{{Short description|Mosquito-borne disease}} {{Other uses}} {{Distinguish|Miliaria}} {{Good article}} {{Pp-move|small=yes}} {{Cs1 config|name-list-style=vanc|display-authors=6}} {{Use dmy dates|date=May 2026}} {{Infobox medical condition | name = Malaria | pronounce = {{IPAc-en|m|ə|ˈ|l|ɛər|i|ə}} | synonym = Ague, paludism, marsh fever | image = Malaria Parasite Connecting to Human Red Blood Cell (34034143483).jpg | caption = Malaria parasite connecting to a red blood cell | field = Infectious disease | symptoms = Mild malaria: fever, chills, vomiting, headache, diarrhoea. Severe malaria: anaemia, jaundice, coma | complications = seizures, coma,<ref name="Caraballo-2014" /> organ failure, anaemia, cerebral malaria<ref>{{cite news |publisher=Mayo Clinic |url=https://www.mayoclinic.org/diseases-conditions/malaria/symptoms-causes/syc-20351184 |title=Malaria |date= |access-date=4 June 2022 |archive-date=2 July 2022 |archive-url=https://web.archive.org/web/20220702235123/https://www.mayoclinic.org/diseases-conditions/malaria/symptoms-causes/syc-20351184 |url-status=live}}</ref> | onset = usually 10–15 days post exposure<ref name="WHO-Factsheet-2025" /> | duration = lifelong if not treated | causes = ''Plasmodium'' transmitted by ''Anopheles'' mosquitoes<ref name="WHO-Factsheet-2025" /> | risks = Exposure to mosquitoes in Endemic areas | diagnosis = Examination of the blood, antigen detection tests<ref name="Caraballo-2014" /> | differential = | prevention = Mosquito nets, insect repellent, mosquito control, prophylactic medication<ref name="Caraballo-2014" /> | treatment = | medication = Antimalarial medication<ref name="WHO-Factsheet-2025" /> | frequency = 282 million (2026)<ref name="Daily 2025" /> | deaths = 610,000 (2025)<ref name="Daily 2025" /> | alt = }}
'''<!--Definition and symptoms-->Malaria''' is a mosquito-borne infectious disease that is transmitted by the bite of ''Anopheles'' mosquitoes.<ref name="WHO-Vector-2023">{{cite web |title=Vector-borne diseases |url=https://www.who.int/news-room/fact-sheets/detail/vector-borne-diseases |access-date=24 April 2022 |publisher=World Health Organization |archive-date=4 January 2023 |archive-url=https://web.archive.org/web/20230104001515/https://www.who.int/news-room/fact-sheets/detail/vector-borne-diseases |url-status=live}}</ref><ref name="WHO-Factsheet-2025" /> The symptoms of human malaria typically include fever, fatigue, vomiting, and headaches.<ref name="Caraballo-2014" /><ref>{{cite journal | vauthors=Basu S, Sahi PK | title=Malaria: An Update | journal=Indian Journal of Pediatrics | volume=84 | issue=7 | pages=521–528 | date=July 2017 | pmid=28357581 | doi=10.1007/s12098-017-2332-2 }}</ref> In severe cases, the disease can cause jaundice, seizures, coma, or death.<ref name="Caraballo-2014" /><ref>{{cite web |title=Fact sheet about malaria |url=https://www.who.int/news-room/fact-sheets/detail/malaria |access-date=10 May 2024 |publisher=World Health Organization |archive-date=2 May 2020 |archive-url=https://web.archive.org/web/20200502021814/https://www.who.int/news-room/fact-sheets/detail/malaria |url-status=live}}</ref> Symptoms usually begin 10 to 15 days after being bitten by an infected ''Anopheles'' mosquito.<ref name="WHO-Factsheet-2025" /><ref name="CDC-FAQ-2023">{{cite web | url=https://www.cdc.gov/malaria/about/faqs.html | title=CDC - Malaria - FAQs | date=28 June 2023 | access-date=9 September 2017 | archive-date=13 May 2012 | archive-url=https://web.archive.org/web/20120513112631/http://www.cdc.gov/malaria/about/faqs.html | url-status=live}}</ref> If not properly treated, people may have recurrences of the disease months later.<ref name="WHO-Factsheet-2025" /> Those who survive an infection develop partial immunity, being susceptible to reinfection although with milder symptoms.<ref name="Caraballo-2014" /> This partial resistance disappears over months to years if the person has no continuing exposure to malaria.<ref name="Caraballo-2014">{{cite journal | vauthors=Caraballo H, King K | title=Emergency department management of mosquito-borne illness: malaria, dengue, and West Nile virus | journal=Emergency Medicine Practice | volume=16 | issue=5 | pages=1–23; quiz 23–24 | date=May 2014 | pmid=25207355 | url=http://www.ebmedicine.net/topics.php?paction=showTopic&topic_id=405 | url-status=live | archive-url=https://web.archive.org/web/20160801202316/http://www.ebmedicine.net/topics.php?paction=showTopic&topic_id=405 | archive-date=1 August 2016}}</ref>
<!-- Cause and diagnosis -->Malaria is caused by single-celled parasites of the genus ''Plasmodium,''<ref name="WHO-Factsheet-2025" /> generally spread through the bites of an infected female ''Anopheles'' mosquito.<ref name="WHO-Factsheet-2025" /><ref>{{cite journal | vauthors=Walter K, John CC | title=Malaria | journal=JAMA | volume=327 | issue=6 | page=597 | date=February 2022 | pmid=35133414 | doi=10.1001/jama.2021.21468 | doi-access=free| hdl=1805/37679 | hdl-access=free }}</ref> The mosquito bite introduces the parasites from the mosquito's saliva into the blood.<ref name="WHO-Factsheet-2025" /> The parasites initially reproduce and mature in the liver without causing symptoms.<ref>{{Cite web |title=Lifecycle of the malaria parasite |url=https://www.mmv.org/malaria/about-malaria/lifecycle-malaria-parasite |access-date=8 January 2026 |website=Medicines for Malaria Venture |language=en |archive-date=2 January 2026 |archive-url=https://web.archive.org/web/20260102114122/https://www.mmv.org/malaria/about-malaria/lifecycle-malaria-parasite |url-status=live }}</ref> After a few days the mature parasites spread into the bloodstream, where they infect and destroy red blood cells, causing the symptoms of infection.<ref>{{Cite web |title=Malaria factsheet |url=https://www.gov.uk/government/publications/malaria-prevention-transmission-symptoms/malaria-transmission-incubation-period-symptoms |access-date=8 January 2026 |website=Public Health England |language=en |archive-date=1 September 2022 |archive-url=https://web.archive.org/web/20220901042339/https://www.gov.uk/government/publications/malaria-prevention-transmission-symptoms/malaria-transmission-incubation-period-symptoms |url-status=live }}</ref> Five species of ''Plasmodium'' commonly infect humans.<ref name="WHO-Factsheet-2025" /> The three species associated with more severe cases are ''P. falciparum'' (which is responsible for the vast majority of malaria deaths), ''P. vivax'', and ''P. knowlesi'' (a simian malaria that spills over into thousands of people a year).<ref name="WHO-Factsheet-2025" /><ref>{{cite web |last=World Health Organization |title=Global Technical Strategy for Malaria 2016-2030 |url=https://www.who.int/docs/default-source/documents/global-technical-strategy-for-malaria-2016-2030.pdf |access-date=19 February 2024 |archive-date=22 February 2024 |archive-url=https://web.archive.org/web/20240222024003/https://www.who.int/docs/default-source/documents/global-technical-strategy-for-malaria-2016-2030.pdf |url-status=live}}</ref> ''P. ovale'' and ''P. malariae'' generally cause a milder form of malaria.<ref name="Caraballo-2014" /><ref name="WHO-Factsheet-2025" /> Malaria is typically diagnosed by the microscopic examination of blood using blood films, or with antigen-based rapid diagnostic tests.<ref name="Caraballo-2014" /> Methods that use the polymerase chain reaction to detect the parasite's DNA have been developed, but they are not widely used in areas where malaria is common, due to their cost and complexity.<ref name="Nadjm-2012">{{cite journal | vauthors=Nadjm B, Behrens RH | title=Malaria: an update for physicians | journal=Infectious Disease Clinics of North America | volume=26 | issue=2 | pages=243–259 | date=June 2012 | pmid=22632637 | doi=10.1016/j.idc.2012.03.010}}</ref>
<!-- Prevention and treatment -->The risk of disease can be reduced by preventing mosquito bites through the use of mosquito nets and insect repellents or with mosquito-control measures such as spraying insecticides and draining standing water.<ref name="Caraballo-2014" /> Several prophylactic medications are available to prevent malaria in areas where the disease is common.<ref name="WHO-Factsheet-2025" /> As of 2023, two malaria vaccines have been endorsed by the World Health Organization.<ref name="WHO recommends R21-2023">{{cite web |title=WHO recommends R21/Matrix-M vaccine for malaria prevention in updated advice on immunization |url=https://www.who.int/news/item/02-10-2023-who-recommends-r21-matrix-m-vaccine-for-malaria-prevention-in-updated-advice-on-immunization |access-date=8 December 2023 |date=2 October 2023 |archive-date=3 October 2023 |archive-url=https://web.archive.org/web/20231003232601/https://www.who.int/news/item/02-10-2023-who-recommends-r21-matrix-m-vaccine-for-malaria-prevention-in-updated-advice-on-immunization |url-status=live}}</ref> Resistance among the parasites has developed to several antimalarial medications; for example, chloroquine-resistant ''P. falciparum'' has spread to most malaria-prone areas, and resistance to artemisinin has become a problem in some parts of Southeast Asia.<ref name="WHO-Factsheet-2025" /> Because of this, drug treatment for malaria infection should be tailored to best fit the ''Plasmodium'' species involved and the geographical location where the infection was acquired.<ref>{{Cite web |date=24 June 2025 |title=Treatment of Uncomplicated Malaria |url=https://www.cdc.gov/malaria/hcp/clinical-guidance/treatment-uncomplicated.html |access-date=8 January 2026 |website=Centers for Disease Control and Treatment |language=en-us}}</ref>
<!-- Epidemiology and history -->The disease is widespread in the tropical and subtropical regions that exist in a broad band around the equator.<ref>{{cite book | vauthors=Baiden F, Malm KL, Binka F |chapter=Malaria | veditors=Detels R, Karim QA, Baum F, Li L, Leyland AH |title=Oxford Textbook of Global Public Health |date=2021 |pages=227–248 |isbn=978-0-19-881680-5 |doi=10.1093/med/9780198816805.003.0073 |edition=7th}}</ref><ref name="Caraballo-2014" /> This includes much of sub-Saharan Africa, Asia, and Latin America.<ref name="WHO-Factsheet-2025" /> In 2023, some 263 million cases of malaria worldwide resulted in an estimated 597,000 deaths.<ref name="WHO-Briefing-2024">{{Cite web |title=Current state: The malaria situation worldwide |url=https://worldmalariareport2024.org/ |access-date=6 January 2026 |website=WHO: World Malaria Report Global Briefing Kit 2024 |language=en}}</ref> Around 95% of the cases and deaths occurred in sub-Saharan Africa.<ref name="WHO-Briefing-2024" /> Malaria is commonly associated with poverty and has a significant negative effect on economic development;<ref name="Gollin-2007" /><ref name="Worrall-2005" /> in Africa, it is estimated to result in economic losses (estimated at US$12 billion a year in 2005) due to increased healthcare costs, lost ability to work, and adverse effects on tourism.<ref name="Greenwood-2005" />
[[File:En.Wikipedia-VideoWiki-Malaria.webm|thumb|thumbtime=0:02|upright=1.3|Video summary (script)]] {{TOC level|3}}
== Etymology == The term ''malaria'' originates from Medieval {{langx|it|mala aria}}, 'bad air', a part of miasma theory; the disease was formerly called ''ague, paludism'' or ''marsh fever'' due to its association with swamps and marshland.<ref>{{cite journal | vauthors=Reiter P | title=From Shakespeare to Defoe: malaria in England in the Little Ice Age | journal=Emerging Infectious Diseases | volume=6 | issue=1 | pages=1–11 | date=1999 | pmid=10653562 | pmc=2627969 | doi=10.3201/eid0601.000101}}</ref> The term appeared in English at least as early as 1768.<ref>{{cite book |vauthors=Sharpe S |date=1768 |title=A view of the customs, manners, drama, &c. of Italy, as they are described in the Frusta letteraria; and in the Account of Italy in English, written by Mr. Baretti; compared with the Letters from Italy, written by Mr. Sharp |location=London |publisher=W. Nicoll}}</ref> The scientific study of malaria is called malariology.<ref>{{cite web |title=Definition of MALARIOLOGY |website=Merriam-Webster Dictionary |url=https://www.merriam-webster.com/dictionary/malariology |language=en |access-date=19 November 2024 |archive-date=2 August 2025 |archive-url=https://web.archive.org/web/20250802160413/https://www.merriam-webster.com/dictionary/malariology |url-status=live }}</ref>
==Signs and symptoms== thumb|upright=1.15|Main symptoms of malaria<ref name="Fairhurst-2015" />
Symptoms during the early stages of malaria infection are fever, chills, headache, nausea, and vomiting and diarrhoea; more serious cases may show enlarged spleen or liver, and mild jaundice.<ref name="Crutcher-1996" /><ref>{{Cite web |date=12 March 2024 |title=Symptoms of Malaria |url=https://www.cdc.gov/malaria/symptoms/index.html |access-date=16 January 2026 |website=Centers for Disease Control and Prevention |language=en-us}}</ref> These symptoms can resemble other conditions such as sepsis, gastroenteritis, flu and other viral diseases.<ref name="Nadjm-2012" /><ref name="Bartoloni-2012" /> Without treatment, symptoms - particularly the fever - can settle into a regular pattern, recurring every two or three days (paroxysmal attacks).<ref name="ECDC-Information-2024" /><ref name="Crutcher-1996" />
Symptoms typically begin 10–15 days after the initial mosquito bite, but can occur as late as several months after infection. Travellers taking preventative malaria medications may develop symptoms once they stop taking the drugs.<ref name="CDC-Features-2024">{{Cite web |date=20 March 2024 |title=Clinical Features of Malaria |url=https://www.cdc.gov/malaria/hcp/clinical-features/index.html |access-date=16 January 2026 |website=Centers for Disease Control and Prevention |language=en-us |archive-date=19 January 2026 |archive-url=https://web.archive.org/web/20260119021035/https://www.cdc.gov/malaria/hcp/clinical-features/index.html/ |url-status=live }}</ref>
Severe malaria occurs when the Plasmodium infection causes damage to vital organs such as the kidney, liver, lungs or brain. Symptoms include severe anaemia, jaundice, convulsions, confusion, coma, kidney failure and eventually death.<ref name="CDC-Features-2024" /><ref name="ECDC-Information-2024" />. Severe malaria is usually caused by ''P. falciparum;''<ref name="Crutcher-1996" /> it should be treated as a medical emergency.<ref>{{Cite web |title=Severe malaria |url=https://www.mmv.org/malaria/symptoms-and-treatments/severe-malaria |access-date=21 January 2026 |website=Medicines for Malaria Venture |language=en |archive-date=7 April 2025 |archive-url=https://web.archive.org/web/20250407170534/https://www.mmv.org/malaria/symptoms-and-treatments/severe-malaria |url-status=live }}</ref>
===Complications=== A unique feature of ''P falciparum'' is its ability to generate adhesive proteins on the surface of infected red blood cells (RBC). Infected RBCs obstruct capillaries (causing hypoxia) and accumulate in vital organs, interfering with their function.<ref>{{cite journal |last1=Autino |first1=Beatrice |last2=Corbett |first2=Yolanda |last3=Castelli |first3=Francesco |last4=Taramelli |first4=Donatella |title=Pathogenesis of Malaria in Tissues and Blood |journal=Mediterranean Journal of Hematology and Infectious Diseases |date=4 October 2012 |volume=4 |issue=1 |pages=e2012061 |doi=10.4084/mjhid.2012.061 |pmc=3499994 |pmid=23170190}}</ref> ''P falciparum'' infection underlies most severe complications of malaria.<ref name="WHO-Factsheet-2025" />
Cerebral malaria is a form of severe malaria affecting the brain. Infected RBCs blocking capillaries in the brain trigger an immune reaction, which in turn damages the blood-brain barrier.<ref>{{cite journal |last1=Schiess |first1=Nicoline |last2=Villabona-Rueda |first2=Andres |last3=Cottier |first3=Karissa E. |last4=Huether |first4=Katherine |last5=Chipeta |first5=James |last6=Stins |first6=Monique F. |title=Pathophysiology and neurologic sequelae of cerebral malaria |journal=Malaria Journal |date=December 2020 |volume=19 |issue=1 |article-number=266 |doi=10.1186/s12936-020-03336-z |doi-access=free |pmc=7376930 |pmid=32703204}}</ref> Individuals with cerebral malaria exhibit neurological symptoms, such as confusion, seizures, or coma.<ref name="Bartoloni-2012" /> Cerebral malaria, if untreated, can lead to death within forty-eight hours of the first symptoms; survivors may have long-term neurological damage.<ref name="Bartoloni-2012" /><ref name="ECDC-Information-2024" />
Severe anaemia is caused by a combination of the destruction of RBCs (both infected and uninfected) together with reduced RBC production in the bone marrow; it is a major cause of deaths in children under 5.<ref>{{cite journal |last1=White |first1=Nicholas J. |title=What causes malaria anemia? |journal=Blood |date=14 April 2022 |volume=139 |issue=15 |pages=2268–2269 |doi=10.1182/blood.2021015055 |pmid=35420692 }}</ref>
Malaria can lead to acute respiratory distress syndrome in up to 25% of cases. It is caused by damage to the capillary endothelium, in turn damaging the alveoli of the lung.<ref name="Greenwood-2005" /><ref name="Taylor-2012">{{cite journal |last1=Taylor |first1=Walter R.J. |last2=Hanson |first2=Josh |last3=Turner |first3=Gareth D.H. |last4=White |first4=Nicholas J. |last5=Dondorp |first5=Arjen M. |title=Respiratory Manifestations of Malaria |journal=Chest |date=August 2012 |volume=142 |issue=2 |pages=492–505 |doi=10.1378/chest.11-2655 |pmid=22871759 }}</ref> Symptoms are extreme shortness of breath and a bluish tinge to the lips (cyanosis) indicating lack of oxygen.<ref name="Taylor-2012" /> It is a leading killer of adults, with around 40% mortality once symptoms begin.<ref>{{cite journal |last1=Prenen |first1=Fran |last2=De Pauw |first2=Bram |last3=Knoops |first3=Sofie |last4=Pollenus |first4=Emilie |last5=Possemiers |first5=Hendrik |last6=Van Weyenbergh |first6=Johan |last7=Van den Steen |first7=Philippe E. |title=Resolution of experimental malaria-associated acute respiratory distress syndrome is Alox12 independent and shows residual inflammation |journal=Malaria Journal |date=4 July 2025 |volume=24 |issue=1 |article-number=216 |doi=10.1186/s12936-025-05462-y |doi-access=free |pmc=12228167 |pmid=40615878}}</ref>
Coinfection of HIV with malaria increases mortality.<ref name="Korenromp-2005" />
Other complications include an enlarged spleen, enlarged liver or both of these.<ref name="Bartoloni-2012" /> So-called blackwater fever occurs when haemoglobin from lysed red blood cells leaks into and discolours the urine; this often precedes kidney failure.<ref name="Bartoloni-2012" />
Malaria during pregnancy can cause stillbirths, infant mortality, miscarriage, and low birth weight,<ref name="Hartman-2010" /> particularly in ''P. falciparum'' infection, but also with ''P. vivax''.<ref name="Rijken-2012" />
==Cause== thumb|upright=1.6|The life cycle of malaria parasites: Sporozoites are introduced by a mosquito bite. When they reach the liver, they multiply into thousands of merozoites. The merozoites infect red blood cells and replicate, infecting more and more red blood cells. Some parasites form gametocytes, which are taken up by a mosquito, continuing the life cycle.
