Malaria time series in the extra-Amazon region of Brazil: epidemiological scenario and a two-year prediction model

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Abstract

Background

In Brazil, malaria is caused mainly by the Plasmodium vivax and Plasmodium falciparum species. Its transmission occurs in endemic and non-endemic areas. Malaria geography in Brazil has retracted and is now concentrated in the North region. The Brazilian Amazon region accounts for 99% of Brazil's cases. Brazil’s extra-Amazon region has a high frequency of imported cases and in 2019 presented a mortality rate 123 times higher than the Amazon region. Extra-Amazon cases present risks of reintroduction. This study aims to characterize the epidemiological scenario for malaria in the extra-Amazon region of Brazil from 2011 to 2020 with a two-year forecast.

Methods

Time-series study with description of malaria cases and deaths registered in Brazilian extra-Amazon region from 2011 to 2020. Public data from the Notifiable Diseases Information System (Sinan) and the Mortality Information System (SIM) were used. Descriptive analysis, incidence, and notification rates were calculated. Flow charts analysed the flux between Places of Probable Infection (PI) and places of notification. The prediction model utilized a multiplicative Holt-winters model for trend and seasonality components.

Results

A total of 6849 cases were registered. Cases were predominantly white males with 9 to 11 years of education, mostly between 30 and 39 years old. Imported cases accounted for 78.9% of cases. Most frequent occupations for imported cases are related to travelling and tourism activities. Among autochthonous cases, there is a higher frequency of agriculture and domestic economic activities. In the period there were 118 deaths due to malaria, of which 34.7% were caused by P. falciparum infections and 48.3% were not specified. The most intense flows of imported cases are from Amazonas and Rondônia to São Paulo, Rio de Janeiro, and Paraná. The prediction estimates around 611 cases for each of the following two years.

Conclusion

The time series allows a vast epidemiological visualization with a short-term prediction analysis that supports public health planning. Government actions need to be better directed in the extra-Amazon region so the objective of eliminating malaria in Brazil is achieved. Carrying out quality assessments for information systems and qualifying personnel is advisable. Malaria outside the Amazon region is mainly due to imported cases and delay in diagnosis is associated with a higher fatality rate. Better strategies to diagnose and treat suspected cases can lead to lower risk of deaths and local outbreaks that will be important for achieving malaria elimination in Brazil.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12936-022-04162-1.

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Most cited references 24

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Malaria in Brazil: an overview

Joseli Oliveira-Ferreira, Marcus Lacerda, Patrícia Brasil … (2010)

Malaria is still a major public health problem in Brazil, with approximately 306 000 registered cases in 2009, but it is estimated that in the early 1940s, around six million cases of malaria occurred each year. As a result of the fight against the disease, the number of malaria cases decreased over the years and the smallest numbers of cases to-date were recorded in the 1960s. From the mid-1960s onwards, Brazil underwent a rapid and disorganized settlement process in the Amazon and this migratory movement led to a progressive increase in the number of reported cases. Although the main mosquito vector (Anopheles darlingi) is present in about 80% of the country, currently the incidence of malaria in Brazil is almost exclusively (99,8% of the cases) restricted to the region of the Amazon Basin, where a number of combined factors favors disease transmission and impair the use of standard control procedures. Plasmodium vivax accounts for 83,7% of registered cases, while Plasmodium falciparum is responsible for 16,3% and Plasmodium malariae is seldom observed. Although vivax malaria is thought to cause little mortality, compared to falciparum malaria, it accounts for much of the morbidity and for huge burdens on the prosperity of endemic communities. However, in the last few years a pattern of unusual clinical complications with fatal cases associated with P. vivax have been reported in Brazil and this is a matter of concern for Brazilian malariologists. In addition, the emergence of P. vivax strains resistant to chloroquine in some reports needs to be further investigated. In contrast, asymptomatic infection by P. falciparum and P. vivax has been detected in epidemiological studies in the states of Rondonia and Amazonas, indicating probably a pattern of clinical immunity in both autochthonous and migrant populations. Seropidemiological studies investigating the type of immune responses elicited in naturally-exposed populations to several malaria vaccine candidates in Brazilian populations have also been providing important information on whether immune responses specific to these antigens are generated in natural infections and their immunogenic potential as vaccine candidates. The present difficulties in reducing economic and social risk factors that determine the incidence of malaria in the Amazon Region render impracticable its elimination in the region. As a result, a malaria-integrated control effort - as a joint action on the part of the government and the population - directed towards the elimination or reduction of the risks of death or illness, is the direction adopted by the Brazilian government in the fight against the disease.

