Ámbito biológico, social, tecnológico, económico, normativo y político del plan hacia la eliminación de la malaria en el Perú 2022-2030 / Biological, social, technological, economic, regulatory and political scope of the plan towards the elimination of malaria in Peru 2022-2030

La malaria es producida por parásitos del género Plasmodium y transmitida por Anopheles. Es considerada un problema de salud pública; a pesar de la reducción significativa de los casos, a nivel mundial, persisten tasas de morbi-mortalidad elevadas. En las Américas, recientemente, se registró brotes palúdicos importantes en seis países, el Perú fue uno de ellos, generando la iniciativa para crear el Plan hacia la Eliminación de la Malaria en el Perú (PEMP), partiendo de la experiencia en el Departamento de Loreto en marco del Plan Malaria Cero. El PEMP, tiene la finalidad de reducir el 90% los casos de malaria antes de 2030, con un enfoque comunitario. El objetivo de este estudio fue evaluar la integralidad del PEMP referidas a los ámbitos biológico, social, tecnológico, económico, normativo y político. Se conformó un grupo de expertos, quienes realizaron la validez aparente de cada uno de los conceptos (DDP< 2,4). Posteriormente, la congruencia de causas por ámbitos y, la contribución por objetivos específicos dentro de cada ámbito. Encontrándose coherencias entre los objetivos específicos, planes y/o acciones dentro de cada ámbito. Se corroboró el enfoque integral del PEMP, encaminando en trabajo multidisciplinario y de comprensión integral de los desafíos actuales para la eliminación de la malaria. Se identifica como debilidad la falta de abordaje de los reservorios de malaria; se recomienda realizar búsqueda activa de casos e investigaciones en hospedadores no humano, especialmente en zonas de alta transmisión; e implementarse un diseño de enfoque holístico como parte del abordaje integral(AU)

Malaria is produced by parasites of the genus Plasmodium and transmitted by Anopheles. It is considered a public health problem; Despite the significant reduction in cases, worldwide, high morbidity and mortality rates persist. In the Americas, important malaria outbreaks were recently registered in six countries, Peru was one of them, generating the initiative to create the Plan for the Elimination of Malaria in Peru (PEMP), based on the experience in the Department of Loreto within the framework of the Zero Malaria Plan. The PEMP aims to reduce malaria cases by 90% before 2030, with a community approach. The objective of this study was to evaluate the integrality of the PEMP referring to the biological, social, technological, economic, regulatory and political fields. A group of experts was formed, who carried out the apparent validity of each one of the concepts (DDP < 2.4). Subsequently, the congruence of causes by areas and the contribution by specific objectives within each area. Finding coherence between the specific objectives, plans and/or actions within each area. The integral approach of the PEMP was confirmed, leading to multidisciplinary work and a comprehensive understanding of the current challenges for the elimination of malaria. The lack of approach to malaria reservoirs is identified as a weakness; It is recommended to carry out active search for cases and investigations in non-human hosts, especially in areas of high transmission; and a holistic approach design implemented as part of the comprehensive approach(AU)

Production of Urban Space and the occurrence of malaria in the Brazilian Amazon: the Porto Velho case / Produção do Espaço Urbano e ocorrência da malária na Amazônia Brasileira: o caso Porto Velho

Abstract Due to intense ongoing urbanization in the Amazon, the urban pattern of malaria may be changing, both in its spatial distribution and epidemiological profile. The purpose of this paper is to analyze how the process of production of urban space in Porto Velho, the capital of the state of Rondonia, Brazil has contributed to the occurrence and maintenance of urban malaria. Using data collected from the Malaria Epidemiological Surveillance System (SIVEP-Malaria), we calculated malaria indices for the districts of Porto Velho from 2005 to 2018. We also developed two typologies for classifying urban space based on functional characteristics and features of the landscape. While the former considers characteristics of urban space in Porto Velho, the latter is based on suitability for malaria vectors. We found that the annual parasite index declined in Porto Velho during the study period. However, changes in the index were not uniform across the districts of the city. Periurban areas showed no decline in the index, which we attribute to these areas' high vegetation density and hydrological characteristics.

Resumo A Amazônia tem passado por um intenso processo de urbanização em anos recentes, produzindo transformações na organização espacial da região que podem estar refletindo no padrão espaço temporal da malária urbana. O objetivo deste trabalho é compreender como o processo de produção do espaço urbano do município de Porto Velho-RO, tem corroborado para a ocorrência e manutenção da malária urbana. Os dados levantados no Sistema de Vigilância Epidemiológica (SIVEP-Malária) possibilitaram o cálculo do Índice Parasitário Anual (IPA) de malária para os bairros da cidade de Porto Velho dos anos de 2005 a 2018 e a construção de duas tipologias da paisagem do espaço urbano. A primeira considerou o processo de produção do espaço urbano de Porto Velho; a segunda se baseou nas condições de receptividade para o vetor da malária. A ocorrência da malária em Porto Velho vem declinando de forma diferenciada ao longo do território, havendo uma tendência de permanência nas áreas periurbanas com maior densidade de vegetação e hidrografia.

