Microsoft Word - 9- Mr Farzinnia RTL 89 10 1_2_.doc Iran J Arthropod-Borne Dis, 2010, 4(2): 61–67 B Farzinnia et al.: Malaria Situation and … 61 Short Communication Malaria Situation and Anopheline Mosquitoes in Qom Province, Central Iran *B Farzinnia1, A Saghafipour2, MR Abai3 1Department of Environmental Health, School of Public Health, Qom University of Medical Sciences, Qom, Iran 2Health Center of Qom Province, Qom University of Medical Sciences, Iran 3Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Iran (Received 10 Mar 2010; accepted 27 Dec 2010) Abstract Background: The aims of this study was to analysis the current situation of malaria and to find the distribution of anopheline mosquitoes, as probable vectors of the disease, in Qom Province, central Iran. Methods: This study was carried out in two parts. First stage was data collection about malaria cases using recorded documents of patients in the Province health center, during 2001–2008. The second stage was entomological survey conducted by mosquito larval collection method in 4 villages with different geographical positions in 2008. Data were analyzed using Excel software. Results: Of 4456 blood slides, 10.9% out were positive. Most of cases were imported from other countries (90.4%), mainly from Afghanistan (56.5%) and Pakistan (16.3%). Slide positive rate showed a maximum of 16.9% and a minimum of 2.9% in 2008 and 2007, respectively. Plasmodium vivax was causative agent of 93.75% of cases, fol- lowed by P. falciparum (6.25%). More than 15 years old age group contained the most malaria reported cases (66.7%). Two Anopheles species, An. superpictus and An. claviger were collected and identified. This is the first report of Anopheles claviger in Qom Province. Conclusion: Malaria is in the control stage in Qom Province. The rate of local transmission is very low (only 1 case), shows Anopheles superpictus, as the main malaria vector of central part of Iran, can play its role in malaria transmission in the area. Keywords: Malaria, Iran, Epidemiology Introduction Malaria is one of the most important in- fectious diseases in tropical and subtropical regions of the world. The last data show 225 million cases of malaria resulted to about 781000 death in 2009 (WHO 2010). Malaria eradication program that started in 1956 in Iran changed to malaria control program from 1980, restricted the local trans- mission of this disease, so that at present it occurs only in 3 southeastern provinces of Sistan and Baluchistan, Hormozgan and Ker- man Provinces and 95% of cases in 2007 reported from these provinces (Raeisi et al. 2009). Multiplicity of malaria vectors and their various behaviors, resistance of the main vector An. stephensi Liston as well as An. culicifacies to some insecticides, absence of suitable transportation roads to some remote villages, structure of living houses, socio- economic conditions of people, immigration from malarious neighbor countries (Afghani- stan and Pakistan) and some other opera- tional problems are the present problems for malaria control program in Iran. According to the latest checklist of Iranian mosquitoes (Azari-Hamidian 2007) there are 28 Anophe- *Corresponding author: Mr Babak Farzinnia, E-mail: B-farzinnia@Muq.ac.ir Iran J Arthropod-Borne Dis, 2010, 4(2): 61–67 B Farzinnia et al.: Malaria Situation and … 62 les species in Iran, 7 out of them are well known as malaria vectors in the country: An. stephensi, An. culicifacies, An. fluviatilis and An. dthali in the southern part, An. macu- lipennis and An. sacharovi in north and north-west, and An. superpictus in central part, although it is distributed in nearly all parts of Iran, except for coastal area of Caspian Sea (Saebi 1987, Manouchehri et al. 1992, Edrissian 2006). During the 1994–95 an outbreak of Plasmodium vivax malaria appeared in the northwest parts of the coun- try in Parsabad, Ardebil Province (Arshi et al. 2002, Edrissian 2006). Anopheles sa- charovi was is responsible for malaria main- taining in this area (Yaghoobi-Ershadi et al. 2001). At present the disease in this area is under control. Besides, the risk of re-emergence of malaria exists in other parts of the coun- try. Iran showed evidence of a sustained de- crease in the number of cases, more than 50% since 2000, associated with wide scale implementation of malaria control activities and is classified in the pre-elimination phase of malaria (WHO 2010). Qom Province located in the central pla- teau region of Iran, where have lower risk of malaria infection compare to southern/south- eastern parts. Situation of this province in- creases its risk for malaria, because many passengers/pilgrims from malarious area visit this province and stay for sometime. The aims of this study was to analysis the current situation of malaria and to find the