Malaria in Bolivia

Travel websites warn tourists to "consider taking medication for malaria prophylaxis (cholorquine, doxycycline, or mefloquine)," particularly in the areas "surrounding Santa Cruz," where "yellow fever and malaria are two common mosquito-borne diseases" (MDTravel). The CDC indicates that "areas of Bolivia with Malaria" include "all areas <2,500 m" in the regions of "Beni, Chuquisaca, Cochabamba, La Paz, Pando, Santa Cruz, and Tarija." However, the CDC also warns that Chloroquine, commonly used to prevent and treat malaria, "is NOT an effective anti-malaria drug in Bolivia and should not be taken to prevent malaria in this region" (CDC). In reality, "none of the currently available prophylactic medications is 100% effective. If travel to malarious areas is unavoidable, insect protection measures must be strictly followed at all times" (MDTravel).

Furthermore, areas above 2,500 meters are not absent of the disease. "Malaria cases have been reported on the Bolivian high plateau, confirming scientists' predictions that mosquitoes have adapted to a colder climate." These cases "were found in Oruro, western Bolivia, around 3,710 metres above sea level". Researchers have "demonstrated that some anopheles mosquitoes" (the ones that carry malaria) "have adapted to living at altitudes between 2,520 and 3,590 metres--conditions very different from their usual environment: warm, tropical and subtropical regions below 2,600 metres." Some researchers postulate that "a new subspecies has emerged." Scientists have noticed that the tails "have become shorter" and the "mosquito can live in dirty water rather than the clean water it inhabits at lower levels. It can survive" nighttime temperatures "as low as eight degrees Celsius" (Pabon) This can be terrifying news for the residents of these high-altitude regions since many do not have access to adequate health care to combat malaria.

One case study, examines the village of Tuntunani, which is "situated at an elevation of 2,300 meters." This community "experienced its first malaria outbreak in 1998". "An investigation two years later indicated that the epidemic resulted from introduced transmission...58% of the people had been ill for three weeks or longer" as a result. "This outbreak demonstrates the vulnerability of highland populations with poor access to health care to introduced malaria" (Rutar 15).

It seems that malaria is spreading in a country where its effects are already devastating. "Malaria affects over 3.5 million people in Bolivia each year. The Amazon basin regions of Beni and Pando have the country's highest infection rates. In these regions, migratory worker populations, such as castaneros" (Brazil nut farmers) "run a high risk of malaria infection"
When these harvesters "are sick with malaria, the family income drops since workers do not earn their wages and family members stay home to care for them." Estimates indicate that "at least 15,000 families from rural areas depend on this market for survival" (USAID). USAid led a pilot study among the community of Brazil nut harvesters and found that one-third of the farmers tested positive for malaria.

Pregnant women in Bolivia are also at high risk for the disease. Malaria affects pregnant women and children drastically. The anemia and fever from malaria can cause birth defects and death. Furthermore, there is no approved treatment or avoidance measures for pregnant women to take in Bolivia. Many of the prophylactic medications that work against the Bolivian strain of malaria can cause birth defects or miscarriages during the first trimester. At this time, most women find that they can only use mosquito repellent and mosquito nets to avoid contracting malaria during pregnancy.

Map of regions in Bolivia where malaria is endemic

Sources:

CDC.gov/travel/destinations/bolivia.aspx
Pabon, Cristina. Malaria spreading on Bolivian High Plains. SciDevNet.
Rutar, Tina. Eduardo J Baldomar Salgueiro, James H Maguire. "Introduced Plasmodium Vivas Malaria in a Bolivian Community at an Elevation of 2,300 Meters."
TravelMD. Bolivia.
USAID Reducing Malaria in Migrant Populations

Malaria in Russia

Many people believe that it is impossible to contract malaria in countries that are far away from the tropics. Unfortunately, this is not the case. Even Russia is not immune to the threat of malaria.

"Dozens of people acquire malaria infections in Moscow annually". Most of these cases are "due to people who arrive in the city from southern countries", but surprisingly some people become "infected from home-grown strains of the disease" (Dmitriyev). In 2007, "128 incidents of malaria were registered in Russia. Two of the cases proved fatal. The average annual rate is 100 cases, with the bulk of them occurring in Moscow, Moscow Region and St. Petersburg" (Dmitriyev).

