SECTION IV: COUNTRIES

ARGENTINA Figure 1. Malaria in Argentina by foci, 2014 Argentina has achieved 100% reduction in malaria since 2000 and only reports imported cases (Figures 1-3). Bolivia

The country is currently in the elimination phase. It has Paraguay surpassed the WHA58.2 target for MDG6C, and in 2014 Brazil only 4 cases had been reported. Also, there was only one malaria-related death during 2000-2014.

Since 2011, Argentina has implemented a two-pronged strategy based on classification of endemic area into two Uruguay strata. Stratum 1 comprises of a low endemicity area Argentina where elimination measures are being implemented and stratum 2 comprises of transmission-free areas Chile Foci monitored by surveillance. Stratum one includes the D Cleared up departments (ADM2) of Oran and General San Martin (of (! Endemic *# New Potential Salta province) and stratum 2 includes the departments of )" New active El Carmen, Santa Barbara, Palpala, San Pedro, Ledesma, (! Pseudofocus *# Residual active and Doctor Manuel Belgrano (of Jujuy province). )" Residual non-active

There have been no autochthonous cases reported since ® 2011 (Figure 2 and Table 1). During 2000-2014, cases 0 125 250 500 Kilometers have only been reported from 5 provinces: Chaco, Jujuy, Longitude/Latitude Datum WGS84 Salta, Tucuman, and Misiones. All other provinces in Source: PAHO/CHA/VT Argentina have interrupted transmission of the disease. Of the reported cases during 2012-2014, all imported cases were identified asP. vivax infections.

Figure 2. Autochthonous and imported cases in Figure 3. Number of cases and deaths due to Argentina, 2000-2014 malaria in Argentina, 2000-2014

350 350 500 500 5 5 300 300 400 400 4 4 250 250 s s s s s e s e

300 s e 3 s e

200 300 s 3 200 s f c a f c a f c a f c a

150 D ea t h 150 200 200 2 2 D ea t h N umber o N umber o N umber o 100 N umber o 100 100 1 50 100 1 50 0 0 0 0 0 0 7 1 5 6 2 3 4 8 9 0 9 0 1 4 5 6 8 2 3 7 2 3 4 0 1 0 3 1 2 4 9 0 1 4 5 6 8 2 3 7 0 3 1 2 4 200 200 200 200 201 200 200 200 200 200 201 201 200 201 201 200 200 200 200 200 200 200 201 201 200 200 200 201 201 201 200 0 200 1 200 2 200 3 200 4 200 5 200 6 200 7 200 8 200 9 201 0 201 1 201 2 201 3 201 4 200 200 200 200 200 200 200 201 201 200 200 200 201 201 Autochthonous Cases Imported Cases P. falciparum201 & Mixed Confirmed Cases Deaths Autochthonous Cases Imported Cases P. falciparum & Mixed Confirmed Cases Deaths ■ Autochthonous cases ■ P. falciparum & mixed ■ Imported cases ■ Confirmed cases 2010 2011 2012 2013 2014 2010 2011 2012 2013 Ag■e g rDeathsoups2014 Total Cases 72 18 4 4 4 Age groups Total Cases 72 18 4 4 504+ 50+ Female Cases Investigated 72 18 4 4 4 45-49 years Female Cases Investigated 72 18 4 4 4 45-49 years Male 40-44 years Male Imported Cases 46 18 4 4 4 40-44 years Imported Cases 46 18 4 4 35-39 year4s 35-39 years Autochthonous Cases 14 0 0 0 0 30-34 years Autochthonous Cases 14 0 0 0 25-29 year0s 30-34 years Introduced 11 0 0 0 0 20-24 years 25-29 years Introduced 11 0 0 0 0 Relapse 0 0 0 0 0 15-19 years 20-24 years Relapse 0 0 0 0 10-14 year0s 15-19 years Induced 0 0 0 0 0 5-9 years 10-14 years - 37 - Induced 0 0 0 0 0 Not Classified 1 0 0 0 0 Under 5 5-9 years Not Classified 1 0 0 0 0 Under 5 Active Foci ...... 0 0 0 3 2 1 0 1 2 3 Confirmed cases Active Foci ...... 0 0 0 3 2 1 0 1 2 3 "..." indicates unavailable data. *Data based on age and sex was unavailable for 2014. Confirmed cases "..." indicates unavailable data. *Data based on age and sex was unavailable for 2014.

