A genomic platform for surveillance and antigen discovery in Plasmodium spp. using long-read amplicon sequencing.

Many vaccine candidate proteins in the malaria parasite Plasmodium falciparum are under strong immunological pressure and confer antigenic diversity. We present a sequencing and data analysis platform for the genomic surveillance of the insertion or deletion (indel)-rich antigens merozoite surface protein 1 (MSP1), MSP2, glutamate-rich protein (GLURP), and CSP from P. falciparum using long-read circular consensus sequencing (CCS) in multiclonal malaria isolates. Our platform uses 40 PCR primers per gene to asymmetrically barcode and identify multiclonal infections in pools of up to 384 samples. With msp2, we validated the method using 235 mock infections combining 10 synthetic variants at different concentrations and infection complexities. We applied this strategy to P. falciparum isolates from a longitudinal cohort in Tanzania. Finally, we constructed an analysis pipeline that streamlines the processing and interpretation of epidemiological and antigenic diversity data from demultiplexed FASTQ files. This platform can be easily adapted to other polymorphic antigens of interest in Plasmodium or any other human pathogen.

Analysis of Fifty Years of Severe Malaria Worldwide Research.

This study analyzed fifty years of severe malaria research worldwide. Malaria is a parasitic disease that continues to have a significant impact on global health, particularly in sub-Saharan Africa. Severe malaria, a severe and often fatal form of the disease, is a major public health concern. The study used different bibliometric indicators such as the number of publications, citations, authorship, and keywords to analyze the research trends, patterns, and progress made in the field of severe malaria. The study covers the period from 1974 to 2021 and includes articles from Scopus. The results of the study indicated that there has been a steady increase in the number of publications on severe malaria over the past fifty years, with a particular increase in the last decade. The study also showed that most of the publications are from USA and Europe, while the disease occurs in Africa, South-East Asia, and the Americas. The study also identified the most frequent keywords used in the publications, and the most influential journals and authors in the field. In conclusion, this bibliometric study provides a comprehensive overview of the research trends and patterns in the field of severe malaria over the past fifty years and highlights the areas that need more attention and research efforts.

A systematic review of asymptomatic Plasmodium knowlesi infection: an emerging challenge involving an emerging infectious disease.

BACKGROUND: In the last decade Plasmodium knowlesi has been detected in humans throughout South East Asia. The highest risk groups for this infection are males, adults and those performing forest-related work. Furthermore, asymptomatic cases of P. knowlesi malaria have been reported including among women and children. METHODS: Pubmed, Scopus and the Web of Science databases for literature describing asymptomatic P. knowlesi malaria published between 2010 and 2020 were searched. A systematic literature review was conducted to identify studies reporting the prevalence and incidence of laboratory confirmed asymptomatic P. knowlesi cases in humans, their clinical and demographic characteristics, and methods used to diagnose these cases. RESULTS: By analysing over 102 papers, thirteen were eligible for this review. Asymptomatic P. knowlesi infections have been detected in 0.03%-4.0% of the population depending on region, and infections have been described in children as young as 2 years old. Various different diagnostic methods were used to detect P. knowlesi cases and there were differing definitions of asymptomatic cases in these studies. The literature indicates that regionally-differing immune-related mechanisms may play a part on the prevalence of asymptomatic P. knowlesi. CONCLUSION: Differing epidemiological characteristics of asymptomatic P. knowlesi malaria in different regions reinforces the need to further investigate disease transmission mechanics. Effective public health responses to changes in P. knowlesi epidemiology require proactive intervention and multisectoral collaboration.

Análisis de las interacciones entre los actores de la Red de Gestión del Conocimiento, Investigación e Innovación en Malaria de Colombia / Analysis of interactions between actors of the Red de Gestión del Conocimiento e Innovación en Malaria de Colombia

