In this presentation you can find about malaria and its preventive aspects.

1. Module: Communicable Diseases
Lesson: Malaria
Mentor: Dr Surya B. Parajuli
Mentees: Rasmita Poudel, Anish Luitel

2. “Zero malaria starts with me”
The theme of World Malaria Day
2020 by WHO

3. Our role as a
community
volunteer ?

4. MCQS
4

5. MCQ1. Mosquito responsible for malaria transmission is
1) Aedes aegypti
2) Aedes albopictus
3) Anopheles
4) Female Anopheles
MCQ2.Malaria is caused by
1) Plasmodium vivax
2) Plasmodium falciparum
3) Plasmodium malariae
4) All of above 5

6. MCQ3. Infective stage of plasmodium is
1) Merozoite
2) Cryptozoite
3) Trophozoite
4) Sporozoite
MCQ 4: Malaria is transmitted by 'Anopheles'. This was discovered by
1) Laveran
2) Ronald Ross
3) Pasteur
4) Huxley

7. Learning Objectives
1. Introduction
2. History
3. Malaria burden
4. Prevalent epidemiology types of malaria
5. Definitions
6. Epidemiological determinants
7. Vectors of malaria
8. Measurement of malaria
9. Mode of transmission
10. Clinical features
11. Complications
12. Diagnosis
13. National Guidelines of Malaria 2019
14. Strategies of malaria control
15. Active intervention measures
16. Malaria vaccines
7

8. Introduction
● Malaria is a protozoan disease caused by infection with parasites of genus
Plasmodium.
● Transmitted to human being by certain species of infected female anopheline
mosquito.
● Widespread in tropical and subtropical regions.
● Febrile paroxysms occurs with definite intermittent periodicity depending upon
the species. 8

9. ● In 1880 Charles Louis Alphonse Laveran first identified the malaria
parasite.
● In 1898 Sir Ronald Ross demonstrated that mosquitoes transmit malaria.
● He won the 1902 Nobel Prize for this work.
● 2008 United Nations adopted April 25 as World Malaria Day.
9
History
C. Laveran Sir Ronald Ross

10. Malaria Burden
World
● Approximately half of world’s population live in areas with malaria risk.
● An estimated 228 million cases of malaria occurred worldwide with 405,000
estimated deaths in 2018 compared with 231 million cases with 416000
estimated deaths in 2017.
● There was estimated 251 million cases with 585,000 estimated deaths in
2010.(WHO Malaria Report,2019)
10

11. ● In 2018,93% were in the African Region followed by the South-East Asia
Region (3.4%) and the Eastern Mediterranean Region (2.1%).
● Children aged under 5 years are the most vulnerable group affected by
malaria. In 2018, they accounted for 67% (272 000) of all malaria deaths
worldwide.
11

12. Nepal
● Nepal’s malaria control programme began in 1954.
● In 1958, the National Malaria Eradication Programme was initiated and in
1978 the concept reverted to a control programme.
● In 1998, the Roll Back Malaria initiative was launch for control in hard core
forests,foothills, the inner Terai and Hill river valleys,which accounted for more
than 70% of malaria cases in Nepal.
12

13. ● In 2017 according to epidemiological profile,about 29% (8.5 million) of the
people were at risk of malaria with 5% (1.5 million) at high risk.
● The Global Fund to Fight AIDS, Tuberculosis and Malaria has supported the
malaria control programme since 2004.
13

14. Ward Level Risk Classification Map (MS 2018)

15. Malaria micro-stratification 2018,Nepal
● Malaria risk stratification identifies geographical areas that are at a potential
risk of malaria transmission based on the recent malaria burden, receptivity
characteristics, and the potential vulnerability of the area to malaria.
● Malaria risk stratification is a prerequisite for a rational targeted intervention
and an essential step for an effective and efficient resource mobilization.
● Malaria risk micro- stratification was conducted at the wards level of Rural
Municipality or Municipalities.
● EDCD provided the overall oversight of the study.
15

16. 16
● Disease burden, receptivity, and vulnerability were given a defined weight and
each ward received a weightage response on the three determinants.
Disease burden:0.6
Receptivity : eco-environment (0.1)
presence of vector (0.2)
Vulnerability:0.1
● The weightage response of each determinant for a ward was calculated and
the summation of the three determinants was converted into percentage. A
cut off percentage of 75 or more was agreed as the criteria to define a
high-risk ward.
High -76% to 100%
Moderate - 51% to 75%
Low -26% to 50%
No - upto 25%

