Malaria in India: the center for the study of complex malaria in India

Abstract

Malaria is a major public health problem in India and one which contributes significantly to the overall malaria burden in Southeast Asia. The National Vector Borne Disease Control Program of India reported ∼1.6 million cases and ∼1100 malaria deaths in 2009. Some experts argue that this is a serious underestimation and that the actual number of malaria cases per year is likely between 9 and 50 times greater, with an approximate 13-fold underestimation of malaria-related mortality. The difficulty in making these estimations is further exacerbated by (i) highly variable malaria eco-epidemiological profiles, (ii) the transmission and overlap of multiple Plasmodium species and Anopheles vectors, (iii) increasing antimalarial drug resistance and insecticide resistance, and (iv) the impact of climate change on each of these variables. Simply stated, the burden of malaria in India is complex. Here we describe plans for a Center for the Study of Complex Malaria in India (CSCMi), one of ten International Centers of Excellence in Malaria Research (ICEMRs) located in malarious regions of the world recently funded by the National Institute of Allergy and Infectious Diseases, National Institutes of Health. The CSCMi is a close partnership between Indian and United States scientists, and aims to address major gaps in our understanding of the complexity of malaria in India, including changing patterns of epidemiology, vector biology and control, drug resistance, and parasite genomics. We hope that such a multidisciplinary approach that integrates clinical and field studies with laboratory, molecular, and genomic methods will provide a powerful combination for malaria control and prevention in India.

Figure 1

Malaria cases and changing species pattern in India during the years 1995–2010. The total number of reported malaria cases has decreased since 1995, primarily through a reduction in the number of reported P. vivax cases. Currently, there is a 1:1 ratio of P. falciparum to P. vivax cases.

Figure 2

Malaria endemicity in India. State boundaries are color-coded according to total malaria endemicity (see key). Data taken from the National Vector Borne Disease Control Programme (http://www.nvbdcp.gov.in/) for year 2010. NIMR field stations are indicated as red dots. The three NIMR field stations incorporated as part of the CSCMi are: Nadiad (Gujarat), Rourkela (Orissa) and Chennai (Tamil Nadu), each with different eco-epidemiological profiles as shown. EIR: entomological inoculation rate; API: annual parasite incidence.