Malaria

Malaria is an acute febrile illness caused by Plasmodium parasites, which are spread to people through
the bites of infected female Anopheles mosquitoes. It is preventable and curable.

What is Malaria and how it is transmitted

Malaria is a life-threatening disease primarily found in tropical countries. It is both preventable and
curable. However, without prompt diagnosis and effective treatment, a case of uncomplicated malaria
can progress to a severe form of the disease, which is often fatal without treatment.

Malaria is not contagious and cannot spread from one person to another; the disease is transmitted
through the bites of female Anopheles mosquitoes. Five species of parasites can cause malaria in
humans and 2 of these species – Plasmodium falciparum and Plasmodium vivax – pose the greatest
threat. There are over 400 different species of Anopheles mosquitoes and around 40, known as vector
species, can transmit the disease.

This risk of infection is higher in some areas than others depending on multiple factors, including the
type of local mosquitoes. It may also vary according to the season, the risk being highest during the
rainy season in tropical countries.

Who is at risk of malaria

Nearly half of the world’s population is at risk of malaria. In 2020, an estimated 241 million people
contracted malaria in 85 countries. That same year, the disease claimed approximately 627 000 lives.

Some people are more susceptible to developing severe malaria than others. Infants and children under
5 years of age, pregnant women and patients with HIV/AIDS are at particular risk.

Symotoms and Diagnosis

The first symptoms of malaria usually begin within 10–15 days after the bite from an infected mosquito.

Fever, headache and chills are typically experienced, though these symptoms may be mild and difficult
to recognize as malaria. In malaria endemic areas, people who have developed partial immunity may
become infected but experience no symptoms (asymptomatic infections).

WHO recommends prompt diagnosis for anyone with suspected malaria. If Plasmodium
falciparum malaria is not treated within 24 hours, the infection can progress to severe illness and death.
Severe malaria can cause multi-organ failure in adults, while children frequently suffer from severe
anaemia, respiratory distress or cerebral malaria. Human malaria caused by other Plasmodium species
can cause significant illness and occasionally life-threatening disease.

Malaria can be diagnosed using tests that determine the presence of the parasites causing the disease.

There are 2 main types of tests: microscopic examination of blood smears and rapid diagnostic tests.

Diagnostic testing enables health providers to distinguish malarial from other causes of febrile illnesses,
facilitating appropriate treatment.
Prevalance

Malaria is a preventable disease.

1. Vector control interventions. Vector control is the main approach to prevent malaria and reduce
transmission. Two forms of vector control are effective for people living in malaria-endemic countries:
insecticide-treated nets, which prevent bites while people sleep and which kill mosquitoes as they try
to feed, and indoor residual spraying, which is the application of an insecticide to surfaces where
mosquitoes tend to rest, such as internal walls, eaves and ceilings of houses and other domestic
structures. For travellers, the use of an insecticide-treated net is the most practical vector control
intervention. WHO maintains a list vector control products that have been assessed for their safety,
effectiveness and quality.

2. Chemopreventive therapies and chemoprophylaxis. Although designed to treat patients already

infected with malaria, some antimalarial medicines can also be used to prevent the disease. Current
WHO-recommended malaria chemopreventive therapies for people living in endemic areas include
intermittent preventive treatment of malaria in pregnancy, intermittent preventive treatment of malaria
in infants and seasonal malaria chemoprevention for children under 5 years for age. Chemoprophylaxis
drugs are also given to travellers before entering an area where malaria is endemic and can be highly
effective when combined with insecticide-treated nets.

Treatment

Malaria is a treatable disease. Artemisinin-based combination therapies (ACTs) are the most effective
antimalarial medicines available today and the mainstay of recommended treatment for Plasmodium
falciparum malaria, the deadliest malaria parasite globally.

ACTs combine 2 active pharmaceuticals with different mechanisms of action, including derivates of
artemisinin extracted from the plant Artemisia annua and a partner drug. The role of the artemisinin
compound is to reduce the number of parasites during the first 3 days of treatment, while the role of the
partner drug is to eliminate the remaining parasites.

As no alternative to artemisinin derivatives is expected to enter the market for several years, the efficacy
of ACTs must be preserved, which is why WHO recommends that treatment should only be
administered if a person tests positive for malaria. WHO does not support the promotion or use
of Artemisia plant material (whether teas, tablets or capsules) for the prevention or treatment of malaria.

Over the last decade, parasite resistance to antimalarial medicines has emerged as a threat in the fight
against malaria, particularly in the Greater Mekong subregion. WHO is also concerned about more
recent reports of drug-resistant malaria in Africa. To date, resistance has been documented in 3 of the
5 malaria species known to affect humans: P. falciparum, P. vivax, and P. malariae. However, nearly
all patients infected with artemisinin-resistant parasites who are treated with an ACT are fully cured,
provided the partner drug is highly efficacious.

Vaccines

RTS,S/AS01 (RTS,S) is the first and, to date, only vaccine that has demonstrated it can significantly
reduce malaria in young children living in moderate-to-high malaria transmission areas. It acts against
the Plasmodium falciparum parasite, the deadliest malaria parasite globally and the most prevalent in
Africa