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Drivers of autochthonous and imported malaria in Spain and their relationship with meteorological variables
Abstract
Since the early twentieth century, the intensity of malaria transmission has decreased sharply worldwide, although it is still an infectious disease with a yearly estimate of 228 million cases. The aim of this study was to expand our knowledge on the main drivers of malaria in Spain. In the case of autochthonous malaria, these drivers were linked to socioeconomic and hygienic and sanitary conditions, especially in rural areas due to their close proximity to the wetlands that provide an important habitat for anopheline reproduction. In the case of imported malaria, the main drivers were associated with urban areas, a high population density and international communication nodes (e.g. airports). Another relevant aspect is that the major epidemic episodes of the twentieth century were strongly influenced by war and military conflicts and overcrowding of the healthcare system due to the temporal overlap with the pandemic flu of 1918. Therefore, military conflicts and overlap with other epidemics or pandemics are considered to be drivers of malaria that can-in a temporary manner-exponentially intensify transmission of the disease. Climatic factors did not play a relevant role as drivers of malaria in Spain (at least directly). However, they did influence the seasonality of the disease and, during the epidemic outbreak of 1940-1944, the climate conditions favored or coadjuvated its spread. The results of this study provide additional knowledge on the seasonal and interannual variability of malaria that can help to develop and implement health risk control measures.
Supplementary information:
The online version contains supplementary material available at 10.1007/s41207-021-00245-8.
... The authors addressed autochthonous and imported malaria separately, highlighting that the drivers of both types of malaria are different. In fact, later studies showed that the effect of temperature as a driver of the phenology of autochthonous malaria cannot be directly extrapolated to cases of imported malaria [17]. This study concluded that the main epidemic outbreaks of malaria in Spain during the 20th century were greatly influenced by military conflicts, population movements and the worsening of hygienic and sanitary conditions. ...
... This study concluded that the main epidemic outbreaks of malaria in Spain during the 20th century were greatly influenced by military conflicts, population movements and the worsening of hygienic and sanitary conditions. Although the meteorological variables did not play a key role in these epidemic episodes, they did contribute to the latter by creating the suitable conditions for their intensification [17]. Thus, the authors of [4] asserted that modern research on this type of infectious diseases must delve into the drivers that explain the historical distribution of the disease, with the aim of differentiating the relevance of each of them in the prevalence of malaria. ...
... In most developed countries, autochthonous malaria was eradicated during the second half of the 20th century. However, during the 21st century, the number of cases of imported malaria has continued to increase in those countries [17]. The globalization of the economy favors the globalization or, at least, spreading of some infectious diseases. ...
One of the greatest challenges that human society currently faces is the hazard of climate change with respect to human health [...]
... Therefore, a continuation of implementing integrated malaria preventive measures is key to preventing the resurgence and reintroduction of malaria transmission in Makkah. In addition, understating the impact of large epidemic processes such as COVID-19 on healthcare systems and the dynamics of other infectious diseases is essential for future health policy planning and preparedness [26]. Further research is needed to determine the extent of autochthonous and imported malaria as well as the presence/resurgence of malaria vectors in and around Makkah. ...
Malaria is a parasitic infection that may result in an acute, life-threatening illness. It is a major public health problem in the tropical world. The disease is caused by the parasites of the genus Plasmodium and is transmitted by female Anopheles mosquitoes. Saudi Arabia is in the elimination phase of malaria control. Several parts of Saudi Arabia report cases of imported malaria among travelers and visitors. The city of Makkah in Saudi Arabia has a population of about 2.3 million. Moreover, over 6 million religious visitors from different parts of the world visit Makkah annually. During the COVID-19 outbreak, travel restrictions were enforced in Makkah to contain the spread of COVID-19. We compare the total reported cases of malaria in Makkah before, during, and after COVID-19 travel restrictions in this retrospective cross-sectional study. Data on demographics, clinical data, and laboratory parameters were collected from the medical records of the Ministry of Health, Saudi Arabia. The annual malaria incidence rates in Makkah were 29.13/million people (2018), 37.82/million people (2019), 15.65/million people (2020), 12.61/million people (2021), and 48.69/million people (2022). Most of the malaria cases in Makkah were caused by Plasmodium falciparum, followed by P. vivax. Sudan, Nigeria, Yamen, Pakistan, and India are the top five countries contributing to malaria cases in Makkah. Weekly malaria case analyses revealed that COVID-19-related travel restrictions resulted in zero malaria cases in Makkah, indicating the magnitude of the travel-related malaria burden in the city.
... Nevertheless, there may be little doubt concerning the need for protecting MRAs from domestic travelers. Recent travel is a conspicuous risk factor for malaria acquired internationally that may occasionally result in local outbreaks in otherwise malaria-free nations [24][25][26][27]. Recent studies have explored domestic travel and malaria risk among residents of MRAs or nonendemic areas with MECs. ...
The prevention of malaria in travelers with the use of antimalarials often occurs in connection with international travel to areas of significant risk of infection. Although these travelers sometimes cause outbreaks in their malaria-free home countries, the cardinal objective of prescribed chemoprophylaxis is to protect the traveler from patent malaria during travel. Here we consider the chemoprophylaxis of domestic travelers from malaria-free but -receptive areas within malaria-endemic countries. The main objective in this setting is the protection of those areas from reintroduced malaria transmission. In order to better understand policy and practices in this regard, we surveyed malaria prevention and treatment guidelines of 36 malaria-endemic countries and 2 that have recently eliminated malaria (Sri Lanka, China) for recommendations regarding malaria chemoprophylaxis for domestic travel. Among them, just 8 provided specific and positive recommendations, 1 recommended without specific guidance, and 4 advised against the practice. Most nations (25/38; 66%) did not mention chemoprophylaxis for domestic travel, though many of those did offer guidance for international travel. The few positive recommendations for domestic travel were dominated by the suppressive prophylaxis options of daily doxycycline or atovaquone-proguanil or weekly mefloquine. The incomplete protection afforded by these strategies, along with impractical dosing in connection with the typically brief domestic travel, may in part explain the broad lack of policies and practices across malaria-endemic nations regarding chemoprophylaxis.
Malaria is a major parasitic disease in the world including Nigeria which currently bears the brunt of the global malaria mortality burden. This paper responds to the need for all countries in the world including Nigeria to understand the geographical distribution and drivers of malaria mortality with the aim of consolidating the gains of global malaria elimination. The thrust of this paper therefore was to examine the geographical distribution, spatial clustering and determinant(s) of malaria mortality in Nigeria from 2006 to 2010. Retrospective data used in this research were obtained from published sources and were analysed with the aid of statistical and spatial analytical tools. Very noticeable state variations were observed in the pattern of malaria mortality, and strong and persistent clustering of malaria-related deaths was found in northwest Nigeria particularly Kano State due to high levels of malaria transmission. Lastly, there was a significant and differential effect of poverty on its geographical distribution; with the greatest effect felt in the north of Nigeria. In order to reduce death toll associated with the disease, the war against poverty must not only be intensified but should be mainstreamed into the national malaria control programme.
