Eliminating malaria in MEXICO

Transcription

1 COUNTRY BRIEFING Eliminating malaria in MEXICO Mexico has nearly eliminated Plasmodium falciparum malaria and plans to further reduce malaria cases by more than 5 percent between 26 and 212 as it works to eliminate all remaining malaria transmission foci. Overview At a Glance 1 1,226 Reported cases of malaria (P. vivax only) Deaths from malaria 5 % of population at risk (total population: 113 million).1.1 Annual parasite incidence (cases/1, total population/year) % Slide positivity rate Source: World Health Organization, World Malaria Report 211 Malaria Transmission Limits Mexico is categorized in the pre-elimination phase by the World Health Organization (WHO) and has experienced an 83 percent decrease in reported malaria cases between 2 and 21, from 7,39 cases to 1,226 cases.1 In 21, all reported cases were due to Plasmodium vivax and since 27, only five cases of P. falciparum have been reported.1 More than two-thirds of Mexican states have been malaria-free since 24, and the endemic region has been primarily concentrated in the southeast along Mexico s border with Guatemala, where more than 8 percent of all cases occurred in 28.2 A majority of cases in 28 were reported in rural areas and 4 percent of all cases occurred in children under 15 years of age.2 The primary malaria vector is Anopheles albimanus which is found in coastal areas and is more active during the rainy season.3 An. pseudopunctipennis has been identified as a malaria vector in rural areas of Chiapas and thrives primarily during the dry season in inland areas.4 Plasmodium vivax Mexico began malaria control initiatives in the 193s and has achieved significant progress despite the challenges associated with its endemic southern border region and rural populations. The ministry of health has outlined specific, measurable goals for its malaria program and developed a plan for 27 to 212 to improve surveillance capacity through: Water P. vivax free Unstable transmission (API <.1) Low stable transmission (.1 API <1.) Stable transmission ( 1. API) MAY 212 1, 2, Kilometres P. vivax malaria risk is classified into no risk, unstable risk of <.1 case per 1, population (API), low stable risk of.1 to <1. case per 1, population (API), and stable risk of 1. case per 1, population (API). Risk was defined using health management information system data and the transmission limits were further refined using temperature and aridity data. Data from the international travel and health guidelines (ITHG) were used to identify zero risk in certain cities, islands and other administrative areas. 1

2 use of geographic information systems mapping; enhanced vector control activities to reduce mosquito populations; use of rapid diagnostic tests to decrease time between diagnosis and treatment; and targeting high-transmission areas in southeast Mexico. 5 Progress Toward Elimination Malaria control in Mexico began in 1938 when two million cases of malaria and 25, deaths prompted the Mexican government to develop the Anti-Malaria Sanitary Commission 6 which spearheaded the 1944 launch of a national DDT spraying campaign. 7 The WHO Eighth World Health Assembly, where the Global Malaria Eradication Program was established, was held in Mexico City in The assembly s presence highlighted Mexico s malaria situation, prompting UNICEF s donation to the national government $15 million to Mexico for malaria control. 6 From 1957 to 1962, Mexico implemented an intensive elimination program, spraying more than four million homes with DDT, testing over six million people for malaria, and distributing 11 million antimalarial drugs as prophylaxis. 8 By 196, malaria morbidity was greatly reduced, from 1.3 cases per 1, population in 1955 to only.1 cases per 1, population. 8 By 1961, Mexico s extensive DDT spraying efforts eliminated the Aedes aegypti mosquito, 4 but more than 6 percent of the country was still living in areas at-risk for malaria. 8 Mexico continued its intensive DDT spraying program in the pursuit of eliminating malaria by However, by the mid-196s DDT resistance had developed, and its use was greatly reduced in the 197s due to concerns over the potential impact to human health and the environment. 9 In 1986, 14, cases were reported, 6 which was a marked increase from the 3,665 cases reported in In 1989, in response to the increase in cases, Mexico implemented the intensive Reported Malaria Cases Number of cases 5, 45, 4, 35, 3, 25, 2, 15, 1, 5, Malaria incidence decreased substantially in the 199s, from nearly 45, cases to less than 5, cases; however, an outbreak in Oaxaca State triggered by a hurricane was responsible for the sharp increase in the number of cases in Source: World Health Organization, World Malaria Report 211 GOALS: 1. Reduce malaria morbidity by 15 percent per year from 26 to 212, a total reduction of 55 percent over the same period Limit imported cases of P. falciparum to 22 or fewer per year Limit the incidence of indigenous cases of P. vivax to fewer than 5 towns by Maintain an annual case-detection coverage rate of 9 percent of all cases in the population at risk. 5 MAY 212 2