17. ● Based on this method, micro stratification 2018 was updated and the wards were
designated as high, moderate, low and no risk wards.
● High risk wards were identified in 49 wards scattered across 13 districts.
Out of these high-risk wards, 6 in Province 2, 1 in Province 3, 3 in Province 5, 8 in
Karnali Province and 31 in Sudurpashchim Province.
● No high-risk ward was detected in Province 1 and Gandaki Province.
● Moderate risk wards were identified in 153 wards in 19 districts (7 additional
districts to the 12 districts that contained high risk wards).Out of these moderate
risk wards, 1 in Province 1, 8 in Province 2, 1 in Province 3, 1 in Gandaki Province,
31 in Province 5, 20 in Karnali Province and 91 in Sudurpashchim Province.
● Malaria transmission is concentrated in the Sudurpashchim and Karnali Province.
17

18. 18

19. Prevalent epidemiological types of malaria
Tribal malaria – population of tribal areas -esp mobile tribal population; engaged
in forest activities; limited health infrastructure and lack of drugs at village level.
Rural malaria – irrigated areas and semiarid plains; moderate to low endemicity;
health infrastructure is moderately developed; P vivax predominant lean period
and P falciparum periodic exacerbation; An culicifacies – main vector.
19

20. Urban malaria –esp vulnerable peri-urban area influenced by poor sanitary
conditions and low socio-economic groups living in unplanned settlements;prone
to periodical epidemics
Malaria in project areas- construction and developmental activities and
temporary tropical aggregation of labourers- brings up diff strains of malarial
parasites in non-immune population;contribute to large no of case disproportionate
to small population group; limited health facilities for prompt treatment; a/w
chloroquine resistant malarial parasite;requires specific control strategy
20

21. Border malaria – high transmission belts along borders; problems in control d/t
mixing of population and poor administrative control
Forest malaria –forests and settlements near them harbours efficient vectors;
return to forest after bites to humans avoiding residual insecticides; more intense
and difficult to control
Floods and Malaria – a/w rise in incidence ;initially flushes out mosquito
breeding,later pooling of water creates mosquitogenic conditions;lag time between
flood and epidemics – around 6 -8 weeks
21

22. Definitions
Malaria control: reducing the malaria burden to a level at which it is no longer a
public health problem.
Malaria elimination: interruption of local mosquito borne malaria transmission ;
reduction to ‘zero’ of incidence of infection caused by human malaria parasites in
a defined geographical area as a deliberate efforts; continued measures to
prevent re-establishment of transmission are required.
22

23. Certification of malaria elimination: can be granted by WHO after it has been
proven beyond reasonable doubt that the chain of local human malaria
transmission by Anopheles mosquito has been fully interrupted in an entire country
for at least three consecutive years.
Malaria eradication: permanent reduction to ‘zero’ of the worldwide incidence of
infection caused by a specific agent; applies to a particular malaria parasite
species. Intervention measures are no longer needed once eradication has been
achieved.
23

24. Epidemological Triad
24

25. Epidemiological determinants
1.Agent
–Malaria in man is caused by four distinct species of the
malaria parasite :- Plasmodium vivax,
–P. falciparum,
–P. malariae and
–P. ovale.
–Plasmodium vivax has the widest geographic distribution throughout the world.
Man=intermediate host and
Mosquito = definitive host
25

26. 26

27. 2.Reservoir of infection
–No animal reservoir (except chimpanzee carry P. malariae)
–Human reservoir : harbours sexual forms (gametocytes) of parasites
Children are more likely to be gametocyte carriers than adults.
3.Period of communicability
–Malaria is communicable as long as mature, viable, gametocyte exist in sufficient
density in blood to infect mosquito
–Appearance of gametocyte after appearance of asexual forms
•P. vivax : 4 to 5 days
•P. falciparum : 10 to 12 days
27

28. 4.Relapse
- usual for vivax and ovale; >3 yrs after first attack; derived from original,
sporozoite-induced liver schizonts which have lain latent long before bursting. In
case of falciparum – due to chronic blood infection i.e. erythroctyic schizogony
persisting at low level.
-P. malariae has a tendency to cause prolonged low-level, asymptomatic
parasitaemia. The infection is known to persist for 40 years or more.
28

29. Host Factor
1.Age
–Affect all ages
–Newborn infant have considerable resistance to infection with P. falciparum
-attributed high concentration of fetal Hb
2.Sex
–Male are are high risk of acquiring malaria than female-
because of outdoor life they lead.
3.Race
–Sickle-cell trait : have milder illness with falciparum infection
–Person with “duffy negative” RBC : resistant to P. vivax infection. 29

