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Malaria
or a disease resembling malaria has been noted for more than 4,000 years.
From the Italian for "bad air," mal'aria has probably influenced
to a great extent human populations and human history.
Ancient
History (2700 BCE-340 CE)
The
symptoms of malaria were described in ancient Chinese medical writings.
In 2700 BC, several characteristic symptoms of what would later be
named malaria were described in the Nei Ching, The Canon of
Medicine).
Nei Ching was edited by Emperor Huang Ti. Malaria became widely
recognized in Greece by the 4th century BCE, and it was responsible
for the decline of many of the city-state populations. Hippocrates noted
the principal symptoms. By the age of Pericles, there were extensive
references to malaria in the literature and depopulation of rural areas
was recorded. In the Susruta, a Sanskrit medical treatise,
the symptoms of malarial fever were described and attributed to the
bites of certain insects. A number of Roman writers attributed malarial
diseases to the swamps.
In China, during the second century BCE, the Qinghao plant (Artemisia
annua L) was described
in the medical treatise, 52 Remedies, found in the
Mawangdui Tomb. In the United
States, this plant is known as the annual or sweet wormwood.) In
340 CE, the anti-fever properties of Qinghao were first described
by Ge Hong of the East Yin Dynasty. The active ingredient of Qinghao
was isolated by Chinese scientists in 1971. Known as artemisinin, it
is today a very potent and effective antimalarial drug, especially in
combination with other medicines.
Quinine
(Early 17th Century)
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Plate
from "Quinologie", Paris, 1854, showing bark of Quinquina
calisaya (from Bolivia).
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Following
their arrival in the New World, the Spanish learned of a medicine used
for the treatment of fevers. Spanish Jesuit missionaries in South America
learned of a medicinal bark from indigenous Indian tribes. With this bark,
the Countess of Chinchón, the wife of the Viceroy of Peru, was
cured of her fever. The bark from the tree was then called Peruvian
bark and the tree was named Cinchona after the countess. The medicine
from the bark is now known as the antimalarial, quinine. Along with artemisinin,
quinine is one of the most effective antimalarial drugs available today.
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Alphonse
Laveran was the first to notice parasites in the blood of a patient
suffering from malaria.
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Discovery
of the Malaria Parasite (1880)
Charles
Louis Alphonse Laveran, a French army surgeon stationed in Constantine,
Algeria, was the first to notice parasites in the blood of a patient suffering
from malaria. This occurred on the 6th of November 1880. For his discovery,
Laveran was awarded the Nobel Prize in 1907.
More: Laveran and the Discovery of the Malaria Parasite
Differentiation
of Species of Malaria (1886)
Camillo
Golgi, an Italian neurophysiologist, established that there were at least
two forms of the disease, one with tertian periodicity (fever every other
day) and one with quartan periodicity (fever every third day). He also
observed that the forms produced differing numbers of merozoites (new
parasites) upon maturity and that fever coincided with the rupture and
release of merozoites into the blood stream. He was awarded a Nobel Prize
in Medicine for his discoveries in neurophysiology in 1906.
Naming
of Human Malaria Parasites (1890,1897)
The
Italian investigators Giovanni Batista Grassi and Raimondo Filetti first
introduced the names Plasmodium vivax and P. malariae for
two of the malaria parasites that affect humans in 1890. Laveran had believed
that there was only one species, Oscillaria malariae. An American,
William H. Welch, reviewed the subject and, in 1897, he named the malignant
tertian malaria parasite, P. falciparum. There were many arguments
against the use of this name, however, the use was so extensive in the
literature that a change back to the name given by Laveran was no longer
thought possible. In 1922, John William Watson Stephens described the
fourth human malaria parasite, P. ovale.
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Ronald
Ross was the first to demonstrate that a mosquito could transmit
a (bird) malaria parasite.
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Discovery
That Mosquitoes Transmit Malaria Parasites (1897-1898)
On August 20th, 1897, Ronald Ross, a British officer in the Indian Medical Service, was the
first to demonstrate that malaria parasites could be transmitted from infected patients to
mosquitoes. In further work with bird malaria, Ross showed that mosquitoes could transmit
malaria parasites from bird to bird. This necessitated a sporogonic cycle (the time interval
during which the parasite developed in the mosquito). Thus, the problem of malaria transmission
was solved. For his discovery, Ross was awarded the Nobel Prize in 1902.
More:
Ross and the Discovery that Mosquitoes Transmit Malaria Parasites
Discovery of the Transmission of the Human Malaria Parasites Plasmodium
(1898-1899)
Led
by Giovanni Batista Grassi, a team of Italian investigators, which included
Amico Bignami and Giuseppe Bastianelli, collected Anopheles claviger
mosquitoes and fed them on malarial patients. The complete sporogonic
cycle of Plasmodium falciparum, P. vivax, and P.
malariae
was demonstrated. In 1899, mosquitoes infected by feeding on a patient
in Rome were sent to London where they fed on two volunteers, both of
whom developed benign tertian malaria.
The
Panama Canal (1905-1910)
The
construction of the Panama Canal was made possible only after yellow fever
and malaria were controlled in the area. These two diseases were a major
cause of death and disease among workers in the area. In 1906, there were
over 26,000 employees working on the Canal. Of these, over 21,000 were
hospitalized for malaria at some time during their work. By 1912, there
were over 50,000 employees, and the number of hospitalized workers had
decreased to approximately 5,600. Through the leadership and efforts of
William Crawford Gorgas, Joseph Augustin LePrince, and Samuel Taylor Darling,
yellow fever was eliminated and malaria incidence markedly reduced through
an integrated program of insect and malaria control.
