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Horak P, Auer H, Wiedermann U, Walochnik J. Malaria in Austria : A retrospective analysis of malaria cases diagnosed at a reference center in 2010-2020. Wien Klin Wochenschr 2023; 135:617-624. [PMID: 37069405 PMCID: PMC10108813 DOI: 10.1007/s00508-023-02179-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/25/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Although malaria is not endemic to Austria, each year infections are imported by travellers, migrants and refugees. This study aims to provide an overview of malaria cases diagnosed at an Austrian institute for tropical medicine between 2010 and 2020. METHODS A retrospective, descriptive study was conducted based on the data of malaria cases confirmed at the Institute of Specific Prophylaxis and Tropical Medicine of the Medical University of Vienna. Laboratory diagnostics included microscopy, polymerase chain reaction (PCR) and real-time quantitative PCR. RESULTS Overall, 122 cases were identified. Annual case numbers were consistently higher from 2016 to 2020 than during the first half of the decade. Most malaria cases were diagnosed during summer and early autumn. This seasonal trend was not observed during the year 2020. With 55.1% (65/118) Plasmodium falciparum was the most common species, followed by Plasmodium vivax (19.5%, 23/118). The majority of patients were male (71.1%, 86/121) and the median age was 34.5 years (interquartile range, IQR 22.5-47.0 years). With a median age of 20.0 years (IQR 14.0-32.0 years), patients with P. vivax infections were younger than those infected with other Plasmodium species. Moreover, they were mostly male (82.6%, 19/23). CONCLUSION From 2010 to 2020, the number of malaria cases diagnosed at the center increased. Growing international mobility and changing travel behavior could at least partly be responsible for this trend and there are indications that particularly P. vivax infections were imported by migrants and refugees.
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Affiliation(s)
- Paul Horak
- Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria
| | - Herbert Auer
- Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria
| | - Ursula Wiedermann
- Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria
| | - Julia Walochnik
- Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria.
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Asadgol Z, Badirzadeh A, Mirahmadi H, Safari H, Mohammadi H, Gholami M. Simulation of the potential impact of climate change on malaria incidence using artificial neural networks (ANNs). ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023:10.1007/s11356-023-27374-7. [PMID: 37219776 DOI: 10.1007/s11356-023-27374-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 04/27/2023] [Indexed: 05/24/2023]
Abstract
Climate change can increase the spread of infectious diseases and public health concerns. Malaria is one of the endemic infectious diseases of Iran, whose transmission is strongly influenced by climatic conditions. The effect of climate change on malaria in the southeastern Iran from 2021 to 2050 was simulated by using artificial neural networks (ANNs). Gamma test (GT) and general circulation models (GCMs) were used to determine the best delay time and to generate the future climate model under two distinct scenarios (RCP2.6 and RCP8.5). To simulate the various impacts of climate change on malaria infection, ANNs were applied using daily collected data for 12 years (from 2003 to 2014). The future climate of the study area will be hotter by 2050. The simulation of malaria cases elucidated that there is an intense increasing trend in malaria cases under the RCP8.5 scenario until 2050, with the highest number of infections occurring in the warmer months. Rainfall and maximum temperature were identified as the most influential input variables. Optimum temperatures and increased rainfall provide a suitable environment for the transmission of parasites and cause an intense increase in the number of infection cases with a delay of approximately 90 days. ANNs were introduced as a practical tool for simulating the impact of climate change on the prevalence, geographic distribution, and biological activity of malaria and for estimating the future trend of the disease in order to adopt protective measures in endemic areas.
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Affiliation(s)
- Zahra Asadgol
- Health Deputy, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Badirzadeh
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Mirahmadi
- Clinical Immunology Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Parasitology and Mycology, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hossein Safari
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamed Mohammadi
- Department of Environmental Health Engineering, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mitra Gholami
- Research Center for Environmental Health Technology, Iran University of Medical Sciences, Tehran, Iran.
