Malaria Disease Plan

2y ago
40 Views
2 Downloads
313.24 KB
10 Pages
Last View : 15d ago
Last Download : 2m ago
Upload by : Mika Lloyd
Transcription

MalariaDisease PlanContents WHY IS MALARIA IMPORTANT TO PUBLIC HEALTH? . 2 DISEASE AND EPIDEMIOLOGY . 2 PUBLIC HEALTH CONTROL MEASURES . 5 CASE INVESTIGATION . 6 REFERENCES . 9 VERSION CONTROL . 9 UT-NEDSS Minimum/Required Fields by Tab . 10Last updated: September 24, 2015, by JoDee BakerQuestions about this disease plan?Contact the Utah Department of Health Bureau of Epidemiology: 801-538-6191.

Malaria: Utah Public Health Disease Investigation Plan WHY IS MALARIA IMPORTANT TO PUBLICHEALTH?Malaria is endemic throughout most of the tropics. Of the approximately 3.4 billion peopleworldwide who are exposed annually, 1.2 billion are at high risk. The World Health Organization(WHO) states that there were 198 million cases of symptomatic malaria in 2013. About 1,500cases of malaria are diagnosed in the United States each year. The vast majority of cases in theUnited States are in travelers and immigrants returning from countries where malariatransmission occurs, many from sub-Saharan Africa and South Asia.Important components for reducing the burden of malaria morbidity and mortality include moresensitive diagnostic tools, effective use of antimalarial drugs, and improved personal andcommunity protection and mosquito control. The approach to elimination or control of malariaincludes these basics, along with improvements in tracking human illness and parasitesurveillance, and effective resource delivery. DISEASE AND EPIDEMIOLOGYClinical DescriptionThe classic symptoms of malaria are high fever with chills, sweats, and headache, which mayinvolve recurrence or intensification of symptoms, especially fever. Depending on the infectingspecies, fever may appear every other or every third day. Other symptoms may include malaise,nausea, vomiting, diarrhea, cough, arthralgia (joint aches), respiratory distress, and abdominaland back pain. Pallor and jaundice may also be present. Enlargement of the liver and spleen(hepatosplenomegaly) may occur and is more prominent in chronic infections.Infection with P. falciparum is potentially fatal and most commonly manifests as a non-specificfebrile illness. Falciparum malaria may present with coagulation defects, shock, renal and liverfailure, acute encephalopathy, pulmonary and cerebral edema, and coma. The duration of anuntreated primary attack can vary from a week to a monthor longer. Relapses of P. vivax and P. ovale infectionscan occur at irregular intervals for up to five years.Malaria infections may persist for life (chronic infections),with or without recurrent episodes of fever.Causative AgentThere are four Plasmodium species (sporozoanparasites) that commonly cause malaria in humans:P.vivax, P. malariae, P. ovale, and P. falciparum.Plasmodium vivax schizonts. CDC, Dr. MaeMelvin, 1977Differential DiagnosisThe differential diagnosis can include dengue fever, schistosomiasis, leptospirosis, tick-bornefevers, trypanosomiasis, and Yellow Fever.Page 2 of 1009/24/2015