Malaria and COVID-19 may have similar aspects and seem to have a strong potential for mutual influence. They have already caused millions of deaths, and the regions where malaria is endemic are at risk of further suffering from the consequences of COVID-19 due to mutual side effects, such as less access to treatment for patients with malaria due to the fear of access to healthcare centers leading to diagnostic delays and worse outcomes. Moreover, the similar and generic symptoms make it harder to achieve an immediate diagnosis. Healthcare systems and professionals will face a great challenge in the case of a COVID-19 and malaria syndemic. Here, we present an overview of common and different findings for both diseases with possible mutual influences of one on the other, especially in countries with limited resources.
Malaria remains a major global health burden, killing hundreds of thousands annually, especially in sub-Saharan Africa. In 2019, a Phase IV Expanded Programme on Immunization (EPI)-linked malaria vaccine implementation was underway. However, in December 2019, a novel pneumonia condition termed coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with many clinical, epidemiological, and biological parallels to malaria, was reported in Wuhan, China. COVID-19 is spreading rapidly, and, as of the 3rd of June, 2020, more than 382,507 persons had died from COVID-19. Children under 5 years who suffer high malaria-attributable mortalities are largely asymptomatic for COVID-19. Considering that the malaria burden is highest in low-income tropical countries with little capacity to fund malaria control and eradication programs, the fight against malaria in these regions is likely to be hampered. Access to healthcare has generally been limited, while malaria interventions, such as seasonal malaria chemotherapy and distribution of insecticide-treated bed nets, have been suspended due to lockdowns. Likewise, the repurposing of antimalarials for treatment of COVID-19 shared symptoms and the shift in focus from the production of malaria rapid diagnostic tests (RDTs) to COVID-19 RDTs is a cause for concern in malaria-endemic regions. Children are less affected by the COVID-19 pandemic compared to the elderly. However, due to the fears of contracting SARS-CoV-2, the elderly who are worst affected by COVID-19 may not take children for malaria medication, resulting in high malaria-related mortalities among children. COVID-19 has disproportionately affected developed countries, threatening their donation capacity. These are likely to thwart malaria control efforts in low-income regions. Here, we present perspectives on the collateral impact of COVID-19 on malaria, especially in Africa.
Malaria is one of the most cited vector-borne infectious diseases by climate change expert panels. Malaria vectors often need water sheets or wetlands to complete the disease life cycle. The current context of population mobility and global change requires detailed monitoring and surveillance of malaria in all countries. This study analysed the spatiotemporal distribution of death and illness cases caused by autochthonous and imported malaria in Spain during the 20th and 21st centuries using multidisciplinary sources, Geographic Information System (GIS) and geovisualisation. The results obtained reveal that, in the 20th and 21st centuries, malaria has not had a homogeneous spatial distribution. Between 1916 and 1930, 77% of deaths from autochthonous malaria were concentrated in only 20% of Spanish provinces; in 1932, 88% of patients treated in anti-malarial dispensaries were concentrated in these same provinces. These last data reveal the huge potential that anti-malarial dispensaries could have as a tool to reconstruct historical epidemiology. Spanish autochthonous malaria has presented epidemic upsurge episodes, especially those of 1917-1922 and 1939-1944, influenced by armed conflict, population movement and damaged health and hygiene conditions. Although meteorological variables have not played a key role in these epidemic episodes, they contributed by providing suitable conditions for their intensification. After the eradication of autochthonous malaria in 1961, imported malaria cases began to be detected in 1973, reaching more than 700 cases per year at the end of the second decade of the 21st century. Therefore, consistent and detailed historical studies are necessary to better understand the drivers that have led to the decline and elimination of malaria in Europe and other temperate countries.
An essential purpose of choropleth maps is the visual perception of spatial patterns (such as the detection of hot spots or extreme values). This requires an effective and as intuitive as possible comparison of color values between different regions. Accordingly, a number of design requirements must be considered. Due to the lack of empirical evidence regarding some elementary design aspects, an online study with 260 participants was conducted. Three closely related effects were examined: the “dark-is-more bias” (i.e., the intuitive ranking of color lightness), the “area-size bias” (i.e., the neglect of small areas, since these are less dominant in perception than larger ones) and the “data-classification effect” (i.e., attention to data classification when interpreting spatial patterns). For each hypothesis, one or more maps in connection with single or multiple choice questions were presented. Users should detect extreme values, central tendencies or homogeneities of values as well as comment on their task solving certainty. In general, the hypotheses regarding the mentioned effects could be confirmed by statistical analysis. The results are used to derive conclusions and topics for future research. In particular, further comparative empirical studies are recommended to determine the best possible map types for given applications, also considering alternatives to choropleth maps.
Background:
Malaria was eliminated in Spain in 1964. Since then, more than 10,000 cases of malaria have been reported, mostly in travellers and migrants, making it the most frequently imported disease into this country. In order to improve knowledge on imported malaria cases characteristics, the two main malaria data sources were assessed: the national surveillance system and the hospital discharge database (CMBD).
Methods:
Observational study using prospectively gathered surveillance data and CMBD records between 2002 and 2015. The average number of hospitalizations per year was calculated to assess temporal patterns. Socio-demographic, clinical and travel background information were analysed. Bivariate and multivariable statistical methods were employed to evaluate hospitalization risk, fatal outcome, continent of infection and chemoprophylaxis failure and their association with different factors.
Results:
A total of 9513 malaria hospital discharges and 7421 reported malaria cases were identified. The number of reported cases was below the number of hospitalizations during the whole study period, with a steady increase trend in both databases since 2008. Males aged 25-44 were the most represented in both data sources. Most frequent related co-diagnoses were anaemia (20.2%) and thrombocytopaenia (15.4%). The risks of fatal outcome increased with age and were associated with the parasite species (Plasmodium falciparum). The main place of infection was Africa (88.9%), particularly Equatorial Guinea (33.2%). Most reported cases were visiting friends and relatives (VFRs) and immigrants (70.2%). A significant increased likelihood of hospitalization was observed for children under 10 years (aOR:2.7; 95% CI 1.9-3.9), those infected by Plasmodium vivax (4.3; 95% CI 2.1-8.7) and travellers VFRs (1.4; 95% CI 1.1-1.7). Only 4% of cases reported a correct regime of chemoprophylaxis. Being male, over 15 years, VFRs, migrant and born in an endemic country were associated to increased risk of failure in preventive chemotherapy.