More:
The Panama Canal
The
U.S. Public Health Service (USPHS) and Malaria (1914-1942)
During
the U.S. military occupation of Cuba and the construction of the Panama
Canal at the turn of the 20th century, U.S. officials made great strides
in the control of malaria and yellow fever. In 1914 Henry Rose Carter
and Rudolph H. von Ezdorf of the USPHS requested and received funds from
the U.S. Congress to control malaria in the United States. Various activities
to investigate and combat malaria in the United States followed from this
initial request and reduced the number of malaria cases in the United
States. The USPHS established malaria control activities around military
bases in the malarious regions of the southern United States to allow
soldiers to train year round.
The
U.S. Tennessee Valley Authority (TVA) - The Integration of Malaria Control
with Economic Development (1933)
U.S.
President Franklin D. Roosevelt signed a bill that created the TVA on
May 18, 1933. The law gave the federal government a centralized body to
control the Tennessee river's potential for hydroelectric power and improve
the land and waterways for development of the region. An organized and
effective malaria control program stemmed from this new authority in the
Tennessee River valley. Malaria affected 30 percent of the population
in the region when the TVA was incorporated in 1933. The Public Health
Service played a vital role in the research and control operations and
by 1947, the disease was essentially eliminated. Mosquito breeding sites
were reduced by controlling water levels and insecticide applications.
Chloroquine
(Resochin) (1934, 1946)
Chloroquine
was discovered by a German, Hans Andersag, in 1934 at Bayer I.G. Farbenindustrie
A.G. laboratories in Eberfeld, Germany. He named his compound resochin.
Through a series of lapses and confusion brought about during the war,
chloroquine was finally recognized and established as an effective and
safe antimalarial in 1946 by British and U.S. scientists.
Dichloro-diphenyl-trichloroethane
(DDT) (1939)
A
German chemistry student, Othmer Zeidler, synthesized DDT in 1874, for
his thesis. The insecticidal property of DDT was not discovered until
1939 by Paul Müller in Switzerland. Various militaries in WWII utilized
the new insecticide initially for louse-borne typhus. DDT was used for
malaria control at the end of WWII after it had proven effective against
malaria-carrying mosquitoes by British, Italian, and American scientists.
Müller won the Nobel Prize for Medicine in 1948.
Malaria
Control in War Areas (MCWA) (1942-1945)
MCWA
was established to control malaria around military training bases in the
southern United States and its territories, where malaria was still problematic.
Many of the bases were established in areas where mosquitoes were abundant.
MCWA aimed to prevent reintroduction of malaria into the civilian population by mosquitoes that would have fed on malaria-infected soldiers, in training or returning from endemic areas. During these activities, MCWA also trained state and local health department
officials in malaria control techniques and strategies.
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Cover of a MCWA booklet (1945).
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CDC
and Malaria (1946-present)
CDC's
mission to combat malaria began at its inception on July 1, 1946. The
Communicable Disease Center, as CDC was first known, stemmed from MCWA.
Thus, much of the early work done by CDC was concentrated on the control
and eradication of malaria in the United States. With the successful reduction
of malaria in the United States, the CDC switched its malaria focus from
eradication efforts to prevention, surveillance, and technical support
both domestically and internationally. This is still the focus of CDC's
Malaria Branch today.
More:
CDC's Origins and Malaria
Eradication of Malaria in the United States (1947-1951)
The
National Malaria Eradication Program, a cooperative undertaking by state
and local health agencies of 13 Southeastern states and the CDC, originally
proposed by Louis Laval Williams, commenced operations on July 1, 1947.
By the end of 1949, over 4,650,000 housespray applications had been made.
In 1947, 15,000 malaria cases were reported. By 1950, only 2,000 cases
were reported. By 1951, malaria was considered eradicated from the United
States.
More: Eradication of Malaria in the United States
Eradication
Efforts Worldwide: Success and Failure (1955-1978)
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Stamps
highlighting malaria eradication
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With
the success of DDT, the advent of less toxic, more effective synthetic
antimalarials, and the enthusiastic and urgent belief that time and money
were of the essence, the World Health Organization (WHO) submitted at
the World Health Assembly in 1955 an ambitious proposal for the eradication
of malaria worldwide. Eradication efforts began and focused on house spraying
with residual insecticides, antimalarial drug treatment, and surveillance,
and would be carried out in 4 successive steps: preparation, attack, consolidation,
and maintenance. Successes included eradication in nations with temperate
climates and seasonal malaria transmission. Some countries such as India
and Sri Lanka had sharp reductions in the number of cases, followed by
increases to substantial levels after efforts ceased. Other nations had
negligible progress (such as Indonesia, Afghanistan, Haiti, and Nicaragua).
Some nations were excluded completely from the eradication campaign (most
of sub-Saharan Africa). The emergence of drug resistance, widespread resistance
to available insecticides, wars and massive population movements, difficulties
in obtaining sustained funding from donor countries, and lack of community
participation made the long-term maintenance of the effort untenable.
Completion of the eradication campaign was eventually abandoned to one
of control.
Page last modified : April 23, 2004
Content source: Division of Parasitic Diseases
National Center for Zoonotic, Vector-Borne, and Enteric Diseases (ZVED)
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