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Malaria in the UK: Past, Present, and Future T Chin, P D Welsby

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Malaria in the UK: Past, Present, and Future T Chin, P D Welsby 663 Postgrad Med J: first published as 10.1136/pgmj.2004.019794 on 10 November 2004. Downloaded from HISTORY OF MEDICINE Malaria in the UK: past, present, and future T Chin, P D Welsby ............................................................................................................................... Postgrad Med J 2004;80:663–666. doi: 10.1136/pgmj.2004.021857 There is strong evidence that malaria was once indigenous components and other quality control defects’’.4 Indeed the UK and the Earth may have to the UK, that global warming is occurring, and that experienced a medieval warming period (800– human activity is contributing to global warming. Global 1300) and the Little Ice Age (1300–1900), both warming will have a variety of effects, one of which will occurring when human activity with greenhouse gas production would not have been relevant.5 It probably be the return of indigenous malaria. is possible that the global warming we have ........................................................................... recently been experiencing is independent of human activities. The Intergovernmental Panel on Climate alaria in the UK is an imported disease Change agree that global warming is occurring but there is evidence that it was once and predict that the globe’s average temperature indigenous.1 The use of land improve- will increase by 1–3.5˚C by 2100 and that this M would be associated with other environmental ment techniques, antimalaria drugs, and improvements in standards of living at the end changes including a rise in sea level, increased of the 19th century were responsible for its global precipitation, and increased frequency of 6 decline and eventual disappearance. It is postu- extreme weather events. lated that global warming will allow malaria to establish itself in the UK. WHAT PART DOES HUMAN ACTIVITY PLAY IN GLOBAL WARMING? IS GLOBAL WARMING OCCURRING? The main human postulated contribution to The conventional wisdom answer is ‘‘Yes’’. global warming is the burning of fossil fuels The global temperature is a result of interac- which release water vapour and approximately tions between the sea, the atmosphere, fluctua- 6.5 billion tons of carbon into the atmosphere tions in energy from the sun, volcanic eruptions, each year. Atmospheric concentrations of carbon changes in the Earth’s orbit, and quantities of dioxide have increased by almost 30% from pre- greenhouse gases in the atmosphere which trap industrial levels, although human activities heat in much the same way that a greenhouse represent only 3% of the carbon dioxide enter- traps heat. The main greenhouse gases are water ing the atmosphere annually. The relationship vapour (the biggest contributor), carbon dioxide, between this slight increase in carbon dioxide ozone, methane, nitrous oxide, and in recent and the increase in Earth’s temperature over the http://pmj.bmj.com/ years chlorofluorocarbons.1 past 100 years may not be causal. Our planet has experienced numerous changes Eighty percent of the carbon dioxide released in climate. The last ice age, when there was from human activity occurred after 1940 during widespread coverage of land by glaciers, ended the industrial expansions of World War II and 12 000 years ago and for the last 10 000 years the the post-war boom yet the observed warming 2 Earth’s climate has been relatively warm. began to take place before this (fig 2). Further- Reliable worldwide temperature records did more, between 1940 and1980 there was slight on September 26, 2021 by guest. Protected copyright. not exist before the 1900s and indirect estimates global cooling despite an increase in fossil fuel for earlier eras have to be made using, for burning.7 The United States disputed the causal example, measurements of tree ring widths, association between carbon dioxide emission ratios of oxygen isotopes in glacial ice, variations and global warming and refused to sign the in species of microscopic animals trapped in 1992 Kyoto treaty designed to limit fossil fuel sediments (different species thrive in different emissions. temperatures), and historical records of harbour No matter what the cause(s) global warming closures from ice. The most frequently quoted will continue in the short term. It would be 3 estimates are those of Mann et al summarised in interesting to see if life on Earth will adapt to fig 1. The circumstantial evidence is that the minimise global warming—a kind of global See end of article for Earth’s temperature had been stable for the past homoeostasis as suggested in Lovelock’s Gaia authors’ affiliations 1000 years before 1900 when global warming, an hypothesis8 with enhanced photosynthesis help- ....................... increase in the average surface temperature of ing to slow the increase in atmospheric carbon the Earth, occurred caused, so it is claimed, by Correspondence to: dioxide. Increasing deforestation may well sub- Dr Philip D Welsby, increasing