Overview of the situation of deaths from malaria or hospitalizations of acute malaria cases in Costa Rica. Figures 1-5
In 2008, Costa Rica along with Nicaragua, Pana- Geographical distribution ma and Belize was among the Central American Figures 1, 12 – 19 countries with less than 1,000 cases of malaria per year. A total of 966 cases were reported in 2008, Matina canton, where 80% of the country’s cases of which a single municipality in Limon Provin- are concentrated, had an API of 17.1 cases per ce was responsible for 80% of the cases. Malaria 1,000 inhabitants. API in the other cantons re- transmission in the country is highly focal and at- porting malaria cases in 2008 was very low. tributable exclusively to Plasmodium vivax. The population at risk, as a percentage of The main vector species are Anopheles albi- the country’s total population, was similar in manus and A. pseudopunctipennis, which prolife- 2008 to what it had been in 2000 (34% in 2000 rate in single-crop areas, converted into farmland and 35% in 2008). Nonetheless, the population in recent decades, where population movements living in medium-risk areas has decreased con- are responsible for perpetuating transmission. siderably (from 493,000 inhabitants in 2000 to Other cases are reported in Puntarenas, on 33,739 in 2008). the Panamanian border, and Guanacaste, to the north, on the Pacific coast. Malaria in specific groups Figures 25–28 Morbidity and mortality trends Only 4.2% of the cases registered in 2008 were Figures 4 – 9 among children under the age of 5, a percenta- A Plasmodium falciparum malaria outbreak oc- ge lower than that noted in most countries. This curred in Matina Canton, Limon Province, in is due to the characteristic occupational malaria 2006, with 236 cases being reported. P. falcipa- transmission in Matina Canton. There are no re- rum malaria was reduced in 2007 to 11 cases and cords of pregnant women with malaria, despite not a single case was reported in 2008. Matina the registration of 246 cases of P. vivax malaria canton also accounted for 80% of the cases (P. infections among women between the ages of 15 vivax malaria) reported in the country in 2008. and 50. There have been no records over the past decade
R e port o n t h e S i t uat i o n o f M a l ar ia i n t h e A m e r i c as , 2 0 0 8 1 0 3 1 0 4 C OS TA R i c A R e port o n t h e S i t uat i o n o f M a l ar ia i n t h e A m e r i c as , 2 0 0 8
Diagnosis and treatment P. falciparum malaria in Costa Rica, as in the other Central American countries, is sensitive to Figures 20-24, 29–30 4-aminoquinolines, and for that reason the use In 2008, 17,304 slides were examined in suspec- of ACTs has not been adopted. ted fever patients, resulting in a SPR similar to that of the previous year (5.6%). In Limon Pro- Prevention and vector control vince, where over 80% of the cases are concentra- Figures 31-33 ted, the SPR was 5.5%. This was very high when compared to other provinces with focal malaria Vector control actions in 2008 included IRS. transmission (Puntaneras and Guanacaste), in- However, considerably less people were protec- dicating the need to intensify active detection of ted by IRS when compared to 2006. Use of LLINs cases in selected localities. has not been adopted as a control strategy in The malaria information system does not Costa Rica. consolidate information about time taken bet- ween the onset of symptoms and the initiation Financing of malaria control of treatment. Figure 34 Costa Rica’s control program has not adop- Malaria control in Costa Rica in recent years has ted the use of RDTs for malaria diagnosis. On been financed totally by the government, wi- the other hand, the number of treatments distri- thout the assistance of Global Fund projects or buted was nearly 10 times the total number of of grants or funding from multinational organi- confirmed cases. zations. R e port o n t h e S i t uat i o n o f M a l ar ia i n t h e A m e r i c as , 2 0 0 8 C OS TA R i c A 1 0 5
Figure 1. Number of cases by ADM 2 level (municipality, district), 2008
Legend
