Evaluation of the malaria elimination policy in Brazil: a systematic review and epidemiological analysis study.

After a centenary fight against malaria, Brazil has seen an opportunity for change with the proposal of the malaria elimination policy set by the Brazilian government, in line with malaria elimination policies in other Latin American countries. Brazilian malaria experts regard eliminating malaria by 2030 to be within reach. Herein we evaluated the likelihood that malaria elimination can be accomplished in Brazil through systematic review of the literature on malaria elimination in Brazil and epidemiological analysis. Fifty-two articles referring to malaria eradication/elimination in Brazil were analyzed to identify challenges and technological breakthroughs for controlling malaria. Monthly deaths (1979-2016) and monthly severe malaria cases (1998-2018) were analyzed according to age groups, geographic region and parasite species. As a result, we observed that the declining malaria burden was mostly attributable to a decline in Plasmodium falciparum-malaria. At the same time, the proportional increase of Plasmodium vivax-malaria in comparison with P. falciparum-malaria was notable. This niche replacement mechanism was discussed in the reviewed literature. In addition, the challenges to P. vivax-malaria elimination outnumbered the available technological breakthroughs. Although accumulated and basic information exists on mosquito vector biology, the lack of specific knowledge about mosquito vector taxonomy and ecology may hamper current attempts at stopping malaria in the country. An impressive reduction in malaria hospitalizations and mortality was seen in Brazil in the past 3 decades. Eliminating malaria deaths in children less than 5 years and P. falciparum severe cases may be achievable goals under the current malaria policy until 2030. However, eliminating P. vivax malaria transmission and morbidity seems unattainable with the available tools. Therefore, complete malaria elimination in Brazil in the near future is unlikely.

Plasmodium infection in Kerteszia cruzii (Diptera: Culicidae) in the Atlantic tropical rain forest, southeastern Brazil.

In Southeastern Brazil, Kerteszia cruzii (former Anopheles cruzii), a bromeliad mosquito species, is considered an efficient human Plasmodium spp. vector. In this region, recent studies showed asymptomatic or sub-patent Plasmodium falciparum infection. In areas of the Atlantic coast in Rio de Janeiro, Plasmodium simium infection was recently reported in both human and howler monkey. Considering that (1) few malaria cases are reported each year in areas across the tropical Atlantic rain forest in southeastern Brazil; (2) malaria elimination in Atlantic forest is challenged by circulation of P. falciparum and P. simium in humans; (3) the complexity of malaria epidemiology in this region; and (4) the public health importance of Kerteszia cruzii as a sylvatic vector; the major goal of this study is to evaluate Plasmodium infection in Ke. cruzii. Mosquito sampling collections were conducted in Esteiro do Morro and Sítio Itapuan, in Cananeia municipality, and Tapiraí municipality in Ribeira Valley, southeastern São Paulo state, Brazil. Influence of climate and landscape factors in Plasmodium infection in Ke. cruzii was addressed. Among the 1719 mosquitoes tested, 3 females collected in Sítio Itapuan and three from Tapiraí were found infected with either P. vivax or P. simium. Results of statistical analyses did not demonstrate association between Plasmodium infection in mosquito and the landscape. Mosquito infection was found in two landscape clusters, with Plasmodium detected in forest fringe mosquitoes. This finding shows that Ke. cruzii can facilitate transmission among human and non-human primates. Plasmodium falciparum was not identified in the samples analyzed. Spatiotemporal variation in local malaria incidence, low prevalence of Plasmodium, variations in humidity and temperature can explain the absence of mosquitoes infected with P. falciparum in the study.