Malaria is caused by infection with parasites in the genus ''Plasmodium'', which are transmitted between the human hosts by mosquitoes in the genus ''Anopheles''.<ref name="CDC-About-2022">{{cite web |publisher=CDC-Centers for Disease Control and Prevention |date=22 March 2022 |title=Malaria - About Malaria - Disease |url=https://www.cdc.gov/malaria/about/disease.html |access-date=28 April 2022 |language=en-US |archive-date=24 May 2023 |archive-url=https://web.archive.org/web/20230524132501/https://www.cdc.gov/malaria/about/disease.html |url-status=live}}</ref>
=== Life cycle === The plasmodium parasite has a complex life cycle involving human and mosquito hosts, taking a different form at each stage of the cycle.<ref name="Arrow-2004" />
* The ''Anopheles'' mosquitoes initially get infected by ''Plasmodium'' by taking a blood meal from a previously infected person. The next time the mosquito feeds, its bite introduces ''Plasmodium''—in a mobile form called sporozoites—into a new human host.<ref name="Arrow-2004">{{cite book |author1=Institute of Medicine (US) Committee on the Economics of Antimalarial Drugs |last2=Arrow |first2=Kenneth J. |last3=Panosian |first3=Claire |last4=Gelband |first4=Hellen |title=Saving Lives, Buying Time: Economics of Malaria Drugs in an Age of Resistance |date=2004 |publisher=National Academies Press (US) |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK215619/ |chapter=The Parasite, the Mosquito, and the Disease |archive-date=16 June 2025 |access-date=19 January 2026 |archive-url=https://web.archive.org/web/20250616233733/https://www.ncbi.nlm.nih.gov/books/NBK215619/ |url-status=live }}</ref> * Within the human host, the sporozoites enter the bloodstream and travel to the liver, where they invade liver cells (hepatocytes).<ref name="Cowman-2016">{{cite journal |vauthors=Cowman AF, Healer J, Marapana D, Marsh K |date=October 2016 |title=Malaria: Biology and Disease |journal=Cell |volume=167 |issue=3 |pages=610–624 |doi=10.1016/j.cell.2016.07.055 |pmid=27768886 |doi-access=free}}</ref> * They grow and divide in the liver, with each infected hepatocyte eventually harboring up to 40,000 parasites.<ref name="Cowman-2016" /> After 5 to 25 days the infected hepatocytes break down, releasing ''Plasmodium''—in a smaller form called merozoites, into the bloodstream.<ref name="Arrow-2004" /> * In the blood, the merozoites rapidly invade individual red blood cells, with each replicating over 24–72 hours to form 16–32 new merozoites.<ref name="Cowman-2016" /> The infected red blood cell bursts, releasing new merozoites which again infect red blood cells, resulting in a cycle that continuously amplifies the number of parasites in an infected person.<ref name="Cowman-2016" /> * A small portion of parasites do not replicate, but instead develop into early sexual stage parasites called male and female gametocytes. These gametocytes develop in the bone marrow for 11 days, then return to the blood circulation to await uptake by the bite of another mosquito.<ref name="Cowman-2016" /> * Once inside a mosquito, the gametocytes undergo sexual reproduction, and eventually form daughter sporozoites that migrate to the mosquito's salivary glands to be injected into a new host when the mosquito next bites.<ref name="Cowman-2016" /><ref name="Arrow-2004" />
The liver infection causes no symptoms; all symptoms of malaria result from the infection of red blood cells.<ref name="Ashley-2018">{{cite journal |vauthors=Ashley EA, Pyae Phyo A, Woodrow CJ |date=April 2018 |title=Malaria |journal=The Lancet |volume=391 |issue=10130 |pages=1608–1621 |doi=10.1016/S0140-6736(18)30324-6 |pmid=29631781 }}</ref> Symptoms develop once there are more than around 100,000 parasites per milliliter of blood.<ref name="Ashley-2018" /> Many of the symptoms associated with severe malaria are caused by the tendency of ''P. falciparum'' to bind to blood vessel walls, resulting in damage to the affected vessels and surrounding tissue. Parasites sequestered in the blood vessels of the lung contribute to respiratory failure. In the brain, they contribute to coma. During pregnancy they accumulate in the intervillous space and hinder the function of the placenta, contributing to low birthweight and preterm labor, and increasing the risk of abortion and stillbirth.<ref name="Ashley-2018" /> The destruction of red blood cells during infection often results in anaemia, exacerbated by reduced production of new red blood cells during infection.<ref name="Ashley-2018" />
Only female mosquitoes feed on blood; male mosquitoes feed on plant nectar and do not transmit the disease. Females of the mosquito genus ''Anopheles'' prefer to feed at night. They usually start searching for a meal at dusk, and continue through the night until they succeed.<ref name="Arrow-2004" /> However, they may be adapting to the extensive use of bed nets and beginning to bite earlier, before bed-nets are deployed.<ref>{{cite web |vauthors=Goldman JG |title=Malaria Mosquitoes Are Biting before Bed-Net Time |url=https://www.scientificamerican.com/podcast/episode/malaria-mosquitoes-are-biting-before-bed-net-time/ |access-date=29 May 2023 |website=Scientific American |archive-date=29 May 2023 |archive-url=https://web.archive.org/web/20230529022719/https://www.scientificamerican.com/podcast/episode/malaria-mosquitoes-are-biting-before-bed-net-time/ |url-status=live}}</ref> Malaria parasites can also be transmitted by blood transfusions, although this is rare.<ref name="Owusu-Ofori-2010" />
=== ''Plasmodium'' species === In humans, malaria is caused by six ''Plasmodium'' species: ''P. falciparum'', ''P. malariae'', ''P. ovale curtisi'', ''P. ovale wallikeri'', ''P. vivax'' and ''P. knowlesi''.<ref name="Ashley-2018" /> Among those infected, ''P. falciparum'' is the most common species identified (~75%) followed by ''P. vivax'' (~20%).<ref name="Nadjm-2012" /> ''P. falciparum'' is prevalent in Africa and accounts for the majority of deaths,<ref name="Sarkar-2009" /> while ''P. vivax'' is dominant outside Africa.<ref name="Arnott-2012" /><ref name="WHO-Factsheet-2025" /> Some cases have been documented of human infections with several species of ''Plasmodium'' from higher apes, but except for ''P. knowlesi''—a zoonotic species that causes malaria in macaques<ref name="Collins-2012" />—these are mostly of limited public health importance.<ref name="Collins-2009" />
Two species—''P. vivax'' and ''P. ovale''—form a dormant stage called a hypnozoite which can persist in the liver, even after drug treatment has eliminated the infection from the blood. These can reactivate after weeks or months and cause relapse of the disease.<ref name="Arrow-2004" />
===Recurrent malaria=== Symptoms of malaria can recur after varying symptom-free periods. Depending upon the cause, recurrence can be classified as either recrudescence, relapse, or reinfection. Recrudescence is when symptoms return after a symptom-free period due to failure to remove blood-stage parasites by adequate treatment.{{sfn|WHO|2015|p=4}} Relapse is when symptoms reappear after the parasites have been eliminated from the blood but have persisted as dormant hypnozoites<ref>{{cite journal | vauthors=Markus MB | title=Malaria: origin of the term 'hypnozoite' | journal=Journal of the History of Biology | volume=44 | issue=4 | pages=781–786 | date=2011 | pmid=20665090 | doi=10.1007/s10739-010-9239-3 }}</ref> in liver cells. Reinfection means that parasites were eliminated from the entire body but a new infection has established. Recurrence of infection within two weeks of treatment ending is typically attributed to treatment failure.{{sfn|WHO|2015|p=41}}
==Pathophysiology== {{further|Plasmodium falciparum#Pathogenesis}} thumb|Electron micrograph of a ''Plasmodium falciparum''-infected red blood cell (center), illustrating adhesion protein "knobs"
Malaria infection develops via two phases: one that involves the liver (exoerythrocytic phase), and one that involves red blood cells, or erythrocytes (erythrocytic phase). When an infected mosquito pierces a person's skin to take a blood meal, sporozoites in the mosquito's saliva enter the bloodstream and migrate to the liver where they infect hepatocytes, multiplying asexually and asymptomatically for a period of 8–30 days.<ref name="Bledsoe-2005" /> During this time, these organisms differentiate to yield thousands of merozoites, which, following rupture of their host cells, escape into the blood and infect red blood cells to begin the erythrocytic stage of the life cycle.<ref name="Bledsoe-2005" />
The first phase of infection is asymptomatic; the clinical symptoms of malaria are all associated with the merozoite stage of the life cycle.<ref name="CDC-Features-2024" /> In this, the parasites multiply asexually within red blood cells, periodically breaking out to infect new ones. Within each infected erythrocyte, the parasite multiplies, consuming the cytoplasm as it does. After a period of 2 or 3 days, the erythrocyte bursts, releasing a number (between 16 and 32) of new merozoites.<ref>{{cite journal |last1=Bucşan |first1=Allison N. |last2=Williamson |first2=Kim C. |title=Setting the stage: The initial immune response to blood-stage parasites |journal=Virulence |date=31 December 2020 |volume=11 |issue=1 |pages=88–103 |doi=10.1080/21505594.2019.1708053 |pmc=6961725 |pmid=31900030}}</ref> This release of merozoites into the bloodstream, together with their waste products and fragments of erythrocyte, triggers fever and other symptoms which can be periodic and intense.<ref name="Bledsoe-2005" /><ref name="CDC-Features-2024" />
In some species of ''Plasmodium'', some sporozoites do not immediately develop into exoerythrocytic-phase merozoites, but instead, produce hypnozoites that remain dormant for periods ranging from several months (7–10 months is typical) to several years.<ref name="White-2011" /> After a period of dormancy, they reactivate and produce merozoites. Hypnozoites are responsible for long incubation and late relapses in ''P. vivax'' and ''P. ovale'' infections.<ref name="White-2011" /><ref>{{cite book |last1=Okafor |first1=Chika N. |last2=Finnigan |first2=Nancy A. |title=StatPearls |date=2026 |publisher=StatPearls Publishing |chapter-url=http://www.ncbi.nlm.nih.gov/books/NBK519021/ |chapter=Plasmodium ovale Malaria |pmid=30085563 }}</ref>
=== Immune system evasion === Immune evasion is a key feature of Plasmodium, underlying its success and persistence as a parasite.<ref>{{cite journal |last1=Rénia |first1=Laurent |last2=Goh |first2=Yun Shan |title=Malaria Parasites: The Great Escape |journal=Frontiers in Immunology |date=7 November 2016 |volume=7 |page=463 |doi=10.3389/fimmu.2016.00463 |doi-access=free |pmc=5098170 |pmid=27872623}}</ref> Approximately 10% of the ''Plasmodium'' genome is dedicated to mechanisms which avoid or subvert the immune system.<ref>{{cite journal |last1=Crabb |first1=Brendan S |last2=Cowman |first2=Alan F |title=Plasmodium falciparum virulence determinants unveiled |journal=Genome Biology |date=2002 |volume=3 |issue=11 |pages=reviews1031.1 |doi=10.1186/gb-2002-3-11-reviews1031 |pmid=12441004 |doi-access=free |pmc=244921 }}</ref>
==== Liver ==== thumb|Illustration of a merosome budding off from an infected hepatocyte
Specialised macrophages called Kupffer cells defend the liver; they identify alien material in the bloodstream and destroy it. Sporozoites attack Kupffer cells and neutralise them.<ref name="Pradel-2001">{{cite journal |last1=Pradel |first1=Gabriele |last2=Frevert |first2=Ute |title=Malaria Sporozoites Actively Enter and Pass Through Rat Kupffer Cells Prior to Hepatocyte Invasion |journal=Hepatology |date=May 2001 |volume=33 |issue=5 |pages=1154–1165 |doi=10.1053/jhep.2001.24237 |pmid=11343244 }}</ref> They transit through these impaired cells (which die after a few hours) to infect hepatocytes.<ref name="Pradel-2001" /> Within the hepatocyte, they generate thousands of merozoites within a vacuole which protects them from cellular defence mechanisms.<ref name="Ezema-2023">{{cite journal |last1=Ezema |first1=Chinonso Anthony |last2=Okagu |first2=Innocent Uzochukwu |last3=Ezeorba |first3=Timothy Prince Chidike |title=Escaping the enemy's bullets: an update on how malaria parasites evade host immune response |journal=Parasitology Research |date=August 2023 |volume=122 |issue=8 |pages=1715–1731 |doi=10.1007/s00436-023-07868-6 |pmc=10348937 |pmid=37219610 }}</ref> After a few days, the infected hepatocyte releases merozoites in batches called merosomes, which bud off from the hepatocyte's membrane. This membrane cloaks the merozoites, enabling them to sneak past the remaining Kupffer cells to exit the liver.<ref>{{cite journal |last1=Scheiner |first1=Mattea |last2=Burda |first2=Paul-Christian |last3=Ingmundson |first3=Alyssa |title=Moving on: How malaria parasites exit the liver |journal=Molecular Microbiology |date=March 2024 |volume=121 |issue=3 |pages=328–340 |doi=10.1111/mmi.15141 |pmid=37602900 }}</ref><ref name="Ezema-2023" /><ref name="Vaughan-2008" />
==== Circulation ==== thumb|An illustration of infected erythrocytes (IE) clustering in the intervillous space around placental villi.
Free merozoites in the blood circulation system are vulnerable to attack by leucocytes which target their surface antigens. The parasite defeats this defence by means of antigenic polymorphism;<ref>{{cite journal |last1=Gomes |first1=Pollyanna S. |last2=Bhardwaj |first2=Jyoti |last3=Rivera-Correa |first3=Juan |last4=Freire-De-Lima |first4=Celio G. |last5=Morrot |first5=Alexandre |title=Immune Escape Strategies of Malaria Parasites |journal=Frontiers in Microbiology |date=17 October 2016 |volume=7 |page=1617 |doi=10.3389/fmicb.2016.01617 |doi-access=free |pmc=5066453 |pmid=27799922}}</ref> at each stage of the life cycle it expresses a different variant of surface antigen, effectively a moving target which outpaces the adaptive immune system.<ref name="Ezema-2023" /> Once they penetrate a red blood cell (RBC) merozoites have a safe haven, masked from leucocytes and protected within a vacuole. Infected RBCs can nevertheless be detected and destroyed, either by the spleen or by phagocytes.<ref name="Lee-2022">{{cite journal |last1=Lee |first1=Wenn-Chyau |last2=Russell |first2=Bruce |last3=Rénia |first3=Laurent |title=Evolving perspectives on rosetting in malaria |journal=Trends in Parasitology |date=October 2022 |volume=38 |issue=10 |pages=882–889 |doi=10.1016/j.pt.2022.08.001 |pmid=36031553 |doi-access=free }}</ref> To avoid this fate, the merozoite generates adhesive proteins which appear as knobs on the surface of infected RBCs.<ref name="Tilley-2011">{{cite journal |last1=Tilley |first1=Leann |last2=Dixon |first2=Matthew W.A. |last3=Kirk |first3=Kiaran |title=The Plasmodium falciparum-infected red blood cell |journal=The International Journal of Biochemistry & Cell Biology |date=June 2011 |volume=43 |issue=6 |pages=839–842 |doi=10.1016/j.biocel.2011.03.012 |pmid=21458590 }}</ref> These work in two ways. They bind to uninfected RBCs forming clumps - nicknamed "rosettes" - in which the infected cell at the centre is shielded by the uninfected cells surrounding it; rosettes interfere with normal blood flow in capillaries.<ref name="Lee-2022" /> Alternatively infected RBCs can avoid passage through the spleen by adhering (sequestering) to the walls of blood vessels in tissues such as the brain, lungs, and intervillous spaces (in pregnancy).<ref>{{cite journal |last1=Franke-Fayard |first1=Blandine |last2=Fonager |first2=Jannik |last3=Braks |first3=Anneke |last4=Khan |first4=Shahid M. |last5=Janse |first5=Chris J. |title=Sequestration and Tissue Accumulation of Human Malaria Parasites: Can We Learn Anything from Rodent Models of Malaria? |journal=PLOS Pathogens |date=30 September 2010 |volume=6 |issue=9 |article-number=e1001032 |doi=10.1371/journal.ppat.1001032 |doi-access=free |pmc=2947991 |pmid=20941396 }}</ref> Both sequestered and rosetted types interfere with the normal organ functions, leading to complications such as cerebral malaria and pregnancy-associated malaria.<ref name="Ezema-2023" />
===Genetic resistance=== {{Main|Human genetic resistance to malaria}}
Due to the high levels of mortality and morbidity caused by malaria—especially the ''P. falciparum'' species—it has placed the greatest selective pressure on the human genome in recent history. Several genetic factors provide some resistance to it including sickle cell trait, thalassaemia traits, glucose-6-phosphate dehydrogenase deficiency, and the absence of Duffy antigens on red blood cells.<ref>{{cite journal | vauthors=Pierron D, Heiske M, Razafindrazaka H, Pereda-Loth V, Sanchez J, Alva O, Arachiche A, Boland A, Olaso R, Deleuze JF, Ricaut FX, Rakotoarisoa JA, Radimilahy C, Stoneking M, Letellier TD| title=Strong selection during the last millennium for African ancestry in the admixed population of Madagascar | journal=Nature Communications | volume=9 | issue=1 | article-number=932 | date=March 2018 | pmid=29500350 | pmc=5834599 | doi=10.1038/s41467-018-03342-5 | bibcode=2018NatCo...9..932P}}</ref><ref name="Kwiatkowski-2005" /><ref name="Hedrick-2011" />
The effect of sickle cell trait on malaria immunity illustrates some evolutionary trade-offs that have occurred because of endemic malaria. Sickle cell trait causes a change in the haemoglobin molecule in the blood. Normally, red blood cells have a very flexible, biconcave shape that allows them to move through narrow capillaries; however, when the modified haemoglobin S molecules are exposed to low amounts of oxygen, or crowd together due to dehydration, they can stick together forming strands that cause the cell to distort into a curved sickle shape. In these strands, the molecule is not as effective in taking or releasing oxygen, and the cell is not flexible enough to circulate freely. In the early stages of malaria, the parasite can cause infected red cells to sickle, and so they are removed from circulation sooner. This reduces the frequency with which malaria parasites complete their life cycle in the cell. Individuals who are homozygous (with two copies of the abnormal haemoglobin beta allele) have sickle-cell anaemia, while those who are heterozygous (with one abnormal allele and one normal allele) experience resistance to malaria without severe anaemia. Although the shorter life expectancy for those with the homozygous condition would tend to disfavour the trait's survival, the trait is preserved in malaria-prone regions because of the benefits provided by the heterozygous form.<ref name="Hedrick-2011" /><ref name="Weatherall-2008" />
==Diagnosis== {{Main|Diagnosis of malaria}}
[[File:5901 lores.jpg|thumb|The blood film is the gold standard for malaria diagnosis.]] [[File:Plasmodium.jpg|thumb|Ring-forms and gametocytes of ''Plasmodium falciparum'' in human blood]]
Due to the non-specific nature of malaria symptoms, diagnosis is typically suspected based on symptoms and travel history, then confirmed with a laboratory test to detect the presence of the parasite in the blood (parasitological test). In areas where malaria is common, the World Health Organization (WHO) recommends clinicians suspect malaria in any person who reports having fevers, or who has a current temperature above 37.5 °C without any other obvious cause.<ref name="WHO-2021a">{{cite book |url=https://www.who.int/publications/i/item/guidelines-for-malaria |title=WHO Guidelines for Malaria |date=13 July 2021 |publisher=World Health Organization |chapter=5.1 Diagnosing Malaria (2015) |access-date=20 January 2026 |archive-url=https://web.archive.org/web/20230318051541/https://www.who.int/publications/i/item/guidelines-for-malaria |archive-date=18 March 2023 |url-status=live}}</ref> Malaria should be suspected in children with signs of anaemia: pale palms or a laboratory test showing haemoglobin levels below 8 grams per deciliter of blood.<ref name="WHO-2021a" /> In areas of the world with little to no malaria, testing is only recommended for people with possible exposure to malaria (typically travel to a malaria-endemic area) and unexplained fever.<ref name="WHO-2021a" /><ref name="CDC-Diagnosis-2024c">{{Cite web |date=24 June 2024 |title=Malaria - Evaluation and Diagnosis |url=https://www.cdc.gov/malaria/hcp/clinical-guidance/evaluation-diagnosis.html |access-date=20 January 2026 |website=Centers for Disease Control and Prevention |language=en-us}}</ref>
