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directing council regional committee PAN AMERICAN WORLD HEALTH HEALTH ORGANIZATION ORGANIZATION XVI Meeting XVII Meeting Washington, D. C. September-October 1965 Provisional Agenda Item 11-A CD16/13 (Eng.) 12 July 1965 ORIGINAL: ENGLISH- SPANISH A. REPORT ON THE STATUS OF MALARIA ERADICATION IN THE AMERICAS XIII REPORT TABLE OF CONTENTS Page Introduction ................... .................. 1 I. Status of the Malaria Eradication Program .............. 1 A. General Picture ......................... 1 B. Current Extent of the Problem .................. 4 C. Field Operations ......................... 13 II. Special Technical Problems ...................... 106 A. General ............................. 106 B. Evaluation of Methods for Solving Problems of Continuing Transmission .......................... 106 a) Change to an alternate insecticide .............. 106 b) Rescheduling or increasing the cycles of DDT ....... 107 C. Anti-larval measures ....................... 107 D. Mass Drug distribution ...................... 108 E. Chloroquinized-salt programs .................. 110 F. Long-acting repository drugs .................. 110 G. Field test of disc flow regulators for spraying ......... 111 H. Poor suspensibility of DDT ................... 111 I. Stimulation and coordination of operational research ...... 111 III. Research on Malaria . .. 111 A. Malaria Eradication Epidemiology Team - AMRO-0210 ... 111 B. Insecticide Testing Team - AMRO-0209 ............. 112 C. Resistance of Malaria Plasmodia Strains to Drugs - AMRO-0212 112 IV. International Cooperation .113 -i- MAPS AND TABLES Maps: Page 1 Status of the Malaria Eradication Program in the Americas, 31 December 1963 ............................................... 2 2 Status of the Malaria Eradication Program in the Americas, 31 December 1964 ............................................... 3 3 Mass Drug Program in El Salvador ............................... 109 Tables: 1 Comparison of 1963 and 1964 Population and Area in various phases of the Malaria Eradication Programs in the Americas, and Percentages of change by phase .............................. ................ 4 2 Progress in Malaria Eradication Programs in the Americas ......... 5 3 Status of Malaria Eradication in the Americas, by Population, 1964 . 6 4 Status of Malaria Eradication in the Americas, by Area, 1964 ....... 7 5 The Extent and Nature of Problem Areas and remedial Measures taken and Planned as of December 1964 ................................. 8 6 Mass Drug Programs in the Americas, 1964 ....................... 12 7 Personnel Employed in Malaria Eradication Programs in the Americas 31 December 1963 and 1964, by Category ......................... 14 8 Personnel Employed in Spraying Operations in Malaria Eradication Programs in the Americas - 31 December 1964 .................... 15 9 Personnel Employed in Epidemiological Evaluation in Malaria Eradication Programs in the Americas - 31 December 1964 ........ ; 16 10 Personnel Employed in Administrative and Other Services in Malaria Eradication Programs in the Americas - 31 December 1964 ......... 17 11 Personnel Employed in Transport Services in Malaria Eradication Programs in the Americas - 31 December 1964 ................... 18 12 Means of Transport in Malaria Eradication Programs in the Americas - 1964 .......................................................... 20 13 National Budgets for Malaria Eradication in the Americas, 1963-1965 21 14 Comparative Results of Active and Passive Case Detection in Malaria Eradication Programs in the Americas, 1964 ...................... 22 15 Summary of Case Detection in the Americas, 1958 - 1964 ........... 23 16 PAHO/WHO Full-time Professional and Technical Staff assigned to Country, Inter-Country and Inter-Zone Malaria Eradication Projects in the Americas, from 1962 to May 1965 ........................... 114 - ii - MAPS AND TABLES (Cont.) Tables: Page 17 Fellowships for study Travel in Malaria Eradication, 1963 and 1964 115 18 Equipment and Supplies, excluding drugs, contributed by PAHO to Malaria Eradication Programs in the Americas, 1958 to December 1964 ........................................ 116 19 Drugs Provided by PAHO to Malaria Eradication Programs in the Americas, 1958-1964 .......................................... 117 20 International Contributions to malaria Eradication Programs in the Americas, 1964 and estimated 1965 ............................. 118 Country Tables showing the Status of the Malaria Eradication Programs at December 1964: Argentina ................................ 24 Bolivia ................................. 27 Brazil (Excl. Sao Paulo) ....................... 30 Brazil (Sao Paulo) ........................... 33 Colombia . ........................ 