Biology Reference
In-Depth Information
Union by the 1960s. War and political instability in Afghanistan and the
resulting population movements reintroduced malaria back into the areas of
Uzbekistan, Tajikistan, Kyrgyzstan, Turkmenistan and Kazakhstan (
Razakov
Sh, 2000
;
Usenbaev et al., 2006
;
Bismil'din et al., 2001
;
Amangel'diev et al.,
2000
;
Matthys et al., 2008
;
Baranova and Sergiev, 2000
). Malaria transmis-
sion was promoted by soldiers returning from the Afghan war with a total of
7683 known malaria cases imported to the Soviet Union, the vast majority
being vivax malaria with only scattered cases of falciparum (
Sergiev et al.,
1993
). Of the malaria relapses documented, 98% occurred within the first
year after leaving Afghanistan. Many cases appeared to be due to failure to
take appropriate post-deployment primaquine meant to kill hypnozoites.
This reintroduction of vivax malaria has necessitated a large control/elimi-
nation effort by reconstituting discontinued malaria programs. The case of
Kyrgyzstan has already been discussed above. Turkmenistan has been certi-
fied free of malaria in 2010 following sporadic local transmission in the
1990s including a 108-case epidemic of vivax in 1998 (
Turkmenistan certi-
fied malaria-free, 2010
). Uzbekistan appears to import most of its malaria
cases from Tajikistan, of which 95% is due to vivax malaria (
Razakov Sh,
2000
). Following a post-independence civil war, endemic malaria was re-
established in southern Tajikistan with 30,000 cases per year during the
peak year of 1997. This has since been controlled with the Tajik govern-
ment aiming to eliminate malaria by 2015 (
Matthys et al., 2008
). Nearly
half of the malaria cases documented in Kazakhstan are in military person-
nel who have been serving on the Tajik-Afghan border (
Bismil'din et al.,
2001
). Although the political landscape of the former Soviet Union is very
different, the malaria problem they are facing is analogous to that of South
Korea.
7. PROSPECTS FOR IMPROVED DRUGS
FOR CONTROL/ELIMINATION
Although the antimalarial drugs available today do work well when
used correctly, they are far from ideal, particularly in terms of use in public
health programs for entire populations. The ideal circumstance envisaged
by malERA was a single encounter radical cure and prophylaxis (SERCaP),
which had few adverse events and was inexpensive (
A research agenda for
malaria eradication: drugs, 2011
). Although SERCaP is certainly a good
goal to work towards, the number of new drugs already in clinical testing or
ways to adapt old drugs is quite limited.