Hacia un mundo libre de malaria: Utopía o realidad / Towards a malaria-free world: Utopia or reality

La Malaria es una enfermedad causada por un parásito que se transmite a los humanos a través de la picadura de mosquito hembra Anophele. Reportando la WHO en el 2019, 229 millones de casos y 409.000 muertes por la enfermedad en 87 paises del mundo, Existen seis especies de este párasito: Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale wallickeri, Plasmodium ovale curtisi, Plasmodium malariae y Plasmodium knowlesi. Siendo la especie P. falciparum la causante de mayor morbilidad, con tasa entre 10 y 50% de mortalidad por malaria complicada. Alrededor de 108 países han declarado la malaria como enfermedad endémica, pudiendo padecer la enfermedad en cualquier época del año. Sin embargo, en el caso de América Latina hoy en día se vive un estancamiento de la enfermedad, reportándose en países menos de 100 casos autóctonos entre el 2000 y 2019, con algunas excepciones. Esta situación de vulnerabilidad de países como Brasil, Colombia, la frontera Perú-Ecuador, Venezuela, se incrementan ante la presencia activa de la pandemia producto del Covid -19 aunado a restricciones económicas, incremento de la actividad minera, o políticas públicas que ponen en riesgo la sostenibilidad del programa de control de la enfermedad. Para el 2021 la OMS corrobora que existen 87 países con malaria a nivel mundial, de los cuales 24 de ellos habían interrumpido su transmisión autóctona por 3 años. Realidad que consolidad la propuesta tras la experiencia adquirida, que cualquiera que sea la situación epidemiológica de entrada, el trabajo hacia la erradicación de la malaria debe entenderse y atenderse como un proceso continuo donde los propios Estados deben desde su realidad y estrategias propias se articulen con el Plan Estratégico Técnico Mundial Contra la Malaria 2016-2030 propuesto por la OMS(AU)

Malaria is a disease caused by a parasite that is transmitted to humans through the bite of the female Anophele mosquito. Reporting the WHO in 2019, 229 million cases and 409,000 deaths from the disease in 87 countries of the world, There are six species of this parasite: Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale wallickeri, Plasmodium ovale curtisi, Plasmodium malariae and Plasmodium knowlesi. The species P. falciparum is the cause of greatest morbidity, with a rate between 10 and 50% of mortality from complicated malaria. About 108 countries have declared malaria as an endemic disease, and the disease can occur at any time of the year. However, in the case of Latin America today there is a stagnation of the disease, with fewer than 100 indigenous cases reported in countries between 2000 and 2019, with some exceptions. This situation of vulnerability of countries such as Brazil, Colombia, the Peru-Ecuador border, Venezuela, increases in the face of the active presence of the pandemic product of the Covid -19 coupled with economic restrictions, increased mining activity, or public policies that put at risk the sustainability of the disease control programme. By 2021, WHO confirms that there are 87 countries with malaria worldwide, of which 24 had interrupted their indigenous transmission for 3 years. Reality that consolidates the proposal after the experience acquired, that whatever the epidemiological situation of entry, The work towards the eradication of malaria must be understood and addressed as a continuous process where the States themselves must from their own reality and strategies articulate with the Global Technical Strategic Plan Against Malaria 2016-2030 proposed by the WHO(AU)

Factores de riesgo asociados a la transmisión de malaria en zona endemica de Córdoba, Colombia / Risk factors associated with the transmission of malaria in the endemic zone of Córdoba, Colombia

El objetivo del trabajo fue determinar factores de riesgo asociados a la transmisión de la malaria en el municipio de Puerto Libertador, Córdoba. Se realizó un estudio observacional analítico transversal, retrospectivo, con enfoque cuantitativo de casos de malaria de zonas rurales del municipio. La información se organizó en Excel, se describieron variables sociodemográficas, aspectos clínicos de los pacientes, de vivienda y ambientales y se realizó un análisis de riesgo para establecer asociación entre las variables y la malaria, además se clasificaron especies de anofelinos vectores y se utilizaron los softwares SatScan y QGis para identificar puntos calientes de malaria en la zona de estudio. Se incluyeron 170 casos de malaria, se identificó que 92% de los individuos carecen de servicio de recolección de basuras, 86,5% sin acueducto, más del 90% no utilizan angeos, repelentes, insecticidas o fumigaciones, se encontró asociación estadística significativa (OR>1) con las aguas estancadas, la falta de acueducto y agua continua como factores de riesgo de malaria; además se clasificaron cinco especies de mosquitos que estarían involucradas en la transmisión y se identificó un punto caliente compuesto por seis veredas del municipio. La malaria en el municipio de Puerto Libertador está asociada principalmente a problemáticas sociales, que se constituyen en factores de riesgo que favorecen la incidencia de esta enfermedad. En la zona de estudio la identificación de los mosquitos Anopheles y del punto caliente, permitirán orientar las medidas de control del vector y dirigir las intervenciones a las localidades focalizadas con mayor riesgo de malaria(AU)