Introducción. La malaria, o paludismo, es una enfermedad de gran impacto en la población colombiana, que debe ser abordada desde el punto de vista del trabajo en equipo de instituciones para el intercambio de conocimiento. Objetivo. Analizar las interacciones de la Red de Gestión del Conocimiento, Investigación e Innovación en Malaria de Colombia. Materiales y métodos. Se hizo un análisis de redes sociales que permitió identificar la proximidad entre los actores y el grado de conocimiento entre ellos; se observaron indicadores de densidad, diámetro, distancia media y centralidad de grado. El corpus documental para el estudio estuvo constituido por 193 documentos técnicos publicados entre el 2016 y el 2021, que fueron analizados empleando técnicas de procesamiento de texto mediante el lenguaje de programación R. La categorización de la red se realizó a partir de cinco variables: atención integral a pacientes, diagnóstico, epidemiología y sistemas de análisis de información en salud, política pública, y promoción y prevención. Resultados. El análisis de las interacciones indicó que la red la conformaban 99 actores, de los cuales 97 (98 %), mostraron más interés en la producción de conocimientos en epidemiología y sistemas de análisis de información en salud, seguido de la categoría de atención integral a pacientes con 79 (80 %). El 54 % de los actores llevó a cabo estudios de promoción y prevención, siendo esta la categoría de menor abordaje. Conclusiones. Este estudio contribuye al fortalecimiento de estrategias clave en la divulgación del conocimiento sobre la malaria en Colombia.

Introduction: Malaria is a disease with a high impact on Colombian population, which must be approached from the point of view of teamwork of institutions for knowledge exchange. Objective: To analyze the interactions of the Red de Gestión del Conocimiento, Investigación e Innovación en Malaria de Colombia. Materials and methods: An analysis of social networks was applied that allowed identifying the proximity between actors and the degree of knowledge between them. Indicators of density, diameter, average distance, and degree of centrality were observed. The documentary corpus for the study consisted of 193 technical documents published between 2016 and 2021, which were analyzed using text mining using the R programming language. The network was categorized based on five variables: comprehensive patient care, diagnosis, epidemiology and health information analysis systems, public policy and promotion and prevention. Results: The analysis of interactions indicated that the network was made up by 99 actors. The main interest in knowledge production was on epidemiology and health information analysis systems (98 % of the actors), followed by the integral patient care (80 % of the actors). On the contrary, the least approached category was malaria promotion and prevention practices (54 % of the actors). Conclusions: In general, this study contributes to the strengthening of key strategies in the dissemination of knowledge about malaria in Colombia.

Plasmodium pitheci malaria in Bornean orang-utans at a rehabilitation centre in West Kalimantan, Indonesia.

BACKGROUND: Plasmodial species naturally infecting orang-utans, Plasmodium pitheci and Plasmodium silvaticum, have been rarely described and reportedly cause relatively benign infections. Orang-utans at Rescue Rehabilitation Centres (RRC) across the orang-utan natural range suffer from malaria illness. However, the species involved and clinical pathology of this illness have not been described in a systematic manner. The objective of the present study was to identify the Plasmodium species infecting orang-utans under our care, define the frequency and character of malaria illness among the infected, and establish criteria for successful diagnosis and treatment. METHODS: During the period 2017-2021, prospective active surveillance of malaria among 131 orang-utans resident in a forested RRC in West Kalimantan (Indonesia) was conducted. A total of 1783 blood samples were analysed by microscopy and 219 by nucleic acid based (PCR) diagnostic testing. Medical records of inpatient orang-utans at the centre from 2010 to 2016 were also retrospectively analysed for instances of symptomatic malaria. RESULTS: Active surveillance revealed 89 of 131 orang-utans were positive for malaria at least once between 2017 and 2021 (period prevalence = 68%). During that period, 14 cases (affecting 13 orang-utans) developed clinical malaria (0.027 attacks/orang-utan-year). Three other cases were found to have occurred from 2010-2016. Sick individuals presented predominantly with fever, anaemia, thrombocytopenia, and leukopenia. All had parasitaemias in excess of 4000/µL and as high as 105,000/µL, with severity of illness correlating with parasitaemia. Illness and parasitaemia quickly resolved following administration of artemisinin-combined therapies. High levels of parasitaemia also sometimes occurred in asymptomatic cases, in which case, parasitaemia cleared spontaneously. CONCLUSIONS: This study demonstrated that P. pitheci very often infected orang-utans at this RRC. In about 14% of infected orang-utans, malaria illness occurred and ranged from moderate to severe in nature. The successful clinical management of acute pitheci malaria is described. Concerns are raised about this infection potentially posing a threat to this endangered species in the wild.

