Abstract
In Brazil, more than 99% of malaria cases are reported in the Amazon, and the State of Amazonas accounts for 40% of this total. However, the accumulated experience and challenges in controlling malaria in this region in recent decades have not been reported. Throughout the first economic cycle during the rubber boom (1879 to 1912), malaria was recorded in the entire state, with the highest incidence in the villages near the Madeira River in the Southern part of the State of Amazonas. In the 1970s, during the second economic development cycle, the economy turned to the industrial sector and demanded a large labor force, resulting in a large migratory influx to the capital Manaus. Over time, a gradual increase in malaria transmission was observed in peri-urban areas. In the 1990s, the stimulation of agroforestry, particularly fish farming, led to the formation of permanent Anopheline breeding sites and increased malaria in settlements. The estimation of environmental impacts and the planning of measures to mitigate them, as seen in the construction of the Coari-Manaus gas pipeline, proved effective. Considering the changes occurred since the Amsterdam Conference in 1992, disease control has been based on early diagnosis and treatment, but the development of parasites that are resistant to major antimalarial drugs in Brazilian Amazon has posed a new challenge. Despite the decreased lethality and the gradual decrease in the number of malaria cases, disease elimination, which should be associated with government programs for economic development in the region, continues to be a challenge.
Highlights
Malaria is considered one of the most important parasitic diseases, and it is responsible for approximately 216 million cases and 655,000 deaths annually worldwide(1)
99.7% of malaria cases are reported in the Amazon region, and the State of Amazonas accounts for 40% of this total(2)
The Programa Nacional de Controle de Malária (PNCM) has supported studies conducted at FMT and the Research Center in Tropical Medicine [Centro de Pesquisa em Medicina Tropical (CEPEM)] in Porto Velho, Rondônia, where a combination of artemisinin-based combination therapies (ACTs) and primaquine is used for the treatment of P. vivax malaria
Summary
Malaria is considered one of the most important parasitic diseases, and it is responsible for approximately 216 million cases and 655,000 deaths annually worldwide(1). (35) It is possible that, in the short term, we may have to make use of artemisinin-based combination therapies (ACTs) as the first choice in the State of Amazonas, other states have not reported cases of chloroquine resistance, which is expected in large areas such as the Brazilian Amazon Concerned about this issue, the PNCM has supported studies conducted at FMT and the Research Center in Tropical Medicine [Centro de Pesquisa em Medicina Tropical (CEPEM)] in Porto Velho, Rondônia, where a combination of ACTs and primaquine is used for the treatment of P. vivax malaria. Introduction of tafenoquine as an anti-hypnozoite drug in the PNCM could be an important tool in the future goal of eliminating malaria, and tafenoquine use should stimulate the systematic screening of G6PDd using a rapid point-of-care testing system, this screening still lacks accuracy and economical evaluation
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