30. 4.Pregnancy
–Malaria during pregnancy may lead to intrauterine fetal death, Premature labor
and Abortion.
5.Housing
–Has important role in epidemiology of malaria as it is acquired most often by
bites inside house.
–Ill lighted and ill ventilated ideal for mosquitoes.
6.Occupation
–Predominantly a rural disease and closely related to agricultural practices
30

31. 7. Human habits
–Sleeping outdoors, nomadism, refusal to accept spraying of houses, replastering
of walls after spraying and not using personal protection e.g. bed nets
8.Immunity
–Infants born of immune mothers : protected during the first 3 – 5 months.
–Immunity to malaria is acquired only after repeated exposure over several years
–epidemics influenced by immune status of the population
–In endemic malarious areas a state of collective immunity becomes
established slowly.
–Active immunity is species-specific
31

32. Environmental Factor
1.Season
–Maximum prevalence from july to november.
2.Temperature
–affects the life cycle of the malaria parasite.
–Optimum temp : 20deg to 30 deg. C
–Cessation of development : < 16 deg.C and Lethal > 30deg.C
3.Altitude
–Anophelines mosquito are not found above 2000 to 2500 m.
32

33. 4.Humidity
–direct effect on length of life of the mosquito, but has no effect on the parasite.
–A relative humidity of 60% is required to live normal life span.
–High humidity : mosquito are active and feed voraciously
– Low humidity : do not live longer.
5.Rainfall
–Provides good opportunities for breeding and may give rise to epidemic.
–Increases humidity which again favours survival of mosquito.
–Heavy rain may have an adverse affect in flushing out the breeding places.
33

34. Vector
Few species of anopheline mosquitoes are regarded as the vectors of primary
importance.
These are:
1)An. Culicifacies, 5)An. philippinensis,
2) An. fluviatilis, 6)An. maculatus.
3)An. stephensi,
4)An. minimus,
An. culicifacies in rural areas and An. stephensi in urban areas are vector of
primary importance.
34

35. In the absence of a vaccine, vector control is the only practical approach to malaria
control.
Factors determining the vectorial importance of mosquitoes are
1) Density
To be an effective vector, a species must be present in adequate density in or near
human habitations.
Below ‘critical density’ no effective transmission
2)Life Span
Key factor for disease transmission
Vector mosquito must live for 10 to 12 days after infective blood meal.
Use of insecticide in malaria eradication process is to shorten lifespan < 10 days
35

36. 3)Choice of host
The anthrophilic species, i.e. , those that have a high preference for human blood
are better vectors of malaria than zoophilic species.
An. fluviatilis is a highly anthrophilic species.
4) Breeding Habits
Important to conduct anti larval measures.
An. fluviatilis breed in moving water, An. stephensi in wells, cisterns, fountains and
overhead tanks.
5)Time of biting
Anophiline mosquito has nocturnal feeding habit.
Aedes has diurnal habit. 36

37. 6)Vectorial Capacity
Refers to combined effect of density of vector population, its susceptibility to infection,
life span and probability of feeding on man.
7)Resistance to Insecticides
We should know about status of vector resistance.
It guides choice of insecticides to be used.
37

38. Measurement of Malaria
VECTOR INDICES
–Human blood index - proportion of mosquitoes whose stomach contains human
blood
–Sporozoite rate – percentage of female anophelines with sporozoites in their
salivary glands
–Mosquito density – no of mosquitoes per man-hour catch
38

39. –Man-biting rate – average incidence of anopheline bites per day per
person;determined by standardized vector catches on human
–Inoculation rate – man-biting rate multiplied by infective sporozoite rate
All these rates are employed in quantitative estimation of malaria and building up
composite epidemiological picture of malaria
39

40. Mode of Transmission
1.Vector transmission :
Transmitted by the bite of certain species of infected, female, anopheline
mosquitoes
2.Direct transmission :
Accidental hypodermic IM or IV injections of blood or plasma
E.g. blood transfusion (because parasites keep their infective activity for at
least 14 days in blood bottles stored at -4 deg.C), malaria in drug addicts.
3.Congenital malaria :
From infected mother to newborn; comparatively rare
40