National Institute of Malaria Research-Malaria Dashboard (NIMR-MDB): A digital platform for analysis and visualization of epidemiological data.

Background: A digital dashboard can be an invaluable resource for the research community and can help analyze and visualize data as per the inputs provided by the user. In India, large data sets on malaria are available though presently no digital dashboard is being used to monitor and analyze the malaria data. Methods: We have developed a dashboard (National Institute of Malaria Research-Malaria Dashboard (NIMR-MDB)) in R software using 19 different packages within which shiny and ggplot2 are used more intensively. NIMR-MDB can be used offline by running the app on any R software installed computer. Furthermore, NIMR-MDB can be accessed across different computers within an organization using a local server, or it may be made publicly available by publishing it online with secured access. There are two options for publishing the shiny dashboard online 1) via a personal Linux server for hosting this application or 2) by hosting the application on a certified online platform such as 'shinyapps.io' at a reasonable cost without setting up a server. Findings: The NIMR-MDB is a versatile interface that allows prompt and interactive analyses of malaria epidemiological data. The primary interface of NIMR-MDB is like a web page with 14 tabs (or pages) where each Tab corresponds to a particular set of analysis. Users may move from one Tab to another via icons. Each Tab allows flexibility in correlating various epidemiological parameters like SPR, API, AFI, ABER, RT, malaria cases, deaths, BSC and BSE. The malaria epidemiological data can be analyzed in the required granularity (national level, state level or district level), and its enhanced visualization allows for facile usage and extensive analysis. Interpretation: This NIMR-MDB developed here will play an important role in the analysis of epidemiological data and in strategizing malaria control in India. Researchers and policymakers may use it as a prototype for developing other dashboards for various diseases globally. Funding: There is no specific grant received from any funding agency for this work yet.

Malaria Elimination in Two Endemic Coastal Environments of Southern India: An Eco-Epidemiological Analysis from 2004 to 2019.

PURPOSE: Presently, India is heading towards malaria elimination. In this context, analysing malaria epidemiological data of endemic pockets is important. In the present investigation, malaria prevalence in two endemic coastal localities of India viz., Besant Nagar (Chennai district) and Pamban (Ramanathapuram district) was analysed from 2004 to 2019 and correlated with the highest maximum temperature. METHODS: Malaria surveillance data and entomological data from the malaria clinics were used to investigate epidemiological parameters. The annual malaria cases were correlated with the highest maximum temperature. RESULTS: The analysis showed that the malaria case (P.v. and P.f.) reports were directly proportional to the temperature increase. Malaria cases were remarkably increased from 2004 to 2011 and subsequently, both Plasmodium vivax and Plasmodium falciparum cases were drastically reduced till 2019. P. vivax was higher than P. falciparum and the male population was found to be more affected. Mixed infection of P. vivax and P. falciparum was observed only in the Besant Nagar site (0.3%). The most affected age group was the adult age group (15 years and above) in both Besant Nagar (76.1%) and Pamban (69.5%). CONCLUSION: Improved surveillance, complete treatment and integrated vector control activities correlated with a declining trend of malaria cases in both the coastal sites towards malaria elimination.

A review of malaria epidemiology and control in Papua New Guinea 1900 to 2021: Progress made and future directions.

The research and control of malaria has a long history in Papua New Guinea, sometimes resulting in substantial changes to the distribution of infection and transmission dynamics in the country. There have been four major periods of malaria control in PNG, with the current control programme having commenced in 2004. Each previous control programme was successful in reducing malaria burden in the country, but multiple factors led to programme failures and eventual breakdown. A comprehensive review of the literature dating from 1900 to 2021 was undertaken to summarize control strategies, epidemiology, vector ecology and environmental drivers of malaria transmission in PNG. Evaluations of historical control programs reveal poor planning and communication, and difficulty in sustaining financial investment once malaria burden had decreased as common themes in the breakdown of previous programs. Success of current and future malaria control programs in PNG is contingent on adequate planning and management of control programs, effective communication and engagement with at-risk populations, and cohesive targeted approaches to sub-national and national control and elimination.

Baseline malaria prevalence at the targeted pre-elimination districts in Ethiopia.