The objective of the work was to determine risk factors associated with the transmission of malaria in the municipality of Puerto Libertador, Córdoba. A retrospective, cross-sectional analytical observational study was carried out, with a quantitative approach to malaria cases in rural areas of the municipality. The information was organized in Excel, sociodemographic variables, clinical aspects of the patients, housing and environmental variables were described, and a risk analysis was carried out to establish an association between the variables and malaria.In addition, vector anopheline species were classified and the SatScan and QGis software to identify malaria hot spots in the study area. 170 cases of malaria were included, it was identified that 92% of the individuals lack garbage collection service, 86.5% without aqueduct, more than 90% do not use angeos, repellents, insecticides or fumigations, a significant statistical association was found ( OR> 1) with stagnant water, lack of aqueduct and continuous water as risk factors for malaria; In addition, five species of mosquitoes that would be involved in the transmission were classified and a hotspot made up of six villages in the municipality was identified. Malaria in the municipality of Puerto Libertador is mainly associated with social problems, which constitute risk factors that favor the incidence of this disease. In the study area, the identification of Anopheles mosquitoes and the hotspot will make it possible to orient vector control measures and direct interventions to targeted localities with the highest risk of malaria(AU)

Characterization of an outbreak of malaria in a non-endemic zone on the coastal region of Ecuador / Caracterización de un brote de malaria en una zona no endémica de la región costera del Ecuador

Abstract | Introduction: Malaria is a vector-borne disease widely distributed in the Amazon region and the coastal area of northern Ecuador. Its epidemiology involves related factors such as human settlements, vector reproduction sites, mobility, productive activity, and the response capacity of health systems, among others. Objective: To describe malaria transmission by Plasmodium vivax in a non-endemic area of Ecuador by analyzing the epidemiological and entomological factors involved. Materials and methods: We conducted the epidemiological study of the cases reported in the Salinas canton and the characterization of vector breeding sites through captures of larvae and adult mosquitoes by human capture of resting mosquitoes. Results: We detected 21 cases of malaria with local transmission related to the presence of initial cases in Venezuelan migrant patients and identified Anopheles albimanus as the predominant vector in natural breeding sites such as estuaries, wells, and water channels. Conclusions: We detected an outbreak of malaria triggered by imported cases from Venezuela. Climatic, social, environmental, and ecological conditions have favored the development of the vector maintaining the transmission cycle. Strategies to control imported malaria should be multiple including early case detection and control of productive breeding sites to avoid local transmission.

Resumen | Introducción. La malaria o paludismo es una enfermedad transmitida por vectores, ampliamente distribuida en la región amazónica y en la zona costera del norte del Ecuador. Su epidemiología involucra factores relacionados, como asentamientos humanos, sitios de reproducción del vector, movilidad, actividad productiva y capacidad de respuesta de los sistemas de salud, entre otros.Objetivo. Describir la transmisión de malaria por Plasmodium vivax en un área no endémica de Ecuador, mediante el análisis de los factores epidemiológicos y entomológicos involucrados. Materiales y métodos. Se hizo el estudio epidemiológico de los casos reportados en el cantón de Salinas y la caracterización de criaderos del vector con capturas de larvas y adultos mediante la captura de mosquitos en reposo. Resultados. Se detectaron 21 casos de malaria con transmisión local relacionados con la presencia de casos iniciales importados de Venezuela. Se identificó Anopheles albimanuscomo el vector predominante en criaderos naturales como estuarios, pozos y canales de agua. Conclusiones. Se detectó un brote de malaria desencadenado por casos importados de Venezuela. Las condiciones climáticas, sociales, ambientales y ecológicas han favorecido el desarrollo del vector, manteniendo el ciclo de transmisión. Las estrategias para controlar la malaria importada deben ser multifacéticas, e incluir la detección temprana de casos y el control de criaderos productivos para evitar la transmisión local.

