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