BACKGROUND: Encouraged by the previous success in malaria control and prevention strategies, the Ethiopian ministry of health launched malaria elimination with a stepwise approach by primarily targeting the low-transmission Districts and their adjacent areas/zones in order to shrink the country's malaria map progressively. Hence, this community survey was conducted to establish baseline malaria information at the preliminary phase of elimination at targeted settings. METHODS: A community-based cross-sectional survey was conducted at 20 malaria-elimination targeted Districts selected from five Regional states and one city administration in Ethiopia. The GPS-enabled smartphones programmed with Open Data Kit were used to enumerate 9326 study households and collect data from 29,993 residents. CareStart™ Malaria PAN (pLDH) Rapid Diagnostic Tests (RDTs) were used for blood testing at the field level. Armpit digital thermometers were used to measure axillary temperature. RESULT: Overall malaria prevalence by RDTs was 1.17% (339/28973). The prevalence at District levels ranged from 0.0 to 4.7%. The proportion of symptomatic cases (axillary temperature > 37.5oc) in the survey was 9.2% (2760/29993). Among the 2510 symptomatic individuals tested with RDTs, only 3.35% (84/2510) were malaria positive. The 75.2% (255/339) of all malaria positives were asymptomatic. Of the total asymptomatic malaria cases, 10.2% (26/255) were under-five children and 89.8% (229/255) were above 5 years of age. CONCLUSION: The study shows a decrease in malaria prevalence compared to the reports of previous malaria indicator surveys in the country. The finding can be used as a baseline for measuring the achievement of ongoing malaria elimination efforts. Particularly, the high prevalence of asymptomatic individuals (0.88%) in these transmission settings indicates there may be sustaining hidden transmission. Therefore, active case detection with more sensitive diagnostic techniques is suggested to know more real magnitude of residual malaria in the elimination-targeted areas.

Time-Varying Effects of Meteorological Variables on Malaria Epidemiology in the Context of Interrupted Control Efforts in the Amazon Rainforest, 2000-2017.

Successful malaria control interventions, mostly based on the training of health workers, distribution of insecticide-treated nets, and spraying, decrease malaria incidence; however, when these interventions are interrupted, a resurgence may occur. In the Peruvian Amazon, after discontinuing the control activities implemented by the PAMAFRO project (2006-2010)-a Global Fund-sponsored project for the strengthening of malaria control and surveillance in multiple countries in Latin America- malaria cases re-emerged dramatically. In parallel, meteorological factors determine the conditions suitable for the development, reproduction, and survival of mosquito vectors and parasites. This study hypothesized that interruption of malaria interventions may have modified the meteorological-malaria relationships over time (i.e., temporal changes in the dose-response between meteorological variables and malaria incidence). In this panel data analysis, we assessed the extent that relationships between meteorological variables and malaria changed temporally using data of monthly malaria incidence due to Plasmodium vivax or P. falciparum in Loreto, Peru (2000-2017). Generalized additive models were used to explore how the effects of meteorological variables changed in magnitude before, during, and after the PAMAFRO intervention. We found that once the PAMAFRO intervention had been interrupted, the estimated effects (dose-response) of meteorological variables on incidence rates decreased for both malaria parasite species. However, these fitted effect estimates did not reach their baseline levels (before the PAMAFRO period); variations of time-varying slopes between 0.45 and 2.07 times were observed after the PAMAFRO intervention. We also reported significant heterogeneity in the geographical distributions of malaria, parasite species, and meteorological variables. High malaria transmission occurred consistently in the northwestern provinces of Loreto Department. Since the end of the PAMAFRO period, a higher effect of precipitation and actual evapotranspiration was described on P. falciparum compared to P. vivax. The effect of temperature on malaria was greater over a shorter time (1-month lag or less), compared with precipitation and actual evapotranspiration (12-month lag). These findings demonstrate the importance of sustained malaria control efforts since interruption may enhance the links between meteorological factors and malaria. Our results also emphasize the importance of considering the time-varying effect of meteorological factors on malaria incidence to tailor control interventions, especially to better manage the current and future climate change crisis.

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

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.

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 albimanus como 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.

Plasmodium malariae, current knowledge and future research opportunities on a neglected malaria parasite species.

