Malaria

Is a parasitic disease, infections with four human malarias can present sufficiently similar symptoms to make species differentiation generally impossible without laboratory studies. The early clinical manifestations of malaria ( in the first few days of illness ) are non-specific and it resembles in early stages of many other febrile illnesses due to bacterial, viral or parasitic causes.

Infectious agents: Plasmodium falciparum,P. vivax, P.ovale and P.malariae. Protozone parasites with asexual and sexual phases that occur in humans and in mosquito. Most species infections are not infrequent in endemic areas.


Transmission of Plasmodium from Mosquito to Human…to Mosquito P. falciparum P. vivax P. ovale P. malariae P. knowlsei

Malaria

It is a disease transmitted by mosquitoes
Malaria interrupts children's social development depleting Africa’s future human recourses The female Anopheles mosquito bites at night
The disease is passed by female Anopheles mosquitoes that bite at NIGHT
The mosquito injects parasites into the blood which take less than 30 minutes to reach the liver
Once in the liver parasites develop until ready to leave and enter the blood stream where they attack red blood cells


one bite is enough to give malaria: one parasite upon entering the liver can produce around 50,000 daughter cells after 6 days. When the liver cells rupture and release the daughter cells into the blood they enter red blood cells, where, after 48 hours a single daughter cell can produce 8-24 daughter cells which are in turn released into the blood stream when the red blood cell ruptures. .



Over 80% of the malaria related fatalities in the world each year are in Africa. The highest mortality rate is amongst young people. Malaria is also a disease of the under nourished, with a poor diet you are less able to withstand an attack of malaria. With such high numbers of young deaths many African countries are losing a significant portion of their potential workforce


It affects over 40% of the worlds population infecting between 300 – 500 million people per year resulting in over a million deaths worldwide (>80% in Africa)From the time one gets bitten to the time the symptoms start to appear can take between 7 and 60 daysThere is no vaccinationTREATMENT IS URGENT! THIS IS AN EMERGENCY

The incubation period for malaria is approximately 9-14 days for P. Falciparum, 12-18 days for P. vivax and P. ovale and 18-40 days for P. Malariae. Some strains of P.vivax, mostly from temporate areas may have an incubation period 6-12 months, with infection through blood transfusion, I.P. depend on the number of parasites infused and are usually short, but may range up to 2 months.


There is no liver stage with transfusion transmitted malaria vivax or ovale ,relapses can not occur.There is a brief prodromal period with symptoms of fever, headache, and myalgia. Symptoms begin with a cold stage (a shaking chill), following by a fever stage (40–41°C) that lasts about 24 hours, and finally a wet stage.

The wet stage occurs several hours after the fever, when the body temperature drops quickly to normal and profuse sweating begins. The patient is exhausted but well until the next cycle of fever begins. Other symptoms include myalgias Arthralgias Headache diarrhea,vomiting splenomegaly anemia, thrombocytopenia often develop after a few days.

Sever malaria if no treatment or delay treatment: Acute encephalopathy Sever anemia Icterus Renal failure Hypoglycemia Res. Distress lactic acidosis More rarely :coagulation defect and shock


Period of communicability: Human may infect mosquito as long as infective gametocytes are present in the blood this varies with parasite species and with response to therapy. Untreated or insufficiently treated patient may be a source of mosquito infection for several years in malariae, up to 5 years in vivax, and generally not more than one year in falciparum. Transfusional transmission as long as asexual form remain in circulating blood( with p. malariae, up to 40 years or longer)

GLOBAL AND REGIONAL RISKApproximately, 40% of the world’s population, mostly those living in the world’s poorest countries, are at risk of malaria. Every year, more than 500 million people become severely ill with malaria. Most cases and deaths are in sub-Saharan Africa. However, Asia, Latin America, the Middle East and parts of Europe are also affected

Malaria’s ImpactIn areas with high transmission, the most vulnerable groups are young children, who have not developed immunity to malaria yet, and pregnant women, whose immunity has been decreased by pregnancy. The costs of malaria – to individuals, families, communities, nations – are enormous.


Reservoir: Humans are the only important reservoir of human malaria , except as regards P.malariae , which is common to man , African apes and probably some South American monkeys

Malaria – Symptoms There are no specific symptoms for malaria. The main symptoms of malaria are often mistaken for those of flu (the common cold). They can include any of the following:
fever chills headache fatigue weakness
If any of these symptoms and live in a malaria country or have visited a malaria country within the last 8 weeks:
seek medical advice
Do not lose time
Until prove otherwise, assume any of these symptoms are symptoms of malaria
aches and pains abdominal pain diarrhoea vomiting


How is malaria diagnosed? 1- Clinical symptoms, when associated with travel to countries that have identified malarial risk, suggest malaria as a diagnosis , live in malaria-endemic area, receive blood products tissues or organs. 2-antigen detection test

3- The classic and most used test is the blood smear on a microscope slide that is stained (Giemsa stain) to show the parasites inside red blood cells 4- RDT's (rapid diagnostic tests) approved for use in the U.S. in 2007 and the polymerase chain reaction (PCR) tests. These are not yet widely available and are more expensive

Preventive measures: 1. Local community measures in endemic areas: *insecticide-treated mosquito nets. *Indoor residual spraying with insecticides *Control of larval stages by elimination of mosquito breeding sites: by filling and draining or by increasing the speed of water flow in a natural or artificial channels

Malaria Prevention is based on…… OFS-QHSE-MALARIA-Level 2-2 Rev. Date: 10 Jul 2006

