Malaria in North-East India: Importance and Implications in the Era of Elimination

Keshab Barman,Balasubramani Karuppusamy,Dibya Ranjan Bhattacharyya,Nachimuthu Senthil Kumar,Devojit Kumar Sarma,Savitha Chellappan,Praveen Balabaskaran Nina,Aditya Prasad Dash,Anil Prakash,Pradumnya Kishore Mohapatra

doi:10.3390/microorganisms7120673

Keshab Barman, Balasubramani Karuppusamy

Open Access

https://doi.org/10.3390/microorganisms7120673

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Abstract

Worldwide and in India, malaria elimination efforts are being ramped up to eradicate the disease by 2030. Malaria elimination efforts in North-East (NE) India will have a great bearing on the overall efforts to eradicate malaria in the rest of India. The first cases of chloroquine and sulfadoxine-pyrimethamine resistance were reported in NE India, and the source of these drug resistant parasites are most likely from South East Asia (SEA). NE India is the only land route through which the parasites from SEA can enter the Indian mainland. India’s malaria drug policy had to be constantly updated due to the emergence of drug resistant parasites in NE India. Malaria is highly endemic in many parts of NE India, and Plasmodium falciparum is responsible for the majority of the cases. Highly efficient primary vectors and emerging secondary vectors complicate malaria elimination efforts in NE India. Many of the high transmission zones in NE India are tribal belts, and are difficult to access. The review details the malaria epidemiology in seven NE Indian states from 2008 to 2018. In addition, the origin and evolution of resistance to major anti-malarials are discussed. Furthermore, the bionomics of primary vectors and emergence of secondary malaria vectors, and possible strategies to prevent and control malaria in NE are outlined.

Highlights

Despite large-scale global efforts to eradicate malaria in the last few years, it still remains a major public health burden with an estimated 219 million cases and 435,000 deaths worldwide in 2017 [1]
There has been a steady increase in P. falciparum (Pf) cases in the last 4 decades, and as of December 2018, Pf was responsible for 48.1% of malaria cases in India [2]
P. vivax (Pv) was more in Arunachal Pradesh, Nagaland and Manipur, the states that border Myanmar, while Pf predominated in Meghalaya, Tripura, Mizoram and Assam, the states that bordered Bangladesh

Summary

Introduction

Despite large-scale global efforts to eradicate malaria in the last few years, it still remains a major public health burden with an estimated 219 million cases and 435,000 deaths worldwide in 2017 [1]. Arunachal Pradesh, Meghalaya, Mizoram, Nagaland, Sikkim, Manipur and Tripura make up the eight states of NE India. Of the 7 NE states, Meghalaya reported the highest proportion of malaria cases (1.15%/year) to the total population. The states of Arunachal, Nagaland and Manipur have reported a steady decline in malaria cases from 2009 until 2018, and in 2018, the number of cases reported were 625 (Pf -154, Pv-471), 113 (Pf -24, Pv-89) and 12 (Pf -3, Pv-9) respectively. Pv was more in Arunachal Pradesh, Nagaland and Manipur, the states that border Myanmar, while Pf predominated in Meghalaya, Tripura, Mizoram and Assam, the states that bordered Bangladesh. A declining trend of malaria was observed in Assam, Arunachal Pradesh, Nagaland and Manipur, the states with higher proportion of Pv cases. A cyclical trend was observed in Meghalaya, Tripura and Mizoram dominated by Pf

Drug Resistance

Assay Method Therapeutic efficacy

Vectors of NE India

Role of Secondary Vectors

Findings

Conclusions and Future Directions