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Hassanein RAM, Alkurbi MO, Alsobhi SH. Prevalence of Plasmodium species in Badr Governorate, Madinah Province, Saudi Arabia using microscopy and rapid diagnostic test. Medicine (Baltimore) 2023; 102:e35516. [PMID: 37861484 PMCID: PMC10589602 DOI: 10.1097/md.0000000000035516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023] Open
Abstract
Malaria infection still represents a notable public health risk in Saudi Arabia. This cross-sectional study aimed to determine the prevalence of Plasmodium species among clinically suspected cases who presented at Badr General Hospital and healthcare facilities in selected regions of Badr Governorate, Madinah Province, Saudi Arabia between January 2021 and January 2022. A total of 493 suspected patients were recruited from Badr Governorate, investigated for malaria infection using CBFME and rapid diagnostic test- CareStart Malaria Pf/PAN (HRP2/pLDH) Ag Combo rapid diagnostic tests. The results showed that malaria infection was 34 (6.89%) cases among 493 suspected patients using microscopic examination as reference test. Moreover, subjects aged 31 to 40 years and those aged 51 to 60 years had the highest (50%) and lowest (8.82%) percentages of malaria cases. Plasmodium vivax (19/34, 55.88%) was higher than P falciparum (15/34, 44.1%) as the causative agents of malaria cases. The majority of malaria cases (29/34, 80.9%) among non-Saudi mainly from Sudan (15/34, 44.1%), Pakistan (5/34, 14.7%), Bangladesh (5/34, 14.7%) and India (4/34, 11.76%) whereas malaria cases among Saudis (5/34, 14.7%). In addition, the majority of malaria cases (32/34, 94.11%) among male subjects while (2/34, 5.88%) among females. The current study revealed that malaria transmission is still active in Badr Governorate, Madinah Province, Saudi Arabia and represents a public health concern. Further screening implements and continuous epidemiological monitor of the status of malaria infection in Kingdom of Saudi Arabia are thus warranted to improve its controlling activities and eradicate malaria endemicity in the country.
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Affiliation(s)
- Raafat Abdel Moneim Hassanein
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
- Department of Zoonoses, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt
| | - Mohammed Othman Alkurbi
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Saad Hussain Alsobhi
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
- Badr General Hospital, Ministry of Health, Badr Governorate, Madinah Province, Saudi Arabia
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Current Epidemiological Characteristics of Imported Malaria, Vector Control Status and Malaria Elimination Prospects in the Gulf Cooperation Council (GCC) Countries. Microorganisms 2021; 9:microorganisms9071431. [PMID: 34361867 PMCID: PMC8307262 DOI: 10.3390/microorganisms9071431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 11/23/2022] Open
Abstract
Malaria is the most common vector-borne parasitic infection causing significant human morbidity and mortality in nearly 90 tropical/sub-tropical countries worldwide. Significant differences exist in the incidence of malaria cases, dominant Plasmodium species, drug-resistant strains and mortality rates in different countries. Six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Qatar, Oman, Saudi Arabia and United Arab Emirates, UAE) in the Middle East region with similar climates, population demographics and economic prosperity are aiming to achieve malaria elimination. In this narrative review, all studies indexed in PubMed describing epidemiological characteristics of indigenous and imported malaria cases, vector control status and how malaria infections can be controlled to achieve malaria elimination in GCC countries were reviewed and discussed. These studies have shown that indigenous malaria cases are absent in Bahrain, Kuwait, Qatar and UAE and have progressively declined in Oman and Saudi Arabia. However, imported malaria cases continue to occur as GCC countries have large expatriate populations originating from malaria-endemic countries. Various malaria control and prevention strategies adopted by GCC countries including more stringent measures to reduce the likelihood of importing malaria cases by prior screening of newly arriving expatriates and vector elimination programs are likely to lead to malaria elimination in this region.