Evaluation of the malaria elimination policy in Brazil: a systematic review and epidemiological analysis study

@#After a centenary fight against malaria, Brazil has seen an opportunity for change with the proposal of the malaria elimination policy set by the Brazilian government, in line with malaria elimination policies in other Latin American countries. Brazilian malaria experts regard eliminating malaria by 2030 to be within reach. Herein we evaluated the likelihood that malaria elimination can be accomplished in Brazil through systematic review of the literature on malaria elimination in Brazil and epidemiological analysis. Fifty-two articles referring to malaria eradication/elimination in Brazil were analyzed to identify challenges and technological breakthroughs for controlling malaria. Monthly deaths (1979–2016) and monthly severe malaria cases (1998–2018) were analyzed according to age groups, geographic region and parasite species. As a result, we observed that the declining malaria burden was mostly attributable to a decline in Plasmodium falciparum-malaria. At the same time, the proportional increase of Plasmodium vivax-malaria in comparison with P. falciparum-malaria was notable. This niche replacement mechanism was discussed in the reviewed literature. In addition, the challenges to P. vivax-malaria elimination outnumbered the available technological breakthroughs. Although accumulated and basic information exists on mosquito vector biology, the lack of specific knowledge about mosquito vector taxonomy and ecology may hamper current attempts at stopping malaria in the country. An impressive reduction in malaria hospitalizations and mortality was seen in Brazil in the past 3 decades. Eliminating malaria deaths in children less than 5 years and P. falciparum severe cases may be achievable goals under the current malaria policy until 2030. However, eliminating P. vivax malaria transmission and morbidity seems unattainable with the available tools. Therefore, complete malaria elimination in Brazil in the near future is unlikely.

Effectiveness of mosquito magnet in preserved area on the coastal Atlantic rainforest: implication for entomological surveillance.

A variety of traps are used for sampling, surveillance, and monitoring of mosquito vector species associated with parasite and pathogen transmission. Here, we assessed the performance of the Mosquito Magnet Independence trap with Lurex3 (MMI), by comparing its effectiveness with those of a Centers forDisease Control and Prevention light trap (CDC-LT) and CDC with CO2 and Lurex3 (CDC-A) in a dense tropical rainforest. Multivariate generalized linear models revealed significant differences among the traps regarding mosquito composition and abundance (deviance = 768; P = 0.016). Variance analyses indicated that the MMI captured significantly more mosquitoes compared with CDC-LT (P < 0.01) and CDC-A (P < 0.03). The abundance values did not significantly differ between the CDC-LT and CDC-A traps (P = 0.7). Mosquito species richness was higher from the MMI than from the CDC-LT and CDC-A traps. Furthermore, medically important mosquito species captured by the three traps showed high association with MMI. These results suggest the potential to use the MMI in studies aiming to obtain entomological surveillance information about medically important mosquitoes that occur in tropical rainforest areas. The MMI could also be used in faunal studies focusing on increasing knowledge about mosquito diversity. Considering the present positive results, the effectiveness of the MMI should additionally be evaluated in other Brazilian natural ecosystems. Further studies are also needed to address demographic data from the mosquito population sampled by the MMI.

Insight into Anopheles (Nyssorhynchus) (Diptera: Culicidae) species from Brazil.

Anopheles (Nyssorhynchus) benarrochi s.l., Anopheles (Nyssorhynchus) oswaldoi s.l., and Anopheles (Nyssorhynchus) konderi s.l. collected in Acrelandia, state of Acre, Brazil, were identified based on morphological characters of the male genitalia, fourth-instar larvae, and pupae. Morphological variation was observed in the male genitalia of these species in comparison with specimens from other localities in Brazil. DNA sequence from the nuclear ribosomal second internal transcribed spacer of individuals identified as An. benarrochi s.l. by using male genitalia characteristics showed that the various morphological forms are conspecific but are distinct from An. benarrochi B from Colombia. Anopheles konderi s.l. and An. oswaldoi s.l. both misidentified as An. oswaldoi s.s. (Peryassti) throughout Brazil, may actually comprise at least two undescribed species. Diagnostic morphological characteristics of the male genitalia are provided to distinguish Anopheles benarrochi s.l., Anopheles oswaldoi s.l., and Anopheles konderi s.l. from morphologically similar species. Incrimination of An. oswaldoi s.s. in malaria transmission in Brazil needs further investigation because other undescribed species from Acre may have been confounded with this taxon.

The history and clinical application of arthroscopy.

Prior to the mid-1970s, few practitioners employed arthroscopic instruments for either diagnostic or surgical purposes. Today, arthroscopy enjoys acceptance and popularity for the diagnosis and therapeutic management of arthropathy. This article outlines the development of arthroscopy and reviews the clinical applications of the technique.