Malaria elimination trend from a hypo-endemic unstable active focus in southern Iran: predisposing climatic factors

Human malaria is the most important vector-borne infectious disease in Iran. It remains focally endemic being restricted to almost 20 counties in three oriental provinces. As a result of control measures applied since 1988, these counties appear to be on the verge of eliminating malaria. Malaria elimination strategy has thus become the new goal in Iran. Malaria due to Plasmodium vivax, whose transmission is particularly hard to interrupt, accounts for nearly 90% of the cases. This study was thus undertaken to show malaria elimination trend from a hypo-endemic unstable active focus in southern Iran and to examine the role of prevailing climatic factors. This focus is now under elimination phase (Stratum III or annual parasitic index<1/1000 person/year). All malaria-positive cases were identified with active and passive procedures from 2003 to 2011. Although all ages were infected, more than half of the patients were in the higher than 20-year age group and a clear majority (77%) of them identified in the warmer months (May-October) of the year were positive with P. vivax parasites. The rate of falciparum to mixed infections was highest (1%) in the penultimate year. Case finding was negatively related to precipitation rate both annually and over the 9-year period and positively to ambient temperature in each year. Despite progress in the scale-up of its elimination, transmission of malaria remains active. This should be tackled by proactive case detection in specific hotspots of the study focus.