MEXICO Figure 1. Malaria by Annual Parasite Index (API) at municipality level (ADM2), Mexico 2014 Mexico has had a 91.0% reduction in malaria cases since 2000, achieving the WHA 58.2 target for the MDG 6C

of reducing malaria by 75% in 2010 (Figures 1 and 2). United States Mexico is currently in the pre-elimination phase, though some malaria endemic areas of substantial transmission intensity exist in the country. There were 664 cases reported in 2014, a 33.1% increase from the previous

year. No malaria-related deaths have been reported Mexico since 1998. API per 1,000 people No cases Figure 2. Number of cases and deaths due to ≤ 0.1 Table 1. Elimination profile of Mexico, 2012-2014 Figure 2. Number of cases and deaths due to 0.11 - 1 malaria in Mexico, 2000-2014 2012 2013 2014 malaria in Mexico, 2000-2014 1.01 - 5 ® 8,000 4 5.01 - 10 0 125 250 500 750 842 499 664 Km Total Cases 10.01 - 50 Longitude / Latitude >50 Datum WGS84 Cases Investigated 842 499 664 Source: PAHO/CHA/VT 6,000 3 Autochthonous Cases 833 495 656 s s e

Autochthonous- P. f 0 0 0 s

f c a All cases caused by P. falciparum have reportedly been 4,000 2 833 495 656 Autochthonous- P. v D ea t h imported in those returning from endemic countries during the 2010 to 2014 period (Table 1). Most of these

Imported Cases 9 4 8 N umber o 2,000 1 imported cases have been imported from countries in Imported- P. f 9 4 6 the Americas (50%) followed by those in Africa (41%). Imported- P. v 0 0 2 In 2014, two imported cases of P. vivax were reported 0 0 imported from Belize and Colombia each. The former Active Foci 71 61 56 reported new active foci of P. vivax malaria along its 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 Figure 10. Funding for malaria in Honduras, *P. f - Plasmodium falciparum border with Mexico in 2014 with movement of people P. v - Plasmodium vivax Confirmed■ Cases P. fa■lciparum & Mixed ■ Deaths 2000-2014 P. falciparum & mixed Confirmed cases Deaths across the border being the reason for re-establishment of transmission. The primary malaria vectors areAn. Figure 3. Municipalities with the highest number of malaria Figure 4. Malaria cases by age and sex in albimanus and An. pseudopunctipennis. cases in Mexico, 2012-2014 Mexico, 2014 Malaria transmission in the country is exclusively due to Municipality State P. vivax infections.Age groups Transmission has been largely limited Men accounted for 56.3% of all cases in 2014 (Figure 60+ Candelaria Campeche 0 0 to southern216 states of Chiapas, Campeche, and QuintanaF emale 4). There were more cases reported among children (5-9 55-59 years Choix Sinaloa 98 61 Roo121 along the border with Guatemala and Belize (FigureMa le years old) and teenagers (10-14 and 15-19 years old) 50-54 years than in any other 5-year age group. Information about Del Nayar Nayarit 48 82 28 3). Two other important areas of transmission exist along the borders of 45-49Sinaloa, year sSonora, and Chihuahua states in number of malaria cases in pregnant women was not Pantelho Chiapas 39 17 25 the north and Nayarit,40-44 year Durango,s and Jalisco states in the available as this is not presently captured by the national Mezquital Durango 96 67 24 center of the country.35-39 years information system. Ocosingo Chiapas 28 18 23 30-34 years Sitala Chiapas 6 5 19 Table 1. Elimination25-29 year profiles of Mexico, 2012-2014 Sabanilla Chiapas 22 18 15 Table 1. Elimination20-24 years profile of Mexico, 2012-2014 Figure 2. Number of cases and deaths due to 15-19 years 2012 2013 2014 malaria in Mexico, 2000-2014 Othon P Blanco Quintana Roo 14 11 14 8,000 4 Total Cases 10-14 years 842 499 664 Yajalon Chiapas 12 9 14 5-9 years Cases Investigated 842 499 664 Decrease 0 100 200 0 100 200 0 100 200 Under 5 6,000 3 Increase 2012 2013 201Au4 tochthonous Cases 833 495 656 60 40 20 0 20 40 60 s s e

Autochthonous- P. f 0 Confirmed cases0 0 s f c a 4,000 2 833 495 656 Autochthonous- P. v D ea t h

