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Outbreak Investigation of Plasmodium vivax Malaria in a Region of Guatemala Targeted for Malaria Elimination

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  • 1 U.S. Army Public Health Command, Edgewood, Maryland.
  • | 2 Area de Salud, Department of Santa Rosa, Ministerio de Salud, Cuilapa, Guatemala.
  • | 3 Universidad del Valle, Guatemala City, Guatemala.
  • | 4 Henry M. Jackson Foundation, Uniformed Services University of Health Sciences, Bethesda, Maryland.
  • | 5 Central American Regional Office, Centers for Disease Control and Prevention, Guatemala City, Guatemala.
  • | 6 Division of Global Health Protection, Center for Disease Control and Prevention, Atlanta, Georgia.

The Department of Santa Rosa, Guatemala, is targeted for malaria elimination. However, compared with 2011, a 13-fold increase in cases was reported in 2012. To describe the epidemiology of malaria in Santa Rosa in the setting of the apparent outbreak, demographic and microscopic data from 2008 to 2013 were analyzed. In April 2012, a new surveillance strategy, funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, was introduced involving more active case detection, centralized microscopy, increased community engagement, and expanded vector control. Interviews with vector control personnel and site visits were conducted in June 2013. From 2008 to 2013, 337 cases of malaria were reported. The increase in cases occurred largely after the new surveillance strategy was implemented. Most (137/165; 83%) 2012 cases came from one town near a lake. Plasmodium vivax was the malaria species detected in all cases. Cases were detected where malaria was not previously reported. Monthly rainfall or/and temperature did not correlate with cases. Interviews with public health personnel suggested that the new funding, staffing, and strategy were responsible for improved quality of malaria detection and control and thus the increase in reported cases. Improvements in surveillance, case detection, and funding appear responsible for the temporary increase in cases, which thus may paradoxically indicate progress toward elimination.

Author Notes

* Address correspondence to Joe P. Bryan, Centers for Disease Control and Prevention, Unit 3190, Box 144, DPO, AA 34024. E-mail: jpbryan@cdc.gov

Authors' addresses: Robert Cohen, Army Public Health Center, Edgewood, MD, E-mail: Rob.L.Cohen.MD@gmail.com. Joel Sarceño Cardona and Eliana Solares Navarro, Vector Control, Area de Salud, Cuilapa, Guatemala, E-mails: vectores.sr@gmail.com and elianasolares@gmail.com. Norma Padilla, Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala, E-mail: npadilla@ces.uvg.edu.gt. Lisette Reyes, Health Center Nueva Santa Rosa, Area de Salud, Nueva Santa Rosa, Guatemala, E-mail: drsamuelpablo@yahoo.com. Rodrigo Javier Pinto Villar, Direccion, Area de Salud, Cuilapa, Guatemala, E-mail: rodrigojpinto19@gmail.com. Penny Masuoka, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, E-mail: penny.masuoka.ctr@usuhs.edu. Chris Bernart, Department of Medicine, University of North Carolina, Raleigh, NC, E-mail: bernart@email.unc.edu. Leonard F. Peruski, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: lperuski@cdc.gov. Joe P. Bryan, Division of Global Health Protection, Centers for Disease Control and Prevention, DPO, AA, E-mail: jpbryan@cdc.gov.

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