Malaria (20th Century-Present)

Incidence, Infection, and Risk

In the first half of the 20th century, there was a significant reduction in the global malarial burden with the application of aggressive vector control modalities. This downward trend improved in the 1950s with the widespread use of the antimalarial chloroquine. However, the hope that this particular scourge of humankind would be totally eradicated significantly dimmed in the latter half of the last century, with the increased resistance to antimalarials; the omnipresent acts of war; governmental complacency, corruption, and ineptitude; and marked decreases in financial resources. As the 21st century unfolds, malaria is considered the most significant parasitic disease in humans, with disease transmission in 109 countries currently. In fact, 49 percent of the world's population reside in these endemic areas, and are at risk for developing malaria. The endemic regions include: Africa, particularly West Africa, involving predominantly P. falciparum; Asia, with equal presentation of P. falciparum and vivax; the Middle East; eastern Europe; Central America, predominantly P. vivax; South America, with equal presentation of P. falciparum and vivax; the Caribbean; and Oceania, with equal presentation of P. falciparum and vivax.

This 1963 Chinese malaria propaganda poster explains the spread, symptoms, consequences, and prevention of malaria

It is estimated that 350 to 500 million people acquire the disease annually. In 2002, malaria ranked as the fourth cause of death (10.7 percent) in children from developing countries, after perinatal conditions, pneumonia, and diarrheal diseases. It is said to cause [Page 398]approximately 1 million deaths annually and may be as high as 3 million. The population most at risk of death is children under 5 years of age living in sub-Saharan Africa. Deaths in this region due to malaria are said to number 2,700 per day, or two per minute.

In endemic areas of the globe, malaria is usually acquired in a characteristic fashion: mosquito to man, man to mosquito, and mosquito to man. However, there is the potential that it can manifest itself ubiquitously and can be acquired by nonclassical means. For example, more than 1,500 cases are diagnosed annually in the United States. This would explain the degree to which nonendemic countries have developed surveillance and management protocols directed at malaria and the potentially infected tourists, refugees, and immigrants who might be entering or re-entering their borders. Therefore, this requires an appreciation of the appropriate terminology developed by the World Health Organization (WHO).

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