Tuesday, June 9, 2009

Malaria: BOG vs. CDC

So, my internship is developing nicely. The Bureau voor Openbare Gezondheids Zorg(BOG) is the Bureau of Public Health here in Suriname. They have just received a lot of funding to combat malaria in the final hold-outs of the disease: the gold mines of the interior. Since I've been here I've learned a lot about malaria and something I hear almost everyday is how in the last 5 years Suriname has experienced a 90% reduction in malaria cases. BOG has campaigned agressively against the disease; Active Case Detection means teams were sent into malaria-endemic areas and tested EVERYONE and treated all who tested positive. Bednets were distributed for free and villages received education about prevention and treating their nets with insecticide. Essentially, malaria has been eradicated in most of the country (especially here in the capital). I will later include a BOG map of Suriname in green and about 20 red dots showing where malaria still persists.**

In this map, the red dots represent areas where there is a risk of malaria. As you can see, malaria is in very specific areas of the country- gold mines in the interior. Most tourists/travelers will never make it to one of these areas so they are not really at risk.

So, why did my school's travel clinic insist on making me buy 2 months worth of Malarone (one of the most expensive anti-malarials available to us)?

Because the CDC recommends it. Apparently, the malaria present here is chloroquine resistant. Which the travel clinic interpreted to mean no mefloquine for me. The CDC page actually says mefloquine is ok. Here's something I don't understand: if the malaria is resistant to chloroquine, then why does BOG recommend it for treatment of vivax (followed by primaquine)? Maybe it just can't be used for prevention but could still be used for treatment. I will find this out later*.
(* Yes, I found out later that you can't use chloroquine for prevention because the falciparum parasite is resistant, but not vivax. So it can still be used to treat the vivax parasite.)

I feel that the CDC needs to update its recommendations for travel to Suriname. The BOG has made great gains in eradication, yet the CDC keeps its page on Suriname written in such a way that travel clinics freak out when they have patients going there.

Here's the CDC's page on Suriname

(Notice they use the wrong map! The one I got scolded for using in an earlier post!)

Note: Chloroquine is NOT an effective antimalarial drug in Suriname and should not be taken to prevent malaria in this region.
Malaria risk area in Suriname: Risk in all areas, except no risk in Paramaribo and coastal districts of Nickerie, Coronie, Saramacca, Wanica, Commewijne, and Marowijne north of latitude 5°N.

The way this is written, travelers would believe the whole country minus a very few places have a high risk of malaria transmission.I think they would have done better to print exactly where malaria is an issue instead of where it isn't. The regions mentioned are the most populated and most likely to be visited by foreigners. It should simply say: Risk of malaria in the interior.

What are your thoughts on this?


Anonymous said...

Thanks for the frequent posts! Let us know what you're doing specifically on the project...Love ya! Ashlee

Anonymous said...

Your mom and I enjoyed reading this very informative comment on malaria (your mom's favorite) in Surinam. I am so proud of you and the contributions you have made so far to society!! Your mom has tried to call and is having trouble-- Shannon

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