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Current Status and the Epidemiology of Malaria in the Middle East Region and Beyond. Microorganisms 2021; 9:microorganisms9020338. [PMID: 33572053 PMCID: PMC7915327 DOI: 10.3390/microorganisms9020338] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 12/22/2022] Open
Abstract
Vector-borne parasitic infectious diseases are important causes of morbidity and mortality globally. Malaria is one of the most common vector-borne parasitic infection and is caused by five Plasmodium species, namely P. falciparum, P. vivax, P. ovale, P. malariae, and P. knowlesi. Epidemiologically, differences in the patterns of malaria cases, causative agent, disease severity, antimicrobial resistance, and mortality exist across diverse geographical regions. The world witnessed 229 million malaria cases which resulted in 409,000 deaths in 2019 alone. Although malaria cases are reported from 87 countries globally, Africa bears the brunt of these infections and deaths as nearly 94% of total malaria cases and deaths occur in this continent, particularly in sub-Saharan Africa. Most of the Middle East Region countries are malaria-free as no indigenous cases of infection have been described in recent years. However, imported cases of malaria continue to occur as some of these countries. Indeed, the six Gulf Cooperation Council (GCC) countries have large expatriate population originating from malaria endemic countries. In this review, the current status and epidemiology of malaria in the Middle East Region countries and other malaria-endemic countries that are home to a large migrant workforce being employed in Middle East Region countries are discussed.
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Iqbal J, Al-Awadhi M, Ahmad S. Decreasing trend of imported malaria cases but increasing influx of mixed P. falciparum and P. vivax infections in malaria-free Kuwait. PLoS One 2020; 15:e0243617. [PMID: 33306727 PMCID: PMC7732060 DOI: 10.1371/journal.pone.0243617] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/20/2020] [Indexed: 01/22/2023] Open
Abstract
Malaria still continues to be the most important parasitic disease worldwide, affecting 228 million people and causing 405,000 deaths each year. In this retrospective study during 2013 to 2018, we documented the incidence of imported malaria infection and evaluated the impact of malaria preventive measures in Kuwait, a non-endemic country. The epidemiologic and demographic data of all malaria cases was collected from the Infectious Diseases Hospital, Kuwait where all suspected cases of malaria are referred for confirmation and therapeutic intervention. The diagnosis of malaria infection was done by microscopy of Giemsa stained blood films. Selected samples were retested with BinaxNOW® Malaria rapid test and molecular assay to reconfirm the Plasmodium spp. or mixed infection. Overall, 1913 (25.9%) malaria cases were detected, 81.5% of which were among male subjects. Male subjects had higher incidence of P. vivax malaria (113; 91.1%) and mixed infection with P. falciparum and P. vivax (1245; 90.0%) compared to females who had higher rate of P. falciparum infection (52.4%). An overwhelming majority of malaria cases (1895; 99.1%) were detected among expatriates from malaria-endemic countries; India (1012; 52.9%), Pakistan (390; 20.4%), Afghanistan (94; 4.9%) and African countries (313; 16.3%). Only 18 cases involved Kuwaiti nationals, all with a history of travel to African countries. The majority of malaria cases were detected during the summer and fall months (May-October). Our data showed that the incidence rate of imported malaria cases was stable during 2013 to 2018, however, the incidence of total malaria cases showed a declining trend over the years. This study confirms that the preventive program has been successful in reducing the incidence of imported malaria infections in Kuwait. The most striking finding of this study was high incidence of mixed infection with P. falciparum and P. vivax, with almost all (97%) cases among workers from India.
