Means for individual chemoprophylaxis of malaria. Prevention of malaria

17.06.2020

Malaria is an acute protozoan infection caused by malarial plasmodia, characterized by a cyclic relapsing course with alternating acute febrile attacks and interictal conditions, hepatosplenomegaly and anemia.

The causative agents of human malaria

P. vivax- causes 3-day malaria, is widespread in Asia, Oceania, South and Central America. P. falciparum- the causative agent of tropical malaria, common in the same regions, and in the countries of Equatorial Africa is the main pathogen. P.malariae- causes 4-day malaria, and R.ovale- 3-day oval malaria, its range is limited to Equatorial Africa, some cases are recorded on the islands of Oceania and in Thailand.

The treatment of malaria is aimed at interrupting the erythrocyte cycle of development of plasmodium (schizogony) and, thus, stopping acute attacks diseases, destroy sexual forms (gametocytes) to stop the transmission of infection, act on the "dormant" tissue stages of development of plasmodium in the liver to prevent distant relapses of three-day and oval malaria. Depending on the effect on a particular stage of development of the pathogen, among antimalarial drugs, schizotropic (schizontocides) are distinguished, which, in turn, are divided into hematoschizotropic, acting on erythrocyte schizonts, histoschizotropic, active against tissue forms of plasmodium in hepatocytes, and gametropic drugs, having an effect on the sexual forms of Plasmodium.

For termination acute manifestations malaria is prescribed hematoschizotropic drugs ().

Table 1 Treatment of uncomplicated malaria

A drug	Application scheme		Course duration (days)	Pathogen	Pathogen resistance
A drug	first dose	subsequent doses	Course duration (days)	Pathogen	Pathogen resistance
Chloroquine	10 mg/kg (grounds)	5 mg/kg	3	P. vivax P.ovale P.malariae	At P. vivax reduced sensitivity in New Guinea, Indonesia, Myanmar (Burma), Vanuatu
Pyrimethamine/ sulfadoxine	0.075 g + 1.5 g	--	1	P. falciparum	Southeast Asia, Africa, South America
Quinine	10 mg/kg (grounds)	10 mg/kg every 8-12 hours	7-10	P. falciparum	Moderate resistance in Southeast Asia
Quinine + doxycycline	10 mg/kg 1.5 mg/kg	10 mg/kg 1.5 mg/kg	10 7	P. falciparum
Mefloquine	15-25 mg/kg (in 1-2 doses)	--	1	P. falciparum	Thailand, Cambodia
Halofantrine	8 mg/kg	2 doses of 8 mg/kg after 6 hours 1.6 mg/kg/day	1	P. falciparum	Cross-resistance with mefloquine
Artemether	3.2 mg/kg		7	P. falciparum
Artesunate	4 mg/kg	2 mg/kg/day	7	P. falciparum

For the purpose of a radical cure (prevention of relapses) in malaria caused by P. vivax or P.ovale, at the end of the course of chloroquine, the histoschizotropic drug primaquine is used. It is used at 0.25 mg / kg / day (base) for 2 weeks. As a gametotropic drug, primaquine is prescribed in the same dose, but for 3-5 days. Strains P. vivax, resistant to primaquine (the so-called strains of the Chesson type), are found in the Pacific Islands and in the countries of Southeast Asia. In these cases, one recommended regimen is primaquine 0.25 mg/kg/day for 3 weeks. When using primaquine, the development of intravascular hemolysis in people with deficiency of glucose-6-phosphate dehydrogenase of erythrocytes is possible. In such patients, if necessary, an alternative regimen of treatment with primaquine - 0.75 mg / kg / day once a week for 2 months can be used.

Due to the extremely wide distribution of strains resistant to chloroquine and some other antimalarial drugs P. falciparum, in almost all endemic areas in cases of mild tropical malaria and the absence of prognostically unfavorable signs, the drugs of choice are mefloquine, artemisinin derivatives (artemether, artesunate) or halofantrine.

It is not uncommon for patients to vomit while taking oral antimalarial drugs. In such cases, if vomiting develops less than 30 minutes after taking the drug, the same dose is repeated. If after taking 30-60 minutes have passed, then the patient additionally takes another half of the dose of this drug.

In severe and complicated course of malaria patients should be admitted to the ICU. Etiotropic therapy in them is carried out by parenteral administration of drugs.

Quinine remains the drug of choice for the treatment of severe tropical malaria, which is used intravenously at a dose of 20 mg / kg / day in 2-3 injections with an interval of 8-12 hours. Daily dose for an adult should not exceed 2.0 g. In order to avoid complications, a significant dilution (in 500 ml of 5% glucose solution or 0.9% sodium chloride solution) and very slow administration, over 2-4 hours, is a mandatory rule. In / in the introduction of quinine is carried out until the patient recovers from a serious condition, after which the course of chemotherapy is completed by oral administration quinine.

There are two regimens for treating severe tropical malaria with quinine:

1st - provides for the initial administration of a loading dose of the drug, providing its high concentration in the blood - 15-20 mg / kg of the base is administered intravenously for 4 hours, then maintenance doses are used - 7-10 mg / kg every 8-12 hours until the patient can be transferred to an oral drug.
2nd - 7-10 mg / kg of the base is injected intravenously for 30 minutes, after which another 10 mg / kg is administered for 4 hours. In the following days, the intravenous administration of the drug is continued at the rate of 7-10 mg / kg every 8 hours until it is possible to transfer to oral administration. Before prescribing these regimens, it is necessary to make sure that the patient has not taken quinine, quinidine, or mefloquine during the last 24 hours.

Since treatment with quinine alone does not provide a radical cure for malaria (quinine remains in the blood for only a few hours; its prolonged use often leads to the development of HP), after the patient's condition improves, a course of treatment with chloroquine is carried out. And if there is a suspicion of chloroquine resistance, then pyrimethamine / sulfadoxine, mefloquine, tetracycline or doxycycline are prescribed.

In view of the fact that in some regions, in particular in South-East Asia, there is resistance P. falciparum and to quinine, where, in severe tropical malaria, artemisinin derivatives are used for parenteral administration (artemether, artesunate) for 3-5 days before switching to oral antimalarial therapy is possible.

Therapy kidney failure, acute hemolysis with anemia and shock, pulmonary edema and other complications of tropical malaria are carried out against the background of antimalarial therapy according to generally accepted principles. With the development of hemoglobinuric fever, it is necessary to cancel quinine or other drugs that caused intravascular hemolysis of erythrocytes and replace it with another hematoschizotropic agent. In cerebral malaria, it is recommended to refrain from the use of glucocorticoids, NSAIDs, heparin, adrenaline, low molecular weight dextran, cyclosporine A, hyperbaric oxygenation. With pulmonary edema due to excessive hydration, infusion therapy should be discontinued.

FEATURES OF TREATMENT OF MALARIA IN PREGNANCY

The drug of choice for the treatment of malaria in pregnant women is quinine, which acts on most strains of plasmodium, and when administered parenterally, has a fairly rapid effect on the pathogen. When used in pregnant women, it is not recommended to use quinine at a dose of more than 1.0 g / day. For the treatment of uncomplicated tropical malaria in pregnant women, except for the first trimester, mefloquine can be used.

CHEMIOPROPHYLAXIS OF MALARIA

There are individual (personal), group and mass chemoprophylaxis. In terms of timing - short-term (during stay in the focus of malaria), seasonal (the entire period of malaria transmission) and off-season (all-season).

Personal malaria chemoprophylaxis is carried out for all people traveling to endemic foci. Depending on the intensity of transmission in a particular focus and the sensitivity of malarial plasmodium, mefloquine, chloroquine (sometimes in combination with proguanil) and doxycycline () are currently used for personal chemoprophylaxis.

Table 2. Personal chemoprophylaxis for malaria

A drug	Dosing regimen		Areas where application is recommended
A drug	adults	children	Areas where application is recommended
Mefloquine	0.25 g/week	body weight 15-45 kg - 5 mg / kg / week (when weighing less than 15 kg does not apply)	Tropical malaria outbreaks with resistance P. falciparum to chloroquine
Chloroquine + proguanil	0.3 g/week 0.2 g/day	5 mg/kg/week 3 mg/kg/day	Outbreaks of 3-day and tropical malaria without chloroquine resistance
Chloroquine	0.3 g/week	5 mg/kg/week	Foci of 3-day malaria
Doxycycline	0.1 g/day	Older than 8 years - 1.5 mg / kg / day (up to 8 years does not apply)	Foci with polyresistance P. falciparum

It should be borne in mind that there are no absolutely effective and safe antimalarial drugs. To achieve the required concentration of the drug in the blood at the time of infection and identify possible adverse events, it is recommended to start taking it in advance: mefloquine - 2 weeks in advance, chloroquine - 1 week in advance, proguanil and doxycycline - 1 day before leaving for a malaria-endemic country. Drugs are taken during the entire period of stay in the outbreak, but not more than 6 months. If the drug is poorly tolerated, it should be replaced with another one without stopping prophylaxis. After leaving the endemic country, drugs continue to be taken for another 4 weeks at the same dose.

Chemoprophylaxis of malaria in pregnant women in the first trimester is carried out with chloroquine in combination with proguanil, replacing them with mefloquine for the next two trimesters.

AMEBIASIS

Amebiasis is an infection caused by Entamoeba histolytica, characterized by ulcerative lesions of the colon, a tendency to chronic recurrent course and the possibility of developing extraintestinal complications in the form of abscesses of the liver and other organs.

Choice of antimicrobials

Drugs of choice for the treatment of invasive amebiasis are tissue amebicides from the group of nitroimidazoles: metronidazole, tinidazole, ornidazole, secnidazole. They are used to treat both intestinal amoebiasis and abscesses of any localization. Nitroimidazoles are well absorbed in the gastrointestinal tract and, as a rule, they are used orally. In / in the introduction of metronidazole is used in severe patients with the impossibility of oral administration.

Alternative drugs. For the treatment of invasive amoebiasis and, above all, amoebic liver abscesses, you can also use emetine hydrochloride (dehydroemetine dihydrochloride is used abroad) and chloroquine. Due to the possibility of developing severe adverse reactions, primarily a cardiotoxic effect, emetine and dehydroemetine are reserve drugs that are recommended for patients with extensive abscesses, as well as for the ineffectiveness of nitroimidazoles. Chloroquine is used in combination with dehydroemetine in the treatment of amoebic liver abscesses.

For the treatment of non-invasive amebiasis (asymptomatic carriers), translucent amebicides are used - etofamide, diloxanide furoate, paromomycin (). In addition, they are recommended to be used after completion of a course of treatment with tissue amoebicides to eliminate amoebae remaining in the intestine and to prevent relapse.

