Download Appendix A: Disease-Specific Chapters

Ministry of Health and Long-Term Care
Infectious Diseases Protocol
Appendix A:
Disease-Specific
Chapters
Chapter: Malaria
Revised March 2017
Health and Long-Term Care
Malaria
Communicable
Virulent
Health Protection and Promotion Act:
Ontario Regulation 558/91 – Specification of Communicable Diseases
Health Protection and Promotion Act:
Ontario Regulation 559/91 – Specification of Reportable Diseases
1.0 Aetiologic Agent
Malaria is caused by protozoan parasites of the genus Plasmodium (P). Four species of
Plasmodium routinely infect humans: P. vivax, P. ovale, P. malariae, and P. falciparum.
Humans also occasionally become infected with Plasmodium species that normally
infect animals, such as P. knowlesi.1, 2
2.0 Case Definition
2.1 Surveillance Case Definition
See Appendix B
2.2 Outbreak Case Definition
Not applicable
3.0 Identification
3.1 Clinical Presentation
The classic symptoms of malaria are high fever with chills, rigor, sweats and headache,
which may be paroxysmal.2 Symptoms can occur in cycles of 48-72 hours if not treated,
though cyclical symptoms are uncommon. Symptoms may also include cough, diarrhea,
respiratory distress, vomiting and muscle pain. Complications may include coma, renal
failure, liver failure, and other system failure resulting in death.1, 2
The most serious malarial infection, falciparum malaria, usually presents a highly
variable clinical picture including one or more of the following: fever, chills, sweats,
anorexia, nausea, lassitude, headache, muscle and joint pain, cough and diarrhea.
Anemia, thrombocytopenia and/or splenomegaly often develop after some days.1
The primary attack can last for weeks or months; relapses may also occur with P. vivax
or P. ovale infection. Infection may remain for years or lifelong without any recurrence of
febrile episodes.1
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Health and Long-Term Care
3.2 Diagnosis
Note: Malaria can be diagnosed by the demonstration of malaria parasites in blood
samples usually through microscopy.1
Diagnosis is made by positive results for Plasmodium sp. in blood smears or positive
results for Plasmodium sp. antigen (presumptive) or positive results for Plasmodium sp.
DNA by nucleic acid amplification (NAAT).
For further information about human diagnostic testing, contact the Public Health
Ontario Laboratories or refer to the Public Health Ontario Laboratory Services webpage:
http://www.publichealthontario.ca/en/ServicesAndTools/LaboratoryServices/Pages/defa
ult.aspx
See Appendix B for diagnostic criteria relevant to Case Definitions.
4.0 Epidemiology
4.1 Occurrence
The global burden of malaria is estimated to have declined or be lower than previously
thought.3 It is endemic in areas of Asia, Africa, Central and South America, and is the
major cause of illness in many tropical and subtropical areas.1, 2
Between 2007 and 2011, an average of 205 cases of malaria were diagnosed per year
in Ontario. Malaria is not endemic to Ontario and reported cases in Ontario are
attributed to recent immigration or travel to malaria endemic countries.
Please refer to the Public Health Ontario Monthly Infectious Diseases Surveillance
Reports and other infectious diseases reports for more information on disease trends in
Ontario.4, 5
http://www.publichealthontario.ca/en/DataAndAnalytics/Pages/DataReports.aspx
4.2 Reservoir
Humans, Simians.1
4.3 Modes of Transmission
The disease is transmitted to humans through the bite of an infected female Anopheles
mosquito.1
The disease may also be transmitted through injection or transfusion of infected blood;
congenital transmission rarely occurs.1
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Health and Long-Term Care
4.4 Incubation Period
The median time between an infective bite and the appearance of clinical symptoms for
P. falciparum is 9 - 14 days; 12 - 18 days for P. vivax and P. ovale and 18 - 40 days for
P. malariae.1
Delayed primary attacks by P. vivax or P. ovale may occur 6 - 12 months after
exposure.1
4.5 Period of Communicability
Mosquitoes may acquire the parasites from infected humans as long as the
gametocytes are present in the blood; this varies with parasite species and with
response to therapy. Untreated or insufficiently treated patients may be a source of
mosquito infection for several years in P. malariae, up to 5 years in P. vivax, and
generally not more than 1 year in P. falciparum malaria.1
Transfusion transmission may occur as long as asexual forms remain in the circulating
blood (with P. malariae up to 40 years or longer).1
Stored blood can remain infective for at least one month.1
4.6 Host Susceptibility and Resistance
Susceptibility is universal.1 Those most at risk are persons travelling to malaria-endemic
areas who are not protected by chemoprophylaxis.
5.0 Reporting Requirements
5.1 To local Board of Health
Individuals who have or may have malaria shall be reported as soon as possible to the
medical officer of health by persons required to do so under the Health Protection and
Promotion Act, R.S.O. 1990 (HPPA).6
5.2 To the Ministry of Health and Long-Term Care (the ministry)
or Public Health Ontario (PHO), as specified by the ministry
Report only case classifications specified in the case definition.
