The “who’s who” in medical journals just published a study for healthcare authorities in southern Europe, Near Middle East and Mediterranean to follow. Along with a growing surge in cholera in Lebanon there is a new malaria threat now in places where the disease has been eradicated. Malaria is very common in Africa, and here and there imported cases come to the Middle East Gulf countries via foreign workers. Malaria wasn’t something people sitting on a beach in Cannes had to worry about: until now.
A paper published in The Lancet Global Health journal is sounding the alarm about the growing threat of malaria potentially spreading to countries in Europe where the disease has been pretty eradicated since the 20th century.
Endemic malaria, saw 229 million new cases and 409,000 deaths in 2019 but mainly in Africa. Historical descriptions of intermittent “tertian” and “quartan” fever were long ago reported in texts of Hippocrates in Greece and Celsus in Italy suggest malaria. So we know it was there. But as climate change heats Europe, new malaria vectors – novel species never before found in Europe – are moving in. They could bring suitcases of malaria with them as the newly introduced Anopheles species (a kind of mosquito) spreads.
The rapid increase in the population of an invasive species of mosquito Anopheles Stephensi across urban settings from east to west Africa, poses a viable threat of malaria spreading to warmer European countries around the Mediterranean over the next decade, the researchers report.
A stephensi, native to rural and urban China, parts of Asia and the Middle East was first discovered in Africa in Ethiopia in 2012. Because it shares similar behaviour patterns to the Aedes mosquito, which is responsible for the ever-growing morbidity burden of the dengue virus now present in 129 countries, urgent action is needed to control its spread.
The new paper in The Lancet outlines how A stephensi has adapted to breed, like Aedes, in man-made water containers in densely populated urban settings. This has huge implications for increased malaria morbidity and mortality potentially affecting millions of people.
With a large proportion of urban residents more immunologically susceptible than rural communities, patients that get infected with malaria are at greater risk of developing severe clinical symptoms with a proportionately higher risk of death.
Richard Allan, Mentor CEO and lead contributor to the paper, said: “The aggressive spread of Anopheles stephensi is closely linked to increases in population movement and rapid, unplanned urbanisation which leads to poor water quality, sanitation, water container removal and hygiene systems.
How we can stop malaria
The simple and hardest answer is stop climate change.
“But we can stop the spread of A stephensi in African urban settings by using improved community-based vector control practices that also target Aedes, such as managing water storage and waste removal; alongside targeted larvicidal source management and the use of new tools like spatial repellents and mosquito proofing of houses.
“We must escalate our response to stop the potentially rapid development of urban malaria transmission and the spread of dengue viruses and other Aedes-borne viruses.
“It is also important that the surveillance of A stephensi is integrated into new and existing entomological surveillance programmes in Europe.
The technical challenges of controlling A Stephensi and malaria in African urban settings, he adds, are no more complex than those used to control diseases that Aedes mosquitoes spread. This presents a real opportunity for disease control and health agencies working together with water and sanitation services and urban planners to effectively protect the millions of people at risk.