Table 3. Treatment of amoebiasis

A drug	Dosing regimen
A drug	intestinal amoebiasis	extraintestinal amebiasis (abscess of the liver and other organs)	Non-invasive amebiasis (carriage)
Metronidazole		30 mg/kg/day in 3 doses for 8-10 days
Tinidazole
Ornidazole	30 mg/kg every 24 hours for 3 days	30 mg/kg once a day for 5-10 days
Secnidazole	30 mg/kg every 24 hours for 3 days	30 mg/kg every 24 hours for 5-10 days
Chloroquine		0.6 g/day (base) for 2 days, then 0.3 g/day for 2-3 weeks
Etofamide			20 mg/kg/day in 2 doses for 5-7 days
Paromomycin			25-30 mg/kg/day in 3 divided doses for 7-10 days
diloxanide furoate			0.5 g every 6-8 hours for 10 days
Emetine Dehydroemetine	1 mg/kg/day (emetin - no more than 60 mg / day, dehydroemetin - no more than 90 mg / day)	1 mg/kg/day (emetin - no more than 60 mg / day, dehydroemetin - no more than 90 mg)

Giardiasis

Giardiasis (giardiasis) is a protozoal infection caused by Giardia lamblia occurring with functional bowel disorders, but more often as an asymptomatic carriage.

Choice of antimicrobials

Drugs of choice: metronidazole for adults - 0.25 g every 8 hours (during meals), for children - 15 mg / kg / day in 3 divided doses. Course duration - 5-7 days. Other regimen in adults: 2.0 g in one dose for 3 days or 0.5 g / day for 10 days.

Alternative drug: tinidazole - 2.0 g once.

CRYPTOSPORIDIOSIS

Cryptosporidiosis is an infection caused by protozoa of the family Cryptosporididae with mucosal lesions digestive system accompanied by diarrhea. In people with normal immunity, the disease ends in self-healing, while patients with immunodeficiency develop profuse diarrhea, dehydration, malabsorption syndrome, and weight loss.

Choice of antimicrobials

In patients without immune disorders, only pathogenetic therapy is carried out, primarily for the correction of water and electrolyte disorders. Standard oral glucose-salt solutions and intravenous solutions are used.

In patients with AIDS, it is necessary to use the entire complex medications including antiretrovirals. Carry out oral and / in rehydration, if necessary, use parenteral nutrition.

There are no effective etiotropic agents for the treatment of cryptosporidiosis.

Drugs of choice: paromomycin (monomycin) orally 0.5 g every 6 hours for 2 weeks or more. In case of relapse, the course of therapy is repeated.

Alternative drugs: in some patients, some positive effect was obtained with the use of macrolides (spiramycin, azithromycin, clarithromycin, roxithromycin).

TOXOPLASMOSIS

Toxoplasmosis is an infection caused by protozoa Toxoplasma gondii, characterized by a wide variety of flow options and polymorphism clinical manifestations. In most cases, asymptomatic carriage develops as a result of infection with Toxoplasma. The most severe forms of lesions of organs and systems develop in patients with immunodeficiency (AIDS, etc.).

Choice of antimicrobials

Treatment is most effective in the acute phase of the disease. In chronic toxoplasmosis, effectiveness is reduced, since the drugs used have little effect on endozoites (bradyzoites) located in tissue cysts. Clarithromycin with sulfonamides, also under cover folic acid. Therapy is carried out for several months.

leishmaniasis

Leishmaniasis - a group of transmissible protozoal infections of humans and animals transmitted by mosquitoes; characterized by limited lesions of the skin and mucous membranes with ulceration and scarring (cutaneous leishmaniasis) or lesions internal organs, fever, splenomegaly, anemia, leukopenia (visceral leishmaniasis).

Main pathogens

Old World cutaneous leishmaniasis is caused by Leishmania tropica (L.tropica minor), L.major (L.tropica major), L.aethiopica; New World - L. mexicana, L. braziliensis, L. peruviana.

The causative agent of visceral leishmaniasis is L. donovani, whose subspecies ( L.donovani donovani, L.donovani chagasi) cause various clinical and epidemiological variants of the infection.

Choice of antimicrobials

Drugs of choice: for the specific treatment of cutaneous leishmaniasis caused by L.tropica, L.major, L.mexicana, L.peruviana- meglumine antimonate (compound of 5-valent antimony). Treatment is carried out by local administration of the drug at a Sb concentration of 85 mg / ml: the lesion is densely infiltrated, 1-3 injections are made with an interval of 1-2 days.

The drug of choice for the treatment of patients with visceral leishmaniasis is meglumine antimonate, which is used in the form of intramuscular injections at the rate of 20 mg Sb per 1 kg of body weight per day, a total of 10-15 injections; the duration of the course of treatment varies in different countries.

Mechanisms of action on pathogens of malaria P. s. various chem. buildings are not the same. For example, 4-aminoquinoline derivatives disrupt the processes of intracellular metabolism in erythrocyte forms of Plasmodium, causing a deficiency of amino acids and the formation of cytolysosomes. Quinine interacts with Plasmodium DNA. Derivatives of 8-aminoquinoline inhibit the functions of mitochondria of extra-erythrocyte forms of plasmodia. Chloridine and sulfonamides disrupt the biosynthesis of folic acid. At the same time, sulfonamides prevent the formation of dihydrofolic acid due to competitive antagonism with n-aminobenzoic acid, and chloridine is an inhibitor of dihydrofolate reductase and disrupts the restoration of dihydrofolic acid to tetrahydrofolic acid.

P. s. used for the treatment and chemoprophylaxis of malaria.

P. s. have unequal activity against different life forms of plasmodia and can have a schizotropic (schizontocidal) effect aimed at asexual forms of these pathogens, and a gamotropic (gamontocidal) effect directed at sexual forms during their development in the human body. In this regard, schizotropic and gamotropic drugs are distinguished.

Schizotropic P. with. differ in activity against asexual erythrocyte and extra-erythrocyte forms of malaria pathogens, therefore, the preparations of this subgroup are divided into histoschizotropic (tissue schizontocides) and hematoschizotropic (blood schizontocides). Histoschizotropic P. s. cause the death of extra-erythrocyte forms: early pre-erythrocyte forms that develop in the liver, and forms that remain in the body outside of erythrocytes in a latent state during the period preceding the remote manifestations of malaria caused by Plasmodium vivax and Plasmodium ovale. Hematoschizotropic P. s. active against asexual erythrocyte forms and stop their development in erythrocytes or prevent it.

Gamotropic P. s., acting on the sexual forms of plasmodia in the blood of persons infected with them, cause the death of these forms (gamotocidal action) or damage them (gamostatic action). P.'s gamostatic action with. by nature, it can be dysflagellated, i.e., preventing the formation of male gametes as a result of exflagellation of male sexual forms in the stomach of a mosquito and thereby disrupting the subsequent fertilization of female sexual forms, or late gamostatic (sporontocidic), i.e., preventing the completion of sporogony and the formation sporozoites (see Malaria).

According to chem. structure among P. s. distinguish: derivatives of 4-aminoquinoline - hingamin, (see), nivachin (chloroquine sulfate), amodiaquine, hydroxychloroquine (plaquenil); diaminopyrimidine derivatives - chloridine (see), trimethoprim; biguanide derivatives - bigumal (see), chlorproguanil; derivatives of 9-aminoacridine - quinacrine (see); derivatives of 8-aminoquinoline - primaquine (see), quinocide (see); sulfonamides - sulfazine (see), sulfadimethoxine (see), sulfapyridazine (see

), sulfalene, sulfadoxine; sulfones - diaphenylsulfone (see). As P. with. also use preparations of quinine (see) - quinine sulfate and quinine dihydrochloride. According to the type of action, derivatives of 4-aminoquinoline, 9-aminoacridine, sulfonamides, sulfones and quinine preparations are hematoschizotropic. Diaminopyrimidine derivatives (chloridine, trimethoprim) and biguanide (bigumal, chlorproguanil) are histoschizotropic, active against early preerythrocytic tissue forms developing in the liver.

Features of action and classification of antimalarial drugs

In areas where there are no drug-resistant pathogens, one of the drugs is usually prescribed for treatment: 4-amino-quinoline derivatives (hingamin, amodiaquine, etc.), quinine. For persons with partial immunity to malaria pathogens (eg, adult indigenous people in endemic areas), these drugs can be prescribed in reduced course doses. In severe tropical malaria, quinine is sometimes prescribed instead of 4-aminoquinoline derivatives. In endemic areas of distribution of drug-resistant tropical malaria, a wedge, treatment is carried out by prescribing combinations of hematoschizotropic P. of page, for example, quinine in combination with chloridine and long-acting sulfonamides.

Preliminary treatment (P.'s use by page at suspicion on a malaria) is carried out before diagnosis establishment for the purpose of weakening a wedge, manifestations of an illness and the prevention of possible infection of mosquitoes. To do this, a single hematoschizotropic drug is prescribed, for example, chingamine or quinine (taking into account the sensitivity of local strains of the pathogen) immediately after taking blood for testing for malaria. If there is a risk of mosquito infection and the possibility of completing sporogony, in addition to these drugs, hemotropic antimalarial drugs (eg, chloridine, primaquine) are prescribed. When the diagnosis is confirmed, a full course of radical treatment is carried out.

The tactics of using these funds in the USSR - see Malaria.

There are three types of malaria chemoprophylaxis - personal, community and off-season; the choice depends on a goal, the protected contingents, epidemiol. conditions, type of pathogen. Different types of malaria chemoprophylaxis should be timed to certain periods, due to the phenology of the infection.

The populations of individuals subject to chemoprophylaxis are determined according to their vulnerability to malaria infection or the degree of danger as a source of infection. P.'s choice with. depends on the type of chemoprophylaxis performed, the sensitivity of local strains to P. s. and individual drug tolerance. Doses and schemes of appointment P. with. establish depending on features of pharmacokinetics of drugs, the type of plasmodia dominating in the given area and degree of an endemicity of a zone, in a cut P. of page are appointed. for chemoprophylaxis.

Personal chemoprophylaxis is aimed at the complete prevention of the development of the pathogen or the prevention of attacks of the disease in individuals at risk of infection. There are two forms of this type of chemoprophylaxis - radical (causal) and clinical (palliative).

For the purpose of radical chemoprevention of tropical malaria, P. can be used with. However, these drugs differ in their effectiveness against different strains of the pathogen. In malaria caused by Plasmodium vivax and Plasmodium ovale, these drugs prevent only the early manifestations of the disease.

Wedge. chemoprophylaxis is carried out with the help of P. s, acting on the erythrocyte forms of plasmodium. In areas where drug-resistant forms of pathogens are not registered, Ch. about r. hingamin and chloridine. The drugs are prescribed during the entire period of possible infection, and in highly endemic tropical zones, where malaria transmission can occur continuously, throughout the year. In areas where there are seasonal breaks in the transmission of malaria or when temporarily staying in an endemic zone, the drugs are prescribed a few days before the onset of a possible infection and continue for 6-8 weeks. after the end of the risk of infection.

