Middle East DVEP - Armed Forces Pest Management Board

Disease Distribution. Endemic malaria has been eradicated from most temperatecountries, but it still is a major health problem in many tropical and subtropical areas.Worldwide, there are an estimated 250 to 300 million cases of malaria annually, with 2 to3 million deaths. The WHO estimates nearly one million children under the age of 10 diefrom malaria every year in Africa. Globally, P. falciparum and P. vivax cause the vastmajority of cases. Plasmodium falciparum occurs in most endemic areas of the worldand is the predominant species in Africa. Plasmodium vivax is also common in mostendemic areas except Africa. Plasmodium ovale occurs mainly in Africa, and P.malariae occurs at low levels in many areas of the world. In most endemic areas, thegreatest malaria risk is in rural locatons, with little or no risk in cities. However, inSomalia, several malaria cases occurred in troops who were only in Mogadishu.Despite the image of the Arabian Peninsula as a desert, malaria has been present there forcenturies. Historically, anopheline mosquitoes were abundant around the wells andoases, and virtually 100% of native populations were infected. Typical "oasis malaria"was characterized by its restriction to islands of cultivation in a sea of sand. Extensivewater resource and agricultural development has increased the area at risk from malaria.Malaria is a significant public health problem in many countries of the Middle East and athreat to military forces operating in the region. Current endemic areas are illustrated inFigure 1.Iran: Malaria occurs throughout Iran in rural areas at elevations up to 1,500 m. The cityof Tehran is considered malaria-free. Highest malaria incidence occurs in thesoutheastern provinces of Sistan va Baluchestan, Kerman, and Hormozgan, and south ofthe Zagros Mountains along the Persian Gulf littoral and the Khuzestan plain.Transmission peaks during April and May. Transmission occurs primarily from Junethrough August in northern provinces of the Caspian Sea littoral, especilly Gilan andMazandaran, and along the Turkmenistan border. Plasmodium vivax predominates in allbut southeastern endemic areas. Cases of P. malariae have been reported.Iraq: Malaria transmission occurs from May through November in the northernprovinces of Dahuk, Erbil, Ninawa, Sulaimaniya, and Tamim below 1,500 m, as well asin the southern province of Basrah. Scattered outbreaks may occur year-round in centraland southern areas from the Tigres-Euphrates River Basin east to the Iranian border.Nearly all cases are vivax malaria. Malaria is absent from Baghdad and its immediatevicinity. The annual incidence of malaria increased from 87 cases per 100,000population in 1989 to 129 per 100,000 in 1994, particularly in the north. Resurgenceafter the Persian Gulf War has been attributed to Kurdish resettlement in the north, lackof vector control programs, and increased rice farming.Oman: Malaria risk is greatest in coastal and foothill areas of Dhahira, South and NorthBatinah, and Dakhilya. Seasonal transmission is greatest from November through April.Incidence has been declining during the 1990s. Over 95 % of cases are attributed to P.falciparum.65