Because malaria is not as prevalent in Russia as it is in tropical regions of the world, "doctors in Russia often lack qualification to diagnose patients" with malaria "and provide the appropriate medical treatment in a timely fashion. Even more often, they fail to determine the exact form of the disease. This may lead to multiple after-effects resulting in the patient's death" (Dmitriyev).

Global climate change threatens to unleash new waves of malaria in Russia. From history, we can see how rises in malaria cases directly corresponds with warm years. For example, "extensive flooding in 1922 resulted in the creation of standing pools of water over wide areas of the upper Volga River basin, which resulted in an explosion of the population of ...mosquitoes" (Packard 7).

"Less than half of all malaria cases in Russia...are caused by guests from tropical countries" (Dmitriyev). Reservoirs, water-logged ditches, and stagnant ponds at parks and recreation areas provide breeding grounds for mosquitoes in Russia. In June of 2008, "the human welfare service successfully eradicated the bulk of the mosquitoes' larvae at several Moscow administrative districts" through regular spraying of these breeding areas (Dmitriyev).

Russia is also contributing to the movement to eradicate malaria worldwide. In 2007, Russia "committed $US 20 MLN to the task" of fighting malaria in Africa. In response, Dr. Brian Chituwa (Zambian Minister of Health) said, "We are confident that this significant contribution will reduce malaria deaths and bring us closer to achieving our millennium development goals" (Russia).



Sources:
Dmitriyev, Sergey. "Malaria Threat." The Moscow News. 24 Jul 2008.

Packard, Randall M. The making of a tropical disease.

"Russia Joins the Fight Against African Malaria." Russia Today. 20 Oct 2007.

Malaria in Ghana

New Release: 24 July 2009 reports prevalence of fake drugs in Ghana

Despite increased prevention efforts, Ghana is struggling to control endemic Malaria. Major roadblocks include economic deterioration, reduced effectiveness of indoor spraying & bed nets, and the importation of fake drugs to treat malaria.

In early July, US President Obama visited Ghana and "reaffirmed the United States' commitment to fighting malaria and other pressing global health needs" (Malaria Policy, President). For Ghana, the fight against malaria is one of medical and economic concern. "One infected person can indirectly infect 100 others that is how efficient the malaria mosquito is" (Afiriyie). Malaria is detrimental to the population of Ghana and the economic standing of the country. All are effected by the "debilitating effects of malaria on adult victims...In addition to time and money spent on preventing and treating malaria, it causes considerable pain and weakness among its victims. This can reduce peoples' working abilities. The adverse impact of the disease on household production and gross domestic product can be substantial. Malaria therefore is not only a public health problem but also a developmental problem." Apart "from the negative effect of lost productivity on the major sectors of the economy, malaria has negative effects on the growth of tourism, investments and trade especially in endemic regions" (Asante 8).

Every year, "huge sums of money" are "spent on malaria" treatment "even though the disease could be prevented," with the establishment of well-funded programs (Joy). Some methods of malaria control include bed-nets (mosquito nets that drape the beds to prevent mosquito bites during the night) and indoor spraying. Unfortunately, there is some indication that "Indoor Residual Spraying will never eliminate malaria in Ghana". "Hayford Siaw, Executive Director of Volunteer Partnerships for West Africa (VPWA) has expressed concern" over the investments in bed-nets and indoor spraying, saying that "The indoor residual spraying is no more effective than the bed nets, about 25% effective". Effectiveness of indoor treatment is reduced by a "genetic pre-disposition of some malaria mosquitoes" to "only bite outdoors" (Afiriyie). Still, the bed nets and indoor spraying do reduce the number of malaria cases and should not be abandoned. Other methods of eradication should be used in tandem with indoor treatments in order to effectively eliminate malaria in the region.