Personal chemoprophylaxis can completely prevent the development of tropical malaria caused by Plasmodium falciparum. In those infected with P. vivax and P. ovale, after the termination of personal chemoprophylaxis, attacks of the disease may occur at a time characteristic of long-term Manifestations (within 2 years, and sometimes later). In this regard, people traveling from areas with a high risk of infection with these types of plasmodia should be prescribed primaquine or quinocide.

Chemoprophylaxis of malaria during blood transfusion, i.e., prevention of infection of recipients as a result of hemotransfusion or hemotherapy with the blood of donors who are possible carriers of malaria infection (for example, indigenous people of endemic zones), is considered as a kind of wedge, chemoprophylaxis. For this purpose, the recipient immediately after the introduction donated blood prescribe any hematoschizotropic P. s. (hingamin, amodiaquine or others) according to the treatment regimen for acute manifestations of malaria.

Interseasonal chemoprophylaxis aims to prevent late manifestations of 3-day malaria with a short incubation and primary manifestations of 3-day malaria with a long incubation in persons infected in the previous malaria season, who may become sources of infection by the beginning of the next malaria season. For this type of chemoprophylaxis, histoschizotropic P. is used. (primaquine or quinocide), acting on long-term extra-erythrocyte forms of the pathogen.

Most P. s. It is well tolerated and, when taken in therapeutic doses for a short time, usually does not cause serious side effects. The latter often occur in long-term use P. s.

The nature of the side effects of P. s., belonging to different classes of chem. connections are different. So, hingamin and other derivatives of 4-aminoquinoline can cause nausea and vomiting. With prolonged continuous use (for many months), drugs in this group can cause visual impairment and vestibular disorders, hair depigmentation, liver damage and dystrophic changes in the myocardium. With fast intravenous administration Chingamine may develop collaptoid reactions.

Diaminopyrimidine derivatives (chloridine, etc.) with short-term use sometimes cause headache, dizziness and dyspeptic disorders. The most severe manifestations of the side effects of these drugs with prolonged use may be megaloblastic anemia, leukopenia, and a teratogenic effect, which are due to the antifolic properties of P. s. this group.

Bigumal and other biguanides cause a transient increase in the number of neutrophils in the blood and leukemoid reactions in some patients. Prolonged intake of bigumal on an empty stomach is accompanied by loss of appetite, possibly due to inhibition of gastric secretion.

P. s. from among the derivatives of 8-aminoquinoline (primaquine, quinocide) more often than other P. pages, cause side effects (dyspeptic disorders, chest pain, cyanosis, etc.). It should be borne in mind that side effect quinocide develops more often and is more severe with the simultaneous appointment of this drug with other P. s. The most severe side effect of 8-aminoquinoline derivatives may be intravascular hemolysis, which develops in individuals with congenital deficiency of the enzyme glucose-6-phosphate dehydrogenase in erythrocytes.

Quinine preparations are more toxic than other P. s. Side effects of quinine - tinnitus, dizziness, nausea, vomiting, insomnia, uterine bleeding. In case of an overdose, quinine can cause a decrease in vision and hearing, a sharp headache, and other disorders from c. n. N of page, and also collaptoid reactions. In the case of idiosyncrasy to quinine, erythema, urticaria, exfoliative dermatitis, and a scarlet-like rash occur. In persons with glucose-6-phosphate dehydrogenase deficiency, under the influence of quinine, hemoglobinuric fever develops.

See also Malaria (Treatment and Chemoprophylaxis) .

Chemoprophylaxis for malaria is an effective and mandatory activity that everyone who travels to Africa or India should take. After all, it is in these countries that the risk of infection is very high. And in some regions, epidemics are raging at all. How is such prevention carried out, and what threatens to ignore it?

Goals of chemoprophylaxis

Chemoprophylaxis has several goals:

strengthening general immunity;
the creation of antibodies in the body to increase its immunity to the virus;
prevention of complications against the background of malaria;
a significant reduction in the risk of death (i.e. even if a person falls ill after chemoprophylaxis, then with adequate treatment he will soon recover);
prevention of distant recurrences (carried out for people who have already had malaria once. It helps to avoid a recurrence of the disease).

Of course, malaria is treated today and quite effectively. But do not rely on this, because there are several pitfalls. First, for successful treatment It should be started as soon as the first symptoms appear. In the countries of Africa and India, they are unlikely to be able to provide proper medical care to a European or a Russian. And not everyone will be able to transfer a flight with a temperature under 40.

Secondly, even after recovery, strains of the virus may remain in the patient's body. And, therefore, a person will be a carrier of the infection. Thirdly, immunity plays a role: malaria is tolerated by everyone in different ways. A healthy and large man, perhaps, will suffer a little less, but a child or a thin woman will suffer greatly. And 1% of deaths still cannot be overlooked. Therefore, it would be advisable to take a course of chemoprophylaxis and only then go on an exotic trip.

Curious! In 2007, World Malaria Day was approved. It falls on April 25th.

Types of chemoprophylaxis

Malaria prevention is a whole system aimed at implementing epidemiological surveillance of one's own health, as well as the health of others. So, there are two types of chemoprophylaxis - personal (individual) and mass.

Personal

This includes taking antimalarial drugs, which can prevent infection after the virus enters the body. Personal chemoprophylaxis must be carried out by tourists planning a trip to regions with a high epidemiological threshold.

The measures of personal prevention of malaria include the refusal to visit a place known to be dangerous in favor of a country with no epidemic at the moment or at all. Also, individual prevention involves the observance of the simplest rules: the use of repellents, wearing closed deaf clothing, avoiding going outside after 17:00, when the peak of attack begins in malaria mosquitoes.

Chemotherapy starts about a week before the trip. Also, medicines are given to a person with him so that he can continue prophylaxis while on the spot. Upon return, preventive measures continue for another 4-6 weeks, so that if there is a fact of infection, the malaria virus does not have time to become active. If symptoms already appear, the tactics are reviewed, and treatment comes in place of chemoprophylaxis.

Bulk

Mass chemoprophylaxis is aimed at preventing the infection of people in the affected area with malaria. More often it is carried out directly in epidemiologically dangerous regions. Some people from Russia or Europe go to Africa or India precisely for the purpose of preventing or treating local residents or military units from malaria.

Mass prevention also includes especially careful medical supervision of a person who has recently arrived from potentially dangerous places. He regularly visits an infectious disease specialist, donates blood for tests; he is temporarily suspended from donating.

What drugs are used

Chloroquine

The active substance is salts of chloroquine phosphate. commercial names many, but one of the most common and used is Delagil tablets. They begin to be taken 2 weeks before visiting an epidemiologically dangerous region. The dosage is determined by the doctor. Upon returning from a trip, Chloroquine should be resumed for another 6 weeks.

Hydroxychloroquine

The commercial name is Plaquenil. It's over strong drug than Chloroquine, because there is also a hydroxo group, which makes it easier to digest. The principle of admission is the same: 2 weeks before the trip and within 6 weeks upon return.

Pyrimethamine + Sulfadoxine

Another effective combination found under the trade name Fansidar. Pyrimethamine and sulfadoxine are taken in combination with chloroquine, which is an excellent chemoprophylaxis against mild tropical malaria. It is also recommended to have Fansidar tablets with you while traveling, and when the first symptoms appear (fever, weakness), take the drug immediately.

Atovaquon-proguanil

Suspension or tablets called Malyaron (Malarone). Strong remedy, which is applied 2-3 days before the trip, then daily until a week has passed after the return.

Primaquine diphosphate

Or just Primakhin. Suitable for preventive prevention and treatment of malaria, i.e. to prevent the development of the disease in people who arrived from the infection zone and did not undergo preliminary chemoprophylaxis. Primaquine has a detrimental effect on plasmodia that are at the tissue stage of growth (dressing in a capsule), thereby preventing the development of various forms of malaria (in particular, three-day).

Doxycycline

An antibiotic familiar to many, which is also used to prevent malaria. The reception tactics are standard: 2 days before the trip, while staying in the region of infection, 7 days after returning.

By the way! Simultaneously with taking prophylactic drugs for malaria, it is recommended to drink a course of probiotics to maintain microflora (for example, Linex).

Drug chemoprophylaxis is one of the most reliable methods to avoid the development of malaria, its exacerbation or distant relapses. The only downside is the side effects. Some simply feel a slight malaise, weakness and nausea, while others may experience insomnia, suffer from diarrhea and vomiting. Therefore, many prefer to take risks and choose less reliable, but more convenient methods for preventing malaria: repellents and deaf clothing.

Prevention of malaria in our country is aimed at preventing infection of citizens traveling to regions endemic for malaria, carrying out protective measures on the territory of our country from the importation of infection, timely detection and adequate treatment of patients, monitoring the cured, conducting chemoprophylaxis and anti-relapse treatment, and implementing extermination measures in against vectors of infection and the implementation of measures to protect against mosquito bites.

In the list of measures aimed at the prevention of malaria in our country, sanitary and educational work is of no small importance. A malaria vaccine is currently under development. However, it is obvious that if it is created, for many reasons it will not replace existing preventive measures regarding malaria.

Due to the lack of proper treatment and system of measures for the prevention of malaria, more than 100 countries in Africa, Asia and South America remain the most unfavorable regions for malaria today.

Rice. 1. In the photo, malarial (left) and non-malarial (right) mosquitoes.

Memo on the prevention of malaria in people traveling to dangerous regions

Organizations and travel agencies that send employees and organize trips to countries endemic for malaria provide information to travelers on the following issues:

the possibility of contracting malaria;
the need to comply with individual protection measures against mosquito bites;
the need for chemoprophylaxis that is effective in the host country;
knowledge of the symptoms of the disease;
immediate appeal for medical care in case of an attack of fever both during a stay in an endemic country and upon returning home;
in case of absence in the region of stay first aid businessmen are provided with antimalarial drugs in a course dose, and when staying in an endemic focus for 6 months, they must have drugs in the amount of 3 course doses;
the need to take prophylactic antimalarial drugs before departure, during the stay in the region and within 4 weeks upon arrival. Know their side effects and contraindications;
persons who took Chloroquine with a preventive purpose, they should be examined by an ophthalmologist 2 times a year in order to monitor the condition of the retina.

Antimalarial drugs used prophylactically may not always protect against malaria. In some cases, the disease may occur in mild form, which can mislead both the patient and the doctor.

Rice. 2. Protect from mosquito bites canopy over the bed.

Who should be tested for malaria

The following are subject to testing for malaria:

Arrived from endemic areas, whose temperature rises above 37 ° C for 5 or more days of the last 3 years against the background of malaise, headache, enlarged spleen and liver, yellowness of the skin and sclera, anemia.