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Affiliation(s)
- Jamshaid Iqbal
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
- * E-mail:
| | - Mohammad Al-Awadhi
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
| | - Suhail Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
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Alkhayat FA, Ahmad AH, Rahim J, Dieng H, Ismail BA, Imran M, Sheikh UAA, Shahzad MS, Abid AD, Munawar K. Charaterization of mosquito larval habitats in Qatar. Saudi J Biol Sci 2020; 27:2358-2365. [PMID: 32884417 PMCID: PMC7451668 DOI: 10.1016/j.sjbs.2020.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/24/2020] [Accepted: 07/05/2020] [Indexed: 01/21/2023] Open
Abstract
Mosquito borne diseases have remained a grave threat to human health and are posing a significant burden on health authorities around the globe. The understanding and insight of mosquito breeding habitats features is crucial for their effective management. Comprehensive larval surveys were carried out at 14 sites in Qatar. A total of 443 aquatic habitats were examined, among these 130 were found positive with Culex pipiens, Cx. quinquefasciatus, Cx. mattinglyi, Ochlerotatus dorsalis, Oc. caspius and Anopheles stephensi. The majority of positive breeding habitats were recorded in urban areas (67.6%), followed by livestock (13.8%), and least were in agriculture (10.7%). An. stephensi larvae were positively correlated with Cx. pipien, Cx. quinquefasciatus, and negatively with water salinity. Large and shaded habitats were the most preferred by An. stephensi. In addition, Cx. pipiens was positively associated with the turbidity and pH, and was negatively associated with vegetation and habitat size. A negative association of Cx. quinquefasciatus with dissolved oxygen, water temperature, and salinity, while positive with habitat surface area was observed. Oc. dorsalis was negatively correlated with pH, water temperature, depth, and habitat surface area, whereas salinity water was more preferable site for females to lay their eggs. These results demonstrate that environmental factors play a significant role in preference of both anopheline and culicine for oviposition, while their effective management must be developed as the most viable tool to minimize mosquito borne diseases.
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Affiliation(s)
- Fatima Abdulla Alkhayat
- School of Biological Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia.,Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Abu H Ahmad
- School of Biological Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia
| | - Junaid Rahim
- Department of Entomology, Faculty of Agriculture, University of Poonch Rawalakot, Poonch, Azad Jammu and Kashmir, Pakistan
| | - Hamady Dieng
- Mosquito Research and Control Unit, 99, Red Gate Road, George Town, Grand Cayman KY1-1106, Cayman Islands
| | | | - Muhammad Imran
- Department of Entomology, Faculty of Agriculture, University of Poonch Rawalakot, Poonch, Azad Jammu and Kashmir, Pakistan
| | - Umer Ayyaz Aslam Sheikh
- Department of Entomology, Faculty of Agriculture, University of Poonch Rawalakot, Poonch, Azad Jammu and Kashmir, Pakistan
| | - Muhmmad Sohail Shahzad
- Department of Plant Protection (Karachi), Ministry of National Food Security and Research, Pakistan
| | - Allah Ditta Abid
- Department of Plant Protection (Karachi), Ministry of National Food Security and Research, Pakistan
| | - Kashif Munawar
- Plant Protection Department, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
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Epidemiology of Malaria in the State of Qatar, 2008-2015. Mediterr J Hematol Infect Dis 2018; 10:e2018050. [PMID: 30210743 PMCID: PMC6131099 DOI: 10.4084/mjhid.2018.050] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/03/2018] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives Imported malaria poses a serious public health problem in Qatar because its population is “naïve” to such infection; where local transmission might lead to serious, life-threatening infection and might even trigger epidemics. Methods This study is a retrospective review of the imported malaria cases in Qatar reported by the malaria surveillance program at the Ministry of Public Health (MoPH), during the period between January 2008 and December 2015. All cases were imported and underwent parasitological confirmation through microscopy. Results A total of 4092 malaria cases were reported during 2008–2015 in Qatar. The demographic features of the imported cases show that the majority of cases were males (93%), non-Qatari (99.6%), and aged 15 to 44 years (82.1%). Moreover, P. vivax was found to be the main etiologic agent accounting for more than three-quarters (78.7%) of the imported cases. In addition, almost a third (33.1%) of the cases were reported during the months of July, August, and September. Conclusions Imported malaria in Qatar has witnessed an increase during the past seven years, despite a long period of constant reduction; where the people most affected were adult male migrants from endemic countries. Many challenges need to be overcome to prevent the reintroduction of malaria into the country.
