Dr Aslesh OP MBBS, MD Assistant professor, community medicine Pariyaram Medical College

 History  Burden  Agent  vector  Epidemiology  Clinical features  control

 Ancient references  China, Assyria, India  500 BC Hippocrates gives first clinical description

 Ancient references  China, Assyria, India  500 BC Hippocrates gives first clinical description  Historical Impacts  413 BC Fall of Greek empire  323 BC Alexander the Great died of malaria  The Roman Empire: Malaria is generally considered to have played a role in the decline of Rome, a city located in marshland, where malaria is transmitted  In world war 2, more people died due to malaria than in war

 Globally 150 to 300 million cases annually  81% in African region  13% South east Asian region  5% eastern Mediterranean

 In India 27% of the population live in malaria high transmission area  58% in low transmission area

 Plasmodium –4 species  P falciparum  P vivax  P ovale  P malaria

 Only human reservoir

 Age  Sex  Genetic- sickle cell anemia, duffy negative blood type  Low socio economic status  Poor housing standards  Migration  Occupation- agriculture

 Season-Rainy season  Temperature – degree  High humidity- above 60%  Altitude- less than 2500 metes

 Length of time between infective mosquito bite and first appearance of fever  P Falciparum malaria- 12 days  P Vivax -14 days  P malaria- 28 days  P ovale -17 days

 Typical fever- 3 stages  Cold stage  Chills and rigor  Last for 1/4 th to 1 hour  Hot stage  Hot and dry  Last for 2-6 hour  Sweating stage  Fever comes down with profuse sweating

 Cerebral malaria  Renal failure  Liver damage  Dehydration  Anemia

 Microscopy-Blood smear examination for parasite  Serological test- fluorescent antibody test  Rapid diagnostic test

 For falciparum  Artisunate combination therapy  For vivax  Chloroquine along with primaquine

Infected People Mosquitoes Uninfected People contact Habitat Climate Food Source of Plasmodium Source of New Hosts Habitat Behavior

Infected People Mosquitoes Uninfected People contact Habitat Climate Food Source of Plasmodium Source of New Hosts Habitat Behavior

 Destroy habitat  Insecticides  Biological control

 Rapid Reproduction  Natural selection

 Drug treatment  Transgenic mosquitoes

 Drug treatment  Transgenic mosquitoes  Why don’t these work?

 Drug treatment  Transgenic mosquitoes  Why don’t these work?  Availability of drugs  Money  Medical staff  Recrudescense  Drug resistance  Reservoir hosts?  Transgenic mosquitoes not a reality  Expensive

 Vaccines  Prophylactic drugs

 Vaccines  Prophylactic drugs  Why don’t these work?

 Vaccines  Prophylactic drugs  Why don’t these work?  Vaccines unsuccessful  Prophylactic drugs expensive  Prophylactic drugs unpleasant

 Insecticides  Mosquito nets  Long clothing  Behavior  Avoid mosquito habitat  Screens on houses

 Insecticides  Mosquito nets  Long clothing Behavior  Avoid mosquito habitat  Screens on houses  Why don’t these work?

 Insecticides  Mosquito nets  Long clothing  Behavior  Avoid mosquito habitat  Screens on houses  Why don’t these work?  Money  Availability of materials  Human behavior difficult to change

 Dengue  Chikenguniya  Filariasis  Japanese encephalitis

Dengue fever Chikunguniya Yellow fever in African countries

Culex mosquito Filarial scrotum Filarial leg 120 millions in 73 countries SEAR countries 31 millions clinical cases, 60 millions mf carriers India 45 prevalence millions, incidence 6 millions per year

 Observe dry day once a week