Marco Libanore
Il 25 April of each year occurs the “World Malaria Day”. Even the theThe Ferrara health authorities adhere to the anniversarythrough the work carried out by dedicated service professionals.
The World Health Organization reports that in the However, in 2021, after twenty years of progress, mortality increased by 12% compared to 2019. According to WHO 247 million people became infected with 619,000 deaths in 2021with a very high increase in cases due to the interruption of essential services for disease control during the pandemic period.
In the province of Ferrara they usually come between 5 and 10 cases of imported malaria diagnosed within a year. This occurs above all in patients from Sub-Saharan Africa, who have temporarily returned to their country of origin without taking any chemoprophylaxis who, staying in Italy, have lost part of the natural immunity previously acquired in their country. Import cases in Italian patients have become rarer than in the past, due to greater attention to the problem and the drastic drop in intercontinental travel during the COVID 19 pandemic.uOperating unit of Infectious Diseases of the University Hospital of Ferrara, directed by Marco Libanore, together with the university section of Infectious Diseases, with its notifications, it contributes to the majority of diagnoses and specific treatments of the forms observed, thanks also to the availability of use of the latest generation of antiprotozoal molecules which have made it possible to rapidly resolve the infections.
Clelia De Sisti
“Malaria – highlights Clelia De Sisti, director of the Public Health Department of the Ausl of Ferrara – can be prevented by taking medicines. There is no single prophylactic scheme applicable everywhere, the suitable prophylaxis must be studied on a case-by-case basis. The choice of drug mainly depends on the country of destination, the type of trip, its duration and the traveller’s state of health. Given that pharmacological prophylaxis must be started before departure, it is advisable to refer, well in advance, to your family doctor or a public health doctor of the AUSL of Ferrara, who will be able to provide useful information for pharmacological prophylaxis and for the adoption of preventive behavioral measures”. To receive free advice, simply fill in an online form on the company Home Page www.ausl.fe.it in the section “Dedicated to” – Dedicated areas – International travellers”.
Malaria is a disease caused by parasitic protozoabelonging to the genus Plasmodium. The plasmodia species responsible for human malaria do they are transmitted naturally from man to man by the bite of infected mosquitoes; however, transmission can rarely occur, even with accidental events by direct blood contact. In endemic countries it is the most common vector-borne disease in the world, in non-endemic countries it is the most important imported diseasemainly linked to travel to tropical areas and the increase in travel and migratory flows.
In the first half of the 20th century, malaria was eradicated from most temperate areas and today it is widespread mainly in tropical and sub-tropical countries.
Altogether nearly half of the world‘s populationespecially those residing in poor countries, lives in malaria-prone areas. Compared to the beginning of the third millennium, the spread of malaria in the world has been considerably reduced thanks to the implementation of fight and control programs promoted by the WHO and various international associations. In non-endemic areas with a temperate climate, despite the high number of imported cases and the presence of competent vectors in the area, the possibility of the reappearance of local transmission is to be considered extremely low.
I symptoms, depending on the species of plasmodium, appear 7, 15 or more days after the bite of the infected mosquito. They are varied in nature, but usually consist of fever, often very high, headache, vomiting, diarrhoea, sweats and chills. All symptoms, at least initially, common to any flu syndrome or other infections. In areas with high transmission conditions, continued exposure to the disease develops partial or adaptive immunity, particularly in the adult population, which, although it does not provide complete protection, reduces the risk of severe malaria. In these areas, most malaria deaths occur in children under 5 years of age, who have not yet developed adaptive immunity. Another group of the population at risk are pregnant women who, due to the immune peculiarities linked to their state, are more susceptible to presenting the disease in an acute form, with severe anemia and compromised fetal growth or even the death of the mother and/or fetus . In areas with low transmission where the population has low immunity, all groups have an equal risk of developing severe malaria. Another category on which malaria can have a very important impact is represented by non-immune travelers who travel to endemic areas.
A accurate diagnosis and precocious it is one of the keys to effectively managing this disease. There chemoprophylaxis it is particularly suitable for travelers heading to endemic areas. Vector control is one of the key measures to prevent and reduce malaria transmission. The main measures implemented are focused on reducing the contact between mosquitoes and humans. Personal protective measures against mosquito bites are bed nets impregnated with insecticide. Interventions to reduce the density of mosquitoes are carried out with treatments with residual action insecticides in homes, with the reduction of larval outbreaks through environmental remediation and with the use of larvicides or natural predators of mosquito larvae.
After more than 30 years of intense research, it was developed the first vaccine against malaria, which showed partial protection against P. falciparum malaria in children. However, due to this only partial protection, the vaccine will be able to support the other methods of fighting malaria but not replace them.