Ghana is working to establish and maintain programs that will diminish the mosquito population that carries malaria. "Zoomlion, a waste management company that works to improve sanitation throughout the country and fight malaria," maintains "a total of 420 'spraying gangs'" that "periodically spray mosquito breeding sites in order to stop the spread of malaria." This agency "aims to educate communities on sanitation issues and to engage young people in the cause. Their efforts have greatly improved waste issues in the region." (Malaria Policy, Ghana).

The sanitation progress is a step in reducing the "more than 3 million cases of malaria" that "are reported every year in Ghana, more than 900,000 of those cases are young children" (USAID). "45 per cent of child mortality rate recorded nationwide" in 2008 "was caused by malaria" (Joy).

International programs and various governments have stepped up to provide support for Ghana's anti-malaria campaign. It is reported that in December of 2008, China provided "medical assistance to some health practitioners in the country" of Ghana, in order to support their education about anti-malaria practices (Ghana News). In 2006 & 2007, Cuba also donated to Ghana in order to help fund the country's eradication program. Other nations have continuously provided their support to Ghana.

But, news journals have recently revealed that some anti-malarial drugs entering Ghana are fake. "Quantities of a prescription medication used throughout the world for treating malaria have been identified as lacking any active ingredient and presumably counterfeit. These are being removed from the market in Ghana, where they were discovered recently and confirmed as fake last Friday" (Pierson).

The drug (sold as Novartis Coartem{R}) lacked the ingredients necessary to effectively treat malaria. "This drug is an artemisinin-based combination therapy" and it is "recommended by the World Health Organization (WHO) for treating "uncomplicated" malaria" (Pierson).

"It has been estimated that up to 15% of all sold drugs are fake, and in parts of Africa this figure exceeds 50% , which paints a grim picture of health delivery in Ghana and elsewhere in Africa. China is emerging as a source country of counterfeit drugs. India and other Asian countries are" also "emerging as sources"(Ghanian).

"A major barrier in combating malaria throughout much of the developing world is the widespread presence of counterfeit and adulterated drugs, which undermines the public health. Not only do these drugs fail to deliver the appropriate treatment to individual patients--putting their lives at risk, but they contribute to the growth of drug-resistant strains of malaria, one of the greatest challenges to malaria control today" (Pierson).


"The FDB [Food & Drug Board] knows more than anyone that the drug counterfeit business is a multi-million dollar business globally, which is gaining roots in Ghana, the emerging gateway to everything...The production of substandard and fake drugs is a vast and under-reported problem, particularly affecting poorer countries. It is an important cause of unnecessary morbidity, mortality, and loss of public confidence in medicines and health structures" (Ghanian).

"Mr. Anthony Ofori, Brong Ahafo Regional Co-coordinator of Malaria Control," requests "effective collaboration between non-governmental organisations (NGOs), corporate bodies and the health authorities in the campaign against malaria in the country" (Joy). Malaria is endemic throughout the entire country (See map). Ghana is in dire need of positive international assistance in the war against malaria.

Note About Malaria:
"Malaria is integrally tied to maternal and child health in Africa." Each year pregnant women and children suffer and die from the infectious parasite. "Effective malaria control programs" are "vital to helping health systems adequately care for mothers and children," (Malaria Policy, President). "The effect of malaria on people of all ages is quite immense. It is however very serious among pregnant women and children because they have less immunity" (Asante 7).

A Note about Donations:
If you would like to donate to the cause, please visit the Malaria No More site.
At this time, Infectious Bite is not accepting donations. Please donate directly to a reputable agency.

Sources:
Afiriyie, Constance. Volunteer Partnerships for West Africa. "Indoor Residual Spraying will never eliminate malaria in Ghana."

Asante, Felix Ankomah. Kwadwo Asenso-Okyere. Economic Burden of Malaria in Ghana.

Ghanian Journal, The. "Let's do away with fake drugs". 24 July 2009.

Ghana News Agency (via fmprc.gov). China donates anti-malaria drugs to Ghana.

Joy Online. Ghana needs effective collaboration in malaria campaign.

Malaria Policy Center: President Obama Visits Ghana and Reaffirms U.S. Commitment to Fight Malaria.

Malaria Policy Center: Ghana fights malaria by improving sanitation.

