Abstract
Brazil currently contributes 42 % of all malaria cases reported in the Latin America and the Caribbean, a region where major progress towards malaria elimination has been achieved in recent years. In 2014, malaria burden in Brazil (143,910 microscopically confirmed cases and 41 malaria-related deaths) has reached its lowest levels in 35 years, Plasmodium falciparum is highly focal, and the geographic boundary of transmission has considerably shrunk. Transmission in Brazil remains entrenched in the Amazon Basin, which accounts for 99.5 % of the country’s malaria burden. This paper reviews major lessons learned from past and current malaria control policies in Brazil. A comprehensive discussion of the scientific and logistic challenges that may impact malaria elimination efforts in the country is presented in light of the launching of the Plan for Elimination of Malaria in Brazil in November 2015. Challenges for malaria elimination addressed include the high prevalence of symptomless and submicroscopic infections, emerging anti-malarial drug resistance in P. falciparum and Plasmodium vivax and the lack of safe anti-relapse drugs, the largely neglected burden of malaria in pregnancy, the need for better vector control strategies where Anopheles mosquitoes present a highly variable biting behaviour, human movement, the need for effective surveillance and tools to identify foci of infection in areas with low transmission, and the effects of environmental changes and climatic variability in transmission. Control actions launched in Brazil and results to come are likely to influence control programs in other countries in the Americas.
Highlights
Malaria is endemic to 21 countries in the region of the Americas, with 389,390 laboratory-confirmed cases and 87 malaria-related deaths reported to the Pan American Health Organization (PAHO) in 2014
By the end of the 1980s, SP failed to cure >90 % of P. falciparum infections in the Amazon [99], and since 1990, SP is no longer recommended for malaria chemotherapy in Brazil [99]
A recent study in Suriname has documented a large proportion (31 %) of P. falciparum-infected patients treated with artemether–lumefantrine who remained parasitaemic by day 3, consistent with some degree of artemether resistance in Suriname [115], these findings have not been confirmed in other areas of the country
Summary
Malaria is endemic to 21 countries in the region of the Americas, with 389,390 laboratory-confirmed cases and 87 malaria-related deaths reported to the Pan American Health Organization (PAHO) in 2014. Low-density asymptomatic P. vivax infections, some of them initially missed by conventional microscopy but indirectly diagnosed by serology [62, 63], have been reported in other bromeliad-malaria settings in southeast Brazil [16].
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