Chloroquine-Resistant Plasmodium falciparum Malaria: Report of Two Locally Acquired Infections in Saudi Arabia

Kinsara, Abdulhalim Jamal; Abdelaal, Mohamed; Jeje, Oluyemi; Osoba, Abimbola O.

doi:10.4269/ajtmh.1997.56.573

Cited by 10 publications

(7 citation statements)

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“…CQ resistant P. falciparum infections and treatment failures began to be documented in the Kingdom from 1992 [ 26 , 27 ]. From 1998, CQ resistance escalated [ 26 , 28 ] and by the mid-2000s the prevalence of molecular markers of CQ resistance were above 80 % [ 29 – 31 ]. As CQ began to fail there was increasing use of the second-line recommended drug, sulfadoxine-pyrimethamine (SP) for treatment.…”

Section: Resultsmentioning

confidence: 99%

Progress toward malaria elimination in Jazan Province, Kingdom of Saudi Arabia: 2000–2014

Hassan

Sahly

Alzahrani

et al. 2015

Malar J

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BackgroundThe draft Global Technical Strategy for malaria aims to eliminate malaria from at least 10 countries by 2020. Yemen and Saudi Arabia remain the last two countries on the Arabian Peninsula yet to achieve elimination. Over the last 50 years, systematic efforts to control malaria in the Kingdom of Saudi Arabia has successfully reduced malaria cases to a point where malaria is now constrained largely to Jazan Province, the most south-western area along the Red Sea. The progress toward elimination in this province is reviewed between 2000 and 2014.MethodsData were obtained from the Ministry of Health case-reporting systems, activity reports, unpublished consultants reports, and relevant scientific published papers. Sub-provincial population data were obtained the national household censuses undertaken in 2004 and 2010. Rainfall data were obtained from the Meteorological Department in Jazan.ResultsBetween 2000 and 2014 there were 5522 locally acquired cases of malaria and 9936 cases of imported malaria. A significant reduction in locally acquired malaria cases was observed from 2000 to 2014, resulting in an average annual incidence (2010–2014) of 0.3 cases per 10,000 population. Conversely imported cases, since 2000, remain consistent and higher than locally acquired cases, averaging between 250 and 830 cases per year. The incidence of locally acquired cases is heterogeneous across the Province, with only a few health districts contributing the majority of the cases. The overall decline in malaria case incidence can be attributed to coincidental expansion of control efforts and periods of exceptionally low rainfall.ConclusionsJazan province is poised to achieve malaria elimination. There is a need to change from a policy of passive case detection to reactively and proactively detecting infectious reservoirs that require new approaches to surveillance. These should be combined with advanced epidemiological tools to improve the definitions of epidemiological receptive and hotspot malaria risk mapping. The single largest threat currently remains the risks posed by imported infections from Yemen.

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Section: Resultsmentioning

confidence: 99%

Progress toward malaria elimination in Jazan Province, Kingdom of Saudi Arabia: 2000–2014

Hassan

Sahly

Alzahrani

et al. 2015

Malar J

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“…Cases of complicated malaria were treated with quinine. However, evidence of widespread CQ resistance was described during the late 1990s in neighbouring Jazan Region [15–17]. There was an increasing use of SP during periods of declining CQ efficacy, and artesunate (AS),plus, SP (AS/SP) and artemether-lumefantrine (AL) were also used during this period.…”

Section: Methodsmentioning

confidence: 99%

The changing malaria landscape in Aseer region, Kingdom of Saudi Arabia: 2000–2015