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Genetic diversity and transmissibility of imported Plasmodium vivax in Qatar and three countries of origin. Sci Rep 2018; 8:8870. [PMID: 29891983 PMCID: PMC5995916 DOI: 10.1038/s41598-018-27229-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/29/2018] [Indexed: 12/02/2022] Open
Abstract
Malaria control program in the Arabian Peninsula, backed by adequate logistical support, has interrupted transmission with exception of limited sites in Saudi Arabia and sporadic outbreaks in Oman. However, sustained influx of imported malaria represents a direct threat to the above success. Here we examined the extent of genetic diversity among imported P. vivax in Qatar, and its ability to produce gametocytes, compared to parasites in main sites of imported cases, the Indian subcontinent (india) and East Africa (Sudan and Ethiopia). High diversity was seen among imported P. vivax in Qatar, comparable to parasites in the Indian subcontinent and East Africa. Limited genetic differentiation was seen among imported P. vivax, which overlapped with parasites in India, but differentiated from that in Sudan and Ethiopia. Parasite density among imported cases, ranged widely between 26.25–7985934.1 Pv18S rRNA copies/µl blood, with a high prevalence of infections carried gametocytes detectable by qRT-PCR. Parasitaemia was a stronger predictor for P. vivax gametocytes density (r = 0.211, P = 0.04). The extensive diversity of imported P. vivax and its ability to produce gametocytes represent a major threat for re-introduction of malaria in Qatar. The genetic relatedness between P. vivax reported in Qatar and those in India suggest that elimination strategy should target flow and dispersal of imported malaria into the region.
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Kardousha MM. First report of some adult mosquitoes captured by CDC gravid traps from North-Eastern Qatar. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2016. [DOI: 10.1016/s2222-1808(15)60993-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chen H, Yao L, Zhang L, Zhang X, Lu Q, Yu K, Ruan W. Malaria in Zhejiang Province, China, from 2005 to 2014. Am J Trop Med Hyg 2015; 93:305-309. [PMID: 26078321 PMCID: PMC4530752 DOI: 10.4269/ajtmh.15-0080] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/13/2015] [Indexed: 11/27/2022] Open
Abstract
To summarize the changing epidemiological characteristics of malaria in Zhejiang Province, China, we collected data on malaria from the Chinese Notifiable Disease Reporting System (NDRS) and analyzed them. A total of 2,738 malaria cases were identified in Zhejiang Province from 2005 to 2014, of which 2,018 were male and 720 were female. Notably, only 7% of malaria cases were indigenous and the other cases were all imported. The number of malaria cases increased from 2005 to 2007, peaked in 2007, and then decreased from 2007 to 2011. There were no indigenous cases from 2012 to 2014. Of all cases, 68% of cases contracted Plasmodium vivax, 27% of cases contracted P. falciparum, and two cases contracted P. malariae. About 88% of malaria cases during 2005–2011 occurred yearly between May and October, but the number of malaria cases in different months during 2012–2014 was similar. The median age was 33 years, and 1,892 cases occurred in persons aged 20–50 years. The proportion of businessmen increased and the proportion of migrant laborers decreased in recent years. The median time from illness onset to confirmation of malaria cases was 5 days and it decreased from 2005 to 2014. Some epidemiological characteristics of malaria have changed, and businessmen are the emphases to surveillance in every month.
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Affiliation(s)
| | | | | | | | | | | | - Wei Ruan
- *Address correspondence to Wei Ruan, Zhejiang Provincial Center for Disease Control and Prevention, Binsheng Road 3399, Hangzhou 310051, China. E-mail:
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Al-Hamidhi S, Mahdy MAK, Idris MA, Bin Dajem SM, Al-Sheikh AAH, Al-Qahtani A, Al-Hashami Z, Al-Farsi H, Al-Mekhlafi AM, Saif-Ali R, Beja-Pereira A, Babiker HA. The prospect of malaria elimination in the Arabian Peninsula: a population genetic approach. INFECTION GENETICS AND EVOLUTION 2014; 27:25-31. [PMID: 24981966 DOI: 10.1016/j.meegid.2014.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 03/21/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND In the Arabian Peninsula malaria control is progressing steadily, backed by adequate logistic and political support. As a result, transmission has been interrupted throughout the region, with exception of limited sites in Yemen and Saudi Arabia. Here we examined Plasmodium falciparum parasites in these sites to assess if the above success has limited diversity and gene flow. METHODS We examined 108 P. falciparum isolates in three sites in Yemen (Taiz, Dhamar and Hodeidah) and 91 isolates from Saudi Arabia (Jazan). Nine microsatellites were analyzed for allelic diversity, multi-locus haplotype and inter-population differentiation. RESULTS Diversity at each locus (unbiased heterozygosity [H]) was relatively lower in Yemen; (Hodeidah, H=0.615, Taiz, H=0.66, Dhamar, H=0.481), compared to Saudi Arabia (Jazan, H=0.76). Microsatellites were distributed widely and private alleles, detected in a single population, were rare. Pairwise comparisons revealed that parasites population in Dhamar was relatively distanced (FST=0.19). However, Taiz (Yemen) (FST=0.065) and Hodeidah (FST=0.107) populations were closer to that in Jazan (Saudi Arabia). Nonetheless, parasites in the four sites can be considered as one population. CONCLUSION Although malaria risk in Saudi Arabia has been cut considerably, the extent of diversity and parasite genetic structure are indicative of a large population size. Elimination strategy should target demographic factors that favor parasite dispersal and flow of imported malaria.