use of fossil fuels and a subsequent vert this possibility. Western General Hospital, rise in atmospheric carbon dioxide. Edinburgh EH4 2XU, UK; The validity of this evidence has been ques- [email protected] tioned. The research was plagued by ‘‘collation WILL GLOBAL WARMING AFFECT Submitted 10 March 2004 errors, unjustifiable truncations of extrapolation MALARIA? Accepted 30 March 2004 of source data, obsolete data, geographical loca- Malaria will be the disease most affected by ....................... tion errors, incorrect calculations of principle global warming9 and an average global warming www.postgradmedj.com 664 Chin, Welsby Postgrad Med J: first published as 10.1136/pgmj.2004.019794 on 10 November 2004. Downloaded from C) C) ° 0.8 ° 0.8 0.4 0.4 0.0 0.0 –0.4 –0.4 –0.8 –0.8 Departures in temperature ( 1000 1200 1400 1600 1800 2000 Departures in temperature ( 1860 1880 1900 1920 1940 1960 1980 2000 Figure 1 Departures in temperature over the past 1000 years in the Figure 2 Departures in temperature globally over the past 140 years northern hemisphere (from1961–80 average). (from the 1961–90 average). quartan periodicity. Geoffrey Chaucer in the Nonne Preeste’s of 3˚C by the year 2100 could increase the world annual Tale of 1386 describes a tertian fever: incidence of malaria by 50–80 million from the current 300– 500 million.10 Temperature (and humidity) are among the most important factors for malaria transmission. Parasite And if it do, I dare lay a grote, multiplication inside the cold blooded mosquito reduces That ye shul hav a fevere tertaine, dramatically at temperatures between 20 and 27˚C and Or an aigu that may be yore bane. parasite development ceases below 16˚C, so that malaria is confined by a 16˚C minimum temperature line.11 Plasmodium vivax was the most likely cause of most UK Currently the range of the malarial parasites has not been malaria because the mortality was lower than that associated significantly extended, but ‘‘airport malaria’’ occurs during with P falciparum infections in non-immunes, ague could hot weather in temperate countries, and small outbreaks of relapse after recovery as can P vivax, and patients with (vivax) malaria have occurred in Florida.12 falciparum malaria either die or survive multiple attacks It is predicted that UK temperatures will rise by 2–3.5˚Cby which eventually leave them immune. 2080, greater in the south and east than in the north and References to quartan fevers in the 17th and 18th centuries west, winters will become wetter, summers will become drier, suggest P malariae also occurred here. Thomas Sydenham summer precipitation may decrease by 50% or more by 2080, (1624–89), a leading 17th century English physician, wrote and winter precipitation may increase by up to 30%.13 that anyone dwelling in the locality of marshes and lakes At least, global warming would increase the chance of becomes ‘‘impressed with a certain miasma which produces a acquisition of malaria by UK residents visiting malarial areas. quartan ague’’.18 The topographer John Norden visited Essex For mosquitoes warmer temperatures will14 15: in the 1590s but was unable to ‘‘commende the healthfulness of it, especiallie nere the sea coastes…. And other low places N Increase populations. about the creeks which gave me a most cruell quarterne N Increase lifespan. fever’’.19 N Produce a wider geographical distribution. There are many references to the association of ague with N Increase rates of parasite multiplication (which increases marshes, but only rarely to insects or mosquitoes. Sydenham http://pmj.bmj.com/ the likelihood of transmission to another host). (1624–89) in Observationes Medicae in 1667 included descrip- tions of paroxysms, both tertian and quartan, with references N Increase feeding on humans. to insects ‘‘When insects do swarm extraordinarily and N Shorten the period between infection and infectivity. when…agues (especially quartans) appear as early as about N Increase duration of feeding patterns. midsummer, then autumn proves very sickly’’. N Enlarge breeding sites and cause floods by increasing Shakespeare (1564–1616) made frequent reference to ague and recognised the connection between ague and marshy rainfall which will also disrupt antimosquito actions by on September 26, 2021 by guest. Protected copyright. humans. areas: N Increase the inoculation rate. N Enhance breeding activity. All the infections that the sun sucks up From bogs, fens flats on Prosper fall and make him In the short term it is unlikely that vaccination, new By inch-meal a disease! antimalarial drugs, genetic engineering to produce malaria The Tempest II, 2, 1–3. resistant mosquitoes, or encouragement of relevant mosquito predators will have significant impacts on malaria. Five species of anopheline mosquitoes (the only species capable of transmitting human malaria) are indigenous to MALARIA IN THE UK: THE PAST the UK, of which only Anopheles atroparvus breeds in sufficient Circumstantial evidence is overwhelming that indigenous numbers and in close enough association with humans to act malaria (‘‘the ague’’) occurred in the UK.
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