Malaria is usually confirmed by the microscopic examination of blood films or by antigen-based rapid diagnostic tests (RDT). Microscopy—i.e. examining Giemsa-stained blood with a light microscope—is the gold standard for malaria diagnosis.<ref name="Ashley-2018" /> Microscopists typically examine both a "thick film" of blood, allowing them to scan many blood cells in a short time, and a "thin film" of blood, allowing them to clearly see individual parasites and identify the infecting ''Plasmodium'' species.<ref name="Ashley-2018" /> Under typical field laboratory conditions, a microscopist can detect parasites when there are at least 100 parasites per microliter of blood, which is around the lower range of symptomatic infection.<ref name="WHO-2021a" /> Microscopic diagnosis is relatively resource intensive, requiring trained personnel, specific equipment and a consistent supply of microscopy slides and stains.<ref name="WHO-2021a" />
Rapid diagnostic tests (RDTs) can be used to confirm a microscopic diagnosis;<ref name="CDC-Diagnosis-2024c" /> they are also used in places where microscopy is unavailable. RDTs are fast and easily deployed to places without full diagnostic laboratories.<ref name="WHO-2021a" /> The test detects parasite proteins in a fingerstick blood sample.<ref name="WHO-2021a" /> A variety of RDTs are available, targeting the parasite proteins lactate dehydrogenase, aldolase, or histidine rich protein 2 (HRP2, which is specific to ''P. falciparum'' only),.<ref name="WHO-2021a" /> The HRP2 test is widely used in Africa, where ''P. falciparum'' predominates.<ref name="Ashley-2018" /> However, since HRP2 persists in the blood for up to five weeks after an infection is treated, an HRP2 test sometimes cannot distinguish whether someone currently has malaria or previously had it.<ref name="WHO-2021a" /> Additionally, some ''P. falciparum'' parasites lack the ''HRP2'' gene, complicating detection.<ref>{{cite journal |last1=Poti |first1=Kristin E. |last2=Sullivan |first2=David J. |last3=Dondorp |first3=Arjen M. |last4=Woodrow |first4=Charles J. |title=HRP2: Transforming Malaria Diagnosis, but with Caveats |journal=Trends in Parasitology |date=February 2020 |volume=36 |issue=2 |pages=112–126 |doi=10.1016/j.pt.2019.12.004 |pmid=31848119 }}</ref> Rapid tests also cannot quantify the parasite burden in a person, nor the species of ''Plasmodium'' involved.<ref name="Daily 2025">{{cite journal |last1=Daily |first1=Johanna P. |last2=Parikh |first2=Sunil |date=3 April 2025 |title=Malaria |journal=New England Journal of Medicine |volume=392 |issue=13 |pages=1320–1333 |doi=10.1056/NEJMra2405313 |pmc=12331251 |pmid=40174226}}</ref><ref name="CDC-Diagnosis-2024c" />
A polymerase chain reaction (PCR) test is the most sensitive method for diagnosing malaria. The test amplifies parasite DNA in blood; it can detect ''Plasmodium'' and identify the species, even at very low levels in the blood.<ref name="Fisher-2022">{{Cite web |last=Fisher |first=John F. |date=2 August 2022 |title=Testing for malaria: Rapid diagnostic tests and PCR |url=https://www.medmastery.com/guides/malaria-clinical-guide/testing-malaria-rapid-diagnostic-tests-rdts-and-polymerase-chain |access-date=20 January 2026 |website=Medmastery GmbH}}</ref> It requires specialised laboratory equipment so is rarely available in developing countries; it is generally used in developed world to confirm diagnosis in returning travellers.<ref name="Fisher-2022" /><ref name="CDC-Diagnosis-2024c" />
In April 2026, WHO prequalified three rapid diagnostic tests designed to detect P. falciparum strains with pfhrp2 deletions, which can evade commonly used HRP2-based tests and cause false-negative results. The new tests target the parasite protein pf-LDH and are recommended where more than 5% of malaria cases are missed because of pfhrp2 deletions.<ref name=prefir/>
==Treatment== [[File:"British India", six stages of malaria. Wellcome L0022443.jpg|alt=Advertisement entitled "The Mosquito Danger". Includes 6 panel cartoon:#1 breadwinner has malaria, family starving; #2 wife selling ornaments; #3 doctor administers quinine; #4 patient recovers; #5 doctor indicating that quinine can be obtained from post office if needed again; #6 man who refused quinine, dead on stretcher.|thumb|An advertisement for quinine as a malaria treatment from 1927]] thumb|''Artemisia annua'', also known as sweet wormwood, the original source of artemisinin<!--Editors please cite reliable secondary sources and check WP:NOTATEXTBOOK-->
Malaria is treated with antimalarial medications. To ensure a complete cure and prevent the parasite from developing drug resistance, treatment guidelines since 2001 generally require two drugs in combination, with one of them being a derivative of artemesinin and the other a complementary drug.<ref>{{Cite web|title=Multiple first-line therapies as part of the response to antimalarial drug resistance|url=https://www.who.int/publications/i/item/9789240103603|access-date=24 January 2026|website=www.who.int|language=en|archive-date=27 January 2026|archive-url=https://web.archive.org/web/20260127213804/https://www.who.int/publications/i/item/9789240103603|url-status=live}}</ref><ref>{{Cite web |date=May 2025|title=Antimalarial drug resistance|url=https://www.mmv.org/our-work/antimalarial-drug-resistance|access-date=24 January 2026|website=Medicines for Malaria Venture|language=en}}</ref> The exact combination of drugs depends on the ''Plasmodium'' species involved, the probability of drug resistance, relevant facts from the patient's medical and travel history, and any previous use of antimalarials.<ref>{{cite journal |last1=Shahbodaghi |first1=S. David |last2=Rathjen |first2=Nicholas A. |title=Malaria: Prevention, Diagnosis, and Treatment |journal=American Family Physician |date=September 2022 |volume=106 |issue=3 |pages=270–278 |url=https://www.aafp.org/link_out?pmid=36126008 |pmid=36126008 }}</ref><ref name="CDC-Treatment-2024">{{Cite web |date=26 March 2024 |title=General Approach to Treatment |url=https://www.cdc.gov/malaria/hcp/clinical-guidance/general-treatment.html |access-date=21 January 2026 |website=Centers for Disease Control and Prevention |language=en-us}}</ref> Treatment regimens in national formularies{{Efn|Examples of formularies: UK<ref name="WHO-Briefing-2024" />, USA,<ref>{{Cite web |date=14 August 2024 |title=Appendix A: Malaria in the United States: Treatment Tables |url=https://www.cdc.gov/malaria/hcp/clinical-guidance/malaria-treatment-tables.html |access-date=26 January 2026 |website=Centers for Disease Control and Prevention |language=en-us |archive-date=7 February 2026 |archive-url=https://web.archive.org/web/20260207212724/https://www.cdc.gov/malaria/hcp/clinical-guidance/malaria-treatment-tables.html |url-status=live }}</ref> Canada<ref>{{Cite web |last=Canada |first=Public Health Agency of |date=10 March 2021 |title=Chapter 7 - Treatment of malaria: Canadian recommendations for the prevention and treatment of malaria |url=https://www.canada.ca/en/public-health/services/catmat/canadian-recommendations-prevention-treatment-malaria/chapter-7-treatment.html |access-date=26 January 2026 |website=www.canada.ca |archive-date=19 January 2026 |archive-url=https://web.archive.org/web/20260119083613/https://www.canada.ca/en/public-health/services/catmat/canadian-recommendations-prevention-treatment-malaria/chapter-7-treatment.html |url-status=live }}</ref>}} are generally based on guidelines issued by WHO which are updated regularly.<ref name="WHO-Guidelines-9.1-2025">{{Cite web|date=13 August 2025|title=MAGICapp - WHO guidelines for malaria v9.1|url=https://app.magicapp.org/#/guideline/LwRMXj|access-date=23 January 2026|website=app.magicapp.org|archive-date=25 September 2020|archive-url=https://web.archive.org/web/20200925214841/https://app.magicapp.org/#/guideline/LwRMXj|url-status=live}}</ref><ref>{{Cite web |title=New and updated malaria guidance|url=https://www.who.int/teams/global-malaria-programme/guideline-development-process/new-and-updated-malaria-guidance|access-date=25 January 2026|website=www.who.int|language=en}}</ref>
Several classes of drugs can be used as components of combination therapies. Artemisinin-based drugs include artemether and artesunate.<ref name="Arrow-2004a">{{cite book |author1=Institute of Medicine (US) Committee on the Economics of Antimalarial Drugs |last2=Arrow |first2=Kenneth J. |last3=Panosian |first3=Claire |last4=Gelband |first4=Hellen |title=Saving Lives, Buying Time: Economics of Malaria Drugs in an Age of Resistance |date=2004 |publisher=National Academies Press (US) |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK215631/ |chapter=Antimalarial Drugs and Drug Resistance }}</ref> Quinoline derivatives include chloroquine, quinine, and mefloquine. Antifolate compounds include pyrimethamine, proguanil, and sulfadoxine.<ref name="Arrow-2004a" /> Other drugs include lumefantrine, atovaquone, doxycycline and clindamycin.<ref name="Evans-2025">{{Cite web|last1=Evans|first1=M|last2=Hill|first2=K|date=May 2025|title=Malaria Treatment Guidance|url=https://www.nhstaysideadtc.scot.nhs.uk/Antibiotic%20site/pdf%20docs/MalariaAlgorithm07.pdf|access-date=24 January 2026|website=NHS Tayside|archive-date=23 July 2025|archive-url=https://web.archive.org/web/20250723165829/https://www.nhstaysideadtc.scot.nhs.uk/Antibiotic%20site/pdf%20docs/MalariaAlgorithm07.pdf|url-status=live}}</ref><ref name="CDC-Treatment-2025">{{Cite web |last=CDC|date=24 June 2025|title=Treatment of Uncomplicated Malaria|url=https://www.cdc.gov/malaria/hcp/clinical-guidance/treatment-uncomplicated.html|access-date=24 January 2026|website=Centers for Disease Control and Prevention|language=en-us}}</ref>
Malaria is generally classified as either "severe" or "uncomplicated".<ref name="Nadjm-2012" /><ref name="CDC-Treatment-2024" /> Symptoms which indicate severe malaria include the following (not a complete list):<ref name="CDC-Treatment-2024" />{{sfn|WHO|2015|p=73}}
* Decreased consciousness, coma, convulsions * Severe anaemia * Acute respiratory distress syndrome * Kidney failure or haemoglobin in the urine * Jaundice * Acidosis or lactate levels of greater than 5 mmol/L * A high level of parasites visible in a blood smear.
=== Uncomplicated malaria === Uncomplicated malaria can be treated using oral medication taken for between 3 and 7 days.<ref name="CDC-Treatment-2025" /> The drug regimen should be selected according to ''Plasmodium'' species, location and patient's history. As an example, the most common first-line treatment for uncomplicated ''P. falciparum'' malaria is Artemether-lumefantrine taken orally over three days.<ref name="Lalloo-2016">{{cite journal |last1=Lalloo |first1=David G. |last2=Shingadia |first2=Delane |last3=Bell |first3=David J. |last4=Beeching |first4=Nicholas J. |last5=Whitty |first5=Christopher J.M. |last6=Chiodini |first6=Peter L. |title=UK malaria treatment guidelines 2016 |journal=Journal of Infection |date=June 2016 |volume=72 |issue=6 |pages=635–649 |doi=10.1016/j.jinf.2016.02.001 |pmc=7132403 |pmid=26880088 }}</ref><ref name="Evans-2025" /> In 2026, WHO prequalified the first artemether-lumefantrine formulation specifically developed for newborns and young infants weighing between 2 and 5 kg.<ref name=prefir>{{cite web | title=WHO prequalifies first-ever malaria treatment for newborns and infants, adds new diagnostic tests | website=World Health Organization (WHO) | date=24 April 2026 | url=https://www.who.int/news/item/24-04-2026-who-prequalifies-first-ever-malaria-treatment-for-newborns-and-infants-adds-new-diagnostic-tests | ref={{sfnref| World Health Organization (WHO)|2026}} | access-date=28 April 2026 | archive-date=27 April 2026 | archive-url=https://web.archive.org/web/20260427164029/https://www.who.int/news/item/24-04-2026-who-prequalifies-first-ever-malaria-treatment-for-newborns-and-infants-adds-new-diagnostic-tests | url-status=live }}</ref>
This treatment is not always suitable, so other drug combinations are recommended.<ref name="CDC-Treatment-2025" /> Treatment should start as soon as possible after diagnosis, in order to prevent severe symptoms from developing.<ref>{{Cite web|title=General Approach to Treatment|url=https://www.cdc.gov/malaria/hcp/clinical-guidance/general-treatment.html|website=Malaria|date=20 May 2025|access-date=25 January 2026|language=en-us|last=CDC}}</ref> In case of infection by ''P. vivax or P. ovale'' (which form dormant hypnozoites in the liver) treatment should continue for a further 7 to 14 days.<ref name="CDC-Treatment-2025" />
=== Severe and complicated malaria === Severe malaria is generally caused by ''P. falciparum''; it is almost always fatal if untreated.<ref>{{cite journal |last1=Walter |first1=Kristin |last2=John |first2=Chandy C. |title=Malaria |journal=JAMA |date=8 February 2022 |volume=327 |issue=6 |page=597 |doi=10.1001/jama.2021.21468 |pmid=35133414 |hdl=1805/37679 |hdl-access=free }}</ref> Even with treatment, the fatality rate is estimated between 13% and 20%, with survivors often facing long term after-effects.<ref>{{cite journal |last1=Sheehy |first1=Susanne Helena |last2=Angus |first2=Brian John |title=Malaria: severe, life-threatening |journal=BMJ Clinical Evidence |date=7 March 2011 |volume=2011 |pmc=3217801 |pmid=21375787 }}</ref> The standard treatment is intravenous artesunate, switching to oral medication once the patient is stable.<ref name="Evans-2025" /><ref>{{Cite web|title=Treatment of Severe Malaria|url=https://www.cdc.gov/malaria/hcp/clinical-guidance/treatment-of-severe-malaria.html|website=Malaria|date=3 April 2024|access-date=25 January 2026|language=en-us|last=CDC|archive-date=3 May 2025|archive-url=https://web.archive.org/web/20250503143920/https://www.cdc.gov/malaria/hcp/clinical-guidance/treatment-of-severe-malaria.html|url-status=live}}</ref> Patients may deteriorate rapidly so close monitoring, preferably in a high dependency unit, is vital.<ref>{{cite journal |last1=Lalloo |first1=David G. |last2=Shingadia |first2=Delane |last3=Bell |first3=David J. |last4=Beeching |first4=Nicholas J. |last5=Whitty |first5=Christopher J.M. |last6=Chiodini |first6=Peter L. |last7=PHE Advisory Committee on Malaria Prevention in UK |first7=Travellers |title=UK malaria treatment guidelines 2016 |journal=Journal of Infection |date=June 2016 |volume=72 |issue=6 |pages=635–649 |doi=10.1016/j.jinf.2016.02.001 |pmid=26880088 |pmc=7132403 }}</ref>
=== Pregnancy === Malaria in pregnancy is more likely to be serious, possibly fatal, for both mother and child; pregnant women are three times more likely to develop severe malaria.<ref name="CDC-Pregnant-2024">{{Cite web|last=CDC|date=3 April 2024|title=Alternatives for Pregnant Women|url=https://www.cdc.gov/malaria/hcp/clinical-guidance/pregnant-women.html|access-date=26 January 2026|website=Malaria|language=en-us|archive-date=18 March 2026|archive-url=https://web.archive.org/web/20260318025909/https://www.cdc.gov/malaria/hcp/clinical-guidance/pregnant-women.html|url-status=live}}</ref> Some drugs could injure the developing embryo, especially during the first trimester. Special treatment regimens are recommended, which vary according to the trimester and pose minimal risk.<ref name="CDC-Pregnant-2024" /><ref>{{Cite web|title=Antimalarial drugs for pregnant women|url=https://www.mmv.org/our-work/antimalarial-drugs-pregnant-women|access-date=26 January 2026|website=Medicines for Malaria Venture|language=en|archive-date=22 September 2025|archive-url=https://web.archive.org/web/20250922102803/https://www.mmv.org/our-work/antimalarial-drugs-pregnant-women|url-status=live}}</ref>
===Drug resistance=== Drug resistance poses a growing problem in malaria treatment; ''Plasmodium'' populations have a high level of genetic diversity and a rapid reproduction rate which enable them to adapt and evade challenges from antimalarials.<ref name="Sinha-2014" /><ref>{{cite journal |last1=Igwe |first1=Matthew Chibunna |last2=Ogbuabor |first2=Ogbonna Alphonsus |last3=Obeagu |first3=Emmanuel Ifeanyi |title=Evolutionary biology of antimalarial drug resistance: Understanding of the evolutionary dynamics |journal=Medicine |date=14 March 2025 |volume=104 |issue=11 |article-number=e41878 |doi=10.1097/MD.0000000000041878 |doi-broken-date=23 May 2026 |pmid=40101051 |pmc=11922465 }}</ref> ''P. falciparum'' parasites began to develop resistance to the first synthetic antimalarial, chloroquine, in the 1950s;<ref name="MMV-History">{{Cite web |title=History of antimalarial drugs |url=https://www.mmv.org/malaria-medicines/history-antimalarials-drugs |access-date=27 January 2026 |website=Medicines for Malaria Venture |language=en |archive-date=16 June 2025 |archive-url=https://web.archive.org/web/20250616062607/https://www.mmv.org/malaria-medicines/history-antimalarials-drugs |url-status=live }}</ref> since then chloroquine resistance has spread to almost the entire range of this species.<ref>{{Cite web |last=CDC |date=8 April 2024 |title=Drug Resistance in the Malaria-Endemic World |url=https://www.cdc.gov/malaria/php/public-health-strategy/drug-resistance.html |access-date=27 January 2026 |website=Malaria |language=en-us |archive-date=7 September 2025 |archive-url=https://web.archive.org/web/20250907153441/https://www.cdc.gov/malaria/php/public-health-strategy/drug-resistance.html |url-status=live }}</ref> Resistance to proguanil developed even more rapidly; the drug was introduced in 1948 and resistance began to be noted the next year, in 1949.<ref name="MMV-History" /> In 2001, malaria with partial resistance to artemisinin emerged in Southeast Asia; resistance has subsequently spread to parts of Africa.<ref name="MMV-History" /><ref>{{Cite web |date=25 April 2023 |title=Current antimalarial drugs at risk due to resistance |url=https://www.ndm.ox.ac.uk/news/current-antimalarial-drugs-at-risk-due-to-resistance |access-date=27 January 2026 |website=Nuffield Department of Medicine, Oxford University |language=en |archive-date=20 January 2026 |archive-url=https://web.archive.org/web/20260120025023/https://www.ndm.ox.ac.uk/news/current-antimalarial-drugs-at-risk-due-to-resistance |url-status=live }}</ref> In order to overcome resistance, drugs may be given in combination, in higher doses, or for longer periods; there is an urgent need for new drugs to be brought on line.<ref name="MMV-History" /><ref>{{Cite journal |last1=Antony |first1=HiasindhAshmi |last2=Parija |first2=SubhashChandra |date=2016 |title=Antimalarial drug resistance: An overview |journal=Tropical Parasitology |volume=6 |issue=1 |pages=30–41 |doi=10.4103/2229-5070.175081 |doi-access=free |pmc=4778180 |pmid=26998432}}</ref>
==Prognosis== When properly treated, people with uncomplicated malaria can usually expect a complete recovery.<ref name="CDC-FAQ-2010a" /> However, severe malaria can progress extremely rapidly and cause death within hours or days.<ref name="Trampuz-2003" /> In the most severe cases of the disease, fatality rates can reach 20%, even with intensive care and treatment.<ref name="Nadjm-2012" />
Malaria has the potential to cause permanent damage to many organs, especially the brain, kidney, liver and spleen.<ref>{{Cite web |date=12 May 2025 |title=Malaria: MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/article/000621.htm |access-date=28 January 2026 |website=medlineplus.gov |language=en |archive-date=17 November 2016 |archive-url=https://web.archive.org/web/20161117064956/https://medlineplus.gov/ency/article/000621.htm |url-status=live }}</ref> During childhood, malaria causes anaemia during a period of rapid brain development, and also direct brain damage resulting from cerebral malaria.<ref name="Fernando-2010" /> Survivors of cerebral malaria have an increased risk of neurological and cognitive deficits, behavioural disorders, and epilepsy.<ref name="Idro-2010">{{cite journal |vauthors=Idro R, Marsh K, John CC, Newton CR |date=October 2010 |title=Cerebral malaria: mechanisms of brain injury and strategies for improved neurocognitive outcome |journal=Pediatric Research |volume=68 |issue=4 |pages=267–274 |doi=10.1203/pdr.0b013e3181eee738 |pmc=3056312 |pmid=20606600}}</ref>
==Prevention== [[File:Anopheles stephensi.jpeg|thumb|An ''Anopheles stephensi'' mosquito shortly after obtaining blood from a human (the droplet of blood is expelled as a surplus). This mosquito is a vector of malaria, and mosquito control is an effective way of reducing its incidence.]]