P. falciparum 1 Dot = 10 cases Nicaragua P. vivax 1 - 116 117 - 435 436 - 1202 1203 - 2314 2315 - 4148 No cases
Costa Rica
Panama
Figure 2. Proportion of cases by species, 2008
0%
100%
Plasmodium species P. vivax P. falciparum and mixed 1 0 6 C OS TA R i c A R e port o n t h e S i t uat i o n o f M a l ar ia i n t h e A m e r i c as , 2 0 0 8
Figure 3. Number of malaria cases by species by ADM1 level in 2008
P. falciparum + ADM1 P. vivax Total cases ADM1 mixed
Limon 0 863 863 Limon Puntarenas 0 60 60 Puntarenas Guanacaste 0 24 24 Guanacaste San Jose 0 6 6 San Jose Cartago 0 4 4 Cartago Heredia 0 3 3 Heredia Alajuela 0 2 2 Alajuela
0 500 0% 50% 100% Plasmodium species Total number of cases Percentage of total cases P. falciparum and mixed P. vivax
Figure 4. Number of cases by species, 2000 - 2008 Figure 5. Number of malaria cases, 2000-2008
4,000 3,538 4,000 3,541
3,000
3,000 2,903 2,667
2,000 1,867
2,000 1,879 1,362 1 Number of cases 1,363
1,112 Number of case s 1,289 1,000 1,284 1,223 704 1,02 966 1,008 966 1,000 8 71 236 12 1 2 14 5 3 11 0 0 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year Year
Plasmodium species P. falciparum and mixed P. vivax
Figure 6. Number of malaria deaths, 2000-2008 Figure 7. Number of hospitalized malaria cases, 2000 - 2008
4
No Data Available
2 Number of deaths
0 0 0 0 0 0 0 0 0 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year R e port o n t h e S i t uat i o n o f M a l ar ia i n t h e A m e r i c as , 2 0 0 8 C OS TA R i c A 1 0 7
Figure 8. Annual variations in number of cases Figure 9. Percentage difference in number of cases compared to 2000
2,000 2,254 1867%
1500% 1,000 580 ence
233 fer 1000% 1 12 -11 0 -11 -9 -2 -146
ence in number of cases -225 -354 -304 centage dif 500% fer -505 Dif -1,000 Per -871 90% 43% -27% -46% 17% -31% -8% -48% -1,555 0% 0% -40% -92% -83% -62% -58% -75% -100% 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year Plasmodium species P. falciparum and mixed P. vivax Plasmodium species P. falciparum and mixed P. vivax
Figure 10. Number of cases and RBM / Figure 11. Percentage of hospitalized cases, 2008 MDG targets for 2010 and 2015
No Data Available 3,000
2,000 Number of cases 1,000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Year
Reported cases RBM / MDG Targets 1 0 8 C OS TA R i c A R e port o n t h e S i t uat i o n o f M a l ar ia i n t h e A m e r i c as , 2 0 0 8
Figure 12. Districts (ADM2) with highest malaria burden and cummulative proportion of total cases in the country, 2008
Matina 769 80% Corredores 40 84% Talamanca 25 87% Guacimo 22 89% Limon 21 91% Pococi 15 93% Liberia 14 94% Siquirres 11 95% Coto Brus 8 96% Puntarenas 8 97% Perez Zeledon 6 97% Garabito 4 98% Turrialba 4 98% Bagaces 3 99% Carrillo 3 99% S 0 100 200 300 400 500 600 700 800 0% 20% 40% 60% 80% 100% Number of cases Cummulative proportion (%) of total cases
* See Annex A for a complete list.
Figure 13. Districts (ADM2) by number Figure 14. Districts (ADM2) by number of of malaria cases, 2008 P. falciparum cases, 2008
Number of cases 501-1,000 1 11-50 7 No district reported cases of P. falciparum malaria in 2008 6-10 3 1-5 10 Grand Total 21 0 5 10 15 20 25 Number of districts
Figure 15. Districts by number of cases, API and percentage of P. falciparum cases, 2008
0 API 25 25 25 0.04 5 10 20 17.07
15
10
5
Percentage of P. falciparum cases Siquirres Talamanca 0 Perez Zeledon Pococi Corredores Matina
2 5 10 20 50 100 200 500 1,000 Number of cases (logarithmic scale) R e port o n t h e S i t uat i o n o f M a l ar ia i n t h e A m e r i c as , 2 0 0 8 C OS TA R i c A 1 0 9
Figure 16. Annual Parasite Index (API) by districts (ADM2), 2008
Legend
Municipal API 0.01 - 1.00 Nicaragua 1.01 - 5.00 5.01 - 10.00 10.01 - 50.00 50.01 - 100.00 100.01 - 500.00
Costa Rica
Panamá
Figure 17. Population by malaria transmission risk, 2008
1% 1% 34%
64%
Population High risk (API > 10/1000) Medium risk (1/1000 < API < 10/1000) Low risk (API < 1/1000) Malaria free areas (No indigenous transmission) 11 0 C OS TA R i c A R e port o n t h e S i t uat i o n o f M a l ar ia i n t h e A m e r i c as , 2 0 0 8