Malaria: Utah Public Health Disease Investigation PlanLaboratory identificationMalaria is usually diagnosed through a blood smear that can be performed at most referencelaboratories. Serology testing is also available, but the test may cross-react with a variety ofother illnesses and reliance solely upon serological results for diagnosis may be misleading.PCR testing has limited availability.UPHL: The Utah Public Health Laboratory (UPHL) does not perform diagnostic testingfor malaria, but it will forward thick and thin blood smears to the CDC for testing. TheCDC will also perform serologic testing for malaria, but only under special circumstances(e.g., serum of a blood donor suspected of being a source of transfusion-related malaria,or serum from laboratories conducting malaria-related studies). ARUP also performsdiagnostic testing.TreatmentMalaria can be a severe, potentially fatal disease (especially when caused by Plasmodiumfalciparum) and treatment should be initiated as soon as possible.In endemic areas, WHO recommends that treatment be started within 24 hours after the firstsymptoms appear. Treatment of patients with uncomplicated malaria can be conducted on anambulatory basis (without hospitalization), but patients with severe malaria should behospitalized, if possible.In areas where malaria is not endemic, all patients with malaria (uncomplicated or severe)should be kept under clinical observation if possible.Most drugs used in treatment are active against the parasite forms in the blood (the form thatcauses disease) and include: Chloroquine*Sulfadoxine-pyrimethamine (Fansidar )Mefloquine (Lariam )Atovaquone-proguanil (Malarone )QuinineDoxycyclineIn addition, primaquine is active against the dormant parasite liver forms (hypnozoites) andprevents relapses. Primaquine should not be taken by pregnant women or by people who aredeficient in G6PD (glucose-6-phosphate dehydrogenase). Patients should not take primaquineuntil a screening test has excluded G6PD deficiency.*In a region of chloroquine resistance in Malawi, return of chloroquine-susceptible P. falciparummalaria was demonstrated following abandonment of chloroquine use. These chloroquinesusceptible parasites likely represent a re-expansion of the susceptible parasites that survivedin the population despite widespread drug pressure in the region. Despite this finding, it is notadvised to use chloroquine for treatment in Malawi.Page 3 of 1009/24/2015

Malaria: Utah Public Health Disease Investigation PlanHow to treat a patient with malaria depends on: The type (species) of the infecting parasiteThe area where the infection was acquired and its drug-resistance statusThe clinical status of the patientAny accompanying illness or conditionPregnancyDrug allergies, or other medications taken by the patientCase fatalityThe case fatality rate is 10–40% in the absence of prompt treatment.ReservoirHumans are the only important reservoir of human malaria. Non-human primates are naturallyinfected by many malarial species that can potentially infect humans, but natural transmissionfrom non-human primates to humans is extremely rare and seldom results in serious disease.The vector for human malaria is the Anopheles mosquito, which transmits the parasite frominfected human to uninfected human.TransmissionMalaria is transmitted by the bite of an infective female Anopheles mosquito, which occursmainly between dusk and dawn. Rarely, transmission can be congenital (via the placenta) orcan occur through transfusions, use of contaminated needles, and organ transplantation.SusceptibilitySusceptibility is universal except in humans with specific genetic traits. Tolerance to clinicaldisease is present in adults in highly endemic communities where exposure is continuous overmany years. Persons with sickle cell trait show relatively low parasitemia when infected with P.falciparum, and, thus, are relatively protected from severe disease. Persons infected with HIVare at increased risk of symptomatic falciparum malaria and its severe manifestations.Incubation periodThe incubation period is approximately 7–14 days for P. falciparum; 8–14 days for P. vivax andP. ovale; and 7–30 days for P. malariae. With some strains of P. vivax, mostly from temperateareas, there may be a prolonged incubation period of 8–10 months until clinical illness;incubation periods for P. ovale may be even longer. With infections acquired by bloodtransfusion, the incubation period depends on the number of parasites infused; it is usuallyshort, but may be up to two months.Period of communicabilityMalaria is not directly communicable from person to person, except through congenitaltransmission; however, during parasitemia, the disease may be transmitted to other personsthrough blood transfusion or through shared, contaminated needles. Infected human hosts canPage 4 of 1009/24/2015

