History and Current Status of Malaria in Korea

Abstract

Vivax malaria which had been highly prevalent in Korea disappeared rapidly from the 1960s to 1984 when domestic occurrence of cases stopped. However, malaria reemerged in 1993 near the demilitarized zone (DMZ) bordering with North Korea. The number of patients thereafter increased exponentially year after year totaling 35,526 cases by the end of 2015. A small number of cases (1 - 53 patients annually) also occurred among the United States military personnel camping in Korea. However, after the 2010s the number of annual malaria cases has been decreasing slowly in Korea. Several reports on malaria situation in North Korea described high malaria prevalence after 1997 which peaked during 1999 - 2002 and has been decreasing thereafter. At the beginning of the reemergence, the majority of cases (60 - 90%) were soldiers aged 20 - 25 years camping around the northern parts of Gyeonggi-do and Gangwon-do (Province), Korea just facing the DMZ. However, as the outbreak continued more civilians were infected. The course of illness was relatively mild, and chemotherapy with chloroquine in combination with primaquine was successful in most of the patients. Mass chemoprophylaxis combined with mosquito control activities greatly contributed to the decline of malaria situation among Korean military soldiers.

Keywords: Current status; Epidemiology; History; Plasmodium vivax; Vivax malaria.

Figure 1. Geographical distribution (1961 - 1965) of Plasmodium vivax positive patients diagnosed via passive case detection (PCD) by the National Malaria Eradication Service. A total of 13,929 out of 45,395 subjects tested positive (30.7%).

Source: Paik et al. [4] (1966) Statistics from Ministry of Health and Social Affairs.

Figure 2. Re-emerging vivax malaria and imported malaria in Korea (1993 - 2015).

Source: Korea Centers for Disease Control and Prevention (KCDC) website.

Figure 3. Local frequency of the malaria resurgence (1995 - 1996, 1999 - 2000 and 2014 - 2015). There were 465 cases in the early stages of the resurgence (1995 - 1996), 7,763 cases during the peak of the epidemic (1999 - 2000), and 1,186 cases in the lull period (2014 - 2015). Northern and western Gyeonggi-do as well as northern Gangwon-do were the main areas of epidemic. Cases that occurred in other regions were primarily from patients with a long incubation period and were either discharged soldiers or travelers from northern Gyeonggi-do and northern Gangwon-do.

Source: Han et al. [17] and KCDC [11].

Figure 4. Malaria chemoprophylaxis conducted by the Korean military. Between 1997 and 2015, a combination therapy of chloroquine and primaquine was primarily administered. Since 2001, a single therapy of primaquine was prescribed for discharged soldiers. The use of primaquine monotherapy significantly expanded since 2014 - 2015.

※ Source: Jung J [37].