High numbers of malaria cases are being reported in the malaria transmission areas in Limpopo (including some cases in farms along the Lephalala River, Waterberg) and Mpumalanga provinces, South Africa. A modest increase in cases in the Kruger National Park and private reserves in the area has been confirmed. This follows a very busy 2017 malaria season, which peaked in April and May and extended into June. High rainfall, humidity and ambient temperatures provided ideal conditions for malaria mosquito breeding and contributed to an increase in malaria cases in the southern African region. Unusually mild winter temperatures in malaria areas have allowed for ongoing mosquito and parasite development and led to an early and busy malaria season, which started already in August 2017.
The key prevention strategy of the malaria control programmes in endemic areas is spraying of households with long-acting residual insecticides (IRS), which target indoor-feeding mosquitoes. This IRS programme is in progress in malaria transmission areas in Limpopo, Mpumalanga and Kwazulu-Natal provinces. The 2017 programme will target a larger area than in 2016. Malaria in KZN is limited to a small area in the far north of the province and control efforts have been successful.
Early treatment of malaria cases is a key strategy and this season there are adequate supplies of drugs and rapid malaria tests in health facilities in the affected provinces to manage the increase in malaria cases. Coartem (artemether-lumefrantine) remains highly effective in the treatment of uncomplicated malaria, provided there is early diagnosis and urgent commencement of treatment. Intravenous artesunate has replaced quinine for the treatment of severe malaria due to a more favourable safety profile, ease of administration and rapidity of action. In October the newly-registered intravenous artesunate product became available in South Africa, which will allow for increased access to this potentially life-saving drug.
Travellers from, or residents of, malaria transmission areas in Limpopo, Mpumalanga, far northern KwaZulu-Natal provinces, and neighbouring countries such as Mozambique, Botswana, Zimbabwe and Namibia, who present with fever and ‘flu-like’ illness must have an urgent blood test, and have any malaria diagnosis should be treated as a medical emergency. Misdiagnosis of malaria as influenza is not uncommon, with disastrous consequences in a number of persons.
All travellers to malaria risk areas must take precautions to prevent mosquito bites, and medication to prevent malaria should be seriously considered.