Informal consultation on Elimination of Residual Malaria Foci and Prevention of Reintroduction of Ma

1
Informal consultation on Elimination of Residual
Malaria Foci and Prevention of Re-introduction of
Malaria

• Rabat, 18-20 June 2002

2
Malaria situation in Russian Federation

• by A.E.Beljaev
• Moscow

3
History

• Malaria incidence is no less than 5 million
  cases per year malaria occupies the first place
  among all the diseases of Russian people (Favr,
  1903)
• Less cases was recordeded officially e.g. 0.5 to
  1.6 million, in 1881-1890, or 7 to 21 of all
  consultations.

4
History (2)

• Most affected were areas of Caucasus (including
  North Caucasus), Ukraine, Central Asia, Volga
  Region and in the south of Western Siberia.
• However, other parts of European Russia were
  being affected by serious epidemics from time to
  time
• In the north the limit of malaria (P. vivax) was
  up to the latitude of Arkhangel in Europe (64)
  and Yakoutsk in Eastern Siberia (62)

5
??????????????? ???????, ???????? ? ???????????
?????
????
??
?????
?????
?????
6
History (3)

• During the Caucasian wars in 19th century,
  malaria was the main casuality among military
  personnel
• On the Black sea coast in the 1830th, 10 of
  garrisons died of malaria yearly
• During the epidemic of 1845, 2500 out of 10000
  personnel died in the same area
• The situation improved only after the instruction
  was released to use quinine from the outset of
  fever (1848)
• In 1839 fatality of fevers in military hospitals
  was 10, and 25 years later, only ??? 2.5

7
(No Transcript)
8
History (5)

• In the end of 1950s and beginning of 1960s all
  the republics of USSR declared malaria eradicated
• Falciparum malaria was eradicated indeed (by 1962
  in Russian Federation (RSFSR))
• However, Georgia, Azerbaijan and Tajikistan
  reported malaria eradicated before it was
  achieved. Georgia did it later, the other two
  never
• Vivax malaria continued to linger on the
  Tajik-Afghan

9
History (6)

• In Tajikistan, vivax malaria continued to linger
  on the border with Afghanistan
• It has been strongly suspected that the problem
  is in trespassing the border by infected
  mosquitoes across the Panj river
• However, in 1977 malaria reappeared inland (in
  Qulab, about 100 km from the dorder)
• Situation further deteriorated after the start of
  the Soviet intervention in Afghanistan, but
  remained under control till the dissolution of
  USSR in 1991

10
History (7)

• In Azerbaijan, vivax malaria continued to linger
  in the Center, in the valley of Kura river
• The main focus was Goejcaj district, the area of
  a very high incidence of G6PD deficiency (about
  10 and up to 36 in one village)
• In 1969 a considerable epidemic started, reaching
  more than 6000 cases in 1971
• Malaria spread southward and reached the Iranian
  border in 1972

11
History (8)

• A team was sent by the Union government that
  succeeded to curtail the epidemic in 2 years, by
  the indoor residual spraying and mass
  prophylactic treatment with primaquine
• Malaria continued at a low level with occasional
  exacerbations till the end of USSR

12
(No Transcript)
13
Zoogeograhy and parasite species
(1998)P.falciparum P.vivax
14
(No Transcript)
15
(No Transcript)
16
Local transmission of P.vivax in Russia from 1994

• Autochthonous cases, 1994-2000
• 201 (introduced), out of which 85 emerged during
  the same year, rest on the next
• In 32 localities

17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
Vivax malaria in Moscow, 1998-02

• Autochthonous cases of P.vivax,
• In 1998-2000
• 11
• in 2001
• 28 infected in the city
• 36 infected in the governorate (???????)
• Autochthonous cases of P.vivax, 2002
• 11 new
• 10 recidives

21
Malaria in Moscow, 2001-02

• Beginning of the season of transmission 24 June
  2001
• In 2002
• Expected effective infectivity of mosquitoes from
  31 May
• Season of transmission expected about as in 2001

22
Legislation for malaria control in Russia

• Control of parasitic diseases is regulated by
  Sanitary Rules and Norms
• ?????? 3.2.569-96
• A special part is on malaria control
• The document is to be revised every 5 years
• by a working group at the State Centre for
  san-epid. Surveillance (ex Sanepidstation of
  RSFSR)
• coming this year
• Members of the Federation have their own
  legislation which is in princnple in line with
  the Federal one

23
Legislation for malaria control in Russia

• The Document Sanitary Rules and Norms
  3.2.569-96 distinguishes 3 facets of antimalaria
  measures
• Treatment and prophylaxis
• Antivector, including entomological surveillance
• Training
• Health education
• No goals of the activities are set
• Which is felt to be a major shortcoming

24
1.????????? ??????? ????????