Cases shall be reported using the integrated Public Health Information System (iPHIS),
or any other method specified by the ministry within five (5) business days of receipt
of initial notification as per iPHIS Bulletin Number 17: Timely Entry of Cases.7
The minimum data elements to be reported for each case is specified in the following:
•
Ontario Regulation 569 (Reports) under the Health Protection and Promotion Act
(HPPA);8, 6
•
The iPHIS User Guides published by PHO; and
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Health and Long-Term Care
•
Bulletins and directives issued by PHO.
6.0 Prevention and Control Measures
6.1 Personal Prevention Measures
Preventive measures:2
•
Refer travellers to a travel clinic or tropical medicine clinic for up to date
information about malaria endemic areas and malaria prophylaxis;
•
Use protective clothing, bed nets and repellents with DEET in high risk areas;
•
Advise about seeking early diagnosis and treatment for a febrile illness during or
following travel to endemic areas.
6.2 Infection Prevention and Control Strategies
Prospective blood donors should be asked about a history of malaria or recent
immigration from or travel to a malaria-endemic country. Donations from individuals
responding in the affirmative should be deferred, as per Canadian Blood Services policy
available at www.bloodservices.ca.
For healthcare settings, routine practices are sufficient for infection prevention and
control purposes.
Refer to Public Health Ontario’s website at www.publichealthontario.ca to search for the
most up-to-date Provincial Infectious Diseases Advisory Committee (PIDAC) best
practices on Infection Prevention and Control (IPAC). PIDAC best practice documents
can be found at:
http://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/PIDAC/Pages/
PIDAC_Documents.aspx.
6.3 Management of Cases
Information required to be reported to the medical officer of health is specified in Ontario
Regulation 569 under the HPPA.8, 6 Investigate the case to determine source of
infection and inquire about the following:
•
Symptoms and date of symptom onset
•
Travel history within last 12 months
•
History of recent blood transfusion within previous 60 days
•
History of needle sharing
•
History of recent immigration from endemic area and
•
History of previous malarial illness
Treatment is under the direction of the attending health care provider.
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Health and Long-Term Care
Provide education about the illness and how to prevent the spread.
6.4 Management of Contacts
Not applicable
6.5 Management of Outbreaks
Not applicable
7.0 References
1. Heymann DL, editor. Control of communicable diseases manual. 19th ed.
Washington, DC: American Public Health Association; 2008.
2. American Academy of Pediatrics. Section 3: summaries of infectious diseases.
In: Pickering LK, Baker CJ, Long SS, McMillan JA, editors. Red book: 2012
report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL:
American Academy of Pediatrics; 2012.
3. Cibulskis RE, Aregawi M, Williams R, Otten M, Dye C. Worldwide incidence of
malaria in 2009: estimates, time trends, and a critique of methods. PLoS Med.
2011;8(12):e1001142. Available from:
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001142
4. Ontario Agency for Health Protection and Promotion (Public Health Ontario).
Monthly infectious diseases surveillance report. Toronto, ON: Queen’s Printer for
Ontario; 2014. Available from:
http://www.publichealthontario.ca/en/ServicesAndTools/SurveillanceServices/Pa
ges/Monthly-Infectious-Diseases-Surveillance-Report.aspx
5. Ontario Agency for Health Protection and Promotion (Public Health Ontario).
Reportable disease trends in Ontario, 2011. Toronto, ON: Queen’s Printer for
Ontario; 2014. Available from:
https://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/Pages/
Reportable-Disease-Trends.aspx
6. Health Protection and Promotion Act, R.S.O. 1990, c. H.7. Available from:
http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90h07_e.htm
7. Ontario. Ministry of Health and Long-Term Care. Timely entry of cases. iPHIS
Bulletin. Toronto, ON: Queen’s Printer for Ontario; 2014:17.
8. Reports, R.R.O. 1990, Reg. 569. Available from:
http://www.e-laws.gov.on.ca/html/regs/english/elaws_regs_900569_e.htm
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Health and Long-Term Care
8.0 Additional Resources
National Advisory Committee on Immunization; Public Health Agency of Canada.
Canadian immunization guide. Evergreen ed. Ottawa, ON: Her Majesty the Queen in
Right of Canada; 2013. Available from:
http://www.phac-aspc.gc.ca/publicat/cig-gci/index-eng.php
Public Health Agency of Canada. Canadian recommendations for the prevention and
treatment of malaria among international travellers. Can Commun Dis Rep. 2009;35
Suppl 1:1-62. Available from:
http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/09vol35/35s1/index-eng.php
World Health Organization [Internet]. Geneva: WHO; c2014. International travel and
health disease information: malaria; 2014 [cited 2014 Jun 26]. Available from:
http://www.who.int/ith/diseases/malaria/en/
9.0 Document History
Table 1: History of Revisions
Revision Date
Description of Revisions
Document Section
March 2017
General
New Template
March 2017
6.3 Management of
Cases
Removal of “As per this Disease-Specific
Chapter, notify the Canadian Blood
Services (CBS) and Trillium Gift-of-Life of
any positive human malaria disease results
with blood/organ donation histories.”
March 2017
9.0 Document
History
Updated
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