Times of India
20 June 2008
Mumbai, India

Two years ago, city doctors picked up a disturbing signal–‘Vivax’, the world’s common malaria strain which affects about 400 million people every year, could no longer be taken lightly. “Patients with vivax malaria now land up in an intensive care unit (ICU) while a decade ago they needed only conventional chloroquine treatment,” says a senior doctor with KEM Hospital in Parel.

A monsoon–related death in KEM that was registered by civic officials on Tuesday was attributed to plasmodium vivax malaria. Vivax, it now emerges, is no longer benign but a killer–and this was underlined by international scientists in a research paper published on Tuesday.

Medical experts have so far believed that malaria–a disease that spreads through the sting of the female anopheles mosquito–is fatal only when it’s the falciparum variant that affects the nervous system. Malaria has four strains but vivax and falciparum are the two common ones.

“The Mumbai experience in the last two years shows that the vivax variant has become extremely dangerous,” says intensivist Dr Khusrav Bajan of Hinduja Hospital. “At least 10–20% of patients with vivax malaria need ICU treatment while another 70–80% need hospitalisation,” he adds. On Tuesday, two studies published in PLOS Medicine, a peer–reviewed medical journal, showed up the similarity in the experiences shared by Indonesia and Papua New Guinea in tackling the vivax strain.

A report by Ric Price of the Menzies School of Health Research in Australia has statistically shown that the vivax strain of malaria is now fatal.

The research shows that the strain has led to 50,000 deaths a year in Asia. “This highlights the fact that what we thought was a benign infection actually has huge implications, both economically and in terms of mortality,” wrote Dr Price.

Says Dr Kishore Harboli, who is in charge of malaria surveillance with the BMC, “Malaria has become resurgent in the last two years, with the number of cases increasing drastically.” Mumbai’s graph shows that vivax cases have risen from 14,189 in 2006 to 20,085 in 2007.

The 26\7 floods and the resulting environmental changes are responsible for this change, say doctors. Another reason is the unfettered construction boom in the city that allows mosquitoes to breed and spread the disease.

In Mumbai, the complications associated with the vivax disease are also changing. “Vivax is now causing multiorgan failure among patients. They come with a lung injury or bleeding in the lungs. There have also been cases of the kidney and liver being affected,” says Dr Bajan.