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Affiliation(s)
- Salama Al-Hamidhi
- Department of Biochemistry, Faculty of Medicine and Health Sciences, Sultan Qaboos University, Oman
| | - Mohammed A K Mahdy
- Research Department, University of Science and Technology, Sana'a, Yemen; Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Mohamed Ahmed Idris
- Department of Microbiology and Immunology, Faculty of Medicine and Health Sciences, Sultan Qaboos University, Oman
| | - Saad M Bin Dajem
- Biology Department, College of Science, King Khalid University, Abha, Saudi Arabia
| | | | - Ahmed Al-Qahtani
- Medical Research, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Zainab Al-Hashami
- Department of Biochemistry, Faculty of Medicine and Health Sciences, Sultan Qaboos University, Oman
| | - Hissa Al-Farsi
- Department of Biochemistry, Faculty of Medicine and Health Sciences, Sultan Qaboos University, Oman
| | - Abdulsalam M Al-Mekhlafi
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Riyadh Saif-Ali
- Biochemistry Department, Faculty of Medicine, Sana'a University, Yemen
| | - Albano Beja-Pereira
- Research Centre in Biodiversity and Genetic Resources (CIBIO), University of Porto, Rua Padre Armando Quintas 7, Vairão 4485-661, Portugal
| | - Hamza A Babiker
- Department of Biochemistry, Faculty of Medicine and Health Sciences, Sultan Qaboos University, Oman.
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Nilles EJ, Alosert M, Mohtasham MA, Saif M, Sulaiman L, Seliem RM, Kotlyar S, Dziura JD, Al-Najjar FJK. Epidemiological and clinical characteristics of imported malaria in the United Arab Emirates. J Travel Med 2014; 21:201-6. [PMID: 24628958 DOI: 10.1111/jtm.12110] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 10/02/2013] [Accepted: 10/03/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The United Arab Emirates (UAE) was certified by the World Health Organization to be free of endemic malaria transmission in 2007. There continued to be, however, a substantial number of imported malaria cases. METHODS A retrospective laboratory and chart review was performed to describe the epidemiological, clinical, and laboratory characteristics of imported malaria in Dubai, UAE. Laboratory records were reviewed at the largest public hospital in Dubai to identify cases of peripheral blood smear-positive malaria from January 1, 2008 to December 31, 2010. Predefined demographic, clinical, and laboratory information was extracted from the electronic medical record system. RESULTS A total of 629 cases of malaria were identified including 493, 122, and 14 cases of Plasmodium vivax, Plasmodium falciparum, and mixed P. vivax/P. falciparum infections, respectively. Of these, 567 (90.1%) cases were either from India or Pakistan and 7% from sub-Saharan Africa. There were no cases among the local Emirati population. There were 162 hospitalizations, including 8 requiring intensive care support and 1 death. More than 10% of P. vivax infections required hospitalization. The interval between arrival in the UAE and diagnosis was 3 months or longer for 25% of P. vivax cases. CONCLUSIONS Imported malaria remains an important cause of morbidity in the UAE. Clinicians need to be aware that P. vivax is not benign and can cause severe disease and that malaria cases may present to health facilities several months after arrival from malaria-endemic regions.