40 40 Table 1. Elimination profile of Argentina, 2010-2014 2010 2011 2012 2013 2014 Total Cases 72 1 8 4 4 4

Cases Investigated 72 1 8 4 4 4

Autochthonous Cases 1 4 0 0 0 0

Autochthonous- P.f. 0 0 0 0 0 350 500 5 300 Autochthonous- P.v. 1 4 0 0 0 0 400 4 250 Imported Cases 46 1 8 4 4 4 s s s e s e 300 0 3 0 0 0 0 200 Imported- P.f. s f c a f c a

Imported- P.v. 46 D ea t h 1 8 4 4 4 150 200 2 N umber o N umber o 100 Active Foci ...... 0 0 0 100 1 50 *P.f.:P .f. Plasmodium - P lasmod falciparumium falciparum PP.v.:.v. Plasmodium- P lasmodi uvivaxm vivax 0 0 "“...”..." indicatesindicate sunavailable unavaila data.ble data. 0 7 1 5 6 2 3 4 8 9 0 9 0 1 4 5 6 8 2 3 7 2 3 4 0 1 0 3 1 2 4 200 200 200 200 201 200 200 200 200 200 201 201 200 201 201 200 200 200 200 200 200 200 201 201 200 200 200 201 201 201 Autochthonous Cases Imported Cases P. falciparum & Mixed Confirmed Cases Deaths Figure 4. Malaria cases by age and sex Figure 5. Blood slides examined and SPR in in Argentina, 2012-2013 Argentina, 2000-2014 2010 2011 2012 2013 2014 Age groups Total Cases 72 18 4 4 4 50+ 15,000 15% Female Cases Investigated 72 18 4 4 4 45-49 years Male 40-44 years R) d 10,000 10% S P

46 18 4 4 4 e Imported Cases ( i n 35-39 years t e m

14 0 0 0 0 x a Autochthonous Cases 30-34 years e l e sitivity R a 25-29 years op 5,000 5% P e Peolple examined Introduced 11 0 0 0 0 P o 20-24 years e Sli d Relapse 0 0 0 0 0 15-19 years 0 0%

10-14 years 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4

Induced 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1

5-9 years 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 1 0 0 0 0 Not Classified Under 5 Blood Slides Examined SPR (%)

Active Foci ...... 0 0 0 3 2 1 0 1 2 3 Confirmed cases "..." indicates unavailable data. *Data based on age and sex was unavailable for 2014. 750

40 Age and sex information was not available for artesunate-mefloquinele 500 or artemether-lumefantrine reported cases in 2014. In 2012-2013, more men combination drugs, while chloroquine and f pe op than women were reported sick with malaria (Figure primaquine o (0.5 mg/kg for 7 days) are used for P. 250 4). The most affected groups were younger males vivaxm be r infections. between 25-29 years and 30-34 years old, belonging N u to the economically productive years of life. Data for0 timeliness of treatment were not available 2 6 8 0 1 3 7 9 4 5 0 3 4 1 2 0 0 0 0 0 0 0 1 1 1 for 2014, but time to 0 treatment0 improved0 in1 20131 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 Diagnosis and Treatment compared to 2012 (Figure2 0 2 0 7). While2 0 these figures2 0 2 0 Argentina does not use RDTs to diagnose malaria are*First -basedline treat monent daat asmall was una vilnumberable for 20 09of an cases,d 2014. shortened (Figure 5). Plasmodium falciparum is treated with diagnosisFirst-line tandreatm etreatmentnts Ctimeonfirm eisd Canase simportant factor

100%

75% s

- 38 - s e 75% f c a

o 50% 100% t ag e n c e r

P e 25% 25% 0% 2012 2013 2014 *Data is unavailable for 2014. >72 hours 48-72 hours 24-48 hours <24 hours

40,000 $3M

30,000 s)

d $2M ct e illi on t e 20,000 m i n pr o ( l e $1M op US $ P e 10,000

$0M 7 6 0 2 4 5 8 9 1 3 2 1 3 4 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 0 1 2 0 9 7 8 3 6 5 1 4 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 3 4 1 0 0 1 0 1 0 0 0 0 1 0 0 0 1 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 *Funding information for 2000 is unavailble. People protected by IRS People protected by ITNs Government Global Fund USAID Others 15,000 15% R) d 10,000 10% S P e ( i n t e m x a e l e sitivity R a op 5,000 5% P e P o e Sli d

0 0% 9 0 2 3 4 5 6 7 8 1 4 0 1 3 2 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0

Blood Slides Examined SPR (%) 15,000 15% R) d 10,000 10% S P e ( i n t e 750 m

15,000 15% x a e l e le sitivity R a op 5,000 5% 500 P e P o R) e f pe op d 10,000 10% S P 15,000 15% o e ( Sli d i n t e

m 250 m be r

x a 0 0% e N u R) 9 0 2 3 4 5 6 7 8 1 4 0 1 3 2 l e 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 d S P

10,000 10% sitivity R a op e ( 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 5,000 5% 2 0 2 0 2 0

i n 0 t e P e P o e m 2 6 8 0 1 3 7 9 4 5 0 3 4 1 2 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 x a Blood Slides Examined SPR (%) Sli d e 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 l e for countries striving to eliminate malaria and Figure 6. Number of malaria cases and those treated sitivity R a op 5,0000 5%0% *First-line treatment data was unavilable for 2009 and 2014. P e

preventing re-introduction. P o 9 0 2 3 4 5 6 7 8 1 with first-line treatment in Argentina, 2000-2014 4 0 1 3 2 e 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 First-line treatments Confirmed Cases Sli d 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 Vector Control 750 Blood0 Slides Examined SPR (%) 0% 9 0 2 3 4 5 6 7 8 Historically,1 IRS use has been an important factor 4 0 1 3 2 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1

in achieving malaria elimination in Argentina. le 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 500 They have even used a trans-border approach, 100%

