Disease Burden - Malaria

Department of Public Health & Preventive Medicine:

MALARIA

1. What is Malaria ?

Malaria is a parasitic disease caused by the Genus Plasmodium and spread by Anopheles mosquitoes.

2 .What are the symptoms of Malaria ?

Fever, Headache, Bodyache, Rigor, Chill and Vomiting.

3 .How does malaria spread ?

Malaria is spread by an infected female anopheles mosquito which breeds in fresh water collections like OHTs, cisterns, wells, sumps etc. There is no direct transmission from the infected person to the healthy person.

4. Is there different type of malaria ?

Yes.There are 4 types of malaria namely Plasmodium vivax, Plasmodium falciparum, Plasmodium malaria and Plasmodium ovale.

5. Do all these are prevalent in Tamil Nadu ?

No. P. vivax and P. falciparum are prevalent in Tamil Nadu and P. vivax Malaria is more common.

6. What are the different types of vector mosquitoes ?

There are 3 different types of vector mosquitoes. Anopheles stephensi, Urban vector; An.culicifacies, Rural vector; An. fluviatilis, Foot hill area vector.

7. How to eliminate the breeding of mosquitoes?

Proper sealing of Over Head Tanks, wells and covering all water containers preventing mosquitoes from laying eggs and thereby preventing the mosquito breeding.

8. Will Malaria cause death ?

Untreated P. falciparum may cause severe complications leading to death.

9. Is there a vaccine for Malaria ?

No.

10. How does a person know that he is suffering from malaria ?

Any person having fever and headache should be suspected as a malaria case and his blood should be examined for confirming the same.

11. Is there any specific treatment for Malaria ?

Yes. After examining the blood-smear, if the person is found positive for malaria, radical treatment with Chloroquine and Primaquine should be administered as per the malaria drug schedule of National Vector Borne Disease Control Programme, Delhi.

MALARIA TREATMENT SCHEDULE

(As per NVBDCP Drug Policy - 2013)

Age	Day 1		Day 2		Day 3		Day 4 - 14
Group	CQ	PQ	CQ	PQ	CQ	PQ	Primaquine 2.5 mg
(Years)	(250 mg)	(2.5 mg)	(250 mg)	(2.5 mg)	(250 mg)	(2.5 mg)	Primaquine 2.5 mg
0 - 1 Year	1/2 (75 mg)	0	1/2 (75 mg)	0	1/4 (37.5 mg)	0	0
1 - 4 years	1 (150 mg)	1	1 (150 mg)	1	1/2 (75 mg)	1	1
5 - 8 Years	2 (300 mg)	2	2 (300 mg)	2	1 (150 mg)	2	2
9 - 14 Years	3 (450 mg)	4	3 (450 mg)	4	1 1/2 (225 mg)	4	4
15 & Above	4 (600 mg)	6	4 (600 mg)	6	2 (300 mg)	6	6
Pregnancy	4 (600 mg)	0	4 (600 mg)	0	2 (300 mg)	0	0

Dosage Chart for Treatment of P.vivax Malaria

{CQ - Chloroquine, PQ - Primaquine

Note: Chloroquine 250 mg tablet is having 150 mg base.

Do not give primaquine to pregnant woman, infants and G6PD deficiency cases.

14 days regimen of Radical Treatment should be given under supervision

Dosage Chart for Treatment of P.falciparum Malaria with ACT-SP

{Artesunate (AS), Sulfadoxine Pyremethamine (SP)} & Primaquine (PQ)

Age	Day 1		Day 2		Day 3
Group	AS	SP	AS	PQ	AS
(Years)	AS	SP	AS	PQ	AS
0 - 1 Year	1 (25 mg)	1 (250 + 12.5 mg)	1 (25 mg)	Nil	1 (25 mg)
1 - 4 years	1 (50 mg)	1 (500 + 25 mg each)	1 (50 mg)	1 (7.5 mg base)	1 (50 mg)
5 - 8 Years	1 (100 mg)	1 (750 + 37.5 mg each)	1 (100 mg)	2 (7.5 mg base each)	1 (100 mg)
9 - 14 Years	1 (150 mg)	2 (500 + 25 mg each)	1 (150 mg)	4 (7.5 mg base each)	1 (150 mg)
15 & Above	1 (200 mg)	2 (750 + 37.5 mg each)	1 (200 mg)	6 (7.5 mg base each)	1 (200 mg)

Note: Do not give primaquine to pregnant woman, infants and G6PD deficiency cases 3 days regimen of Radical Treatment should be given under supervision Treatment of uncomplicated P.falciparum cases in pregnancy:

1st Trimester: Quinine salt 10 mg/kg 3 times daily for 7 days.

Quinine may induce hypoglycemis, pregnant woman should not start taking quinine on an empty stomach and should eat regularly, while on quininetreatment

2nd & 3rd Trimester: ACT as per dosage given above (without Primaquine).

Dosage Chart for Treatment of mixed (vivax & falciparum) Infection

Malaria with ACT-SP

Malaria with ACT-SP
Age	Day 1			Day 2		Day 3		Days 4-14
Group	AS	SP	PQ (2.5 mg)	AS	PQ (2.5 mg)	AS	PQ (2.5 mg)	PQ (2.5 mg)
(Years)	AS	SP	PQ (2.5 mg)	AS	PQ (2.5 mg)	AS	PQ (2.5 mg)	PQ (2.5 mg)
0 - 1 Year	1/2	1/2	0	1/2	0	1/2	0	0
1 - 4 years	1	1	1	1	1	1	1	1
5 - 8 Years	2	1 1/2	2	2	2	2	2	2
9 - 14 Years	3	2	4	3	4	3	4	4
15 & Above	4	3	6	4	6	4	6	6

Note: Do not give primaquine to pregnant woman, infants and G6PD deficiency cases

14 days regimen of Radical Treatment should be given under supervision

12. How to control malaria?

Early diagnosis of fever and taking complete radical treatment will prevent transmission of malaria parasites.
Larval source management by mosquito breeding source reduction and application of Temephos in breeding sources.
Anti-adult measures by spray operation in malaria problem areas
Intensified IEC activities.

Treatment for malaria is free in all Government Hospitals, Primary Health Centres and Malaria Clinics

MALARIA INCIDENCE RURAL AND URBAN AREAS OF TAMIL NADU 2010 - 2017

YEAR	STATE CASES	RURAL CASES	CHENNAI CASES	CHENNAI%	OTHER UMS CASES	OTHER UMS %
2010	17086	6031	9789	57.20	1266	12.90
2011	22171	6602	14927	67.30	642	4.30
2012	18869	7146	11090	58.80	633	3.40
2013	15081	5893	8537	56.60	651	4.30
2014	8729	3708	4669	53.50	352	4.00
2015	5587	2045	3338	59.75	204	3.60
2016	4340	1409	2743	62.40	224	5.20
2017	5449	1360	3895	71.5	194	3.6
2018	3758	806	2823	75.1	129	3.4
January 2019	87	35	48	55.2	4	4.6
February 2019	90	26	63	70.0	1	1.1
March 2019	94	41	48	51.1	5	5.3
April 2019	111	33	73	65.8	5	4.5
May 2019	171	63	101	59.1	7	4.1
June 2019	191	56	127	66.5	8	4.2