Methods used to prevent malaria include vaccination, prophylactic medication, mosquito elimination and the prevention of bites.<ref name="WHO-Factsheet-2025" />
=== Vaccines === {{Main|Malaria vaccine}}
It has proved very difficult to develop an effective malaria vaccine. The parasite has evolved several strategies to evade the human immune response.<ref>{{Cite journal |last1=Gomes |first1=Pollyanna S. |last2=Bhardwaj |first2=Jyoti |last3=Rivera-Correa |first3=Juan |last4=Freire-De-Lima |first4=Celio G. |last5=Morrot |first5=Alexandre |date=2016 |title=Immune Escape Strategies of Malaria Parasites |journal=Frontiers in Microbiology |volume=7 |page=1617 |doi=10.3389/fmicb.2016.01617 |pmc=5066453 |pmid=27799922 |doi-access=free}}</ref> There are five species of ''plasmodium''; each of these has three life stages in the human host—sporozoite, merozoite, and gametocyte. Each stage has different antigens on its surface, meaning that an immune response against one stage is not effective against the others.<ref name="Good-2021">{{cite journal |last1=Good |first1=Michael F. |last2=Stanisic |first2=Danielle I. |title=Biological strategies and political hurdles in developing malaria vaccines |journal=Expert Review of Vaccines |date=February 2021 |volume=20 |issue=2 |pages=93–95 |doi=10.1080/14760584.2021.1889094 |pmid=33595407 |hdl=10072/402649 |hdl-access=free }}</ref> In addition, genetic variation in the parasites means that the antigens themselves can vary even within a single life stage.<ref name="Good-2021" /><ref>{{Cite journal |last1=Day |first1=Karen P. |last2=Artzy-Randrup |first2=Yael |last3=Tiedje |first3=Kathryn E. |last4=Rougeron |first4=Virginie |last5=Chen |first5=Donald S. |last6=Rask |first6=Thomas S. |last7=Rorick |first7=Mary M. |last8=Migot-Nabias |first8=Florence |last9=Deloron |first9=Philippe |last10=Luty |first10=Adrian J. F. |last11=Pascual |first11=Mercedes |date=16 May 2017 |title=Evidence of strain structure in Plasmodium falciparum var gene repertoires in children from Gabon, West Africa |journal=Proceedings of the National Academy of Sciences |volume=114 |issue=20 |pages=E4103–E4111 |doi=10.1073/pnas.1613018114 |doi-access=free |pmc=5441825 |pmid=28461509 |bibcode=2017PNAS..114E4103D }}</ref> As a consequence, natural immunity seems to develop slowly—acquired through multiple infections—is only partial, and is not long lasting.<ref name="Crutcher-1996">{{cite book |last1=Crutcher |first1=James M. |last2=Hoffman |first2=Stephen L. |title=Medical Microbiology |date=1996 |publisher=University of Texas Medical Branch at Galveston |isbn=978-0-9631172-1-2 |edition=4th |chapter-url=http://www.ncbi.nlm.nih.gov/books/NBK8584/ |chapter=Malaria |pmid=21413352 |archive-date=23 April 2021 |access-date=9 January 2026 |archive-url=https://web.archive.org/web/20210423100221/https://www.ncbi.nlm.nih.gov/books/NBK8584/ |url-status=live }}</ref><ref name="CDC-Vaccines-2024">{{Cite web |last=CDC |date=2 April 2024 |title=Malaria Vaccines |url=https://www.cdc.gov/malaria/php/public-health-strategy/malaria-vaccines.html |access-date=9 January 2026 |website=Centers for Disease Control and Prevention |language=en-us |archive-date=12 January 2026 |archive-url=https://web.archive.org/web/20260112092027/https://www.cdc.gov/malaria/php/public-health-strategy/malaria-vaccines.html |url-status=live }}</ref> The Malaria Vaccine Technology Roadmap has set a target for new malaria vaccines to have a protective efficacy of at least 75% against clinical malaria.<ref name="CDC-Vaccines-2024" />
The first promising vaccine studies into a malaria vaccine were performed in 1967 by immunising mice with live, radiation-attenuated ''Plasmodium'' sporozoites, which provided significant protection to the mice upon subsequent injection with normal, viable sporozoites.<ref>{{cite journal |last1=Nussenzweig |first1=R. S. |last2=Vanderberg |first2=J. |last3=Most |first3=H. |last4=Orton |first4=C. |title=Protective Immunity produced by the Injection of X-irradiated Sporozoites of Plasmodium berghei |journal=Nature |date=October 1967 |volume=216 |issue=5111 |pages=160–162 |doi=10.1038/216160a0 |bibcode=1967Natur.216..160N |pmid=6057225 }}</ref><ref name="Vanderberg-2009" />
In 2013, the WHO and the malaria vaccine funders group set a goal to develop vaccines designed to interrupt malaria transmission with the long-term goal of malaria eradication.<ref>{{cite web |title=World Malaria Report 2013 |url=https://www.who.int/entity/malaria/publications/world_malaria_report_2013/wmr2013_no_profiles.pdf?ua=1 |access-date=13 February 2014 |publisher=World Health Organization |format=PDF}}</ref> {{As of|2026|February}}, two malaria vaccines have been licensed for use.<ref name="WHO recommends R21-2023" />
The first approved vaccine targeting ''P. falciparum'' is RTS,S, known by the brand name Mosquirix,<ref name="EMA Mosquirix">{{cite web |date=October 2015 |title=Mosquirix: Opinion on medicine for use outside EU |url=https://www.ema.europa.eu/en/opinion-medicine-use-outside-EU/human/mosquirix |url-status=live |archive-url=https://web.archive.org/web/20191123055901/https://www.ema.europa.eu/en/mosquirix-h-w-2300 |archive-date=23 November 2019 |access-date=22 November 2019 |website=European Medicines Agency (EMA)}}</ref> which completed clinical trials in 2014. The WHO adopted a cautious approach to awarding it prequalification and, as part of the Malaria Vaccine Implementation Programme (MVIP) approved pilot programs in three sub-Saharan African countries—Ghana, Kenya and Malawi—starting in 2019. These programs targeted children under 5, who are particularly at risk of severe infection and death.<ref>{{cite journal |last1=Willyard |first1=Cassandra |title=The slow roll-out of the world's first malaria vaccine |journal=Nature |date=22 December 2022 |volume=612 |issue=7941 |pages=S48–S49 |doi=10.1038/d41586-022-04343-7 |pmid=36536213 |bibcode=2022Natur.612S..48W }}</ref><ref>{{cite web |author=World Health Organization |date=March 2020 |title=Q&A on the malaria vaccine implementation programme (MVIP) |url=https://www.who.int/malaria/media/malaria-vaccine-implementation-qa/en/ |url-status=live |archive-url=https://web.archive.org/web/20200513074401/https://www.who.int/malaria/media/malaria-vaccine-implementation-qa/en/ |archive-date=13 May 2020 |access-date=6 May 2020 |publisher=WHO}}</ref> Up to 2023, three million children had received the vaccine,<ref>{{Cite web |title=Life-saving malaria vaccines reach children in 17 endemic countries in 2024 |url=https://www.who.int/news-room/feature-stories/detail/life-saving-malaria-vaccines-reach-children-in-17-endemic-countries-in-2024 |access-date=10 January 2026 |website=www.who.int |language=en |archive-date=28 December 2025 |archive-url=https://web.archive.org/web/20251228035119/https://www.who.int/news-room/feature-stories/detail/life-saving-malaria-vaccines-reach-children-in-17-endemic-countries-in-2024 |url-status=live }}</ref> showing a significantly reduced incidence of malaria as well as a reduction in childhood mortality (from all causes) of 13%.<ref name="WHO-Factsheet-2025" /><ref>{{Cite web |last=Holmes |first=David |date=7 November 2023 |title=RTS,S vaccine pilot: 13% mortality reduction fuels hope for malaria control |url=https://www.gavi.org/vaccineswork/rtss-vaccine-pilot-13-mortality-reduction-fuels-hope-malaria-control |access-date=10 January 2026 |website=GAVI The Vaccine Alliance |language=en}}</ref>
The second vaccine is R21/Matrix-M, with a 77% efficacy rate shown in initial trials and significantly higher antibody levels than with the RTS,S vaccine.<ref name="Roxby-2021">{{Cite web |date=23 April 2021 |title=Malaria vaccine hailed as potential breakthrough |url=https://www.bbc.com/news/health-56858158 |url-status=live |archive-url=https://web.archive.org/web/20210424010402/https://www.bbc.com/news/health-56858158 |archive-date=24 April 2021 |access-date=24 April 2021 |publisher=BBC News |vauthors=Roxby P}}</ref><ref name="EurekAlert-2021">{{Cite press release |date=23 April 2021 |title=Malaria vaccine becomes first to achieve WHO-specified 75% efficacy goal |url=https://www.eurekalert.org/news-releases/744976 |url-status=live |archive-url=https://web.archive.org/web/20210727180115/https://www.eurekalert.org/news-releases/744976 |archive-date=27 July 2021 |access-date=24 April 2021 |website=EurekAlert!}}</ref> The R-21/Matrix M malaria vaccine was found to reduce cases of malaria by 75% in areas with seasonal spread and by 68% in areas of year-round spread in children in sub-Saharan Africa.<ref>{{cite journal |last1=Datoo |first1=Mehreen |last2=Dicko |first2=Alassane |last3=Tinto |first3=Halidou |display-authors=etal |date=10 February 2024 |title=Safety and efficacy of malaria vaccine candidate R21/Matrix-M in African children: a multicentre, double-blind, randomised, phase 3 trial |journal=The Lancet |volume=403 |issue=10426 |pages=533–544 |doi=10.1016/S0140-6736(23)02511-4 |pmid=38310910 |pmc=7618965 }}</ref> The R-21/Matrix M malaria vaccine was endorsed by the WHO for the prevention of malaria in children in 2023.<ref name="WHO recommends R21-2023" />
===Mosquito control=== [[File:Mansprayingkeroseneoil.jpg|thumb|Man spraying kerosene oil in standing water, Panama Canal Zone, 1912]]{{Main|Mosquito control}}
The objective of mosquito control is to stop mosquitoes from biting humans - either by using some forms of barrier, or by reducing mosquito numbers. They can broadly be classified as personal protection, environmental controls outside buildings, indoor measures within houses and buildings, and those incorporated into the fabric of buildings.<ref name="EPA-Control-2016">{{Cite web|title=Success in Mosquito Control: An Integrated Approach|url=https://www.epa.gov/mosquitocontrol/success-mosquito-control-integrated-approach|website=www.epa.gov|date=5 July 2016|access-date=1 February 2026|language=en|first=OCSPP|last=US EPA|archive-date=6 February 2026|archive-url=https://web.archive.org/web/20260206223356/https://www.epa.gov/mosquitocontrol/success-mosquito-control-integrated-approach|url-status=live}}</ref>
==== Personal protection ==== Insect repellent, such as DEET or picaridin, is recommended for travellers. Loose clothing that covers most of the body is also recommended. Clothing may be treated with permethrin as an additional safeguard.<ref name="mosquitobiteavoidance">{{Cite web |title=Mosquito bite avoidance: advice for travellers |url=https://www.gov.uk/government/publications/mosquito-bite-avoidance-for-travellers/mosquito-bite-avoidance-advice-for-travellers--2 |access-date=2 February 2026 |website=GOV.UK |language=en |archive-date=24 January 2023 |archive-url=https://web.archive.org/web/20230124113031/https://www.gov.uk/government/publications/mosquito-bite-avoidance-for-travellers/mosquito-bite-avoidance-advice-for-travellers--2 |url-status=live }}</ref><ref>{{Cite web |title=Avoid bug bites {{!}} Travelers' Health {{!}} CDC |url=https://wwwnc.cdc.gov/travel/page/avoid-bug-bites |access-date=2 February 2026 |website=wwwnc.cdc.gov |archive-date=13 March 2016 |archive-url=https://web.archive.org/web/20160313104044/http://wwwnc.cdc.gov/travel/page/avoid-bug-bites |url-status=live }}</ref>
==== Environmental control ==== Since many mosquitoes breed in standing water, source reduction can be as simple as emptying water from containers around the home, by filling or draining puddles, swampy areas, and tree stumps. Eliminating such mosquito breeding areas can be an extremely effective and permanent way to reduce mosquito populations without resorting to insecticides.<ref>{{cite journal |vauthors=Healy K, Hamilton G, Crepeau T, Healy S, Unlu I, Farajollahi A, Fonseca DM |date=25 September 2014 |title=Integrating the public in mosquito management: active education by community peers can lead to significant reduction in peridomestic container mosquito habitats |journal=PLOS ONE |volume=9 |issue=9 |bibcode=2014PLoSO...9j8504H |doi=10.1371/journal.pone.0108504 |pmc=4177891 |pmid=25255027 |doi-access=free |article-number=e108504 |editor-first1=Nigel |editor-last1=Beebe}}</ref> It is also possible to use larvicides to kill mosquito larvae in pools or puddles that cannot be drained.<ref name="Mississippi-2025">{{Cite web |date=13 February 2025 |title=Mosquito Prevention: What the Homeowner Can Do |url=https://www.msdh.ms.gov/page/14,1097,93.html |access-date=2 February 2026 |website=Mississippi State Department of Health |language=en |archive-date=14 February 2026 |archive-url=https://web.archive.org/web/20260214232607/https://www.msdh.ms.gov/page/14,1097,93.html |url-status=live }}</ref>
==== Indoors ==== Insecticide-treated nets (ITNs) and indoor residual spraying (IRS) are effective, have been widely used to prevent malaria, and their use has contributed significantly to reducing the prevalence of malaria in the 21st century.<ref name="Fox-2022">{{cite journal |vauthors=Fox T, Furnival-Adams J, Chaplin M, Napier M, Olanga EA |date=October 2022 |title=House modifications for preventing malaria |journal=The Cochrane Database of Systematic Reviews |volume=2022 |issue=10 |doi=10.1002/14651858.CD013398.pub4 |pmc=9536247 |pmid=36200610 |article-number=CD013398}}</ref><ref name="mosquitobiteavoidance" /><ref name="Pluess-2010">{{cite journal |vauthors=Pluess B, Tanser FC, Lengeler C, Sharp BL |date=April 2010 |title=Indoor residual spraying for preventing malaria |journal=The Cochrane Database of Systematic Reviews |volume=2010 |issue=4 |doi=10.1002/14651858.CD006657.pub2 |pmc=6532743 |pmid=20393950 |article-number=CD006657 |veditors=Lengeler C}}</ref> ITNs and IRS may not be sufficient to eliminate the disease, as these interventions depend on how many people use nets, how many gaps in insecticide there are (low coverage areas), if people are not protected when outside of the home, and an increase in mosquitoes that are resistant to insecticides.<ref name="Fox-2022" />
===== Insecticide-treated nets ===== thumb|A mosquito net in use
Mosquito nets help keep mosquitoes away from people and reduce infection rates and transmission of malaria. Nets are not a perfect barrier and are often treated with an insecticide designed to kill the mosquito before it has time to find a way past the net. (ITNs are estimated to be twice as effective as untreated nets and offer greater than 70% protection compared with no net.<ref name="Raghavendra-2011" />
Most nets are impregnated with pyrethroids, a class of insecticides with low toxicity; they are most effective when used from dusk to dawn.<ref>{{Cite book |vauthors=Schlagenhauf-Lawlor P |title=Travelers' Malaria |year=2008 |publisher=PMPH-USA |isbn=978-1-55009-336-0 |url=https://books.google.com/books?id=54Dza0UHyngC| page=[https://books.google.com/books?id=54Dza0UHyngC&pg=PA215 215]}}</ref> In areas where mosquitoes are resistant to pyrethroids, other ingredients are being combined with pyrethroids in mosquito netting; these include piperonyl butoxide, chlorfenapyr and pyriproxyfen.<ref name="Gleave-2021">{{cite journal | vauthors=Gleave K, Lissenden N, Chaplin M, Choi L, Ranson H | title=Piperonyl butoxide (PBO) combined with pyrethroids in insecticide-treated nets to prevent malaria in Africa | journal=The Cochrane Database of Systematic Reviews | volume=5 | issue=5 | article-number=CD012776 | date=May 2021 | pmid=34027998 | pmc=8142305 | doi=10.1002/14651858.CD012776.pub3}}</ref><ref>{{Cite web|title=WHO publishes recommendations on two new types of insecticide-treated nets|url=https://www.who.int/news/item/14-03-2023-who-publishes-recommendations-on-two-new-types-of-insecticide-treated-nets|website=www.who.int|access-date=29 January 2026|language=en|archive-date=27 January 2026|archive-url=https://web.archive.org/web/20260127093142/https://www.who.int/news/item/14-03-2023-who-publishes-recommendations-on-two-new-types-of-insecticide-treated-nets|url-status=live}}</ref>
UNICEF notes that the use of insecticide-treated nets has been increased since 2000 through accelerated production, procurement and delivery, stating that "Almost 2.5 billion ITNs have been distributed globally since 2004, with 2.2 billion (87 per cent) distributed in sub-Saharan Africa".<ref name="UNICEF-2023">{{cite web |date=November 2024|title=Nearly every minute, a child under 5 dies of malaria|url=https://data.unicef.org/topic/child-health/malaria/|url-status=live|archive-url=https://web.archive.org/web/20230921230733/https://data.unicef.org/topic/child-health/malaria/|archive-date=21 September 2023|access-date=29 January 2026|publisher=UNICEF}}</ref> By 2023, 52% of children in sub-Saharan Africa were sleeping under ITNs; however there were large regional differences in coverage.<ref name="UNICEF-2023"/>
A 2025 Malaria Atlas Project analysis estimated that malaria interventions in Africa prevented 1.57 billion cases from 2000 to 2024, with ITNs accounting for 72% of cases averted.<ref name="Malaria-Atlas-2025">{{Cite web|title=The changing impact of malaria control in Africa 2000-2025 – MAP|url=https://www.ivcc.com/wp-content/uploads/2025/11/IVCC-MAP-brochure-V4-Nov-25.pdf|access-date=14 November 2025|website=|publisher=Malaria Atlas Project|archive-date=22 January 2026|archive-url=https://web.archive.org/web/20260122232340/https://www.ivcc.com/wp-content/uploads/2025/11/IVCC-MAP-brochure-V4-Nov-25.pdf|url-status=live}}</ref> The report warned that progress has slowed due to plateauing ITN coverage and emphasized that expanding access to ITNs remains essential.<ref name="Malaria-Atlas-2025" />
===== Indoor residual spraying ===== thumb|right|Walls where indoor residual spraying of DDT has been applied. The dead mosquitoes remain on the wall, eventually falling to the floor.
