Published Date: 2011-01-04 18:00:04
Subject: PRO> Malaria - India, (Mumbai): urban malaria comment
Archive Number: 20110104.0040
MALARIA INDIA, (MUMBAI): URBAN MALARIA COMMENT
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Date: Tue 4 Jan 2011
From: Michael J. Bangs, PhD, MSPH
<Michael_Bangs@fmi.com>
It comes as no surprise that Mumbai would be
experiencing urban malaria; probably has for a
long time but is now being more widely recognized
(and reported). As urbanization increases in
India one can presume 'urban' malaria will become
more of an issue in the future.
Regard subject posting below (Malaria, Fever -
India: (Mumbai), RFI) [14 Jul 2010] I would like
to comment on the last remark provided in the
communication : [Malaria mosquitoes (Anopheles
spp.) do not breed in the water sources mentioned
here, but dengue vector mosquitoes (Aedes spp.)
do. It is likely that the fever cases referred to
are cases of dengue. - Mod.JW] [ProMED-mail
regrets that due to technical difficulties the
following discussion was not posted when
originally sent in July 2010. - Mod.MPP]
Comment: On the contrary, the potential larval
habitats mentioned in the article (i.e., "Water
stagnation -- be it in puddles on the road, in
discarded rubber tyres, in water tanks, or even
in buckets used to store water inside homes -- is
what makes Mumbaikars vulnerable to mosquitoes,
said doctors.") can, in fact, all be acceptable
aquatic sources for _Anopheles stephensi_ in
urban areas. Moreover, this species serves a
primary malaria vector along the northwestern
coastal zone and western interior of India.
As far back as 1908 a severe epidemic was
reported "in the densely crowed city of Bombay,
the epidemic being due to the establishment of
_A. stephensi_ in the wells and cisterns
throughout the city, an unexpected adaptation
which only this species has displayed." (Boyd,
1949. Malariology). [Actually a few other
species, notably, _An. claviger_ show this
tendency of 'urbanization' under ideal
conditions]. _Anopheles stephensi_ is the only
anopheline in India (and Pakistan) which can
readily adapt to the conditions available in many towns and cities.
This species has also been implicated as the
primary vector responsible for past outbreaks in
Kolkata, Bangalore and other cities in India and
Pakistan (Karachi) -- often exhibiting very
localized but intense transmission. "In such
situations it breeds in wells, cisterns, roof
gutters, fountain basins, garden tanks, tubs,
discarded tins, and receptacles of all
descriptions" (Covell, 1928. Malaria in Bombay,
Bombay Govt Press; In: Boyd, 1949.). _An.
stephensi_ is atypical for an anopheline (also,
interestingly tolerant of relatively high
pollution); therefore mistaking such container
habitats as Aedes 'only' is understandable except
when dealing with this species.
Not discounting the possibilities of dengue
contributing to these reported illnesses (or
concurrent with malaria infections), it seems
unlikely that many local health care
practitioners would mistake dengue for malaria
infection. For Mumbai, one would assume (hope)
that many of cases of "malaria" (versus those
reported as "fever") would have been reliably
confirmed by the majority of private and public hospitals.
During a decade or more of intense malaria
eradication efforts in India (late 1950's thru
the 1960's), _An. stephensi_ was effectively
brought under control and urban malaria became an
extremely uncommon occurrence. However, from 1970
onwards that all began to change with the shift
in national control priorities. As a result,
malaria transmission rapidly resurged, both in
rural and urban areas. The fact that Mumbai would
now experience outbreaks of malaria should come as no surprise.
More troubling for India and Pakistan is that
with the explosive urban expansion in both
countries the subsequent increase in suitable
ecological conditions for this mosquito will
likewise place a larger proportion of the human population at risk.
--
Michael J. Bangs, PhD, MSPH
Technical Advisor
Public Health and Malaria Control
Kuala Kencana
<Michael_Bangs@fmi.com>
[ProMED thanks Michael Bangs for his comments and
detailed information on the habitats for
different malaria vectors on the Indian
subcontinent. The point that increasing
urbanization is driving increased transmission is
well taken. ProMED will be happy to post a
comment from health authorities in India and Pakistan. - Mod.EP]
See Also
2010----
Malaria - India (12): (Mumbai) 20101221.4496
Malaria - India (06): (Mumbai) 20100808.2701
Malaria - India (05): Mumbai 20100722.2462
Malaria - India (04): (Mumbai) 20100717.2397
Malaria, fever - India: (Mumbai), RFI 20100703.2216
Malaria - India (02): Mumbai 20100518.1636
Malaria - India: (KA) 20100426.1346
2009
----
Malaria, falciparum - India (02): (AS) RFI 20091220.4294
Malaria, falciparum - India: (BR) cerebral 20090810.2840
Malaria drug, adverse events - India: RFI 20090706.2431
Malaria, falciparum - EU ex India (GA) 20090125.0325
2008
----
Malaria - India (02): (Chandigarh) 20081207.3841
Malaria, falciparum - EU ex India (Goa) (02) 20080202.0418
Malaria, falciparum - EU ex India (Goa): Sweden 20080124.0294
2007
----
Malaria - India (Goa, Rajastan) 20070716.2287
Malaria - EU ex India (Goa) (02): UK 20070301.0728
Malaria - EU ex India (Goa) 20070112.0150
Malaria - Germany, Sweden ex India (Goa) 20070102.0014
Denmark ex India (Goa): RFI 20070101.0001
2006
----
Malaria - India (West Bengal) 20060627.1783
Malaria - India (Assam) (03) 20060507.1318
Malaria - India (Assam) (02) 20060430.1254
Malaria - India (Assam) 20060420.1160
2005
----
Malaria, resistant - India 20050107.0047
2004
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Malaria - India (Mumbai) 20041002.2716
2003
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Malaria - India (Haryana) (02) 20031018.2620
Malaria - India (Kerala): request for information 20030605.1378
2002
----
Malaria - India (Assam) 20020613.4483
2001
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Malaria - India (Assam) 20010604.1102
2000
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Malaria - India (Uttar Pradesh) 20001017.1777
1999
----
Malaria, vivax, resistant - India (Mumbai) 19990316.0389
1996
----
Malaria - India, 1995 (5) 19960405.0652
...................ep/ejp/mpp
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