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Affiliation(s)
- Eric J Nilles
- Department of Emergency Medicine, Rashid Hospital and Trauma Centre, Dubai Health Authority, Dubai, UAE
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Al-Hamidhi S, Mahdy MAK, Al-Hashami Z, Al-Farsi H, Al-mekhlafi AM, Idris MA, Beja-Pereira A, Babiker HA. Genetic diversity of Plasmodium falciparum and distribution of drug resistance haplotypes in Yemen. Malar J 2013; 12:244. [PMID: 23855834 PMCID: PMC3729657 DOI: 10.1186/1475-2875-12-244] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 07/11/2013] [Indexed: 11/25/2022] Open
Abstract
Background Despite evident success of malaria control in many sites in the Arabian Peninsula, malaria remains endemic in a few spots, in Yemen and south-west of Saudi Arabia. In addition to local transmission, imported malaria sustains an extra source of parasites that can challenge the strengths of local control strategies. This study examined the genetic diversity of Plasmodium falciparum in Yemen and mutations of drug resistant genes, to elucidate parasite structure and distribution of drug resistance genotypes in the region. Methods Five polymorphic loci (MSP-2, Pfg377 and three microsatellites on chromosome 8) not involved in anti-malarial drug resistance, and four drug resistant genes (pfcrt, pfmdr1, dhfr and dhps) were genotyped in 108 P. falciparum isolates collected in three sites in Yemen: Dhamar, Hodeidah and Taiz. Results High diversity was seen in non-drug genes, pfg377 (He = 0.66), msp-2 (He = 0.80) and three microsatellites on chr 8, 7.7 kb (He = 0.88), 4.3 kb (He = 0.77) and 0.8 kb (He = 0.71). There was a high level of mixed-genotype infections (57%), with an average 1.8 genotypes per patient. No linkage disequilibrium was seen between drug resistant genes and the non-drug markers (p < 0.05). Genetic differentiation between populations was low (most pair-wise FST values <0.03), indicating extensive gene flow between the parasites in the three sites. There was a high prevalence of mutations in pfmdr1, pfcrt and dhfr; with four mutant pfmdr1 genotypes (NFCDD[57%], NFSND[21%], YFCDD[13%] and YFSND[8% ]), two mutant pfcrt genotypes (CVIET[89%] and SVMNT[4%]) and one mutant dhfr genotype (ICNI[53.7%]). However, no dhps mutations were detected. Conclusion The high diversity of P. falciparum in Yemen is indicative of a large parasite reservoir, which represents a challenge to control efforts. The presence of two distinct pfcrt genotype, CVIET and SVMNT, suggests that chloroquine resistance can possibly be related to a migratory path from Africa and Asia. The absence of the triple mutant dhfr genotype (IRN) and dhps mutations supports the use of artesunate + sulphadoxine-pyrimethamine as first-line therapy. However, the prevalent pfmdr1 genotype NFSND [21%] has previously been associated with tolerance/resistance response to artemisinin combination therapy (ACT). Regular surveys are, therefore, important to monitor spread of pfmdr1 and dhfr mutations and response to ACT.
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Shibl A, Senok A, Memish Z. Infectious diseases in the Arabian Peninsula and Egypt. Clin Microbiol Infect 2013; 18:1068-80. [PMID: 23066725 DOI: 10.1111/1469-0691.12010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Infectious diseases are important causes of morbidity and mortality globally. Epidemiologically, differences in the patterns of infectious diseases and antimicrobial resistance exist across diverse geographical regions. In this review on infectious diseases in the Arabian Peninsula and Egypt, the epidemiology of tuberculosis, malaria and human immunodeficiency virus (HIV) infections will be addressed. The challenges of the hepatitis C epidemic in Egypt and the epidemiology of this infection across the region will be reviewed. In recent years, we have seen dengue endemicity become established, with major outbreaks in parts of the region. Emerging data also indicate that, across the region, there is an increasing burden of antibiotic resistance, with endemicity in healthcare settings and dissemination into the community. New challenges include the emergence of the Alkhurma haemorrhagic fever virus in Saudi Arabia. The annual Hajj pilgrimage in Saudi Arabia serves as a model for the control of infectious disease in mass gatherings. As most of these countries constantly experience a uniquely dynamic population influx in the form of expatriate workers, tourists, or pilgrims, concerted regional and international collaboration to address these public health concerns in a region that lies at the crossroads for the global spread of infectious pathogens is imperative.