Indoor residual spraying (IRS) is the spraying of insecticides on the walls inside a home. After a blood meal (during which it may ingest ''Plasmodium'' parasites), the female mosquito rests on a nearby surface while digesting the blood and developing eggs. If the walls of houses have been coated with insecticides, the resting mosquitoes can be killed before they can bite another person. Spraying indoor surfaces does not prevent the mosquito from its first feeding, however it protects the community as a whole by preventing a second blood meal in which they may pass the infection to a human host.<ref name="CDC-Spraying-2024">{{Cite web|title=Indoor Residual Spraying Prevention Strategies|url=https://www.cdc.gov/malaria/php/public-health-strategy/irs-strategies.html|website=Centers for Disease Control and Prevention|date=1 April 2024|access-date=31 January 2026|language=en-us|last=CDC|archive-date=1 February 2026|archive-url=https://web.archive.org/web/20260201171347/https://www.cdc.gov/malaria/php/public-health-strategy/irs-strategies.html|url-status=live}}</ref><ref name="mosquitobiology">{{Cite web|title=Mosquito Biology|url=https://capemaycountynj.gov/489/Mosquito-Biology|website=Cape May County, NJ (Official Website)|access-date=31 January 2026|archive-date=9 February 2026|archive-url=https://web.archive.org/web/20260209095707/https://capemaycountynj.gov/489/Mosquito-Biology|url-status=live}}</ref> Chemicals recommended by WHO for IRS fall into the following classes;<ref name="Pryce-2022a">{{cite journal |last1=Pryce |first1=Joseph |last2=Medley |first2=Nancy |last3=Choi |first3=Leslie |title=Indoor residual spraying for preventing malaria in communities using insecticide-treated nets |journal=Cochrane Database of Systematic Reviews |date=17 January 2022 |volume=2022 |issue=1 |article-number=CD012688 |doi=10.1002/14651858.CD012688.pub3 |pmc=8763033 |pmid=35038163 }}</ref><ref name="WHO-Spraying-2024">{{Cite book |title=Operational Manual on Indoor Residual Spraying: Control of Vectors of Malaria, Aedes-Borne Diseases, Chagas Disease, Leishmaniases and Lymphatic Filariasis |edition=1st |location=Geneva |publisher=World Health Organization |year=2024 |isbn=978-92-4-008399-8}}</ref>
* Pyrethroids such as Alpha-cypermethrin, Bifenthrin * Organophosphates such as malathion * Carbamates: Bendiocarb, Propoxur * Organochlorides: DDT (very restricted use)<ref name="mosquitobiology" />
In order to be effective, IRS should be applied to a minimum of 80% of households in a community. It is estimated that IRS has contributed to 10% of the malaria cases averted in parts of Africa.<ref name="Pryce-2022a" />
==== Structures ==== To keep mosquitoes from entering the home, screens should be installed on windows and doors and eaves, as well as netting to cover any other sources of ventilation.<ref name="EPA-Control-2016" /><ref>{{Cite web |date=12 September 2023 |title=It's Warming Up And Mozzies Are Coming. Here's How To Mosquito-proof Your Backyard |url=https://pathology.health.nsw.gov.au/articles/its-warming-up-and-mozzies-are-coming-heres-how-to-mosquito-proof-your-backyard/ |access-date=2 February 2026 |website=NSW Health Pathology |language=en}}</ref> In 2021, the World Health Organization's (WHO) Guideline Development Group conditionally recommended screening houses in this manner to reduce malaria transmission.<ref name="WHO-Guidelines-9.1-2025" /> Several studies have suggested that screening houses can have a significant effect on malaria transmission. Beyond the protective barrier screening provides, it also does not call for daily behavioral changes in the household.<ref name="Nalinya-2022">{{cite journal |vauthors=Nalinya S, Musoke D, Deane K |date=February 2022 |title=Malaria prevention interventions beyond long-lasting insecticidal nets and indoor residual spraying in low- and middle-income countries: a scoping review |journal=Malaria Journal |volume=21 |issue=1 |doi=10.1186/s12936-022-04052-6 |pmc=8812253 |pmid=35109848 |doi-access=free |article-number=31}}</ref> Screening eaves can also have a community-level protective effect, ultimately reducing mosquito-biting densities in neighboring houses that do not have this intervention in place.<ref name="Nalinya-2022" />
====Limitations in vector control====
As insecticides are used more widely, mosquito populations can evolve resistance, reducing the effectiveness of both long-lasting insecticide-treated nets (LLINs) and indoor residual spraying (IRS).<ref>{{Cite web |last=CDC |date=19 September 2024 |title=Indoor Residual Spraying Prevention Strategies |url=https://www.cdc.gov/malaria/php/public-health-strategy/irs-strategies.html |access-date=23 April 2026 |website=Malaria |language=en-us |archive-date=11 May 2026 |archive-url=https://web.archive.org/web/20260511090804/https://www.cdc.gov/malaria/php/public-health-strategy/irs-strategies.html |url-status=live }}</ref><ref name="WHO-Report-2025a" /> This resistance can occur through physiological mechanisms, in which genetic changes allow mosquitoes to survive insecticide contact.<ref name="Abbasi-2026">{{cite journal |last1=Abbasi |first1=Ebrahim |title=Mechanisms of insecticide resistance in mosquitoes: A systematic review of biochemical and physiological perspectives for sustainable vector control |journal=Medicine |date=27 March 2026 |volume=105 |issue=13 |article-number=e48068 |doi=10.1097/MD.0000000000048068 |pmid=41894285 |pmc=13034918 }}</ref><ref name="Fouet-2018">{{cite journal |last1=Fouet |first1=Caroline |last2=Atkinson |first2=Peter |last3=Kamdem |first3=Colince |title=Human Interventions: Driving Forces of Mosquito Evolution |journal=Trends in Parasitology |date=February 2018 |volume=34 |issue=2 |pages=127–139 |doi=10.1016/j.pt.2017.10.012 |pmid=29301722 }}</ref> Mosquitoes with these advantageous traits can pass them on to their offspring, increasing the proportion of resistant mosquitoes in the population over time.<ref name="Abbasi-2026" /><ref name="Fouet-2018" />
Beyond physiological resistance, malaria vectors have demonstrated behavioral adaptations that further reduce the effectiveness of current vector control methods. These changes are termed "behavioral resistance", where mosquito behavior shifts in ways that reduce exposure to insecticides.<ref name="Gatton-2013">{{cite journal |last1=Gatton |first1=Michelle L. |last2=Chitnis |first2=Nakul |last3=Churcher |first3=Thomas |last4=Donnelly |first4=Martin J. |last5=Ghani |first5=Azra C. |last6=Godfray |first6=H. Charles J. |last7=Gould |first7=Fred |last8=Hastings |first8=Ian |last9=Marshall |first9=John |last10=Ranson |first10=Hilary |last11=Rowland |first11=Mark |last12=Shaman |first12=Jeff |last13=Lindsay |first13=Steve W. |title=The Importance of Mosquito Behavioural Adaptations to Malaria Control in Africa |journal=Evolution |date=April 2013 |volume=67 |issue=4 |pages=1218–1230 |doi=10.1111/evo.12063 |pmc=3655544 |pmid=23550770 |bibcode=2013Evolu..67.1218G }}</ref> ''Anopheles'' mosquitoes have traditionally exhibited endophagy, meaning they prefer to bite humans indoors, and endophily, meaning they rest indoors after feeding.<ref name="Huho-2013">{{cite journal |last1=Huho |first1=Bernadette |last2=Briët |first2=Olivier |last3=Seyoum |first3=Aklilu |last4=Sikaala |first4=Chadwick |last5=Bayoh |first5=Nabie |last6=Gimnig |first6=John |last7=Okumu |first7=Fredros |last8=Diallo |first8=Diadier |last9=Abdulla |first9=Salim |last10=Smith |first10=Thomas |last11=Killeen |first11=Gerry |title=Consistently high estimates for the proportion of human exposure to malaria vector populations occurring indoors in rural Africa |journal=International Journal of Epidemiology |date=February 2013 |volume=42 |issue=1 |pages=235–247 |doi=10.1093/ije/dys214 |pmc=3600624 |pmid=23396849 }}</ref> They also typically bite at night, when individuals are protected by bed nets.<ref name="Huho-2013" />
However, some ''Anopheles'' species have increasingly been observed biting earlier in the evening or outdoors, exhibiting exophagy, when people are less likely to be protected by bed nets or indoor spraying.<ref name="Gatton-2013" /><ref name="Carrasco-2019">{{cite journal |last1=Carrasco |first1=David |last2=Lefèvre |first2=Thierry |last3=Moiroux |first3=Nicolas |last4=Pennetier |first4=Cédric |last5=Chandre |first5=Fabrice |last6=Cohuet |first6=Anna |title=Behavioural adaptations of mosquito vectors to insecticide control |journal=Current Opinion in Insect Science |date=August 2019 |volume=34 |pages=48–54 |doi=10.1016/j.cois.2019.03.005 |pmid=31247417 |bibcode=2019COIS...34...48C }}</ref> They may also rest outdoors rather than on indoor walls that have been sprayed, exhibiting exophily.<ref name="Gatton-2013" /><ref name="Carrasco-2019" /> These behavioral changes contribute to what is known as residual transmission, defined as malaria transmission that persists even after the implementation of core vector control interventions.<ref name="Carrasco-2019" /> As a result, malaria transmission can continue even in areas with widespread use of LLINs and IRS.
These adaptations indicate a key limitation of current strategies, which primarily rely on interrupting the human mosquito contact during nighttime indoor feeding.<ref name="WHO-Report-2025a" /> Therefore, incorporating vector behavioral changes into malaria control strategies is increasingly important, as the protective effects of their interventions are being reduced by such adaptations.
===Preventive medication=== {{Main|Malaria prophylaxis}}
There are a number of medications that can help prevent or interrupt malaria in travellers to places where infection is common; many of these medications are also used in treatment. In places where ''Plasmodium'' is resistant to one or more medications, three medications—mefloquine, doxycycline, or the combination of atovaquone/proguanil (''Malarone'')—are frequently used for prevention.<ref name="Tickell-Painter-2017">{{cite journal | vauthors=Tickell-Painter M, Maayan N, Saunders R, Pace C, Sinclair D | title=Mefloquine for preventing malaria during travel to endemic areas | journal=The Cochrane Database of Systematic Reviews | volume=2017 | issue=10 | article-number=CD006491 | date=October 2017 | pmid=29083100 | pmc=5686653 | doi=10.1002/14651858.CD006491.pub4}}</ref>
The protective effect does not begin immediately, and people visiting areas where malaria exists are recommended to start taking the drugs one to two weeks before they arrive, and continue taking them for four weeks after leaving (except for atovaquone/proguanil, which only needs to be started two days before and continued for seven days afterward).<ref name="Freedman-2008" /> Malaria preventative medications are recommended for those vulnerable to the disease. Children under 5-years old, pregnant women, and some experts recommend school age children, in malaria endemic areas are recommended to receive malaria preventative medications on a seasonal basis or intermittent basis.<ref name="Daily 2025" /><ref name="Littmann 2024">{{cite journal |last1=Littmann |first1=Jasper |last2=Achu |first2=Dorothy |last3=Laufer |first3=Miriam K. |last4=Karema |first4=Corine |last5=Schellenberg |first5=David |title=Making the most of malaria chemoprevention |journal=Malaria Journal |date=19 February 2024 |volume=23 |issue=1 |article-number=51 |doi=10.1186/s12936-024-04867-5 |doi-access=free |pmid=38369497 |pmc=10875741 }}</ref> Combining malarial preventative medications with anti-malarial vaccines has a greater effect in reducing malaria case-loads than medications alone.<ref name="Daily 2025" />
Intermittent preventive therapy is an intervention that has been used successfully to control malaria in pregnant women and infants,<ref name="Bardají-2012" /> and in preschool children where transmission is seasonal.<ref name="Meremikwu-2012a" /> During pregnancy, medication to prevent malaria has been found to improve the weight of the baby at birth and decrease the risk of anaemia in the mother.<ref>{{cite journal | vauthors=Radeva-Petrova D, Kayentao K, ter Kuile FO, Sinclair D, Garner P | title=Drugs for preventing malaria in pregnant women in endemic areas: any drug regimen versus placebo or no treatment | journal=The Cochrane Database of Systematic Reviews | volume=2014 | issue=10 | article-number=CD000169 | date=October 2014 | pmid=25300703 | pmc=4498495 | doi=10.1002/14651858.CD000169.pub3}}</ref> Giving antimalarial drugs to infants through intermittent preventive therapy can reduce the risk of having malaria infection, hospital admission, and anaemia.<ref>{{cite journal | vauthors=Esu EB, Oringanje C, Meremikwu MM | title=Intermittent preventive treatment for malaria in infants | journal=The Cochrane Database of Systematic Reviews | volume=2021 | issue=7 | article-number=CD011525 | date=July 2021 | pmid=34273901 | pmc=8406727 | doi=10.1002/14651858.CD011525.pub3}}</ref>
Antimalarial mass drug administration to an entire population at the same time may reduce the risk of contracting malaria in the population.<ref name="Shah-2021">{{cite journal |vauthors=Shah MP, Hwang J, Choi L, Lindblade KA, Kachur SP, Desai M |date=September 2021 |title=Mass drug administration for malaria |journal=The Cochrane Database of Systematic Reviews |volume=2021 |issue=9 |doi=10.1002/14651858.CD008846.pub3 |pmc=8479726 |pmid=34585740 |article-number=CD008846}}</ref> In the 1950s, the WHO included mass drug administration (MDA) of antimalarial drugs as a tool for malaria eradication in exceptional conditions when conventional control techniques have failed.<ref name="WHO-1951">WHO. (1951) Technical Report Series #38</ref> In 1971, the WHO expert committee on malaria still recommended MDA in special circumstances.<ref name="WHO-1951" /> Subsequently, MDA was linked to the emergence of drug resistance and its overall benefit was questioned.<ref name="Wernsdorfer-1992">{{cite journal |author=Wernsdorfer WH |date=September 1992 |title=The biological and epidemiological basis of drug resistance in malaria parasites |journal=Southeast Asian J. Trop. Med. Public Health |series=23 |volume=Suppl 4 |pages=123–9 |pmid=1364857}}</ref><ref name="Verdrager-1995">{{cite journal |author=Verdrager J |date=March 1995 |title=Localized permanent epidemics: the genesis of chloroquine resistance in Plasmodium falciparum |journal=Southeast Asian J. Trop. Med. Public Health |volume=26 |issue=1 |pages=23–8 |pmid=8525414}}</ref><ref name="Verdrager-1986">{{cite journal |author=Verdrager J |date=December 1986 |title=Epidemiology of the emergence and spread of drug-resistant falciparum malaria in South-East Asia and Australasia |journal=J Trop Med Hyg |volume=89 |issue=6 |pages=277–89 |pmid=3543384}}</ref><ref name="Payne-1988">{{cite journal |author=Payne D |date=April 1988 |title=Did medicated salt hasten the spread of chloroquine resistance in Plasmodium falciparum? |journal=Parasitol. Today (Regul. Ed.) |volume=4 |issue=4 |pages=112–5 |doi=10.1016/0169-4758(88)90042-7 |pmid=15463062}}</ref>
===Others=== Community participation and health education strategies promoting awareness of malaria and the importance of control measures have been successfully used to reduce the incidence of malaria in some areas of the developing world.<ref name="Lalloo-2006" /> Recognising the disease in the early stages can prevent it from becoming fatal. Education can also inform people to cover over areas of stagnant, still water, such as water tanks that are ideal breeding grounds for the parasite and mosquito, thus cutting down the risk of the transmission between people. This is generally used in urban areas where there are large centers of population in a confined space and transmission would be most likely in these areas.<ref name="Mehlhorn-2016" />
==Epidemiology== {{owidslider | start = 2023 | list = Template:OWID/incidence of malaria#gallery | location = commons | caption = | title = | language = | file = link=|thumb|upright=1.6|Incidence of malaria (new cases per 1,000 population) | startingView = World }} {{owidslider |start = 2023 |list = Template:OWID/Malaria death rates#gallery |location = commons |caption = |title = |language = |file = link=|thumb|upright=1.6|right|Malaria death rates |startingView = World }}
According to the World Health Organization's 2025 World Malaria Report,<ref name="WHO-Report-2025a">{{Cite web |date=4 December 2025 |title=World malaria report 2025 |url=https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2025 |access-date=5 January 2026 |website=World Health Organization |language=en |archive-date=5 January 2026 |archive-url=https://web.archive.org/web/20260105141123/https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2025 |url-status=live }}</ref> there were an estimated 282 million new malaria cases globally in 2024, in 80 endemic countries. The number of deaths attributed to malaria stood at 610,000 in 2024. Children under five years old were the most affected, accounting for 75% of malaria deaths in Africa during 2024.<ref name="WHO-Report-2025a" />
The malaria parasite depends on mosquitoes of the ''Anopheles'' genus to transmit between hosts. It is endemic in areas where conditions are favourable for these species of mosquitoes.<ref name="WHO-Report-2025a" /> This includes almost all tropical and subtropical areas of the world, where either regular rainfall creates essential breeding habitats all year, or seasonally during and after rainy seasons when standing water is abundant.<ref name="vectorsofmalaria">{{Cite web |title=VECTORS OF MALARIA |url=https://ncvbdc.mohfw.gov.in/index4.php?lang=1&level=0&linkid=429&lid=3706 |access-date=1 January 2026 |website=National Center for Vector Borne Diseases Control (NCVBDC), Ministry of Health & Family Welfare, Government of India}}</ref> The optimum temperature for the parasite is {{Convert|27|C|F|abbr=unit}} but it can develop in temperatures between {{Convert|20|C|F|abbr=unit}} and {{Convert|40|C|F|abbr=unit}}.<ref>{{Cite web |title=OLCreate: HEAT_CD_ET_1.0 Communicable Diseases Module: 6. Factors that Affect Malaria Transmission {{!}} OLCreate |url=https://www.open.edu/openlearncreate/mod/oucontent/view.php?id=89 |access-date=1 January 2026 |website=www.open.edu}}</ref> Malaria is uncommon at altitudes above 1,500 meters, where temperatures tend to be lower,<ref>{{cite book |last1=Bloland |first1=Peter B. |last2=Williams |first2=Holly A. |last3=Population |first3=National Research Council (US) Committee on |last4=Program on Forced Migration and Health at the Mailman School of Public Health |first4=Columbia University |title=Malaria Control during Mass Population Movements and Natural Disasters |date=2002 |publisher=National Academies Press (US) |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK221152/ |chapter=Epidemiology of Malaria |archive-date=6 February 2025 |access-date=5 January 2026 |archive-url=https://web.archive.org/web/20250206094636/https://www.ncbi.nlm.nih.gov/books/NBK221152/ |url-status=live }}</ref> and in urban environments where good drainage eliminates pools of water.<ref>{{cite journal |last1=Villena |first1=Oswaldo C. |last2=Arab |first2=Ali |last3=Lippi |first3=Catherine A. |last4=Ryan |first4=Sadie J. |last5=Johnson |first5=Leah R. |title=Influence of environmental, geographic, socio-demographic, and epidemiological factors on presence of malaria at the community level in two continents |journal=Scientific Reports |date=20 July 2024 |volume=14 |issue=1 |article-number=16734 |doi=10.1038/s41598-024-67452-5 |pmid=39030306 |pmc=11271557 |bibcode=2024NatSR..1416734V }}</ref>