Pierson, Francine. US Pharmacopeia. "Counterfeit Antimalarial Drug Discovered in Ghana with Aid of USP Drug Quality and Information Program". 22 July 2009.

USAID Press Release. USAID Administrator Tours Ghana Malaria Control Center.

Halting Malaria Transmission

Brought to my attention by @sarahsearle

"Researchers at the Johns Hopkins Malaria Research Institute have for the first time produced a malarial protein" that can "generate a significant immune response" and be used to create "a potential transmission-blocking vaccine" (Parsons). Antibodies produced in response to the protein, inhibit the "sexual development of the malaria-causing parasite, Plasmodium, as it grows within the mosquito".

"According to the study, a single-dose vaccine provided a 93 percent transmission-blocking immune response, reaching greater than 98 percent after a booster was given several months later" (Parsons).

Humans are on the verge of successfully creating a vaccine that may inhibit the spread of malaria. In the late 1980s, scientists understood the possibility of transmission-blocking immunity. They discovered that individuals can "develop immunity that suppresses the infectivity of the sexual stages of the parasite." This "immunity is antibody mediated and is directed against the parasites in the mosquito midgut shortly after ingestion of blood by a mosquito." In 1987, scientists declared that "This immunity could be expected to have significant effects on the natural transmission of P. vivax malaria" (Mendis).

"Development of a successful transmission-blocking vaccine is an essential step in efforts to control the global spread of malaria" (Kumar). This study indicates that "it is possible to gradually reduce malaria transmission to a point of almost eradication" (Parsons).

Sources:
Kumar, Nirbhay.

Mendis, K N. Y D Munesinghe, Y N de Silva, I Keragalla, and R Carter. Malaria transmission-blocking immunity induced by natural infections of Plasmodium vivax in humans. 1987 February.

Parsons, Tim. Vaccine Blocks Malaria Transmission in Lab Experiments. 22 July 2009.

Malaria in China

China has seen a resurgence of Malaria in recent years. "China reported about 24 million malaria cases in the 1970s, the number of cases declined to several hundred thousand by the late 1990s. However, the disease recently has "re-emerged" in China's central and southern provinces, possibly as a result of insufficient prevention work" (Global).

China suffers from Falciparum malaria which "is the most deadly among the four main types of human malaria. Although great success has been achieved since the launch of the National Malaria Control Programme in 1955, malaria remains a serious public health problem in China" (Lin). "Falciparum malaria was endemic in two provinces of China during 2004–05" (Lin). "The 'level one' areas have an annual malaria incidence of more than one case per 10,000 people, while the 'level two' regions have an annual incidence of less than one per 10,000 people" (Global).


Map provided by Travax

"Imported malaria was reported in 26 non-endemic provinces. Annual incidence of falciparum malaria was mapped at county level in the two endemic provinces of China: Yunnan and Hainan. The sex ratio (male vs. female) for the number of cases in Yunnan was 1.6 in the children of 0–15 years and it reached 5.7 in the adults over 15 years of age" (Lin).

The recent resurgence of malaria in China has prompted "China's Ministry of Health" to draft a "plan to eliminate malaria from the country by 2015" (Xinhuanet). "Central and local governments will provide funding for the malaria control programs, an unnamed official from the health ministry's disease control department said." "The plan aims to reduce malaria incidence to less than one case per 10,000 people in high-burden regions and to no cases in low-burden regions between 2010 and 2015" (Global).

Sources:
Global Health Reporting. "Malaria | China Develops Nationwide Malaria Eradication Plan". 10 April 2009.

Lin, Hualiang. Liang Lu, Linwei Tian, Shuisen Zhou, Haixia Wu, Yan Bi, Suzanne C Ho, Qiyong Liu. Spatial and temporal distribution of falciparum malaria in China.

Xinhuanet. "China lays out plans to quell malaria" http://news.xinhuanet.com/english/2009-04/10/content_11163891.htm 10 April 2009.

Malaria in Libya

Malaria is rare in the desert regions, but Libya has reported some cases of Malaria outbreaks and fears the invasion of mosquitoes carrying the deadly disease.


