Malaria in Myanmar (Burma)

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QUESTION

Is Malaria an issue in Myanmar where I am going in June?

ANSWER from Malaria.com Editor

YES. Malaria is a risk in all rural areas of the country below 1,000 meters of altitude (anything below 3300 feet). Rangoon/Yangon and Mandalay do not have malaria.

You should take medication to prevent malaria (prophylaxis) throughout your stay, and also protect yourself from getting bitten by mosquitoes if you are travelling to risk areas for malaria. Personal protection measures including sleeping under an insecticide treated bednet, wearing insect repellent and wearing long-sleeved clothing, especially in the evenings, early morning and throughout the night, which is when the mosquitoes that transmit malaria are active and feeding.

Myanmar/Burma is known to have strains of malaria which are resistant to certain medications; specifically, chloroquine resistance is widespread, while some areas in addition have malaria which is resistant to mefloquine (sold as Lariam). As such, the CDC recommends atovaquone-proguanil (sold as Malarone) or doxycycline if you will be travelling in the provinces of Bago, Kachin, Kayah, Kayin, Shan, and Tanintharyi. In all other areas of the country, mefloquine should also be considered as an option.

Answer from Malaria.com medical advisor

For anyone planning a trip abroad its important to know the health risks in your destination. Malaria is an especially important concern for anyone traveling to tropical or subtropical regions. Here’s what I found on the CDC Travelers’ Health website. I find this is the best place to look for this information.

  • Areas of Burma with Malaria: Rural areas throughout the country at altitudes
  • If you will be visiting an area of Burma with malaria, you will need to discuss with your doctor the best ways for you to avoid getting sick with malaria. Ways to prevent malaria include the following:
  • Taking a prescription antimalarial drug.
  • Using insect repellent and wearing long pants and sleeves to prevent mosquito bites. Sleeping in air-conditioned or well-screened rooms or using bednets.
  • Some areas of Burma have resistance to certain antimalarial drugs.

See the malaria information for Burma to find out which antimalarial drug is appropriate for the area you plan to visit in Burma.

Chloroquine Resistant Malaria

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QUESTION

What is chloroquine resistant malaria?

ANSWER

Chloroquine-resistant malaria is exactly what it sounds like—particular types of malaria which are not cured by treatment with chloroquine.

Chloroquine was first discovered in the 1930s in Germany and began to be widely used as an anti-malaria post-World War II, in the late 1940s. However, resistance to the drug also rapidly emerged, with the first cases of Plasmodium falciparum not being cured by administration of chloroquine being reported in the 1950s.

Since then, resistance has spread rapidly (since obviously it is beneficial to the parasite to be resistant, so various mutations conferring this protection have arisen multiple times in different areas in the world and also been passed on preferentially to new generations of malaria parasites), and now chloroquine resistant P. falciparum can be found globally in malaria-endemic areas.

Chloroquine resistance in Plasmodium vivax has also now arisen, though more recently—the first reports came from 1989, in Australia, in travellers returning from Papua New Guinea. Now, chloroquine resistant forms of P. vivax are found in multiple locations in south-east Asia, such as Myanmar and India, as well as from Guyana in South America.

Nowadays, other drugs, and notably ones containing artemisinin-based compounds, are preferentially used to treat uncomplicated malaria and especially in areas where chloroquine resistance is known to occur. However, due to fears of resistance to these compounds also developing, the World Health Organisation recommends that artemisinin-based compounds only be administered in conjunction with other anti-malaria drugs, such as lumefantrine (which in combination with artemether forms the widely-used anti-malarial treatment Coartem). These combinations are known as artemisinin-based combination therapies, or ACTs for short.

Of Macaques and Men

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Plasmodium knowlesi —a new challenge in the Roll Back Malaria Program?

Deforestation oil palm Malaysia

Oil palm plantation in Malaysia: Such land-use change may be affecting malaria transmission. Photo courtesy of Yusmar Yahaya (http://www.flickr.com/photos/leafbug/4880638055/sizes/m/)

Mention of malaria often conjures images of infants hospitalized in Africa. Although most deaths from malaria are children under 5 in sub-Saharan Africa, there are many different types of malaria that put over half of the world’s population at risk in subtropical and tropical regions worldwide.

