Malaria Elimination in Costa Rica: Changes in Treatment and Mass Drug Administration

Abstract

<jats:p>Costa Rica is a candidate to eliminate malaria by 2020. The remaining malaria transmission hotspots are located within the Huétar Norte Region (HNR), where 90% of the country’s 147 malaria cases have occurred since 2016, following a 33-month period without transmission. Here, we examine changes in transmission with the implementation of a supervised seven-day chloroquine and primaquine treatment (7DCPT). We also evaluate the impact of a focal mass drug administration (MDA) in January 2019 at Boca Arenal, the town in HNR reporting the greatest local transmission. We found that the change to a seven-day treatment protocol, from the prior five-day program, was associated with a 98% reduction in malaria transmission. The MDA helped to reduce transmission, keeping the basic reproduction number, RT, significantly below 1, for at least four months. However, following new imported cases from Nicaragua, autochthonous transmission resumed. Our results highlight the importance of appropriate treatment delivery to reduce malaria transmission, and the challenge that highly mobile populations, if their malaria is not treated, pose to regional elimination efforts in Mesoamerica and México.</jats:p>

Towards the elimination of Plasmodium vivax malaria: Implementing the radical cure

“…vivax parasitaemia within 6 months of follow-up than those in which treatment was semi-supervised [ 21 ]. Similar findings were reported in Costa Rica where PQ treatment is supervised by trained personnel [ 14 , 24 ]. Elimination is possible with optimal use of current tools as demonstrated by Sri Lanka which has recently been declared malaria free [ 25 ].…”

Plasmodium vivax Genetic Diversity in Panama: Challenges for Malaria Elimination in Mesoamerica

“…This is especially important in settings where it is assumed that most cases are imported and that local outbreaks are triggered by initial imported infections. This, for example, is the situation in Costa Rica where recent outbreaks have been linked with migrant workers, but no evidence grounded on genetic markers have been used to support the inference [ 21 ].…”

Plasmodium falciparum Genetic Diversity in Panamá Based on glurp, msp-1 and msp-2 Genes: Implications for Malaria Elimination in Mesoamerica

“…At present, four countries in Mesoamerica (Costa Rica, El Salvador, Belize and Mexico) have been identified by the WHO as having the potential to soon eliminate malaria [38]. In these countries, as in Panamá, an important proportion of cases are found among migrant and mobile populations living in remote areas mostly near the borders [39][40][41][42]. For regional elimination efforts to succeed, imported infections must be detected and treated rapidly.…”