Avaliação de modelos de predição para ocorrência de malária no estado do Amapá, 1997-2016: um estudo ecológico / Evaluación de modelos de predicción para la ocurrencia de aparición de la malaria en el estado del Amapá, Brasil, 1997-2016: un estudio ecológico / Evaluation of prediction models for the occurrence of malaria in the state of Amapá, Brazil, 1997-2016: an ecological study

Objetivo: Avaliar a capacidade preditiva de diferentes modelos de série temporal de casos de malária no estado do Amapá, Brasil, no período 1997-2016. Métodos: Estudo ecológico de séries temporais com casos de malária registrados no Amapá. Foram utilizados dez modelos estatísticos determinísticos ou estocásticos para simulação e teste em horizontes de previsão de 3, 6 e 12 meses. Resultados: O teste inicial mostrou que a série é estacionária. Os modelos determinísticos apresentaram melhor desempenho do que os modelos estocásticos. O modelo ARIMA apresentou erros absolutos menores do que 2% na escala logarítmica e erros relativos 3,4-5,8 vezes menores em relação ao modelo nulo. A predição de casos futuros de malária nos horizontes de 6 e 12 meses de antecedência foi possível. Conclusão: Recomenda-se o uso de modelo ARIMA para a previsão de cenários futuros e para a antecipação do planejamento nos serviços de saúde dos estados da Região Amazônica.

Objetivo: Evaluar el poder predictivo de diferentes modelos de series de temporales de casos de malaria en el estado de Amapá, Brasil, en el periodo 1997-2016. Métodos: Se trata de un estudio ecológico de series de temporales con casos de malaria registrados en el estado de Amapá. Se utilizaron diez modelos estadísticos determinísticos o estocásticos para la simulación y la prueba en horizontes de predicción de 3, 6 y 12 meses. Resultados: La prueba inicial mostró que la serie es estacionaria. Los modelos determinísticos mostraron mejor desempeño que los modelos estocásticos. El modelo ARIMA mostró errores absolutos menores al 2% en la escala logarítmica y errores relativos 3,4-5,8 veces menores que el modelo nulo. La predicción de casos futuros en horizontes de 6 y 12 meses de antelación fue posible. Conclusión: Se recomienda utilizar el modelo ARIMA para predecir escenarios futuros y anticipar la planificación en los servicios de salud en los estados de la Región Amazónica.

Objective: To evaluate the predictive power of different malaria case time-series models in the state of Amapá, Brazil, for the period 1997-2016. Methods: This is an ecological time series study with malaria cases recorded in the state of Amapá. Ten deterministic or stochastic statistical models were used for simulation and testing in 3, 6, and 12 month forecast horizons. Results: The initial test showed that the series is stationary. Deterministic models performed better than stochastic models. The ARIMA model showed absolute errors of less than 2% on the logarithmic scale and relative errors 3.4-5.8 times less than the null model. It was possible to predict future malaria cases 6 and 12 months in advance. Conclusion: The ARIMA model is recommended for predicting future scenarios and for earlier planning in state health services in the Amazon Region.

The socio-environmental production of malaria in three municipalities in the Carajás region, Pará, Brazil / A produção socioambiental da malária em três municípios da região de Carajás, Pará, Brasil

ABSTRACT OBJECTIVE To analyze the environmental production of malaria in the municipalities of Marabá, Parauapebas, and Canaã dos Carajás, in Pará, from 2014 to 2018. METHODS This ecological, cross-sectional study used epidemiological data in the Sistema de Informações de Vigilância Epidemiológica da Malária (Malaria Epidemiological Surveillance Information System) from the Secretaria de Saúde do Estado do Pará (State of Pará Health Department), cartographic data from the Brazilian Institute of Geography and Statistics (IBGE), and environmental data in the Projeto TerraClass (TerraClass Project) from the National Institute of Space Research (INPE). Statistical analyses used the chi-square test, while the spatial ones, the kernel and Moran's (I) global bivariate techniques. RESULTS We analyzed a total of 437 confirmed cases of malaria in the selected area and period. The highest percentage of cases occurred among male miners and farmers, living in rural areas; Plasmodium vivax was the most frequent species; and the most used diagnosis, the thick drop/smear. We also observed a heterogeneous distribution of the disease — with evidence of spatial dependence between incidence areas and different forms of land use, and spatial autocorrelations related to the high variability of anthropic activities in the municipalities. CONCLUSION The environmental production of malaria relates mainly to cattle production and mining — anthropisms related to land use and occupation in the observed municipalities. Spatial data analysis technologies sufficed for the construction of the epidemiological scenario of the disease.

