Malaria in North-East India: Importance and Implications in the Era of Elimination

Abstract

Worldwide and in India, malaria elimination efforts are being ramped up to eradicate the disease by 2030. Malaria elimination efforts in North-East (NE) India will have a great bearing on the overall efforts to eradicate malaria in the rest of India. The first cases of chloroquine and sulfadoxine-pyrimethamine resistance were reported in NE India, and the source of these drug resistant parasites are most likely from South East Asia (SEA). NE India is the only land route through which the parasites from SEA can enter the Indian mainland. India’s malaria drug policy had to be constantly updated due to the emergence of drug resistant parasites in NE India. Malaria is highly endemic in many parts of NE India, and Plasmodium falciparum is responsible for the majority of the cases. Highly efficient primary vectors and emerging secondary vectors complicate malaria elimination efforts in NE India. Many of the high transmission zones in NE India are tribal belts, and are difficult to access. The review details the malaria epidemiology in seven NE Indian states from 2008 to 2018. In addition, the origin and evolution of resistance to major anti-malarials are discussed. Furthermore, the bionomics of primary vectors and emergence of secondary malaria vectors, and possible strategies to prevent and control malaria in NE are outlined.

Effect of climate change and deforestation on vector borne diseases in the North-Eastern Indian state of Mizoram bordering Myanmar

“…Plasmodium falciparum is responsible for the majority of the cases, and accounts for >90% of the malaria cases [22]. Based on the cumulative cases from 2008-2018, and population density, 1.1% of the total population is estimated to be affected by malaria on an average per year, and is the second most malarious state in NE India after Meghalaya [24]. Over the last decade, there has been a steep fall in malaria cases throughout India, mainly attributed to the public health measures and greatly hinder malaria control efforts in this region [24].…”

“…Based on the cumulative cases from 2008-2018, and population density, 1.1% of the total population is estimated to be affected by malaria on an average per year, and is the second most malarious state in NE India after Meghalaya [24]. Over the last decade, there has been a steep fall in malaria cases throughout India, mainly attributed to the public health measures and greatly hinder malaria control efforts in this region [24]. In addition, significant deforestation in Mizorama net decline in forest cover (1079 sq.km) from 1987-2019, the highest among all states could be an important factor in malaria transmission.…”

“…The tribal population of the State is 94.43% [23]. Malaria is endemic in Mizoram for many decades, and is one of the highly malarious states in India [24]. While the malaria cases have continued to steeply decline in other states, Mizoram continues to have a stable malaria transmission.…”

“…Compared to 2018 (3937 cases), the malaria cases more than doubled in 2019 (8543 cases) (Source: SVBDCP). Mizoram is also a key entry route for the drug resistant malaria parasites from Myanmar to mainland India [24]. Until the emergence of dengue in 2012 [25], malaria remained the major vector-borne disease in the state.…”

Study of Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency and Genotype Polymorphism of G6PD B and G6PD (A+/A-) in Patients Treated for Plasmodium vivax Malaria in a Tertiary Care Hospital in North East India

“…North East India bears a large case burden of malaria in India and is co-endemic for both P. falciparum and P. vivax malaria [17][18][19][20]. Vivax malaria has been reported in almost all states of North East India, attributing up to 60-80% of all malaria cases in some states [17].…”