Imported Cases 9 4 8 N umber o 83 2,000 1 Imported- P. f 9 4 6

Imported- P. v 0 0 2 0 0 1 5 6 0 3 4 8 9 2 7 0 1 3 4 Active Foci 71 61 56 2 200 200 200 201 201 200 200 200 200 200 201 201 200 200 201 *P. f - Pl*P.a fs-Plasmodiummodium falci falciparumparum * P. v - PlP. av.s-Plasmodiummodium viv vivaxax Confirmed Cases P. falciparum & Mixed Deaths Figure 3. Municipalities with the highest number of malaria Figure 4. Malaria cases by age and sex in cases in Mexico, 2012-2014 Mexico, 2014 Municipality State Age groups - 81 - 60+ Candelaria Campeche 0 0 216 Female 55-59 years Choix Sinaloa 98 61 121 Male 50-54 years Del Nayar Nayarit 48 82 28 45-49 years Pantelho Chiapas 39 17 25 40-44 years Mezquital Durango 96 67 24 35-39 years Ocosingo Chiapas 28 18 23 30-34 years

Sitala Chiapas 6 5 19 25-29 years

Sabanilla Chiapas 22 18 15 20-24 years 15-19 years Othon P Blanco Quintana Roo 14 11 14 10-14 years Yajalon Chiapas 12 9 14 5-9 years Decrease 0 100 200 0 100 200 0 100 200 Under 5 Increase 2012 2013 2014 60 40 20 0 20 40 60 Confirmed cases

83 Table 1. Elimination profile of Mexico, 2012-2014 Figure 2. Number of cases and deaths due to 2012 2013 2014 malaria in Mexico, 2000-2014 8,000 4 Total Cases 842 499 664

Cases Investigated 842 499 664 6,000 3 Autochthonous Cases 833 495 656 s s e

Autochthonous- P. f 0 0 0 s f c a 4,000 2 833 495 656 Autochthonous- P. v D ea t h

Imported Cases 9 4 8 N umber o 2,000 1 Imported- P. f 9 4 6

Imported- P. v 0 0 2 0 0 1 5 6 0 3 4 8 9 2 7 0 1 3 4 Active Foci 71 61 56 2 200 200 200 201 201 200 200 200 200 200 201 201 200 200 201 *P. f - Plasmodium falciparum P. v - Plasmodium vivax Confirmed Cases P. falciparum & Mixed Deaths Figure 3. Municipalities with the highest number of malaria Figure 4. Malaria cases by age and sex in Figure 3. Municipalitiescases with in the Mexico, highest 2012-2014 number of malaria cases in Mexico, 2012-2014 Mexico, 2014 Municipality State Age groups 60+ Candelaria Campeche 0 0 216 Female 55-59 years Choix Sinaloa 98 61 121 Male 50-54 years Del Nayar Nayarit 48 82 28 45-49 years Pantelho Chiapas 39 17 25 40-44 years Mezquital Durango 96 67 24 35-39 years Ocosingo Chiapas 28 18 23 30-34 years

Sitala Chiapas 6 5 19 25-29 years Report on the Situation of Malaria in the Americas, 2000-2014(DRAFT V.3) Sabanilla Chiapas 22 18 15 20-24 years 15-19 years Othon P Blanco Quintana Roo 14 11 14 10-14 years Yajalon Chiapas 12 9 14 5-9 years Decrease 0 100 200 0 100 200 0 100 200 Under 5 Increase 2012 2013 2014 60 40 20 0 20 40 60 Confirmed cases

The municipality of Candelaria in Campeche state, near efforts have been implemented in Chiapas along the the Guatemalan border, reported an outbreak of malaria 83 train route and focused on increasing microscopy, in 2014, although it had no cases in previous years. A improving access to treatment, distributing bed nets, Table 1. Elimination profile of Mexico, 2012-2014 Figurechange 2. Number in migratory of cases patternsand deaths has due been to suggested as a and engaging indigenous peoples. The Oaxaca state in possible reason for this outbreak. This area is endemic particular has demonstrated significant achievements malaria in Mexico, 2000-2014 2012 2013 2014 as a result of human trafficking and movement of illegal in eliminating malaria; no malaria case was reported in 8,000 4 Total Cases 842 499 664 migrants along the train routes. Inadequate surveillance 2014, decreasing from 902 cases in 2009. This has

Cases Investigated 842 499 664 quality was another reason for the outbreak in Candelaria been achieved by modifying the treatment scheme 6,000 wherein detected cases were reported to 3have been to the PAHO/WHO recommended 14-day treatment Autochthonous Cases 833 495 656 s infected elsewhere upon case investigation thereby with chloroquine and primaquine for P. vivax in 2011, s e