Conclusions:
The joint analysis of two data sources allowed for better characterization of imported malaria profile in Spain. Despite the availability of highly effective preventive measures, the preventable burden from malaria is high in Spain. Pre-travel advice and appropriately delivered preventive messages needs to be improved, particularly in migrants and VFRs.
Background:
Plasmodium vivax exacts a significant toll on health worldwide, yet few efforts to date have quantified the extent and temporal trends of its global distribution. Given the challenges associated with the proper diagnosis and treatment of P vivax, national malaria programmes-particularly those pursuing malaria elimination strategies-require up to date assessments of P vivax endemicity and disease impact. This study presents the first global maps of P vivax clinical burden from 2000 to 2017.
Methods:
In this spatial and temporal modelling study, we adjusted routine malariometric surveillance data for known biases and used socioeconomic indicators to generate time series of the clinical burden of P vivax. These data informed Bayesian geospatial models, which produced fine-scale predictions of P vivax clinical incidence and infection prevalence over time. Within sub-Saharan Africa, where routine surveillance for P vivax is not standard practice, we combined predicted surfaces of Plasmodium falciparum with country-specific ratios of P vivax to P falciparum. These results were combined with surveillance-based outputs outside of Africa to generate global maps.
Findings:
We present the first high-resolution maps of P vivax burden. These results are combined with those for P falciparum (published separately) to form the malaria estimates for the Global Burden of Disease 2017 study. The burden of P vivax malaria decreased by 41·6%, from 24·5 million cases (95% uncertainty interval 22·5-27·0) in 2000 to 14·3 million cases (13·7-15·0) in 2017. The Americas had a reduction of 56·8% (47·6-67·0) in total cases since 2000, while South-East Asia recorded declines of 50·5% (50·3-50·6) and the Western Pacific regions recorded declines of 51·3% (48·0-55·4). Europe achieved zero P vivax cases during the study period. Nonetheless, rates of decline have stalled in the past five years for many countries, with particular increases noted in regions affected by political and economic instability.
Interpretation:
Our study highlights important spatial and temporal patterns in the clinical burden and prevalence of P vivax. Amid substantial progress worldwide, plateauing gains and areas of increased burden signal the potential for challenges that are greater than expected on the road to malaria elimination. These results support global monitoring systems and can inform the optimisation of diagnosis and treatment where P vivax has most impact.
Funding:
Bill & Melinda Gates Foundation and the Wellcome Trust.
Background:
Since 2000, the scale-up of malaria control interventions has substantially reduced morbidity and mortality caused by the disease globally, fuelling bold aims for disease elimination. In tandem with increased availability of geospatially resolved data, malaria control programmes increasingly use high-resolution maps to characterise spatially heterogeneous patterns of disease risk and thus efficiently target areas of high burden.
Methods:
We updated and refined the Plasmodium falciparum parasite rate and clinical incidence models for sub-Saharan Africa, which rely on cross-sectional survey data for parasite rate and intervention coverage. For malaria endemic countries outside of sub-Saharan Africa, we produced estimates of parasite rate and incidence by applying an ecological downscaling approach to malaria incidence data acquired via routine surveillance. Mortality estimates were derived by linking incidence to systematically derived vital registration and verbal autopsy data. Informed by high-resolution covariate surfaces, we estimated P falciparum parasite rate, clinical incidence, and mortality at national, subnational, and 5 × 5 km pixel scales with corresponding uncertainty metrics.
Findings:
We present the first global, high-resolution map of P falciparum malaria mortality and the first global prevalence and incidence maps since 2010. These results are combined with those for Plasmodium vivax (published separately) to form the malaria estimates for the Global Burden of Disease 2017 study. The P falciparum estimates span the period 2000-17, and illustrate the rapid decline in burden between 2005 and 2017, with incidence declining by 27·9% and mortality declining by 42·5%. Despite a growing population in endemic regions, P falciparum cases declined between 2005 and 2017, from 232·3 million (95% uncertainty interval 198·8-277·7) to 193·9 million (156·6-240·2) and deaths declined from 925 800 (596 900-1 341 100) to 618 700 (368 600-952 200). Despite the declines in burden, 90·1% of people within sub-Saharan Africa continue to reside in endemic areas, and this region accounted for 79·4% of cases and 87·6% of deaths in 2017.
Interpretation:
High-resolution maps of P falciparum provide a contemporary resource for informing global policy and malaria control planning, programme implementation, and monitoring initiatives. Amid progress in reducing global malaria burden, areas where incidence trends have plateaued or increased in the past 5 years underscore the fragility of hard-won gains against malaria. Efforts towards elimination should be strengthened in such areas, and those where burden remained high throughout the study period.
Funding:
Bill & Melinda Gates Foundation.
Background
In the scope of climate change the possible recurrence and/or expansion of vector-borne diseases poses a major concern. The occurrence of vector competent Anopheles species as well as favorable climatic conditions may lead to the re-emergence of autochthonous malaria in Europe and the Mediterranean area. However, high-resolution assessments of possible changes of Anopheles vector distributions and of potential malaria transmission stability in the European-Mediterranean area under changing climatic conditions during the course of the 21st century are not available yet.
Methods
Boosted Regression Trees are applied to relate climate variables and land cover classes to vector occurrences. Changes in future vector distributions and potential malaria transmission stability due to climate change are assessed using state-of-the art regional climate model simulations.
Results
Distinct changes in the distributions of the dominant vectors of human malaria are to be expected under climate change. In general, temperature and precipitation changes will lead to a northward spread of the occurrences of Anopheles vectors. Yet, for some Mediterranean areas, occurrence probabilities may decline.
Conclusions
Potential malaria transmission stability is increased in areas where the climatic changes favor vector occurrences as well as significantly impact the vectorial capacity. As a result, vector stability shows the highest increases between historical and future periods for the southern and south-eastern European areas. Anopheles atroparvus, the dominant vector in large parts of Europe, might play an important role with respect to changes of the potential transmission stability.
Electronic supplementary material
The online version of this article (10.1186/s13071-018-3278-6) contains supplementary material, which is available to authorized users.
Malaria burden has considerably declined in the last 15 years mainly due to large-scale vector control. The continued decline can be sustained through malaria risk stratification. Malaria stratification is the classification of geographical areas according to malaria risk. In this study, ecological niche modelling using the maximum entropy algorithm was applied to predict malaria vector habitat suitability in terms of bioclimatic and topographic variables. The output vector suitability map was integrated with malaria prevalence data in a GIS to stratify Zimbabwe into different malaria risk zones. Five improved and validated malaria risk zones were sucessfully delimited for Zimbabwe based on the World Health Organisation classification scheme. These results suggest that the probability of occurrence of major vectors of malaria is a key determinant of malaria prevalence. The delimited malaria risk zones could be used by National Malaria Control programmes to plan and implement targeted malaria interventions based on vector control.
