Malaria is one of the oldest tropical diseases and still remains a focus of attention. Sub-Saharan African countries contribute 90% of the total malaria cases in the world. The World Health Organization (WHO) has advocated eliminating this disease by 2030 with the existing strategies and tools. Many initiatives are underway by several organizations, and 38 countries have achieved the elimination goal. The main backbone of the elimination process is smart surveillance followed by prompt public health responses. The control of the disease mainly relies on treatment of malaria positive cases with anti-malarials namely artemisinin-based combination therapy (ACT) for Plasmodium falciparum. In India, chloroquine is still effective against P. vivax. Use of 8-aminoquinolines primaquine and more recently tefenoquine warrants testing of G6PD deficiency status to avoid unnecessary hemolysis. Vector control operations mainly depend on the use of long-lasting insecticidal nets (LLINs) and indoor residual spray (IRS) with insecticides. The threat of resistance draws an open challenge in both treatment and vector management. New initiatives on surveillance, treatment, chemoprevention, and vector control using modern techniques of artificial intelligence, machine learning, genetic engineering, and digital approach of community engagement have great potential to accelerate the malaria elimination process.
Part of the book: Vector-Borne Diseases
India is the second largest populous and democratic country in the world. Several geo-ecological settings are favorable for most of the vector borne diseases (VBDs) in the country. Malaria, Lymphatic Filariasis (LF), Japanese Encephalitis (JE), Dengue (DEN), Chikungunya (CHIK) and Kala-azar (KA) are major VBDs. Kyasanur Forest Disease (KFD), Plague and Chandipura virus (CHPV) infections have limited and localized foci, but needs attention. Crimean-Congo Hemorrhagic Fever (CCHF) and Zika are recent entries in India that also need to be handled on priority. National Vector Borne Disease Control Program (NVBDCP) is responsible for control and prevention of all these diseases. Malaria, LF, JE, DEN, CHIK and Zika are transmitted by different species of mosquitoes. KA and CHPV are transmitted by shadflies, while KFD, CCHF by ticks; plague by fleas. Scrub typhus (ST) responsible for acute encephalopathy syndrome (AES) is transmitted by Leptotrombidium mite species. It needs specific and strategic action plan in view of the diversified biodiversity. New innovations to strengthen the public health responses are the main intervention protocols. Already two diseases Guineaworm (Dracunculiasis) transmitted by different species of Cyclops, and polio have been successfully eradicated/eliminated from India. Such experience would be very helpful for the elimination of malaria, LF and KA, and all are on the elimination drive.
Part of the book: Public Health in Developing Countries
In India, human lymphatic filariasis (LF) is the most common vector-borne disease after malaria. It is a roundworm nematode parasitic helminthiases group of diseases under Filarioidea type of infection. The parasites are found in the lymphatic system, damage the system leading to deformities of body organs. Of the eight human filarial parasites, Wuchereria bancrofti, Brugia malayi and B. timori are involved with the lymphatic system. Globally W. bancrofti is the most predominant species sharing 90% of the burden. In India, W. bancrofti and B. malayi are present. The revised control strategy was aimed at a single-dose mass drug administration (MDA) and home-based morbidity management. The Elimination of LF (ELF) was initiated in 2004 in 202 districts which were expanded later in 256 districts after a pilot study in LF endemic districts initiated in 1997. The initial start of ELF campaign was with a single drug, i.e. diethylcarbamazine (DEC), but later in 2007, a combination of two drugs DEC and albendazole (ALB) were given through MDA. Now a third drug ivermectin (IVM) has been added to accelerate the elimination process by 2020 which is the global goal of elimination under Global Programme to Eliminate Lymphatic Filariasis (GPELF).
Part of the book: Parasitology and Microbiology Research
In recent years, efforts to eliminate malaria has gained a tremendous momentum, and many countries have achieved this goal — but it has faced many challenges. Recent COVID-19 pandemic has compounded the challenges due to cessation of many on-field operations. Accordingly, the World Health Organization (WHO) has advocated to all malaria-endemic countries to continue the malaria elimination operations following the renewed protocols. The recent reports of artemisinin resistance in Plasmodium falciparum followed by indication of chloroquine resistance in P. vivax, and reduced susceptibility of synthetic pyrethroids used in long lasting insecticide nets are some issues hindering the elimination efforts. Moreover, long distance night migration of vector mosquitoes in sub-Saharan Africa and invasion of Asian vector Anopheles stephensi in many countries including Africa and Southeast Asia have added to the problems. In addition, deletion of histidine rich protein 2 and 3 (Pfhrp2/3) genes in P. falciparum in many countries has opened new vistas to be addressed for point-of-care diagnosis of this parasite. It is needed to revisit the strategies adopted by those countries have made malaria elimination possible even in difficult situations. Strengthening surveillance and larval source management are the main strategies for successful elimination of malaria. New technologies like Aptamar, and artificial intelligence and machine learning would prove very useful in addressing many ongoing issues related to malaria elimination.
Part of the book: Current Topics and Emerging Issues in Malaria Elimination