Sampaio Vanderson Souza, Siqueira André Machado, Alecrim Maria das Graças Costa, Mourão Maria Paula Gomes, Marchesini Paola Barbosa, Albuquerque Bernardino Cláudio, Nascimento Joabi, Figueira Élder Augusto Guimarães, Alecrim Wilson Duarte, Monteiro Wuelton Marcelo, Lacerda Marcus Vinícius Guimarães
Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil.
Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
Rev Soc Bras Med Trop. 2015;48 Suppl 1:4-11. doi: 10.1590/0037-8682-0275-2014.
In Brazil, more than 99% of malaria cases are reported in the Amazon, and the State of Amazonas accounts for 40% of this total. However, the accumulated experience and challenges in controlling malaria in this region in recent decades have not been reported. Throughout the first economic cycle during the rubber boom (1879 to 1912), malaria was recorded in the entire state, with the highest incidence in the villages near the Madeira River in the Southern part of the State of Amazonas. In the 1970s, during the second economic development cycle, the economy turned to the industrial sector and demanded a large labor force, resulting in a large migratory influx to the capital Manaus. Over time, a gradual increase in malaria transmission was observed in peri-urban areas. In the 1990s, the stimulation of agroforestry, particularly fish farming, led to the formation of permanent Anopheline breeding sites and increased malaria in settlements. The estimation of environmental impacts and the planning of measures to mitigate them, as seen in the construction of the Coari-Manaus gas pipeline, proved effective. Considering the changes occurred since the Amsterdam Conference in 1992, disease control has been based on early diagnosis and treatment, but the development of parasites that are resistant to major antimalarial drugs in Brazilian Amazon has posed a new challenge. Despite the decreased lethality and the gradual decrease in the number of malaria cases, disease elimination, which should be associated with government programs for economic development in the region, continues to be a challenge.
在巴西，超过99%的疟疾病例报告来自亚马逊地区，其中亚马孙州占总数的40%。然而，近几十年来该地区在疟疾控制方面积累的经验和面临的挑战尚未见报道。在橡胶繁荣时期的第一个经济周期（1879年至1912年），整个州都有疟疾记录，亚马孙州南部马德拉河附近村庄的发病率最高。在20世纪70年代的第二个经济发展周期，经济转向工业部门，需要大量劳动力，导致大量人口涌入首都马瑙斯。随着时间的推移，城市周边地区的疟疾传播逐渐增加。在20世纪90年代，农林业的发展，特别是养鱼业，导致了永久性按蚊繁殖地的形成，定居点的疟疾增加。如在科阿里-马瑙斯天然气管道建设中所见，对环境影响的评估和减轻这些影响的措施规划证明是有效的。考虑到自1992年阿姆斯特丹会议以来发生的变化，疾病控制一直基于早期诊断和治疗，但巴西亚马逊地区主要抗疟药物抗性寄生虫的出现带来了新的挑战。尽管致死率下降，疟疾病例数量逐渐减少，但与该地区政府经济发展计划相关的疾病消除仍然是一项挑战。
