Malaria

Question 1

Is malaria nationally notifiable?

Answer 1

Yes - routine, labs and doctors

Question 2

Which organism causes malaria?

Answer 2

Malarial parasites:
* Plasmodium vivax
* P. malariae
* P. falciparum
* P. ovale
* P. knowlesi.

Mixed infections can occur

Question 3

What is the primary vector for malaria transmission?

Answer 3

Female Anopheles mosquito

The mosquito-human-mosquito cycle facilitates the spread of malaria.

Question 4

What are the clinical features of acute malaria?

Answer 4

Acute febrile illness.

Fever, chills, sweating, myalgia, cough, diarrhea, jaundice

These symptoms can vary by individual and species.

Question 5

What severe outcomes are associated with malaria, particularly P. falciparum?

Answer 5

Shock, coagulopathy, liver/renal failure, cerebral edema, pulmonary edema

Severe malaria has a very high case fatality rate if untreated.

Question 6

Who are considered high-risk groups for malaria?

Answer 6

• Infants, children < 5yo
• Pregnant women
• Immunosuppressed
• HIV-positive individuals

People traveling to endemic areas are also at high risk.

Question 7

What are the case definitions for confirmed malaria?

Answer 7

Parasites on blood film, or detection by NAT

Question 8

What diagnostic methods are used for malaria?

Answer 8

Parasites on blood film (thick & thin), PCR

An experienced laboratory is essential for accurate diagnosis.

Question 9

What is the typical incubation period for malaria?

Answer 9

Usually 10-15 days, varies by species

Some strains of P. vivax can have prolonged incubation of 8-10 months.

Question 10

When can a malaria case become infectious to mosquitoes?

Answer 10

If untreated or inadequately treated

Cases may remain infectious for a period even after symptoms appear.

Question 11

What resources are available for PH management of malaria?

Answer 11

DH protocol
(No SoNG)

Question 12

What is the global epidemiology of malaria?

Answer 12

Endemic in Africa, Asia, Central/South America
95% cases/deaths in Africa (children < 5yo)

The disease burden is especially high in low-income countries.

Question 13

Is drug resistance to malaria increasing or decreasing?

Answer 13

Increasing

Question 14

What is the status of malaria in Australia?

Answer 14

Declared free of endemic malaria in 1981, sporadic locally-acquired cases in recent decades

Northern Australia is still at risk due to the presence of Anopheles mosquitoes.

Question 15

T / F: most cases of malaria are locally transmitted?

Answer 15

False - imported

Question 16

Who are high-risk groups for importation of malaria cases?

Answer 16

• Regugees and assylum seeks
• Refugee camps

Question 17

What preventive measures can be put in place for malaria?

Answer 17

Individuals:
* Chemoprophylaxis based on risk assessment - strict adherence
* Avoid mosquito exposure, seek immediate care if symptoms arise

Health care workers / healthcare setting:
* Clinical education - high index of suspicion in returned travellers
* Transfusion screening
* Needle-stick precautions for HCWs caring for malaria cases

Environmental control:
* Disinfection of aircrafts / ships following international arrivals

Question 18

How are cases of malaria treated?

Answer 18

Interview - travel, PPX used, exclude potential local transmission; if no travel hx - URGENT Ix

T - prompt; ID referral; usually artemisan-based combination therapy (ACT)
**I **- NA
E - avoid mosquito contact esp. in receptive zone

Question 19

What is the recommended treatment for malaria cases?

Answer 19

Usually artemisinin-based combination therapy (ACT)

Prompt treatment is a clinician’s responsibility and may involve complex decision-making.

Question 20

What is a locally acquired malaria case considered?

Answer 20

An outbreak requiring immediate assessment (epi, entomology) and public health interventions:
* Vector control
* Public health alerts / education
* Report to WHO

This includes vector control and public alerts.

Question 21

How are contacts of malaria managed?

Answer 21

Contact / co-exposed = travelling companion
Contact tracing if local acquisition

T - NA
I - NA
M - monitor sx, test
E - sx, transmission, prevention

Question 22

True or False: Malaria can be transmitted through blood transfusion.

Answer 22

True

While rare, transmission via blood transfusion or vertical transmission is possible.