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Fact sheet N°94 October 2011
• • • • • • Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected mosquitoes. In 2009, malaria caused an estimated 781 000 deaths, mostly among African children. Malaria is preventable and curable. Increased malaria prevention and control measures are dramatically reducing the malaria burden in many places. Malaria can decrease gross domestic product by as much as 1.3% in countries with high disease rates. Non-immune travelers from malaria-free areas are very vulnerable to the disease when they get infected.
According to the World Malaria Report 2010, there were 225 million cases of malaria and an estimated 781 000 deaths in 2009, a decrease from 233 million cases and 985 000 deaths in 2000. Most deaths occur among children living in Africa where a child dies every 45 seconds of malaria and the disease accounts for approximately 20% of all childhood deaths. Malaria is caused by Plasmodium parasites. The parasites are spread to people through the bites of infected Anopheles mosquitoes, called "malaria vectors", which bite mainly between dusk and dawn. There are four types of human malaria: • Plasmodium falciparum • Plasmodium vivax • Plasmodium malariae • Plasmodium ovale. Plasmodium falciparum and Plasmodium vivax are the most common. Plasmodium falciparum is the most deadly. In recent years, some human cases of malaria have also occurred withPlasmodium knowlesi – a monkey malaria that occurs in certain forested areas of South-East Asia.
Malaria is transmitted exclusively through the bites of Anopheles mosquitoes. The intensity of transmission depends on factors related to the parasite, the vector, the human host, and the environment. About 20 different Anopheles species are locally important around the world. All of the important vector species bite at night. Anopheles mosquitoes breed in water and each species has its own breeding preference; for example some prefer shallow collections of fresh water, such as puddles, rice fields, and hoof prints. Transmission is more intense in places where the mosquito lifespan is longer (so that the parasite has time to complete its development inside the mosquito) and where it prefers to bite humans rather than other animals. For example, the long lifespan and strong human-biting habit of the African vector species is the main reason why more than 85% of the world's malaria deaths are in Africa.
falciparum and P. whereas in areas with less transmission and low immunity. Malaria epidemics can occur when climate and other conditions suddenly favour transmission in areas where people have little or no immunity to malaria. Asia. with the peak during and just after the rainy season. • people with HIV/AIDS. • international travellers from non-endemic areas because they lack immunity. For this reason. For both P. respiratory distress in relation to metabolic acidosis. headache. Immunity is developed over years of exposure. or cerebral malaria. The first symptoms – fever. In malaria endemic areas. especially among adults in areas of moderate or intense transmission conditions. Human immunity is another important factor. clinical relapses may occur weeks to months after the first infection. Children with severe malaria frequently develop one or more of the following symptoms: severe anaemia. In 2009. temperature and humidity. falciparum malaria can progress to severe illness often leading to death. In many places. or as refugees. • semi-immune pregnant women in areas of high transmission. Who is at risk? Approximately half of the world's population is at risk of malaria. P. most malaria deaths in Africa occur in young children. However. multi-organ involvement is also frequent. and to a lesser extent the Middle East and parts of Europe are also affected. Latin America. Most malaria cases and deaths occur in sub-Saharan Africa. Malaria can result in miscarriage and low birth weight. all age groups are at risk. for instance to find work. In a non-immune individual. persons may develop partial immunity. Specific population risk groups include: • young children in stable transmission areas who have not yet developed protective immunity against the most severe forms of the disease. ovale. An estimated 200 000 infants die annually as a result of malaria infection during pregnancy. during all pregnancies. and special treatment – targeted at these liver stages – is mandatory for a complete cure.malariae). and while it never gives complete protection. • immigrants from endemic areas and their children living in non-endemic areas and returning to their home countries to visit friends and relatives are similarly at risk because of waning or absent immunity. malaria was present in 108 countries and territories. In adults. Women with malaria infection of the placenta also have a higher risk of passing HIV infection to their newborns. such as rainfall patterns. vivax and P.Transmission also depends on climatic conditions that may affect the number and survival of mosquitoes. allowing asymptomatic infections to occur. especially during first and second pregnancies. even if the patient has left the malarious area. • semi-immune HIV-infected pregnant women in stable transmission areas. falciparum infection) and maternal death rates of 10–50%. • non-immune pregnant women as malaria causes high rates of miscarriage (up to 60% in P. Symptoms Malaria is an acute febrile illness. They can also occur when people with low immunity move into areas with intense malaria transmission. chills and vomiting – may be mild and difficult to recognize as malaria. If not treated within 24 hours. transmission is seasonal. symptoms appear seven days or more (usually 10–15 days) after the infective mosquito bite. it does reduce the risk that malaria infection will cause severe disease. . These new episodes arise from "dormant" liver forms (absent in P.