Malaria is presently endemic in a broad band around the equator, in areas of the Americas, many parts of Asia, and much of Africa.<ref name="WHO-Report-2025a" /> Malaria was once common in parts of Europe and North America, where it is no longer endemic.<ref name="ECDC-Information-2024">{{Cite web |date=22 August 2024 |title=Disease information about malaria |url=https://www.ecdc.europa.eu/en/malaria/facts |access-date=29 December 2025 |website=European Centre for Disease Prevention and Control (ECDC) |language=en |archive-date=6 July 2021 |archive-url=https://web.archive.org/web/20210706064110/https://www.ecdc.europa.eu/en/malaria/facts |url-status=live }}</ref><ref name="CDC-where-2024a">{{Cite web |date=1 April 2024 |title=Where Malaria Occurs |url=https://www.cdc.gov/malaria/data-research/index.html |access-date=6 January 2026 |website=Centers for Disease Control and Prevention |language=en-us |archive-date=6 January 2026 |archive-url=https://web.archive.org/web/20260106090753/https://www.cdc.gov/malaria/data-research/index.html |url-status=live }}</ref> ''Anopheles'' mosquitoes are still present in these areas, so there is a risk of the disease returning.<ref name="CDC-where-2024a" /><ref>{{Cite web |date=19 August 2014 |title=Anopheles atroparvus - Factsheet for experts |url=https://www.ecdc.europa.eu/en/disease-vectors/facts/mosquito-factsheets/anopheles-atroparvus |access-date=6 January 2026 |website=European Centre for Disease Control |language=en |archive-date=28 January 2026 |archive-url=https://web.archive.org/web/20260128210216/https://www.ecdc.europa.eu/en/disease-vectors/facts/mosquito-factsheets/anopheles-atroparvus |url-status=live }}</ref>
* Since 2015, the WHO European Region has been free of malaria.{{sfn|WHO|2022|p={{page needed|date=July 2024}}}} Travel-related cases still occur occasionally.<ref>{{Cite web |date=24 April 2024 |title=Malaria - Annual Epidemiological Report for 2022 |url=https://www.ecdc.europa.eu/en/publications-data/malaria-annual-epidemiological-report-2022 |access-date=4 January 2026 |website=European Centre for Disease Prevention and Control |language=en |archive-date=16 December 2025 |archive-url=https://web.archive.org/web/20251216173112/https://www.ecdc.europa.eu/en/publications-data/malaria-annual-epidemiological-report-2022 |url-status=live }}</ref> * The United States eradicated malaria as a major public health concern in 1951.<ref name="CDC-Malaria-2024a">{{Cite web |last=CDC |date=13 June 2024 |title=CDC & Malaria |url=https://www.cdc.gov/malaria/cdc-malaria/index.html |access-date=4 January 2026 |website=Malaria |language=en-us |archive-date=4 January 2026 |archive-url=https://web.archive.org/web/20260104220145/https://www.cdc.gov/malaria/cdc-malaria/index.html |url-status=live }}</ref> A small number of cases are detected each year, mostly in travellers returning from malaria endemic areas.<ref name="CDC-Malaria-2024a" /> * The African region continues to bear a disproportionate share of the global malaria burden, accounting for 95% of all cases and 95% of deaths.<ref name="vectorsofmalaria" />
Those most at risk of severe malaria if they are exposed to the disease are:
* infants & children under 5 years, who have not yet developed immunity to the parasite.<ref name="WHO-Factsheet-2025">{{Cite web |date=4 December 2025 |title=Fact sheet about malaria |url=https://www.who.int/news-room/fact-sheets/detail/malaria |access-date=5 January 2026 |website=World Health Organization |language=en |archive-date=2 May 2020 |archive-url=https://web.archive.org/web/20200502021814/https://www.who.int/news-room/fact-sheets/detail/malaria |url-status=live }}</ref> * pregnant women, because pregnancy modifies the immune response.<ref name="WHO-Press-Release-2019">{{Cite web |date=4 December 2019 |title=More pregnant women and children protected from malaria, but accelerated efforts and funding needed to reinvigorate global response, WHO report shows |url=https://www.who.int/news/item/04-12-2019-more-pregnant-women-and-children-protected-from-malaria-but-accelerated-efforts-and-funding-needed-to-reinvigorate-global-response-who-report-shows |access-date=5 January 2026 |website=World Health Organization |language=en |archive-date=12 January 2026 |archive-url=https://web.archive.org/web/20260112015117/https://www.who.int/news/item/04-12-2019-more-pregnant-women-and-children-protected-from-malaria-but-accelerated-efforts-and-funding-needed-to-reinvigorate-global-response-who-report-shows |url-status=live }}</ref> * maternal malaria also affects the unborn foetus, leading to premature delivery and low birth weight, a leading cause of infant mortality.<ref name="WHO-Press-Release-2019" /> * and others with weakened immune system, such as people affected by HIV/AIDS.<ref name="WHO-Factsheet-2025" />
Travelers to endemic areas are at risk because they also lack immunity.<ref name="ECDC-Information-2024" />
===Climate change=== {{Further|Climate change and infectious diseases#Malaria}}
Climate change is likely to affect malaria transmission, but the degree of effect and the areas affected is uncertain.<ref name="WHO-Climate-2016">{{cite web|title=Climate Change And Infectious Diseases|url=https://www.who.int/globalchange/climate/en/chapter6.pdf|url-status=live|archive-url=https://web.archive.org/web/20160304063626/http://www.who.int/globalchange/climate/en/chapter6.pdf|archive-date=4 March 2016|work=Climate Change and Human Health—Risk and Responses|publisher=World Health Organization}}</ref> Greater rainfall in certain areas of India, and following an El Niño event is associated with increased mosquito numbers.<ref>{{cite web|title=Climate change and human health—risks and responses. Summary|url=https://www.who.int/globalchange/climate/summary/en/index5.html|archive-url=https://web.archive.org/web/20031225023503/http://www.who.int/globalchange/climate/summary/en/index5.html|archive-date=25 December 2003|access-date=29 October 2018|publisher=World Health Organization}}</ref>
Since 1900 there has been substantial change in temperature and rainfall over Africa.<ref>{{Cite journal|vauthors=Hulme M, Doherty R, Ngara T, New M, Lister D|date=August 2001|title=African climate change: 1900-2100.|url=https://www.int-res.com/articles/cr/17/c017p145.pdf|journal=Climate Research|volume=17|issue=2|pages=145–68|doi=10.3354/cr017145|bibcode=2001ClRes..17..145H|doi-access=free|access-date=8 September 2020|archive-date=30 June 2021|archive-url=https://web.archive.org/web/20210630114729/https://www.int-res.com/articles/cr/17/c017p145.pdf|url-status=live}}</ref> However, factors that contribute to how rainfall results in water for mosquito breeding are complex, incorporating the extent to which it is absorbed into soil and vegetation for example, or rates of runoff and evaporation.<ref name="Smith-2020">{{cite journal | vauthors=Smith MW, Willis T, Alfieri L, James WH, Trigg MA, Yamazaki D, Hardy AJ, Bisselink B, De Roo A, Macklin MG, Thomas CJ | title=Incorporating hydrology into climate suitability models changes projections of malaria transmission in Africa | journal=Nature Communications | volume=11 | issue=1 | article-number=4353 | date=August 2020 | pmid=32859908 | pmc=7455692 | doi=10.1038/s41467-020-18239-5 | bibcode=2020NatCo..11.4353S}}</ref> Recent research has provided a more in-depth picture of conditions across Africa, combining a malaria climatic suitability model with a continental-scale model representing real-world hydrological processes.<ref name="Smith-2020" />
====Changes in geographic distribution==== Climate change has led to shifts in malaria-endemic regions, with the disease expanding into higher altitudes and previously malaria-free areas.<ref name="Caminade-2014">{{cite journal |vauthors=Caminade C, Kovats S, Rocklov J, Tompkins AM, Morse AP, Colón-González FJ, Stenlund H, Martens P, Lloyd SJ |title=Impact of climate change on global malaria distribution |journal=Proceedings of the National Academy of Sciences USA |volume=111 |issue=9 |pages=3286–91 |date=March 2014 |pmid=24596427 |pmc=3948226 |doi=10.1073/pnas.1302089111 |doi-access=free |bibcode=2014PNAS..111.3286C}}</ref> Rising temperatures allow mosquitoes to survive in regions that were once too cold for them, including highland areas in Africa, South America, and parts of Asia.<ref name="Caminade-2014" /> A study analyzing malaria cases in Ethiopian and Colombian highlands found a strong correlation between increased temperatures and malaria incidence, demonstrating that climate change has made previously inhospitable areas suitable for transmission.<ref name="Siraj-2014">{{cite journal |vauthors=Siraj AS, Santos-Vega M, Bouma MJ, Yadeta D, Ruiz Carrascal D, Pascual M |title=Altitudinal changes in malaria incidence in highlands of Ethiopia and Colombia |journal=Science |volume=343 |issue=6175 |pages=1154–8 |date=March 2014 |pmid=24604201 |doi=10.1126/science.1244325 |bibcode=2014Sci...343.1154S}}</ref>
====Increased transmission season==== Malaria transmission is highly sensitive to temperature and rainfall patterns.<ref name="Siraj-2014" /> Climate change has led to longer transmission seasons in tropical regions, where mosquitoes can breed year-round due to prolonged periods of high humidity and warm temperatures.<ref name="Colon-Gonzalez-2021">{{cite journal |vauthors=Colón-González FJ, Sewe MO, Tompkins AM, Sjödin H, Casallas A, Rocklöv J, Caminade C, Lowe R |title=Projecting the risk of mosquito-borne diseases in a warmer and more populated world: a multi-model, multi-scenario intercomparison modelling study |journal=Lancet Planet Health |volume=5 |issue=7 |pages=e404–14 |date=July 2021 |pmid=34245711 |pmc=8280459 |doi=10.1016/S2542-5196(21)00132-7 |bibcode=2021LanPH...5.e404C }}</ref> Research suggests that in parts of sub-Saharan Africa, the malaria transmission season has lengthened by several months, particularly in regions where warming has pushed temperatures into the optimal range for ''Plasmodium falciparum'' development.<ref name="Colon-Gonzalez-2021" /> In regions such as West Africa and parts of India, increasing temperatures and prolonged rainy seasons have contributed to a rise in malaria cases.<ref name="Colon-Gonzalez-2021" /> Some studies predict that by 2050, many malaria-endemic areas will experience a 20–30% increase in transmission duration due to warming trends.<ref name="Caminade-2014" />
====Effects of extreme weather events==== Extreme weather events, such as heavy rainfall, flooding, and droughts, are increasing in frequency and intensity due to climate change, creating favorable conditions for malaria outbreaks.<ref name="Bouma-1996">{{cite journal |vauthors=Bouma MJ, van der Kaay HJ |title=The El Niño Southern Oscillation and the historic malaria epidemics on the Indian subcontinent and Sri Lanka: an early warning system for future epidemics? |journal=Tropical Medicine & International Health |volume=1 |issue=1 |pages=86–96 |date=February 1996 |pmid=8673827 |doi=10.1046/j.1365-3156.1996.d01-7.x |bibcode=1996TMIH....1...86B }}</ref> Flooding provides ideal breeding grounds for mosquitoes by forming stagnant water pools, while droughts can also exacerbate malaria by forcing human populations to store water in open containers, which serve as mosquito habitats.<ref name="Bouma-1996" /> This effect has been observed in parts of sub-Saharan Africa and South Asia, where prolonged drought periods were followed by spikes in malaria cases.<ref name="Bouma-1996" /> A review of malaria outbreaks linked to climate variability found that El Niño events, which increase rainfall and temperatures in malaria-endemic regions, have been associated with significant surges in cases.<ref>{{cite journal |vauthors=Hay SI, Shanks GD, Stern DI, Snow RW, Randolph SE, Rogers DJ |title=Climate variability and malaria epidemics in the highlands of East Africa |journal=Trends in Parasitology |volume=21 |issue=2 |pages=52–53 |date=February 2005 |pmid=15664524 |pmc=3173848 |doi=10.1016/j.pt.2004.11.007}}</ref>
====Resistance and adaptation of vectors==== Higher temperatures accelerate the development of ''Plasmodium'' parasites within mosquitoes, potentially leading to increased transmission efficiency.<ref name="Shapiro-2017">{{cite journal |vauthors=Shapiro LL, Whitehead SA, Thomas MB |title=Quantifying the effects of temperature on mosquito and parasite traits that determine the transmission potential of human malaria |journal=PLOS Biology |volume=15 |issue=10 |article-number=e2003489 |date=October 2017 |pmid=29036170 |pmc=5658182 |doi=10.1371/journal.pbio.2003489 |doi-access=free}}</ref> Additionally, rising temperatures and changing environmental conditions have been linked to the spread of insecticide resistance in mosquito populations, complicating malaria control efforts.<ref name="Shapiro-2017" /> A global survey found that ''Anopheles'' mosquitoes in Africa, Asia, and South America have developed increased resistance to commonly used insecticides such as pyrethroids.<ref>{{cite journal |vauthors=Suh PF, Elanga-Ndille E, Tchouakui M, Sandeu MM, Tagne D, Wondji C, Ndo C |title=Impact of insecticide resistance on malaria vector competence: a literature review |journal=Malaria Journal |volume=22 |issue=1 |article-number=19 |date=January 2023 |pmid=36650503 |pmc=9847052 |doi=10.1186/s12936-023-04444-2 |doi-access=free}}</ref>
==History== {{Main|History of malaria|Mosquito-malaria theory}}
[[File:Malaria pathogens.jpg|thumb|upright|Ancient malaria oocysts preserved in Dominican amber]]
Although the parasite responsible for ''P. falciparum'' malaria has been in existence for 50,000–100,000 years, the population size of the parasite did not increase until about 10,000 years ago, concurrently with advances in agriculture<ref name="Harper-2010" /> and the development of human settlements. Close relatives of the human malaria parasites remain common in chimpanzees. Some evidence suggests that the ''P. falciparum'' malaria may have originated in gorillas.<ref name="Prugnolle-2011" />
References to the unique periodic fevers of malaria are found throughout history.<ref name="Cox-2002" /> The Roman Columella associated the disease with insects from swamps.<ref name="Strong-1944" /> Hippocrates described periodic fevers, labelling them tertian, quartan, subtertian and quotidian.<ref name="Strong-1944">{{cite book| vauthors=Strong RP |title=Stitt's Diagnosis, Prevention and Treatment of Tropical Diseases|date=1944|publisher=The Blakiston Company|location=York, PA|page=3|edition=Seventh}}</ref> Malaria may have contributed to the decline of the Roman Empire,<ref name="BBC News-2001" /> and was so pervasive in Rome that it was known as the "Roman fever".<ref name="Sallares-2002" /> Several regions in ancient Rome were considered at-risk for the disease because of the favourable conditions present for malaria vectors. This included areas such as southern Italy, the island of Sardinia, the Pontine Marshes, the lower regions of coastal Etruria and the city of Rome along the Tiber. The presence of stagnant water in these places was preferred by mosquitoes for breeding grounds. Irrigated gardens, swamp-like grounds, run-off from agriculture, and drainage problems from road construction led to the increase of standing water.<ref name="Hays-2005" /> [[File:Ronald Ross.jpg|thumb|left|British doctor Ronald Ross received the Nobel Prize for Physiology or Medicine in 1902 for his work on malaria.]]
The few surviving medical records of Mesoamerican civilizations do not show any record of malaria. European settlers and the West Africans they enslaved likely brought malaria to the Americas starting in the 16th century.<ref>{{cite journal |vauthors=De Castro MC, Singer BH |title=Was malaria present in the Amazon before the European conquest? Available evidence and future research agenda |journal=J. Archaeol. Sci. |volume=32 |pages=337–40 |year=2005 |doi=10.1016/j.jas.2004.10.004 |issue=3|bibcode=2005JArSc..32..337D}}</ref><ref>{{cite journal | vauthors=Yalcindag E, Elguero E, Arnathau C, Durand P, Akiana J, Anderson TJ, Aubouy A, Balloux F, Besnard P, Bogreau H, Carnevale P, D'Alessandro U, Fontenille D, Gamboa D, Jombart T, Le Mire J, Leroy E, Maestre A, Mayxay M, Ménard D, Musset L, Newton PN, Nkoghé D, Noya O, Ollomo B, Rogier C, Veron V, Wide A, Zakeri S, Carme B, Legrand E, Chevillon C, Ayala FJ, Renaud F, Prugnolle F | title=Multiple independent introductions of ''Plasmodium falciparum'' in South America | journal=Proceedings of the National Academy of Sciences of the United States of America | volume=109 | issue=2 | pages=511–516 | date=January 2012 | pmid=22203975 | pmc=3258587 | doi=10.1073/pnas.1119058109 | doi-access=free | bibcode=2012PNAS..109..511Y}}</ref>
Scientific studies on malaria made their first significant advance in 1880, when Charles Louis Alphonse Laveran—a French army doctor working in the military hospital of Constantine in Algeria—observed parasites inside the red blood cells of infected people for the first time.<ref>{{cite journal |title=Malarial organisms in the blood |journal=Scientific American |url=https://books.google.com/books?id=zoE9AQAAIAAJ&pg=PA37 |date=21 January 1882 |publisher=Munn & Company |pages=37–38 |volume=46 |issue=3}}</ref> He, therefore, proposed that malaria is caused by this organism, the first time a protist was identified as causing disease.<ref name="Nobel-Medicine-1907" /> For this and later discoveries, he was awarded the 1907 Nobel Prize for Physiology or Medicine. A year later, Carlos Finlay, a Cuban doctor treating people with yellow fever in Havana, provided strong evidence that mosquitoes were transmitting disease to and from humans.<ref name="Tan-2008" /> This work followed earlier suggestions by Josiah C. Nott,<ref name="Chernin-1983" /> and work by Sir Patrick Manson, the "father of tropical medicine", on the transmission of filariasis.<ref name="Chernin-1977" />
[[File:Tu Youyou 5012-1-2015.jpg|thumb|left|Chinese medical researcher Tu Youyou received the Nobel Prize for Physiology or Medicine in 2015 for her work on the antimalarial drug artemisinin.]]