Plasmodium malariae is often reported as a benign malaria parasite. There are limited data on its biology and disease burden in sub-Saharan Africa (sSA) possibly due to the unavailability of specific and affordable tools for routine diagnosis and large epidemiology studies. In addition, P. malariae occurs at low parasite densities and in co-infections with other species, predominately P. falciparum. The paucity of data on P. malariae infections limits the capacity to accurately determine its contribution to malaria and the effect of control interventions against P. falciparum on its prevalence. Here, we summarise the current knowledge on P. malariae epidemiology in sSA - overall prevalence ranging from 0-32%, as detected by different diagnostic methods; seroprevalence ranging from 0-56% in three countries (Mozambique, Benin and Zimbabwe), and explore the future application of next-generation sequencing technologies as a tool for enriching P. malariae genomic epidemiology. This will provide insights into important adaptive mechanisms of this neglected non-falciparum species, including antimalarial drug resistance, local and regional parasite transmission patterns and genomic signatures of selection. Improved diagnosis and genomic surveillance of non-falciparum malaria parasites in Africa would be helpful in evaluating progress towards elimination of all human Plasmodium species.

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.

Mapping the travel patterns of people with malaria in Bangladesh.

BACKGROUND: Spread of malaria and antimalarial resistance through human movement present major threats to current goals to eliminate the disease. Bordering the Greater Mekong Subregion, southeast Bangladesh is a potentially important route of spread to India and beyond, but information on travel patterns in this area are lacking. METHODS: Using a standardised short survey tool, 2090 patients with malaria were interviewed at 57 study sites in 2015-2016 about their demographics and travel patterns in the preceding 2 months. RESULTS: Most travel was in the south of the study region between Cox's Bazar district (coastal region) to forested areas in Bandarban (31% by days and 45% by nights), forming a source-sink route. Less than 1% of travel reported was between the north and south forested areas of the study area. Farmers (21%) and students (19%) were the top two occupations recorded, with 67 and 47% reporting travel to the forest respectively. Males aged 25-49 years accounted for 43% of cases visiting forests but only 24% of the study population. Children did not travel. Women, forest dwellers and farmers did not travel beyond union boundaries. Military personnel travelled the furthest especially to remote forested areas. CONCLUSIONS: The approach demonstrated here provides a framework for identifying key traveller groups and their origins and destinations of travel in combination with knowledge of local epidemiology to inform malaria control and elimination efforts. Working with the NMEP, the findings were used to derive a set of policy recommendations to guide targeting of interventions for elimination.

Caracterización del paludismo como enfermedad endémica en Ecuador / Characterization of the malaria like endemic illness in Ecuador

RESUMEN Fundamento: el paludismo como problema de salud pública mundial, afecta a un elevado número de personas cada año. Congruente con evaluaciones de la Organización Mundial de la Salud y la Organización Panamericana de la Salud, cada año se presentan entre 50 y 100 millones de casos de la enfermedad. Objetivo: caracterizar el paludismo como enfermedad endémica en Ecuador. Métodos: se realizó una revisión bibliográfica de un total de 23 artículos en las bases de datos Scopus, Latindex y SciELO, mediante un gestor de búsqueda y administrador de referencias Endnote, de ellos 22 corresponden a los últimos cuatro años, 12 corresponden a artículos en diferentes revistas electrónicas y sitios web especializados en el tema y 11 a informes y documentos de organizaciones mundiales, de los cuales se utilizaron 72 citas seleccionadas para la revisión. Resultados: los diferentes documentos relacionados con las estadísticas, destacan el incremento del paludismo en diferentes áreas del planeta, por lo cual se intencionan acciones que contribuyen a su disminución e incluso erradicación, sin embargo en Ecuador, en los últimos dos años los resultados son desfavorables en este sentido. Conclusiones: es evidente que los directivos de la salud pública y factores comunitarios de cada país afectado por paludismo, deben asumir un enfoque preventivo que vele por los problemas de salud de las comunidades y favorezca el medio ambiente, fomenten en iniciativas que promuevan mayor responsabilidad ambiental a favor de erradicarla. En el caso de Ecuador, se muestran resultados desfavorables que tienden al incremento de esta enfermedad.

