مروری بر وضعیت مالاریا در ایران

Malaria has been prevalent for a long time in Iran. About 1000 years ago, the Iranian physicians such as Avicenna (979-1037) were acquainted to the clinical feature of the disease. The scientific study of malaria in Iran was started by Latycheve in 1921. Later on up to 1944, malaria have been studied by some Iranian and foreign investigators and it was found hyper-endemic in some littoral parts of Caspian Sea in the north and Persian Golf in the south and hypo-or meso-endemic in the central parts of the country. From 1941 to 1948 the anti-malaria campaign were using quinine for chemotherapy and chemoprophylaxis as well as anti-larval measures for vector control. From 1949 DDT was used for the control of the Anopheles vectors which were determined at that time as A.maculipennis and A.superpictus in the north and some central parts of Iran, A. sacharovi in the west and A.stephensi and A. culicifacies in the south parts of the country. At the present time A.d;aposthali and A.fluviatilis are also considered as malaria vectors and A.pulcherrimus as a suspected vector in the south parts of Iran.Spraying (using DDT) and malaria surveillance (case finding and treatment) caused a great reduction in malaria incidence in the malarious areas, particularly in the north and central parts of the country. The Institute of Malariology was established in the Department of Medical Parasitology, Medical School of Tehran University for training and research works on malaria in 1952.Malaria Eradication Programme (MEP) was recommended by the World Health Organization in 1956 and actually started in 1957 in Iran under General Office of Malaria Eradication (GOME) in the Ministry of Health.Anti-malaria campaign in MEP during 1957-1971 caused interruption of transmission of malaria in the north parts of Zagross mountains, approximately, half north parts of Iran, and reduced, greatly, the incidence of the disease in the south parts of Iran which were considered as problem or refractory areas.In 1973, GOME became a division of CDC in Ministry of Health and this integration caused some standstill in the activities of MEP. Thus, the incidence of malaria increased in the refractory areas in the south as well as in consolidation areas in the north parts of the country and the total diagnosed cases of malaria in Iran raised from less than 35,000 to approximately 100,000 cases per year. Therefore, the Ministry of Health strengthened the MEP again. Actually, from 1980 the anti-malaria campaign from MEP changed to malaria control programme , because in the refractory areas due to some behaviors or resistance of vectors to insecticides and, partly, due to the resistance of P.falciparum to chloroquine at RI & RII levels, the interruption of transmission was not possible. However, there was about 80% reduction of annual malaria incidence as well as percentage of P.falciparum during the recent decade. The prevalent species of Plasmodia are P.vivax & P.falciparum in the malarious areas of south and P.vivax in the north parts of Iran. P.malariae is rarely found at present time.