36 Costa Rica .. ....................... 39 Cuba .................................. 42 Dominican Republic .......................... 45 Ecuador ................................. 48 El Salvador ............................... 51 Guatemala ............................... 54 Haiti .. ........................... 57 Honduras ................................ 60 Jamaica ............................... 63 Mexico ................................. 65 Nicaragua ............................... 68 Panama ................................ 71 Paraguay ................................ 74 Peru .................................. 77 Trinidad and Tobago .......................... 81 Venezuela ............................... 83 British Guiana ............................. 86 British Honduras ............................ 89 Dominica ............................... 91 French Guiana ............................. 93 Grenada and Carriacou ........................ 95 - iii - MAPS AND TABLES (Cont.) Page Guadeloupe. .... ...... ... .. ......... 97 Panama Canal Zone ........... ....... ....... 99 St. Lucia...... ..... ...... 101 Surinam .............................. 103 - iv - CD16/13 (Eng.) Page 1 REPORT ON THE STATUS OF MALARIA ERADICATION IN THE AMERICAS XIII REPORT Introduction The Director of the Pan American Sanitary Bureau has the honor to present to the XVI Meeting of the Directing Council the XIII Report on the status of malaria eradication in the Americas. The report consists of four chapters. The first contains information on the status of the program in general and also country-by-country summaries of progress, depicting the history and present condition of each program in tables and graphs. The second chapter discusses special tech- nical problems which have arisen. The third chapter concerns research in malaria currently in progress; the last chapter, international cooperation in malaria eradication programs. The data presented are taken from the answers by each country to a detailed annual ques- tionnaire and from monthly and quarterly statistical reports submitted to the Pan American Sanitary Bureau by most of the programs, supplemented by data from plans of operation. Special technical reports concerning research projects are also presented when appropriate. I. STATUS OF THE MALARIA ERADICATION PROGRAMS A. General Picture The progress made in 1964 toward eradicating malaria from the Hemisphere cannot be summed up and expressed in a global figure; the situation was complex, with different trends in different regions. In most programs satisfactory progress was made, but in a number of those in Central America and in Mexico, the situation was stationary or deteriorated. Maps 1 and 2 and the summary presented in Table 1 permit comparison of the over-all status at the end of 1964 with that at the end of 1963. During 1964 two countries completed their consolidation phase and they are in process of receiving certification of the eradication of malaria - Jamaica and Trinidad and Tobago. The population of consolidation areas shows a decrease compared with December 1963, from 33.9 million persons to 32.3 million. This change is the combined result of the progression of many relatively small areas in various programs from attack to consolidation phase, and the re- gression of areas with about 3.4 million persons from consolidation to attack phase in Mexico, where persistent transmission has resisted attack measures in problem areas and re-infection of previous- ly clean regions has occurred. The countries showing the greatest numbers of persons in areas placed in consolidation during 1964 are Colombia, Honduras, Ecuador, and the State of Sao Paulo in Brazil; a number of other programs shifted areas with smaller populations. In addition to Mexico, programs which were forced to return areas from consolidation to attack included Guatemala, Nica- ragua and Venezuela (Nicaragua also shifted some attack areas into consolidation, with a net gain in population and loss in area in the consolidation phase). The increase in population in the attack phase at the end of 1964 reflects primarily the shift in Mexico mentioned above and movements in the Brazilian and Guatemalan programs. In the federal program in Brazil, areas inhabited by some 660 thousand persons were brought from prepa- ratory stage to attack phase; in Sao Paulo areas with over 900 thousand moved from attack to con- solidation. In Colombia some areas were advanced to consolidation (and attack was actually sus- pended in others with a population of 1.2 million, although these areas have not officially been placed in consolidation as yet), while at the same time a large but sparsely-populated area was withdrawn from attack and activities of the program were suspended there to concentrate resources on more