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Lecture

week 9 - Malaria

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Department
Health Studies
Course
HLTB21H3
Professor
Caroline Barakat
Semester
Fall

Description
HLTA01 – week 9 November, 3 2011 Malaria Lecture Outline – Historical context – Epidemiology – Etiology – Mode of transmission – Clinical manifestations – Treatment and Prevention 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..." – This quote is not completely correct, but it does show that there are records of Malaria this early in history – Roman Fever – Belief– resulting from poisonous vapours that emanate from ‘Roman Campagna’ – mal’aria i.e. ‘bad air’ – (Roman) th – 12 century - Spain and Russia – 14 century – England – 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 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 • Anopheles Claviger – the only misquito that is able to be a vector 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 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 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 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 T
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