• ?????? ?????, ????????? ??????? ????????
• ???????? (???????, ??????????? ???????????,
  ???????, ?????????, ???????????)
• ???????????????? ?? ??????????? ? ????????????
  ??????? ??? ???
• ??????? ????? ? ?????????
• ???????? ?????????? ????????????????
• ??? ?????? ???????????? ??????

25
1.????????? ??????? ????????

• ??? ?????? ???????????? ??????, ????????
• ??????????? ????????,
• ?????????????,
• ??????????, ???????
• ?????????????? ?? ???????? ??????
• ????, ?????????? ??? ?????????? ????????????????,
  
• ????? ????????????????? ?????
• ?????????

26
1.????????? ??????? ????????

• ????? ?? ??????? ??????????? ??????????????
  ??????????? ?? ????????? ?????, ????? ???????
  ???????? ????? ??????? ?????????????????, ???-??
• ??????????? ????????,
• ?????????????,
• ?????????

27
1.????????? ??????? ???????? (??????????????)

• ????????? ????? ?????????
• ? ??????????? ??????????? ?????????????
• ? ?????????????????? ??????????? ?????? ????
• ?? ???????? ??????????
• ??? ?????????????
• ? 10 ?????????????
• ???? ?????? ????????

28
1.????????? ??????? ???????? (??????????????)

• ????????, ?????????? ??????????? ????????
• ???????????? ???????, ?.?. ????????? ?? ??????
  ????? ? ??????????? ?????????? ????????????
• ??????????? ? ???????? ????????????? ? ???????
  ??????????, ? ????????? ????????? ?????? ??????
• ?????????????? ?????????? ???????????, ?
  ?????????????? ??????????????? ??????????????
  ??????????? (???????????????? ? ?????????????)
• ?????? ? ??????????? ??? ??????? ??????? ?? ?????

29
1.????????? ??????? ???????? (??????????????)

• ???? ?????? ????????
• ?????? ???????????? ?????????? ?????
• ??????????? ??????? ?????
• ??????? ?? ????????????-?????
• ??????????? ????????????? ?????????? ?????? ??
  pH7,2
• ???????? ?? ????? 100 ????? ??????

30
1.????????? ??????? ???????? (??????????????)

• ???? ?????? ????????
• ?????????? ?????? ? ??????????? - ????????????
  ????????
• ???? ?????????
• ?????? ?????? ??? P.falciparum
• ??????????? ?????????

31
3.??????????? ??????? ??????? ? ?????????????????

• -
• ?????? ? ???????? ??????????
• ????????? ????? ????????? ? 1-?, 4-? ??? ? ?????
  ????????

32
3.??????????? ??????? ??????? ? ?????????????????

• ????????
• ?????????? ?????? ? ?????????? ???????? ?
  ???????? ????????????
• ??????? ? ?????????? ????? ?????? ??? ???????, ??
  ?? ??? ????????, ???????? ????? ???????????
  ?????? ??????????
• ??????? ??????????? ????????? ???????? ?
  ?????????? (?????? ??????????? ??????? ?? 4-14-?
  ???? ???????) ?????? ??????, ??? ??? ?????? ???
  ???????? ?????? ?????????, ?? ????????? ?? ?
  ????????????? ????? ??????, ?? ? ????? ??????
  ???? ????????
• ?????????????, ??? ????????????? ????? ??????
  ????????? ????????? ????? ?? ????????? ?????
  ???????

33
4.???????????????? ?????

• -
• ?????????? ? ?????? ????? ????? ????????? ??????
• ???? ????????
• ?????? ?????? ???????????
• ????? ?????????
• ????????? ?????
• ?????? ?????????? ????? ? ??????????????
• ???????????? ???? ??????? ? ??????
• ?????????? ????? 357/?

34
4.???????????????? ?????

• ???????? ????? ? ???, ??? ?? ????????? ????? ????
  ????????????
• ????? ?? ? ???, ??? ???????? ??????? ?????????
  ?????
• ?????? ???????????????? ?? ??????????
  (?????????????????? ???????)
• ?? ???? ????????? ???????????? ??????????????
  ????????? ?????

35
5.????????????????? ????????, ???????????

• - -
• ???????? 3 ???????
• ?? ???????? - ??????? ??? ????????
• ??????????? ? ?????? ??????????? ????????????
  ???????
• ??????????????? ??????? - ?? ?? ?????????
• ?????????? ??? ?????????
• ?? ??????????? - ????????
• 14 ???? ????? ?????????? ?????? ????????

36
5.????????????????? ????????, ???????????

