The history of 20th century malaria control in Peru

Abstract

Malaria has been part of Peruvian life since at least the 1500s. While Peru gave the world quinine, one of the first treatments for malaria, its history is pockmarked with endemic malaria and occasional epidemics. In this review, major increases in Peruvian malaria incidence over the past hundred years are described, as well as the human factors that have facilitated these events, and concerted private and governmental efforts to control malaria. Political support for malaria control has varied and unexpected events like vector and parasite resistance have adversely impacted morbidity and mortality. Though the ready availability of novel insecticides like DDT and efficacious medications reduced malaria to very low levels for a decade after the post eradication era, malaria reemerged as an important modern day challenge to Peruvian public health. Its reemergence sparked collaboration between domestic and international partners towards the elimination of malaria in Peru.

Epidemiology of Plasmodium vivax Malaria in Peru

“…Even though reported malaria cases were not systematically differentiated by Plasmodium species from the 1940s to the 1990s,4 it is likely that P. vivax dominated. Long-standing practices for gathering malaria case data are based on test-and-treat models, which involve Ministry of Health information systems that passively gather microscopy-confirmed malaria cases using paper registries.…”

“…Paper documentation is the practice at the local levels where the primary data are gathered. After peaking with over 80,000 cases in 1944,4 malaria dropped substantially in the following years; from 1960 to 1970, annual incidence rates remained below one case per 1,000 inhabitants with the lowest levels registered in 1965, when only about 1,500 total cases were reported (Figure 1). 33 These results have been due to the use of dichloro-diphenyl-trichloroethane (DDT) in vector control campaigns after 1946, and to the shift of malaria control to a formal eradication strategy after 1957 4.…”

“…Numbers in the timeline point out important events that influenced malaria incidence: 1) first report of Plasmodium falciparum in Loreto (1990); 2) first reports of chloroquine resistance (CQR) in P. falciparum (after 1994); 3) very strong El Niño Southern Oscillation (ENSO) phenomenon (1996–1998); 4) implementation of new antimalarial treatment policy for P. falciparum and Plasmodium vivax malaria (2001–2004); and 5) Global Fund-PAMAFRO project (2005–2010).). Therefore, malaria remains an important public health problem in the country 4. In Peru, the vast majority of malaria is concentrated in Loreto Department (capital, Iquitos), in the northwest Amazon region, which accounts for 95% of reported malaria cases 3.…”

Unstable Malaria Transmission in the Southern Peruvian Amazon and Its Association with Gold Mining, Madre de Dios, 2001–2012

“…9,10 Peru has the third highest number of malaria cases in South America, 6 with significant health 11 and economic 12 impacts. Despite decades of control efforts, 13 malaria remains endemic in the Peruvian Amazon, and has resurged in recent years, 11 posing a significant threat to public health.…”

Enfoque sindrómico para el diagnóstico y manejo de enfermedades infecciosas febriles agudas en situaciones de emergencia

“…Existe un perfil etiológico que es prevalente en cada nicho ecológico-social, debiendo considerarse las etiologias parasitarias (malaria), bacterianas (leptospirosis, bartonelosis, peste), virales (dengue, chikungunya, zika, mayaro, oropouche, encefalitis equina venezolana, hantavirus, fiebre amarilla, etc), riketsiosis (tifus murino, tifus exantemático), entre los más frecuentes en nuestro país (Figura 1) (1,2,3) . Existen áreas endémicas de malaria en el Perú, particularmente en la Amazonía y en la costa norte, aunque actualmente está circunscrita a la Amazonía (4) . El dengue está disperso en el país, econtrándose, prácticamente, el todas las ciudades amazónicas y en la costa desde Tumbes hasta Ica, favorecido en la Amazonía por la lluvias y en la costa, principalmente, por la falta de acceso al agua, lo que obliga a los pobladores a almacenarla de manera inadecuada y se transforma en un factor de riesgo para tener criaderos de Aedes aegyti (5,6) , últimamente, debido al fenómeno El Niño Costero y el cambio climático en general, se hace más dificil el control de este vector.…”