Previous malaria survivors who have had a fever in the past 2 years.
Enlargement of the liver and spleen of unknown origin.
Persons suffering from fever during the last 3 months after a blood transfusion.
Persons residing in an active outbreak or areas at high risk of malaria for any febrile illness.
Persons with fever lasting more than 5 days of unknown origin.

Rice. 3. Jaundice skin and sclera - a sign of liver damage.

Timely detection of patients and rational treatment

Discharge of patients with malaria from the hospital is made only after negative control studies of blood samples.

Chemoprophylaxis of malaria

Chemoprophylaxis of malaria involves taking antimalarial drugs by healthy individuals when they visit endemic areas. Optimal dose medicinal product and its regular reception will ensure the success of the event.

Rice. 5. Drugs for the prevention of malaria.

Public Prevention of Malaria

Public prevention malaria involves the destruction of the sexual forms of malarial plasmodia in the body of a sick person in order to prevent infection of insects, which prevents the further spread of infection. Primakhin, Chinocide, Bigumal b and Plasmicide are representatives of the gamototropic group of drugs that are used together with drugs that affect the development cycle of malarial plasmodia, which takes place in erythrocytes.

Rice. 6. Female gametocytes (sex cells) of P. falciparum under a microscope.

Mosquito extermination

Malaria is caused by malarial Plasmodium, which enters the human bloodstream through the bites of female Anopheles mosquitoes.

Personal prevention of malaria includes taking measures to protect against.
Public prevention includes a number of activities aimed at the destruction of winged forms of insects in settlements and in nature, as well as larvae and pupae of mosquitoes in their breeding areas using land reclamation and the use of insecticides.

Winged forms of insects destroyed in nature and indoors. In rooms, the ceiling, walls and windows are pollinated with powders or emulsions of persistent insecticides. Mosquito wintering areas are subject to processing: attics, basements, outbuildings and barnyards.

Fight against larvae and pupae mosquito control is carried out with the help of aircraft and ground equipment, which is used in the treatment of water bodies and wetlands.

Rice. 7. Before processing, all suspicious reservoirs are carefully examined.

Destruction of mosquitoes using insecticides

They are destroyed at all stages of their development. In places where mosquitoes accumulate, the premises are pollinated or sprayed with insecticides, for which hexachloran or DDT preparations are used in the form of aerosols, emulsions or powders. Processing must be thorough, regular and total, which is not always possible. In addition, mosquitoes often develop resistance to DDT.

In the fight against mosquitoes, organophosphorus compounds are used: Karbofos, Diphos, Dichlorvos, Tryphos, Temephos, Malathion.

Types of insecticide treatment:

continuous processing carried out in malaria foci of the previous and current years. All commercial, non-residential and residential buildings are subject to processing.
Barrier treatment It is used to prevent the entry of insects from large areas of their breeding to large settlements, for which the houses of the first row, located in the path of mosquitoes, are processed.
Selective Processing produced on premises in places where cases of malaria are reported.

Rice. 8. Fight against mosquitoes in the coastal zone of reservoirs.

Rice. 9. Fight against mosquitoes on reservoirs.

Mosquito larvae and pupae control

The fight against mosquito larvae is carried out with the help of aviation and ground equipment. Water bodies located within a radius of 3 km around the affected settlement are subject to treatment. Before processing, all suspicious reservoirs are carefully examined.

For the development of larvae and pupae of malarial mosquitoes, special conditions are necessary:

relatively clean water
presence of microplankton for food,
sufficient content of dissolved oxygen in the reservoir,
minimum salinity of the reservoir,
lack of strong currents, waves and ripples on the surface,
weak shading.

Methods of dealing with larvae and pupae of mosquitoes:

Small reservoirs are covered with earth, others are drained,
Large reservoirs are cleaned and oiled, sprayed with pesticides.
In rice fields, intermittent irrigation is used - a short-term descent of water.
Zooprophylaxis is used when livestock farms are located between settlements and mosquito breeding sites. Animal blood is a good nutrient for adult mosquitoes.
Biological methods are used to control larvae and pupae of malaria mosquitoes in water bodies used for growing crops. For example, it is widely practiced to breed viviparous mosquito fish ( Gambusia affinis) that feed on the larvae and pupae of mosquitoes.

Rice. 10. Larva of a malarial mosquito (photo on the left) and a non-malarial mosquito (photo on the right).

Rice. 11. In the photo there are mosquito fish. Female (pictured top left) and male (pictured bottom left). In the photo on the right is a mosquito fish and a mosquito larva.

Mechanical protection against mosquitoes

An important place in protection against mosquito bites is played by mechanical protection: meshing doors, vestibules, windows and ventilation openings in residential premises, the use of curtains and curtains, the use of repellents.

From dusk until dawn, it is necessary to wear clothing that covers the arms and legs, and treat open areas with repellent. Arrange a canopy over the bed. When spending the night in a forest or field, it is necessary to build a gauze canopy. The canopy should be of the right length so that it is convenient to tuck it under the mattress.

One of the ways to prevent malaria is the use of insecticidal-repellent preparations (repellants scare away, insecticides kill). They are applied to the skin, they treat clothes and all protective devices against mosquito attacks - mosquito nets, curtains, curtains, outer walls of tents, etc. Rooms are treated with insecticidal-repellent preparations. Water emulsions are impregnated with curtains made from gauze, muslin or fabric.

Repellents are available in the form of creams, ointments, lotions, emulsions and aerosols.

Residual insecticides are divided into synthetic and natural ( essential oils some plants).

Synthetic repellents are widely used "OFF SMOOTH & DRY", "OFF Extreme", "Gardex Extreme", "Moskidoz", "Mosquitoll Super active protection", "Medilis comfort", "DETA", "DETA Vokko", "Ultraton" , "Biban", "Bayrepel®", "Permethrin", "IR3535", etc.

Rice. 12. Mosquito repellents. From left to right, mosquito sprays "OFF SMOOTH & DRY", "Off Extreme" and "Gardex Extreme".

Fast and effective way protection against mosquitoes are spirals, insecticidal-repellent cords used in the open air or well-ventilated areas - arbors, sheds, verandas. good effect achieved by using a smoldering electric fumigator.

Pyrotechnic compositions (tablets, checkers, briquettes) are used for processing closed-type premises from 15 to 20 m 2.

Rice. 13. Protective mesh for windows and doors.

Rice. 14. Canopy over the bed.

Definition:

Malaria is a protozoal anthroponotic disease with a predominantly transmissible transmission of pathogens through the bite of an Anopheles mosquito, characterized by febrile paroxysms, anemia, enlarged spleen and liver, and a tendency to relapse.

Clinical classification:

I. By etiology:

Three-day
Four-day
Tropical
Ovale - malaria
mixed forms.

II. According to the severity of clinical manifestations:

III. Severity: light, medium, heavy.

IV. By the presence and absence of complications in tropical malaria:

Complicated (malarial coma - cerebral, algidic malaria, hemoglobinuric fever, acute renal failure, etc.).
Uncomplicated.

V. By sensitivity to antimalarial drugs:

resistive
Non-resistant.

VI. By the occurrence of the disease:

primary manifestations.
Relapses.

VII. Associated with other diseases:

Criteria for making a diagnosis.

Epidemiological history:

an indication of staying in endemic foci of malaria, in countries with a hot climate during the last three years before the disease;
an indication of a history of malaria (relapse);
blood transfusions within three or less months before the onset of the disease.

Clinical manifestations:

Characterized by an acute onset of the disease with a sudden onset of chills and a rapid increase in body temperature to 39-40 ° C, followed by a feeling of heat, followed by profuse sweating. An attack of fever ends with a critical decrease in body temperature to normal values. In the period of apyrexia, the state of health of patients can be satisfactory.

Objective data:

During an attack:

hyperemia of the face; injection of vessels of the sclera, dry hot skin.

After two or three attacks, it is found:

pale skin or jaundice;
hepatosplenomegaly.

Features of the flow various forms malaria.

Tropical malaria:

incubation period - 7-10 days;
the onset of the disease from the prodromal period within 1-2 days:
often the first symptom is diarrhea;
fever persistent or remittent, periods of apyrexia
not expressed (t° does not decrease to normal);
characterized by irregularity and prolongation of paroxysms (days);
the spleen increases by the 10th day of illness and reaches a large size;
possible damage to the kidneys;
there are no late relapses, complications are frequent (malarial coma, acute renal failure, pulmonary edema).
hemoglobinuric fever, algid, hypoglycemia, acute hemolysis;
mortality in late diagnosis and inadequate therapy is high.

Malaria in young children:

malarial paroxysms are not expressed;
frequent bouts of vomiting:
rapid stool without pathological impurities;
convulsions even at a moderately elevated temperature;
slow enlargement of the liver and spleen (earlier with a three-day than with a tropical);
anemia develops rapidly;
children from 6 months to 4-5 years are most seriously ill.

Malaria in pregnancy:

danger of severe current;
severe anemia, especially in tropical malaria;
a sharp increase in the spleen and liver;
the risk of abortion, premature birth, postpartum complications and death.

Occurs in endemic areas after repeated clinical pronounced form diseases.

Laboratory criteria.

Detection of malarial plasmodia by microscopic examination of blood products (thin smear, thick drop), or confirmed by molecular diagnostics using polymerase chain reaction.

Laboratory and instrumental research methods. At level 1:

complete blood count (decrease in the number of red blood cells, hemoglobin concentration, aniso- and poikilocytosis, an increase in the content of reticulocytes, a tendency to thrombocytopenia, leukopenia with relative lymphocytosis, monocytosis, an increase in ESR).

At levels 2-3:

study of blood products - thick drops and thin smear (at least 100 fields of view in a thick drop);
general blood analysis;
general urine analysis.

According to indications: urea, creatinine; electrolytes (potassium); blood sugar test; bilirubin and its fractions; hemostasogram. Instrumental: ultrasound of the liver, spleen.

Case classification

The standard definition is a case of protozoal anthroponotic disease manifested by febrile paroxysms, anemia, enlargement of the spleen and liver, or asymptomatic carriage, with the presence of malarial plasmodia in a blood product.

Suspicious case - a patient with febrile paroxysm, hepatosplenomegaly and anemia in the clinic.
Confirmed case:

A patient with febrile paroxysm, hepatosplenomegaly, anemia and laboratory confirmation of the presence of plasmodia in blood products (smear and thick drop) in the clinic.

In the absence of symptoms, but laboratory detection of plasmodia in blood products (smear and thick drop).

A medical worker who has identified a patient with malaria or is suspicious of it submits an emergency notice (f. 58 / y). Only laboratory-confirmed cases are subject to registration in the accounting system.

