Rabat Russia

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

Informal consultation on Elimination of Residual Malaria Foci and Prevention of Re-introduction of Malaria Rabat, 18-20 June 2002

Malaria situation in the Russian Federation: 

Malaria situation in the Russian Federation by A.E.Beljaev Moscow

History: 

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.

History (2): 

History (2) Most affected were areas of Caucasus (including North Caucasus), Ukraine, Central Asia, Volga Region and in the south of Western Siberia (areas of Russia proper in red). 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°)

Map: distribution of malaria: 

Map: distribution of malaria Modern distribution after WHO, 2000 Maximum historic distribution: red line

Slide6: 

НеАрк НеоТр АфрТр ПАрк Ор Австр Распространение малярии, исходное и современное

History (3): 

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 лет 2.5%

History (5): 

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 achieved this

History (6): 

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

History (7): 

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

History (8): 

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

Epidemics of 1990s: 

Epidemics of 1990s After 1994, the incidence went astray in Tajikistan (civil war) and Azerbaijan (Karabagh conflict) Estimated > 100,000 cases annually in Tajikistan, reappearance of P.falciparum Comparable number in Azerbaijan, P.vivax only

Fallout of revolutionary changes of 1990s: 

Fallout of revolutionary changes of 1990s Millions of refugees within the countries affected by war and crisis and mass emigration, mostly towards Russia Liberalisation of economic activities in Russia attracting mass immigration (one-way and cyclic); activities of particular importance for malaria: From Azerbaijan, trade in vegetables and flowers From Tajikistan, narcotics traffic

Zoogeograhy and parasite species (1998)P.falciparum P.vivax : 

Zoogeograhy and parasite species (1998) P.falciparum P.vivax

Local transmission of P.vivax in Russia from 1994: 

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

Vivax malaria in Moscow, 1998-02: 

Vivax malaria in Moscow, 1998-02 Autochthonous cases of P.vivax, contracted either in Moscow proper or its governorate (two autonomous territories) In 1998-2000 11 in 2001 28 infected in the city 36 infected in the governorate (область) In 2002: autochthonous cases of P.vivax, contracted in 2001, as per 15 June 2002 11 new 10 recidives

Malaria in Moscow, 2001-02: 

Malaria in Moscow, 2001-02 Calculated beginning of the season of transmission of P.vivax was 24 June 2001 In 2002 (as per 15 June): Calculated effective infectivity of mosquitoes from 31 May The start of the season of transmission expected at about the same time as in 2001

Control of malaria in Moscow: 

Control of malaria in Moscow Degree of vigilance and training status of curative and preventive services are reasonably good Detection among the Moscovites is reasonably prompt, treatment adequate Immigrants are not adequately covered

Control of malaria in Moscow: 

Control of malaria in Moscow Vector control by larviciding and bonification Above 600, potential breeding places, 1/3 of them with Anopheline breeding All are registered and visited regularly by the medical entomologists They are treated by municipal “dezstations” (desinfection/desinsection), under the instructions from the epidemiologist/ parasitologists of one of the 10 administrative “okrug”

Malaria in Moscow : 

Malaria in Moscow Cases scattered, with clustering in some landscapes; the valley of Moscow river above the city center seems more affected Concentration of cases traced to construction sites employing guest workers Excavations Poor living conditions of workers employed illegally Illegal temporary residents from the South living in unsanitary conditions near or even at the marketplaces

Malaria in Moscow : 

Malaria in Moscow Most families own vacation houses in the governorate, forming settlements of up to several thousand households in each These settlements are inhabited mostly in summer and are not adequately protected by antivector measures. For the governorate they hardly exist, since they are not an official place of residence of anybody

Malaria in Moscow : 

Malaria in Moscow Transmission and source Problem of warming: warm period became longer by about 10 days in spring and the same in fall Vectors: A.maculipennis s.s., A.messeae probably along with A.beklemishevi, A.claviger More water bodies became suitable to vectors because of a decrease in pollution after many obsolete industries of the Soviet era disappeared Problem of detection: illegal status of immigrants, their knowledge of treatment methods, deterring effect of the obligatory 17-day hospitalisation

Legislation for malaria control in Russia: 

Legislation for malaria control in Russia Control of parasitic diseases is regulated by “Sanitary Rules and Norms” СанПиН 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 principle in line with the Federal one

Legislation for malaria control in Russia: 

Legislation for malaria control in Russia The Document “Sanitary Rules and Norms” 3.2.569-96 distinguishes 4 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

Shortcomings (1): 

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, > 100 spurious cases)

Shortcomings (2): 

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