MALARIA IN PARAGUAY Current scenario and forecasting system Antonieta Rojas de Arias [email protected] MALARIA IN THE AMERICAS: historical summary (1900-1950’S) • • • • • • At the beginning of the 20th.
Download ReportTranscript MALARIA IN PARAGUAY Current scenario and forecasting system Antonieta Rojas de Arias [email protected] MALARIA IN THE AMERICAS: historical summary (1900-1950’S) • • • • • • At the beginning of the 20th.
MALARIA IN PARAGUAY Current scenario and forecasting system Antonieta Rojas de Arias [email protected] MALARIA IN THE AMERICAS: historical summary (1900-1950’S) • • • • • • At the beginning of the 20th century: malaria transmission by the entire continent 1902: foundation of the Pan American Sanitary Bureau; malaria was one of the most prevalent infectious diseases 1942: malaria was considered the most harmful disease in continent 1948: great success in the reduction in the incidence of malaria and in the elimination of the transmission in some areas, thanks to the DDT 1954: malaria eradication campaign in the Americas 1955: the campaign of eradication is made at the world level Organización Panamericana de la Salud 2005 MALARIA IN THE AMERICAS: historical summary (1960- up to now) • • • • Decade of 1960: interruption of the malaria transmission in the Caribbean, except in Hispaniola 1992: `Global malaria control strategy`; the emphasis passes of the eradication to the control 1998: roll back malaria (RBM); reduce to half morbidity and mortality by malaria for 2010 2000: the Member States of PAHO adopt the resolution for roll back malaria 2000: Millennium Development Goals, of the United Nations: "… Have stopped and begun to reduce, for the year 2015, the spread of HIV/AIDS, tuberculosis and malaria" Organización Panamericana de la Salud 2005 MALARIA CURRENT SITUATION 264 of the 869 million inhabitants of the American hemisphere live in ecological risk areas of malaria transmission (2004) Very low or low risk areas: 223 million Moderate risk areas : 30 million High risk areas: 11 million Organización Panamericana de la Salud 2005 Distribution of population* according to risk area, in the Americas Population at moderate risk areas 30,391 Population at high risk 11,145 Population at low risk 222,603 High Risk Organización Panamericana de la Salud Moderate Risk Low Risk *millons (2004) 2005 REPORTED CASES OF MALARIA (1998-2004) • Morbidity (2004): 1400000 • • • 882,360 cases 74% due to P. vivax 23.3% reduction in cases compared with 2000 21% reduction in moderate and high risk areas 1200000 • 1000000 800000 600000 400000 200000 0 1998 1999 2000 2001 2002 2003 2004 Organización Panamericana de la Salud 2005 DEATHS ATTRIBUTED TO MALARIA (1998-2004) 400 350 300 250 200 150 100 50 0 Total de defunciones • • • 1998 1999 2000 2001 2002 2003 2004 372 185 301 219 168 99 96 Mortality (2004): 156 deaths 55% reduction in attributable deaths to malaria since 2000 Reduction in case-fatality rate of 13 per 10,000 to 7 per 10,000 cases P. falciparum Organización Panamericana de la Salud 2005 PARAGUAY: Population at Risk of Malaria Transmission, 1998-2004 (in thousands) 6000 5000 4000 3000 2000 1000 0 1998 1999 2000 2001 2002 2003 2004 Population at Risk 3035 3108 3185 2193 2391 1972 3049 Total Population 5222 5358 5496 5634 5774 5917 5917 Organización Panamericana de la Salud 2005 PARAGUAY: Population at Ecological Risk of Malaria Transmission According to Level of Transmission Risk , 1998-2004 (in thousands) 2500 2000 1500 1000 500 0 1998 1999 2000 2001 2002 2003 2004 Low Risk 905 1048 1054 1291 834 1492 1263 Moderate Risk 914 2060 818 752 1557 480 1786 1216 … 1313 150 0 0 0 High Risk Organización Panamericana de la Salud 2005 PARAGUAY: Malaria Morbidity, 1998-2004 (number of positive blood slides) 10000 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 No. of Cases 1998 1999 2000 2001 2002 2003 2004 2091 9947 6853 2710 2778 1392 694 Organización Panamericana de la Salud 2005 PARAGUAY: Malaria Morbidity According to Level of Transmission Risk, 1998-2004 (number of positive blood slides) 10000 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 