Malaria in Brazil, Colombia, Peru and Venezuela: current challenges in malaria control and elimination

Abstract

In spite of significant progress towards malaria control and elimination achieved in South America in the 2000s, this mosquito-transmitted tropical disease remains an important public health concern in the region. Most malaria cases in South America come from Amazon rain forest areas in northern countries, where more than half of malaria is caused by Plasmodium vivax, while Plasmodium falciparum malaria incidence has decreased in recent years. This review discusses current malaria data, policies and challenges in four South American Amazon countries: Brazil, Colombia, Peru and the Bolivarian Republic of Venezuela. Challenges to continuing efforts to further decrease malaria incidence in this region include: a significant increase in malaria cases in recent years in Venezuela, evidence of submicroscopic and asymptomatic infections, peri-urban malaria, gold mining-related malaria, malaria in pregnancy, glucose-6-phosphate dehydrogenase (G6PD) deficiency and primaquine use, and possible under-detection of Plasmodium malariae. Some of these challenges underscore the need to implement appropriate tools and procedures in specific regions, such as a field-compatible molecular malaria test, a P. malariae-specific test, malaria diagnosis and appropriate treatment as part of regular antenatal care visits, G6PD test before primaquine administration for P. vivax cases (with weekly primaquine regimen for G6PD deficient individuals), single low dose of primaquine for P. falciparum malaria in Colombia, and national and regional efforts to contain malaria spread in Venezuela urgently needed especially in mining areas. Joint efforts and commitment towards malaria control and elimination should be strategized based on examples of successful regional malaria fighting initiatives, such as PAMAFRO and RAVREDA/AMI.

Keywords: Amazon; Control; Elimination; Eradication; Plasmodium; South America.

Fig. 1

South American malaria endemic countries in this review. Brazil, Colombia, Peru and Venezuela are shown. Green indicates Amazon rain forest areas, where a majority of malaria cases are reported in each of the countries except in Colombia where a considerable contribution of malaria cases comes from the Pacific coast. Colombian Pacific and Caribbean coastal forest areas are also shown in green

Fig. 2

Confirmed malaria cases 2011–2015. Number of confirmed malaria cases in Brazil, Colombia, Peru and Venezuela are shown per 1000 population Data from [1]

Fig. 3

Change (%) in malaria cases in 2014 compared to 2000 baseline. 2014 reduction (%) in number of malaria cases relative to the baseline year 2000 in Brazil, Colombia, Brazil, Peru and Venezuela are shown Data from [2, 5]