Indications for hospitalization

Malaria treatment

Treatment is prescribed immediately upon establishing a laboratory diagnosis.

In the event of a laboratory result delay (more than 3-6 hours), a patient suspected of having malaria may begin pre-treatment, but with the condition of the full therapeutic dose. In this case, in the absence of a positive laboratory result, the course of treatment is stopped.

Treatment of three-day malaria

Cupping treatment of patients with three-day malaria is carried out with a hematoschizotropic drug; chloroquine diphosphate(delagil) (in 1 tab. 150 mg or 300 mg of base) according to the standard scheme.

The course of treatment for adults consists of taking 25 mg of the base of the drug per 1 kg of body weight for three days:

Day 1 - 10 mg/kg in two divided doses 6-8 hours apart;

2nd day - 10 mg/kg in two divided doses 6-8 hours later;

3rd day - 5 mg/kg in one dose.

(total 10+10+5=25 mg.).

Doses of chloroquine (delagil) for the treatment of malaria in children

		Doses of chloroquine in tablets of 150 mg.
Age	0-3 months	4-11 months	1-2 years	3-4 years	5-7 l.	8-10 l	11-13 l	14 l
Weight		7-10	11-14	15-18	19-24	25-35	36-50	50 and
body								more
sick
(kg.)
1st day	0.5t	0.5t			1.5 t	2.5t
2nd day	0.25t	0.5t			1.5 t	2.5t
3rd day	0.25t	0.25t	0.5t

Such treatment does not guarantee a radical cure for three-day malaria, since hemotoshizotropic drugs do not act on hypnozoites in hepatocytes, so the course of stopping treatment with chloroquine should be supplemented with radical treatment.

For radical treatment using a histoschizotropic drug primaquine 0.25 mg⁄kg⁄day base for adults for 14 days without interruption, concomitantly with stopping treatment with chloroquine. Reducing the course of primaquine to less than 14 days leads to relapses of malaria. The drug must be dispensed medical staff directly on the principle of "in the patient's mouth."

The duration of the full course of treatment for three-day malaria (stopping and radical) is 14 days. The study of blood products is carried out three times - before the start of taking chloroquine, on the 4th day of treatment and before discharge from the hospital.

Primaquine is contraindicated:

pregnant and breastfeeding women;
children under 4 years old;
persons with a deficiency of the enzyme glucose-6-phosphate dehydrogenase due to possible hemolysis.

Treatment of three-day malaria in pregnant women:

Treatment of tropical malaria

The main WHO strategy in the treatment of tropical malaria is to take into account the sensitivity of the pathogen to drugs in the country of origin of the patient (see WHO annual supplement)

Uncomplicated

1. Artemether in combination with lumefantrine (Artemether - 20 mg Lumefantrine - 120 mg) - Riamet

Treatment regimen for uncomplicated tropic malaria

Weight in kg	Age in years	Number of Riamet tablets and hours of administration
Weight in kg	Age in years	0 hour	8th hour	24th hour	36th hour	48th hour	60th hour
5-14	Less than 3 years old
15-24
25-34	9-14
35 or more	Over 14

The combination of Artemether and Lumefantrine is contraindicated in pregnant women.

2. Meflokin (Lariam, Meflaquine) 25mg base/kg in two divided doses - 15mg/kg plus 10 mg/kg with an interval of 6-24 hours between doses. Pregnant women in the first trimesters, with mental disorders and epilepsy is contraindicated.

3. Quinine in combination with doxycycline: Quinine (dihydrochloride or sulfate) 10 mg⁄kg + doxycycline 100 mg daily for 7 days simultaneously or sequentially (by mouth).

Treatment with quinine should be combined with antibiotics (tetracycline, doxycycline, clindamycin) to reduce the risk of early relapses.

Doxycycline is not prescribed for children under 8 years of age. Children under 8 years of age are prescribed quinine at a dose of 10 mg/kg. per day for 7 days. Children over 8 years of age are prescribed quinine 10 mg⁄kg + doxycycline 2 mg⁄kg per day for 7 days

4. Combination of artesunate and sulfadoxine + pyrimethamine (fansidara)

In combination treatment, the doses of artesunate are 4 mg/kg once a day for three days with a single dose of sulfadoxine-pyrimethamine (by mouth)

Age	Dose in mg (number of tablets)
Age	Artesunate (50 mg)			sulfadoxine-pyrimethamine (500/25)
	1st day	2nd day	3rd day	1st day	2nd day	3rd day
5-11 months	25 (1/2t)	25 (1/2t)	25(1/2t)	250/12.5 (1/2 tons)
1-6 years old	50 (1t)	50 (1t)	50(1t)	500/25 (1 t)
7-13 years old	100(2t)	100(2t)	100(2t)	1000/50 (2t)
Over 13 years	200 (4t)	200 (4t)	200 (4t)	1500/75 (3t)

Complicated

1. Etiotropic treatment

A) Treatment is carried out by parenteral administration of quinine dihydrochloride 30% - 2 ml (600 mg), based on:

loading dose of quinine - 20 mg of salt / kg, dissolved in 10 ml / kg of isotonic solution for four hours every 8-12 hours, drip, slowly intravenously;
then 10 mg/kg for four hours every 8-12 hours until the patient can take quinine sulfate tablets at a dose of 10 mg/kg of salt every 8 hours for 7 days.

V) Artesunate the first dose of 2.4 mg per 1 kg / IV, or IM after the first dose, is repeated after 12-24 hours (three times), then 1 time per day for 6 days.

With) Artemeter first dose 3.2 mg/kg/im, 2.6 mg/kg for 6 days. Pregnancy is a contraindication for prescribing artemisinin preparations.

2. Case management and symptomatic treatment with complications:

a) with cerebral malaria- accounting for the volume of injected and excreted fluid; measurement of the patient's body temperature every 4-6 hours, respiratory rate, blood pressure. To prevent convulsions in / m phenobarbital 10-15 mg / kg; in the event of seizures - diazepam 0.15 mg/kg IV or paraldehyde 0.1 mg/kg IV;

b) with anemia- hematocrit below 20% - transfusion of red blood cells, with normal kidney function - together with 20 mg of furosemide;

c) with kidney failure- careful introduction of isotonic solution under the control of venous pressure; peritoneal dialysis or hemodialysis while maintaining oliguria after rehydration and raising the concentration of urea and creatinine in the blood;

d) with hypoglycemia- glucose 50% - 50 ml IV, subsequently, if necessary, 5% or 10% glucose IV; for children - 1.0 ml / kg;

e) with pulmonary edema- semi-sitting position; oxygenation (including artificial ventilation); furosemide 40 mg IV, in the absence of effect - increase the dose progressively to 200 mg; with pulmonary edema due to excessive hydration - stop IV fluids, immediate hemofiltration, furosemide 40 to 200 mg IV;

f) with hyperpyrexia in children- repeated measurement of temperature in the rectum, when it rises more than 39 ° C, active cooling of the body with a damp towel and fan, paracetamol 15 mg / kg (suppositories, nasogastric tube);

Treatment of vaccinated (schizontal) malaria

Monitoring the effectiveness of treatment

In case of three-day malaria, the study of blood products should be carried out on the 4th day of treatment, i.e. at the end of the stopping treatment and before discharge, i.e. after completion of radical treatment.

In tropical malaria, daily microscopy of a blood preparation is indicated during the treatment period. If gametocytes are still detected after treatment, the patient should be treated with a one-day dose of primaquine (0.45 mg base in an adult) to prevent infection by malarial mosquitoes during the malaria transmission season.

Discharge conditions

Three-day and tropical malaria convalescents are discharged after complete clinical recovery, completion of a radical course of treatment, and a negative result of a blood product study before discharge.

Persons who did not receive radical treatment primaquine (pregnant women, children under 4 years of age, etc.), are subjected to anti-relapse treatment after the removal of contraindications, within 14 days, on an outpatient basis.

If the period of contraindication coincides with the season of malaria transmission, they can receive seasonal chloroquine chemoprophylaxis once a week according to their age.

Available antimalarial drugs

A drug	English Name	Tick prevention	Treatment	Notes
Artemether-lumefantrine	Artemether-lumefantrine			commercial name Coartem
Artesunate-amodiaquine	Artesunate-amodiaquine
Atovaquon-proguanil	Atovaquone-proguanil			commercial name Malaron
Quinine	Quinine
				after the appearance
Chloroquine	Chloroquine			resistance use
				limited
Cotriphazid	Cotrifazid
Doxycycline	Doxycycline
Mefloquine	Mefloquine			commercial name Lariam
Proguanil	Proguanil
Primakhin	Primaquine
Sulfadoxine pyrimethamine	Sulfadoxine pyrimethamine

Dosing schedule for chloroquine treatment (WHO)

		Number of tablets
Weight, kg)	Age (years)	Tablets, 100 mg				Tablets, 150 mg
		Day 1	Day 2	Day 3	Day 1		Day 2	Day 3
	< 4 мес						0.25	0.25
7-10	4-11 months
11-14
15-18
19-24
25-35	8-10
36-50	11-13

Treatment of uncomplicated malaria

Chloroquine
sensitive
P. vivax and P.	Adult dose	Pediatric dose	Notes
falciparum
(imported)
	600 mg base	10 mg base
Chloroquine (by mouth) (Aralen®)	(1000 mg phosphate salt), then 300 mg (500 mg) 6 hours later,	(max 600 mg base) orally, then 5 mg/kg 6 hours later,	See Table1
	and 300 mg base, 2 days	and 5 mg/kg base, 2 days
Chloroquine-resistant P.vivax	Adult dose	Pediatric dose
Mefloquine (by mouth) (Lariam®)	1,250 mg (in 2 doses: 750 mg + 500 mg 8-12 hours later), 1 day	< 45	DO NOT apply to pilots and drivers of public transport

		kg
Quinine sulfate + doxycycline (orally)	650 mg every 8 hours (3-7 days + doxycycline 100 mg/day, 7 days	25 mg/kg/day in 3 doses, 3-7 days + doxycycline 2 mg/kg/day to 100 mg, 7 days	Doxycycline: CONTRAINDICATED in children under 8 years of age and during pregnancy
Prevention of P. vivax recurrence	Adult dose	Pediatric dose
			CONTRAINDICATED
	15 mg base		pregnant women and
Primaquine (by mouth)	(26.3 mg phosphate salt) daily (14 days)	0.3 mg base (0.5 mg salt) per kg/day, 14 days	breastfeeding women and persons with G6PD deficiencyChloroquine-resistant P. falciparum (imported)
Chloroquine
resistant P. falciparum	Adult dose	Pediatric dose
(imported)
Quinine sulfate (orally)	650 mg every 8 hours, 7 days	10 mg/kg every 8 hours, 7 days	Very bitter, zinconism (nausea, dysphoria, tinnitus)
* Tetracycline	250 mg every	DO NOT administer to children and
(inside)	6 hours, 7 days	pregnant
* Doxycycline (by mouth)	100 mg/day, 7 days	DO NOT administer to children under 8 years of age	CAUTION: May reduce effectiveness birth control pills
* Pyrimethamine 25 mg / Sulfadoxine 500 mg (in one tablet) orally /	2-3 tablets once, on the 2nd day	6 weeks-1 year -1/4 tab on day 2 1-3 years - ? tab on day 2 4-8 years -1 tab on day 2	PRECAUTION: if the patient is allergic to sulfur-containing drugs

