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A REVIEW OF THE CLINICAL AND EPIDEMIOLOGIC BURDENS OF EPIDEMIC MALARIA

The role of epidemic malaria as a distinct epidemiologic entity posing unique intervention challenges is reviewed from a global perspective. Epidemic malaria derives from particular interactions of vectors, parasites, and various environmental and anthropogenic determinants. Malaria epidemics generally afflict immunologically vulnerable populations, and their explosiveness can strain the capacity of health facilities, causing case fatality rates to increase five-fold or more during outbreaks. People of all ages remain susceptible to the full range of clinical effects. This flatter demographic profile may translate into larger economic consequences, although the full economic impact of epidemic malaria remains undefined. Specialized intervention approaches are recommended for epidemic-prone areas, including enhanced surveillance activities and intensified antivector interventions. Such considerations are particularly critical during a time when malaria epidemics are occurring more frequently in Africa and throughout the world.

Received August 21, 2003. Accepted for publication February 27, 2004.

Acknowledgements: We are grateful for the assistance of Gezahegn Tesfaye, Asnakew Kebede, and Dr. Afework Hailemariam (Malaria and Other Vector-Borne Diseases Control Team, Ministry of Health, Ethiopia), Dr. Charles Delacollette (World Health Organization CDS/MAL), and the staff of the Ministries of Health of Ethiopia and Uganda.

Financial support: Portions of this work were funded by a grant from Roll Back Malaria, World Health Organization.

Authors’ addresses: Anthony E. Kiszewski, Department of Immunology and Infectious Diseases, 1-109, Harvard School of Public Health, Boston, MA 02115, E-mail:akisz{at}hsph.harvard.edu. Awash Teklehaimanot, Center for Global Health and Economic Development, Mailman School of Public Health and the Earth Institute at Columbia University, New York, NY 10027.

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