Map provided by Wikimedia Commons

For the most part, the natural climate of Libya protects it from Malaria outbreak. Libya "is an extremely arid North African country extending southwards from the Mediterranean into the Sahara" (Ramsdale). "Many Libyan oases, like those in other parts of the Sahara, have a history of occasional outbreaks of malaria involving Plasmodium vivax" (Grassi and Feletti) and P. farcipamm (Welch). "The latter species of malaria parasite has been eradicated from the Mediterranean basin but still predominates in Africa south of the Sahara" (Ramsdale).

Although Libya is safe within the Mediterranean basin and sheltered by the Sahara, it is still at risk for malaria. "In Libya, a continuing influx of foreign workers, many from highly malarious parts of the world, ensures the maintenance of a parasite reservoir probably larger than at any time in the past" (Ramsdale). "Malaria was endemic in libya until 1973 where it was declared by WHO to be a country free of malaria" (Kraza). "The situation continued like this until 1976 where there was an epidemic of febrile illness among petroleum company workers ...blood slides of all" cases "were positive for falciparum malaria, reconfirmed in a referral lab" (Kraza). In 2004, cases of malaria were again discovered in Libya. "All cases" were "confirmed microscopically" and were considered "imported, except for one case thought to be introduced" from an imported case (Kraza). The National Center for Infectious Diseases Prevention and Control cites the mission purpose "to prevent reemergence of malaria transmission in the country and to control imported malaria" (Kraza).

The potential for introduction of the fatal malaria parasite is possible in Libya. The feeling of safety against malaria that has developed in Libya in recent years may be dangerous. It is important to remain vigilant in diagnosing new cases and educating the populace about malaria avoidance.

Sources:
Kraza, Ibrahim. "Malaria in Libyan Jamahirya during 2004". National Center For Infectious Diseases Prevention and Control. Damascus 2005.
Ramsdale, C.D. Mosquito Systematics. "Anopheles: Mosquitoes and Imported Malaria in Libya." Vol 22, No.1.
Wikimedia Commons. Location Libya.

Malaria in Mexico

Mexico is successfully combating the malaria infection and "has made substantial" advances "in decreasing its malaria burden," according to the Center for Disease Control (CDC). There has been no reported death in Mexico attributed to malaria since 1982.

"The risk of Malaria in Mexico low" (Traveldoctor). Infections caused by the most severe form of malaria (P. falciparum) account for less than 1% of cases. Furthermore, the number of reported cases has also dropped significantly in that time. "Between 1985 and 2003, the numbers of reported cases decreased by 97%, to 3,819 cases in 2003" (CDC).

The climate of Mexico yields itself to the spread and breeding of malaria; however, the country has nearly eradicated the disease in many regions. "17 of the country's 32 states have not reported any case of malaria during the past 4 years, and are in the process of being certified as having eliminated malaria" (CDC).

Mexico attributes its success to a strategy of "intensive surveillance". "In such areas, patients and their families are treated repeatedly with antimalarial drugs; breeding sites for mosquito larvae are destroyed or treated; and pyrethroid insecticides are sprayed as needed, inside houses and outdoors" (CDC). Mexico is also taking measures to safeguard the ecosystems, by "introducing new strategies to prevent malaria outbreaks -- without the help of DDT" (IDRC).

Mexico's success inspires other countries in the region to make moves to eradicate malaria within their borders.

Sources:
CDC: Centers for Disease Control and Prevention. "Malaria Nobel Prizes". 26 January 2005.
IDRC Archive. "Controlling Malaria in Mexico Using Alternatives to DDT". 14 September 2001.
TravelDoctor. "Mexico". 13 July 2009.

Malaria in Malawi

"Malaria is one of Malawi's most serious heath problems" (CDC). The most common malaria found in Malawi is the Plasmodium falciparum, which is "also the most lethal malaria parasite".

The entire population of Malawi is at risk for Malaria, and the highest concern is for children and pregnant women, who are victims of the most severe cases. "In 2001, malaria accounted for 22% of all hospital admissions, 26% of all outpatient visits, and 28% of all hospital deaths. Not all people go to hospitals when sick or having a baby and many die at home, and thus the true numbers are likely much higher" (CDC).