41. Incubation Period
•Length of time between the infective mosquito bite and the 1st
appearance of clinical signs:-
•Varies with species of the parasites
P. falciparum : (9 – 14) days
P. malariae : (18 – 40) days
P. vivax : (8 – 17) days
P. ovale : (16 – 18) days
41

42. Clinical Features
•Fever is most common clinical sign.
•Peaks coincide with the release of successive broods of merozoites
into blood stream.
•Typical attack comprises three distinct stages:
–COLD stage
–HOT stage
–SWEATING stage

43. •Febrile paroxysms occur with definite intermittent periodicity
repeating every third or fourth day depending upon the species
•Above mentioned 3 classical stages may not always be observed
due to maturation of generation of parasites at different times.
•Period of latency may last several weeks to months
•Disease has tendency to relapse characterized by splenomegaly and
secondary anemia; febrile herpes is common in all patients
43

44. •COLD stage: (15 min to 1 hour)
–Onset is with lassitude,headache,nausea and chilly sensation
followed by rigor in an hour
–Temperature rapidly rises to 39 – 41 degree celsius
–Headache is severe and commonly vomiting is present
–Skin feels cold earlier but becomes hot later
–Parasites are demonstrable in blood
–Pulse: rapid may be weak
44

45. •Hot stage: (2 to 6 hours)
–Feels burning hot and casts off clothes
–Skin is hot and dry to touch
–Headache is intense but nausea diminishes
–Pulse is full and respiration rapid
•Sweating stage : (2 to 4 hours)
–Fever comes down with profuse sweating
–Skin is cool and moist to touch
–Pulse rate becomes slower
45

46. •P. falciparum
–Primary Fever in its 1st
few days is usually irregular or even continuous
and then classical 48 hour periodicity is established
–Hot and cold stages are less clearly separated from one another
–Headache,Nausea and vomiting are more severe
–Greater tendency of delirium, hemolytic jaundice and anemia
–Mortality is greater compared to others
46

47. •P. vivax :
–Symptoms are same but usually milder
–More regularly divided into hot and cold stages than in P.
falciparum infections
•P. ovale:
–Milder than P. vivax
–Cease after a few paroxysms even if no treatment is given
•P. malariae :
–Resemble those of P. vivax but cycle is of 72 hours instead of 48 47

48. COMPLICATIONS
P. falciparum Other Species
● Cerebral malaria ● Anemia
● Anemia ● Hepatomegaly
● Hyperpyrexia ● Splenomegaly
● Hypoglycemia ● Herpes
● Black water fever ● Renal complication
● Gastro intestinal and Hepatic
syndromes
● Dehydration
48

49. DIAGNOSIS
1.MICROSCOPY
–Thin and thick film are prepared on a single microscope glass
slide
–Thick film : reliable in searching for parasite
–Thin film : identify the species of the parasite
–Sensitivity is high, detects malarial parasite at low densities
–Quantify the parasite load
–Distinguish various species of malaria parasite and their different
stage
49

50. 50
The advantage of microscopy are-
1.The sensitivity is high
2.Possible to detect malarial parasite at low
densities
3.Possible to distinguish various species of
malaria parasite and their different stages

51. 2. Serological Test
● Malarial fluorescent antibody test usually
becomes positive two weeks or more after
primary infection
● It has the greatest value in epidemiological
studies and in determining whether a person
had malaria in the past.
51

52. 3.Rapid Diagnostic Test
● Used to detect circulating parasite antigens with a simple
dipstick test
● Blood sample is collected from the patient
● Applied to the sample pad on the test card along with certain
reagents
● After 15 minutes, the presence of specific bands in the test card
window indicate whether the patient is infected with
P.falciparum or one of the other 3 species of human malaria
52

53. Binax kit
53

54. Useful for outbreak or epidemic investigation especially in
remote areas
RDT detecting plasmodium Antigen have been
successfully introduced into National Malaria Control
Program
Increase access to early diagnosis is ensured by
availability of RDT
54

55. Measurement of magnitude of Malaria
•PRE ERADICATION ERA
–Determined mostly from reports of clinically diagnosed malarial cases
–Classical malariometric measures are
•Spleen rate – percentage of children between 2 to 10 yrs of age showing
enlargement of spleen
•Average enlarge spleen - denoting size of enlarged spleen
•Parasite rate – percentage of children between 2 to 10 yrs showing
malarial parasites in their blood films
55