This paper summarizes our work on building a data model and a geovisualization tool that provides access to global climate data: the Global Climate Monitor Web Viewer. Linked to this viewer, a complete set of climate-environmental indicators capable of displaying climate
patterns on a global scale that is accessible to any potential user (scientists and laypeople) will be built and published using the same online application. The data currently available correspond to the CRU TS3.21 version of the Climate Research Unit (University of East Anglia) database – a product that provides data at a spatial resolution of half of a degree in latitude and longitude, spanning January 1901 to December 2012, on a monthly basis. Since January 2013, the datasets feeding the system have been the GHCN-CAMS
emperature dataset and the Global Precipitation Climatology Centre (GPCC) First Guess precipitation dataset. Climatologists, hydrologists, planners and non-experts users such as media workers, policymakers, non-profit organizations, teachers or students, can access useful climatological information through the
Global Climate Monitor system.
Background
In the process of geographical retraction of malaria, some important endemicity pockets remain. Here, we report results from a study developed to obtain detailed community data from an important malaria hotspot in Latin America (Alto Juruá, Acre, Brazil), to investigate the association of malaria with socioeconomic, demographic and living conditions. MethodsA household survey was conducted in 40 localities (n = 520) of Mâncio Lima and Rodrigues Alves municipalities, Acre state. Information on previous malaria, schooling, age, gender, income, occupation, household structure, habits and behaviors related to malaria exposure was collected. Multiple correspondence analysis (MCA) was applied to characterize similarities between households and identify gradients. The association of these gradients with malaria was assessed using regression. ResultsThe first three dimensions of MCA accounted for almost 50% of the variability between households. The first dimension defined an urban/rurality gradient, where urbanization was associated with the presence of roads, basic services as garbage collection, water treatment, power grid energy, and less contact with the forest. There is a significant association between this axis and the probability of malaria at the household level, OR = 1.92 (1.23–3.02). The second dimension described a gradient from rural settlements in agricultural areas to those in forested areas. Access via dirt road or river, access to electricity power-grid services and aquaculture were important variables. Malaria was at lower risk at the forested area, OR = 0.55 (1.23–1.12). The third axis detected intraurban differences and did not correlate with malaria. Conclusions
Living conditions in the study area are strongly geographically structured. Although malaria is found throughout all the landscapes, household traits can explain part of the variation found in the odds of having malaria. It is expected these results stimulate further discussions on modelling approaches targeting a more systemic and multi-level view of malaria dynamics.
En las últimas décadas se ha producido en España un resurgimiento de algunas enfermedades transmitidas por vectores, que se creían bajo control, y también la aparición de otras nuevas. Asimismo, la llegada de nuevos vectores, su implantación y expansión en algunos casos, está generando nuevos riesgos para la salud pública. Estos fenómenos han estado, en general, asociados a cambios ecológicos y climáticos complejos que han favorecido e incrementado las densidades de los vectores y de sus reservorios, pero en los que también han incidido procesos propiciados o acelerados por el hombre como la globalización, la urbanización, la desforestación y la modificación de los usos del suelo.
Los cambios en la distribución de los vectores y en su capacidad para trasmitir patógenos debido al cambio climático van a ser más evidentes en las zonas en las que los vectores se encuentran en el límite de su distribución como es el caso de España. A esto se añade la cercanía de África y la posible entrada de nuevos vectores y patógenos procedentes de este continente. Ante este escenario es preciso establecer programas de acción dirigidos tanto a la identi cación de los riesgos y la prevención de las enfermedades vectoriales como a la gestión eficaz de los posibles brotes que se puedan producir en el futuro.
Se realiza una revisión en el ámbito nacional de los escenarios que se prevén en relación con el cambio climático y su impacto en la incidencia de enfermedades transmitidas por mosquitos, flebotomos, garrapatas, otros artrópodos y roedores.
Background:
Europe once had widespread malaria, but today it is free from endemic transmission. Changing land use, agricultural practices, housing quality, urbanization, climate change, and improved healthcare are among the many factors thought to have played a role in the declines of malaria seen, but their effects and relative contributions have rarely been quantified.
Methods:
Spatial datasets on changes in climate, wealth, life expectancy, urbanization, and land use trends over the past century were combined with datasets depicting the reduction in malaria transmission across 31 European countries, and the relationships were explored. Moreover, the conditions in current malaria-eliminating countries were compared with those in Europe at the time of declining transmission and elimination to assess similarities.
Results/conclusions:
Indicators relating to socio-economic improvements such as wealth, life expectancy and urbanization were strongly correlated with the decline of malaria in Europe, whereas those describing climatic and land use changes showed weaker relationships. Present-day malaria-elimination countries have now arrived at similar socio-economic indicator levels as European countries at the time malaria elimination was achieved, offering hope for achievement of sustainable elimination.
The possible connectivity between the spatial distribution of water bodies suitable for vectors of malaria and endemic malaria foci in Southern Europe is still not well known. Spain was one of the last countries in Western Europe to be declared free of malaria by the World Health Organization (WHO) in 1964. This study combines, by means of a spatial-temporal analysis, the historical data of patients and deceased with the distribution of water bodies where the disease-transmitting mosquitos proliferate. Therefore, data from historical archives with a Geographic Information System (GIS), using the Inverse Distance Weighted (IDW) interpolation method, was analyzed with the aim of identifying regional differences in the distribution of malaria in Spain. The reasons, why the risk of transmission is concentrated in specific regions, are related to worse socioeconomic conditions (Extremadura), the presence of another vector (Anopheles labranchiae) besides A. atroparvus (Levante) or large areas of water bodies in conditions to reproduce theses vectors (La Mancha and Western Andalusia). In the particular case of Western Andalusia, in 1913, the relatively high percentage of 4.73% of the surface, equal to 202362 ha, corresponds to wetlands and other unhealthy water bodies. These wetlands have been reduced as a result of desiccation policies and climate change such as the Little Ice Age and Global Climate Change. The comprehension of the main factors of these wetland changes in the past can help us interpret accurately the future risk of malaria re-emergence in temperate latitudes, since it reveals the crucial role of unhealthy water bodies on the distribution, endemicity and eradication of malaria in southern Europe.
Background
The impact of socio-demographic factors and baseline health on the mortality burden of seasonal and pandemic influenza remains debated. Here we analyzed the spatial-temporal mortality patterns of the 1918 influenza pandemic in Spain, one of the countries of Europe that experienced the highest mortality burden.