RESUMO OBJETIVO Analisar a produção ambiental da malária nos municípios de Marabá, Parauapebas e Canaã dos Carajás, no Pará, entre 2014 e 2018. MÉTODOS Estudo ecológico e transversal a partir de dados epidemiológicos do Sistema de Informações de Vigilância Epidemiológica da Malária, da Secretaria de Saúde do Estado do Pará. Foram utilizados também dados cartográficos do Instituto Brasileiro de Geografia e Estatística (IBGE) e ambientais do projeto TerraClass, do Instituto Nacional de Pesquisas Espaciais (INPE). As análises estatísticas utilizaram o cálculo de percentuais e o teste qui-quadrado e as espaciais as técnicas de Kernel e de Moran global bivariado (I). RESULTADOS Foram analisados 437 casos confirmados de malária, na área e periodo de estudo. O maior percentual de casos ocorreu em indivíduos do sexo masculino, adultos, morador da zona rural, com atividades de garimpagem e agropecuária, sendo o Plasmodium vivax a espécie de maior frequência e o diagnóstico mais utilizado a gota espessa/esfregaço. A distribuição da malária não ocorreu de forma homogênea, com evidências de dependência espacial entre áreas com ocorrência de casos e diferentes tipos de uso da terra. Foram observadas também autocorrelações espaciais relacionadas à alta variabilidade dos tipos antropismos, ocorrida nos municípios. CONCLUSÃO A produção ambiental da malária está associada principalmente à pastagem e à mineração, antropismos relacionados às formas de uso e ocupação da terra nos municípios estudados. As tecnologias de análises de dados espaciais em saúde foram satisfatórias para a construção do cenário epidemiológico da doença.

Reemergence of human malaria in Atlantic Forest of Rio Grande do Sul, Brazil

Unforeseen Plasmodium infections in the Atlantic Forest of Brazilian Extra-Amazonian region could jeopardise malaria elimination. A human malaria case was registered in Três Forquilhas, in the Atlantic Forest biome of Rio Grande do Sul, after a 45 years' time-lapsed without any malaria autochthonous notification in this southern Brazilian state. This finding represents the expansion of the malaria distribution areas in Brazil and the southernmost human malaria case record in South America in this decade. The coexistence of the bromeliad-breeding vector Anopheles (Kerteszia) cruzii and non-human primates in the Atlantic Forest regularly visited by the patient claimed for the zoonotic origin of this infection. The reemergence of Atlantic Forest human malaria in Rio Grande do Sul was also discussed.

Caracterización epidemiológica de pacientes con malaria, notificados por un asegurador en salud en Colombia, 2016-2017 / Epidemiological characterization of patients with malaria notified by a health insurer in Colombia, 2016-2017

Introducción: La malaria es un problema de salud pública para Colombia, con comportamiento endémico/epidémico y variación entre las diferentes áreas de transmisión. Objetivo: Describir las características epidemiológicas de pacientes con malaria, notificados por un asegurador en salud en Colombia durante los años 2016 y 2017. Métodos: Estudio descriptivo, en el que se revisó de forma retrospectiva la base de datos de todos los casos de malaria notificados por un asegurador en salud en Colombia durante los años 2016 y 2017. Se realizó un análisis descriptivo, teniendo en cuenta la naturaleza de las variables. Las variables cualitativas se analizaron a partir de las frecuencias absolutas y relativas. Se usó el test de chi cuadrado para comparar las diferencias entre proporciones, en todos los casos se estableció un valor p< 0,05 como significativo. Los datos se analizaron en el programa SPSS versión 19. Resultados: Durante el período de observación se notificaron 26 017 casos de malaria; el 50 por ciento (13 014) eran hombres y el 50 por ciento (13 003) mujeres. Los grupos etarios más afectados fueron los adultos jóvenes (26,37 por ciento), escolares (15,04 por ciento), preescolares (12,75 por ciento) y adolescentes iniciales (12,18 por ciento). La mayoría de los pacientes estudiados eran indígenas y mulatos; trabajadores no calificados, que residían y fueron notificados en el departamento del Chocó. En cuanto a las características clínicas y paraclínicas se encontró que el 95,9 por ciento de los pacientes eran sintomático, las especies parasitaria más frecuentemente fueron P. falciparum (58,86 por ciento) y P. vivax (35,95 por ciento) y en menor frecuencia P. malariae (0,06 por ciento). Se registró complicaciones en 410 pacientes, estas eran principalmente de tipo hematológicas (56,3 por ciento); sin embargo, también se registraron complicaciones cerebrales, renales, hepáticas y pulmonares. Durante los dos años se observó brotes epidémicos entre las semanas 6 a la 31, y posteriormente se observó un descenso en la notificación de casos. Conclusiones: Este estudio encontró una marcada diferencia en la incidencia de casos de malaria notificados por el asegurador objeto de estudio entre los años 2016 y 2017; la mayoría de estos casos eran por P. falciparum y se registraron en el departamento de Chocó(AU)