National programs have been established in Malawi to combat malaria. Malawi's National Malaria Control Programme (NMCP) and The National Malaria Technical Committee seek to reduce the cases of malaria in Malawi by using the Roll-back malaria strategy[Website: Roll Back Malaria]. First-line treatment includes the antimalarial drug, sulfadoxine-pyrimethamine, administered as both a medicine and prevention. Insecticide mosquito nets are distributed in Malawi, but their use and spread is limited due to lack of funds. Consquently, 40% of all deaths in this region are considered to be related to malaria (USAID).

Malaria in India

Ancient records describing malaria have emerged from India. "Details of this disease can be found even in the ancient Indian medical literature like the 'Charaka Samhita'" (Malaria). More recent history has been more tumultuous with crests and falls in numbers of infected individuals.

Since the 1947 epidemic, India has greatly reduced the number of deaths due to Malaria, but the disease is still a threat in many regions. In 2006, there were over 1.04 million documented cases of Malaria, with 890 ending in death. Resurgences of the disease were seen during the 1970s due to DDT shortages, and in the 1990s due to the emergence of mosquitoes that were resistant to insecticide. During the periods "of resurgence of malaria, certain states of the Union of India like Uttar Pradesh, Bihar, Karnataka, Orissa, Rajasthan, Madhya Pradesh and Pondichery are found to be worst affected" (Malaria). In the 1990s, malaria was considered "endemic in all of India except at elevations above 1800 meters and in some coastal areas" (Sharma, 1996a). However, "the total number of cases of malaria in India has stabilized somewhat over the past ten years" (Brown).

Some accuse the local and national governments of failing to report the correct number of malaria cases and assert that the actual severity of malaria in India is much greater than it appears. "India has always under-reported its malaria cases, government officials admit off the record. But the scope of the hidden problem has become astounding. While the official figures state that in 2008 India had 1.5 million malaria cases, resulting in 924 deaths, the real number of deaths is higher by several orders of magnitude" (Neelakantan). While 924 deaths from malaria were reported last year, some accusers claim that the "real number of malaria-related deaths in India was closer to 40,000 in 2008." The assertions are made by various non-governmental sources and some government officials who didn't want to be named. Since these sources prefer to remain anonymous, no conclusive evidence can be derived. Regardless, these statements may lead to further questioning and investigation in anti-malaria programs within India.

All visitors to India should note that malaria does "occur in most parts of India (including large cities). According to the World Health Organization, every year in India an estimated 2 million cases of malaria occur, with 1,000 deaths; and 95% of the population live in malaria-risk areas" (CDC.gov).

The Threat of Drug Resistant Malaria

Recent tests indicate that the most common malaria strains are becoming resistant to combination treatments in vulnerable areas. "Selected trials" showed "high failure rates for some combinations" of medicines. Anti-malarial treatments must be questioned, particularly in susceptible regions (Wiley).

The most common type of malaria parasite causes uncomplicated malaria, which is a mild form of the disease. However, if this strain remains untreated, it can develop into a life-threatening condition. "Resistance" of this strain "to the older antimalarials has led the WHO to recommend treatments combining" a fast-acting drug with a "longer-lasting drug to combat resistance."

Malaria can be a difficult disease to cure and is most often treated with a combination of medicines. During the recent tests, "there were examples of treatment failure rates above 10% for all evaluated combinations." According to the WHO, this exceeds the "maximum allowable failure rate for a first line antimalarial" treatment.

A recently introduced drug, dihydroartemisinin-piperaquine, performed well when compared to the standard treatment of artemisinin-based combination therapies (ACTs). This new treatment "offers another potential first-line therapy for the disease".

"Patterns of resistance change from place to place and over time," so continued testing of infected individuals and monitoring of progress is necessary to ensure successful treatment. These research and medical programs are costly, and severely underfunded. If you would like to contribute money to malaria research, please visit the following sites.