Methods
We analyzed monthly death rates from respiratory diseases and all-causes across 49 provinces of Spain, including the Canary and Balearic Islands, during the period January-1915 to June-1919. We estimated the influenza-related excess death rates and risk of death relative to baseline mortality by pandemic wave and province. We then explored the association between pandemic excess mortality rates and health and socio-demographic factors, which included population size and age structure, population density, infant mortality rates, baseline death rates, and urbanization.
Results
Our analysis revealed high geographic heterogeneity in pandemic mortality impact. We identified 3 pandemic waves of varying timing and intensity covering the period from Jan-1918 to Jun-1919, with the highest pandemic-related excess mortality rates occurring during the months of October-November 1918 across all Spanish provinces. Cumulative excess mortality rates followed a south–north gradient after controlling for demographic factors, with the North experiencing highest excess mortality rates. A model that included latitude, population density, and the proportion of children living in provinces explained about 40% of the geographic variability in cumulative excess death rates during 1918–19, but different factors explained mortality variation in each wave.
Conclusions
A substantial fraction of the variability in excess mortality rates across Spanish provinces remained unexplained, which suggests that other unidentified factors such as comorbidities, climate and background immunity may have affected the 1918–19 pandemic mortality rates. Further archeo-epidemiological research should concentrate on identifying settings with combined availability of local historical mortality records and information on the prevalence of underlying risk factors, or patient-level clinical data, to further clarify the drivers of 1918 pandemic influenza mortality.
Before the discovery of Treponema pallidum as the etiologic agent, the origins of syphilis have been the subject of several debates. Diverse therapeutic agents were employed in an attempt to cure the disease. Examining the milestones in the history of syphilis, the present article reviews the existing theories that tried to explain the origins of the disease, the approach in art, the cultural and the evolution of the treatments from the empiric means to the discovery of penicillin.
Este libro consiste en un análisis de las estrategias antipalúdicas que se llevaron a cabo en España y sus colonias (Marruecos y Guinea Ecuatorial), así como los avatares que entrañó la lucha para combatir esa epidemia, desde la organización de esa lucha, la creación de observatorios, el manejo terapéutico y profilaxis de elección, como la quinina y algunos fármacos sustitutivos, las cuestiones higiénico sociales, y en el caso de las colonias, además aspectos que tienen que ver con las comisiones y coordinaciones cívico militares, terapias e incluso del racismo científico en relación con esta enfermedad, entre otros aspectos que pueden encontrarse en esta obra, que cuenta también con una amplia bibliografía sobre el tema. Un análisis que permite ver la evolución de la actuación médico-social en torno a esta epidemia la primera década del siglo XX hasta su erradicación en territorio hispano la década del sesenta.
Remotely sensed imagery has been used to update and improve the spatial resolution of malaria transmission intensity maps in Tanzania, Uganda, and Kenya. Discriminant analysis achieved statistically robust agreements between historical maps of the intensity of malaria transmission and predictions based on multitemporal meteorological satellite sensor data processed using temporal Fourier analysis. The study identified land surface temperature as the best predictor of transmission intensity. Rainfall and moisture availability as inferred by cold cloud duration (ccd) and the normalized difference vegetation index (ndvi), respectively, were identified as secondary predictors of transmission intensity. Information on altitude derived from a digital elevation model significantly improved the predictions. "Malaria-free" areas were predicted with an accuracy of 96 percent while areas where transmission occurs only near water, moderate malaria areas, and intense malaria transmission areas were predicted with accuracies of 90 percent, 72 percent, and 87 percent, respectively. The importance of such maps for rationalizing malaria control is discussed, as is the potential contribution of the next generation of satellite sensors to these mapping efforts.
Malaria is a parasitic disease that is currently affecting a good number of countries with approximately one million deaths per year. Traditionally, this pathology has been related to wetlands and other unhealthy water bodies. It disappeared from most of Western Europe after the Second World War; however, its eradication from Spain took place later. In fact, the WHO didn’t of�cially declare malaria in Spain eradicated until 1964, after a gradual controlled process of the illness, through the improvement of health and hygienic conditions in the country, and the �ght against the vectors, the parasite, and its reservoirs.
In 1913, the Spanish regions with the largest number of municipalities with autochthonous malaria were, precisely, those containing larger areas covered by unhealthy water bodies (except for Extremadura). Among them, Western Andalusia outstood as the main region with the largest area of unhealthy malaria focuses and with high mortality and morbidity rates. Within Western Andalusia, Huelva —and especially its coastal areas— has been, for centuries, one of the provinces with greater endemicity.
After the Spanish Civil War a process of reforestation with fast-growing species took place in the Coastal Aeolian Sheet of the Province of Huelva, which led to an 88% reduction of the surface covered by ponds in his territory. These lagoons had started a natural regression process by the end of the XIXth Century related to the post-Little Ice Age warming in Andalusia.
The parallel evolution of malaria patients and the regression process experienced by these wetlands for the above mentioned reasons have had a determinant in�uence in the eradication of the disease. All of this leads us to consider the relevant role of wetlands when studying the future risk of malaria reemergence in SW Spain.
In our study¹ we did not address the impact of predicted climate change on malaria incidence because a complete global assessment is reported elsewhere². Regarding the climate surfaces we used, the data set has superior spatial resolution compared with other data sets of similar temporal extent3, ⁴, and has been used to quantify climate change across Africa at 0.5 × 0.5° spatial resolution⁵ (although the resulting maps are smoothed to emphasize regional changes). It is inconsistent to assert that these same data are insufficient to demonstrate a lack of climate change.
OBJECTIVES: Malaria is considered to have been eradicated in Greece and only sporadic cases in travelers are reported. However the migration of populations from endemic countries of Asia to Greece may have caused a re-emergence of the disease. METHODS: A cluster of nine human malaria cases due to Plasmodium vivax infection in the area of Laconia (southern Peloponnesus) from 2009 to 2010 is presented. Patients were hospitalized in Sparta General Hospital. RESULTS: Eight patients were diagnosed in 2009 and one in 2010. Two were refugees from Pakistan and Afghanistan and five were Romas living in a local camp. Apart from the two immigrants, no other patient had any history of travel, blood transfusion, or organ transplantation. All patients had a febrile illness, hematological abnormalities, and irregular liver function tests. Parasites were identified in peripheral blood smears, and PCR confirmed the presence of P. vivax. Sensitivity testing showed chloroquine susceptibility. Combined treatment with chloroquine followed by primaquine was completed uneventfully. Entomological surveillance disclosed the presence of Anopheles saccharovi as the predominant mosquito species, however PCR testing failed to identify P. vivax in the mosquito population. CONCLUSIONS: We have presented the first large outbreak of the local transmission of autochthonous malaria cases in Greece since the 1950s. Enhanced entomological surveillance and early detection of malaria cases are crucial in order to prevent the re-emergence of malaria, not only in Greece, but in Europe as well.