Introduction: Malaria is a health problem in Colombia. Its behavior is endemic / epidemic and variation is observed between the different transmission areas. Objective: Describe the epidemiological characteristics of patients with malaria notified by a health insurer in Colombia during the years 2016 and 2017. Methods: A descriptive study was conducted in which a retrospective review was performed of the database of all the malaria cases notified by a health insurer in Colombia during the years 2016 and 2017. A descriptive analysis was done taking into account the nature of the variables. Qualitative variables were analyzed in terms of absolute and relative frequencies. The chi-square test was used to compare the differences between proportions. A value of p< 0.05 was set as significant in all cases. The software SPPS version 19 was used for data analysis. Results: During the observation period a total 26 017 malaria cases were notified, of whom 50 percent were men (13 014) and 50 percent were women (13 003). The most affected age groups were young adults (26.37 percent), schoolchildren (15.04 percent), pre-schoolers (12.75 percent) and preadolescents (12.18 percent). Most of the patients studied were indigenous and mulatto, unskilled workers, and lived or were notified in the department of Chocó. With respect to clinical and paraclinical characteristics, it was found that 95.9 percent of the patients were symptomatic. The most common parasite species were P. falciparum (58.86 percent) and P. vivax (35.95 percent) and to a lesser degree P. malariae (0.06 percent). Complications were recorded in 410 patients. These were mainly hematological (56.3 percent), but brain, kidney, liver and lung complications were also found. During the two study years, epidemic outbreaks were observed between weeks 6 and 31, followed by a decrease in the number of case notifications. Conclusions: The study found a marked difference in the incidence of malaria cases notified by the study insurer between the years 2016 and 2017. Most of these cases were due to P. falciparum and were recorded in the department of Chocó(AU)

Desde el ISET al InDRE. IV. Instituto de Diagnóstico y Referencia Epidemiológicos: nueva orientación, 1990-2012 / From ISET to InDRE. IV. Institute of Epidemiological Diagnosis and Reference: new orientation, 1990-2012

Resumen De 1990 a 2012, el Instituto de Salubridad y Enfermedades Tropicales experimentó los cambios más importantes. En 1989 modificó su nombre y orientación a Instituto Nacional de Diagnóstico y Referencia Epidemiológicos. Poco antes se había formalizado como cúspide de la Red Nacional de Laboratorios en Salud Pública y había incorporado los laboratorios de programas preventivos como el de citología exfoliativa y los de diagnóstico de rabia, paludismo, tuberculosis; posteriormente incorporaría otras redes que surgieron como parte de la respuesta a brotes epidémicos y al nuevo panorama epidemiológico. En este periodo, 27 algoritmos diagnósticos se definieron y organizaron en 18 redes, algunas de las cuales comenzaron a colaborar con redes globales. En 2001, en el Instituto se empezó a trabajar con patógenos relacionados con el bioterrorismo. Para entonces, las restricciones del edificio sede fueron evidentes; en 2008, se decidió construir nuevas instalaciones. El Instituto y sus redes diagnósticas constituyen un hito en la salud pública latinoamericana del siglo XXI.

Abstract From 1990 to 2012, the Sanitary and Tropical Diseases Institute experienced the most important changes. In 1989, its name and orientation were modified to become the National Institute of Epidemiological Diagnosis and Reference (InDRE). Shortly before, it had been formalized as the apex of the National Network of Public Health Laboratories and had incorporated laboratories for preventive programs such as exfoliative cytology and rabies, malaria and tuberculosis diagnosis; subsequently, it would incorporate other networks that emerged as part of the response to major epidemic outbreaks and to the new epidemiological outlook. In this period, 27 priority diagnostic algorithms were defined and organized in 18 networks, some of which began to collaborate with global networks. In 2001, the Institute started working with pathogens related to bioterrorism. By then, space restrictions of the headquarters’ building were evident; in 2008, starting the construction of new facilities was decided. The institute and its diagnostic networks constitute a milestone in Latin American public health of the 21st century.

The impact of imported malaria by gold miners in Roraima: characterizing the spatial dynamics of autochthonous and imported malaria in an urban region of Boa Vista

BACKGROUND The number of malaria cases in Roraima nearly tripled from 2016 to 2018. The capital, Boa Vista, considered a low-risk area for malaria transmission, reported an increasing number of autochthonous and imported cases. OBJECTIVES This study describes a spatial analysis on malaria cases in an urban region of Boa Vista, which sought to identify the autochthonous and imported cases and associated them with Anopheles habitats and the potential risk of local transmission. METHODS In a cross-sectional study at the Polyclinic Cosme e Silva, 520 individuals were interviewed and diagnosed with malaria by microscopic examination. Using a global positional system, the locations of malaria cases by type and origin and the breeding sites of anopheline vectors were mapped and the risk of malaria transmission was evaluated by spatial point pattern analysis. FINDINGS Malaria was detected in 57.5% of the individuals and there was a disproportionate number of imported cases (90.6%) linked to Brazilian coming from gold mining sites in Venezuela and Guyana. MAIN CONCLUSIONS The increase in imported malaria cases circulating in the west region of Boa Vista, where there are positive breeding sites for the main vectors, may represent a potential condition for increased autochthonous malaria transmission in this space.