56. Parasite density index – average degree of parasitemia in a sample of
well-defined group of the population
•Infant parasite rate – percentage of infants showing malarial parasites in
their blood films;
Most sensitive index of recent transmission in locality
If it is zero for 3 consecutive yrs, it is regarded as absence of malarial
transmission in locality.
•Proportional case rate – Number of cases diagnosed as clinical malaria
for every 100 patients attending the hospitals and dispensaries.
56

57. •Annual Blood Examination Rate (ABER)
–API depends upon annual blood collection
and examination rates
–Sufficient no of blood slides must be systematically obtained and
examined for malarial parasite to work out accurate API
•Slide Positivity Rate (SPR) – percentage of slides found positive for
malarial parasite, irrespective of the types of species
•Slide Falciparum Rate (SFR) - percentage of slides positive for P.
falciparum parasite
57

58. •ERADICATION ERA
–Diagnosis based on microscopy and parameters are parasitological in
nature
–Commonly used parameters are
•Annual Parasite Index (API)
–Sophisticated measure of malaria incidence
–Based on intensive surveillance
–Areas with API≥2 per 1000 population are classified as high risk areas
eligible for vector control
58

59. National Guideline Of Malaria 2019
1) Treatment of uncomplicated P.vivax, P.ovale, P.malariae or P.knowlesi
First line treatment
Chloroquine (CQ) for 3 days.
Day 1: chloroquine is given at an initial dose of 10 mg base/kg body weight.
Day 2: followed by 10 mg/kg body weight.
Day 3: 5 mg/kg body weight.
For P.vivax, P.ovale, 14-day course of primaquine at 0.25 mg/kg body weight per day is given.
Second line treatment
Dihydroartemisinin + Piperaquine (DHA/PPQ is given over 3 days.
Dihydroartemisinin at a dose of 4 mg/kg bw per day and
Piperaquine at a dose of 18 mg/kg bw per day once a day for 3 days
59

60. 2. Treatment of P. falciparum malaria (Uncomplicated)
First line treatment
artemether + lumefantrine (AL) given over three days and a single dose primaquine.
Total dose of 5-24 mg/kg - bw of artemether and 29-144 mg /kg- bw of lumefamtrine is given.
Second line treatment
Dihydroartemisinin + piperaquine (DHA/PPQ).
Dihydroartemisinin 4 mg/kg bw per day and 18 mg/kg bw per day piperaquine once a day for 3 days and
a single dose primaquine.
60

61. Treatment of Severe malaria
It is a medical emergency requiring in-patient care. Deaths from severe malaria can result either from direct effect of the disease or
the complications.
Specific antimalarial treatment
An initial treatment with injectable (IV/IM) artesunate
Recommended Dosage Children less than 20kg – artesunate 3.0 mg/kg bw
Older children and adults – artesunate 2.4mg/kg bw
followed by a full course of AL as soon as the patient is stable enough and able to tolerate oral medication.
Dosage regimen - Give 3 parenteral doses of injection artesunate in the first 24 hours
first dose on admission (time zero),
second dose 8 hours after the first dose and
third dose at 24 hours after the first dose.
Thereafter every 24 hours until patient is able to tolerate oral medication. The parenteral antimalarial drugs should be given for a
minimum of 24 h once started (irrespective of the patient's ability to tolerate oral medication earlier) or until the patient can tolerate
61

62. Mixed infection:
In Nepal, mixed infection (mostly vivax and falciparum) constitute less than 1 percent
of the total case burden.
ACTs are effective against all malaria species and is the treatment of choice for blood
stage mixed infection.
In case of vivax or ovale mixed infection with P. falciparum, 14 days of primaquine
should be given along with the 1st line ACT (AL) for 3 days.
62

63. Treatment of severe P.falciparum malaria 2015
Parenteral antimalarials for at least 24 hours
Main choice- Artesunate 2.4mg/kg IV OR IM given on admission, then at 12hrs
and 24hrs,then once a day.
During epidemic- Artemether 3.2mg/kg IM given on admission then 1.6mg/kg per
day
Or
20mg quinine salt/kg on admission(IV OR IM) followed by maintenance dose of
10mg/kg every 8 hour
.Once patient can tolerate oral therapy, effective oral antimalarial is continued
-ACT
-Artesunate + clindamycin or doxycycline
-Quinine + clindamycin or doxycycline
63

64. National Malaria Strategic Plan (2014-2015)
-The aim of NMSP is to attain “Malaria Free Nepal by 2026”.
The strategic plan was divided into two phases: achieve Malaria Pre - Elimination by 2018
and attain Malaria Elimination by 2026. Malaria pre-elimination targets were set to
achieve and sustain zero deaths due to malaria by 2015, reduce the incidence of indigenous
malaria cases by 90%, and reduce the number of VDCs having indigenous malaria cases
by 70% of current levels by 2018. The baseline year was taken as 2012. 64

