Malaria: Standard Case Definitions: Suspected case: Uncomplicated malaria History of recent fever within last 48 hours (may

y be continuous or irregular in beginning), chills, headache, body aches, weakness, anaemia, hepato-splenomegaly. (In falciparum infection, the fever may be continuous with bouts of high peaks.) Severe Malaria History of fever with prostration (inability to sit), altered consciousness (lethargy, coma), generalized seizures (followed by coma), difficulty in breathing, low urinary output or dark urine, severe anaemia, abnormal bleeding, and hypoglycaemia. Probable case: A suspected case; with history of similar manifestations among other household members Confirmed case: Clinical case, which is confirmed by: Laboratory diagnosis of malarial parasites in peripheral blood film (thick and thin smear). Parasite antigens by immunodiagnostic test kit and Rapid Diagnostic test (RDT). Alert Threshold: Number of cases reaches two times the mean number of suspected cases of the previous 3 weeks for a given location. Outbreak Threshold: In endemic area: Slide positivity rate above 50% or falciparum rate above 40%; while in non-endemic area, evidence of indigenous transmission of falciparum. Surveillance Goal: Detect malaria epidemics promptly, especially in areas with seasonal epidemic transmission or with a large population at risk. Response to Alert: Report suspected epidemic to the next level Treat with appropriate anti-malarial drugs according to national treatment guidelines Investigate the cause for the increase in new cases Make sure new cases in children age 2 months up to 5 years are managed according to IMNCI guidelines. Conduct community education for prevention, prompt detection of cases and access to health facilities. Response to Outbreak/Epidemic Measures: All above plus Evaluate and improve, as needed, prevention strategies, such as use of ITNs and IRS for all at risk of malaria. Analyse and interpret data

o Time: Graph the number of cases by week/month. Construct an epidemic curve during epidemics. o Place: Plot location of households for new cases and deaths. o Person: Count the number of new malaria cases and deaths by month and analyse age groups and time of onset. Case Management: The results of parasitological diagnosis are usually available within a short time (less than two hours). However, in the absence or delay of parasitological diagnosis, patients with suspected severe malaria, and other high risk groups, should be treated immediately on clinical grounds. Treatment of uncomplicated Falciparum Malaria o Artemisinin-based combination therapies (ACTs) are the recommended treatments for uncomplicated P. falciparum malaria however Artemisinin and its derivatives should not be used as monotherapy. The following ACTs are recommended: Artemether plus lumefantrine, Artesunate plus sulfadoxine-pyrimethamine. Artemether-Lumefantrine is currently available as a fixed-dose formulation with dispersible or standard tablets containing 20 mg of Artemether and 120 mg of lumefantrine. The recommended treatment is a 6-dose regimen Twice Daily over a 3-day period. The dosing is based on the number of tablets per dose according to pre-defined weight bands (514 kg: 1 tablet; 1524 kg: 2 tablets; 2534 kg: 3 tablets; and > 34 kg: 4 tablets) In case of pregnant women, during first trimester quinine plus clindamycin to be given for 7 days (Artesunate plus clindamycin for 7 days is indicated if this treatment fails); However, During Second and Third trimester, Artesunate plus clindamycin to be given for 7 days, or quinine plus clindamycin are to be given for 7 days. Uncomplicated Vivax Infections o Chloroquine combined with Primaquine is the treatment of choice for chloroquinesensitive infections. Dosage is as given below: Chloroquine: 04 STAT, 02 after 6 hours, then 12 hourly for 02 days. Primaquine: 14 days treatment is prescribed for radical treatment of Vivax. Artesunate plus sulfadoxine-pyrimethamine is not effective in many places. Warnings: Do not give Primaquine to pregnant women and children below 2 years of age, and it is advisable to do a Glucose 6-Phosphate dehydrogenase test before giving this drug. Give Primaquine preferably after the patient has recovered from the acute illness. Do not give undiluted chloroquine or quinine by I/M or I/V route, as it can cause sudden cardiac arrest, especially in children. Do not give Sulfadoxine-pyrimethamine to children below 2 months of age or during first trimester of pregnancy. Halofantrine (Halfan) is potentially a cardio-toxic drug and should be used under strict government control, according to WHO recommendations. Laboratory Confirmation:

Diagnostic Test: Microscopy: Presence of malarial parasites in blood films for suspected cases Malaria Rapid diagnostic test Specimen: Blood: Usually finger-stick sample for all ages or other accepted method for collecting blood from very young children Collect 3-5ml blood in a tube with anticoagulant (EDTA) for demonstration of malarial parasites in peripheral blood film. When to collect the specimen: All suspected malaria cases both from outpatient and indoor departments before the start of antimalarial drugs. From patients where cause of fever is not known (Pyrexia of Unknown Origin). How to prepare, store, and transport the specimen: Blood smear: Collect blood directly onto correctly cleaned and labelled microscope slides and prepare thick and thin smears. Allow smears to dry thoroughly Stain using the appropriate stain and technique Store stained and thoroughly dried slides at room temperature out of direct sunlight. For rapid diagnostic test: Collect specimen and perform test according to manufacturers instructions. Results: Thick and thin smear results can be available the same day as preparation. Microscopic examination of malarial slides may also reveal the presence of other blood-borne parasites. RDT result is obtained immediately. Note: In the inpatient setting, perform a hemoglobin estimation laboratory test to confirm severe anaemia, in children 2 months to 5 years in age. PREVENTION: Personal protection Wear long sleeves and trousers outside the houses in the evening. Use repellent creams and sprays. Avoid of night time outside activities. Screen windows and use mosquito nets. Use mosquito's coils or vaporizing mat containing a pyrethrin. Destroy breeding places of mosquitoes by filling in ditches where water stands or stagnates. Prompt diagnosis and treatment of cases to prevent spread of the disease. Vector control Two forms of vector control are effective in a wide range of circumstances. These are: Insecticide-treated mosquito nets (ITNs) Indoor spraying with residual insecticides (IRS) Chemoprophylaxis

Drugs can also be used to prevent malaria. For travellers, malaria can be prevented through chemoprophylaxis, which suppresses the blood stage of malaria infections, thereby preventing malaria disease.