O feroz mosquito africano no Brasil: o Anopheles gambiae entre o silêncio e a sua erradicação (1930-1940) / The ferocious African mosquito in Brazil: the Anopheles gambiae between silence and its eradication (1930-1940)

Mostra uma trajetória ampliada do Anopheles gambiae no Brasil. evidencia a importância de compreender seu percurso desde sua chegada em 1930, considerando o processo histórico que o fez ser inicialmente entendido como um problema emergencial local, tratado de maneira paleativa para, posteriormente, ser enquadrado em um experimento de demonstração em saúde pública tendo em vista sua erradicação

Malária entre povos indígenas na fronteira Brasil-Guiana Francesa, entre 2007 e 2016: um estudo descritivo / Malaria entre pueblos indígenas en la frontera Brasil-Guyana Francesa, entre 2007 y 2016: un estudio descriptivo / Malaria among indigenous peoples on the Brazil-French Guiana border, 2007-2016: a descriptive study

Resumo Objetivo: descrever o perfil e a incidência dos casos de malária entre indígenas e não indígenas na fronteira franco-brasileira, no período de 2007 a 2016. Métodos: estudo descritivo, realizado a partir de casos notificados no Sistema de Informação de Vigilância Epidemiológica da Malária (SIVEP-Malária), organizados pelo software Tableau 10.3. Resultados: de um total de 21.729 casos no período, o ano de 2009 apresentou o maior registro, 3.637 (16,7%) notificações, das quais 1.956 (53,8%) entre indígenas com incidência parasitária anual (IPA) de 261 por 1 mil habitantes; os polos-base de Kumenê (IPA entre 13 e 534/1 mil hab.) e Manga (IPA entre 55 e 448/1 mil hab.) apresentaram maior risco de infecção; crianças representaram 20,0 a 40,0% dos casos notificados, e gestantes cerca de 2,0% dos casos entre não indígenas e 1,0% entre indígenas. Conclusão: a malária se apresentou de maneira desigual entre indígenas e não indígenas, com maior ocorrência entre povos indígenas.

Resumen Objetivo: describir el perfil y la incidencia de los casos de malaria entre indígenas y no indígenas en la frontera franco-brasileña, entre 2007 y 2016. Métodos: estudio descriptivo, realizado a partir de análisis de casos notificados en el Sistema de Información de Vigilancia Epidemiológica de la Malaria (SIVEP-Malaria), organizados por el software Tableau 10.3. Resultados: de 21.729 casos en el período, 2009 presentó el registro más alto, 3.637 (16,7%) notificaciones, 1.956 (53,8%) entre indígenas con incidencia parasitaria anual (IPA) de 261/1.000; el mayor riesgo de infección ocurrió en los polos Kumenê (IPA entre 13 y 534/1,000) y Manga (IPA entre 55 y 448/1.000); los niños representan 20% hasta 40% de los casos, y las mujeres embarazadas alrededor del 2,0% entre no indígenas y 1,0% entre indígenas. Conclusión: la malaria es desigual entre los dos grupos, con mayor riesgo para los indígenas.

Abstract Objective: to describe the profile and incidence of malaria cases among indigenous and non-indigenous people on the Brazil-French Guiana border, between 2007 and 2016. Methods: this is a descriptive study based on analysis of cases notified on the Malaria Epidemiological Surveillance Information System (SIVEP-Malaria), organized using Tableau 10.3. Results: a total of 21,729 cases were notified in the period; the highest annual number of notifications was 3,637 (16.7%) in 2009, 1,956 (53.8%) of which related to indigenous people, representing annual parasite incidence (API) of 261/1,000; higher risk of infection was found in the Kumenê base area (API between 13 and 534/1,000) and the Manga base area (API between 55 and 448/1,000); children accounted for 20.0 to 40.0% of notified cases, while pregnant women accounted for 2.0% among non-indigenous people and 1.0% among the indigenous. Conclusion: malaria case distribution was unequal between indigenous and non-indigenous people, with greater occurrence among the indigenous.

Anopheles gambiae no Brasil: antecedentes para um " alastramento silencioso ", 1930-1932 / Anopheles gambiae in Brazil: the background to a " silent spread, " 1930-1932

Resumo O artigo analisa a chegada e identificação do mosquito africano Anopheles gambiae no Brasil em 1930 e as primeiras reações de cientistas e autoridades de saúde pública contra as epidemias de malária causadas por essa espécie. Apesar de ter sido reconhecido como perigoso vetor da malária, sua presença em território nacional foi negligenciada a partir de 1932, após ações emergenciais na capital do Rio Grande do Norte, favorecendo um alastramento silencioso que resultou em uma grande epidemia de malária em 1938. São abordadas questões científicas e políticas que contribuíram para que o combate ao mosquito fosse colocado em segundo plano nas articulações entre a Divisão Sanitária Internacional da Fundação Rockefeller e autoridades brasileiras até 1937.

