Investigation of a malaria outbreak in a highly endemic city - Par, Brazil, 2009.

Abstract Text:

Background: On October 2009 the Brazilian National Malaria Control Program (NMCP) was notified of an increase of malaria cases in Anajs, located in the Amazon region. The average Parasite Incidence Rate (PIR: malaria positive smears/population) from 2003 to 2008 was 478/1,000 inhabitants. We performed an investigation to confirm the outbreak, describe the timeliness of case detection and treatment, and recommend control measures.

Methods: Descriptive studies were conducted: a historical series of the occurrence of malaria from 2003 to 2009 using the Malaria Surveillance Database (SIVEP) and household surveys in two regions, an urban area (UA) using cluster sampling and a rural area (RA) using simple random sampling. A confirmed case was defined as an individual who reported at least one episode of malaria in 2009 with a positive smear recorded in the SIVEP.

Results: The overall PIR (731.4/1,000) increased 62%; the proportion of P.falciparum infections was 27%, a 59% increase over 2008. The highest PIR (975/1,000) was among children aged <5 years. The prevalence of at least one episode of malaria in 2009 was 29% (CI 95%23 35%) in the UA and 61% (CI 95% 48 79%) in the RA where the median of days from the onset of symptoms and care seeking was 2 days (0 30). In both areas 100% received therapy at the time of diagnose, however 21/39 in the RA and 25/53 treated people in the UA did not report the treatment scheme followed, as required by NMCP protocols.

Conclusions: The malaria outbreak was confirmed and its characteristics indicate failure in implementing monitoring and prevention activities. We recommend employing methods for outbreaks forecasting, mobilizing the community to improve healthcare-seeking behavior, and evaluation of treatment adherence.

Keywords: malaria, outbreak, timeliness, case-detection, treatment

Word count: 275

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Author (s): 

Authors: Gilmara L. Nascimento1, A. Castro1, A. N_brega1, W. Araujo1, M. N_brega2 1. Brazilian Field Epidemiology Training Program (EPISUS), Center for Strategic Information and Response in Health Surveillance (CIEVS), Department of Epidemiological S

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