Malaria Types In Belize

Belize was certified as a malaria-free country by the World Health Organization (WHO) in 2023. There have been zero indigenous malaria cases since December 2018, and the country continues to invest in the prevention of the re-establishment of malaria transmission. The last death due to malaria was reported in 2006, and the last indigenous case was reported in December 2018. Belize is now the second country in Central America to be awarded a certification of malaria elimination by the WHO.

Malaria prevention in Belize

Malaria is a risk in some parts of Belize. If you are travelling to a malaria-risk area, it is important to take preventative measures to protect yourself from mosquito bites and reduce your risk of infection. Here are some recommendations for preventing malaria when travelling to Belize:

• Consult a healthcare professional or travel clinic before your trip to get advice on malaria prevention and any necessary medications or vaccines.
• Take antimalarial medication as prescribed by your healthcare provider. Some medications need to be started before your trip, so be sure to follow your doctor's instructions.
• Use insect repellent containing at least 20% DEET to protect against mosquito bites.
• Wear long-sleeved shirts, long pants, and hats to cover exposed skin.
• Stay in accommodations with air conditioning or screens on windows and doors to prevent mosquitoes from entering.
• Sleep under a bed net if you are sleeping in an area that is exposed to the outdoors.
• Remove standing water, where mosquitoes breed.
• Be vigilant about hand hygiene and avoid unsanitary street food to prevent travellers' diarrhea.
• If you develop a fever during or after your trip, seek immediate medical attention and inform your doctor about your travel history.

In addition to these measures, it is important to be aware of the latest government guidance and travel advisories when planning your trip to Belize.

History of malaria in Belize

Belize has been certified as malaria-free by the World Health Organization (WHO) as of 2023. The country's journey to eliminating the disease began in 1950, when it launched a targeted programme aimed at eliminating malaria nationwide. This included spraying households with insecticides and increasing efforts to detect malaria cases through the use of vector control staff, health facilities, and community-based health workers. In 1957, the country established a National Malaria Eradication Service (NMES) within the Ministry of Health.

Belize's efforts led to a significant decline in malaria cases between 1957 and 1963, with annual cases falling from over 1,000 to just 17. However, by 1965, the number of cases had increased twelve-fold, attributed to inconsistent implementation of insecticide spraying, a weak surveillance system, and a lack of domestic and international funding.

In the late 1980s, Belize had thousands of malaria cases, which started to steadily decline. The last death due to malaria was reported in 2006, and the last indigenous malaria case was reported in December 2018. Over the last three decades, Belize has achieved a dramatic reduction in its malaria caseload, from a peak of about 10,000 cases in 1994 to zero indigenous cases in 2019.

Belize's success in eliminating malaria is attributed to effective investments at both the domestic and international levels, as well as the crucial role of dedicated staff for malaria surveillance, early detection, prompt diagnosis and treatment, and complementary preventive measures such as indoor residual spraying and long-lasting insecticidal nets. The country also maintained malaria surveillance during the COVID-19 pandemic and integrated malaria and COVID-19 surveillance systems. Additionally, cross-border collaboration with neighboring Mexico and Guatemala has been key to success.

Belize's malaria-free certification

Belize was certified as a malaria-free country by the World Health Organization (WHO) in 2023. This milestone was achieved through a combination of surveillance, vector control interventions, multisectoral collaboration, dedicated health staff, and public education.

Surveillance strategies played a crucial role in ensuring prompt diagnosis, treatment, investigation, and timely response to malaria cases. Vector control interventions were implemented in selected areas at higher risk of malaria importation, helping to prevent the transmission of the disease. Multisectoral collaboration was also key, with various sectors working together towards the early detection of imported cases among seasonal workers.

The dedication and expertise of health staff, including doctors, microscopists, nurses, community health workers, and voluntary collaborators, were instrumental in maintaining malaria suspicion and providing timely treatment. Additionally, educating the public about the early recognition of malaria signs and symptoms empowered them to seek appropriate medical attention promptly.

Prior to its malaria-free status, Belize had a significant history of malaria. In the late 1980s until the mid-1990s, the country reported thousands of malaria cases annually. However, through sustained efforts, the number of cases steadily declined over time. The last reported death due to malaria was in 2006, and the last indigenous malaria case was reported in December 2018.