Anti-malaria agencies:

• Roll Back Malaria Partnership: Index of non-profit organizations that fight malaria (and need donations)
• United Nations Foundation: With your donation you are helping us expand the worldwide fight against disease, poverty, climate change, and conflict

(Infectious bite is not currently accepting donations. Please see the appropriate agencies for information on donations)

Source:
Wiley-Blackwell. "Continued Vigilance Against Drug-resistance Malaria Is Needed." ScienceDaily 7 July 2009. 9 July 2009 < http://www.sciencedaily.com­ /releases/2009/07/090707201209.htm >.

Spread of Malaria

Undoubtedly, mosquito bites are the most common way that malaria is spread. Specifically, the female anopheles mosquito is most often the culprit of infection. There are approximately sixty varieties of this mosquito.

How mosquitoes spread malaria:
When an infected individual is bitten by a mosquito, the insect ingests the gametocytes (reproductive forms of the parasite) with the blood. These gametocytes continue in the sexual phase of their cycle. Soon sporozoites (cells that infect new hosts) develop and fill the salivary glands of the mosquito. When the mosquito bites the next person, it injects the sporozoites into the human blood stream along with its saliva.

Most mosquito bites occur between 17:00 (5PM) and 07:00.

Other ways malaria is spread:
Mosquito bites are not the only way that malaria is spread. Other common methods of infection include:

1. Blood transfusions
2. Congenital infection
3. Blood-instrument transmission

Infection through Blood Transfusions:
Infection through blood transfusions is a common problem in areas where malaria is rampant. Even when an individual no longer feels sick from malaria, he/she can still transmit the disease via blood transfusion. Infectious periods differ by malaria strain, but for all strains the malaria may remain in the bloodstream for a number of years.

The duration of time malaria remains infectious by strain:
P. falciparum: 1-3 years
P. vivax: 3-4 years
P. malariae: 15+ years (duration may be for life)

Infections through blood transfusions occur when the blood is not stored properly for a long enough period of time. Most infections occur when blood is stored less than five days. It is rare for blood that has been stored over two weeks to transmit the disease. Frozen plasma is not considered infectious.

Blood can be tested for the infectiousness through the indirect fluorescent antibody test or Enzyme-linked immunosorbent assay (ELISA). Visual examination of the blood manually cannot deliver conclusive results.

Another method to reduce the spread of malaria through blood transfusion is to administer chloroquine to the transfusion recipients. Chloroquine is used to prevent malaria from Plasmodium vivax, ovale and malariae.

Congenital Infection:
"80% of deaths due to malaria in Africa occur in pregnant women and children below 5 years. In Africa, perinatal mortality due to malaria is at about 1500/day" (Malaria Site). Physiological changes within the pregnant woman increases the severity of malaria symptoms. Morbidity may be caused by anemia, high fever, pulmonary edema, puerperal sepsis, and hemorrhage.

The infection may be spread from the mother to the child during pregnancy; however this occurs in less than 5% of malaria cases. Congenital malaria is most common in the first pregnancy. Generally, the placenta protects the child from the infection. However, it is possible for transmission to occur prenatally. Babies who contract the disease congenitally are born with symptoms of malaria. Also, infants born to a mother with malaria may be premature, underweight, or stillborn. Malaria and pregnancy are

Blood-instrument transmission:
Instruments that come in contact with blood (including surgical instruments and needles) may transmit the disease. Much like HIV, malaria can be spread through any contact with the blood of an infected individual. Needles (particularly those used in relation to recreational drugs) may transmit malaria if they are shared. At times, malaria was transmitted unintentionally by medical personnel seeking to inoculate against infectious diseases. Medical personal no longer uses the same needles for multiple individuals, so this risk has decreased dramatically. Intravenous drug users can still transmit the disease if needles are shared between individuals.

Note: People have been intentionally infected with malaria (via needles) as a treatment for syphilis because it produced prolonged high-fevers.

Malaria is a disease that can be treated and in some cases prevented. For information how you can help support malaria research and treatment programs, please visit: The Roll Back Malaria Partnership. Infectious bite is not currently accepting money. All donations should be directed through the individual programs.

Sources:
The Malaria Site. 6 July 2009.
Roll Back Malaria Partnership. 30 June 2009.
World Health Organization: Malaria. 26 June 2009.
Center for Disease Control: Malaria. 26 June 2009.