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
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Siddiqui JA, Aamar H, Siddiqui A, Essar MY, Khalid MA, Mousavi SH. Malaria in Afghanistan: Challenges, efforts and recommendations. Ann Med Surg (Lond) 2022; 81:104424. [PMID: 35991507 PMCID: PMC9381426 DOI: 10.1016/j.amsu.2022.104424] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/25/2022] Open
Abstract
Malaria, a vector borne disease that can quickly become life-threatening, has become endemic to many countries, in particular Afghanistan. Ranking third for world's highest burden of malaria, Afghanistan has found itself in a downward spiral, burdened by outbreaks of not only malaria, but dengue, watery diarrhea and measles as well. The civil conflict and lack of healthcare services present compounded with the COVID-19 pandemic resulted in a five-to tenfold increase of malarial incidence in the past years. Increased refugee shuttling and fluctuating environmental conditions have allowed proliferation of malarial vectors, with restricted access to treatment impeding elimination of malaria as well. Although efforts like larvicides, indoor spraying and initiatives like the Sehatmandi project have been made to control the spread of malaria, further efforts focusing on more sustainable and economical preventative measures are essential. Thus, efforts on both individual and global levels, more research and maintenance of control measures, are necessary to eliminate outbreaks and risks of resurgence.
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Nguyen HTT, Romano F, Wampfler R, Mühlethaler K, Tannich E, Oberli A. Case Report: Diagnostic Challenges in the Detection of a Mixed Plasmodium vivax/ ovale Infection in a Non-Endemic Setting. Am J Trop Med Hyg 2020; 103:1085-1087. [PMID: 32314695 PMCID: PMC7470571 DOI: 10.4269/ajtmh.20-0079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In clinical practice, mixed-species malaria infections are often not detected by light microscopy (LM) or rapid diagnostic test, as a low number of parasites of one species may occur. Here, we report the case of an 8-year-old girl migrating with her family from Afghanistan with a two-species mixed infection with Plasmodium vivax and Plasmodium ovale. This case demonstrates the significance of molecular testing in the detection of mixed-species malaria infections and highlights the importance of a detailed data analysis during the medical validation procedure to prevent underestimation of mixed-species infections. To our knowledge, this is the first case report of a two-species mixed infection comprising both P. vivax and P. ovale confirmed by LM and different real-time polymerase chain reaction (PCR) approaches.
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Affiliation(s)
| | - Fabrizio Romano
- Pediatric Emergency Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rahel Wampfler
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Konrad Mühlethaler
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Egbert Tannich
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Alexander Oberli
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
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Clinical-Pathological Conference Series from the Medical University of Graz : Case No 174: A 25-year-old pregnant woman from Afghanistan with headache and a blast flag in the automated differential blood count. Wien Klin Wochenschr 2020; 132:403-409. [PMID: 32601727 PMCID: PMC7371650 DOI: 10.1007/s00508-020-01681-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Awab GR, Imwong M, Bancone G, Jeeyapant A, Day NPJ, White NJ, Woodrow CJ. Chloroquine-Primaquine versus Chloroquine Alone to Treat Vivax Malaria in Afghanistan: An Open Randomized Superiority Trial. Am J Trop Med Hyg 2017; 97:1782-1787. [PMID: 29141719 PMCID: PMC5805052 DOI: 10.4269/ajtmh.17-0290] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 08/04/2017] [Indexed: 11/18/2022] Open
Abstract
Afghanistan's national guidelines recommend primaquine (PQ) for radical treatment of Plasmodium vivax malaria, but this is rarely implemented because of concerns over potential hemolysis in patients who have G6PD deficiency. Between August 2009 and February 2014, we conducted an open-label, randomized controlled trial of chloroquine (CQ) alone versus chloroquine plus primaquine (0.25 mg base/kg/day for 14 days) (CQ+PQ) in patients aged 6 months and older with microscopy confirmed P. vivax infection. In the CQ+PQ group, G6PD deficiency was excluded by fluorescent spot testing. The primary outcome was P. vivax recurrence assessed by survival analysis over one year follow-up. Of 593 patients enrolled, 570 attended at or after 14 days of follow-up. Plasmodium vivax recurrences occurred in 37 (13.1%) of 282 patients in the CQ+PQ arm versus 86 (29.9%) of 288 in the CQ arm (Cox proportional hazard ratio [HR] 0.37, 95% confidence interval [CI] 0.25-0.54) (intention-to-treat analysis). Protection against recurrence was greater in the first 6 months of follow-up (HR 0.082; 95% CI 0.029-0.23) than later (HR 0.65, 95% CI 0.41-1.03). Five of seven patients requiring hospital admission were considered possible cases of PQ-related hemolysis, and PQ was stopped in a further six; however, in none of these cases did hemoglobin fall by ≥ 2 g/dL or to below 7 g/dL, and genotyping did not detect any cases of Mediterranean variant G6PD deficiency. PQ 0.25 mg/kg/day for 14 days prevents relapse of P. vivax in Afghanistan. Patient visits during the first week may improve adherence. Implementation will require deployment of point-of-care phenotypic tests for G6PD deficiency.
