This analysis presents a comprehensive description of malaria burden and risk factors in Peruvian Amazon villages where malaria transmission is hypoendemic. More than 9,000 subjects were studied in contrasting village settings within the Department of Loreto, Peru, where most malaria occurs in the country. Plasmodium vivax is responsible for more than 75% of malaria cases; severe disease from any form of malaria is uncommon and death rare. The association between lifetime malaria episodes and individual and household covariates was studied using polychotomous logistic regression analysis, assessing effects on odds of some vs. no lifetime malaria episodes. Malaria morbidity during lifetime was strongly associated with age, logging, farming, travel history, and living with a logger or agriculturist. Select groups of adults, particularly loggers and agriculturists acquire multiple malaria infections in transmission settings outside of the main domicile, and may be mobile human reservoirs by which malaria parasites move within and between micro-regions within malaria endemic settings. For example, such individuals might well be reservoirs of transmission by introducing or reintroducing malaria into their home villages and their own households, depending on vector ecology and the local village setting. Therefore, socio-demographic studies can identify people with the epidemiological characteristic of transmission risk, and these individuals would be prime targets against which to deploy transmission blocking strategies along with insecticide treated bednets and chemoprophylaxis.

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Dietary exposure of the Valencian region population to lead, cadmium, inorganic arsenic (iAs), chromium, copper, tin and methylmercury (meHg) was assessed in a total diet study carried out in the region of Valencia in 2010-11. A total of 8100 food samples were collected and analysed. Occurrence data were combined with consumption data to estimate dietary exposure in adults (> 15 years of age) and young children (6-15 years of age). The estimated intake was calculated by a probabilistic approach. Average intake levels (optimistic scenario) for lead, iAs, chromium and tin were 0.21, 0.08, 1.79 and 1.87 µg kg bw day respectively; for Cd and meHg average intake levels were 0.77 and 0.54 µg kg bw week, respectively, and for Cu, 1.60 mg day. In terms of risk characterisation, the results showed that 2.84% of the adult population may exceed the BMDL (benchmark dose lower confidence limit) established for Pb, which is linked to renal effects; whereas 28.01% of the young children population may exceed the BMDL related to neurodevelopment effects. In addition, 8.47% of the adult population and 12.32% of young children exceeded the meHg tolerable weekly intake (TWI).

Graphical abstract

Dietary exposure of the Valencia Region population to polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs) and PCBs was assessed in the Region of Valencia in 2010-2011. A total of 7700 food samples were collected. Occurrence data were combined with consumption data to estimate dietary exposure in adults (>15 years of age) and young people (6-15 years of age). The estimated intake was calculated by a probabilistic approach. Average intake levels (upper-bound scenario) were 1.58 and 2.76 pg toxic equivalent (TEQ) kg body weight (bw) day for adults and young people, respectively. These average intakes are within range of the tolerable daily intake of 1-4 pg WHO-TEQ kg bw day recommended by WHO, and slightly above the tolerable weekly intake (TWI) of 14 pg TEQ kg bw week and the Provisional tolerable monthly intake of 70 pg TEQ kg bw month set by the Scientific Committee on Food and the Joint FAO/WHO Expert Committee on Food, respectively. These results show that the contamination levels in food and therefore the exposure of the general population to PCDD/Fs and PCBs have declined in this region and therefore show the efficiency of the European risk-management measures. In terms of risk characterisation, the results showed that, under the upper-bound scenario, 22% of the adult and 58% of the young people population could exceed the TWI.