Blood Slides Examined SPR (%) f pe op

implementing a binational project spraying houses in o bordering750 Bolivian towns. As of 2014, IRS usage has 250 75% m be r s s e decreased substantially and currently protects about N u 75% le 300 people (Figure 8). This is due to the fact that f c a

500 o 0 50% 100% 9 8 7 6 5 4 3 2 1 750 0 0 1 2 3 4

lowf pe op transmission areas (stratum 1) have graduated t ag e 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 o n 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0

into areas with no detectable transmission (stratum c e r

le 250 m be r 2)50 and0 thus no longer need IRS. Argentina does not *First-line treatment data was unavilable for 2009 and 2014. P e 25% N u

f pe op use ITNs as a means of vector control. First-line treatments Confirmed Cases 25% o 0 0% 2 6 8 0 1 3 7 9 4 5 0 3 4 250 1 2 m be r 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 2012 2013 2014 N u 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 *Data is unavailable for 2014. *First-li0ne treatment data was unavilable for 2009 and 2014. 100% >72 hours 48-72 hours 24-48 hours <24 hours 2 6 8 0 1 3 7 9 4 5 0 3 4 First-line treatments Confirmed Cases 1 2 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 Figure 7. Time between2 0 2 0 first symptom2 0 and2 0 2 0 Figure 8. People protected by IRS and by ITNs in initiation of treatment in Argentina, 2012-2014 Argentina,75% 2000-2014 *First-line treatment data was unavilable for 2009 and 2014. s First-line treatments Confirmed Cases s e 75% f c a 100% o 405,0%00 100% $3M t ag e n c e 75% r 30,000 P e

s 25% s)

d $2M s e 100% 75% ct e 25% illi on f c a t e m o 50% 100% 20,000%0 i n pr o 75% ( l e t ag e

s 2012 2013 2014

n $1M op s e US $ c e 75% r

*DP e ata is unavailable for 2014. f c a

P e 25% 10,000 o 50% 100% >72 hours 48-72 hours 24-48 hours <24 hours 25%

t ag e $0M n 7 6 0 2 4 5 8 9 1 3 2 1 3 4 0% 0 0 c e 0 1 0 0 0 0 0 0 1 1 1 0 0 1 0 r 1 2 0 9 7 8 3 6 5 1 4

P e 25% 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 3 2012 2013 2014 4 1 0 1 1 0 0 0 1 0 0 0 0 0 1 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 *Data is unavailable f25or %2014. 2 0 *Funding information for 2000 is unavailble. >0742%0 ,h0o0u0rs 48-72 hours 24-48 hours <24 hours Peop$3leM protected by IRS People protected by ITNs Government Global Fund USAID Others 2012 2013 2014 *Data is3 un0,a0v0a0ilable for 2014. s)

d $2M >72 hours 48-72 hours 24-48 hours <24 hours ct e illi on t e Figure20,000 9. Funding for malaria in Argentina, Funding m

40,000 $3M i n pr o ( 2000-2014l e The government$1M has consistently provided around op US $

P e US$1.08 million for malaria since 2009. The budget 30,000 10,000 s)

d $2M 40,000 $3M has been on a steady decline since 2001 (Figure ct e

illi on $0M t e 9). The government has exclusively funded malaria 7 6 0 2 4 5 8 9 1 3 m 2 1 3 4 20,000 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 0 i n pr o 30,000 ( prevention since 2000. 1 2 0 9 7 8 3 6 5 1 4 l e 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 3 4 s) 1 0 0 1 0 1 0 0 0 0 1 0 0 0 1

d $2$1MM op US $ 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 ct e P e *Funding information for 2000 is unavailble. illi on

t e 10,000 20,000 m People protected by IRS People protected by ITNs Government Global Fund USAID Others i n pr o (

l e $0M $1M 7 6 0 2 4 5 8 9 1 3 op 2 1 3 4 0

0 US $ 0 1 0 0 0 0 0 0 1 1 1 0 0 1 0 P e 1 2 0 9 7 8 3 6 5 1 4 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 3 10,000 4 1 0 0 1 0 1 0 0 0 0 1 0 0 0 1 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 *Fundi$0ngM information for 2000 is unavailble. 0 1 2 3 4 5 6 7 8 9 0 0 1 2 3 4

People protected by IRS People protected by ITNs Governmen0 t 0 0 Global0 Fund0 0 0 USAID0 0 0 1 Ot1 her1 s 1 1 1 2 0 9 7 8 3 6 5 1 4 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 3 4 1 0 0 1 0 1 0 0 0 0 1 0 0 0 1 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 *Funding information for 2000 is unavailble. People protected by IRS People protected by ITNs Government Global Fund USAID Others

- 39 -