Figure 18. Annual Parasite Index (API) and number Figure 19. Population by malaria transmission risk, 2000-08 of cases by district, 2008 Year High risk Medium risk Low risk Malaria free (API > (1/1000 < API (API < 1/1000) areas (No Matina 769 17.07 10/1000) < 10/1000) indigenous transmission) Corredores 40 1.19 Talamanca 25 0.77 2000 25,000 493,000 841,000 2,665,000 Guacimo 22 0.48 2001 33,000 307,000 948,000 2,522,000 Liberia 14 0.26 2002 36,000 281,000 1,057,000 2,651,000 Coto Brus 8 0.22 2003 39,000 149,000 1,215,000 2,767,092 Garabito 4 0.2 2004 41,000 187,000 1,196,000 2,825,000 Limon 21 0.2 2005 42,000 235,000 1,298,000 2,751,108 Siquirres 11 0.18 2006 43,000 240,000 1,312,000 2,807,094 Bagaces 3 0.16 2007 22,699 126,634 280,530 1,184,278 Tilaran 2 0.12 2008 45,040 33,739 1,517,128 2,880,773 Pococi 15 0.11 Carrillo 3 0.1 Puntarenas 8 0.08 Turrialba 4 0.06 Los Chiles 1 0.05 Nicoya 2 0.05 Figure 20. Slides examined and Slide Positivity Rate (SPR). Perez Zeledon 6 0.05 2000-2008 Santa Cruz 2 0.05 Year Number of slides Number of slides Slide Positivity Sarapiqui 3 0.04 examined positive Rate (%) San Carlos 1 0.01 2000 61,261 1,879 3.07 0 500 0 10 20 2001 43,053 1,363 3.17 Number of cases API 2002 16,738 1,021 6.1 API (cases/ 1000 people at risk) 2003 9,622 718 7.46 0 17.07 2004 9,204 1,289 14 2005 12,767 3,541 27.74 2006 24,498 2,903 11.85 2007 22,641 1,223 5.4 2008 17,304 966 5.58
Figure 21. Cases diagnosed by microscopy Figure 22. Number of cases diagnosed and RDTs, 2000-08 and cases treated, 2000-2008
Diagnostic Method Diagnosed cases Year Cases treated Year Microscopy RDTs 2000 Diagnosed cases 2000 61,261 Cases treated 2001 43,053 2001 Diagnosed cases 2002 17,738 Cases treated 2003 9,622 2002 Diagnosed cases 2004 9,204 Cases treated 2005 12,767 2003 Diagnosed cases 2006 24,498 Cases treated 2007 22,641 2004 Diagnosed cases 2008 447,627 Cases treated 2005 Diagnosed cases 0 20,000 40,000 60,000 0 20,000 40,000 60,000 Cases treated Number of cases Number of cases 2006 Diagnosed cases Cases treated 2007 Diagnosed cases Cases treated 2008 Diagnosed cases Cases treated 0 10,000 20,000 30,000 Number of cases diagnosed/treated R e port o n t h e S i t uat i o n o f M a l ar ia i n t h e A m e r i c as , 2 0 0 8 C OS TA R i c A 111
Figure 23. Slide Positivity Rate (SPR) by ADM1, 2008 Figure 24. Time span between onset of symptoms and diagnosis, 2008 ADM1 Examined Total cases SPR (%) Limon 15,711 863 5.49 Puntarenas 119 60 50.42 No Data Available Guanacaste 28 24 85.71 San Jose 20 6 30 Cartago 4 4 100 Heredia 3 3 100 Alajuela 451 2 0.44
Figure 25. Number and percentage Figure 26. Number and percentage of cases by age group, 2008 of cases by locality type, 2008
<5 4.2% Urban 0.0% 5-14 15.5% Rural 100.0% 15-49 68.3% 0 500 1000 >50 11.9% Number of cases 0 200 400 600 Number of cases
Figure 27. Number and percentage of cases in pregnant Figure 28. Number and percentage of cases women among women of child bearing age, 2008 in indigenous population, 2008
Pregnant 0.0% Not pregnant 100.0% No Data Available 0 100 200 Number of cases
Figure 29. Proportion of P. falciparum cases. 2000-2008 Figure 30. Number of ACT treatments distributed by year, 2000-08 100
80 Not Distributed
60
40
falciparum cases centage of P. 20 8.1 Per 1.9 0.1 0 0.6 0.1 0.2 0.4 0.9 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year 11 2 C OS TA R i c A R e port o n t h e S i t uat i o n o f M a l ar ia i n t h e A m e r i c as , 2 0 0 8
Figure 31. Indoor residual spraying Figure 32. Number of LLINs distributed by year, 2000-2008 coverage by year, 2000-08
Not Distributed
20,000 19,400 otecte d 12,435
10,000 6,45 0 Number of people pr 3,13 5 55 0 35 5 20 0 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year
Figure 33. Number of ITNs distributed by year, 2000-08 Figure 34. Sources for malaria control funds by year, 2000-08
6M Not Distributed
4M
US $
2M
NA 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year
Financing sources USAID Other bilateral funds Government UN agencies Global Fund
NA - Data not available