In Spain, malaria cases are mostly due to migrants and travellers returning from endemic areas. The objective of this work was to describe the malaria cases diagnosed at the Severo Ochoa University Hospital (HUSO) in Leganés in the south of the Madrid Region from 2005 to 2008.
Descriptive retrospective study performed at HUSO. Data sources are registries from the Microbiology Department and malaria cases notified to the Preventive Medicine Department. Analysed parameters were: administrative, demographical, related to the stay at the endemic country, clinical, microbiological diagnosis method, pregnancy, treatment and prophylaxis, co-infections, and days of hospital stay.
Fifty-seven patients diagnosed with malaria were studied. Case distribution per year was 13 in 2005, 15 in 2006, 15 in 2007 and 14 in 2008. Thirty-three patients were female (57.9%) and 24 male (42.1%). Mean age was 27.8 years. Most of the malaria cases were acquired in Nigeria (49.1%) and Equatorial Guinea (32.7%). 29.1% of the patients were immigrants who had arrived recently, and 61.8% acquired malaria when travelling to their countries of origin to visit friends and relatives (VFR). Majority of cases were diagnosed between June and September. Microscopy was positive in 39 cases (68.4%) immunochromatography in 42 (73.7%) and PCR in the 55 cases where performed. Plasmodium falciparum was responsible for 94.7% of the cases. The more frequent symptoms were fever (77.2%), followed by headache and gastrointestinal symptoms (33.3%). Nine cases needed hospital admittance, a pregnant woman, three children, four VFR and an African tourist, but all evolved favourably. Chemoprophylaxis data was known from 55 patients. It was taken correctly in one case (1.8%), in five (9.1%) the prophylaxis was improper while the others 49 (89.1%) cases had not followed any anti-malarial prophylaxis.
Children, pregnant women and the VFR have the highest risk to present severe malaria and to need hospital admittance. Another important risk factor for acquiring malaria is incorrect prophylaxis. The first place for malaria acquisition was Nigeria and the main species causing malaria was P. falciparum.
Por la proximidad con el continente africano, siendo lugar de tránsito obligado de aves migratorias y personas, y por las condiciones climáticas, cercanas a las de zonas donde hay transmisión de enfermedades vectoriales, España es un país en el que este tipo de enfermedades podrían verse potenciadas por el cambio climático. El posible riesgo vendría por extensión geográfica de vectores ya establecidos o por la importación e instalación de vectores sub-tropicales adaptados a sobrevivir en climas menos cálidos y más secos. Hipoté- ticamente, las enfermedades vectoriales susceptibles de ser influidas por el cambio climático en España serían aquellas transmitidas por dípteros como dengue, encefalitis del Nilo occidental, fiebre del valle del Rift, malaria y leishmaniosis; las transmitidas por garrapatas como la fiebre de Congo Crimea, encefalitis por garrapata, enfermedad de Lyme, fiebre botonosa y fiebre recurrente endémica; y las transmitidas por roedores. Pero la mayor y más factible amenaza sería la instauración del mosquito Aedes albopictus, que sería capaz de transmitir enfermedades virales como la del Nilo occidental o el dengue. Pero para el establecimiento de auténticas áreas de endemia se necesitaría la conjunción de otros factores, tales como el aflujo masivo y simultáneo de reservorios animales o humanos y el deterioro de las condiciones socio-sanitarias y de los servicios de Salud Pública.
This paper focuses on the health reforms during the republican Spain (1931-1939) and the crisis derived from the three-year of civil war. It considers how the war affected the health system and the impairment of health conditions of the population during the late 1930s, considering the changing conditions caused by the conflict. Some of the specific topics analysed are the changing healthcare system, the adaptation of health organization after the outbreak of the war, the impact of the war on the health of the population and epidemiological changes, the problem of the refugees and the clinical studies by experts, mainly on undernourishment.
The incidence of infectious syphilis in the UK has greatly increased since 1995, mainly in cities and commonly among gay men. Syphilis is a systemic disease from the outset. It usually presents early with a painless penile ulcer, or later with a maculopapular rash, lymphadenopathy and condylomata lata. Diagnosis is confirmed serologically, at first by specific treponemal screening and confirmatory tests (eg enzyme immunoassay and Treponema pallidum particle agglutination test), subsequently by non-specific serology (eg rapid plasmin reagin test) to gauge disease activity. Clinical suspicion of neurosyphilis should be confirmed by analysis of a clear specimen of cerebrospinal fluid. The cornerstones of management are rapid investigation and treatment, tracing and treating sexual contacts, and education about safer sex.
Malaria is a mosquito-borne disease of global concern with 1.5 to 2.7 million people dying each year and many more suffering from it. In Indonesia, malaria is a major public health issue with around six million clinical cases and 700 deaths each year. Malaria is most prevalent in the developing countries of the world. Aid agencies have provided financial and technical assistance to malaria-prone countries in an effort to battle the disease. Over the past decade, the focus of some of this assistance has been in the provision of geographic information systems (GIS) hardware, software and training. In theory, GIS can be a very effective tool in combating malaria, however, in practice there have been a host of challenges to its successful use.
This review is based, in part, on the literature but also on our experience working with the Indonesian Ministry of Health. The review identifies three broad problem areas. The first of these relates to data concerns. Without adequate data, GIS is not very useful. Specific problem areas include: accurate data on the disease and how it is reported; basic environmental data on vegetation, land uses, topography, rainfall, etc.; and demographic data on the movement of people. The second problem area involves technology – specifically computer hardware, GIS software and training. The third problem area concerns methods – assuming the previous data and technological problems have been resolved – how can GIS be used to improve our understanding of malaria? One of the main methodological tools is spatial statistical analysis, however, this is a newly developing field, is not easy to understand and suffers from the fact that there is no agreement on standard methods of analysis.
The paper concludes with a discussion of strategies that can be used to overcome some of these problems. One of these strategies involves using ArcView GIS software in combination with ArcExplorer (a public domain program that can read ArcView files) to deal with the problem of needing multiple copies of GIS software. Another strategy involves the development of a self-paced training package that can be used to train individuals
Due to Spain's being located near Africa, being a stopping-off point for migrating birds and individuals and due to its climate conditions, nearing those of areas where there are vector-borne diseases, this is a country where this type of diseases could taken on greater importance due to the climate change. The possible risk would result from the geographical spread of already established vectors or due to subtropical vectors adapted to surviving in cooler, dried climates being imported and taking up residence. Hypothetically, the vector-borne diseases subject to be influenced by the climate change in Spain would be those transmitted by dipterans, such as dengue fever, West Nile encephalitis, Rift Valley fever, malaria and leishmaniasis; tick-transmitted diseases, such as Crimean-Congo hemorrhagic fever, tick-borne encephalitis, Lyme disease, spotted fever and endemic relapsing fever; and rodent-transmitted diseases. But the greatest, most viable threat would be the Aedes albopictus mosquito, which would be capable of transmitting viral diseases such as West Nile encephalitis or dengue fever, taking up residence. But, for actual areas of endemia being established, a combination of other factors, such as the massive, simultaneous influx of animal or human reservoirs and the deterioration of the social healthcare conditions and of the Public Health services.
