HCDCP

World Malaria Day, 25 April 2019 “Zero malaria starts with me”

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25.04.2019

Every year we celebrate the World Malaria Day on 25th April, as an opportunity to emphasize the need for constant mobilization and political commitment, towards the gloval prevention and control of malaria.

After more than a decade of steady advances in fighting malaria, progress has leveled off. According to WHO’s latest World malaria report, no significant gains were made in reducing malaria cases in the period 2015 to 2017. The estimated number of malaria deaths in 2017, at 435 000, remained virtually unchanged over the previous year.

The WHO African Region continues to account for approximately 90% of malaria cases and deaths worldwide. It is alarming that in 10 African countries hardest hit by malaria (Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Uganda and United Republic of Tanzania), there were an estimated 3.5 million more cases of malaria in 2017 over the previous year.

The key to success is to empower communities to take ownership of malaria prevention and care

WHO underlines that urgent action is needed to get the global response to malaria back on track, and that this challenge could be met if ownership of the actions lies in the hands of countries most affected by malaria. On World Malaria Day 2019, WHO joins forces with organizations, the African Union Commission and the RBM Partnership to End Malaria, in order to promote the campaign “Zero Malaria starts with me”. This campaign aims to:

“Zero Malaria starts with me”

This campaign first launched in Senegal in 2014 and was officially endorsed at the African Union Summit by all African Heads of State in July 2018. It engages all society members:

As the WHO Director General, Dr Tedros Adhanom Ghebreyesus, has noted, individual and community empowerment through grassroots initiatives like the “Zero malaria” campaign can play a critical role in driving progress in the global malaria fight:

 

“Globally, the world has made incredible progress against malaria. But we are still too far from the end point we seek: a world free of malaria. Every year, the global tally of new malaria cases exceeds 200 million. And every 2 minutes, a child dies from this preventable and treatable disease. The damage inflicted extends far beyond loss of life: malaria takes a heavy toll on health systems, sapping productivity and eroding economic growth. Ultimately, investing in universal health care is the best way to ensure that all communities have access to the services they need to beat malaria. Individual and community empowerment through grassroots initiatives like “Zero malaria starts with me” can also play a critical role in driving progress.”

Key messages

Since 2000, malaria-affected countries and their development partners have made remarkable progress in reducing the total number of malaria cases and deaths. However, the toll of malaria remains unacceptably high. Every two minutes, a child dies of this preventable and treatable disease. And each year, more than 200 million new cases of the disease are reported. WHO is particularly concerned by trends seen in recent years (since 2015). Our latest World malaria report shows that progress has leveled off and, in some countries, malaria is on the rise.

Changing the trajectory of current malaria trends will require stepped-up and coordinated action by all stakeholders. But progress can only be achieved through malaria responses that are country-owned.

Malaria by numbers: global and regional malaria burden

In 2017, there were an estimated 219 million cases of malaria in 87 countries. No significant gains were made in reducing malaria cases in the period 2015-2017. The estimated number of malaria deaths in 2017 stood at 435 000, a similar number to the previous year.

The WHO African Region continues to account for approximately 90% of malaria cases and deaths worldwide.  In the 10 African countries hardest hit by malaria (Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Uganda and United Republic of Tanzania), there were an estimated 3.5 million more cases of malaria in 2017 over the previous year.

Estimated malaria burden by WHO region in 2017

 WHO region Malaria cases Malaria deaths
African 200 million 403.000
Americas 976.000 630
East Mediterranean 4,4 million 8.300
South-East Asia 11,3 million 19.700
Western Pacific 1,9 million 3.620
World 219 million 435.000

Source: World malaria report 2018

 

Global targets and funding

In view of recent data and trends, progress towards two critical targets of the Global Technical Strategy for Malaria 2016–2030 (GTS) – reducing malaria case incidence and death rates by at least 40% by 2020 – is off track.

Funding for the global malaria response in 2017 remained largely unchanged when compared to 2016. US$ 3.1 billion was available for global malaria control and elimination programmes in 2017, well below the GTS funding target for 2020 US $6.6 billion).

