16 March 2017

South Africa: Malaria Has Not Expanded in SA

Pretoria — The National Institute for Communicable Diseases (NICD) says the malaria cases that have been reported in parts of the country's northern provinces do not represent an expansion in the malaria transmission areas in South Africa.

A number of malaria cases have been reported in parts of Limpopo, North West and Gauteng provinces in the last few weeks. In Limpopo, the north-eastern parts of the province are traditional malaria transmission areas.

The NICD said about 49 cases of malaria have been confirmed in the rural areas of Limpopo, including Thabazimbi and Lephalale.

"This area in the western Waterberg was historically prone to malaria during favourable transmission years, so this is not totally unexpected. Limited seasonal transmission also occurs in parts of southern Sekhukhune.

"There have been a number of initiatives in response to these cases by the malaria control programme in Limpopo. The community have been informed of the signs and symptoms of malaria and to seek early medical attention. The health facilities in the area have adequate supplies of malaria diagnostic tests and medication for treatment," said the NICD.

Vector control intervention commenced last week and about 200 homes, mainly along the Lephalale River, have been sprayed with long-acting insecticides applied to indoor walls. Malaria surveillance teams are permanently placed in Waterberg to detect and manage malaria appropriately.

Vector control is any method to limit or eradicate insects, mammals and birds, which transmit diseases.

"Over the past few days, there have been no malaria cases confirmed in this area and it is likely that this malaria focus is coming under control. The ambient temperatures are starting to decrease in the area.

"During the summer rain period, between September and April, malaria transmission occurs annually in the north-eastern parts of Limpopo bordering Mozambique and Zimbabwe.

"[About] 42 malaria teams from the Limpopo Department of Health are fully operational in these communities, with indoor residual spraying as a major control intervention," the NICD said.

Normally, low numbers of cases are reported from Waterberg. However, it is viewed as an area with potential for malaria transmission.

"Every notified malaria case is fully investigated and preventative measures are introduced where appropriate. All health facilities in Limpopo are prepared to deal with increased malaria cases. Primary health care facilities can all test for malaria and treatment is available at this level. All hospitals also have access to the latest malaria treatment regime available," said the NICD.

Cases in Tshwane and North West

The organisation also said it was notified of two people with malaria from Doornpoort, a suburb in the northern part of the City of Tshwane, and two patients from Swartruggens in the North West province.

"None of these people had travelled to a known malaria transmission area. Unfortunately three of the patients passed away due to complications of malaria.

"These incidents are rare but a few cases of the so-called 'Odyssean' malaria or 'mini-bus' or 'suitcase' malaria are confirmed mainly in Gauteng province each year and coincide with the seasonal increase in malaria cases in the usual malaria transmission areas from January to April."

It said there is no link between the cases in Tshwane and those in Swartruggens and the cases do not represent an expansion in the malaria transmission areas in South Africa but rather to translocation of an infected malaria mosquito from a malaria area.

"Given that females of certain Anopheles mosquito species are responsible for transmitting malaria parasites, an investigation of the two residences and environs in Tshwane and Swartruggens was carried out.

"No anopheles mosquito adults or larvae were found. There are Culex mosquitoes breeding in the general area as expected but Culex mosquitoes never transmit malaria.

"The evidence available therefore suggests that these cases did not result from local transmission in Tshwane and Swartruggens but from translocation of infected mosquitoes from a malaria risk area in a vehicle or suitcase as a very uncommon event -- most mosquitoes would in fact not survive the journey."

All healthcare practitioners are encouraged to consider malaria as a differential diagnosis in all patients presenting with unexplained fever, body temperature above 38°C and flu-like illness, especially in the presence of a change in the level of consciousness and/or progressive jaundice, even in the absence of a travel history to a malaria-endemic region.

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