Origin of malaria cases: a 7-year audit of global trends in indigenous and imported cases in relation to malaria elimination

Figures & data

Box 1. Definitions of malaria control, pre-elimination, elimination, and prevention of reintroduction, and malaria-free status (1, 2)

Control: The reduction of the malaria disease burden to a level at which it is no longer a public health problem. Pre-elimination: The annual incidence of malaria in the district with the highest number of cases being less than five cases per 1,000 population. Elimination: Interruption of local transmission (reduction to zero incidence) of a specified malaria parasite in a defined geographic area as a result of deliberate efforts. Continued measures to prevent reestablishment of transmission are required. Prevention of reintroduction: 1) Recently, endemic country with zero local transmission for at least 3 years or 2) country on the WHO Register or Supplementary List that has ongoing local transmission.^a Malaria-free status: An area in which there is no continuing local mosquito-borne malaria transmission and the risk for acquiring malaria is only limited to introduced cases.^b

^aOngoing local transmission=2 consecutive years of local P. falciparum malaria transmission or 3 consecutive years of local P. vivax malaria transmission in the same locality or otherwise epidemiologically linked.

^bIntroduced: A case contracted locally, with strong epidemiological evidence linking it directly to a known imported case.

Table 1 Classification of countries by stage of elimination, December 2014

Region	Pre-elimination	Elimination	Prevention of reintroduction	Certified as malaria-free since 2000
AFR	Cape Verde	Algeria
AMR	Belize Costa Rica Ecuador El Salvador Mexico Paraguay	Argentina
EMR		Iran (Islamic Republic of) Saudi Arabia	Egypt Iraq Oman Syrian Arab Republic^a	Morocco – 2010 United Arab Emirates – 2007
EUR		Azerbaijan Tajikistan Turkey	Georgia Kyrgyzstan Uzbekistan	Turkmenistan – 2010 Armenia – 2011
SEAR	Bhutan Democratic People's Republic of Korea	Sri Lanka
WPR	Malaysia	Republic of Korea

^aLimited information is available from the Syrian Arab Republic.

Source: World Malaria Report 2014.

Fig. 1 Proportion of countries reporting the origin of malaria cases between 2007 and 2013, by stage of malaria elimination. NA=Not applicable

Fig. 2 Total number of imported and indigenous malaria cases reported by countries in pre-elimination, elimination and prevention of reintroduction, 2007–2013. (a) Pre-elimination.^a (b) Elimination. (c) Prevention of reintroduction.

^aFor countries in pre-elimination, data on indigenous and imported cases was not available for year 2007.

Fig. 3 Proportion of imported malaria cases by WHO region, 2013. AFR, African Region; AMR, Region of the Americas; EMR, Eastern Mediterranean Region; EUR, European Region; SEAR, South-East Asia Region; WPR, Western Pacific Region. The numbers in brackets indicate the total number of countries in pre-elimination, elimination, and prevention of reintroduction in each of the regions.

World Health Organization. Malaria elimination: a field manual for low and moderate endemic countries. 2007; Geneva: World Health Organization. 98.

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World Health Organization. World malaria report 2014. 2014. Available from: http://www.who.int/malaria/publications/world_malaria_report_2014/report/en/ [cited 30 August 2015]..

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