Malaria: Utah Public Health Disease Investigation Planbe a source of infection for Anopheles mosquitoes for prolonged periods of time (1–3 years orlonger, depending on the species of malaria) if not adequately treated.EpidemiologyMalaria is endemic throughout the tropical areas of the world. About half of the world’spopulation lives in areas where transmission occurs. Areas with the highest prevalence includesub-Saharan Africa, parts of Central and South America, India, and parts of Oceania andSoutheast Asia. Transmission is also possible in more temperate climates, such as in the U.S.,if Anopheles mosquitoes are present. Locally-acquired cases of malaria have been reportedrecently in Florida, New York, and Virginia. Mosquitoes in airplanes flying from tropical climateshave been the source of occasional cases in persons working or living near internationalairports. However, nearly all of the malaria cases reported annually in the U.S. ( 1,000) areacquired outside of the U.S. P. vivax and P. falciparum are the most common speciesworldwide. The worldwide spread of strains of chloroquine-resistant P. falciparum and P. vivaxis of increasing importance. Resistance to other antimalarial drugs is now occurring in manyareas where the drugs are widely used. PUBLIC HEALTH CONTROL MEASURESPublic health responsibility Identify the source of infection and prevent further transmission.Investigate all reported cases; complete and submit proper investigation forms.PreventionInternational TravelPeople traveling to malaria-endemic parts of the world should be notified of their risk ofcontracting the disease and of control measures they can take to protect themselves frommosquitoes. Travelers can use repellents, wear protective clothing, and use mosquito netswhen rooms are not screened. They have a choice of medications recommended forprophylaxis depending on circumstances.Detailed recommendations for preventing malaria are available 24 hours a day from the CDCMalaria Hotline, which can be accessed by telephone at 770-488-7788, by fax at 888-CDCFAXX or 888-232-3299, or on the CDC website at www.cdc.gov/travel.Travelers and recent immigrants from malaria-endemic regions with symptoms suggestive ofmalaria should be referred to a health care provider for prompt testing and treatment. Failure totreat individuals with malaria could lead to transmission of the disease to mosquitoes that bitethese individuals, and then to other people bitten by those mosquitoes.ChemoprophylaxisNon-immune individuals who will be exposed to mosquitoes in malaroius areas must make useof protective measures against mosquito bites, and will benefit from the use of suppressivedrugs for chemoprophylaxis. The possible side effects of long-term (up to 3-5 months) use ofPage 5 of 1009/24/2015

Malaria: Utah Public Health Disease Investigation Planthe drug or drug combination recommended for use in any particular area should be weighedagainst the actual likelihood of being bitten by an infected mosquito.VaccineNo approved vaccine is available yet. Vaccine trials are underway.Isolation and quarantine requirements:No restrictions, except for exclusion from blood donation. CASE INVESTIGATIONCase Definition: Malaria (2014)Reporting Report all suspect and confirmed cases of malaria.Table of criteria to determine whether a case should be reported to public healthauthoritiesCriterionConfirmed123Laboratory EvidenceDemonstration of Plasmodium species in blood filmSDemonstration of Plasmodium species bySmolecular testing (e.g., PCR)Demonstration of unspeciated malaria parasite in bloodSfilm*Detectionof Plasmodium species by rapiddiagnostic antigen testingSuspect4SNotes: S This criterion alone is Sufficient to identify a case for reporting.*Efforts should be made to determine a species for all cases of malaria either by expert microscopistsor by molecular methods such as PCR.Laboratory criteria Detection of circulating malaria-specific antigens using rapid diagnostic test (RDT),OR Detection of species specific parasite DNA in a sample of peripheral blood using aPolymerase Chain Reaction (PCR) test (Note: Laboratory-developed malaria PCRtests must fulfill CLIA requirements, including validation studies),OR Detection of malaria parasites in thick or thin peripheral blood films, determining thespecies by morphologic criteria, and calculating the percentage of red blood cellsinfected by asexual malaria parasites (parasitemia).Page 6 of 1009/24/2015