Al-Shahrani

Abdelgader

Saeed

et al. 2016

Malar J

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BackgroundIn 2004, a revised action plan was developed, supported by the World Health Organization, to eliminate malaria from Saudi Arabia by preventing re-introduction of malaria into regions since declared malaria free, eliminating foci of transmission in the Mecca and Medina areas and a concerted effort of foci surveillance and control, to eliminate malaria from the regions of Jazan and Aseer. This paper provides the context, activities, progress, and possible contributions toward malaria elimination in the Aseer region since 2000, with a more detailed analysis of the spatial location of locally acquired case incidence since 2012.MethodsThis is a descriptive study of all available Ministry of Health surveillance data and process reports since 2000, with higher spatial resolution analysis of data between 2012 and 2015.ResultsIn 2000, there were 511 cases of Plasmodium falciparum locally acquired infection. The following 4 years witnessed a dramatic decline in cases to only 18 locally acquired infections reported in 2005. A resurgence in local infections was reported in 2006 (93) and 2007 (165), thereafter (2008–2014) local cases continued to decline to fewer than 40 per year across the region. However, in 2015, a small rise was noted (51). All locally acquired infections were P. falciparum. There has been a constant flow of imported infections into Aseer since 2000, mostly among immigrant labour from Pakistan, India, Sudan, and Yemen. Imported infections have included both Plasmodium vivax and P. falciparum. The spatial extent of malaria appears to be changing, but there remain two intractable areas Sarat Abeda and Dhran Aljanub, where risks per reporting centre have changed little since 2001, remaining above 0.5 per 10,000 population. Only seven villages contributed 55% of all locally acquired infection since 2012.DiscussionAseer has reached a state of very low incidence of locally acquired infections, despite a constant source of imported infections from outside the country. How many of the local infections are F2 generations from imported infections or how many are a result of residual active transmission between asymptomatic carriers of infections transmitted by pockets of existing Anopheles arabiensis populations remains unknown. A more detailed investigation of the spatial and temporal patterns of infected hosts, parasites and vectors would help define whether this region has managed to effectively prevent local transmission of new infections.

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“…During the 1990s, attempts were made to integrate case management within an expanded Primary Health Care (PHC) scheme. Chloroquine-resistant case reports began to emerge in the early 1990s (Kinsara et al, 1997; Malik et al, 1997) with documented treatment failure rates of 12% in Jizan by 1998 (Ghalib et al, 2001). Overall, the attention given to malaria control waned.…”

Section: Kingdom Of Saudi Arabiamentioning

confidence: 99%

The Malaria Transition on the Arabian Peninsula: Progress toward a Malaria-Free Region between 1960–2010

Snow

Amratia

Zamani

et al. 2013

Advances in Parasitology

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The transmission of malaria across the Arabian Peninsula is governed by the diversity of dominant vectors and extreme aridity. It is likely that where malaria transmission was historically possible it was intense and led to a high disease burden. Here, we review the speed of elimination, approaches taken, define the shrinking map of risk since 1960 and discuss the threats posed to a malaria-free Arabian Peninsula using the archive material, case data and published works. From as early as the 1940s, attempts were made to eliminate malaria on the peninsula but were met with varying degrees of success through to the 1970s; however, these did result in a shrinking of the margins of malaria transmission across the peninsula. Epidemics in the 1990s galvanised national malaria control programmes to reinvigorate control efforts. Before the launch of the recent global ambition for malaria eradication, countries on the Arabian Peninsula launched a collaborative malaria-free initiative in 2005. This initiative led a further shrinking of the malaria risk map and today locally acquired clinical cases of malaria are reported only in Saudi Arabia and Yemen, with the latter contributing to over 98% of the clinical burden.

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Chloroquine-Resistant Plasmodium falciparum Malaria: Report of Two Locally Acquired Infections in Saudi Arabia

Cited by 10 publications

References 0 publications

Progress toward malaria elimination in Jazan Province, Kingdom of Saudi Arabia: 2000–2014

Progress toward malaria elimination in Jazan Province, Kingdom of Saudi Arabia: 2000–2014

The changing malaria landscape in Aseer region, Kingdom of Saudi Arabia: 2000–2015

The Malaria Transition on the Arabian Peninsula: Progress toward a Malaria-Free Region between 1960–2010

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