In April 1894, a Scottish physician, Sir Ronald Ross, visited Sir Patrick Manson at his house on Queen Anne Street, London. This visit was the start of four years of collaboration and fervent research that culminated in 1897 when Ross, who was working in the Presidency General Hospital in Calcutta, proved the complete life-cycle of the malaria parasite in mosquitoes.<ref name="Cox-2010" /> He thus proved that the mosquito was the vector for malaria in humans by showing that certain mosquito species transmit malaria to birds. He isolated malaria parasites from the salivary glands of mosquitoes that had fed on infected birds.<ref name="Cox-2010" /> For this work, Ross received the 1902 Nobel Prize in Medicine. After resigning from the Indian Medical Service, Ross worked at the newly established Liverpool School of Tropical Medicine and directed malaria-control efforts in Egypt, Panama, Greece and Mauritius.<ref name="CDC-History-Ross" /> The findings of Finlay and Ross were later confirmed by a medical board headed by Walter Reed in 1900. Its recommendations were implemented by William C. Gorgas in the health measures undertaken during construction of the Panama Canal. This public-health work saved the lives of thousands of workers and helped develop the methods used in future public-health campaigns against the disease.<ref name="Simmons-1979" />
In 1896, Amico Bignami discussed the role of mosquitoes in malaria.<ref>{{cite web |title=Amico Bignami |url=https://www.whonamedit.com/doctor.cfm/2484.html |website=whonamedit.com |access-date=30 July 2019 |archive-date=30 July 2019 |archive-url=https://web.archive.org/web/20190730000452/https://www.whonamedit.com/doctor.cfm/2484.html |url-status=live}}</ref> In 1898, Bignami, Giovanni Battista Grassi and Giuseppe Bastianelli succeeded in showing experimentally the transmission of malaria in humans, using infected mosquitoes to contract malaria themselves which they presented in November 1898 to the Accademia dei Lincei.<ref name="Cox-2010">{{cite journal | vauthors=Cox FE | title=History of the discovery of the malaria parasites and their vectors | journal=Parasites & Vectors | volume=3 | issue=1 | page=5 | date=February 2010 | pmid=20205846 | pmc=2825508 | doi=10.1186/1756-3305-3-5 | doi-access=free}}</ref>
[[File:Artemisia annua West Virginia.jpg|thumb|right|''Artemisia annua'', source of the antimalarial drug artemisinin]]
The first effective treatment for malaria came from the bark of cinchona tree, which contains quinine. This tree grows on the slopes of the Andes, mainly in Peru. The indigenous peoples of Peru made a tincture of cinchona to control fever. Its effectiveness against malaria was found and the Jesuits introduced the treatment to Europe around 1640; by 1677, it was included in the London Pharmacopoeia as an antimalarial treatment.<ref name="Kaufman-2005" /> It was not until 1820 that the active ingredient, quinine, was extracted from the bark, isolated and named by the French chemists Pierre Joseph Pelletier and Joseph Bienaimé Caventou.<ref name="Pelletier-1820" /><ref name="Kyle-1974" />
Quinine was the predominant malarial medication until the 1920s when other medications began to appear. In the 1940s, chloroquine replaced quinine as the treatment of both uncomplicated and severe malaria until resistance supervened, first in Southeast Asia and South America in the 1950s and then globally in the 1980s.<ref name="Achan-2011" />
The medicinal value of ''Artemisia annua'' has been used by Chinese herbalists in traditional Chinese medicines for 2,000 years.<ref>{{cite journal | vauthors=Ekiert H, Świątkowska J, Klin P, Rzepiela A, Szopa A | title=Artemisia annua - Importance in Traditional Medicine and Current State of Knowledge on the Chemistry, Biological Activity and Possible Applications | journal=Planta Medica | volume=87 | issue=8 | pages=584–599 | date=July 2021 | pmid=33482666 | doi=10.1055/a-1345-9528 | bibcode=2021PlMed..87..584E}}</ref><ref>{{cite journal | vauthors=Timóteo P, Wessels C, Righeschi C, Goris H, Bilia A |title=Evaluation of stability of constituents of herbal drug preparations from Artemisia annua L |journal=Planta Medica |date=24 August 2010 |volume=76 |issue=12 |doi=10.1055/s-0030-1264749 |bibcode=2010PlMed..7664749T}}</ref> In 1596, Li Shizhen recommended tea made from qinghao specifically to treat malaria symptoms in his "Compendium of Materia Medica", however the efficacy of tea, made with ''A. annua'', for the treatment of malaria is dubious, and is discouraged by the World Health Organization (WHO).<ref>{{cite book |title=WHO monograph on good agricultural and collection practices (GACP) for Artemisia annua L |date=2006 |publisher=World Health Organization |isbn=978-92-4-159443-1 |hdl=10665/43509 |hdl-access=free}}{{page needed|date=July 2024}}</ref><ref>{{cite journal | vauthors=van der Kooy F, Sullivan SE | title=The complexity of medicinal plants: the traditional Artemisia annua formulation, current status and future perspectives | journal=Journal of Ethnopharmacology | volume=150 | issue=1 | pages=1–13 | date=October 2013 | pmid=23973523 | doi=10.1016/j.jep.2013.08.021 | type=Review}}</ref> Artemisinins, discovered by Chinese scientist Tu Youyou and colleagues in the 1970s from the plant ''Artemisia annua'', became the recommended treatment for ''P. falciparum'' malaria, administered in severe cases in combination with other antimalarials.<ref name="Hsu-2006" /> Tu says she was influenced by a traditional Chinese herbal medicine source, ''The Handbook of Prescriptions for Emergency Treatments'', written in 340 by Ge Hong.<ref>{{cite web | vauthors=Hao C |date=29 September 2011 |url=https://www.science.org/content/article/lasker-award-rekindles-debate-over-artemisinins-discovery |title=Lasker Award Rekindles Debate Over Artemisinin's Discovery |publisher=Science/AAAS |work=News: ScienceInsider |url-status=live |archive-url=https://web.archive.org/web/20140104214759/http://news.sciencemag.org/asia/2011/09/lasker-award-rekindles-debate-over-artemisinins-discovery |archive-date=4 January 2014}}</ref> For her work on malaria, Tu Youyou received the 2015 Nobel Prize in Physiology or Medicine.<ref name="Nobel-Medicine-2015">{{cite web |title=Nobel Prize announcement |url=https://www.nobelprize.org/nobel_prizes/medicine/laureates/2015/press.pdf |website=NobelPrize.org |access-date=5 October 2015 |url-status=live |archive-url=https://web.archive.org/web/20151006112430/http://www.nobelprize.org/nobel_prizes/medicine/laureates/2015/press.pdf |archive-date=6 October 2015}}</ref>
''Plasmodium vivax'' was used between 1917 and the 1940s for malariotherapy—deliberate injection of malaria parasites to induce a fever to combat certain diseases such as tertiary syphilis. In 1927, the inventor of this technique, Julius Wagner-Jauregg, received the Nobel Prize in Physiology or Medicine for his discoveries. The technique was dangerous, killing about 15% of patients, so it is no longer in use.<ref name="Vogel-2013" />
[[File:GuadMarinesMalaria.gif|thumb|U.S. Marines with malaria in a field hospital on Guadalcanal, October 1942]]
The first pesticide used for indoor residual spraying was DDT.<ref name="CDC-Eradication-2010" /> Although it was initially used exclusively to combat malaria, its use quickly spread to agriculture. In time, pest control, rather than disease control, came to dominate DDT use, and this large-scale agricultural use led to the evolution of pesticide-resistant mosquitoes in many regions. The DDT resistance shown by ''Anopheles'' mosquitoes can be compared to antibiotic resistance shown by bacteria. During the 1960s, awareness of the negative consequences of its indiscriminate use increased, ultimately leading to bans on agricultural applications of DDT in many countries in the 1970s.<ref name="van den Berg-2009" /> Before DDT, malaria was successfully eliminated or controlled in tropical areas like Brazil and Egypt by removing or poisoning the breeding grounds of the mosquitoes or the aquatic habitats of the larval stages, for example by applying the highly toxic arsenic compound Paris Green to places with standing water.<ref name="Killeen-2002" />
==Eradication efforts== {{Main|Eradication of malaria}}
There have been two major global malaria eradication efforts: the first, led by the World Health Organization between 1955 and 1969, and the second, initiated by the United Nations in the 21st century through the Millennium and Sustainable Development Goals. {{As of|2025}}, malaria has been eliminated or significantly reduced in many regions of the world, but remains widespread in others. Most of Europe, North America, Australia, North Africa and the Caribbean, along with parts of South America, and Asia are now free from malaria, while much of the central part of Africa continues to experience high levels of transmission.<ref name="Malaria-free-2025">{{Cite web |date=15 July 2025 |title=Countries and territories certified malaria-free by WHO |url=https://www.who.int/teams/global-malaria-programme/elimination/countries-and-territories-certified-malaria-free-by-who |access-date=8 February 2026 |website=Global Malaria Programme of the World Health Organization |language=en |archive-date=30 January 2024 |archive-url=https://web.archive.org/web/20240130184957/https://www.who.int/teams/global-malaria-programme/elimination/countries-and-territories-certified-malaria-free-by-who |url-status=live }}</ref>
===Initial WHO program (1955–1969)=== thumb|right|1962 Pakistani postage stamp promoting malaria eradication program
In 1955 the WHO launched the Global Malaria Eradication Program (GMEP).<ref name="Duintjer-2009">{{cite journal | vauthors=Duintjer Tebbens RJ, Thompson KM | title=Priority Shifting and the Dynamics of Managing Eradicable Infectious Diseases | journal=Management Science | volume=55 | issue=4 | pages=650–663 | year=2009 | doi=10.1287/mnsc.1080.0965}}</ref> The program relied largely on DDT for mosquito control and rapid diagnosis and treatment to break the transmission cycle.<ref>{{cite journal | vauthors=Mendis K, Rietveld A, Warsame M, Bosman A, Greenwood B, Wernsdorfer WH | title=From malaria control to eradication: The WHO perspective | journal=Tropical Medicine & International Health | volume=14 | issue=7 | pages=802–809 | date=July 2009 | pmid=19497083 | doi=10.1111/j.1365-3156.2009.02287.x | doi-access=free}}</ref> The program eliminated the disease in "North America, Europe, the former Soviet Union",<ref name="Sadasivaiah-2007">{{cite journal | vauthors=Sadasivaiah S, Tozan Y, Breman JG | title=Dichlorodiphenyltrichloroethane (DDT) for indoor residual spraying in Africa: how can it be used for malaria control? | journal=The American Journal of Tropical Medicine and Hygiene | volume=77 | issue=6 Suppl | pages=249–263 | date=December 2007 | pmid=18165500 | doi=10.4269/ajtmh.2007.77.249 | bibcode=2007AJTMH..77..249S | doi-access=free}}</ref> and in "Taiwan, much of the Caribbean, the Balkans, parts of northern Africa, the northern region of Australia, and a large swath of the South Pacific"<ref name="Gladwell-2001">{{cite news | vauthors=Gladwell M |author-link=Malcolm Gladwell |title=The Mosquito Killer |newspaper=The New Yorker |date=2 July 2001 |url=http://gladwell.com/the-mosquito-killer/ |access-date=20 August 2014 |archive-url=https://web.archive.org/web/20160416165010/http://gladwell.com/the-mosquito-killer/ |archive-date=16 April 2016 }}</ref> and dramatically reduced mortality in Sri Lanka and India.<ref name="Harrison-1978">{{Cite book |last=Harrison |first=Gordon A. |url=http://archive.org/details/mosquitoesmalari00harr |title=Mosquitoes, malaria, and man: a history of the hostilities since 1880 |date=1978 |publisher=New York : Dutton |others=Internet Archive |isbn=978-0-525-16025-0}}</ref>
However, failure to sustain the program, increasing mosquito tolerance to DDT, and increasing drug resistance (e.g. to chloroquine) led to a resurgence.<ref name="van den Berg-2009" /><ref name="Feachem-2007">{{cite journal |vauthors=Feachem RG, Sabot OJ |date=May 2007 |title=Global malaria control in the 21st century: a historic but fleeting opportunity |journal=JAMA |volume=297 |issue=20 |pages=2281–2284 |doi=10.1001/jama.297.20.2281 |pmid=17519417}}</ref> In many areas early successes partially or completely reversed, and in some cases rates of transmission increased. Experts tie malarial resurgence to multiple factors, including poor leadership, management and funding of malaria control programs; poverty; civil unrest; and increased irrigation.<ref name="Chapin-1981">{{cite journal |vauthors=Chapin G, Wasserstrom R |year=1981 |title=Agricultural production and malaria resurgence in Central America and India |journal=Nature |volume=293 |issue=5829 |pages=181–185 |bibcode=1981Natur.293..181C |doi=10.1038/293181a0 |pmid=7278974 |doi-access=free}}</ref> Besides, the program barely managed to be implemented in sub-Saharan Africa, the region of the planet with the highest malaria burden.<ref>{{Cite web |title=Malaria: progress and challenges toward elimination |url=https://saludeverywhere.com/en/health-in-humanitarian-crises/malaria-progress-challenges-elimination/ |access-date=11 May 2026 |website=Salud everywhere - Online learning in humanitarian health and international cooperation |language=en-US |archive-date=17 May 2026 |archive-url=https://web.archive.org/web/20260517210130/https://saludeverywhere.com/en/health-in-humanitarian-crises/malaria-progress-challenges-elimination/ |url-status=live }}</ref>
WHO suspended the program in 1969<ref name="Duintjer-2009" /><ref name="Nájera-2011">{{cite journal |vauthors=Nájera JA, González-Silva M, Alonso PL |date=January 2011 |title=Some lessons for the future from the Global Malaria Eradication Programme (1955-1969) |journal=PLOS Medicine |volume=8 |issue=1 |doi=10.1371/journal.pmed.1000412 |pmc=3026700 |pmid=21311585 |doi-access=free |article-number=e1000412}}</ref> and attention instead focused on controlling and treating the disease. Efforts shifted from spraying to the use of bednets impregnated with insecticides and other interventions.<ref name="Sadasivaiah-2007" /><ref name="Rogan-2005">{{cite journal | vauthors=Rogan WJ, Chen A | title=Health risks and benefits of bis(4-chlorophenyl)-1,1,1-trichloroethane (DDT) | journal=The Lancet | volume=366 | issue=9487 | pages=763–773 | year=2005 |id={{Zenodo|1259797}} | pmid=16125595 | doi=10.1016/S0140-6736(05)67182-6 }}</ref>
=== The Roll Back Malaria Partnership === In 1998, a new major global initiative was launched: The Roll Back Malaria Partnership. However, it failed to secure adequate funding and reverse the upward trend in malaria deaths, which peaked in 2004.<ref>{{cite journal |title=Reversing the failures of Roll Back Malaria |journal=The Lancet |date=April 2005 |volume=365 |issue=9469 |page=1439 |doi=10.1016/S0140-6736(05)66391-X | vauthors = ((The Lancet)) }}</ref>
===21st century=== thumb|Global incidence of new cases of malaria from 2015 to 2023, expressed as cases per thousand in vulnerable populations. Source: WHO thumb|Global malaria deaths from 2015 to 2023 (in thousands). Source: WHO
At the start of the 21st century, several global initiatives renewed efforts to control and eventually eradicate malaria. In 2000, malaria control became a key objective of the United Nations Millennium Development Goals,<ref>{{cite journal |vauthors=Sato S |date=January 2021 |title=''Plasmodium''-a brief introduction to the parasites causing human malaria and their basic biology |journal=Journal of Physiological Anthropology |volume=40 |issue=1 |doi=10.1186/s40101-020-00251-9 |pmc=7792015 |pmid=33413683 |doi-access=free |article-number=1}}</ref> followed in 2015 by the Sustainable Development Goals, which aim to end the malaria epidemic by 2030. From 2005 to 2014, global financing for malaria programmes rose sharply from about US $960 million to US $2.5 billion, largely driven by international donors and focused on the WHO African Region.<ref name="Cibulskis-2016">{{cite journal |last1=Cibulskis |first1=Richard E. |last2=Alonso |first2=Pedro |last3=Aponte |first3=John |last4=Aregawi |first4=Maru |last5=Barrette |first5=Amy |last6=Bergeron |first6=Laurent |last7=Fergus |first7=Cristin A. |last8=Knox |first8=Tessa |last9=Lynch |first9=Michael |last10=Patouillard |first10=Edith |last11=Schwarte |first11=Silvia |last12=Stewart |first12=Saira |last13=Williams |first13=Ryan |title=Malaria: Global progress 2000 – 2015 and future challenges |journal=Infectious Diseases of Poverty |date=December 2016 |volume=5 |issue=1 |article-number=61 |doi=10.1186/s40249-016-0151-8 |pmc=4901420 |pmid=27282148 |doi-access=free }}</ref> This surge in funding, channelled through programmes such as the Global Fund to Fight AIDS, Tuberculosis and Malaria<ref>{{cite web |date=30 June 2025 |title=Results Report 2025 |url=https://www.theglobalfund.org/en/results/ |access-date=3 November 2025 |website=The Global Fund to Fight AIDS, Tuberculosis and Malaria |archive-date=2 November 2025 |archive-url=https://web.archive.org/web/20251102171645/https://www.theglobalfund.org/en/results |url-status=live }}</ref> and Malaria No More<ref>{{Cite news |author-link=Stephanie Strom |date=1 April 2011 |title=Mission Accomplished, Nonprofits Go Out of Business |url=https://www.nytimes.com/2011/04/02/business/02charity.html |url-status=live |archive-url=https://web.archive.org/web/20111225132828/http://www.nytimes.com/2011/04/02/business/02charity.html |archive-date=25 December 2011 |access-date=9 May 2012 |newspaper=The New York Times |oclc=292231852 |vauthors=Strom S}}</ref> supported an extensive scale-up of malaria control tools such as insecticide-treated nets, indoor spraying, rapid diagnostic tests, and artemisinin-based combination therapies, though overall resources remained below the estimated US $5 billion needed annually to meet global targets.<ref name="Cibulskis-2016" />
Between 2004 and 2015, the global scale-up of malaria control led to a dramatic rise in insecticide-treated net deliveries to endemic countries, from 6 million to nearly 190 million per year, with more than a billion distributed overall. As a result, household access to such nets in sub-Saharan Africa increased from 7 percent in 2005 to about two-thirds by 2015, though universal coverage targets remained unmet.<ref name="Cibulskis-2016" /> By 2014, coverage of preventive malaria treatment during pregnancy had increased, with more than half of eligible women receiving at least one dose. However, many opportunities to deliver treatment were missed, and preventive drug programmes for children and infants were adopted in only a few countries.<ref name="Cibulskis-2016" />
Between 2005 and 2014, diagnostic testing for malaria increased sharply, particularly in the WHO African Region, where testing of suspected cases in the public sector rose from 36 to 65 percent, largely due to the spread of rapid diagnostic tests. Over the same period, treatment practices improved, with the share of children under five receiving artemisinin-based combination therapies increasing from under 1 percent in 2005 to about 16 percent in 2015, while use of older antimalarial drugs declined.<ref name="Cibulskis-2016" /> From 2000 to 2015, global malaria cases declined from about 262 million to 214 million, a reduction of roughly 18 percent, with the WHO African Region accounting for nearly nine out of ten infections. During the same period, malaria deaths fell by almost half, from an estimated 839 000 to 438 000, reflecting major progress toward international targets to reduce disease incidence and mortality.<ref name="Cibulskis-2016" />
By 2015, a growing number of countries had moved closer to eliminating malaria. The number of nations with fewer than 1,000 cases rose from 13 in 2000 to 33, and 16 countries reported no locally transmitted cases. That same year, the WHO European Region recorded zero indigenous infections for the first time, meeting the target set in the Tashkent Declaration.<ref name="Cibulskis-2016" />
The progress made until 2015 stalled thereafter. From 2015 to 2022, the rate of new cases rates remained broadly stable, followed by a slight rise in 2023 (see illustration), with sharp increases reported in Ethiopia, Madagascar, and Pakistan. Malaria deaths fell steadily until 2019, rose sharply in 2020 as a result of COVID-19 disruptions, and then declined again in the following years. While malaria remained most deadly for young children, their share of overall deaths had fallen. Sub-Saharan Africa continues to account for 95% of global cases, with Nigeria, the Democratic Republic of the Congo, Uganda, Ethiopia, and Mozambique together responsible for more than half.<ref>{{cite book |last1=WHO |url=https://www.who.int/teams/global-malaria-programme/ |title=World Malaria Report 2024 |date=2024 |publisher=World Health Organization |isbn=978-92-4-010444-0 |location=Switzerland |access-date=4 November 2025 |archive-date=12 November 2025 |archive-url=https://web.archive.org/web/20251112043211/https://www.who.int/teams/global-malaria-programme |url-status=live }}</ref><ref name="WHO-Briefing-2024" />
This stalling from 2015 was due to a combination of environmental, humanitarian, and biological challenges. Climate change created conditions that favored mosquito breeding and survival, with rising temperatures, shifting rainfall, and frequent floods expanding transmission zones. In Pakistan, for example, the 2022 floods led to an eightfold increase in malaria cases within two years.<ref name="Health Policy Watch-2024">{{cite web |date=11 December 2024 |title=Global Malaria Progress Stalled With Nearly 600,000 Deaths In 2023 |url=https://healthpolicy-watch.news/global-malaria-progress-stalled/ |access-date=4 November 2025 |website=Health Policy Watch |archive-date=5 December 2025 |archive-url=https://web.archive.org/web/20251205171125/https://healthpolicy-watch.news/global-malaria-progress-stalled/ |url-status=live }}</ref> Conflicts and resulting humanitarian crises have also disrupted health services and displaced millions of people into areas with little access to prevention or treatment. At the same time, growing resistance to both insecticides and artemisinin-based therapies has made malaria harder to control and treat. These overlapping pressures—climate change, conflict, displacement, and resistance—have together undermined the progress achieved in earlier decades.<ref name="Health Policy Watch-2024" />