Autochthonous- P. f 0 0 0 delaying the detection of increasing transmission s and supervised treatment, vector control interventions, and f c a 4,000 2 833 495 656 consequently the response. improving access to prompt diagnosis and treatment. Autochthonous- P. v D ea t h

Imported Cases 9 4 8 N umber o Another vulnerable group affected by malaria is the Diagnosis and Treatment 2,000 1 Imported- P. f 9 4 6 indigenous people who live in rural areas. The states of Microscopy has been the primary method of diagnosis. Chiapas and Oaxaca have large indigenous populations The number of blood slides examined has decreased by Imported- P. v 0 0 2 0 that have been affected due to lack of0 healthcare 55.1% since 2000 (Figure 5); however, this follows the 1 5 6 0 3 4 8 9 2 7 0 1 3 4 Active Foci 71 61 56 access. Development of intervention2 programs is trend of decrease in cases. In 2014, all 282 laboratories 200 200 200 201 201 200 200 200 200 200 201 201 difficult200 because200 of language 201 barriers. Prevention were reported to have been included in a program of quality *P. f - Plasmodium falciparum P. v - Plasmodium vivax Confirmed Cases P. falciparum & Mixed Deaths assurance for microscopic diagnosis. Figure 3. Municipalities with the highest number of malaria FigureFigure 4. 4. Malaria Malaria cases cases by by age age and and sex sex in in cases in Mexico, 2012-2014 Mexico, 2014 Mexico, 2014 Municipality State Age groups 60+ Candelaria Campeche 0 0 216 Female FigureFigure 5. 5.Blood Blood slides slides examined, examined, RDTs RDTs examined, examined, 55-59 years Choix Sinaloa 98 61 121 Male and SPR in Mexico,and SPR 2000-2014 in Mexico, 2000-2014 50-54 years Del Nayar Nayarit 48 82 28 2.0M 40% 45-49 years Pantelho Chiapas 39 17 25 40-44 years 1.5M 30%

Mezquital Durango 96 67 24 SPR)

35-39 years ( t e Ocosingo Chiapas 28 18 23 30-34 years

Sitala Chiapas 6 5 19 25-29 years 1.0M 20% sitivity R a Sabanilla Chiapas 22 18 15 20-24 years 15-19 years Othon P Blanco Quintana Roo 14 11 14 Bl ood Sli de s Ex am i ne d 0.5M 10% 10-14 years Sli de P o Yajalon Chiapas 12 9 14 5-9 years 0.0M 0% 7 0 1 2 3 4 5 6 8 9 0 Decrease 1 2 3 4 0 100 200 0 100 200 0 100 200 Under 5 200 200 200 200 200 200 200 200 200 201 Increase 2012 2013 2014 200 201 201 201 201 60 40 20 0 20 40 60 Blood Slides Examined SPR(%) Confirmed cases Figure 6. Number of malaria cases and those treated with first-line treatment in Mexico, 2000-2014 83 - 82 - 800,000

s 600,000 s e f c a 400,000

N umber o 200,000

0 2 3 4 6 0 1 5 7 8 9 0 2 3 4 1 200 200 200 200 201 201 201 201 200 200 200 200 200 200 201

*Data for first-line treatment was unavailable for 2001, 2003, 2006-2007, 2009-2011.

First-line treatments Confirmed Cases Report on the Situation of Malaria in the Americas, 2000-2014(DRAFT V.3)

Both P. falciparum and P. vivax infections are treated with Figure 7. Time between first symptom and result of chloroquineFigure 5. Bloodand slidesprimaquine examined, as RDTsa first-line examined, treatment diagosis in Mexico, 2008 - 2014 (Figure 6). Aand 3x3x3 SPR intreatment Mexico, 2000-2014scheme for P. vivax is recommended in the country wherein a single dose is 100% 2.0M 40% administered monthly for 3 months, followed by 3 months

s 75%

without treatment. This is repeated twice in a year and s e 1.5M 30% continued for 3 years; in total 18 single doses are given SPR) (

t e 93% 93% 94% 92% per patient. A recent study demonstrated that this scheme 50% 96% 97% 97% (50%1.0M relapsed after 1 year of follow-up) is not efficacious20 %in

preventing relapses compared to the WHO recommended sitivity R a P er c en t age o f a 25% 14-day treatment with chloroquine and primaquine (12.1%