Malaria is one of the infectious diseases with the highest number of cases worldwide. It has always been linked to aquatic environments, since these can be a necessary reservoir for the anophelines that transmit the disease. This study analyses the role that unhealthy water bodies have played, since the early 20th century, in the most endemic and/or prevalent foci of malaria in Spain. Western Andalusia was the region with the largest surface of unhealthy water bodies and wetlands. The desiccation of much of the continental waters contributed to its eradication.
Introduction This chapter examines what is known about the effects of climate change on human health and, briefly, the more direct impacts of climate-altering pollutants (CAPs; see Glossary) on health. We review diseases and other aspects of poor health that are sensitive to weather and climate. We examine the factors that influence the susceptibility of populations and individuals to ill health due to variations in weather and climate, and describe steps that may be taken to reduce the impacts of climate change on human health. The chapter also includes a section on health "co-benefits." Co-benefits are positive effects on human health that arise from interventions to reduce emissions of those CAPs that warm the planet or vice versa. This is a scientific assessment based on best available evidence according to the judgment of the authors. We searched the English-language literature up to August 2013, focusing primarily on publications since 2007. We drew primarily (but not exclusively) on peer-reviewed journals. Literature was identified using a published protocol (Hosking and Campbell-Lendrum, 2012) and other approaches, including extensive consultation with technical experts in the field. We examined recent substantial reviews (e.g., Gosling et al., 2009; Bassil and Cole, 2010; Hajat et al., 2010; Huang et al., 2011; McMichael, 2013b; Stanke et al., 2013) to check for any omissions of important work. In selecting citations for the chapter, we gave priority to publications that were recent (since AR4), comprehensive, added significant new findings to the literature, and included areas or population groups that have not previously been well described or were judged to be particularly policy relevant in other respects. We begin with an outline of measures of human health, the major driving forces that act on health worldwide, recent trends in health status, and health projections for the remainder of the 21st century. 11.1.1. Present State of Global Health The Fourth Assessment Report (AR4) pointed to dramatic improvement in life expectancy in most parts of the world in the 20th century, and this trend has continued through the first decade of the 21st century (Wang et al., 2012).
Malaria was eradicated from Europe in the 1970’s through a combination of insecticide spraying, drug therapy and environmental engineering. Since then, it has been mostly imported into the continent by international travelers and immigrants from endemic regions. Despite the substantial number of imported malaria cases and the documented presence of suitable anopheline vectors, autochthonous transmission has not been widely observed in Europe, probably due to early diagnosis and treatment, afforded by efficient health care systems. Current climatic conditions are conducive to malaria transmission in several areas of Southern Europe and climate change might favor mosquito proliferation and parasite development, further facilitating malaria transmission. Moreover, the continuing massive influx of refugee and migrant populations from endemic areas could contribute to building up of an infectious parasite reservoir. Although the malariogenic potential of Europe is currently low, particularly in the northern and western parts of the continent, strengthening of disease awareness and maintaining robust public health infrastructures for surveillance and vector control are of the utmost importance and should be technically and financially supported to avert the possibility of malaria transmission in Europe’s most vulnerable areas.
Although often forgotten among people in affluent nations, malaria represents a leading global health concern in poor, rural countries. Malaria is traditionally thought of as a rural disease, given the close proximity of rural households to mosquito disease vectors. However, more insight is needed to investigate the larger social, economic, and environmental conditions that perhaps interact with rurality to explain why some nations continue to have high levels of prevalence of this preventable and eradicable parasitic infection. We employ structural equation modeling to efficiently test for both direct and indirect effects of rurality. The results demonstrate that rurality works in important indirect ways; although rurality has indirect links to malaria through export agriculture, health spending, and sociohealth resources, careful decomposition of the indirect effects illustrates that the indirect effects through heath spending and sociohealth resources are most important. Overall, the findings suggest that rural vulnerabilities to malaria are not inherent and can be largely addressed by increasing public health provisions among rural populations.
The financial crisis in Europe has posed major threats and opportunities to health. We trace the origins of the economic crisis in Europe and the responses of governments, examine the effect on health systems, and review the effects of previous economic downturns on health to predict the likely consequences for the present. We then compare our predictions with available evidence for the effects of the crisis on health. Whereas immediate rises in suicides and falls in road traffic deaths were anticipated, other consequences, such as HIV outbreaks, were not, and are better understood as products of state retrenchment. Greece, Spain, and Portugal adopted strict fiscal austerity; their economies continue to recede and strain on their health-care systems is growing. Suicides and outbreaks of infectious diseases are becoming more common in these countries, and budget cuts have restricted access to health care. By contrast, Iceland rejected austerity through a popular vote, and the financial crisis seems to have had few or no discernible effects on health. Although there are many potentially confounding differences between countries, our analysis suggests that, although recessions pose risks to health, the interaction of fiscal austerity with economic shocks and weak social protection is what ultimately seems to escalate health and social crises in Europe. Policy decisions about how to respond to economic crises have pronounced and unintended effects on public health, yet public health voices have remained largely silent during the economic crisis.
Plasmodium vivax was endemic in temperate areas in historic times up to the middle of last century. Temperate climate P. vivax has a long incubation time of up to 8-10 months, which partly explain how it can be endemic in temperate areas with a could winter. P. vivax disappeared from Europe within the last 40-60 years, and this change was not related to climatic changes. The surge of P. vivax in Northern Europe after the second world war was related to displacement of refugees and large movement of military personnel exposed to malaria. Lately P. vivax has been seen along the demilitarized zone in South Korea replication a high endemicity in North Korea. The potential of transmission of P. vivax still exist in temperate zones, but reintroduction in a larger scale of P. vivax to areas without present transmission require large population movements of P. vivax infected people. The highest threat at present is refugees from P. vivax endemic North Korea entering China and South Korea in large numbers.
