Malaria: Without effective control, diagnostic and treatment actions, the number of cases growth will be greater, adverts Dr. André Siqueira

The success confronting the disease will only achieved with effective political commitment and participation of all involved

The increase in the number of malaria cases after years of progress is worrying. For Tropical Diseases PhD, infectious diseases expert André Siqueira, there are several reasons for this increase, not only in Brazil, but also in other parts of the world. For him, the disease elimination theme is not yet discussed and endorsed with vigor in several Brazilian public health environments. Within this context, where the incidence of new cases was continuously decreasing, it is hard for managers to increase (or even maintain) the investments in this disease when there other diseases (such as zika and chikungunya) are advancing. However, malaria has an infectious reservoir that could be asymptomatic and pass unnoticed by the passive surveillance system. One the case detection and management system is demobilized, we can expect an increase in the number of cases, he stresses. Still according to the specialist, other investigated reasons involve climate change, which could have changed the transmitting anophelinae mosquito density. The involved factors are many and all require attention for the country to overcome the current situation.

According to data from the Amazonas Health Surveillance Foundation (FVS-AM), the state registered in the two first months of the year 11,707 cases of the disease. Dr. André Siqueira, who is also a researcher at the Evandro Chagas National Infectious Diseases Institute (INI-Fiocruz), reinforces the need to implement effective control measures with appropriate diagnostic and treatment as well as effective vector control measures. Otherwise, by the end of the year we will have a much greater increase in number of cases. The success combating malaria will only be achieved with effective political commitment and participation of all involved. The collaboration efforts from several initiatives, such as Malaria Eradication Research Agenda (Malera), among others, should be taken as example, as well as the Asia Pacific Malaria Elimination Network (APMEN) that has gathered politicians, managers and researchers with the common goal to eliminate the disease from that region, where the risk of multi-resistant parasites spreading is worrying. In Latin America and Brazil we have much to advance in this perspective, including greater regional integration with migration in the Amazon borders, he regrets.

April is the month of malaria combat: What has been done about diagnostic and treatment of the disease?

Brazil is currently classified as under control situation, where the goal is the reduction in cases incidence. With the last years increase, it is even more important to intensify measures to avoid a greater growth and keep track of the advances achieved in the last decade. The infectious diseases expert explains that the goal must be to move from a control phase to a transmission elimination phase, which imply, besides vector control and appropriate clinical cases treatment, the adoption of strategies that approach the infectious reservoir. For such, the use of more sensitive tools and effective political commitment are needed.

There are two main ways to control malaria: diagnostic and proper treatment (the earlier an infected person is treated, the lower are the chances of complication and of becoming a transmission source), and vector control, performed by household spraying and use of impregnated mosquito nets, says Dr. André Siqueira while adding that regarding diagnostic and proper treatment, one of the challenges is the fact that in low transmission areas, diagnosis is usually late, since professionals ignore malaria as the cause of fever and many times, even considering the disease, access to diagnostic is not easy. Therefore, it is a challenge to keep the system alert to the detection of malaria febrile cases when control is effective, since the delay can increase the number of cases. Regarding vector control, there is much to question about what actually works and how it should be done in different transmission contexts, and systematized information to reach these conclusions. It is worth noting that the National Malaria Control Program (PNCM) is launching a vector information system where control actions and entomological measurements will be registered, what should help this assessment.

Asked if there is something to celebrate this April, the researcher said the malaria combat month should be taken as an opportunity to reaffirm the need for consistent and well-defined combat against this disease, instilling the conviction that it is possible to eliminate transmission. He stresses that several initiatives and advances are in course and should be recognized and taken as examples to define the confrontation strategies. Locally we had advances, as an expressive reduction of cases in Eirunepé (Amazonas) – a city that held a high number of cases – and the city supporters program that allocates, through the PNCM, skilled professionals to assist cities in critical situation, he says while adding that there are also relevant scientific advances, as a new drug against Plasmodium vivax relapses (Tafenoquine), whose studies include Brazilian researchers in Manaus and Porto Velho, besides developing more sensitive diagnostic methods. Finally, Dr. André Siqueira, who also conducts clinical researches in Acute Febrile Diseases, adds that the perspective of an effective vaccine against the disease is still far from reality, but pre-clinical trials have advanced, however, the perspective of its application in large scale in public health programs is still not seen, he regrets. However, the researcher remains optimist and believes important advances regarding malaria treatment and control will happen in the next decade. The National Meeting on Malaria Research, to be held during the 54th Medtrop, will be a great opportunity to re-evaluate these goals, he celebrates.…