Learning Unit 6. Prevention of Reintroduction Biregional Training Course on Malaria Elimination Lipa City, Philippines, February 2014 Allan Schapira Learning objectives By the end of this Unit, the participant should be able to: 1.Explain the concepts receptivity, vulnerability, and malariogenic potential and their relationship to the likelihood of malaria becoming re- established 2.Define vigilance 3.Describe patterns of vigilance that are required to prevent re- establishment of transmission in different settings 4.Explain the required organization of the health services in countries that have recently been freed from malaria transmission 5.Discuss training needs for adequate malaria vigilance in different settings What happens after interruption of transmission ? Risk of renewed transmission = VxR Vulnerability Likely inflow of malaria parasites Receptivity Risk of onward transmission Vigilance A function of the public health service during the programme for prevention of reintroduction of transmission, consisting of watchfulness for any occurrence of malaria in an area in which it did not exist or from which it had been eliminated, and application of necessary measures against it Vulnerability is more than risk of importation by human vectors Infected mosquitoes can fly across borders Infected mosquitoes can be flown across borders/continents An other serious risk is the introduction of an exotic vector by plane or ship. The toolbox Timely effective case management Chemoprophylaxis including engagement with travel agents, military etc. Targeted/reactive vector control Engagement with immigrant groups Collaboration with employers, border police, educational institutions Screening of immigrants/travellers The undetectable parasite P.vivax hypnozoite Capacity/training for vigilance Target groupsTopics Health personnel in areas where there is a possibility of re-establishment of transmission All relevant personnel in the public health service The general medical profession and undergraduate medical students Laboratory services involved in diagnosis of malaria Publication of an annual report on the national malaria situation Re-establishment of transmission Criteria are given on page 50 of the malaria elimination field manual 2 last paragraphs Exercise 6.1 Each country is required to prepare a short summary about a specific experience on prevention of malaria re-introduction or a history of a post-elimination outbreak. Identify specific factors posing risk for re-introduction of malaria transmission: Is it possible to quantify and classify vilnerability e.g. types of relevant population movement? What measures are taken to reverse/prevent it? Give your opinion whether the measures are all equally useful and cost-effective Exercise 6.2 Examine MEG/WHO Case Study 4: Preventing reintroduction in Mauritius. What is peculiar about the situation there? What are main lessons?