Laboratory and Epidemiology Communications

Tertian Malaria Outbreak Three Decades after its Eradication
Dimitar Vutchev*
Departmen i ofParasitology and TTropical Medicine,National Center of Infectious and Parasitic Diseases,
26, Y Sakazov BIvd" 1504 Sojia, Bulgaria

Communicated by Takuro Endo

(Accepted May 1, 2001)

In the past, Bulgaria, situated in Southeastem Europe, hasdiagnosed as having Imported malaria caused mainly bybeen heavily affected by malaria known as "thracian fever"

Plasmodium vivax and P.falcIParum and at a lesserfrequency(1)･ The highest incidence rate‑2066% (144,632 cases)‑wasby P. ovale and P. malariae (3,4).

recorded in 1 946. ConventlOnal anti‑epidemic actions have

For the first time after the malaria eradication in 19951

been coordinated since 1 955 through the strategy of the World

1 996, Some cases have been fわund in southeast Bulgarla, near

Health Organization (WHO). Since 1 962, a diminishment of

the border with Greece and Macedonia‑18 local cases of

the number of the autochthonous cases has been achieved,

tertian malaria ofP. vivax. In August 1995, eight cases ofand in 1965 the WHO announced the eradication of the local

malaria were fわund, and three cases more in September. Themalaria (2)･ In the fわllowing years, cases of imported malaria

sick people range in the age from 5160 years, and are residents

by Bulgarian and forelgn PeOPlefrom endemic countries haveof four rural areas in the neighborhood of the townof Sandanski,

been recognized, e.g., nine lethal cases from malignant

situated in the valley of the Strumariver. The climate of thismalaria. During the period 1 965‑2000, 2,850 people have beenregion is strongly innuenced by the Mediterranean Sea, andhas been highly hyperendemic in the past, with the malaria*Corresponding author: Tel: +35912143471, Fax: +359‑2‑943‑

and its vector, Anopheles maculli,ennis seasons lastlng from3075, E‑mail: ncipd@ncipd.netbg.com

April to October. Most probably the orlgln Or the parasite79

Jpn. J. Infect. Dis., 54, 2001
carrier ofP. vivax comes kom an African immlgrant that has
been in this area in June‑July 1995 0n his way to Greece.
All these malaria patients have been isolated and treated inannounced outbreak showed a real risk of the roll‑back ofmalaria being Imported into countries where it has alreadybeen eradicated. This is especially true of tertian malaria,

hospital with chloroqulne and for antirelapse with primaqulne.

caused by P. vivαr that is more adaptlVe tO anOPheline popula‑

An insecticide treatment was carried out in the villages. Intions.

1996, from May to August, seven cases of tertian malaria
have been found in adults. Ofthem, five live in two of theseepidemic villages and have been diagnosed as having tertian

REFERENCES

malaria with prolonged incubation period. The other two

1. Bruce‑Chwatt, C. ∫. and de Zulueta, ∫. (1980): The rise

people who fell ill in August were in the area only temporarily
and were suspected of having the disease due to transmisIand fall of Malaria in Europe. University Press, Oxford.
2･ Stanchev, P. and Tbdorov, T. (1967):Malaria in Bulgaria.

sion of the local cases in the previous months. All of the 18MF, Sofia (in Bulgarianwith English summary).

people that were infected in 1995 and 1996 from local
malaria have been recognized and have been tested at least

3. Petrov, P. (1990): Malaria. MF, Sofia (in Bulgarian withonce a year for 3 years for malaria. Relapses have not been

4. Kurdova, R., Vutchev, D.and Petrov, P. (2001 ): Epidemi0‑
10glCal problems of malaria in Bulgaria,1991‑2000.

found. Antiepidemic measures and control over the outbreakEnglish summary).

of tertian malaria have been ca汀ied out by the local medical

p. 35142. Proceedings of the lst Balkan Conference on

unlt, in cooperation with the Department of Parasitology andMalaria and Mosquito Control. 5‑7 April 200 I , Lithotopos‑Serres, Greece.
5. Najera, J. A" Kouznetsov, R. L and Delacollette, C.

Tropical Medicine at the National Center of Infectious andParasitic Diseases.

Recently the WHO has glVen Special attention to the increaseof the number of malaria cases worldwide (5). The brieny(1 998): Malaria epidemics. WHO, Geneva.