Insect Bite Prevention
Preventative Anti-Malarial Medication
If you are a visitor to or an employee in a high risk country, your safety is based on two lines of defense…


6
STAGE 6 Mosquitoes bite humans
Malaria - Mosquito control: 6 Building Blocks
5
STAGE 5 Adult mosquitoes enter human dwellings between 5-10 pm and early morning, hide in dark corners
Prevent Entry
Actions Close the doors and windows at that time; clear hiding places if possible
4
STAGE 4 Adult mosquitoes can live up to 4-10 weeks or more
Actions Kill the adults with space sprays (for instant kill) and residual sprays (for lasting effect)
Insecticides
2
STAGE 2 Eggs laid on standing water
Source Reduction Deny breeding grounds

1
STAGE 1 Female mosquitoes develop eggs, fed by human blood
Personal Protection Deny the blood meal

3
STAGE 3 Eggs hatch and develop into larvae and pupae in a week
Larvicides Chemical/Biological
Actions Kill the larvae with larvicidal agents
Bite Prevention Adult female mosquitoes bite human beings at night, maximum at 10pm-4am
Actions Personal protection by covering the body with clothes; use of mosquito nets and repellents



1. Bed Nets Ensure chemically treated nets are fitted above each bed and that the nets are used and retreated every 6 - 12 months
2. Chemical Diffusers Use electro-chemical diffusers in your house/rooms. Tabs give 10 hours of bite protection, while liquid insecticide bottles give 21 days
3. Insect repellent Make sure you carry in your hand luggage and apply before arrival in Geomarket. Carry in your pocket when going out for the night
6. Insect spray Make sure you spray your accommodation regularly
Malaria – Insect bite prevention: 6 Top Tips
5. Mosquito coils Use if socialising outside, burn coils where people are gathering


OUTDOORS - CHECKLIST Long sleeve shirts are worn Long trousers are worn at all times Always wear socks outside at night Before going outdoors apply repellent to uncovered parts of the body Stay indoors at night whenever possible
Malaria – Insect bite prevention OFS-QHSE-MALARIA-Level 2-2 Rev. Date: 10 Jul 2006
INDOORS – CHECKLISTWindows and doors are kept closedDoors and windows are fitted with screens and regularly checked for holesWhere available air conditioning is working and on cold (preferably ≤ 20єC)At night electric diffusers are plugged in and working, particularly in bedroomsOn verandas coils are burnedAccommodation is regularly sprayed with insecticideChemically treated bed net is provided and regularly checked for holes and used correctly (tucked under the mattress all around the bed)

Malaria – Preventative medication In company designated high malaria risk countries, use of preventative medication is highly recommended especially for visitors who are particularly susceptible. Preventative medicine works by preventing the malaria parasite from growing in the liver.

Take as preventative medication one of the following medicines:

All medication needs to be taken REGULARLY during the entire stay in a malaria country and for 4 weeks after leaving a malaria country except for Malarone which needs to be taken for only 7 days after leaving a malaria country.The risk of side effects exists with all medications but is small and reversible when medication is stopped. The risk of side effects is always smaller than the risk of malaria which is….. DEATH !

4- Pregnant women are at high risk of malaria. *Non-immune pregnant women risk both acute and severe clinical disease, resulting in up to 60% fetal loss and over 10% maternal deaths, including 50% mortality for severe disease. *Semi-immune pregnant women with malaria infection risk severe anaemia and impaired fetal growth, even if they show no signs of acute clinical disease. An estimated 10 000 of these women and 200 000 of their infants die annually as a result of malaria infection during pregnancy.


Intermittent preventive treatment with a full curative dose of an effective antimalarial at predefined intervals durig the 2nd and 3rd trimester of pregnancy is highly effective in reducing malaria burden in pregnant women in areas of stable, moderate to intense P. falciparum transmission. ( promoted in Africa), but is of limited value in other parts of the world where transmission often unstable or of low intensity.

WHO recommends that all endemic countries provide a package of interventions for prevention and management of malaria in pregnancy, consisting of (1) diagnosis and treatment for all episodes of clinical disease and anaemia and (2) insecticide-treated nets for night-time prevention of mosquito bites and infection. In highly endemic falciparum malaria areas, this should be complemented by (3) intermittent preventive treatment with sulfadoxine–pyrimethamine to clear the placenta periodically of parasites.

5. in epidemic prone areas ,malaria surveillance should be based on weekly reporting

How do we keep from getting malaria? CDC recommendations suggest individuals begin taking antimalarial drugs about one to two weeks before traveling to a malaria infested area and for four weeks after leaving the area. Currently, there is no vaccine available for malaria, but researchers are trying to develop one

Malaria – Conclusion If you suspect malaria – take Coartem ® / Riamet ® for 3 days and use your Curative Kit to perform a malaria test for confirmation of the diagnosis. Even if the 3 tests remains negative continue the Coartem ® or Riamet ® treatment for 3 days (4 tablets morning and evening) The risk is highest after leaving a high risk country or when working in a remote location/rig
THIS IS AN EMERGENCY!
Falciparum Malaria is fatal if not treated rapidly!!! Take preventive medication regularly
Malaria can be prevented and treated

Then, the plan of control of disease changes from control to final elimination of local transmission of malaria at the end of 2010. The most malarial species that caused infection in Iraq is the Plasmodium vivax. Malaria is a nationally notifiable disease; clinicians and health-care facilities are mandated by legislation or state and local regulations to report cases to their state health department State and local health departments and CDC investigate malaria cases