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Affiliation(s)
- Ghulam Rahim Awab
- Medical Faculty, Nangarhar University, Jalalabad, Afghanistan
- Ministry of Public Health, Islamic Republic of Afghanistan, Kabul, Afghanistan
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mallika Imwong
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Germana Bancone
- Shoklo Malaria Research Unit, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Atthanee Jeeyapant
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nicholas P. J. Day
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nicholas J. White
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Charles J. Woodrow
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Howard N, Guinness L, Rowland M, Durrani N, Hansen KS. Cost-effectiveness of adding indoor residual spraying to case management in Afghan refugee settlements in Northwest Pakistan during a prolonged malaria epidemic. PLoS Negl Trop Dis 2017; 11:e0005935. [PMID: 29059179 PMCID: PMC5695615 DOI: 10.1371/journal.pntd.0005935] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 11/02/2017] [Accepted: 09/05/2017] [Indexed: 11/24/2022] Open
Abstract
Introduction Financing of malaria control for displaced populations is limited in scope and duration, making cost-effectiveness analyses relevant but difficult. This study analyses cost-effectiveness of adding prevention through targeted indoor residual spraying (IRS) to case management in Afghan refugee settlements in Pakistan during a prolonged malaria epidemic. Methods/Findings An intervention study design was selected, taking a societal perspective. Provider and household costs of vector control and case management were collected from provider records and community survey. Health outcomes (e.g. cases and DALYs averted) were derived and incremental cost-effectiveness ratios (ICERs) for cases prevented and DALYs averted calculated. Population, treatment cost, women’s time, days of productivity lost, case fatality rate, cases prevented, and DALY assumptions were tested in sensitivity analysis. Malaria incidence peaked at 44/1,000 population in year 2, declining to 14/1,000 in year 5. In total, 370,000 malaria cases, 80% vivax, were diagnosed and treated and an estimated 67,988 vivax cases and 18,578 falciparum and mixed cases prevented. Mean annual programme cost per capita was US$0.56. The additional cost of including IRS over five years per case prevented was US$39; US$50 for vivax (US$43 in years 1–3, US$80 in years 4–5) and US$182 for falciparum (US$139 in years 1–3 and US$680 in years 4–5). Per DALY averted this was US$266 (US$220 in years 1–3 and US$486 in years 4–5) and thus ‘highly cost-effective’ or cost-effective using WHO and comparison thresholds. Conclusions Adding IRS was cost-effective in this moderate endemicity, low mortality setting. It was more cost-effective when transmission was highest, becoming less so as transmission reduced. Because vivax was three times more common than falciparum and the case fatality rate was low, cost-effectiveness estimations for cases prevented appear reliable and more definitive for vivax malaria. We conducted a cost-effectiveness analysis of adding malaria prevention to routine malaria diagnosis and treatment in Afghan refugee settlements in Pakistan during a five-year malaria epidemic. We found that malaria incidence peaked at 44 per 1,000 in year 2 and declined to 14 per 1,000 in year 5, with an average annual programme cost per capita of US$0.56 in 2015 currency. Cost per case prevented averaged US$88 (US$111 for vivax, US$442 for falciparum), per death prevented averaged US$316,734, and per DALY averted averaged US$601. The additional cost of including IRS over five years per case prevented was US$39 (US$50 for vivax and US$182 for falciparum malaria case prevented) and per DALY averted was US$266. While our cost-effectiveness results were relatively high, when compared with internationally recognised cost-effectiveness thresholds both prevention and case management were highly cost-effective, indicating the relevance of an integrated approach for epidemic malaria control and global malaria elimination.