		9-14 years - 2
		tab for day 2
Mefloquine (by mouth)	1,250 mg (in 2 doses: 750 mg + 500 mg 8-12 hours later), 1 day	25 mg/kg (in 2 doses: 15 mg/kg + 10 mg/kg 6 hours later);< 45 кг	Nausea, vomiting, dysphoria, weakness, nightmares
		11-20 kg: 1 tab
Malarone (Atovahon 250mg + Proguanil 100mg) orally	4 tablets, one dose, 3 days	3 days 21-30 kg: 2 tabs in one go, 3 days 31-40 kg: 3	Expensive
		tab in one
		reception, 3 days
		< 15кг: по 1
Riamet (Artemether 20mg+Lumefantrine 120mg)	4 tablets, twice a day, 3 days	tab twice, 3 days 15-25kg: 2 tabs twice, 3 days 25-35 > kg:	Effective against multidrug-resistant P.falciparum
		3 tabs twice
		3 days

* Administered with quinine

Treatment of severe chloroquine-resistant falciparum malaria (antimalarial drugs)

intravenous

Adult dosage

Children's dosage

(iv) injections

20mg salt/kg (saturation dose),

20 mg salt/kg (dose dissolved in 10 ml/kg saturation) dissolved in isotonic fluid, IV

10 ml/kg isotonic drip over 4 hours, liquid,

IV drip in Quinine (VV)

then, 8 hours after for 2 hours, then after the start of the saturation dose, 10 mg 12 hours after the start of the dose of salt/kg for 4 hours of saturation, 10 mg of salt/kg every 8 hours until for 2 hours every 12 the patient will be able to swallow for hours until

	Must complete 7-	the patient can swallow
	daily course of quinine tablets	Must complete 7-
	(10mg salt/kg every 8-12	daily course of tablets
	hours)	quinine (10mg salt/kg every
		8-12 hours)
Artesunate (BB)	2.4 mg/kg (loading dose) IV on day 1 followed by 1.2 mg/kg daily for at least 3 days until patient can swallow
Intramuscular
th VM
injections (if	Adult dosage	Children's dosage
BB
unavailable)
Quinine (VM)	20mg salt/kg diluted at 60-100mg/mL, IM, then 8 hours after the start of the loading dose, 10mg salt/kg every 8 hours until the patient is able to	Same as adults (according to weight)
	to swallow
Artemether (VM)	3.2 mg/kg (loading dose) IM on day 1, then 1.6 mg/kg daily for at least 3 days until patient can swallow	Same as for adults (according to weight) 1 ml tuberculin syringes are recommended due to small volume
Rectal
candles (BB / VM	Adult dosage	Children's dosage
unavailable)
	40 mg/kg (saturation dose),
Candles with	rectally, then 20 mg/kg via	Same as adults (in
artemisinin		according to weight)
	oral treatment
Candles with artesunate	200 mg rectally at 0, 4, 8, 12, 24, 36, 48 and 60 hours, followed by oral treatment

protocol for epidemiological surveillance for malaria

Epidemiological surveillance is a process of systematic collection and analysis of epidemiological data in order to plan and implement anti-epidemic measures to prevent, detect, suppress the spread of infection, as well as evaluate their effectiveness, to protect public health and the environment.

The purpose of epidemiological surveillance is to maintain well-being in the rehabilitated areas and prevent the restoration of local transmission and spread from imported cases of malaria.

I. The main tasks of health care institutions.

1. Improving the malaria surveillance system

II. The main functions of epidemiological surveillance:

III. The system of epidemiological surveillance for malaria includes:

2. Ecological, entomological, epidemiological and socio-demographic monitoring of the malaria situation:

analysis of meteorological data (temperature and humidity);
analysis of the socio-demographic situation (migration of the population, economic activity);
determination of the level of malariogenicity of the territory and zoning according to the risk of malaria infection;
entomological observations of the vector and their breeding sites.

3. Organization and implementation of antimalarial activities:

hydrotechnical measures and preventive sanitary
supervision during the construction and operation of irrigation facilities;
environmentally sound vector control measures
(larvicidal measures, mosquito breeding sites of malarial mosquitoes);
providing the population with means of protection against insect bites;
health education of the population;
prevention of vaccinated malaria.

4. Training of medical personnel in the diagnosis, treatment, epidemiology and prevention of malaria.
5. Evaluation of the effectiveness of antimalarial measures taken.
6. Interdepartmental and intersectoral integration and coordination of antimalarial activities.

1. Collection and analysis of information on the incidence of malaria.

Active detection.

Early detection of patients with malaria is carried out by health workers during house-to-house or door-to-door rounds on the basis of a journal with family lists of residents and dates of visits. All persons suspected of having malaria are subjected to thermometry and taking a blood product (thick drop and thin smear). The log makes a note about the visit in the line against each person interviewed and a note about taking blood from those suspected of malaria.

1. 2. Laboratory diagnosis of malaria

The main method for diagnosing malaria is the study of a thick drop and a thin smear of blood stained according to Romanovsky-Giemsa. Cooking technique drugs.

Blood for testing for malaria is taken from a finger on a clean, fat-free glass using a disposable sterile scarifier. 2 thick drops are placed on one glass, and a thin smear is placed on the other (as an exception, a thick drop and a thin smear can be prepared on one glass). After drying with a simple pencil put an index on the edge of the stroke medical institution(the index of the medical institution is assigned by the Reference laboratory) who took the blood and the serial number of the drug corresponding to its serial number in the blood collection log. For blood products, referrals to the laboratory are filled out. Blood samples taken from patients with fever are immediately sent to the laboratory with a note "urgent" on the referral. If a resident suspected of having malaria during the malaria transmission season received single dose chloroquine as a pre-treatment pending a response from the laboratory, this is noted in the referral to the hospital.

1.3. Quality assurance laboratory diagnostics malaria -

carry out control over the completeness and timely laboratory examination for malaria of patients at all stages of medical care in health facilities, over timely research and reporting of results. Delaying the study period is unacceptable.

The scanned blood products are stored in primary laboratories for 3 months in a special box or in a box. Positive drugs(with malaria pathogens) Health facilities are sent to etrap, velayat SES laboratories for confirmation, then to the OPC. External quality control of laboratory diagnostics.

Components of external control:

confirmation of all positive drugs;
control of at least 10% of negative preparations once a month during the transmission season, and outside the season once every 3 months (the timing of the direction and number of the drug for verification is reported by the control laboratory).

1.5. Registration, notification, accounting and reporting on malaria, information flow.

1.5.1. Registration Cases of malaria

As a result of the epidemiological survey, it is determined epidemiological category case:

grafting- the case when the infection is carried out by blood; the remaining four categories are cases of infection through a mosquito:
imported- a case of infection outside the given territory (country);

recurrent - a case of local infection that occurred long ago, before the interruption of transmission in the outbreak; in the case of three-day malaria, it is usually assumed that the infection occurred earlier than in the previous epidemiological season; the other two categories are cases of recent infection:
secondary from imported- a case originating from an imported case;
local- a case that originates from any other case and is the result of local transmission.

1.5.2. Alert

1.1.5.3. Accounting

Accounting for the incidence of malaria at the level of the etrap (city) SES is carried out on the basis of emergency notices (f.058 / y) received from medical institutions. Accounting forms - a journal of infectious patients, a map of the epidemiological examination of the patient and the outbreak, a journal for house-to-house rounds, a journal for registering fever patients, a journal for taking and examining samples in the laboratory.

2.1.5.4. Report

Reporting forms on the incidence of malaria, a report on the conduct of mass chemoprophylaxis and others are provided from the etrap (city) level to the velayat, then to the OPTs and SSES, according to the accounting and reporting forms.

1.5.5. Feedback

An information flow diagram for malaria is attached.

1.6. Surveillance and monitoring of malaria outbreaks

primary link

The following types of malaria foci exist:

Pseudofoci-settlements where transmission is not possible due to lack of heat or due to the absence of a carrier. The remaining six categories (2-7) are foci:
Rehabilitated Hearth- a locality where transmission is possible but absent for at least two epidemiological seasons, not counting the current one (longer periods may be accepted). There are no cases. The remaining five categories (3-7) are localities where there are cases. Of these, new foci (3 and 4) arise from the healed ones:
New potential focus- a locality where imported or grafted cases appear during the season of effective mosquito infestation, but there is no evidence that transmission occurs.
New active focus- focus where transmission occurs after a long break, as evidenced by the presence of secondary cases from imported cases, as well as local ones. In contrast to new foci, residual(5 and 6) arose earlier than during the present epidemiological season.
Residual active focus- the focus where transmission occurs or occurred in the past epidemiological season.
Residual inactive focus- the focus where the transmission has stopped, there are only recurrent cases. If the measures are insufficient, then the focus may go into a state more or less close to what took place before the start of the measures. SES conducts constant monitoring of outbreaks, maintains a database of outbreaks - a card file of outbreaks, which reflects their dynamics, and periodically prepares reports on their status.

The source transitions from one state to another are shown in the figure.

1.7. Analysis of malaria incidence and situation.

The indicators of the work of medical institutions are the time from the onset of the disease to the patient seeking medical help, the time from the appeal to the diagnosis, to the taking of blood products, to the referral for research, to the examination of the drug in the laboratory, to the sending of an emergency message and to the hospitalization of the patient.

The date of onset of the disease makes it possible to calculate the approximate date of infection. To do this, the possible duration is subtracted from the date of onset of the disease. incubation period: 7 days for tropical, 10 days for 3 days, 14 days for oval malaria and 25 days for 4 days malaria. Taking into account the amount of heat for the time preceding the possible date of infection, it is possible to calculate how long it took for the development of pathogens in the body of the mosquito and get the latest possible date of infection of the mosquito that bit the patient. Knowing the date, it is possible to determine whether this bite incident caused the infection of this patient.

To assess the degree of rooting of three-day malaria and determine the scope of antimalarial measures in the service area, a differentiated account of local and secondary from imported cases of diseases is necessary. To assess the possible role of the patient as a source of new cases of malaria, the time required for the completion of sporogony in the mosquito and the minimum incubation time in humans for this type of pathogen are added to the date of onset of the disease.