Malaria: Utah Public Health Disease Investigation PlanCase classificationConfirmed1. Detection and specific identification of malaria parasite species by microscopy onblood films in a laboratory with appropriate expertise in any person (symptomatic orasymptomatic) diagnosed in the U.S., regardless of whether the person experiencedprevious episodes of malaria while outside the country.OR2. Detection of Plasmodium species by nucleic acid test* in any person (symptomatic orasymptomatic) diagnosed in the U.S., regardless of whether the person experiencedprevious episodes of malaria while outside the country.OR3. Detection of unspeciated malaria parasite by microscopy on blood films in alaboratory with appropriate expertise in any person (symptomatic or asymptomatic)diagnosed in the U.S., regardless of whether the person experienced previousepisodes of malaria while outside the country.Suspect1. Detection of Plasmodium species by rapid diagnostic antigen testing withoutconfirmation by microscopy or nucleic acid testing in any person (symptomatic orasymptomatic) diagnosed in the U.S., regardless of whether the person experiencedprevious episodes of malaria while outside the country.2. Clinical samples, including blood smears or EDTA whole blood from all cases, maybe referred to the CDC Division of Parasitic Diseases and Malaria DiagnosticLaboratory for confirmation of the diagnosis and anti-malarial drug resistance testing.Any questionable cases should be referred to the CDC Division of Parasitic Diseasesand Malaria Diagnostic Laboratory for confirmation of the diagnosis.Criteria to distinguish a new case of this disease or condition from reports ornotifications which should not be enumerated as a new case for surveillance:A subsequent attack experienced by the same person, but caused by a different Plasmodiumspecies, is counted as an additional case. A subsequent attack experienced by the sameperson and caused by the same species in the U.S. may indicate a relapsing infection ortreatment failure caused by drug resistance, or a separate attack.Cases also are classified according to the following WHO categories: Autochthonous:o Indigenous: malaria acquired by mosquito transmission in an area where malariais a regular occurrence.o Introduced: malaria acquired by mosquito transmission from an imported case inan area where malaria is not a regular occurrence. Imported: malaria acquired outside a specific area (e.g., the U.S. and its territories).Page 7 of 1009/24/2015

Malaria: Utah Public Health Disease Investigation Plan Induced: malaria acquired through artificial means (e.g., blood transfusion, commonsyringes, or malariotherapy). Relapsing: Recurrence of disease after it has been apparently cured. In malaria, truerelapses are caused by reactivation of dormant liverstage parasites (hypnozoites) of P.vivax and P. ovale. Cryptic: an isolated case of malaria that cannot be epidemiologically linked to additionalcases.Case Classification TableCriterionLaboratory EvidenceDemonstration of Plasmodium species in blood filmDemonstration of Plasmodium species by moleculartesting (e.g., PCR)Demonstration of malaria parasite in blood films*Detection of Plasmodium species by rapid diagnosticantigen testing without confirmation by microscopy ornucleic acid testing in any person (symptomatic orasymptomatic)Case DefinitionConfirmedSuspectedSSSSCase Investigation Process Complete morbidity form.Verify case status.Complete disease investigation form.Determine whether patient had travel/exposure history consistent with acquisition ofdisease in Utah or elsewhere.If patient acquired disease in Utah, identify the source of transmission and eliminate it.OutbreaksOne or more non-imported cases of malaria would constitute an outbreak.Identification of case contactsDetermine history of previous infection or of possible exposure. If a history of sharing needles isobtained from the patient, investigate and treat all persons who shared the equipment. Intransfusion-induced malaria, all donors must be located and their blood examined for malariaparasites and for antimalarial antibodies; parasite-positive donors must receive treatment.Case contact managementNone.Page 8 of 1009/24/2015

Malaria: Utah Public Health Disease Investigation Plan REFERENCES1. Breman, Joel G (2015). Epidemiology, prevention, and control of malaria in endemicareas. Retrieved July 22, 2015 from e search result&search malaria&selectedTitle 8 150#H14.2. Centers for Disease Control, Case Definitions for Infectious Conditions Under PublicHealth Surveillance. MMWR 46 (RR-10), 1997.l.3. Control of Communicable Diseases Manual (20th Edition), Heymann, D.L., Ed; 2015.4. Council for State and Territorial Epidemiologists (CSTE) Position statements. Availablefrom URL: http://www.cste.org/default.asp?page PositionStatements.5. Massachusetts Department of Health Malaria Disease Plan.6. Red Book Plus: 2009 Report of the Committee on Infectious Diseases (29th Edition),Larry K. Pickering MD, Ed; 2012. VERSION CONTROLUpdated July 2015: "Why is Malaria Important to Public Health" section added. Additionalinformation added to “Treatment” section. "Version Control,” and "Minimum Data Set" sectionsadded.Page 9 of 1009/24/2015

