[HTML][HTML] Epidemiology of Plasmodium vivax malaria in Peru

A Rosas-Aguirre, D Gamboa, P Manrique… - The american Journal …, 2016 - ncbi.nlm.nih.gov
The american Journal of tropical medicine and hygiene, 2016ncbi.nlm.nih.gov
Malaria in Peru, dominated by Plasmodium vivax, remains a public health problem. The
1990s saw newly epidemic malaria emerge, primarily in the Loreto Department in the
Amazon region, including areas near to Iquitos, the capital city, but sporadic malaria
transmission also occurred in the 1990s–2000s in both north-coastal Peru and the gold
mining regions of southeastern Peru. Although a Global Fund-supported intervention
(PAMAFRO, 2005–2010) was temporally associated with a decrease of malaria …
Abstract
Malaria in Peru, dominated by Plasmodium vivax, remains a public health problem. The 1990s saw newly epidemic malaria emerge, primarily in the Loreto Department in the Amazon region, including areas near to Iquitos, the capital city, but sporadic malaria transmission also occurred in the 1990s–2000s in both north-coastal Peru and the gold mining regions of southeastern Peru. Although a Global Fund-supported intervention (PAMAFRO, 2005–2010) was temporally associated with a decrease of malaria transmission, from 2012 to the present, both P. vivax and Plasmodium falciparum malaria cases have rapidly increased. The Peruvian Ministry of Health continues to provide artemesinin-based combination therapy for microscopy-confirmed cases of P. falciparum and chloroquine–primaquine for P. vivax. Malaria transmission continues in remote areas nonetheless, where the mobility of humans and parasites facilitates continued reintroduction outside of ongoing surveillance activities, which is critical to address for future malaria control and elimination efforts. Ongoing P. vivax research gaps in Peru include the following: identification of asymptomatic parasitemics, quantification of the contribution of patent and subpatent parasitemics to mosquito transmission, diagnosis of nonparasitemic hypnozoite carriers, and implementation of surveillance for potential emergence of chloroquine-and 8-aminoquinoline-resistant P. vivax. Clinical trials of tafenoquine in Peru have been promising, and glucose-6-phosphate dehydrogenase deficiency in the region has not been observed to be a limitation to its use. Larger-scale challenges for P. vivax (and malaria in general) in Peru include logistical difficulties in accessing remote riverine populations, consequences of government policy and poverty trends, and obtaining international funding for malaria control and elimination.
Background
Peru, located along South America's central Pacific coast, is home to about 30 million inhabitants living in 1,838 municipalities in 24 administrative departments and one constitutional province (Callao, adjacent to Lima) 1; the population is highly concentrated in the arid megacity, Lima, with almost 10 million inhabitants. Arthropod-borne diseases (malaria, arboviruses) generally are not important public health threats in Lima and the southern desert regions, but affect the humid, tropical regions where the environment sustains arthropod vectors. Peru has the third greatest biodiversity in the world, largely concentrated in the humid tropical ecosystems within 84 of the 117 recognized ecosystems found in Peru. 2
ncbi.nlm.nih.gov