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University of Toronto Scarborough
Health Studies
Caroline Barakat

Lecture 8: Malaria History -Old disease -‘Nei Chang’ (2700 BC) -Hippocratic corpus: "Those who drink [stagnant water] have always large, stiff spleens and hard, thin, hot stomachs, while their shoulders, collarbones, and faces are emaciated; the fact is that their flesh dissolves to feed the spleen..." -Recognizes spleenic changes -two different types of malaria: every third day and every fourth day -Roman Fever -Belief– resulting from poisonous vapours that emanate from ‘Roman Campagna’ -mal’aria i.e. ‘bad air’ -12 century - Spain and Russia -14 century - England th -15 century - New world -1800s - worldwide -19 century - prevalent in the Mississippi Valley, NE US, American subtropics and tropics including Carribean ‘Malaria’ in Literature -Dante [1265-1321] : "As one who has the shivering of the quartan so near,/ that he has his nails already pale/ and trembles all, still keeping the shade,/ such I became when those words were uttered." (The Inferno) He died of malaria -William Shakespeare (1564–1616) - “ague” (English word for malaria) History -Charles Louis Alphonse Laveran (1845 – 1922) –observe black-brown malaria pigment in infected blood – a process he called exflagellation (1880) -1898-Robert Koch argued that human malaria was caused by a mosquito bite but was unsuccessful in his efforts Ronald Ross & Patrick Manson -Mentored by Manson, Ross performed a series of experiments -Examined the stomachs of thousands of mosquitoes; observed specific species of mosquitoes needed “Anopheles” -Observed wartlike oocysts that developed 4 -5 days after feeding on infected blood -Observed stripes or ridges that develop 7 – 8 days later -Discovered the infectious stages in the mosquito salivary glands in sparrows -In 1898, Giovanni Battista Grassi was able to report that the Anopheles claviger, was the carrier of human malaria Epidemiology (WHO, 2006) -Killed more than half the people who have ever lived on this planet -Every 10-30 seconds a person dies of malaria -300 – 500 M cases of malaria each year -2 – 3 M deaths annually -Majority is among children aged 5 years or younger -Currently endemic in over 100 countries -Most prevalent in rural tropical areas below elevations of 1000 m -Plasmodium falciparum is found mostly in the tropics -P. falciparum and P. vivax account for 95% of infections -P. vivax is distributed more widely than P. falciparum, but it causes less morbidity and mortality Areas of Concern 90% in Africa and common in tropics and south East Asia, central/south America Global malaria -First spatial map of global malaria risk: many of the people exposed to malaria are at a lower risk than previously thought -Malaria Atlas Project (MAP) (2008) found that 2.37 billion people are at risk of contracting malaria from P. falciparum- but about 1 billion of them live under a much lower risk of infection than was assumed by previous historical maps -50% of global population -China, Indonesia, Philippines, Solomon Islands, Sudan, Vanuatu and Yemen have subnational elimination programmes Epidemiology in Canada -Reportable communicable disease in Canada since 1929 -No longer endemic in Canada - imported disease -Number of imported cases varies generally around 400 cases annually (1,036 reported cases in 1997) -Estimated that only 30% to 50% of cases are reported to public health agencies Reported Cases in US 1995 – 2004: 7,944 cases of malaria - 4,959 (62%) were acquired in sub-Saharan Africa - 1,310 (19%) in Asia - 1,271 (16%) in the Caribbean and Central and South America - 273 (3%) in other parts of the world -43 fatal infections: 38 (88%) were caused by P. falciparum, of which 34 (80%) were acquired in sub-Saharan Africa Etiology -Acute flu-like illness caused by parasite of the genus Plasmodium -4 specific to humans -Plasmodium falciparum (high risk of a fatal infection) –cause cerebral malaria / malignant tertian malaria -Plasmodium vivax -Plasmodium ovale -Both P. vivax and P. ovale can cause relapse after clinical recovery -Plasmodium malariae (quartan malaria – may occur after many years) Mode of Transmission -Caused by the bite of a female Anopheles species mosquito (vector = carrier ) that is infected with the genus Plasmodium -Anopheles mosquito ingests blood from a malaria-infected person -Parasites develop and migrate into the salivary glands -Infec
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