as no alternative antimalarial medicines will be available for at least five years. as has happened before with chloroquine and sulfadoxine-pyrimethamine (SP). Drug resistance Growing resistance to antimalarial medicines has spread very rapidly. and such patients still have persistent parasites in their blood. falciparum malaria. DDT can be effective for 9–12 months in . depending on the insecticide used and the type of surface on which it is sprayed. and supports countries to strengthen their efforts in this important area of work. Without a second drug given as part of a combination (as is done with an ACT). and in most places.Diagnosis and treatment Early diagnosis and treatment of malaria reduces disease and prevents deaths. undermining malaria control efforts. these resistant parasites survive and can be passed on to a mosquito and then another person. It also contributes to reducing malaria transmission. This results in incomplete treatment. WHO recommends the routine monitoring of antimalarial drug resistance. Indoor spraying with residual insecticides Indoor residual spraying (IRS) with insecticides is the most powerful way to rapidly reduce malaria transmission. the public health consequences could be dire. Indoor spraying is effective for 3–6 months. More detailed recommendations are available in the Guidelines for the treatment of malaria. Insecticide-treated mosquito nets (ITNs) Long-lasting insecticide impregnated nets (LLINs) are the preferred form of ITNs for public health distribution programmes. The best available treatment. WHO recommends that all cases of suspected malaria be confirmed using parasite-based diagnostic testing (either microscopy or rapid diagnostic test) before giving treatment. Such monotherapies are therefore one of the primary forces behind the spread of artemisinin resistance. Two forms of vector control are effective in a wide range of circumstances. is artemisinin-based combination therapy (ACT). WHO recommends coverage for all at-risk persons. It is the only intervention that can reduce malaria transmission from very high levels to close to zero. If resistance to artemisinins develops and spreads to other large geographical areas. Treatment solely on the basis of symptoms should only be considered when a parasitological diagnosis is not possible. When treated with an artemisinin-based monotherapy. Its full potential is realized when at least 80% of houses in targeted areas are sprayed. the most cost effective way to achieve this is through provision of LLINs. so that everyone in high transmission areas sleeps under a LLIN every night. Prevention Vector control is the main way to reduce malaria transmission at the community level. patients may discontinue treatment prematurely following the rapid disappearance of malaria symptoms. particularly for P. For individuals personal protection against mosquito bites represents the first line of defence for malaria prevention. More comprehensive recommendations are available in the Global Plan for Artemisinin Resistance Containment (GPARC). Results of parasitological confirmation can be available in a few minutes.
strong national commitments. The development of new. currently available tools. cost-effective and safe insecticides. For travellers. thus being abandoned less than two decades later in favour of the less ambitious goal of malaria control. for infants living in high-transmission areas of Africa. The global malaria eradication campaign. Large-scale use of WHO-recommended strategies. Vaccines against malaria . Economic and health system impact Malaria causes significant economic losses. but is an expensive and long-term endeavour. Similarly. Elimination Many countries – especially in temperate and sub-tropical zones – have been successful in eliminating malaria. and coordinated efforts with partners. Longer-lasting forms of IRS insecticides are under development. Resistance to pyrethroids has emerged. will enable more countries – particularly those where malaria transmission is low and unstable – to progress towards malaria elimination. Insecticide resistance Much of the success to date in controlling malaria is due to vector control. but ultimately failed to achieve its overall goal. thereby preventing malaria disease. these aggregated annual losses have resulted in substantial differences in GDP between countries with and without malaria. Malaria disproportionately affects poor people who cannot afford treatment or have limited access to health care. local data on the susceptibility target vectors. was successful in eliminating the disease in some countries. malaria can be prevented through chemoprophylaxis. during the second and third trimesters. and can decrease gross domestic product (GDP) by as much as 1.some cases. Development of new insecticides for use on nets is a particular priority. WHO recommends intermittent preventive treatment with sulfadoxine-pyrimethamine for pregnant women living in high transmission areas. Drugs can also be used to prevent malaria. • up to 60% of outpatient health clinic visits. The health costs of malaria include both personal and public expenditures on prevention and treatment. Detection of insecticide resistance should be an essential component of all national malaria control efforts to ensure that the most effective vector control methods are being used. 3 doses of intermittent preventive treatment with SP is recommended delivered alongside routine vaccinations. which suppresses the blood stage of malaria infections. Currently there is a lack of alternative. especially Africa. however. In some heavy-burden countries. • 30% to 50% of inpatient hospital admissions. trapping families and communities in a downward spiral of poverty. The choice of insecticide for IRS should always be informed by recent. alternative insecticides is a high priority. Vector control is highly dependent on the use of pyrethroids. although so far there have been only one or two cases of obvious control failure.3% in countries with high levels of transmission. Over the long term. particularly in Africa. interest in malaria eradication as a long-term goal has re-emerged. launched by WHO in 1955. which are the only class of insecticides used on currently recommended ITNs or LLINs. In recent years. the disease accounts for: • up to 40% of public health expenditures.
One research vaccine against P. nongovernmental and community-based organizations. and research and academic institutions. and each set of results will be reviewed by external WHO advisory committees. Other malaria vaccines are at earlier stages of research. . • developing approaches for capacity building. systems strengthening. This vaccine is currently being evaluated in a large clinical trial in 7 countries in Africa. development partners. including malaria endemic countries. • keeping independent score of global progress. A WHO recommendation for use will depend on the final results from the large clinical trial. • identifying threats to malaria control and elimination as well as new areas for action. Final results are expected in 2014 . Results will be emerging from this trial in 3 stages. the private sector. WHO is also a co-founder and host of the Roll Back Malaria partnership.There are currently no licensed vaccines against malaria or any other human parasite. The partnership mobilizes for action and resources and forges consensus among partners. is most advanced. It is comprised of over 500 partners. known as RTS.S/AS01. falciparum. and surveillance. which is the global framework to implement coordinated action against malaria. WHO response The WHO Global Malaria Programme is responsible for charting the course for malaria control and elimination through: • forming evidence-based policy and strategy formulation. foundations.
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