Malaria in Southern Venezuela: The hottest hotspot in Latin America

Abstract

Malaria elimination in Latin America is becoming an elusive goal. Malaria cases reached a historical ~1 million in 2017 and 2018, with Venezuela contributing 53% and 51% of those cases, respectively. Historically, malaria incidence in southern Venezuela has accounted for most of the country's total number of cases. The efficient deployment of disease prevention measures and prediction of disease spread to new regions requires an in-depth understanding of spatial heterogeneity on malaria transmission dynamics. Herein, we characterized the spatial epidemiology of malaria in southern Venezuela from 2007 through 2017 and described the extent to which malaria distribution has changed country-wide over the recent years. We found that disease transmission was focal and more prevalent in the southeast region of southern Venezuela where two persistent hotspots of Plasmodium vivax (76%) and P. falciparum (18%) accounted for ~60% of the total number of cases. Such hotspots are linked to deforestation as a consequence of illegal gold mining activities. Incidence has increased nearly tenfold over the last decade, showing an explosive epidemic growth due to a significant lack of disease control programs. Our findings highlight the importance of spatially oriented interventions to contain the ongoing malaria epidemic in Venezuela. This work also provides baseline epidemiological data to assess cross-border malaria dynamics and advocates for innovative control efforts in the Latin American region.

The clinical–epidemiological profile of malaria patients from Southern Venezuela, a critical hotspot in Latin America

“…The dramatic increase in malaria transmission in Venezuela has changed the regional epidemiological landscape [ 1 , 5 ]. Still, there is limited information about the current clinical profile of malaria cases in Venezuela.…”

“…Bolivar state is in the country's south, bordering Brazil and Guyana; it has 240,528 km 2 , corresponding to 26.2% of the national territory, with an approximate population of 1,837,485 inhabitants projected by 2018 [ 12 ]. Plasmodium vivax is the most prevalent parasite, with 70–80% of malaria cases, whereas P. falciparum causes the remaining 20–30% of cases annually [ 5 ]. This study was carried out in Ciudad Bolívar, the state capital (Fig.…”

“…However, in Bolivar state in the southeastern region bordering Brazil and Guyana, there has been a high risk of malaria infection for decades [ 4 ]. Due to the ongoing Venezuelan health crisis, the Bolivar state has also become the hottest malaria hotspot for the Americas region [ 5 ].…”

The malaria burden of Amerindian groups of three Venezuelan states: a descriptive study based on programmatic data

“…Surprisingly, the Sifontes municipality, recently identified as the most important cluster of malaria transmission in the Americas [ 2 ], was not found to be a significant hot spot for Amerindian groups. While this might reflect a predominance of mining activity by the Pemon, the Yekuana, and other groups in different areas, further research is needed to confirm this finding and understand the reasons behind it.…”

“…Fifty-three percent of these cases, and 73% of all deaths came from Venezuela, where incidence has increased over 1000% in the last two decades, amidst a context of economic crisis and political unrest [ 1 ]. The disease disproportionally affects regions south of the Orinoco River, where cases are clustered in the Sifontes municipality, of the Bolivar State [ 2 ]. There is a significantly lesser burden in the northeast coast of the country [ 3 ].…”