3 simultaneous action plan, a mass antimalarial drug administration and indoor residual spraying program aimed at high-transmission areas. 1 In 1996, because of environmental and health concerns, Mexico set the goals of reducing DDT spraying by 8 percent by 22 and completely stopping its use by In 1998, there was a malaria outbreak in Oaxaca State of more than 25, cases due to destruction caused by Hurricane Pauline. 2 To address at-risk areas, Mexico improved its malaria control program by conducting indoor residual spraying, mobilizing inland at-risk communities to remove algae from stagnant water, and employing rapid diagnostic testing to help reduce lag time between diagnosis and treatment. 11 In 28, approximately 3, homes in 2 locations were sprayed mainly in Mexico s southern states bordering Guatemala and Belize. The program also empowered more than 82, community volunteers to participate in vector control activities by removing mosquito breeding grounds within their communities. 2 Eligibility for External Funding The Global Fund to Fight AIDS, Tuberculosis and Malaria U.S. Government s President s Malaria Initiative World Bank International Development Association Challenges to Eliminating Malaria Indigenous population A majority of cases occur in indigenous people living in rural areas. 2 Indigenous people living in rural areas of the states of Chiapas and Oaxaca have less access to health facilities due to poor transportation infrastructure. 16 Additionally, the ministry of health is challenged with developing malaria education programs for nonnative Spanish speakers and addressing vector control for a population that may live in less-enclosed housing structures. 16 Migration More than two million documented and undocumented migrants cross into Mexico each year. More than 25, undocumented Guatemalans now live in Mexico, many of whom fled from Guatemala during its civil war ( ). 17 Cross-border migration along Mexico s border with Guatemala increases malaria transmission in this area. 2 Conclusion Mexico has developed a plan to reduce cases and eliminate transmission in targeted states. 5 Mexico s malaria program will benefit from cross-border initiatives with Guatemala and Belize, including focalized control of transmission in high-risk states such as Chiapas and Oaxaca. With continued success in reducing malaria, Mexico will be able to achieve its goals toward malaria elimination. Economic Indicators 15 GNI per capita (US$) $8,93 Country income classification Upper middle Total health expenditure per capita (US$) $64 Total expenditure on health as % of GDP 6.3 Private health expenditure as % total health expenditure 51 MAY 212 3

4 Sources 1. WHO. World Malaria Report 211. Geneva: World Health Organization; PAHO. Informe de la Situacion del Paludismo en las Americas 28: Mexico; Sinka ME, Rubio-Palis Y, Manguin S, Patil AP, Temperley WH, Gething PW, et al. The dominant Anopheles vectors of human malaria in the Americas: occurrence data, distribution maps and bionomic precis. Parasit Vectors. 21; 3: Secretería de Salud. El Paludismo en México; Secretería de Salud. Programa de Accion Especifico Paludismo. México, D.F: Secretaría de Salud; Malagón F. Malaria eradication in Mexico: Some historico-parasitological views on Cold war, deadly fevers, by Marcos Cueto. Philosophy, Ethics, and Humanities in Medicine. 28; 3(15): Stapleton D. Lessons of History? Anti-Malaria Strategies of the International Health Board and the Rockefeller Foundation from the 192s to the Era of DDT. Public Health Reports. 24; 119: Cueto M. Appropriation and Resistance: Local Responses to Malaria Eradication in Mexico, J Lat Amer Stud 25; 37: Rodriguez M. Improving Malaria Control Towards Elimination in Mesoamerica. Hainan, China; Ministerio de Salud. Paludismo en México: Eliminable?; Eberlee J. Controlling Malaria in Mexico Using Alternatives to DDT: International Development Research Center; IDA. International Development Association Eligibility. 212; Available from: TUS/IDA/,,contentMDK:254572~menuPK:341421~pagePK: ~piPK:437394~theSitePK:73154,.html. 13. PMI. U.S. Government s President s Malaria Initiative (PMI). 212; Available from: The Global Fund to Fight AIDS Tuberculosis and Malaria. The Global Fund Eligibility List. 212; Available from: org/en/application/applying/ecfp/eligibility. 15. World Bank. World Development Indicators Database. 212; Available from: Carter ED. God bless General Peron: DDT and the endgame of malaria eradication in Argentina in the 194s. J Hist Med Allied Sci. 29; 64(1): Migration Policy Initiative. Guatemala: Economic Migrants Replace Political Refugees. 26; Available from: Transmission Limits Map Sources Guerra, CA, Howes, RE, Patil, AP, Gething, PW, Van Boeckel, TP, Temperley, WH, Kabaria, CW, Tatem, AJ, Manh, BH, Elyazar, IRF, Baird, JK, Snow, RW and Hay, SI. (21). The international limits and population at risk of Plasmodium vivax transmission in 29. Public Library of Science Neglected Tropical Diseases, 4(8): e774. Juan E. Hernandez (29), Instituto Nacional de Salud Publica, Cuernavaca, Mexico (Data years 25 28) MAY 212 4

5 About This Briefing This country briefing was produced through a collaboration of the Global Health Group, in partnership with the National Malaria Control Program in Mexico. Malaria transmission risk maps were provided by the Malaria Atlas Project (MAP). Funding was provided through a grant to the Global Health Group from the Exxon Mobil Corporation. The Malaria Elimination Initiative at the Global Health Group of the University of California, San Francisco ( edu/global-health-group) convenes the Malaria Elimination Group ( and supports countries actively pursuing elimination at the endemic margins of the disease. Funding for the Malaria Elimination Initiative is provided by the Bill & Melinda Gates Foundation and Exxon Mobil Corporation. The Malaria Atlas Project (MAP) provided the malaria transmission maps. MAP is committed to disseminating information on malaria risk, in partnership with malaria endemic countries, to guide malaria control and elimination globally. Find MAP online at: GlobAL Health Group Project Team Editor: Allison Phillips Managing Editor: Chris Cotter Researcher and Content Developer: Janelle Downing Graphic Designer: Kerstin Svendsen MAY 212 5