ABSTRACT Background: the malaria as problem of world public health, affects a high number of persons every year. Coherent with evaluations of the World Health Organization and the Pan-American Health Organization, between 50 and 100 million cases of the illness are presented every year. Objective: to characterize the malaria as an endemic illness in Ecuador. Methods: a bibliographical review of a whole of 23 articles was carried out in the Scopus, Latindex and SciELO databases, by means of a search engine and Endnote references manager, of them 22 correspond to last four years, 12 correspond to articles in different electronic magazines and web sites specializing in the topic and 11 to reports and documents of world organizations, of which 72 quotations selected for the review were used. Results: the different documents related to the statistics, emphasize the increase of the malaria in different areas of the planet, for which actions that contribute to its decrease and even eradication are carried out, nevertheless in Ecuador, in the last two years the results are unfavorable in this sense. Conclusions: it is clear that the managers of the public health and community factors of every country affected by malaria, must assume a preventive approach that looks over the problems of health of the communities and favors the environment, they encourage in initiatives that promote major environmental responsibility in favor of eradicating it. In case of Ecuador, there appear unfavorable results that tend to the increase of this illness.

Risk Associated with Malaria Infection in Tihama Qahtan, Aseer Region, Kingdom of Saudi Arabia: 2006-2007.

INTRODUCTION: Since 2004, the Kingdom of Saudi Arabia has pursued a policy of malaria elimination. The distribution of malaria at this time was constrained to regions located in the South Western part of the country. The present study aimed to understand the risk of malaria infection and factors associated with these events between March 2006 and August 2007 in one part of Aseer region. METHODS: The study was carried out in Tihama Qahtan area in the far southeastern part of Aseer, historically the most malaria endemic area of this region. The area covers 54 villages served by three primary health care centres (Wadi Alhayah, Alfarsha and Albuqaa). Malaria cases were detected using passive case detection (PCD) at the three health centres for 18 months from March 2006, each positive case was investigated using patient and household level enquiries. In addition, four cross-sectional surveys in 12 villages were undertaken using rapid diagnostic tests within the catchments of each health centre coinciding with malaria transmission seasons. RESULTS: Among 1840 individuals examined in the PCD survey, 49 (2.7%) were positive for malaria, most were Plasmodium falciparum cases and one was a P. vivax case. The majority of these infections were likely to have been acquired outside of the area and represent imported cases, including those from the neighboring region of Jazan. Among the 18 locally acquired cases, the majority were adult males who slept outdoors. 3623 individuals were screened during the cross-sectional surveys, 16 (0.44%) were positive and infections only detected during peak, potential transmission periods. CONCLUSION: There was evidence of local malaria transmission in the Tihama Qahtan area in 2006-2007, however prevalence and incidence of new infections was very low, making the future ambitions of elimination biologically feasible. The constant source of imported infections must be considered in the area's elimination ambitions, alongside strong behavioural community messages about sleeping outdoors unprotected and travel to malaria endemic areas outside the region.

Distribution of Anopheles vectors and potential malaria transmission stability in Europe and the Mediterranean area under future climate change.

BACKGROUND: In the scope of climate change the possible recurrence and/or expansion of vector-borne diseases poses a major concern. The occurrence of vector competent Anopheles species as well as favorable climatic conditions may lead to the re-emergence of autochthonous malaria in Europe and the Mediterranean area. However, high-resolution assessments of possible changes of Anopheles vector distributions and of potential malaria transmission stability in the European-Mediterranean area under changing climatic conditions during the course of the 21st century are not available yet. METHODS: Boosted Regression Trees are applied to relate climate variables and land cover classes to vector occurrences. Changes in future vector distributions and potential malaria transmission stability due to climate change are assessed using state-of-the art regional climate model simulations. RESULTS: Distinct changes in the distributions of the dominant vectors of human malaria are to be expected under climate change. In general, temperature and precipitation changes will lead to a northward spread of the occurrences of Anopheles vectors. Yet, for some Mediterranean areas, occurrence probabilities may decline. CONCLUSIONS: Potential malaria transmission stability is increased in areas where the climatic changes favor vector occurrences as well as significantly impact the vectorial capacity. As a result, vector stability shows the highest increases between historical and future periods for the southern and south-eastern European areas. Anopheles atroparvus, the dominant vector in large parts of Europe, might play an important role with respect to changes of the potential transmission stability.