1998 1999 2000 2001 2002 2003 2004 Low Risk 8 188 17 798 193 837 14 Moderate Risk 16 9744 1333 1107 2563 525 677 2048 … 5493 777 0 0 0 19 15 10 28 22 30 3 High Risk Originally Non-Malarious Organización Panamericana de la Salud 2005 PARAGUAY: Malaria Morbidity According to Parasite Species (In All Risk Areas), 1998-2004 5 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0 In All Risk Areas Moderate and High Risk Only 1998 1999 2000 2001 2002 2003 2004 … … … 1.23 1.16 0.7 0.23 0.97 4.79 3.22 2.09 1.78 1.09 0.38 Organización Panamericana de la Salud 2005 PARAGUAY: Passive vs. Active Case Detection, 1998-2004 (% of Blood Slides Examined) 56.21 43.79 2004 57.85 42.15 2003 56.78 43.22 2002 48.96 51.04 2001 40.16 59.84 2000 46.58 53.42 1999 0 20 36.18 63.82 1998 40 60 Passive 80 100 120 Active Organización Panamericana de la Salud 2005 PARAGUAY: Annual Blood Examination Rate (ABER) in Malarious Areas, 1998-2004 2004 2003 2002 2001 2000 1999 1998 97246 3049000 126528 1972000 99338 2391000 Examined Population at Risk / In Malarious Areas 76607 2193000 97026 3185000 101074 3108000 42934 3035000 Organización Panamericana de la Salud 2005 PARAGUAY: Slide Positivity Rate (SPR), 19982004 2004 2003 2002 2001 2000 97246 694 126528 1392 99338 2778 97026 6853 101074 1999 1998 Examined Positive 76607 2710 9947 42934 2091 Organización Panamericana de la Salud 2005 PARAGUAY: Antimalarial Drugs Used, 19982004 400000 350000 300000 250000 200000 150000 100000 50000 0 1998 1999 2000 2001 2002 2003 2004 Chloroquine &/or Amodiaquine @ 150mg … 356000 330244 282900 251775 341973 288328 Primaquine @ 15mg … 211607 173466 40535 51341 35186 15596 Sulfa/Pyrimethamine @ 500/25mg … … … … … … … Mefloquine @250mg … … … … … … … Artemisinine Derivatives (# of Tx) … … … … … … … Quinine @ 300mg … … … … … … … Organización Panamericana de la Salud 2005 PARAGUAY: National Budget and NonBudgetary Contributions to Malaria Control Programs, 1998-2004 (in US$) 10000000 1000000 100000 10000 Contributed Funds and Loans National Malaria Budget 1000 Total Budget 100 10 1 Contributed Funds and Loans 1998 1999 2000 2001 2002 2003 2004 … 21281 … … … 175000 202404 National Malaria Budget 7501159 4338457 1932103 1061490 1126149 1164935 1147905 Total Budget 7501159 4359738 1932103 1061490 1126149 1339935 1350309 Organización Panamericana de la Salud 2005 PARAGUAY: Annual $US Funds / Person in Malarious Areas, 1998-2004 2,5 2 1,5 1 0,5 0 $US Funds / Person in Malarious Area 1998 1999 2000 2001 2002 2003 2004 2,47 1,4 0,61 0,48 0,58 0,68 0,44 Organización Panamericana de la Salud 2005 THE VICTIMS Tendencia de Control de Paludismo Paraguay-2000/2005* 2000 1500 casos Epidemia 1000 Alarma 500 Control 0 ene feb mar 2005* Datos parciales hasta noviembre Curva Endem: 2000/2004 FUENTE: SECC.ESTADISITCA - SENEPA abr may jun jul ago set oct Lim.Sup Lim.Medio 2000 2001 2002 2003 2004 2005 nov dic meses Malaria in 2005 Corridor of Transmission CANINDEYÚ CAAGUAZÚ ALTO PARANÁ CLIMATIC CONDITION BEHAVIOUR IN 2010 2.0 2.0 1.5 1.5 IB1-L. Base 1.0 IB1-2010 0.5 0.5 0.0 0.0 -0.5 -0.5 -1.0 -1.0 -1.5 -1.5 Proyección del Paludismo para el 2010, bajo condiciones de intervención y sin intervención epidemiológica respecto a línea base y condiciones actuales L.Base 550 C. Actuales 500 450 Proyección-1 400 Proyección-2 350 300 250 200 150 100 NOV OCT AGO JUL JUN MAY ABR MAR FEB ENE 0 DIC 50 SEP -2.0 Patrón medio DIC NOV OCT SEP AGO JUL JUN MAY ABR MAR -2.0 FEB 600 ENE Valor del IB 1.0 IB1-C.Actuales HISTORIAL SERIES OF MALARIA CASES 1988: 2884 cases 1997: 567 cases 1999: 9946 cases 2000: 6853 cases 2001: 2706 cases 2002: 2778 cases 2003: 1235 cases: 2004: 694 cases: 2005: 376 cases: : 7.1 % slides (97,026) : 3.8 % slides (71,708) : 2.8 % slides (99,338) 0.9 % slides (126,528) 0.7 % slides (97,246) 0.4 % slides ( 85,942) THE VECTOR Anopheles spp. (A. darlingi and others) ANOPHELINE SPECIES BREEDING SITES IN PARAGUAY An.darlingi An.albitarsis An. strodei An.trianulatus An.noroestenci An.brasiliensis An.rondoni An.argyrytarsis An. osvaldoi An.galvaoi An.lanei An.parvus An.lutzi An. antunesis An.punctimacula An.mediopuntatus An. fluminensis An. neomaculipalpus An. apicimácula An.minor An.pseudopuntipennis An. peryassui Fuente: Secc.Entomología - SENEPA INTRADOMICILE X X X X X X X X X X X X X X X X X EXTRADOMICILE X X X X X X X X X X X X X X X X X X X X X MALARIA CASES AND ANOPHELINE DENSITIES 500 600 450 NRO. DE CASOS 350 400 300 250 300 200 200 150 100 100 50 0 0 ENE FEB MAR ABR MAY JUN JUL AGO SET OCT NOV DIC MES nro. de casos Fuente: Secc.Estadística-SENEPA An.