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A global map of dominant malaria vectors

Marianne Sinka, Michael J Bangs, Sylvie Manguin … (2012)

Background Global maps, in particular those based on vector distributions, have long been used to help visualise the global extent of malaria. Few, however, have been created with the support of a comprehensive and extensive evidence-based approach. Methods Here we describe the generation of a global map of the dominant vector species (DVS) of malaria that makes use of predicted distribution maps for individual species or species complexes. Results Our global map highlights the spatial variability in the complexity of the vector situation. In Africa, An. gambiae, An. arabiensis and An. funestus are co-dominant across much of the continent, whereas in the Asian-Pacific region there is a highly complex situation with multi-species coexistence and variable species dominance. Conclusions The competence of the mapping methodology to accurately portray DVS distributions is discussed. The comprehensive and contemporary database of species-specific spatial occurrence (currently available on request) will be made directly available via the Malaria Atlas Project (MAP) website from early 2012.

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Ecology of Anopheles darlingi Root with respect to vector importance: a review

Hélène Hiwat, Gustavo Bretas (2011)

Anopheles darlingi is one of the most important malaria vectors in the Americas. In this era of new tools and strategies for malaria and vector control it is essential to have knowledge on the ecology and behavior of vectors in order to evaluate appropriateness and impact of control measures. This paper aims to provide information on the importance, ecology and behavior of An. darlingi. It reviews publications that addressed ecological and behavioral aspects that are important to understand the role and importance of An. darlingi in the transmission of malaria throughout its area of distribution. The results show that Anopheles darlingi is especially important for malaria transmission in the Amazon region. Although numerous studies exist, many aspects determining the vectorial capacity of An. darlingi, i.e. its relation to seasons and environmental conditions, its gonotrophic cycle and longevity, and its feeding behavior and biting preferences, are still unknown. The vector shows a high degree of variability in behavioral traits. This makes it difficult to predict the impact of ongoing changes in the environment on the mosquito populations. Recent studies indicate a good ability of An. darlingi to adapt to environments modified by human development. This allows the vector to establish populations in areas where it previously did not exist or had been controlled to date. The behavioral variability of the vector, its adaptability, and our limited knowledge of these impede the establishment of effective control strategies. Increasing our knowledge of An. darlingi is necessary.

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Author and article information

Contributors

Klauss Kleydmann Sabino Garcia:

ORCID: http://orcid.org/0000-0003-2268-8742

kleydmann25@gmail.com

Journal

Journal ID (nlm-ta): Malar J

Journal ID (iso-abbrev): Malar J

Title: Malaria Journal

Publisher: BioMed Central (London )

ISSN (Electronic): 1475-2875

Publication date (Electronic): 31 May 2022

Publication date PMC-release: 31 May 2022

Publication date Collection: 2022

Volume: 21

Electronic Location Identifier: 157

Affiliations

[1 ]GRID grid.7632.0, ISNI 0000 0001 2238 5157, Tropical Medicine Center, , University of Brasilia, Darcy Ribeiro University Campus, ; Brasília, Brazil

[2 ]Health Ministry of Brazil, Federal District, Brasilia, Brazil

[3 ]GRID grid.472940.c, ISNI 0000 0004 0566 2142, Federal Institute of Education, Science and Technology of Tocantins, , IFTO, ; Araguaína, Brazil

[4 ]GRID grid.418068.3, ISNI 0000 0001 0723 0931, FIOCRUZ, Evandro Chagas National Institute of Infectious Diseases, ; Av. Brasil, Rio de Janeiro, RJ 4365 Brazil

[5 ]GRID grid.442239.a, ISNI 0000 0004 0573 2534, School of Medicine, , Centro Universitário Serra Dos Órgãos (UNIFESO), ; Teresópolis, RJ Brazil

Author information

Klauss Kleydmann Sabino Garcia http://orcid.org/0000-0003-2268-8742

Article

Publisher ID: 4162

DOI: 10.1186/s12936-022-04162-1

PMC ID: 9153870

PubMed ID: 35641976

SO-VID: 7655acad-854a-4a6b-a1db-223d907957e4

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 12 November 2021

Date accepted : 13 April 2022

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000865, Bill and Melinda Gates Foundation;

Award ID: INV-003970

Award Recipient : André Machado Siqueira

Funded by: FundRef http://dx.doi.org/10.13039/501100006506, Ministério da Saúde;

Award ID: MoH/DECIT/CNPq (443148/2019-8)

Award Recipient : André Machado Siqueira

Custom metadata

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: malaria,malaria case,epidemiology,public health,control; elimination,extra-amazon

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: malaria, malaria case, epidemiology, public health, control; elimination, extra-amazon

Malaria time series in the extra-Amazon region of Brazil: epidemiological scenario and a two-year prediction model

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Supplementary Information

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SDG 3: Good Health and Well-Being

Most cited references 24

Malaria in Brazil: an overview

A global map of dominant malaria vectors

Ecology of Anopheles darlingi Root with respect to vector importance: a review

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