 

Gaps in access to core tools

The latest World malaria report highlights major coverage gaps in access to core WHO-recommended tools for preventing, detecting and treating malaria, particularly in the world’s highest burden countries.

“High burden to high impact”

As a response to the data and trends published in the World malaria report, WHO and the RBM Partnership recently catalyzed “High burden to high impact,” a new approach to intensify support for countries that carry a high burden of malaria, particularly in Africa. The approach is founded on 4 pillars:

1. Political will to reduce malaria deaths

2. Strategic information to drive impact

3. Better guidance, policies and strategies

4. A coordinated national malaria response

Pillar 1 calls on leaders of malaria-affected countries to translate their stated political commitments into resources and tangible actions that will save more lives. To this end, campaigns that engage communities and country leaders – like “Zero malaria starts with me” – can foster an environment of accountability and action.

 

Signs of hope

While progress in the global response to malaria has levelled off, a subset of countries with a low burden of malaria is moving quickly towards elimination.  In 2017:

China and El Salvador reported zero indigenous cases of malaria in 2017 – a first for both countries.

Countries that achieve at least 3 consecutive years of zero indigenous cases can apply for an official WHO certification of malaria elimination. In 2018, two countries reached this milestone: Paraguay and Uzbekistan.

Some countries with a high burden of malaria are also making strong strides in reducing their burden of the disease.

Prospects for new interventions

Boosting investments in the development and deployment of a new generation of malaria tools is key to achieving the 2030 global malaria targets.

For vector control, new interventions that target outdoor-biting mosquitoes are being explored. New chemical formulations to mitigate the threat of insecticide resistance are under development, as are new strategies to improve the delivery of treated nets and indoor spraying.

 

Source of this informative material: World Health Organization (WHO) https://www.who.int/campaigns/world-malaria-day/world-malaria-day-2019

 

General facts about malaria

Malaria is an infectious disease which is caused by the parasite “plasmodium” of malaria and is transmitted through the bite of an infected mosquito of the “Anopheles” genus. These insects become infected when they bite patients with parasitaemia. These mosquitoes are more active from the dusk until the dawn and lay their eggs on stagnant water.

There are five plasmodium species which infect humans: Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, Plasmodium malariae and Plasmodium knowlesi. From the above mentioned species, the most common are P.falciparum and P.vivax.

The clinical presentation of the disease varies from asymptomatic (in persons from endemic countries who have been sick in the past and develop partial immunity to the disease) to serious illness and death (mainly in P.falciparum infection). The most common symptoms of malaria (chills, high fever, sweating, malaise, headache and muscle aches) manifest usually 1-4 weeks after infection with the parasite, while relapses of the disease are usually observed in short intervals but up to five -and in extreme cases even up to eight- years after P. vivax and P. ovale infections (if not properly treated). P.falciparum, the most widespread plasmodium in African continent, causes the most serious and fatal type of illness, while the infection from other plasmodium species is usually not life- threatening. Travelers from non endemic countries, who are not immune to malaria, can get severely ill if infected.

Malaria is a curable disease and a number of effective anti-malarial drugs are available to treat the infection; starting the treatment promptly is essential in avoiding complications and interrupting the transmission of the disease in the community

More information regarding malaria you can find at NPHO website.

 

Global epidemiological malaria data, 2017

(source: World malaria report, 2018, WHO)

Malaria is endemic –with ongoing transmission- in 87 countries/ areas globally (Figure 1)

 

 

 

Figure 1. Countries with indigenous local malaria transmission in 2010 and the situation in 2017 (source: World malaria report, 2018, WHO)

 

 

Malaria surveillance data in Greece

Malaria was eliminated from Greece in 1974, following an intense control program (1946- 1960). Since then and up to 2017, several (20-110 cases) imported cases were reported annually to the HCDCP (currently NPHO) referring to patients infected abroad (returning travelers or migrants from malaria endemic countries). Increased numbers of imported malaria cases are expected due to the increase of travels and population movements worldwide, and are observed in all developed countries. According to the European Centre for Disease Control and Prevention (ECDC), in 2016 more than 7,000 malaria cases were recorded in EU/EEA countries (https://ecdc.europa.eu/sites/portal/files/documents/AER_for_2016-malaria.pdf).