distribution of anopheline mosquitoes, as probable vectors of the disease, in Qom Prov- ince, central Iran. Materials and Methods Study area Qom is one of the 30 provinces of Iran, between 50o 06’–51 o 58’ E and 34 o 09’–35 o 11’ N with 11,237 km², covering 0.89% of the total area in Iran. It is in the northern part of the country, and its provincial capital is the city of Qom (Fig. 1). Based on the last census in 2005, this province had a population of approximately 2,000,000 out of which 91.2% resided in urban areas and 8.8% in rural vicinities. The province contains one city, five counties, nine rural districts, and 256 villages. The climate of Qom Province varies be- tween a desert and semi-desert climate, and comprises mountainous areas, foothills and plains. Due to being located near an arid region and far inland, it experiences a dry climate, with low humidity and scanty rainfall. The minimum and maximum temperatures in 2008 were -1.9 in January and 37.4 in June, respectively. The annual rainfall in this year was 114.9 mm. Relative humidity was ranged between 10.2 in June and 79.3 in February (Iran Meteorological Organization). Fig. 1. Position of Qom Province in Iran (left) and its geographical situation (right) Iran J Arthropod-Borne Dis, 2010, 4(2): 61–67 B Farzinnia et al.: Malaria Situation and … 63 Malaria information All data about malaria cases during 2001- 2008 were obtained from disease prevention unit, Qom Province health center. A databank was created in Excel software. Entomological survey In order to determine the anopheline mos- quito fauna of Qom Province, 4 villages with different geographical positions and weather conditions were selected: Agholak (Qahan District), Ahmadabad (Dastjerd District), Rah- jerd (Qomrood District) and Emamzadeh Esmail (Kahak District). Mosquito larval col- lection was conducted biweekly during April to November 2008, using dipping standard method of WHO. Larvae were collected from riversides which had small vegetation, and conserved in lactophenol medium. In the labo- ratory, the specimens were mounted in de Faure’s medium and identified using illustrated keys for Iranian mosquitoes (Shahgudian 1960, Azari-Hamidian and Harbach 2009). Results During the study period, 448 malaria cases were detected and reported in Qom Province. Out of them 420 cases were infected by Plas- modium vivax, while 28 cases were due to P. falciparum (Table 1). Based on recorded data only one case was due to local transmission and others were imported. This case was an Ira- nian man who lived close to 15 families of for- eign religious sciences students. Most of cases observed among passengers who came to Qom from other countries (90.4%) and dif- ferent parts of Iran for pilgrimage and also studying the religious sciences. Afghani pa- tients had the highest rate of infection (56.5%), followed by Pakistani peoples (16.3%) and other nationalities such as Sudanese, Yemeni and so on (17.6%). Reported cases were higher in males (63.8%) than females (36.2%). Analysis of cases based on age showed 11.6%, 21.6% and 66.8% were in 0-4, 5-15 and more than 15 yr old age groups, respectively. Most of cases were reported in August and Sep- tember. Plasmodium vivax was dominant parasite species and the trend of the disease had a decreasing pattern (Fig. 2). During April–November 2008, a total of 223 Anopheles larvae were collected and identified from collection stations. Anophe- les claviger was dominant species (78.9%) and An. superpictus had the second frequency (21.1%). The activity of these species started from June and finished at December with a peak at September for An. claviger (Fig. 3) and August for An. superpictus (Fig. 4). Anopheles claviger is more distributed than An. superpictus in Qom Province, and found in three rural districts of Dastjerd, Qahan and Kahak, while An. superpictus was only col- lected from Kahak. In Qomrood District we found only Culicinae larvae. 0 20 40 60 80 100 120 140 160 2001 2002 2003 2004 2005 2006 2007 2008 Year N o. P.vivax P.falciparum Fig. 2. Malaria cases based on parasitic species, Qom province, 2001-2008 Iran J Arthropod-Borne Dis, 2010, 4(2): 61–67 B Farzinnia et al.: Malaria Situation and … 64 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Months N o. pe r 10 di pp er Dastjerd Qahan Kahak Qomrood Fig. 3. Monthly activity of Anopheles claviger larvae in Qom province, 2008 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Months N o. p er 10 di pp er Dastjerd Qahan Kahak Qomrood Fig. 4. Monthly activity of Anopheles superpictus larvae in Qom province, 2008 Iran J Arthropod-Borne Dis, 2010, 4(2): 61–67 B Farzinnia et al.: Malaria Situation and … 65 Table 1. Malaria information in Qom Province, 2001–2008 Nationality Sex Age groups Species Residenceplace Y ears A t risk population