Brazil

Photo: Fundação de Medicina Tropical

The population at risk of malaria in Brazil is 42.5 million from a total population of 209.3 million. There were an estimated 217,928 (196,000 to 236,000) malaria cases in 2017 (falciparum and vivax).1

Malaria transmission is almost exclusively confined to the Amazon rainforest, intensifying towards the northwest of the country. Children, pregnant women and men working in the forest engaged in forestry or mining or in fish farming are most at risk.1

Source: World Malaria Report 2018

Source: World Malaria Report 2018

Surveillance

Of the estimated malaria cases, around 86% were reported. Brazil aims to investigate all confirmed malaria cases. Data on malaria cases is gathered in real time to a malaria-specific epidemiological surveillance system and is available online to municipalities.1 The Programa Nacional de Prevenção e Controle da Malária (PNCM) monitors weekly outbreak alerts at the state and municipal levels to prevent resurgence in areas that have seen a reduction in malaria incidence and mortality and to prevent re-establishment of transmission in areas where malaria has been eliminated.1

Changes in the epidemiological scenario have required adjustments to better serve vulnerable and disadvantaged populations in areas of difficult access, indigenous areas, agrarian reform settlements, garimpos (small-scale mining camps) and border areas.1 

Brazil was part of the Amazon Network for Surveillance of Antimalarial Resistance (RAVREDA) and was supported by the United States Agency for International Development (USAID) through the Amazon Initiative against Malaria (AMI) project.1 

2020 milestones/ malaria elimination

Although by 2017 Brazil had met its targets for a decrease in malaria mortality and case incidence of at least 40%, recent increases suggest that the projected reduction in case incidence by 2020 will be less than 40%.1

Of the 5,565 municipalities in Brazil, in relation to the transmission of P. vivax, 156 municipalities were classified in the control phase, 38 in pre-elimination, 447 in the elimination phase and 4,924 in the phase of prevention of reintroduction.1

Treatment policy for P. vivax 

Chloroquine followed by 0.5 mg/kg primaquine for 7 days in the Amazon region or 0.25 mg/kg primaquine for 14 days for radical cure of P. vivax in other parts of the country.2
 
Diagnosis and treatment is free of charge in the public sector.1

G6PD testing policy

G6PD testing before primaquine radical cure is not part of the national treatment guidelines. A study to assess the use of a qualitative G6PD test before primaquine is currently underway in the Amazon region.2  

G6PD deficiency prevalence

The most frequent G6PD-deficient variant in Africa, known as G6PD*A−, seems to be also the most predominant in South America, and is thought to have been carried to South America in West African slaves. G6PD deficiency prevalence in Brazil is generally high (>5%), and predominant G6PD*A−, reflecting the genetic heritage of African slaves and European migration from northern Italy and Spain, where G6PD*A− is also prevalent. G6PD Mediterranean might also be expected, but appears to be rare. Other rare G6PD-deficient variants are also reported.