Additionally, since 2009 a number of locally acquired/introduced P. vivax malaria cases have been recorded in various areas of the country (i.e., among patients without travel history to a malaria endemic country), mainly as sporadic introduced cases but also in clusters (in 2011- 2012). Most areas where locally acquired cases were recorded over the last years were rural close to wetlands with high number of persons from endemic countries.

You can find more information regarding epidemiological malaria data at the NPHO website (www.eody.gov.gr).

Since 2012 NPHO/ former HCDCP has developed and continuously implements an Action Plan for the Management of Malaria, which was updated for 2018. In addition, in 2015 the Ministry of Health published the “National Action Plan for the Management of Malaria”.

According to these plans, a series of activities are implemented nationwide for the prevention and management of malaria, with the collaboration of national, regional and local authorities, including:

  1. Risk assessment for the re-emergence of malaria
  2. Enhanced malaria surveillance and intervention activities
  3. Enhancing laboratory diagnosis of malaria
  4. Case management – Standardization of the malaria treatment in Greece
  5. Increase awareness amongst health professionals
  6. Vector surveillance and control activities

Designation of affected areas – Blood safety and haemovigilance measures

 

More details regarding the malaria management actions in Greece can be found on the last Malaria epidemiological report, 2018 of NPHO.

 

Conclusions

As indicated by the malaria surveillance data, the risk of re-appearance of the disease in specific vulnerable and receptive areas of the country exists, especially where the presence of adequate numbers of Anopheles mosquitoes (the competent vector of the disease) is combined with the presence of malaria patients coming from endemic countries.

Following a peak of locally acquired malaria cases between 2011-2012, their number declined steadily in the following years. This decrease was the result of a number of intense and costly public health interventions uninterrupted implemented since 2011, with the collaboration of various stakeholders at the national, regional and local level, which have contributed to the successful prevention of the re-establishment of malaria in Greece

However, sporadic introduced malaria cases or small clusters of introduced cases were still recorded over the last years, up to 2018, in few vulnerable and receptive areas, indicating the need to sustain malaria activities as a priority for the preparedness of public health authorities.

Early detection and radical treatment of malaria cases, together with appropriate investigation and effective integrated vector control measures represent the main components of the public health strategy to prevent P.vivax reintroduction in high risk areas of the country. In this context, high level of preparedness and awareness of health and public health services should be maintained.

 

Prevention measures

Malaria prevention measures include:

1. Mosquito protection measures:

Regarding mosquito protection measures, we should:

Participate all to reduce mosquitoes around us:

Identify and reduce the sites where mosquitoes
can lay their eggs, inside your own premises

 

The appropriate mosquito protection measures are available in detail in NPHO website:

In addition, it is crucial that the local authorities (Regions, Municipalities) to timely and systematically implement the integrated mosquito control programs.

2. Travelers to malaria endemic counties prevention measures

People who plan to travel to any country abroad should timely get informed about the diseases that are endemic in the country they plan to visit and receive the appropriate preventive measures (e.g.  malaria prevention when traveling to an endemic country/ area: chemoprophylaxis, mosquito personal protection measures).

In order to receive all the necessary information regarding the risk of transmission of malaria and other diseases at your destination country and the ways to protect yourself,  please contact your local Public Health Directorates or the NPHO’s Travel Medicine office, 4- 6 weeks before traveling, but also promptly when last minute travels occur. More information regarding guidelines for travelers to malaria endemic countries can be found at NPHO’s website, at the Travel Medicine section.

3. Awareness for suspicious symptoms (e.g. fever, often accompanied with chills, that cannot be attributed somewhere else) and timely seek of medical assessment, especially –but not only- if you reside or have visited areas where local malaria cases have been recorded or have traveled to a malaria endemic country.

More information regarding preventive measures you can find at NPHO website.

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