Upstate-led study finds resurgence of malaria cases at the Ecuador-Peru border linked to Venezuelan crisis
In 2018, Ecuador and other countries in South America received a massive influx of Venezuelan migrants, who left their country following a social and economic collapse. The public health sector in Venezuela is struggling to control infectious disease epidemics, including measles, diphtheria, and malaria, presenting a major public health threat to the region. As a result, migrant populations and people living near border crossings are particularly susceptible to these infectious diseases.
These findings are included in a new study to be published in April in the Emerging Infectious Diseases journal of the U.S. Centers for Disease Control and Prevention but available online now.
The study was led by investigators from SUNY Upstate Medical University, the Ecuadorian and Peruvian Ministry of Health, the Technical University of Machala and the University of Florida. They found a number of imported cases of malaria in Venezuelan migrants residing at the Ecuador-Peruvian border in 2018. In El Oro Province, Ecuador, they found 5 cases of malaria in recent migrants from Venezuela, and 1 imported case from Peru. They also documented a locally acquired malaria case in November 2018, the first evidence of local malaria transmission since elimination in 2011. In the Tumbes Region, Peru, they found 17 cases of malaria in recent migrants from Venezuela, and 3 locally acquired malaria infections.
The authors found that the cases were not properly treated prior to detection in El Oro Province, often due to the transience of the migrant population. Senior author Upstate’s Anna Stewart-Ibarra, PhD, MPA, states: “This study is a great example of why we need regional collaborations to tackle complex public health issues. Diseases know no borders.”
Malaria was eliminated in El Oro Province in 2011 and in the Tumbes Region in 2012 through successful binational public health collaboration at the border. However, the mosquito vector that transmits malaria is still present, and this report warns of the risk of resurgence of malaria. Over a 5-year period, malaria cases in Ecuador increased from 378 (2013) to 1,279 (2017). Peru and other countries in South America also reported an increase in malaria in 2017. Venezuela accounted for more than half of all malaria cases in the region. This comes at a time when the Minister of Health of Ecuador has stated that Ecuador is aiming for the certification of malaria eradication within 2-3 years.
The authors report that the Ecuadorian and Peruvian Ministries of Health responded quickly to treat these cases and to implement surveillance. However, malaria control efforts in Ecuador and Peru are severely limited by scarce resources, which were reduced following local elimination in 2011/2012.
According to the UN Refugee Agency, 3 million Venezuelan migrants and refugees have fled their country due to an untenable situation of severe adversity and poverty. Upon arriving to Ecuador and other countries in the region, they need access to health care and other social and economic support, midst a climate of increasing xenophobia. An integrative humanitarian response is imperative to care for migrants and refugees, coupled with strengthened malaria surveillance efforts to reduce the threat of emerging infectious disease epidemics the region.
Stewart-Ibarra states:“Following the earthquake in 2016 in Ecuador, we saw a tremendous outpouring of generosity and care for vulnerable families in the midst of the Zika epidemic. Now the region is facing a kind of sociopolitical earthquake, and migrant families need our support to reduce the threat of an impending malaria epidemic.”
Caption: An area of standing water in Machala, Ecuador, is sprayed by the Ministry of Health to eliminate the malaria mosquito in 2016. Photo by Dany Krom.