Factors Associated with the Rapid and Durable Decline in Malaria Incidence in El Salvador, 1980-2017

• Published in: The American journal of tropical medicine and hygiene Vol. 99; no. 1; pp. 33 - 42
• Main Authors: Burton, Robert A, Chévez, José Eduardo Romero, Sauerbrey, Mauricio, Guinovart, Caterina, Hartley, Angela, Kirkwood, Geoffrey, Boslego, Matthew, Gavidia, Mirna Elizabeth, Alemán Escobar, Jaime Enrique, Turkel, Rachel, Steketee, Richard W, Slutsker, Laurence, Schneider, Kammerle, Campbell, Carlos C Kent
• Format: Journal Article
• Language: English
• Published: United States Institute of Tropical Medicine 01-07-2018; American Society of Tropical Medicine and Hygiene; The American Society of Tropical Medicine and Hygiene
• Subjects: Amèrica Central; Central America; Communicable Disease Control - organization & administration; Disease Eradication - methods; El Salvador - epidemiology; Epidemiological Monitoring; Humans; Malaria; Malaria, Falciparum - epidemiology; Malaria, Falciparum - prevention & control; Malaria, Falciparum - transmission; Malaria, Vivax - epidemiology; Malaria, Vivax - prevention & control; Malaria, Vivax - transmission; Malària; Mosquito Control - organization & administration; Plasmodium falciparum - pathogenicity; Plasmodium falciparum - physiology; Plasmodium vivax - pathogenicity; Plasmodium vivax - physiology; Surveillance; Travel - statistics & numerical data; El Salvador
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.17-0629

A decade after the Global Malaria Eradication Program, El Salvador had the highest burden of malaria in Mesoamerica, with approximately 20% due to
. A resurgence of malaria in the 1970s led El Salvador to alter its national malaria control strategy. By 1995, El Salvador recorded its last autochthonous
case with fewer than 20
cases annually since 2011. By contrast, its immediate neighbors continue to have the highest incidences of malaria in the region. We reviewed and evaluated the policies and interventions implemented by the Salvadoran National Malaria Program that likely contributed to this progress toward malaria elimination. Decentralization of the malaria program, early regional stratification by risk, and data-driven stratum-specific actions resulted in the timely and targeted allocation of resources for vector control, surveillance, case detection, and treatment. Weekly reporting by health workers and volunteer collaborators-distributed throughout the country by strata and informed via the national surveillance system-enabled local malaria teams to provide rapid, adaptive, and focalized program actions. Sustained investments in surveillance and response have led to a dramatic reduction in local transmission, with most current malaria cases in El Salvador due to importation from neighboring countries. Additional support for systematic elimination efforts in neighboring countries would benefit the region and may be needed for El Salvador to achieve and maintain malaria elimination. El Salvador's experience provides a relevant case study that can guide the application of similar strategies in other countries committed to malaria elimination.