65. Strategy ;The strategy to achieve the targets was identified as follows:
•i) to strengthen strategic information for decision making towards malaria elimination
•ii) to further reduce malaria transmission and eliminate the foci wherever feasible
•iii) to improve quality of and access to early diagnosis and effective treatment of malaria
•iv) to develop and sustain support through advocacy and communication, from the political
leadership and the communities towards malaria elimination and
•v) To strengthen programmatic technical and managerial capacities towards malaria elimination.
65

66. Major Activities 2073/2074
● Conducted the ward level micro-statification of malaria cases in
44 districts.
● Introduced case base survillance system,including web base
recording and reporting system for district
● Conducted National Malaria vector survey
● Oriented district and peripheral level health workers on case
based survillance
66

67. ● Conducted G6PD deficiency prevalence study across 30 wards
in high risk VDC
● Oriented district health workers and FCHVs on government
malaria elimination initiative
● Conduct operational research on vector behavioural and
insecticides resistance
● Celebrate World Malaria in 25th Aprill
67

68. Current Achievement
NEPAL achieved MDG 6 by reducing malaria morbidity and mortality
rate by more than 50% in 2010. High and moderate risk district are
reduced from 31to25 due to micro-statification exercises(2013)
Malaria Disease Information System(MDIS) is now made operational.
68

69. By 2016, National Malaria Program had achieved 54% reduction in
indigenous malaria cases compared to 2012, death was recorded in
an imported case of malaria, and no foci have been cleared of
malaria transmission.
69

70. Active Interventions Measures
Neither chemotherapy nor chemoprophylaxis will be able to reduce
significantly the malaria prevalence or transmission
can be obtained only when proper anti-mosquito measures are
introduced.
1.VECTOR CONTROL STRATEGIES
a)Anti-adult measures
-Residual spraying: spraying of the indoor surfaces of houses with
residual insecticides(DDT,malathion) is most effective measure to
kill adult mosquito 70

71. Space application:major anti-epidemic measure in mosquito borne
diseases.Involves the application of pesticides in the form of fog or
mist using special equipment.
-Individual protection:use of repellents, protective clothing, bed
nets, mosquito coils,screening of houses etc.
71

72. Active Intervention Measures
b)Anti-larval measures:
-Larvicides:During the first half of the 20th century,anti-larval measures such as
oiling the collections of standing water or dusting them with Paris green
effectively controlled malaria.Modern larvicides such as temephos confer long
effect with low toxicity are widely used.
-source reduction:Techniques to reduce mosquito breeding sites includes drainage
or filling,deeping or flushing, management of water level
-Integrated control:includes bioenvironmental and personal protection measure. 72

73. Intervention Strategy In Malaria Elimination
Cross border collaboration
WHO play the role of mediator to establish cross border
collaboration in order to
1. Decrease the number of imported cases by targeting identified
foci on both side of the border
2. To decrease the transmission mechanism and focal points
73

74. Malaria Elimination Task Force
➔ Malaria elimination task force (estd.2017) function
as a gateway for malaria data banking and
management ;document success and failure
monitor and evaluate the progress.
74

75. Malaria Vaccines
•Although progress has been made in the last 10 years toward developing
malaria vaccines, there is currently no effective malaria vaccine on the
market
•The only approved vaccine as of 2015 is RTS,S(Mosquirix)
•Requires four injections but has low efficacy (26–50%).
•Due to low efficacy, WHO does not recommend the use of RTS,S
vaccine in babies between 6 and 12 weeks of age
•RTS,S vaccine reduced clinical and severe cases of malaria by half in
children who received the vaccine.
•The vaccine is going to be studied further in Africa in 2018.
75

77. References
•Park’s Textbook of PREVENTIVE AND SOCIAL MEDICINE By K. PARK, 25th Edition
•DoHS, Annual Report 2075/76
•Malaria Micro-stratification 2018 report
•World malaria report 2019
•National malaria treatment protocol 2015
•Google for images
https://www.who.int/malaria/en/
http://www.jnhrc.com.np/index.php/jnhrc/article/view/911
https://www.iamat.org/country/nepal/risk/malaria
https://www.who.int/malaria/publications/country-profiles/profile_npl_en.pdf?ua=1
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78. T
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