Session:

Parasitology & Parasitic Infections

Abstract No.:

42.034

Title:

Epidemiology of malaria in gold mining camps, Madre de Dios, Peru

Author(s):

J. F. Sanchez¹, E. Rivera², L. A. Rosales¹, G. C. Baldeviano¹, J. L. Asencios², R. G. Burrus³, J. Vinetz⁴, K. A. Edgel¹, A. G. Lescano¹; ¹US Naval Medical Research Unit No. 6 (NAMRU-6), Department of Parasitology, Lima/PE, ²Ministerio de Salud del Peru, Direccion Regional de Salud Madre de Dios, Puerto Maldonado/PE, ³US Naval Medical Research Unit No. 6 (NAMRU-6), Department of Entomology, Lima/PE, ⁴University of California, San Diego Travel Clinic, La Jolla, CA/US

Abstract:

Background: Malaria transmission in special populations such as miners has demonstrated to pose an important challenge to control and elimination efforts, as shown by the rise of artemisinin resistance in the gem mining areas of Pailin, Thailand. We studied the epidemiology of malaria transmission in the informal gold mining camps of Madre de Dios (MDD), Peru, a recent hotspot of malaria transmission in the region.
Methods: We analyzed malaria and febrile illness surveillance data collected regularly by the Peruvian Ministry of Health (MoH), conducted three site visits and evaluations of malaria control activities, assessed the distribution of antimalarials by private providers and initiated epidemiologic studies based on passive case detection.
Results: Surveillance illustrated an increase in malaria transmission in MDD since 2004 and peaks of ~4000 annual cases. All malaria was due to Plasmodium vivax and 75% came from Delta-1, a single facility in the core of informal gold mining camps. Transmission presented year-long with sustained, high incidence. Field assessments showed that supervised treatment across the region was inconsistent due to the nomadic nature of mining operations. The MoH provided free-of-charge treatment and drugs in all towns with active malaria transmission, but informal private pharmacies also offered antimalarials although chloroquine and primaquine purchased from them presented highly variable levels of the active components.
Conclusion: The combination of high incidence rates, widespread unsupervised treatment and private selling of variable-quality drugs represent a high risk for the generation of P. vivax chloroquine resistance in the region. Illegal mining has proven dreadful to malaria control worldwide and immediate action in MDD may prevent a public health catastrophe.