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Affiliation(s)
- A Shibl
- Department of Pathology and Pharmacology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
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Snow RW, Amratia P, Zamani G, Mundia CW, Noor AM, Memish ZA, Al Zahrani MH, Al Jasari A, Fikri M, Atta H. The malaria transition on the Arabian Peninsula: progress toward a malaria-free region between 1960-2010. ADVANCES IN PARASITOLOGY 2013; 82:205-51. [PMID: 23548086 PMCID: PMC3951717 DOI: 10.1016/b978-0-12-407706-5.00003-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The transmission of malaria across the Arabian Peninsula is governed by the diversity of dominant vectors and extreme aridity. It is likely that where malaria transmission was historically possible it was intense and led to a high disease burden. Here, we review the speed of elimination, approaches taken, define the shrinking map of risk since 1960 and discuss the threats posed to a malaria-free Arabian Peninsula using the archive material, case data and published works. From as early as the 1940s, attempts were made to eliminate malaria on the peninsula but were met with varying degrees of success through to the 1970s; however, these did result in a shrinking of the margins of malaria transmission across the peninsula. Epidemics in the 1990s galvanised national malaria control programmes to reinvigorate control efforts. Before the launch of the recent global ambition for malaria eradication, countries on the Arabian Peninsula launched a collaborative malaria-free initiative in 2005. This initiative led a further shrinking of the malaria risk map and today locally acquired clinical cases of malaria are reported only in Saudi Arabia and Yemen, with the latter contributing to over 98% of the clinical burden.
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Affiliation(s)
- Robert W. Snow
- Malaria Public Health Department, Kenya Medical Research Institute–Wellcome Trust–University of Oxford Programme, GPO, Nairobi, Kenya
- Center for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Punam Amratia
- Malaria Public Health Department, Kenya Medical Research Institute–Wellcome Trust–University of Oxford Programme, GPO, Nairobi, Kenya
| | | | - Clara W. Mundia
- Malaria Public Health Department, Kenya Medical Research Institute–Wellcome Trust–University of Oxford Programme, GPO, Nairobi, Kenya
| | - Abdisalan M. Noor
- Malaria Public Health Department, Kenya Medical Research Institute–Wellcome Trust–University of Oxford Programme, GPO, Nairobi, Kenya
- Center for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | | | - Adel Al Jasari
- Malaria Control Programme, Ministry of Public Health and Population, Yemen
| | | | - Hoda Atta
- Malaria Control & Elimination, Division of Communicable Diseases Control, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
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Abstract
OBJECTIVE This study estimated the annual incidence of imported malaria in Qatar from 1997 to 2006 and described the epidemiological features of malaria from 2004 to 2006. METHODS A retrospective review was conducted of the imported malaria cases in Qatar reported by the malaria surveillance program during the period 1997 to 2006 to estimate annual incidence. Data on 438 malaria cases reported during 2004 to 2006 were analyzed to describe the epidemiological features of imported malaria in Qatar. RESULTS The incidence of malaria in 1997 was 58.6/100,000, and since then, it has shown a consistent decline to reach the lowest rate of 9.5/100,000 in 2004. After that the incidence of malaria has increased by more than two times in 2005 and 2006. All 438 malaria cases were contracted as a result of travel to endemic countries, namely India, Pakistan, and Sudan. The majority of cases were male, non-Qatari, and aged 15 years and older. Plasmodium vivax was the main etiologic agent in 40% of cases and most occurred between August and October. CONCLUSIONS Imported malaria reported in Qatar has shown an increase in the past 2 years after a long period of constant reduction, and the people most affected were adult male migrants from endemic countries. This group should be targeted by malaria prevention programs.
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