When analyzing maps of the epidemiological examination of patients with tropical malaria, attention should be paid to the previous intake of drugs for chemoprophylaxis, adherence to their dosages and regimen of use.

The incidence of malaria (the ratio of the number of cases detected over a period of time to the number of a given population) of adults is calculated per 100 thousand of the population, and children per 1000. The incidence is analyzed by calendar years, but for three-day malaria it is more convenient to use the "epidemiological" year - the period from the beginning manifestations of infection in a given season until the onset of primary manifestations of infections in the next season of transmission. At the same time, the period of the malaria season (months with the largest number of diseases) and the off-season period (the remaining months) are distinguished. The initial manifestation in the summer of a given year and a recurrence in the spring (without treatment with primaquine) of the following year in one patient are counted as 1 case.

2. Ecological and epidemiological analysis of the conditions affecting the spread of malaria.

For effective planning and rational implementation of antimalarial measures, it is necessary to monitor the situation: epidemiological, entomological, environmental, socio-demographic.

2.1. Entomological supervision.

Entomological examinations are carried out in malaria foci (in residential and utility premises), as well as in all anophelogne reservoirs. The data are entered into the map of the epidemiological survey of the outbreak and into the passports of reservoirs.

Collections of preimaginal phases of mosquito development are necessary to establish breeding sites and seasonal changes in their area, the seasonal course of the number of larvae, and to assess the effectiveness of mosquito extermination measures.

There should be several control reservoirs, taking into account their probable settlement. different types anopheles. Control water bodies should not be inhabited by larval fish and should not be treated with larvicidal preparations - this is necessary to register the seasonal variation in the number of vectors undisturbed by human impacts and to adequately assess the effectiveness of anti-larval measures in water bodies of similar types.

In parallel with the identification of vector larvae, the entomologist must monitor the temperature regime of different types of control reservoirs. Observations are carried out once a decade during the entire period of vector activity. The results are entered in the passport of the reservoir.

Observations of the course of the number of adult mosquitoes are composed of two components: accounting for the number of adults of mosquitoes on the day and accounting for the number of adults attacking the host.

One of the main indicators for assessing the seasonal course of the number of endophilic malaria vectors is the regular registration of winged mosquitoes in control rooms - day rooms. Monitoring the seasonal course of the number of mosquitoes should be carried out by counting them in barns and living quarters at least once a decade. To select control days, the premises in the estate (sheds, cellars, living rooms, etc.) are preliminarily examined for the presence of mosquitoes in them and the most favorable ones for examination are selected. In each village, at least 10 control estates should be selected.

Collection of mosquitoes is carried out with an exhauster necessarily using an electric flashlight. The most accurate method is the complete catch of all mosquitoes in the room, which is acceptable only with a low number of mosquitoes, and with a high number, it is necessary to treat the room with a 0.2-0.3% solution of pyrethrin in kerosene using a manual sprayer, after covering the floor with a white cloth, with to make it easier to count the number of mosquitoes that have fallen. In the absence of an exhauster, mosquito trapping can be carried out with a regular test tube. It is most convenient to place the caught mosquitoes in a cage, where they put a label indicating the number of the control day, its type, date, time of registration and the name of the collector. The number of mosquitoes is represented by the average number per 1 m2, or per room.

Exophilic mosquitoes choose vegetation, hollows of trees, ditches, pits, caves and other suitable shelters as daytime. Depending on the weather or changing local conditions, mosquitoes can change days. Therefore, when counting the number, one should choose a site that includes all possible types of daylight hours. After the establishment of days for each population count, it is necessary to examine the same area at least once every 7-10 days. The main condition for the reliability of the results obtained are regular captures in the same areas, by the same collectors. The time of examination - in the morning and the first half of the day - must be precisely fixed, during the examination all Anopheles mosquitoes should be caught with an exhauster and placed in a cage. At the end of trapping, the number of mosquitoes caught per 1 person/hour of trapping is recalculated.

In addition, when collecting exophilic mosquitoes, you can use a "macro-seed" (a grid of the mill gas type, mounted on a frame in the shape of a parallelepiped). With this “macro-seed”, the assistants cover the counter, who collects all the mosquitoes that have flown out of the grass and, simultaneously with the collection, scares them out of the vegetation and gets the rest. Since the base area of the "macroseed" is known or can be determined, the number of mosquitoes caught can be expressed as the number of specimens per 1 m2. If during a decade in the village 2 or more catches were carried out, then the average number per decade is derived from them. In the process of observations, it is necessary to keep graphs of the seasonal course of the number of mosquitoes for each species.

To collect mosquitoes that attack a person, you need an exhauster, an electric torch and a container for caught mosquitoes. The collector in a sitting position exposes the shins of the legs and, periodically illuminating them with a flashlight, collects attacking mosquitoes (i.e. trapping on himself). Be sure to ensure that during fishing there are no strangers or animals nearby that distract mosquitoes.

The abundance indicator is the number of mosquitoes collected by one collector in 1 hour during the daily peak of the attack. attractiveness different people for mosquitoes is not the same, so it is better to use a group of collectors. Accounts cannot be taken during strong wind or rain - this will distort the results of the study. Animals (cow) can be used as bait, usually attracting more mosquitoes, but in this case it is difficult to assess the danger of the vector to humans.

2.2. Zoning (stratification) of the territory depending on the malariogenic potential.

The main task of zoning during the period of malaria elimination is a comprehensive assessment of the malariogenic potential of the territory and its “vulnerability” and “susceptibility”, mapping the results, assessing the situation, forecasting and rational planning preventive measures.

The zoning process includes:

analysis of data from meteorological stations (average daily temperatures and humidity);
study of the ranges of malaria vectors;
analysis of species abundance based on long-term data; - determination of the period of effective infectivity of malarial mosquitoes;
assessment of the structure of the transmission season;
determination of the malariogenic potential of the territory.

The main preventive measures are: reducing breeding sites and reducing the number of carriers, protecting the population from insect bites.

3. Organization, planning and implementation of antimalarial activities.

The annual plan should contain 4 main sections: -organizational and methodological measures; -preventive actions; - improvement of knowledge and training of medical personnel; - health education of the population.

For each activity, deadlines, performers (responsible persons) must be clearly established. The last vertical column contains a mark on the completion of this activity. The scope of activities should be expanded during the epidemic season with an influx of people for construction or agricultural work, as well as in settlements with common places mosquito breeding. The duration of the incubation period of three-day malaria requires planning antimalarial activities in the focus for the next 2 years after the registration of the last patient with malaria. A.

Preventive actions.

1) Hydraulic measures aimed at preventing, reducing or eliminating breeding sites for malarial mosquitoes and reducing malariogenic potential. Preventive sanitary supervision is carried out by specialists of the Sanitary and Epidemiological Service during the design and construction of hydraulic structures and the operation of potentially dangerous anophegenic reservoirs.

One of the prerequisites for the construction of reservoirs is a detailed and timely development of a forecast for changes in the malariogenic situation in the zone of their influence. Within the reservoirs, the main danger as a breeding ground for mosquitoes is represented by shallow waters overgrown with aquatic vegetation. Reducing the area of shallow waters is achieved by choosing the marks of the retaining horizon, as well as by deepening, backfilling, embanking, etc. Thorough cleaning of the bed of reservoirs from shrubs and forests reduces the possibility of overgrowing it with vegetation and reduces the breeding of mosquitoes.

During the construction and operation of irrigation systems, it is necessary to comply with sanitary requirements, which include repairing the walls of canals or ridges, regular cleaning of canals, timely discharge of excess water into water inlets, elimination of temporary or permanent swamps that occur along canals, construction of special locks that contribute to the correct distribution of water. Small hydrotechnical measures are carried out by economic organizations on the basis of a comprehensive plan and according to the instructions of the sanitary and epidemiological service in the order of current sanitary supervision, as well as residents of outbreaks in household plots.

The public, religious and public organizations, and nature protection institutions should be involved in monitoring the implementation of preventive measures. It is necessary to carry out hygiene education of the population to protect against insect bites.

2) biological methods are based on the use of agents of biological origin (biological insecticides based on entomopathogenic bacteria) and predators (primarily larviphage fish, for example, gambusia) in the fight against the preimaginal stages of development of malarial mosquitoes.

Most of the biological insecticides (bactoculicide, larviol, bacticide) used in the fight against Anopheles mosquito larvae are produced on the basis of the bacterium Bacillus thuringiensis israelensis (Bti), the death of the larvae occurs after the absorption of particles of the drug containing toxins.

The positive properties of bacterial insecticides include their selective effect on mosquito larvae and safety for non-target fauna of water bodies. The disadvantage is a short residual effect, as a result of which the frequency of treatments of reservoirs is 1 time in 10-15 days. The consumption rates of preparations depend on the concentration of the active substance (bacterial toxin) in them and the preparative form.

The use of larviphage fish (i.e., fish that eat mosquito larvae) is quite effective and relatively inexpensive method regulation of the number of Anopheles. The most widely used larvifago is Gambusia affinis. The settlement of permanent reservoirs with mosquito fish is carried out, as a rule, only once, then the fish reproduce themselves and to increase their efficiency, it is only necessary to clean the reservoirs from excessive overgrowth of vegetation, primarily filamentous algae.

3) Providing the population with means of protection against insect bites.

Repellent preparations are applied to the skin, they process clothes, curtains, mosquito nets, curtains. As active substances in repellent preparations, diethyltoluamide (DETA), drug 3535 (ethyl-3N-butylacetamidopropionate), oxamate, acrepe, essential oils (lavender, geranium, clove, etc.) are used.

For application to the skin, repellents are used in the form of creams, gels, emulsions, aerosols. The duration of the protective effect of repellents applied to the skin is several hours (1-5), depending on the nature of the activity, because. the drug is then washed off, washed off, partially absorbed through the skin. To treat the skin of the face, the repellent is applied to the palm, which is then lightly smeared on the face, avoiding the drug getting into the eyes and mucous membranes of the nose and mouth. The period of protective action of repellents applied from aerosol cans to the skin is 2-4 hours. For the treatment of clothing, nets, curtains, individual sections of tents, etc., 30% aqueous emulsions of repellents are used.

To protect sleeping people, curtains made of fabric, gauze are used. Currently, long-acting curtains impregnated with synthetic pyrethroids are being produced. The edge of the canopy should be wrapped under the mattress. To prevent mosquitoes from flying into tourist tents, it is advisable to selectively treat individual sections of the tent (near the entrance, windows) with repellents.

You can protect the room from mosquitoes by screening windows, ventilation openings, vestibules, doors. To do this, use a grid with a mesh size of 0.8 mm, its edges are fixed with slats. It is possible to use mesh, tulle curtains impregnated with repellents.

