Unstable Malaria Transmission in the Southern Peruvian Amazon and Its Association with Gold Mining, Madre de Dios, 2001–2012

Juan F. Sanchez Department of Parasitology, U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru.

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Andres M. Carnero Department of Parasitology, U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru.

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Esteban Rivera Dirección Regional de Salud de Madre de Dios, Ministerio de Salud del Perú, Puerto Maldonado, Peru.

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Luis A. Rosales Department of Parasitology, U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru.

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G. Christian Baldeviano Department of Parasitology, U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru.

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Jorge L. Asencios Dirección Regional de Salud de Madre de Dios, Ministerio de Salud del Perú, Puerto Maldonado, Peru.

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Kimberly A. Edgel Department of Parasitology, U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru.

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Joseph M. Vinetz Division of Infectious Diseases, Department of Medicine, University of California San Diego, La Jolla, California.

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Andres G. Lescano Department of Parasitology, U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru.
School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.

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The reemergence of malaria in the last decade in Madre de Dios, southern Peruvian Amazon basin, was accompanied by ecological, political, and socioeconomic changes related to the proliferation of illegal gold mining. We conducted a secondary analysis of passive malaria surveillance data reported by the health networks in Madre de Dios between 2001 and 2012. We calculated the number of cases of malaria by year, geographic location, intensity of illegal mining activities, and proximity of health facilities to the Peru–Brazil Interoceanic Highway. During 2001–2012, 203,773 febrile cases were identified in Madre de Dios, of which 30,811 (15.1%) were confirmed cases of malaria; all but 10 cases were due to Plasmodium vivax. Cases of malaria rose rapidly between 2004 and 2007, reached 4,469 cases in 2005, and then declined after 2010 to pre-2004 levels. Health facilities located in areas of intense illegal gold mining reported 30-fold more cases than those in non-mining areas (ratio = 31.54, 95% confidence interval [CI] = 19.28, 51.60). Finally, health facilities located > 1 km from the Interoceanic Highway reported significantly more cases than health facilities within this distance (ratio = 16.20, 95% CI = 8.25, 31.80). Transmission of malaria in Madre de Dios is unstable, geographically heterogeneous, and strongly associated with illegal gold mining. These findings highlight the importance of spatially oriented interventions to control malaria in Madre de Dios, as well as the need for research on malaria transmission in illegal gold mining camps.

Author Notes

* Address correspondence to Andres G. Lescano, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Avenida Honorio Delgado 430, Urbanización Ingenieria, San Martin de Porres, Lima, Peru. E-mail: andres.lescano.g@upch.pe
† These authors contributed equally to this work.

Financial support: This study was supported by U19AI089681 from NIAID (JMV) and partially funded by the Armed Forces Health Surveillance Center, Global Emerging Infections Surveillance and Response System (AFHSC/GEIS) of the U.S. Department of Defense. Lescano is sponsored by the training grant 2D43 TW007393 awarded by the Fogarty International Center of the U.S. National Institutes of Health.

Copyright statement: Several authors of this manuscript are military service members or employees of the U.S. Government. This work was prepared as part of their duties. Title 17 U.S.C. § 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. § 101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person's official duties.

Authors' addresses: Juan F. Sanchez, Andres M. Carnero, Luis A. Rosales, G. Christian Baldeviano, and Kimberly A. Edgel, Department of Parasitology, U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru, E-mails: chiroque@gmail.com, andrescarnero@gmail.com, larhpe@hotmail.com, geralc.baldeviano.fn@mail.mil, and kimberly.a.edgel.mil@mail.mil. Esteban Rivera and Jorge L. Asencios, Dirección Regional de Salud de Madre de Dios, Ministerio de Salud del Perú, Puerto Maldonado, Peru, E-mails: estebanriveracarrera@gmail.com and arjorgeluis@hotmail.com. Joseph M. Vinetz, Division of Infectious Diseases, Department of Medicine, University of California San Diego, La Jolla, CA, E-mail: jvinetz@ucsd.edu. Andres G. Lescano, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru, E-mail: andres.lescano.g@upch.pe.

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