SITUATION (Personal communication by Mr. Kulkarni, DMO, Maharashtra State, 1982) Group 1 12 th August 2015

Borada section Shirpur taluk sub-district. Dhulia District. Maharashtra State. Transmission of malaria had been virtually stopped in Pv cases-reported in imported from Madhya Pradesh + 2 as relapse 27 Pv cases were reported in Bamboo Cutting in the forest Lakdya Hanuman M L K

Common features of all cases: a)All had – fever 2-3 days b/f blood exam; b)No one experienced such type of fever since 2 yrs back c) Only adult males were found (+) d) All (+) – Forest goers 2 days journey to forest 5 day stay in jungle 8-10 days after returning from forest MBE Feb – alll negative MBE Mar-all negativ e Surveilan ce: No cases March – Dec January February - December Detailed information of 27 Pv cases o/of 70 forest goers

1)To which category do the cases belong? Likely to be imported cases ( of Lakkadpur and Kolsapani) but in Malkatar, cannot be excluded relapse or imported cases. More information required as outbreak investigation, ie Date of going into the forest, date of return from the forest, date of onset of fever, who was the first index case and how it was spread ( one or more after him). Any other people from other villages of the same section (or) from other areas also came to that forest before their arrival? (or) at the same time? (may be among those people carry the parasite)

2)To which category of foci do the three villages belong? Since only imported or relapsing cases were present and no indigenous cases were documented earlier and none throughout Feb-Dec, the 3 villages could be new potential focus or pseudo focus. (no entomological surveillance data was available)

3) Is the area around Lakdya Hanuman (temple area in forest) a focus of malaria? Yes, the area is “Active Focus”. “Transmission” was going on in that area.

4)What was the source of infection in this case? Unknown. But likely to be an imported case to that area or relapse case in that area. From monkeys????

Malaria infection Due to mosquito borne transmission Acquired locally Acquired outside area or abroad Not due to mosquito borne transmission INTRODUCED First-generation local transmission; epidemiologically linked to proven imported cases INDIGENOUS all cases without evidence of a direct link to an imported case IMPORTED RRELAPSING – history of P.vivax or P.ovale infection within past 3 years; no epidemiologically linked cases in vicinity INDUCED e.g, due to blood transfusion, congenital malaria Classification of malaria cases by origin of infection 9 A field manual for low and moderate endemic countries

Transition of functional status of a malaria focus depending on the situation Cleared up Endemic Residual non- active New Active New potential Residual Active Absent Effective Ineffective Present Control Transmission Case 17 December 2012, saw lwin10 A field manual for low and moderate endemic countries