Belize's success in eliminating malaria is a testament to the effectiveness of comprehensive strategies and the dedication of healthcare professionals and the community. The country continues to invest in preventing the re-establishment of malaria transmission, ensuring the health and safety of its citizens and visitors alike.

Vector control interventions

Larval Control

• Environmental modification: This involves draining and filling larval habitats to prevent the breeding of mosquitoes. For example, filling in depressions that collect water, draining swamps, or ditching marshy areas to remove standing water.
• Larviciding: In some cases, habitat elimination is not possible, so chemical insecticides can be applied directly to the larval habitats. Oils can be applied to the water surface to suffocate the larvae and pupae. Toxins from the bacterium Bacillus thuringiensis var. israelensis (Bti) can also be used, which specifically target mosquitoes, black flies, and midges.

Source Reduction

This involves the removal or permanent destruction of mosquito breeding sites. For example, filling in burrow pits created by brick-making, which can be potential breeding sites for mosquitoes.

Insect Growth Regulators

Substances such as methoprene, which are specific to mosquitoes, can be applied directly to the larval habitats to regulate their growth and prevent them from reaching adulthood.

Fogging or Area Spraying

Fogging or ultra-low volume spraying is typically reserved for emergency situations such as epidemics. While fogging has not been shown to be effective in malaria-endemic areas, it can be used in combination with other interventions.

Personal Protection Measures

These include the use of window screens, ITNs, and insect repellents (such as DEET). Wearing light-colored, long-sleeved shirts and long pants can also help prevent mosquito bites. Well-constructed houses with window screens can effectively prevent mosquito bites indoors and may have contributed to the elimination of malaria from the United States and Europe.

Sterile Male Release

Introducing sterile male mosquitoes into an area has been successfully applied in small-scale settings. However, this approach is often impractical due to the large number of mosquitoes required.

Genetic Modification of Malaria Vectors

This approach aims to develop mosquitoes that are not susceptible to the malaria parasite. While this is still years away from field application, there have been significant technological advances in direct genome modification.

Malaria transmission prevention

Malaria is a life-threatening disease spread to humans by some types of mosquitoes. It is preventable and curable. The infection is caused by a parasite and does not spread from person to person. The most common early symptoms of malaria are fever, headache, and chills. These symptoms usually start within 10–15 days of getting bitten by an infected mosquito.

• Use mosquito nets when sleeping in places where malaria is present.
• Use mosquito repellents (containing DEET, IR3535, or Icaridin) after dusk.
• Use coils and vaporizers to repel mosquitoes.
• Wear protective clothing, such as long-sleeved shirts, long pants, and hats.
• Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). Do not use permethrin directly on the skin.
• Stay and sleep in air-conditioned or screened rooms.
• Use bed nets if the sleeping area is exposed to the outdoors.
• Take antimalarial medication as prescribed by a doctor.
• Avoid mosquito bites by covering exposed skin and using insect repellent.
• Practice food and water safety by opting for fully cooked dishes, steering clear of raw seafood, choosing eateries with good hygiene practices, and sticking to bottled beverages.
• Prevent travellers' diarrhea through vigilant hand hygiene and avoiding unsanitary street food.
• Get vaccinated against diseases like typhoid, hepatitis A, polio, yellow fever, chikungunya, rabies, hepatitis B, influenza, COVID-19, pneumonia, meningitis, chickenpox, shingles, Tdap (tetanus, diphtheria, and pertussis), and measles, mumps, and rubella (MMR).
• Avoid contact with animals that may carry the disease, such as dogs, bats, monkeys, and snakes.
• Wash your hands frequently and avoid touching your eyes, nose, or mouth.
• Avoid sharing body fluids with infected individuals.
• Use condoms to reduce the risk of sexually transmitted infections.
• Do not inject drugs or share needles.
• Avoid swallowing water when swimming in freshwater in developing areas or where sanitation is poor.
• Practise safe sex and use sterile equipment for body modifications to reduce the risk of hepatitis B transmission.

Frequently asked questions