[Malaria in Mayotte: past, present and future].

Discovered as a form of intermittent fevers in 1852 and confirmed by Blin in 1905, malaria has had a large impact on the mortality and the morbidity of the population living in Mayotte until 1976. An evolutionary analysis of the disease shows two distinct periods. The first period between 1792 and 1974 concerns the date of introduction of malaria to the island and the limited actions of the fight against malaria led by different organizations. The second period from 1976, when the program was established, to today could be entitled "18 years of fighting malaria in Mayotte". The second period has featured many events punctuated by two epidemics in 1984 and 1991. The results obtained in terms of the fight against malaria are characterized by a rapid fall of the transmission between 1976 and 1980, a resurgence of an epidemic in 1984, a cessation of the transmission in 1986, an explosive epidemic in 1991, and maintenance of the microcenters of epidemics since 1991 to today. They demonstrate the fragility of the conditions and prove that the ecosystem of Mayotte remains favorable to deterioration of the situation. These sero-epidemiological studies based on the estimation of the "geometrical rate of antibodies" allows for compensation of the techniques of parasitic evaluation when the index of malaria becomes very low. The principal vector Anopheles gambiae has adapted to the many varieties of natural habitats and to those of human origin due to environmental modification. Also the parasite, originating from the endemic residential zones, has been quasi-permanently introduced to the island. Thus, we are obliged to consolidate and diversify our means, notably towards a periodic evaluation of the phenomenon of in vivo resistance to chloroquine. This objective could be integrated within the framework of regional scientific cooperation. Moreover, the use of mosquito bed nets impregnated with pesticides is beginning to be the answer to the problem of people refusing to spray insecticide within their homes.