Abstract The article analyzes the arrival and identification of the African mosquito Anopheles gambiae in Brazil in 1930, and the initial reactions of scientists and public health authorities against the epidemics of malaria caused by this species. Although this mosquito was recognized as a dangerous vector of malaria, its presence in Brazil was neglected after initial emergency actions in the city of Natal in 1932; this encouraged it to spread silently, resulting in a major malaria epidemic in 1938. This article examines scientific and political issues which caused the fight against mosquitoes to be pushed into the background until 1937 in cooperative efforts between the Rockefeller Foundation's International Health Division and the Brazilian authorities.

Estrategias para la eliminación de malaria: una perspectiva afro-colombiana / Strategies for malaria elimination: an Afro-Colombian perspective

RESUMEN Objetivo Describir las estrategias para la eliminación de la malaria a partir de la percepción de pobladores afro-colombianos residentes en Guapi en el contexto de la Estrategia de Gestión Integrada para la promoción, prevención y control de las Enfermedades Transmitidas por Vectores en Colombia (EGI). Métodos Estudio de tipo cualitativo basado en el análisis de discurso de grupos focales. Ocho participantes residentes en zona urbana de Guapi, divididas en dos grupos: el primero correspondió a tres mujeres auxiliares de enfermería, denominadas "mujeres con mayor experiencia", trabajadoras en el actual sistema de salud y funcionarias del antiguo Servicio de Erradicación de la Malaria. El segundo correspondió a cinco mujeres auxiliares de enfermería, denominadas "mujeres con limitada experiencia", trabajadoras en el actual sistema de salud y no tuvieron formación directa con el programa de malaria. Análisis inductivo e interpretativo. Resultados Emergieron ocho subcategorias enmarcadas en la EGI, con énfasis en la promoción y prevención orientadas a disminuir la malaria, especialmente en el área rural. El abordaje del problema debe hacerse de forma integral incluyendo otras problemáticas en salud y determinantes sociales que los afectan como: saneamiento básico, acceso al servicio de salud, falta de educación, uso de tratamientos populares, fragilidad de infraestructura, entre otros. Conclusión Las participantes consideran que la malaria en Guapi se puede reducir pero no eliminar. Se requiere abordar este problema desde una perspectiva institucional y comunitaria, teniendo en cuenta las diferencias culturales, a partir de estrategias que incluyan el empoderamiento comunitario y fortalecimiento administrativo e institucional del programa.(AU)

ABSTRACT Objective To describe strategies for malaria elimination based on the perception of Afro-Colombian residents in Guapi, in the context of the Integrated Management Strategy for the Promotion, Prevention and Control of Vector-Borne Diseases in Colombia (EGI-ETV). Materials and Methods Qualitative study based on focus group discourse analysis. Eight participants from the urban area of Guapi were divided into two groups. The first group included three female nursing assistants, and was called "women with more experience"; they were workers in the current health system and former Malaria Eradication Service officers. The second group was made up of female nursing assistants, and was called "women with limited experience"; they were workers in the current health system and were not directly trained in the malaria program. An inductive and interpretative analysis was performed. Results Eight subcategories emerged, framed in the EGI-EVT, making emphasis on promotion and prevention aimed at reducing malaria, especially in rural areas. This problem must be addressed comprehensively, including other health issues and social determinants that affect them, such as: basic sanitation, access to health services, lack of education, use of popular treatments, and lack of infrastructure, among others. Conclusion Participants consider that malaria in Guapi can be reduced but not eliminated. This problem needs to be addressed from an institutional and community perspective, taking into account cultural differences, based on strategies that include community empowerment and administrative and institutional strengthening of the program.(AU)

Environmental and socioeconomic analysis of malaria transmission in the Brazilian Amazon, 2010-2015

ABSTRACT OBJECTIVE To analyze the environmental and socioeconomic risk factors of malaria transmission at municipality level, from 2010 to 2015, in the Brazilian Amazon. METHODS The municipalities were stratified into high, moderate, and low transmission based on the annual parasite incidence. A multinomial logistic regression that compared low with medium transmission and low with high transmission was performed. For each category, three models were analyzed: one only with socioeconomic risk factors (Gini index, illiteracy, number of mines and indigenous areas); a second with the environmental factors (forest coverage and length of the wet season); and a third with all covariates (full model). RESULTS The full model showed the best performance. The most important risks factors for high transmission were Gini index, length of the wet season and illiteracy, OR 2.06 (95%CI 1.19-3.56), 1.73 (95%CI 1.19-2.51) and 1.10 (95%CI 1.03-1.17), respectively. The medium transmission showed a weaker influence of the risk factors, being illiteracy, forest coverage and indigenous areas statistically significant but with marginal influence. CONCLUSIONS As a disease of poverty, the reduction in wealth inequalities and, therefore, health inequalities, could reduce the transmission considerably. Besides, environmental risk factors as length of the wet season should be considered in the planning, prevention and control. Municipality-level and fine-scale analysis should be done together to improve the knowledge of the local dynamics of transmission.