WHO releases new guidance on malaria elimination (24 March 2017)

The World Health Organization (WHO) has released new guidance on malaria elimination 10 years after the launch of the first field manual for elimination in 2007.

Background information:

Malaria elimination is defined as the interruption of local transmission (i.e. reduction to zero incidence of indigenous cases) of a specified malaria parasite species in a defined geographical area.

Key Messages

New guidance was required because:

  • the malaria landscape has changed
  • several guidelines have been issued in the intervening period
  • existing guidance is not aligned with the Global Technical Strategy for Malaria 2016-2030, released in 2015.

Principles

All countries should work towards the goal of malaria elimination, regardless of their malaria burden.

Within a country, malaria transmission intensity can vary widely– high, moderate, low or very low. This information should inform appropriate interventions for an area under respective National malaria programmes.

There is no “one size fits all” strategy.

The recommended interventions for deployment are as follow:

  • Enhancing and optimizing  vector control and case management
  • Increasing the sensitivity and specificity of surveillance
  • Accelerating transmission reduction
  • Investigating and clearing individual cases

What’s new in the latest guidance?

It outlines the critical requirements needed for all endemic countries to achieve and maintain malaria elimination, instead of merely providing a framework to assess if elimination is a feasible goal (2007 elimination manual)

The classification of transmission foci has been strengthened to facilitate programme planning. Instead of seven foci, now there are just three:

  • active (ongoing transmission),
  • residual non-active (transmission recently interrupted) and
  • cleared (no transmission for more than 3 years).

Countries are encouraged to establish a national malaria elimination advisory committee that meets regularly to review progress, gaps and trends.

The process for WHO certification of malaria elimination* has been streamlined, and is described in the new framework.

*Requires zero incidence of indigenous cases for at least the past 3 consecutive years.

In a first, the concept of sub-national verification of malaria elimination has been introduced- for large countries.

Also, a careful national investigation and consultation with WHO will now be required before a country loses its malaria-free certification.

Useful Links:

Link to the WHO news release:

http://www.who.int/malaria/news/2017/new-guidance-on-elimination/en/

Link to WHO document “A Framework for Malaria Elimination” (English) [PDF] (full):

http://apps.who.int/iris/bitstream/10665/254761/1/9789241511988-eng.pdf?ua=1

Link to WHO document ‘Key points and Questions and Answers’ on the new guidance (English) [PDF]:

http://apps.who.int/iris/bitstream/10665/254889/1/WHO-HTM-GMP-2017.5-eng.pdf?ua=1

Link to WHO document ‘Global Technical Strategy for Malaria 2016-2030′(2015) (English)[PDF]:

http://apps.who.int/iris/bitstream/10665/176712/1/9789241564991_eng.pdf?ua=1&ua=1

Link to WHO document ‘Eliminating Malaria’ (2016) (English) [PDF]:

http://apps.who.int/iris/bitstream/10665/205565/1/WHO_HTM_GMP_2016.3_eng.pdf?ua=1

Link to WHO page containing resources on malaria elimination:

http://www.who.int/malaria/areas/elimination/en/

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