use preventive medicine directly as soon as they feel temperature rise (during or after travel) to 38 C or when any symptoms of malaria appear without waiting for doctors diagnose.
- In very rare cases, the disease is transmitted from an infected mother to her fetus, or by transfusion of contaminated blood, or through a contaminated organ transplant, or through injection with a syringe used by a malaria infected person.
Symptoms and Diagnosis:
- Incubation period between infection and appearance of symptoms of disease, depends on the type of parasite, and in most cases ranges from 7 to 30 days.
- Most important symptoms are fever - chills - general feeling of being unwell - headache, nausea and vomiting, diarrhea - abdominal pain - joint or muscle pain - lethargy - rapid breathing - rapid heartbeat - coughing.
- Some people with malaria experience cycles of malaria “attacks.” The attack usually begins with shivering and chills, followed by a high fever, sweating, and then return to normal temperature.
- Signs and symptoms of malaria usually begin within a few weeks after being bitten by an infected mosquito. However, some types of parasites that cause malaria can remain dormant in the body for up to a year.
- Diagnosis depends on pattern of symptoms, history of the disease and environment in which the patient lives. When symptoms of malaria appear, two blood samples are taken at spaced intervals ranging between 6-12 hours to confirm presence and type of malaria parasite.
- Residents of a malaria-endemic area acquire partial immunity to the disease, which may reduce severity of malaria symptoms. However, this partial immunity may disappear if the infected person moves to a place where no longer exposed to the parasite frequently.
Treatment:
Malaria is treated with prescription medications to eradicate the parasite. Types of medications and duration of treatment vary depending on type of parasite, severity of symptoms, age, and presence of pregnancy.
Most common antimalarials include:
- Chloroquine medicines, which are common to get rid of malaria parasites. Parasites are resistant to chloroquine in many parts of the world and this drug is no longer an effective treatment.
- Artemisinin-based combination therapies. It is a combination of two or more medicines that work together to kill malaria parasite in different ways. This treatment is often preferred for treating chloroquine-resistant malaria. Examples include artemether-lumefantrine (Coartem) and artesunate-mefloquine.
Vaccine:
World Health Organization recommends the widespread use of Mosquirix (RTS,S/AS01) malaria vaccine in children living in regions with moderate to high transmission of P. falciparum. The vaccine has been shown to significantly reduce incidence of malaria and fatal severe malaria in children.
Protection:
- Prevention of mosquito bites by wearing long clothes, covering most parts of the body, and using mosquito repellents and insect detonators of all kinds.
- Sleeping under a bed net in case of living in rooms that do not have windows with insect-protective wire screens. Soaking mosquito nets in permethrin to prevent mosquitoes from approaching.
- Getting rid of stagnant water around homes or treating it and periodically spraying drains and ponds with pesticides or kerosene to kill mosquito larvae.
- The fumes intended to repel mosquitoes from home gardens.
- Avoid going out to open areas after sunset until dawn in areas where mosquitoes are spreading.
WHO Recommendations:
Adoption of the Global Technical Strategy on Malaria 2016-2030, updated in 2021, a technical framework for all malaria-endemic countries to guide and support regional and country programs in their quest for malaria control and elimination. The strategy sets ambitious and achievable global goals, including the following:
- Reduce malaria incidence rates by at least 90% by 2030.
- Reduce malaria mortality rate by at least 90% by 2030.
- Eliminate malaria in at least 35 countries by 2030.
- To prevent the re-emergence of malaria in all malaria-free countries.
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