Malaria: Utah Public Health Disease Investigation Plan UT-NEDSS Minimum/Required Fields by TabDemographic County State Street City Zip Code Date of Birth Birth Gender Ethnicity Race Last Name First NameClinical Date Diagnosed Died Date of Death Disease Onset Date Hospitalized Was malaria chemoprophylaxis taken? Were all pills taken as prescribed? History of Malaria in the last 12 months(prior to this report)? Was it vivax? Was it falciparum? Was it Malariae? Was it Ovale? Was it not determined? Back pain Chills Diarrhea Fever Headache Myalgia Sweats WeaknessEpidemiological Imported From Date of ExposureInvestigation Has patient traveled or lived outside theUnited States during the past 4 years? Please specify countries, dates arrived inthe U.S. and duration of stay Blood transfusion/transplant within thepast 12 months? Date of transfusion/transplant Did patient receive a blood donation froma donor with malaria Was patient recently born to a mother withmalaria Did the patient travel to a malaria endemicarea within the previous 3 monthsReporting Date First Reported to Public HealthAdministrative Outbreak Name Outbreak Associated State Case StatusLaboratory Organism Specimen Source Test Result Test TypePage 10 of 1009/24/2015

CDC, Dr. Mae Melvin, 1977 . Malaria: Utah Public Health Disease Investigation Plan Page 3 of 10 09/24/2015 . Detailed recommendations for preventing malaria are available 24 hours a day from the CDC Malaria Hotline, which can be accessed by telephone at 770-488-7788, by fax at 888-CDC-FAXX or 888-232-3299, or on the CDC website at www.cdc.gov .

Related Documents:

WORLD MALARIA REPORT 2016 iii Contents Foreword iv Acknowledgements vii Abbreviations xi Key points xii 1. Global targets, milestones and indicators 2 2. Investments in malaria programmes and research 7 2.1 Total expenditure for malaria control and elimination 8 2.2 Funding for malaria-related research 11 2.3 Malaria expenditure per capita for malaria control and elimination 12

6 Malaria Each year, 300-500 million people become ill with malaria One to Two million die (most 5 y.o.) 2,000 – 8,000 children die every day World’s leading killer of children ( 5 y.o.) 200-300 children die from malaria each hr Malaria in pregnancy: 10-20% of LBW Families and communities suffer worldwide The Intolerable Burden of Malaria

Apr 02, 2021 · Attributable fraction (l) 43.7%Model PPV for density cut-off (lc) 85.9%Model Source data and model results Fever classification according cut-off True Malaria True No Malaria Total Malaria Fever (density cut off) 281 (Nc x lc) 46 327 (Nc) Non Malaria fever 5 324 329 Total fevers 286 (Nx l) 370 656 (N) Synthetic 2x2 table created from data .

Malaria might affect educational attainment through several mechanisms. First, malaria in pregnant women can result in anemia and interruption of in utero nutri- . Hoyt Bleakley (2007b) used malaria eradication campaigns in the United States, Brazil, Colombia, and Mexico to estimate the effect of childhood exposure to malaria in pre .

ENSURING APPROPRIATE TREATMENT OF MALARIA FACILITATOR'S MANUAL 3 . TRAINING PROGRAME ON MALARIA DIAGNOSIS AND TREATMENT Overview of the Training Programme Introduction to the course . Malaria is a major public health problem in Cameroon. You will already know something on how to diagnose and treat malaria.

METHODS IN MALARIA RESEARCH 6th edition . Welcome to this new edition of Methods in Malaria Research which contains protocols provided by 122 scientists from the global malaria community. The manual is considered a “working document” that, with the help of our readers and users, will continuously grow and evolve as new and improved methods are

climate change scenarios based on MARA/ARMA (Mapping Malaria Risk in Africa/Atlas du Risque de la Malaria en Afrique) decision rules. . rainfall and sea surface temperature on malaria incidence in Botswana finding that variability in rainfall and sea temperature accounts for more than two-thirds of the inter-annual variability in malaria .

2.15.20 Profit sharing transactions 28 2.15.21 Re-importation of goods after repair or processing abroad 29 2.15.22 Split shipments or split consignments 29 2.15.23 Sole distributors, concessionaires and agents 30 2.15.24 Tie-in sales 30 . Effective 24 January 2014 Valuation of Imports – External Directive SC-CR-A-03 Revision: 2 Page 3 of 52 2.15.25 Time element 30 2.15.26 Transfer pricing .