(N) darlingi An.(N) albitarsis An.(N) strodei Otros anofeles EJEMPLARES CAPTURADOS 500 400 THE ENVIRONMENT Organización Panamericana de la Salud 2005 HISTORICAL SERIES OF CASES 1966-2000 1400 1300 1200 1100 900 800 700 600 500 400 300 200 100 Añ o s 1999 1995 1990 1985 1980 1975 -100 1970 0 1966 Casos diagnosticados 1000 INFORMATIVE BASELINE • Epidemiological variables – Total monthly cases 1966-1998; Baseline: 1966-70 and 1985-1990: control line: 1971-1984. Current conditions: 1992-1998. • Climatic variables – Temperature max, medium y min; Daily termical Oscillation, monthly precipitations METHODOLOGY Use of empirical-statistical models for the malaria projection • Model regressive auto with non-constant variance (with index of parcel). Analysis of time series + statistics multivariate-analysis of the principal components (ACP) Verification of the models Validation of the models empirical-statistical Analyses of sensitivity of the models METHODOLOGY: CLIMATE CHANGE SCENARIOS • General circulation models: - UKTR - CCCEQ - hadcm2. • Climatic sensitivities: - 1.5 ºc (decline) - 2.5 ºc (average) - 4.5 ºC (discharge) • • • • Emission scenarios: LOWER HYPOTHESIS: IS92C INTERMEDIATE HYPOTHESIS: IS92A HIGH HYPOTHESIS: IS92E STRATIFICATION OF THE BULTÓ INDEX • • • • • • • SI IB< -1.62 SI -1.61 <IB< -1.24 SI -1.23 <IB< -.64 SI -.63 <IB< .63 SI .64 <IB< .89 SI .90 <IB< 1.2 SI IB> 1.2 • • • • • • • EXTREME COLD VERY COLD COLD WINTER TRANSITE WARM SUMMER VERY WARM SUMMER EXTREME SUMMER ADAPTATION MEASURES • • • • • • To horizontalize the malaria control system. To concentrate the malaria programs in the attention to the patient concerning the diagnosis and treatment. To strengthen the surveillance system, control and analysis of trends of malaria. To intensify the studies of vulnerability of malaria to the climate change. To establish a monthly forecasting system of malaria in the endemic departments. To strengthen the epidemiological control of the people at bordering countries. MONTHLY FORECASTING OF THE MALARIA CASES IN ALTO PARANÁ SISTEMA DE PRONOSTICO DE CASOS DE PALUDISMO EN ALTO PARANÁ 400 350 300 250 200 150 100 50 0 -50 ENE FEB MAR ABR MAY JUN JUL AGO SEP OCT NOV DIC CONCLUSIONS • • • • • • • Malaria in Paraguay is in re-emergency. Since 1999 the new world strategy was applied for its control. The installed capacity for its control is vertical, still has not been incorporation of the health services for its control and treatment. Case persistence is observed in the areas of the indigenous corridor of the more high endemicity departments. There is no resistance demonstrated to chloroquine. The radical scheme of 7 days is implemented. Malaria is sensitive both to the variability and to the climate change. Malaria is a disease that will suffer a great impact under conditions of climate change, according to the projections for 2010 should be produced a total increase of 82% with regard to the recorded cases before the 90s. The use of the climatic forecast in the field of health not only requires a greater scientific comprehension of the system climate health. It implies, in addition, a radical change in the way of thinking. It is necessary to find tools that take into account the various interactions that are given in this system, and that facilitate the integration of the climatic, ecological and epidemiological approaches, when evaluating the future behavior of the diseases. Acknowledgements • • • To Dr. Keith Carter, Malaria Regional Adviser PAHO To Lic. Blanca Cousiño, Technical Coordinator of SENEPA. To Dr. Paulo Ortiz B. Adviser. Centro Nacional de Clima, Cuba. Thank You!!!