A Malaria Outbreak in a Malaria-Free Zone, Philippines-2010

Background: On March 9, 2010, increasing number of malaria cases from an Eastern Philippines municipality was reported to the National Epidemiology Center. An investigation was conducted to verify the existence of an outbreak, identify risk factors and recommend control and preventive measures. The locale is adjacent to areas hyperendemic for malaria. Methods: Unmatched case-control study was done. Suspect case was a well individual from the municipality who had fever and any of the following: chills, headache or pallor from November 1, 2009-March 20, 2010. Confirmed case was a suspect case positive for malaria parasite on blood smear. Controls were household members or neighbors of cases and negative for malaria parasite on microscopy. Environmental and entomological studies were done. Knowledge, attitude and practices were assessed. Results: Seventy-three confirmed cases were identified. Ages ranged from 1-81years (median 24). Age-group most (37%) affected was the 6-19 years age-group. Thirty-eight were female. Majority (96%) had fever. Plasmodium vivax was seen in 72 (99%) malarial smears. Carabao Bait Trap showed presence of Anopheles flavirostris. Houses were built in deforested hills near a shallow and slow flowing swamp. Living in a nipa hut (OR=5.25, 95%CI: 2.70-10.34, p=0.0000001), sleeping in the living room (OR=4.04, 95%CI=2.28-7.22, p=0.0000001), living in an unscreened house (OR= 2.31, 95%CI=1.34-3.99, p=0.0018727) and bathing in the swamp (OR=5.92, 95%CI=3.17-11.08, p=0.0000000) were risk factors. Conclusion: Malaria outbreak occurred in Jose Panganiban, brought about by the presence of malaria vectors, suitable breeding sites, and susceptible and highly mobile population of indigenous people. As a result, the malaria prevention and control program was strengthened. Community elders initiated a community-wide effort to clean and clear breeding areas near creeks.