• ???????? ?? ? ?????? ??????? ???????? ? ? ??????
  ??????????? ????????????
• ????????, ??? ??? ???????? ? ????????? ???????,
  ?? ?? ? ???????? ????????
• ????????? ? ????? ?? ??????????? ????, ???????? ?
  ??????? ?????????? ? ? ???????
• ????????????? ??????? ?????? ???? ??
  ???????????, ? ???? ?????????? ???????????????
  ??? ???????, ?? ??????? ????????????

37
5.????????????????? ????????, ???????????

• ??????????????? ???????, ????? ???? ??????
  ???????? ??????????? ?????????? ??? ????????????
  ????????
• ??????????????, ??? ?????? ??? ?????? ????
  ??????? ???????????????????? ????????????

38
1.???? ??????????? ????????????

• ?????????? ?????
• ????? ???????
• ??????????? ???????? ? ????????? ??????? ????
• ???????? ??? ??????????? ????? ? ????????????-???
  ??????
• ??????? ?????? ?? ????????????? ???????????????
  (? ?????????-?????????????)

39
1.???? ??????????? ????????????

• ????????
• ?? ??????? ??????????? ????????
• ?????? ????????????? ??????
• ????? ????, ???????-??????????? ???? ??????
  ?????? ?? ?????????? ??? ? ?????????? ??????, ?
  ????? ?? ?? ???????

40
???????????????? ??????????

• ????????? ?? ????????, ??? ??? ??????????
  ?????????? ?????????
• ? ????????????? ???????????????? ??????
• ? ??????, ??? ?????????????? ????????
• ???????????? ???? ?????????????? ???????, ??
  ??????? ????????????
• ?????? ????? ?????? ?????????
• ? ????? ???? ???????? ???? ??????? ?? ???????

41
??? ???? ????? ????????????????? ?
???????????????? ???????????

• ????????? ?? ???????, ??? ?? ?????? ????
  ??????????, ??? ????????? ??????? ????
  ??????????? ??????????
• ???? ??? ???????? ??????, ???????? ?? ?? ????
  ????????? ???????? ??????
• ???? ??, ?? ????? ????? ??????? ????????? ??????
• ???? ??????? ??? ??????, ??? ?? ???? ????????? ??
  ???????

42
2.??????????? ?????? ??????????? ????????????
??????? ? ?????? ???????? ???????

• -
• ??? ??????????? ??????????
• ?????????????, ? ?????? ???? ???????????
  ?????????? ?????????, ?? ???????????????? ??????
  ????????????? ???????? ????????, ?????????
  ???????????? ???????????? ?????????? ????????
  ???????????, ???????? ??? ????? ?????? ????? ???
  ??????????? ???????
• ??? ???????? ??????????? ?????????? ???????????,
  ?? ???????????? ? ????????????

43
2.??????????? ?????? ??????????? ????????????
??????? ? ?????? ???????? ???????

• ????????? ?? ???????, ???
• ???????????? ????? ?.?. ???????????
• ????? ??????? ??? ????????????, ?? ? ???????????
  ?? ??????? ????????? ??????? ????????????

44
2.??????????? ?????? ??????????? ????????????
??????? ? ?????? ???????? ???????

• ?????????? ??????? ?? ??????????? ??????????????
  ?????????? ? ???????? ???????
• ????? ???????, ???????????? ???? ???????????
  ?????????????? ???????, ????????,
• ?????? ????????? ????????? ??????,
• ?????? ????????? ???????? ??????,
• ????? ?????? ??????????? ?????? ?????????
  ???????? ???? ? ??.

45
2.??????????? ?????? ??????????? ????????????
??????? ? ?????? ???????? ???????

• ?????? ? ???, ?????????? ????? ?????? ?????????
  ?????????? ?? ??????? ??????????? ??????????????
  ????????????
• ????? ???????, ???????? ???? ??????????????
  ?????.
• ???? ?????, ????????? ???????? ???????? ????
• ?.?. ??????, ????????? ???????????? ???
  ?????????????? ??????? ??? ??? ???????? ???????

46
2.??????????? ?????? ??????????? ????????????
??????? ? ?????? ???????? ???????

• ?????? ?????????? ???????????? ? ???????
  ?????????? ????? ???? ?????????????? ???????,
  ??????????? ? ???????????,
• ?????????? ?
• ???????? ????
• ????????, ???????? ????? ? ???????.

47
Shortcomings (1)

• Insufficient awareness of some clinicians,
  insufficient knowledge of the situation abroad,
  methods of diagnosis and treatment
• Insufficient laboratory support in some
  geographic areas
• Hence late diagnosis, sometimes loss of cases or
  pseudo-epidemics (Voronezh, 1995, gt 100 spurious
  cases)

48
Shortcomings (2)

• Insufficient epidemiological analysis
• Hence, late detection of local transmission
• Weak prognosis
• Insufficient knowledge of control methods
• Hence, irrational and often wasteful, but
  ineffective measures
• Low quality of measures