Between 2009 and September 2012, locally acquired cases of P.vivax infection were reported in Greece, mostly from the agricultural area of Evrotas, Lakonia (n = 48), but also sporadically from five other regions (n = 14), suggesting that conditions in these areas are favourable for local transmission of malaria. The risk of re-establishment of malaria in Greece will depend on whether the receptivity for disease transmission (presence of the mosquito vector and adequate ecological and climatic factors) and the vulnerability (importation of the parasite in human reservoirs or presence of infected mosquito vectors) continue to be present in the country. The continuous implementation of the integrated preparedness and response plan for malaria that covers all aspects from surveillance and laboratory diagnosis to vector control and the reorganization of public health infrastructures are necessary to prevent transmission and control the disease in the long term. However, the impact of the severe economic crisis on current health-care, public health infrastructures and vector control constitute a great challenge for the future. The current threat of renewed sustained local malaria transmission in Greece (and thus in continental Europe) merits an international response, including financial and technical support, from European and international stakeholders.
Disease outbreaks are known to be often influenced by local weather, but how changes in disease trends might be affected by long-term global warming is more difficult to establish. In a study of malaria in the African highlands, Hay et al.1 found no significant change in long-term climate at four locations where malaria incidence has been increasing since 1976. We contend, however, that their conclusions are likely to be flawed by their inappropriate use of a global climate data set. Moreover, the absence of a historical climate signal allows no inference to be drawn about the impact of future climate change on malaria in the region.
The 1918–1919 influenza pandemic was the most devastating epidemic in modern history. Here, we review epidemiological and
historical data about the 1918–1919 influenza epidemic in Spain. On 22 May 1918, the epidemic was a headline in Madrid's ABC newspaper. The infectious disease most likely reached Spain from France, perhaps as the result of the heavy railroad traffic
of Spanish and Portuguese migrant workers to and from France. The total numbers of persons who died of influenza in Spain
were officially estimated to be 147,114 in 1918, 21,235 in 1919, and 17,825 in 1920. However, it is likely that >260,000 Spaniards
died of influenza; 75% of these persons died during the second period of the epidemic, and 45% died during October 1918 alone.
The Spanish population growth index was negative for 1918 (net loss, 83,121 persons). Although a great deal of evidence indicates
that the 1918 A(H1N1) influenza virus unlikely originated in and spread from Spain, the 1918–1919 influenza pandemic will
always be known as the Spanish flu.
El paludismo es una enfermedad caracterizada por fiebres intermitentes y causada por diversos especies de protozoo Plasmodium sp. (P.vivax que origina las fiebres tercianas; P.malariae que causa las cuartanas; P.falciparum, responsable de las fiebres malignas o tropicales y P.ovale, que origina terciarias benignas). La transmisión de la malaria se realiza por varias especies de la hembra del díptero Anopheles sp. Las investigaciones de Laveran, Ross y Grassi sobre el ciclo biológico de Plasmodium sp., y su transmisión por Anopheles sp., permitieron en el siglo XX la lucha contra la enfermedad. Los primeros tratamientos contra el paludismo se basaron en las cualidades febrífugas de la corteza del árbol de la quina (Cinchona sp.) utilizada desde 1638. El aislamiento por Pelletier y Caventou en 1820 de los alcaloides de la quina, quinina y cinconina y posteriormente de sus derivados, permitió eliminar al hombe enfermo como fuente infectiva. En los años cuarenta del siglo XX comenzó la utilización de los insecticidas, DDT y Lindano que suponía luchar contra la malaria de forma barata y generalizada. En España los conocimientos sobre el paludismo se dieron a conocer por el Dr. Jan Macdonald, médico de la Compañía Minera de Riotinto en 1900, por los doctores Huertas y Mendoza en Cáceres en 1901 y por el Dr. Pittaluga en Cataluña, Valencia, Islas Baleares y Madrid en 1902. Pittaluga estudió la distribución y extensión del paludismo en España y lo relacionó con temperatura y humedad elevadas, encharcamientos locales, aglomeraciones humanas y condiciones sanitarias desfavorables. La lucha antipalúdica constituyó en España la primera lucha epidemiológica organizada. El primer dispensario antipalúdico se estableció en 1920 en Talayuela (Cáceres), una de las zonas más palúdicas. En 1925 se creó el Instituto Antipalúdico de Navalmoral de la Mata que asumió la dirección científica contra el paludismo hasta los años sesenta del siglo veinte. La labor de los malariólogos Gustavo Pittaluga y Sadí de Buen resultó fundamentalmente en la organización antipalúdica española, así como las investigaciones del naturalista Juan Gil Collado sobre la biología de Anopheles sp. En noviembre de 1950 el Gobierno español y la Organización Mundial de la Salud firmaron un convenio para erradicar el paludismo del territorio nacional, hecho que se produjo oficialmente en 1964
Malaria is a mosquito-borne disease of global concern with 1.5 to 2.7 million people dying each year and many more suffering from it. In Indonesia, malaria is a major public health issue with around six million clinical cases and 700 deaths each year. Malaria is most prevalent in the developing countries of the world. Aid agencies have provided financial and technical assistance to malaria-prone countries in an effort to battle the disease. Over the past decade, the focus of some of this assistance has been in the provision of geographic information systems (GIS) hardware, software and training. In theory, GIS can be a very effective tool in combating malaria, however, in practice there have been a host of challenges to its successful use. This review is based, in part, on the literature but also on our experience working with the Indonesian Ministry of Health. The review identifies three broad problem areas. The first of these relates to data concerns. Without adequate data, GIS is not very useful. Specific problem areas include: accurate data on the disease and how it is reported; basic environmental data on vegetation, land uses, topography, rainfall, etc.; and demographic data on the movement of people. The second problem area involves technology – specifically computer hardware, GIS software and training. The third problem area concerns methods – assuming the previous data and technological problems have been resolved – how can GIS be used to improve our understanding of malaria? One of the main methodological tools is spatial statistical analysis, however, this is a newly developing field, is not easy to understand and suffers from the fact that there is no agreement on standard methods of analysis. The paper concludes with a discussion of strategies that can be used to overcome some of these problems. One of these strategies involves using ArcView GIS software in combination with ArcExplorer (a public domain program that can read ArcView files) to deal with the problem of needing multiple copies of GIS software. Another strategy involves the development of a self-paced training package that can be used to train individuals Page numbers are not for citation purposes. Instead, this article has the unique article number of 36. Yes Yes
Few infectious diseases have influenced human civilization to the same degree as louse-transmitted typhus. Rickettsia prowazekii continues to strikes tens to hundreds of thousands of persons who live with war, famine, crowding, and in squalid conditions associated with social unrest, with mortality rates in excess of 10% to 15%. Historical documents confirm that such devastation has been a continuous feature of human existence to the extent that typhus has been a major determinant in the outcome of many wars, altering human history in its wake-despite incomplete knowledge of its precise origin. In the twenty-first century, circumstances are still conductive for outbreak; the emerging threat of bioterrorism raises justifiable concerns that typhus could affect civilization just as greatly in the future as it has in the past.