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Affiliation(s)
- Natasha Howard
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Lorna Guinness
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mark Rowland
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- HealthNet-TPO, Peshawar, Pakistan
| | | | - Kristian S. Hansen
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Leslie T, Rowland M, Mikhail A, Cundill B, Willey B, Alokozai A, Mayan I, Hasanzai A, Baktash SH, Mohammed N, Wood M, Rahimi HUR, Laurent B, Buhler C, Whitty CJM. Use of malaria rapid diagnostic tests by community health workers in Afghanistan: cluster randomised trial. BMC Med 2017; 15:124. [PMID: 28683750 PMCID: PMC5501368 DOI: 10.1186/s12916-017-0891-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 06/12/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The World Health Organisation (WHO) recommends parasitological diagnosis of malaria before treatment, but use of malaria rapid diagnostic tests (mRDTs) by community health workers (CHWs) has not been fully tested within health services in south and central Asia. mRDTs could allow CHWs to diagnose malaria accurately, improving treatment of febrile illness. METHODS A cluster randomised trial in community health services was undertaken in Afghanistan. The primary outcome was the proportion of suspected malaria cases correctly treated for polymerase chain reaction (PCR)-confirmed malaria and PCR negative cases receiving no antimalarial drugs measured at the level of the patient. CHWs from 22 clusters (clinics) received standard training on clinical diagnosis and treatment of malaria; 11 clusters randomised to the intervention arm received additional training and were provided with mRDTs. CHWs enrolled cases of suspected malaria, and the mRDT results and treatments were compared to blind-read PCR diagnosis. RESULTS In total, 256 CHWs enrolled 2400 patients with 2154 (89.8%) evaluated. In the intervention arm, 75.3% (828/1099) were treated appropriately vs. 17.5% (185/1055) in the control arm (cluster adjusted risk ratio: 3.72, 95% confidence interval 2.40-5.77; p < 0.001). In the control arm, 85.9% (164/191) with confirmed Plasmodium vivax received chloroquine compared to 45.1% (70/155) in the intervention arm (p < 0.001). Overuse of chloroquine in the control arm resulted in 87.6% (813/928) of those with no malaria (PCR negative) being treated vs. 10.0% (95/947) in the intervention arm, p < 0.001. In the intervention arm, 71.4% (30/42) of patients with P. falciparum did not receive artemisinin-based combination therapy, partly because operational sensitivity of the RDTs was low (53.2%, 38.1-67.9). There was high concordance between recorded RDT result and CHW prescription decisions: 826/950 (87.0%) with a negative test were not prescribed an antimalarial. Co-trimoxazole was prescribed to 62.7% of malaria negative patients in the intervention arm and 15.0% in the control arm. CONCLUSIONS While introducing mRDT reduced overuse of antimalarials, this action came with risks that need to be considered before use at scale: an appreciable proportion of malaria cases will be missed by those using current mRDTs. Higher sensitivity tests could be used to detect all cases. Overtreatment with antimalarial drugs in the control arm was replaced with increased antibiotic prescription in the intervention arm, resulting in a probable overuse of antibiotics. TRIAL REGISTRATION ClinicalTrials.gov, NCT01403350 . Prospectively registered.
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Affiliation(s)
- Toby Leslie
- London School of Hygiene & Tropical Medicine, London, WC1H 7HT, UK. .,Health Protection and Research Organisation, Kabul, Afghanistan.
| | - Mark Rowland
- London School of Hygiene & Tropical Medicine, London, WC1H 7HT, UK
| | - Amy Mikhail
- London School of Hygiene & Tropical Medicine, London, WC1H 7HT, UK.,Health Protection and Research Organisation, Kabul, Afghanistan
| | - Bonnie Cundill
- London School of Hygiene & Tropical Medicine, London, WC1H 7HT, UK
| | - Barbara Willey
- London School of Hygiene & Tropical Medicine, London, WC1H 7HT, UK
| | - Asif Alokozai
- Health Protection and Research Organisation, Kabul, Afghanistan
| | - Ismail Mayan
- Health Protection and Research Organisation, Kabul, Afghanistan
| | | | | | - Nader Mohammed
- Health Protection and Research Organisation, Kabul, Afghanistan
| | - Molly Wood
- Health Protection and Research Organisation, Kabul, Afghanistan
| | | | - Baptiste Laurent
- London School of Hygiene & Tropical Medicine, London, WC1H 7HT, UK
| | - Cyril Buhler
- Health Protection and Research Organisation, Kabul, Afghanistan.,OR Diagnostics, Paris, France
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