Iranian Non-Iranian Male F em ale <5 5–14 14< P. vivax P . falciparum M ix T otal slides T otal cases A P I A SP R A B E R A V I A F I City Village 2001 917080 15 136 83 68 29 43 79 149 2 0 972 151 0.00016 0.155 0.0010 0.153 0.002 105 46 2002 942045 9 105 59 55 15 36 63 97 17 0 815 114 0.00012 0.139 0.0008 0.119 0.020 56 58 2003 967193 4 47 36 15 4 5 42 45 6 0 741 51 0.00005 0.068 0.0007 0.060 0.008 43 8 2004 991993 3 54 47 10 0 3 54 57 0 0 661 57 0.00005 0.086 0.0006 0.085 0 45 12 2005 1018997 4 18 16 6 1 0 21 22 0 0 233 22 0.00002 0.094 0.0002 0.094 0 18 4 2006 1046737 3 16 17 2 0 6 13 19 0 0 500 19 0.00002 0.038 0.0004 0.038 0 4 15 2007 1074475 4 8 8 4 1 1 10 10 2 0 404 12 0.00001 0.029 0.0003 0.024 0.005 12 0 2008 1102948 1 21 20 2 2 3 17 21 1 0 130 22 0.00002 0.169 0.0001 0.161 0.008 21 1 Total --- 43 405 286 162 52 97 299 420 28 0 4456 448 -- -- -- -- -- 304 144 API = Annual Parasite Incidence, ASPR = Annual Slide Positive Rate, ABER = Annual Blood Examination Rate AVI = Annual Vivax Incidence, AFI = Annual Falciparum Incidence Iran J Arthropod-Borne Dis, 2010, 4(2): 61–67 B Farzinnia et al.: Malaria Situation and … 66 Discussion In the entomological survey we found An. superpictus and An. claviger were active in the study area. Saebi (1987) reported only An. superpictus from Qom area, so this is the first report of An. claviger for Qom fauna. A study on malaria situation in Kashan City, close to Qom reported three anopheline mos- quitoes, An. superpictus, An. claviger and An. molticolor in that area (Doroudgar et al. 1999). The Human Blood Indexes (HBIs) in An. superpictus in Iran was reported 4.9 (Edrissian et al. 1985). This show An. super- pictus has antropophilic behavior, although it is an exophilic species. This species is intro- duced as malaria vector in central plateau of Iran and can play its role in local transmis- sion of malaria in Qom Province under fa- vorite conditions. The activity peak of this Anopheles in the area is the same with ma- laria disease occurrence. So it can be an alarm for malaria transmission in the area. Natural sporozoite infections of An. claviger have been recorded in Syria, Cyprus, Meso- potamia, and Taranto in Italy (Muir and Keilany 1972). More studies are recommended on this species in Iran to clear its antropo- philic index and probable role in malaria transmission. Results of this survey show malaria is at control stage in Qom Province, like many other provinces of the country. Trend of this disease was decreased up to 2007, but in- creased after that in 2008 (Fig. 2). Although all reported cases in this province were im- ported, the history of malaria in this province shows one indigenous case in 2004. Annual parasite index (API) decreased from 0.00016 in 2001 to 0.00001 in 2007, while annual blood examination rate (ABER) is also de- creased from 0.0010 to 0.0003 during this period (Table 1). This show the surveillance system is not alert and only passive slides were taken. This may be due to low impor- tance of malaria in Qom Province. Most of patients were non-Iranian, so it is recom- mended to take blood slide from all foreign students that mainly came from endemic countries for malaria, to improve the sur- veillance system of malaria detection and treatment. Qom Province has thousands passengers from all parts of the country as well as other countries like Afghanistan, Pakistan, Yemen, Sudan, Djibouti and other malarious coun- tries, so imported cases can play their role as malaria parasite reservoirs in the area and local transmission can occurs in suitable conditions. Results of this study show only 0.2% of recorded cases were due to local transmis- sion. Survey on the epidemiology of malaria in Kashan Province, bordered with Qom, showed 95% of positive cases were Afghani immigrants (Doroudgar et al. 1999). A simi- lar study in Hamadan Province, western of Iran, shows 2.56% of reported cases during a 20 yr period were due to local transmission (Fallah et al. 2003). In addition, in Mazanda- ran Province, northern Iran, during 1999- 2003; 13.7% of cases had no history of travel to other parts of the country (Najafi et al. 2006). Results of a demographic study on malaria in Kohgiloye and Boyer Ahmad Prov- ince, west of Iran, showed 62.7% of cases were local Iranian peoples (Moshfe et al. 2003). This shows local transmission is oc- curred in this province, maybe due to favor- able conditions for malaria vectors in that area. Although the probability of local trans- mission of malaria in Qom Province is very low, it is not impossible. So we recommend improving the surveillance system for case detection and treatment by active slide pre- paring among foreign students of religious sciences as well as pilgrims coming from malarious countries. 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