Malaria in Iran: past and present situation

ABSTRACT

Malaria had being widely prevalent for a long time in Iran. Before starting any anti-malarial campaign in Iran about 60% of population was living in malaria endemic areas. In hyper-endemic areas, approximately 30 to 40% of the total mortality was due to malaria. The malariometric data, reported during 1921-1949 in the malaria surveys in some endemic areas, showed high endemicities of the disease in most parts of the country. The first malaria-training course for preliminary operations of anti-malaria campaign was started in Iran in 1945. Afterwards, in the courses conducted, mostly by the Institute of Malariology many technical personnel were trained. In 1947, for the first time DDT was used in mosquito control in a pilot study in malaria hyper-endemic villages near Tehran. It caused great reduction in malaria transmission. Anti-malarial campaign including drug prophylaxis and treatment, anti-mosquito spraying with DDT and some anti-larval control measures, carried out during 1948-1956, considerably decreased malaria infection rate in most endemic areas. In 1957, malaria eradication programme [MEP] started in Iran and up to 1980 almost interrupted malaria transmission in the north parts of the country. However, in the south parts although the infection rate considerably decreased, but due to some technical and operational problems, malaria transmission was not interrupted. Therefore, in 1980 the MEP shifted to malaria control programme [MCP] which has been continuing up to present time. From 25 species of Anopheles found in Iran, 8 species of A. stephensi, A. fluviatilis, A. culicifacies, A. pulcherimus, A. d_thali, A. superpictus, A. sacharovi and A. maculipennis are considered to be malaria vectors. The prevalent species of Plasmodia in Iran are P. falciparum and P. vivax. P. malariae is rare. The main problems, in the malaria endemic areas of the southeast parts of Iran are resistance of the main vectors to some insecticides as well as high resistance of P. falciparum to chloroquine. The total reported malaria cases in Iran from 96340 with 45% P. falciparum in 1991, gradually, decreased to 18966 with 12% P. falciparum in 2005. About 30 to 50% of malaria patients have been among foreign immigrants