For the destruction of mosquitoes in the premises, residents can use insecticidal-repellent cords, spirals containing allethrin. The death of insects in the premises after the start of smoldering of the spiral begins in 20-30 minutes. Cords and spirals are recommended for use in well-ventilated areas or outdoors (canopies, verandas, etc.).

When using electrofumigators (plates or liquid), evaporation is designed for 6-8 hours of their operation, a set of liquid in electrofumigators lasts for 40 days with daily use from 1 to 6 hours.

4) Prevention of vaccinated malaria. Basic requirements: - residents of active centers cannot be donors; - territorial SES submit lists of active malaria foci once a year to blood transfusion points; - according to vital indications, blood transfusion and organ transplantation are carried out from donors of the inhabitants of the foci with the appointment of chloroquine to the recipient (course dose of 25 mg/kg of body weight).

5) Chemoprophylaxis of malaria

Individual chemoprophylaxis

Individual chemoprophylaxis serves for personal protection of persons traveling to malaria endemic countries (workers, students, tourists, businessmen, diplomatic delegations, transport workers, etc.)

Organizations that send employees to countries in the tropics, or travel agencies that organize trips to these countries, are required to inform travelers about the need to comply with measures to prevent tropical diseases, including malaria. Before traveling, travelers should consult with a doctor in the office for combating tropical diseases at the OPC and purchase an antimalarial drug recommended for individual chemoprophylaxis in this area (Table No. 2).,

Organization and implementation of seasonal chemoprophylaxis and off-season preventive treatment population. Mass seasonal chemoprophylaxis with chloroquine is carried out in an active focus in the season of malaria transmission according to epidemic indications (Table No. 2). Interseasonal prophylactic treatment of the population with primaquine is carried out after the end of the transmission season or before the start of the next epidemiological season to prevent late manifestations of 3-day malaria. The form for analyzing the implementation of inter-seasonal preventive treatment of the population is indicated in table No. 3, which is filled in by specialists of the medical institution and transferred to the OPC, the logbook of the conduct - in table No. 4.

In the map of the epidemiological survey of the focus of malaria, the type of focus should be indicated and the case of malaria should be classified.

Activities carried out in the centers of different categories:

c) residual active focus- carry out a complex of antimalarial measures indicated in paragraph b), plus seasonal chemoprophylaxis of the population and in the spring of the next year - preventive treatment with primaquine of the same inhabitants of the focus.

d) inactive focus- remains under observation, preventive measures are being taken.

e) a healthy hearth- continue to carry out sanitary and educational work among the population and entomological monitoring of the vector. In the event of an outbreak, take from the emergency plan (Headquarters, daily collection of information, analysis and development of emergency measures to prevent further spread of infection).

B. Health education of the population.

Its tasks include:

The acquisition by the population of an idea of the initial, earliest and characteristics disease, the need for immediate medical attention.
Establishing certain skills among the population that contribute to the prevention of the occurrence of cases of the disease. The public should contribute to the implementation of measures in the event of the emergence and spread of malaria.

During the implementation of antimalarial activities in endemic areas, weekly workshops, monthly conferences, and annual seminars are mandatory, since the exchange of experience, information, and improvement of staff knowledge are important.

4. Training of national personnel.

Personnel training on the issues of malaria control and prevention is carried out according to plan in institutions of medical pre- and post-graduate education. Forms of training may include long (1-2 months) courses and cycles of specialization and improvement, thematic seminars (1-5 days), scientific and practical conferences.

5. Evaluation of the effectiveness of antimalarial measures taken.

Evaluation of the effectiveness of identifying patients with malaria.

The blood test index is one of the main indicators characterizing the work to identify patients. This indicator is calculated by dividing the number of examined persons for a certain period by the population and expressed as a percentage. The coverage of the population with a survey should correspond to the capabilities of the laboratory service, since the quality of research is reduced when laboratories are overloaded. In malarious areas, it is sufficient to survey 3% of the population per month during the malarial season.

To assess the work of health facilities to identify sources of infection, it is necessary to determine the coverage of the population in time and space (by months and settlements), the multiplicity by age (0-11 months, 1-4 years, 5-9 years, 10-14 years, 15- 19 years old, 20-59 years old, 60 and older). The optimal period from the disease to treatment is 1 week, from treatment to diagnosis is 1-3 days.

Assessment of clinical and laboratory diagnosis of malaria.

Evaluation of the effectiveness of chemoprevention of the population.

In active malaria foci, the effectiveness of seasonal and interseasonal chemoprophylaxis is assessed by analyzing the reporting forms filled out by doctors. The assessment takes into account the completeness of coverage of the population, compliance with the terms of administration and age dosages of drugs. Usually, the high efficiency of seasonal and interseasonal chemoprophylaxis is evidenced by the rapid rate of decline in the incidence and improvement of the focus for 2 epidemic years.

Assessing the effectiveness of malaria vector control measures.

The effectiveness of these measures is estimated by the number of mosquitoes. For this, the number of mosquitoes in the treated settlement is compared with the number in the previous year. If the treatment is carried out with persistent insecticides, then the effect of the treatment is immediately noticeable and depends on the coverage of the premises with treatments. With 80-100% coverage and an effective insecticide, mosquitoes disappear in a day. Single individuals flying from water bodies can still be caught within 2 weeks (larval hatching). In the future, mosquitoes will be absent until the end of the insecticide. When the treatments cover 50-60% of the premises, mosquitoes disappear gradually and complete disappearance can be expected only after 20-30 days. With a coverage of 30-40%, mosquitoes disappear only by the end of the second month.

6. Interdepartmental and intersectoral coordination of antimalarial activities.

The problem of combating malaria is multi-sectoral and requires coordination of the Ministry of Health with the ministries of other departments: agriculture, water management, internal affairs, economics and development, finance, as well as local government and public organizations. Integration is achieved both through direct contacts of key stakeholders from different departments, and decisions of boards, ICC, state administrations, or joint decisions of different departments.

Table No. 1 Scheme of personal chemoprophylaxis for those traveling to tropical malaria endemic countries

Territories	A drug	Dosage	Reception schedule for adults
with the presence
or
absence
resistant
sti to p / m
drugs
Without	Chloroquine	5 mg	Until departure	During	After
sustainability	tab. 0.250	base/kg		stay	return
and to	(150 mg	body weight		in the country	nia
chloroquine	base)	1 time per week
		or	1 week before departure	300 mg base	once
		10 mg base/kg body weight, 6	1 day before	once a week	but per week, 4 weeks
		days in a week (Sunday break)	departure	100 mg base per day - 6	after returning
				days in
				week
Without stability	Proguanil 0.200+	200 mg daily +			4 weeks
and to chloroquine	Chloroquine 0.100	100 mg per day	1 day before departure	1 tab. in a day	after return
	(or combined	1 tab. in a day	1 tab.		niya 1 tab. V
	en)				day

	Mefloquine*				4 weeks
sustainability	(Lariam)	5 mg/kg b.w. 1 time	1-3 days before	1 tab. V	after
ew	tab. 0.250	in Week	departure	week	return
To chloroquine			1 tab. V		nia
and fansidar			day		1 tab. V
					week
	Doxycycline	1.5 mg/kg.m. t. in	1 day before	1 tab. V	4 weeks
polyresist	**	day	departure	day	after
ntnost	(Vibramycin	1 tab. 100 mg per	1 tab.		return
	)	day			nia
mefloquine,	tab. 0.100				1 tab. V
fansidaru,					day
quinine)
With polyresistance (to mefloquine, fansidar, quinine)	Atovaquone * 250 mg -Proguanil 100 mg Combination tablets (Malarone)**	11-20 kg -Atovaquone -62.5 mg Proguanil - 25 mg (1 Children's Tablet) 21-30 kg- (2 children's tab.) 31-40 kg- (3 children's tab.) over 40 kg- 1	1 day before departure 1 tab.	1 tab. per day Duration: up to 3 months	7 days after return 1 tab. in a day
		adult tab.

Note * - do not prescribe to pregnant women in the 1st trimester, children less than 5 kg of weight, persons taking ß-blockers. Causes incoordination. **- do not prescribe to children under 8 years of age, pregnant women, women during lactation. Causes photosensitivity. *** - do not prescribe to pregnant women, children less than 11 kg of weight.

Table number 2

Event Type	Drugs and regimens	Indications
Mass (seasonal) chemoprophylaxis	Chloroquine 300mg once a week	In foci of three-day malaria during the season of human transmission
		Residual population
Mass	Primaquine 15 mg	or new active lesions
preventive	grounds in	three day malaria
population treatment	day	relapse prevention
(off-season)	14 days (adult)	and primary manifestations after prolonged incubation.

Table number 3

Analysis of the implementation of interseasonal preventive treatment of the population with Primakhin.

days			Not subject to prophylactic treatment
days				including
distribution	Yes	Number		Children	pregnant	Feeding	Other
preparation	You	population	Total	before	first	ing	anti-
rata		eniya			and last	mothers	testimony
				of the year	3 months

Table continuation

Subject to prophylactic treatment Total 9 10 Not covered Including Temporarily absent -cheno % of coverage to the total population % of coverage to the number of people subject to preventive treatment 11 12 13 14 15 16

Table No. 4

Journal of accounting for chemoprophylaxis with primaquine.

Full name

age

address

Primaquine days

Total days of taking the drug

Marks of a violation of the regimen of taking the drug

Failures

absence

notes

Note:

“Clinical protocol for the treatment of malaria” and “Protocol for the epidemiological surveillance of malaria” were approved by the Educational and Methodological Council of the National Institute of Health of the Ministry of Health of the Republic of Armenia on December 11, 2009.

The causative agents of human malaria

Table 1 Treatment of uncomplicated malaria

FEATURES OF TREATMENT OF MALARIA IN PREGNANCY

CHEMIOPROPHYLAXIS OF MALARIA

Table 2. Personal chemoprophylaxis for malaria

AMEBIASIS

Choice of antimicrobials

Table 3. Treatment of amoebiasis

Giardiasis

Choice of antimicrobials

CRYPTOSPORIDIOSIS

Choice of antimicrobials

TOXOPLASMOSIS

Choice of antimicrobials

leishmaniasis

Main pathogens

Choice of antimicrobials

Features of action and classification of antimalarial drugs

Goals of chemoprophylaxis

Types of chemoprophylaxis

Personal

Bulk

What drugs are used

Chloroquine

Hydroxychloroquine

Pyrimethamine + Sulfadoxine

Atovaquon-proguanil

Primaquine diphosphate

Doxycycline

Memo on the prevention of malaria in people traveling to dangerous regions

Who should be tested for malaria

Timely detection of patients and rational treatment

Chemoprophylaxis of malaria

Public Prevention of Malaria

Mosquito extermination

Destruction of mosquitoes using insecticides

Mosquito larvae and pupae control

Mechanical protection against mosquitoes

Report a typo

Text to be sent to our editors:

Your comment (optional):