Bl ood Sli de s Ex am i ne d 0.5M 10% Sli de P o relapsed) (44). Some states, especially Chiapas and 0% Oaxaca,0.0M have switched to the WHO recommended 14-day0% 2008 2009 2010 2011 2012 2013 2014 7 0 1 2 3 4 5 6 8 9 0 treatment and the latter has nearly eliminated1 2 3 malaria.4 >72 hours 48-72 hours 24-48 hours <24 hours 200 200 200 200 200 200 200 200 200 201 200 201 201 201 201 Blood Slides Examined SPR(%) Figure 6. Number of malaria cases and those treated Vector100% Control Figurewith first-line 6. Number treatment of malaria incases Mexico, and those 2000-2014 treated IRS usage has declined since 2011, but it has remained People protected by IRS with first-line treatment in Mexico, 2000-2014 1s ,00075,00% 0

nears e constant in the past 4 years and an estimated People protected by ITNs 800,000 57,000d people were still protected by it in 2014 (Figure

ct e 750,000 93% 93% 94% 92% 8). 50In% 2010, about 350,000 96ITNs% were97% distributed,97%

s 600,000

s e protecting an estimated 567,000 people. As of 2014, an 500,000 f c a estimated 65,000 people are protected by ITNs. Larval 400,000 P er c en t age o f a 25% controlP eop l e pro t is used in the country, especially in endemic foci. 250,000

N umber o 200,000 Insecticide0% resistance surveillance for Anopheles has not been conducted0 2008 in200 recent9 201 years.0 2011 2012 2013 2014 1 2 4 5 8 1 2 4 0 0 3 6 7 9 0 3 >72 hours 48-72 hours 24-48 hours <24 hours 2 3 4 6 0 1 5 7 8 9 0 2 3 4 1 200 200 200 200 200 201 201 201 Funding 200 200 200 200 200 201 201 200 200 200 200 201 201 201 201 200 200 200 200 200 200 201

*Data for first-line treatment was unavailable for 2001, 2003, 2006-2007, Malaria prevention and elimination is almost exclusively 2009-2011. funded$25M by the government who provided an estimated First-line treatments Confirmed Cases US$23.81,000,000 million in 2014, US$1.5 millionPeop lessle pro thantected 2013 by IRS (Figure$20M 9). This decline is due to a changePeop inl ethe pro teexchangected by ITNs rated between those 2 years. Information about funding ct e 750,000

Presently the 14-day treatment is also recommended in isilli on s) reported$15M from national level, which does not take into m

the national treatment guidelines although its adoption accounti n 500,00 0funds available at the state and other lower ( is 100patchy.% levels.$10M PAHO/WHO provides technical assistance and P eop l e pro t US $ financial250,000 resources for specific malaria related activities.

Thes 75% country reported that 92% of all cases in 2014 were No other$5M external funding is received by the country. diagnoseds e in more than 72 hours after onset of the first 0 1 2 4 5 8 1 2 4 symptoms (Figure 7). This was only slightly less than $0M 0 3 6 7 9 0 3 3 7 4 5 6 8 2 3 4 93% 93% 94% 92% 0 1 2 9 0 1 200 200 200 200 200 201 201 201 50% 96% 97% 97% Figure 9. Funding200 for200 malaria 200 in Mexico,200 200 2000-2014201 201 200 200 200 200 200 200 201 201 201 in previous years suggesting that access to malaria 200 200 200 200 201 201

diagnosis and consequently treatment is limited and a Government Others continuingP er c en t age o f a 25% challenge for malaria elimination. Information $25M about time taken to treat was not available. 0% $20M 2008 2009 2010 2011 2012 2013 2014 >72 hours 48-72 hours 24-48 hours <24 hours Figure 8. People protected by IRS and by ITNs in illi on s) $15M m

Mexico, 2000-2014 i n ( $10M US $

1,000,000 People protected by IRS $5M People protected by ITNs d $0M

ct e 750,000 3 7 4 5 6 8 2 3 4 0 1 2 9 0 1 200 200 200 200 200 200 201 201 201 200 200 200 200 201 201 500,000 Government Others P eop l e pro t 250,000

0 1 2 4 5 8 1 2 4 0 3 6 7 9 0 3 200 200 200 200 200 201 201 201 200 200 200 200 200 201 201

*IRS data unavailable for 2000, 2003, and 2006. ITN data unavailable for 2000-2009. $25M - 83 - $20M

illi on s) $15M m i n ( $10M US $

$5M

$0M 3 7 4 5 6 8 2 3 4 0 1 2 9 0 1 200 200 200 200 200 200 201 201 201 200 200 200 200 201 201

Government Others