Malaria Situation & Drug Policy Malaysia Infectious Disease Consultant/Physician MOH Malaysia
Malaria incidence
Incidence and Incidence Rate Malaria in Malaysia
MALARIA CASES AND INCIDENCE RATE BY GEOGRAPHICAL AREA (STATE) 2004
Malaria Parasite Distribution Malaysia 2004
Malaria Age-specific Incidence Rate Malaysia 2004
Malaria cases among Malaysian and foreign citizens % % % % % 4145
Malaria deaths and CFR Malaysia
Malaria Deaths contributed by Malaysians and foreign citizens in 2004 Mortality Rate: Malaysian: 18/4145 (0.43%) Foreigners: 17/2008 (0.84%)
MANAGEMENT: DRUG THERAPY: PROPHYLAXIS: 1. FANSIDAR & CHLOROQUINE 2. PROGUANIL & CHLOROQUINE 3. DOXYCYLINE RISK GROUP: 1. VISITORS TO HIGH RISK AREA IN SABAH,SARAWAK & PAHANG 2. ARMY : WORKING OR FIELD TRAINING IN HIGH RISK AREA 3. LOCAL PEOPLE WHO WORK OR ENTER HIGH RISK AREA-surveyors,loggers or jungle related occ.
MANAGEMENT DRUG TREATMENT: -TO ALL CONFIRMED CASES -ALL CASES WILL BE HOSPITALISED EXCEPT THOSE FROM REMOTE AREA PLASMODIUMDRUGS (1 st line) Remarks FALCIPARUMCQ & SP +/- PQ 1.QUININE & DOXY For foreigners/immigrants 2. SP & PQ (Single dose) -Orang Asli lives in remote area -mass radical Rx during large outbreak in remote area VIVAXCQ & PQ NON COMPLICATED
COMPLICATED CASES 2. SEVERE MALARIA (i) QUININE at 10mg/kg with 5% Dextrose over 4 hours then 8hourly AND DOXYCYLINE (ICU or HDW Management) 1.RESISTANT MALARIA (i) QUININE & DOXYCLINE- physician approval (ii) MEFLOQUINE – requires Health State Director Approval
Status of P. falciparum resistance to antimalarial drugs West Malaysia. 28.5% CQ resistance (1963 by Montgomery & Eyles) > 60% by the mid-90's (Hakim et al, 1996) in Peninsular Malaysia. 47.4% SP resistance for the first time in Malaysia , two 28-day in vivo studies on the CQ+SP combination reported 51.4% (19/37) resistance in Kemaman, Terengganu state, 62.5% (15/24) in Air Bah, Perak state. Sentinel surveillance was started early 2003 in 10 sites looking at treatment response (unpublished Report, VBDC, MoH)
Summary of response by drugs (completed 28 days follow-up) in 2003 DrugValid cases Completed D28 Incon- clusive (%) Adequate response (%) Early failure (%) Late failure (%) Total failure (%) CHL (20.4) 40 (54.8) 18 (24.7) 15 (20.5) 32 (45.2) SP (78.8) 10 (83.3) 1 (8.3) 1 (8.3) 2 (16.7) CHL + SP (31.7) 77 (68.8) 16 (14.3) 19 (17.0) 35 (31.3) Total (36.2) 127 (64.5) 35 (17.8) 35 (17.8) 70 (35.5)
Summary of response by drugs in 2004 (completed 28 days follow-up) DrugValid cases Completed D28 Incon- clusive (%) Adequate response (%) Early failure (%) Late failure (%) Total failure (%) CHL + PQ (44.8%) 8 (21.6%) 9 (24.3%) 20 (54.1%) 29 (78.4%) SP + PQ (55.0%) 14 (77.8%) 2 (11.1%) 2 (11.1%) 4 (22.2%) SP + CQ + PQ (45.9%) 15 (75.0%) 2 (10.0%) 3 (15.0%) 5 (25.0%) Total (47.9%) 37 (49.3%) 13 (86.7%) 25 (33.3%) 38 (50.7%)
East Malaysia. There are no studies documented on chloroquine resistance from In 1996, the VBDC, MoH reported 29.4% SP treatment failures ( 28-day in vivo study done in Tawau, Sabah, East Malaysia). -100% sensitivity to Mefloquine and Quinine, -16.6% (2/12) failures to Artesunate 20 mg/kg x 6 days (Unpublished report, 2003) in Sarawak - 43% failures to the CQ+SP combination (Cox-Singh et al, 2003). There are 8 surveillance sites in Sarawak and Sabah (4 each) as part of the MoH/IMR National Surveillance Program that started early this year.
Distribution of Insecticide Treated Bednets in Malaysia 1995 &
1.CROSS BORDER MIGRATION - Sarawak & Indonesia - Northern part of Pen Malaysia & Thailand 2.Foreign workers from endemic areas- urban malaria outbreaks & emergence of resistance 3.Geographical inaccessibility : Remote settlement/interior area- 4.As the number of malaria cases comes down - delay in diagnosis/ management 5. Inadequate drug efficacy monitoring & resistance surveillance 6. Lack in number of experienced personnel in malaria management 7. Unavailability of anti-malaria drug policy CHALLENGES
ACT issue ACT will be a definite treatment alternative for Malaysia because of its benefits Formulation of anti malaria drug policy.