Characterization of imported malaria, the largest threat to sustained malaria elimination from Sri Lanka.

Priyani Dharmawardena,Kamini Mendis,Mihirini Hewawitarane,Risintha G Premaratne,Deepika Fernando,Wm Kumudunayana T De Aw Gunasekera

doi:10.1186/s12936-015-0697-0

Priyani Dharmawardena, Kamini Mendis + Show 4 more

Open Access

https://doi.org/10.1186/s12936-015-0697-0

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Journal: Malaria journal	Publication Date: Apr 24, 2015
Citations: 44	License type: CC BY 4.0

Affiliation: Anti Filariasis Campaign, University of Colombo

Abstract

Sri Lanka has reached zero indigenous malaria cases in November 2012, two years before its targeted deadline for elimination. Currently, the biggest threat to the elimination efforts are the risk of resurgence of malaria due to imported cases. This paper describes two clusters of imported malaria infections reported in 2013 and 2014, one among a group of Pakistani asylum-seekers resident in Sri Lanka, and the other amongst local fishermen who returned from Sierra Leone. The two clusters studied reveal the potential impact of imported malaria on the risk of reintroducing the disease, as importation is the only source of malaria in the country at present. In the event of a case occurring, detection is a major challenge both amongst individuals returning from malaria endemic countries and the local population, as malaria is fast becoming a “forgotten” disease amongst health care providers. In spite of a very good coverage of diagnostic services (microscopy and rapid diagnostic tests) throughout the country, malaria is being repeatedly overlooked by health care providers even when individuals present with fever and a recent history of travel to a malaria endemic country. Given the high receptivity to malaria in previously endemic areas of the country due to the prevalence of the vector mosquito, such cases pose a significant threat for the reintroduction of malaria to Sri Lanka. The challenges faced by the Anti Malaria Campaign and measures taken to prevent the resurgence of malaria are discussed here.

Highlights

The decline in the number of malaria cases between the years 2000–2007 led to the commencement of preelimination malaria efforts in Sri Lanka
This study reports on two clusters of imported malaria, one amongst Pakistani asylum-seekers resident in a malaria non-endemic area in Sri Lanka and the other amongst local fishermen who returned from Sierra Leone, the statistics of which added to the burden of imported malaria in Sri Lanka in 2013/14
Extensive field and outbreak investigation was immediately initiated after the first case was reported, which led to a coordinated effort between the Anti Malaria Campaign (AMC) Headquarters (AMC Anti malaria campaign headquarters (HQs)) and religious leaders under whose patronage this Pakistani community was settled

Summary

Introduction

The decline in the number of malaria cases between the years 2000–2007 led to the commencement of preelimination malaria efforts in Sri Lanka. This together with the end of the civil conflict in May 2009 made it possible to strengthen surveillance, prevention and control efforts throughout the country, rapidly changing the epidemiology of malaria. During the period 2008–2012, the objectives of the national programme were the elimination of indigenous Plasmodium falciparum infections by end 2012 in non-conflict and transitional areas and the elimination of indigenous Plasmodium vivax infections by the year 2012 in 75% of non-conflict and transitional areas of the country, Over the past six years, most of the imported malaria cases were being reported from foreign travellers or Sri Lankan nationals returning from malaria endemic countries, mainly India [3,4]. The implications of the imported cases are discussed in the context of the challenges faced by the Anti Malaria Campaign (AMC) and measures taken to prevent the reintroduction of malaria

Results

Discussion

Conclusion