Success in controlling a major outbreak of malaria because of Plasmodium falciparum in Jamaica

Abstract

SummaryIn 2006, after 44 years of eradication of malaria, Jamaica had an outbreak of Plasmodium falciparum: 406 confirmed cases between September 2006 and December 2009 with a peak of the epidemic in December 2006. In response to the outbreak, the Ministry of Health launched an emergency response through early detection and prompt treatment of cases, vector control, public education and intersectoral collaboration. Ninety percent (361) of cases were residents of Kingston, and 63.6% were identified through house to house surveillance visits. For 56% of the confirmed cases, treatment with chloroquine was initiated within a week of onset of symptoms. Only one (0.3%) of 358 cases who had a post-treatment smear on day 7 had a persistent asexual parasitaemia, while none of the 149 persons who had a follow-up smear on day 28 was positive. The outbreak highlighted the need for increased institutional capacity for surveillance, confirmation and treatment of malaria as well as effective prevention and control of outbreaks which can occur after elimination. Jamaica appears to have successfully eliminated malaria after its reintroduction.

Leptospirosis and malaria as causes of febrile illness during a dengue epidemic in Jamaica

“…32 The reintroduction and limited spread of malaria in Jamaica provided a unique opportunity to study another possible underlying cause of fever during an epidemic. 30 We were able to use serology (IgG) for exposure to malaria in a relatively naïve population to show that this vector-borne protozoan infection was a possible important cause of morbidity during the epidemic. While IgG does not indicate acute infection, it was sufficient to show that persons had been previously exposed to the parasite.…”

“…34 It was reported that the malaria epidemic was limited to western Kingston and was controlled and it was not unclear if positive IgG status represented antibodies from persons who were already free of malaria. 30 As Jamaica moves to re-establish its malaria-free status, serology may play an important role in highlighting geographic regions and at risk groups for malaria. While we were not able to describe the differences in clinical picture of dengue, malaria, and leptospirosis positive patients as we did not collect this data, primarily because of the limits of the study objectives, ethical approval, and resources, the Ministry of Health will use the data in planning future surveillance activities.…”

“…The reintroduction of malaria to Jamaica resulted in the detection and confirmation of 406 cases of P. falciparum. 28,30 These cases were tracked by a combination of several active and passive surveillance strategies and prompt treatment. This resulted in the interruption and control of transmission and the termination of the outbreak.…”

“…29 Following eradication in the 1960s, Jamaica implemented strict surveillance protocols and has recorded only imported cases associated with travel by nationals or visitors. 30 The peak of imported cases was associated with screening and treatment of a large number of Haitian refugees to Jamaica in 2005, which revealed 88 cases of predominantly P. falciparum but with some Plasmodium malariae.…”

South-to-North, Cross-Disciplinary Training in Global Health Practice: Ten Years of Lessons Learned from an Infectious Disease Field Course in Jamaica

“…vivax malaria in Jamaica initiated autochthonous cases. The island, having been certified free of malaria since eradication in 1965, experienced more than 390 cases, 15 lost tourism revenue, and incurred enormous costs of containment and treatment.…”