There have historically been four species of Plasmodium parasites that cause malaria humans.  P. falciparum is the most lethal species that infects humans, whereas P. vivax is the most widespread.  P. vivax and P. ovale also cause clinical symptoms and decreased economic potential in certain regions.

[Read more…]

Soil-Transmitted Helminths and Malaria in Pregnant Women on the Thai-Burmese Border

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Background: Deworming is recommended by the WHO in girls and pregnant and lactating women to reduce anaemia in areas where hookworm and anaemia are common. There is conflicting evidence on the harm and the benefits of intestinal geohelminth infections on the incidence and severity of malaria, and consequently on the risks and benefits of deworming in malaria affected populations. We examined the association between geohelminths and malaria in pregnancy on the Thai-Burmese border.

Methodology: Routine antenatal care (ANC) included active detection of malaria (weekly blood smear) and anaemia (second weekly haematocrit) and systematic reporting of birth outcomes. In 1996 stool samples were collected in cross sectional surveys from women attending the ANCs. This was repeated in 2007 when malaria incidence had reduced considerably. The relationship between geohelminth infection and the progress and outcome of pregnancy was assessed.

Principal Findings: Stool sample examination (339 in 1996, 490 in 2007) detected a high prevalence of geohelminths 70% (578/829), including hookworm (42.8% (355)), A. lumbricoides (34.4% (285)) and T.trichuria (31.4% (250)) alone or in combination. A lower proportion of women (829) had mild (21.8% (181)) or severe (0.2% (2)) anaemia, or malaria 22.4% (186) (P.vivax monoinfection 53.3% (101/186)). A. lumbricoides infection was associated with a significantly decreased risk of malaria (any species) (AOR: 0.43, 95% CI: 0.23–0.84) and P.vivax malaria (AOR: 0.29, 95% CI: 0.11–0.79) whereas hookworm infection was associated with an increased risk of malaria (any species) (AOR: 1.66, 95% CI: 1.06–2.60) and anaemia (AOR: 2.41, 95% CI: 1.18–4.93). Hookworm was also associated with low birth weight (AOR: 1.81, 95% CI: 1.02–3.23).

Conclusions / Significance: A. lumbricoides and hookworm appear to have contrary associations with malaria in pregnancy.

Author Summary: Intestinal worms, particularly hookworm and whipworm, can cause anaemia, which is harmful for pregnant women. The WHO recommends deworming in pregnancy in areas where hookworm infections are frequent. Some studies indicate that coinfection with worms and malaria adversely affects pregnancy whereas other studies have shown that coinfection with worms might reduce the severity of malaria. On the Thai-Burmese border malaria in pregnancy has been an important cause of maternal death. We examined the relationship between intestinal helminth infections in pregnant women and their malaria risk in our antenatal care units. In total 70% of pregnant women had worm infections, mostly hookworm, but also roundworm and whipworm; hookworm was associated with mild anaemia although ova counts were not high. Women infected with hookworm had more malaria and their babies had a lower birth weight than women without hookworm. In contrast women with roundworm infections had the lowest rates of malaria in pregnancy. Deworming eliminates all worms. In this area it is unclear whether mass deworming would be beneficial.

Citation: Boel M, Carrara VI, Rijken M, Proux S, Nacher M, et al. (2010) Complex Interactions between Soil-Transmitted Helminths and Malaria in Pregnant Women on the Thai-Burmese Border. PLoS Negl Trop Dis 4(11): e887. doi:10.1371/journal.pntd.0000887

Editor: Simon Brooker, London School of Hygiene & Tropical Medicine, United Kingdom

Copyright: © 2010 Boel et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: This study was part of the Wellcome Trust Mahidol University Oxford Tropical Medicine Research Programme funded by the Wellcome Trust of Great Britain. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

More information: Full text: Complex Interactions between Soil-Transmitted Helminths and Malaria in Pregnant Women on the Thai-Burmese Border (PDF)