In 2021, the WHO Global Technical Strategy for Malaria was updated, proposing three consecutive priorities to be addressed as progress is made in reducing disease transmission.<ref>{{Cite web |title=Global technical strategy for malaria 2016-2030, 2021 update |url=https://www.who.int/publications/i/item/9789240031357 |access-date=11 May 2026 |website=www.who.int |language=en |archive-date=18 May 2026 |archive-url=https://web.archive.org/web/20260518074810/https://www.who.int/publications/i/item/9789240031357 |url-status=live }}</ref> The first priority focuses on reducing morbidity and mortality by decreasing transmission, the second one pursues malaria elimination through epidemiological surveillance of clinical cases and active case-finding, and the third one seeks to consolidate achievements and prevent the resurgence of malaria once local transmission has been eliminated. This renewed global commitment aims to reach a world largely free of malaria by 2050.<ref>{{cite journal |last1=Feachem |first1=Richard G A |last2=Chen |first2=Ingrid |last3=Akbari |first3=Omar |last4=Bertozzi-Villa |first4=Amelia |last5=Bhatt |first5=Samir |last6=Binka |first6=Fred |last7=Boni |first7=Maciej F |last8=Buckee |first8=Caroline |last9=Dieleman |first9=Joseph |last10=Dondorp |first10=Arjen |last11=Eapen |first11=Alex |last12=Sekhri Feachem |first12=Neelam |last13=Filler |first13=Scott |last14=Gething |first14=Peter |last15=Gosling |first15=Roly |last16=Haakenstad |first16=Annie |last17=Harvard |first17=Kelly |last18=Hatefi |first18=Arian |last19=Jamison |first19=Dean |last20=Jones |first20=Kate E |last21=Karema |first21=Corine |last22=Kamwi |first22=Richard Nchabi |last23=Lal |first23=Altaf |last24=Larson |first24=Erika |last25=Lees |first25=Margaret |last26=Lobo |first26=Neil F |last27=Micah |first27=Angela E |last28=Moonen |first28=Bruno |last29=Newby |first29=Gretchen |last30=Ning |first30=Xiao |last31=Pate |first31=Muhammad |last32=Quiñones |first32=Martha |last33=Roh |first33=Michelle |last34=Rolfe |first34=Ben |last35=Shanks |first35=Dennis |last36=Singh |first36=Balbir |last37=Staley |first37=Kenneth |last38=Tulloch |first38=James |last39=Wegbreit |first39=Jennifer |last40=Woo |first40=Hyun Ju |last41=Mpanju-Shumbusho |first41=Winnie |title=Malaria eradication within a generation: ambitious, achievable, and necessary |journal=The Lancet |date=September 2019 |volume=394 |issue=10203 |pages=1056–1112 |doi=10.1016/S0140-6736(19)31139-0 |pmid=31511196 }}</ref>
== Society and culture ==
=== Economic consequences === thumb|right|Malaria clinic in Tanzania
Malaria is not just a disease commonly associated with poverty; some evidence suggests that it is also a cause of poverty and a major hindrance to economic development.<ref name="Gollin-2007" /><ref name="Worrall-2005" />
A comparison of average per capita GDP in 1995, adjusted for parity of purchasing power, between countries with malaria and countries without malaria gives a fivefold difference (US$1,526 versus US$8,268). In the period 1965 to 1990, countries where malaria was common had an average per capita GDP that increased only 0.4% per year, compared to 2.4% per year in other countries.<ref name="Sachs-2002" />
Poverty can increase the risk of malaria since those in poverty do not have the financial capacities to prevent or treat the disease. In its entirety, the economic consequences of malaria has been estimated to cost Africa US$12 billion every year. This includes costs of health care, working days lost due to sickness, days lost in education, decreased productivity due to brain damage from cerebral malaria, and loss of investment and tourism.<ref name="Greenwood-2005" /> The disease has a heavy burden in some countries, where it may be responsible for 30–50% of hospital admissions, up to 50% of outpatient visits, and up to 40% of public health spending.<ref name="WHO-2003" />
Cerebral malaria is one of the leading causes of neurological disabilities in African children.<ref name="Idro-2010" /> Studies comparing cognitive functions before and after treatment for severe malarial illness continued to show significantly impaired school performance and cognitive abilities even after recovery.<ref name="Fernando-2010" /> Consequently, severe and cerebral malaria have far-reaching socioeconomic consequences that extend beyond the immediate effects of the disease.<ref name="Ricci-2012" />
===Counterfeit and substandard drugs=== {{Update|part=section|date=February 2026|reason=Sources are more than 15 years old}} Sophisticated counterfeits have been found in several Asian countries such as Cambodia,<ref name="Lon-2006" /> China,<ref name="Newton-2008" /> Indonesia, Laos, Thailand, and Vietnam, and are a major cause of avoidable death in those countries.<ref name="Newton-2006" /> The WHO said that studies indicate that up to 40% of artesunate-based malaria medications are counterfeit, especially in the Greater Mekong region. They have established a rapid alert system to rapidly report information about counterfeit drugs to relevant authorities in participating countries.<ref name="Parry-2005" /> There is no reliable way for doctors or lay people to detect counterfeit drugs without help from a laboratory. Companies are attempting to combat the persistence of counterfeit drugs by using new technology to provide security from source to distribution.<ref name="Gautam-2009" />
Another clinical and public health concern is the proliferation of substandard antimalarial medicines resulting from inappropriate concentration of ingredients, contamination with other drugs or toxic impurities, poor quality ingredients, poor stability and inadequate packaging.<ref name="Caudron-2008" /> A 2012 study demonstrated that roughly one-third of antimalarial medications in Southeast Asia and Sub-Saharan Africa failed chemical analysis, packaging analysis, or were falsified.<ref name="Nayyar-2012" />
In February 2023 a United Nations report estimated that 267,000 deaths per year are linked to counterfeit or substandard medication in Africa alone.<ref>{{Cite news |date=1 February 2023 |title=Fake medicines kill almost 500,000 sub-Saharan Africans a year: UNODC report |url=https://news.un.org/en/story/2023/02/1133062 |archive-url=https://web.archive.org/web/20251202105459/https://news.un.org/en/story/2023/02/1133062 |archive-date=2 December 2025 |access-date=11 February 2026 |work=UN News |language=en |url-status=live }}</ref>
===War=== thumb|right|World War II poster
Throughout history, the contraction of malaria has played a prominent role in the fates of government rulers, nation-states, military personnel, and military actions.<ref name="Russell-2009" /> In 1910, Nobel Prize in Medicine-winner Sir Ronald Ross (himself a malaria survivor), published a book titled ''The Prevention of Malaria'' that included a chapter titled "The Prevention of Malaria in War". The chapter's author, Colonel C. H. Melville, Professor of Hygiene at Royal Army Medical College in London, addressed the prominent role that malaria has historically played during wars: "The history of malaria in war might almost be taken to be the history of war itself, certainly the history of war in the Christian era. ... It is probably the case that many of the so-called camp fevers, and probably also a considerable proportion of the camp dysentery, of the wars of the sixteenth, seventeenth and eighteenth centuries were malarial in origin."<ref name="Melville-1910" /> In British-occupied India the cocktail gin and tonic may have come about as a way of taking quinine, known for its antimalarial properties.<ref>{{cite book |vauthors=Bryant BJ, Knights KM |title=Pharmacology for Health Professionals |date=2011 |publisher=Elsevier Australia |isbn=978-0-7295-3929-6 |page=895 |url=https://books.google.com/books?id=TQV6sLzYsOYC&pg=PA895}}</ref>
Malaria was the most significant health hazard encountered by U.S. troops in the South Pacific during World War II, where about 500,000 men were infected.<ref name="Bray-2004" /> According to Joseph Patrick Byrne, "Sixty thousand American soldiers died of malaria during the African and South Pacific campaigns."<ref name="Byrne-2008" /> Malaria was a contributing factor to the U.S. surrender at Bataan in 1942.<ref>{{cite journal |last1=Mertens |first1=Jonas E. |title=A History of Malaria and Conflict |journal=Parasitology Research |date=March 2024 |volume=123 |issue=3 |article-number=165 |doi=10.1007/s00436-024-08167-4 |pmc=10951023 |pmid=38504009 }}</ref>
During World War II, both Germany and the Axis powers suffered troop losses caused by malaria and committed resources to malaria prevention. In Germany, concentration camp inmates in Dachau and Buchenwald were used as guinea pigs for sometimes lethal experimental drug treatments.<ref>{{cite journal |last1=Eckart |first1=W. U. |last2=Vondra |first2=H. |title=Malaria and World War II: German malaria experiments 1939-45 |journal=Parassitologia |date=June 2000 |volume=42 |issue=1–2 |pages=53–58 |pmid=11234332 }}</ref> Early in 1942, the U.S. established a program called Malaria Control in War Areas (MCWA), "established to control malaria around military training bases in the southern United States and its territories, where malaria was still problematic". This organisation evolved into the present day Centers for Disease Control and Prevention.<ref name="CDC-History-2010b" />
==Research directions==<!--Please do not add specific research studies here. For more infomation see - https://en.wikipedia.org/wiki/Wikipedia:Manual_of_Style/Medicine-related_articles#Trivia-->
=== Global coordination === The Malaria Eradication Research Agenda (malERA) was a project carried out in 2007 by the global scientific community to identify the steps and future research that must be done in order to eradicate malaria. It was created after the Malaria Forum in 2007, and resulted in a research and development agenda intended to complement ongoing research into malaria control by identifying knowledge gaps and tools needed for full eradications.<ref>{{cite journal |last1=Alonso |first1=Pedro L. |last2=Brown |first2=Graham |last3=Arevalo-Herrera |first3=Myriam |last4=Binka |first4=Fred |last5=Chitnis |first5=Chetan |last6=Collins |first6=Frank |last7=Doumbo |first7=Ogobara K. |last8=Greenwood |first8=Brian |last9=Hall |first9=B. Fenton |last10=Levine |first10=Myron M. |last11=Mendis |first11=Kamini |last12=Newman |first12=Robert D. |last13=Plowe |first13=Christopher V. |last14=Rodríguez |first14=Mario Henry |last15=Sinden |first15=Robert |last16=Slutsker |first16=Laurence |last17=Tanner |first17=Marcel |title=A Research Agenda to Underpin Malaria Eradication |journal=PLOS Medicine |date=25 January 2011 |volume=8 |issue=1 |article-number=e1000406 |doi=10.1371/journal.pmed.1000406 |doi-access=free |pmc=3026687 |pmid=21311579 }}</ref> In 2015, it was reviewed and updated under 6 headings: "basic science and enabling technologies, insecticide and drug resistance, characterizing the reservoir and measuring transmission, tools for elimination, combination interventions and modeling, health systems and policy research."<ref>{{Cite web |title=malERA Refresh (Full series) - MESA |url=https://mesamalaria.org/resource-hub/malera-refresh/ |archive-url=https://web.archive.org/web/20250803181847/https://mesamalaria.org/resource-hub/malera-refresh/ |archive-date=3 August 2025 |access-date=28 February 2026 |website=mesamalaria.org |language=en-US |url-status=live }}</ref>
===Vaccines=== The search for a malaria vaccine started in the 1960s, and is ongoing.<ref name="El-Moamly-2023">{{cite journal |last1=El-Moamly |first1=Amal A. |last2=El-Sweify |first2=Mohamed A. |title=Malaria vaccines: the 60-year journey of hope and final success—lessons learned and future prospects |journal=Tropical Medicine and Health |date=17 May 2023 |volume=51 |issue=1 |article-number=29 |doi=10.1186/s41182-023-00516-w |pmid=37198702 |doi-access=free |pmc=10189698 }}</ref><ref>{{Cite web |last=CDC |date=9 May 2024 |title=Malaria Vaccines |url=https://www.cdc.gov/malaria/php/public-health-strategy/malaria-vaccines.html |access-date=18 February 2026 |website=Malaria |language=en-us |archive-date=15 February 2026 |archive-url=https://web.archive.org/web/20260215074710/https://www.cdc.gov/malaria/php/public-health-strategy/malaria-vaccines.html |url-status=live }}</ref> {{As of|February 2026}}, two malaria vaccines have completed clinical trials and are in use; they are RTS,S (Mosquirix) and R21/Matrix-MTM,<ref name="WHO recommends R21-20232">{{cite web |date=2 October 2023 |title=WHO recommends R21/Matrix-M vaccine for malaria prevention in updated advice on immunization |url=https://www.who.int/news/item/02-10-2023-who-recommends-r21-matrix-m-vaccine-for-malaria-prevention-in-updated-advice-on-immunization |url-status=live |archive-url=https://web.archive.org/web/20231003232601/https://www.who.int/news/item/02-10-2023-who-recommends-r21-matrix-m-vaccine-for-malaria-prevention-in-updated-advice-on-immunization |archive-date=3 October 2023 |access-date=8 December 2023}}</ref> both of which target the ''P. falciparum'' sporozoite;<ref>{{Cite web |date=16 February 2024 |title=Two vaccines, one target: How the RTS,S and R21 malaria vaccines work |url=https://www.gavi.org/vaccineswork/two-vaccines-one-target-how-rtss-and-r21-malaria-vaccines-work |access-date=18 February 2026 |website=Gavi, The Vaccine Alliance |language=en |archive-date=13 February 2026 |archive-url=https://web.archive.org/web/20260213125921/https://www.gavi.org/vaccineswork/two-vaccines-one-target-how-rtss-and-r21-malaria-vaccines-work |url-status=live }}</ref> a further 25 clinical trials are in progress.<ref>{{Cite web |title=WHO review of malaria vaccine clinical development |url=https://www.who.int/observatories/global-observatory-on-health-research-and-development/monitoring/who-review-of-malaria-vaccine-clinical-development |access-date=18 February 2026 |website=www.who.int |language=en |archive-date=26 January 2026 |archive-url=https://web.archive.org/web/20260126231643/https://www.who.int/observatories/global-observatory-on-health-research-and-development/monitoring/who-review-of-malaria-vaccine-clinical-development |url-status=live }}</ref>
There are three main types of vaccine candidate. Pre-erythrocytic vaccines aim to block infection completely by incapacitating the sporozoite before it reaches the liver.<ref name="El-Moamly-2023" /> Erythrocytic vaccines (blood-stage vaccines) aim to target the merozoite stage in the bloodstream; these have largely proved ineffective due to antigenic polymorphism of this stage of the parasite.<ref name="El-Moamly-2023" /> Transmission-blocking vaccines aim to generate antibodies against the sexual stages of the parasite - gametes, zygotes and ookinetes. These either prevent transmission of the parasite from human to mosquito, or hinder the sexual stage of its life cycle within the infected mosquito.<ref name="El-Moamly-2023" />
=== Drugs === There are two aspects to drug research. As the parasite evolves to resist to existing drugs, there is an urgent need for new drugs.<ref name="Siqueira-Neto-2023">{{cite journal |last1=Siqueira-Neto |first1=Jair L. |last2=Wicht |first2=Kathryn J. |last3=Chibale |first3=Kelly |last4=Burrows |first4=Jeremy N. |last5=Fidock |first5=David A. |last6=Winzeler |first6=Elizabeth A. |title=Antimalarial drug discovery: progress and approaches |journal=Nature Reviews Drug Discovery |date=October 2023 |volume=22 |issue=10 |pages=807–826 |doi=10.1038/s41573-023-00772-9 |pmc=10543600 |pmid=37652975 }}</ref> There is also ongoing research into existing drugs, to improve their effectiveness by testing drug combinations and dosage,<ref>{{Cite web|title=Multiple first-line therapies as part of the response to antimalarial drug resistance|url=https://www.who.int/publications/i/item/9789240103603|access-date=22 February 2026|website=www.who.int|language=en|archive-date=13 February 2026|archive-url=https://web.archive.org/web/20260213155340/https://www.who.int/publications/i/item/9789240103603|url-status=live}}</ref> and by improving diagnosis, availability and compliance in people who need them.<ref>{{cite journal |last1=Amoako |first1=Michelle Akua |last2=Wutor |first2=Victor Collins |last3=N'guessan |first3=Benoit Banga |title=Knowledge, beliefs and adherence to antimalarial medications among patients in the Ga East Municipality of Ghana |journal=Frontiers in Malaria |date=28 August 2025 |volume=3 |article-number=1582682 |doi=10.3389/fmala.2025.1582682 |doi-access=free }}</ref>
An element of the search for new drugs is finding novel mechanisms which can be targeted. There are many candidates - some of these include the parasite's proteasome, proteases, and kinases.<ref>{{cite journal |last1=Guerra |first1=Francisco |last2=Winzeler |first2=Elizabeth A |title=New targets for antimalarial drug discovery |journal=Current Opinion in Microbiology |date=December 2022 |volume=70 |article-number=102220 |doi=10.1016/j.mib.2022.102220 |pmc=9934905 |pmid=36228458 }}</ref><ref name="Siqueira-Neto-2023" />
=== Vector biology and control === This field of research looks at the mosquito vector, identifying and investigating the species which serve as vectors, as well as ways in which they can either be controlled, or prevented from harboring the parasite e.g. by genetic modification.<ref>{{cite journal |last1=Tajudeen |first1=Yusuf Amuda |last2=Oladipo |first2=Habeebullah Jayeola |last3=Oladunjoye |first3=Iyiola Olatunji |last4=Oladipo |first4=Muhammad Kamaldeen |last5=Shittu |first5=Hameedat Damilola |last6=Abdulmumeen |first6=Imam-Fulani |last7=Afolabi |first7=Abdullateef Opeyemi |last8=El-Sherbini |first8=Mona Said |title=Transforming malaria prevention and control: the prospects and challenges of gene drive technology for mosquito management |journal=Annals of Medicine |date=12 December 2023 |volume=55 |issue=2 |article-number=2302504 |doi=10.1080/07853890.2024.2302504 |pmc=10795774 |pmid=38232762 }}</ref><ref>{{Cite web|title=What are gene drives?|url=https://www.malariagen.net/article/what-are-gene-drives/|access-date=26 February 2026|website=MalariaGen - Genomic Epidemiology Network|language=en-GB|archive-date=19 January 2026|archive-url=https://web.archive.org/web/20260119214223/https://www.malariagen.net/article/what-are-gene-drives/|url-status=live}}</ref><ref>{{cite journal |last1=Hadebe |first1=Mzwandile Thabani |last2=Malgwi |first2=Samson Anjikwi |last3=Okpeku |first3=Moses |title=Revolutionizing Malaria Vector Control: The Importance of Accurate Species Identification through Enhanced Molecular Capacity |journal=Microorganisms |date=31 December 2023 |volume=12 |issue=1 |page=82 |doi=10.3390/microorganisms12010082 |doi-access=free |pmid=38257909 |pmc=10818655 }}</ref>
=== Socioeconomic research === Malaria is strongly linked to poverty.<ref>{{Cite web|last1=Mermet|first1=Luciana|last2=Tarlton|first2=Dudley|title=Poverty and malaria are linked. Can we tackle them together?|url=https://www.undp.org/blog/poverty-and-malaria-are-linked-can-we-tackle-them-together|archive-url=https://web.archive.org/web/20250920091704/https://www.undp.org/blog/poverty-and-malaria-are-linked-can-we-tackle-them-together|archive-date=20 September 2025|access-date=26 February 2026|website=United Nations Development Programme|language=en|url-status=live}}</ref> This field of research aims to investigate social and economic factors which obstruct eradication efforts. It includes studies on improving access to diagnostic tools and appropriate treatment in under-served regions.<ref>{{cite journal |last1=Macarayan |first1=Erlyn |last2=Papanicolas |first2=Irene |last3=Jha |first3=Ashish |title=The quality of malaria care in 25 low-income and middle-income countries |journal=BMJ Global Health |date=February 2020 |volume=5 |issue=2 |article-number=e002023 |doi=10.1136/bmjgh-2019-002023 |pmid=32133188 |pmc=7042579 }}</ref> It is also important to understand and address community perceptions of malaria to improve the adoption of preventative measures like bed nets.<ref>{{cite journal |last1=Edusei |first1=Marian Yaa Abrafi |last2=Alaba |first2=Olufunke |last3=Okova |first3=Denis |last4=Obse |first4=Amarech |title=Socio-economic inequalities in malaria prevalence among under-five children in Ghana between 2016 and 2019: a decomposition analysis |journal=Malaria Journal |date=8 May 2025 |volume=24 |issue=1 |article-number=147 |doi=10.1186/s12936-025-05349-y |doi-access=free |pmid=40340795 |pmc=12063222 }}</ref><ref>{{cite journal |last1=Pell |first1=Christopher |last2=Straus |first2=Lianne |last3=Andrew |first3=Erin V. W. |last4=Meñaca |first4=Arantza |last5=Pool |first5=Robert |title=Social and Cultural Factors Affecting Uptake of Interventions for Malaria in Pregnancy in Africa: A Systematic Review of the Qualitative Research |journal=PLOS ONE |date=20 July 2011 |volume=6 |issue=7 |article-number=e22452 |doi=10.1371/journal.pone.0022452 |pmid=21799859 |doi-access=free |pmc=3140529 |bibcode=2011PLoSO...622452P }}</ref>
=== Climate-informed malaria surveillance and early warning systems ===
Recent research has focused on integrating climate data into malaria surveillance systems to improve prediction and prevention of outbreaks. Climate-informed early warning systems use environmental data such as temperature, rainfall, and humidity, combined with epidemiological and satellite data, to forecast malaria risk in specific regions.<ref name="worldmalariareport">{{cite report |title=World Malaria Report 2023 |publisher=World Health Organization |year=2023 |url=https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2023 |archive-date=18 July 2024 |access-date=21 July 2024 |archive-url=https://web.archive.org/web/20240718025316/https://www.who.int/teams/global-malaria-Programme/reports/world-malaria-report-2023 |url-status=live }}</ref> These systems allow public health authorities to implement targeted interventions, such as indoor residual spraying and distribution of insecticide-treated bed nets, before outbreaks occur.<ref>{{cite journal |last1=Thomson |first1=MC |last2=Mason |first2=SJ |last3=Phindela |first3=T |last4=Connor |first4=SJ |title=Use of rainfall and sea surface temperature monitoring for malaria early warning in Botswana |journal=American Journal of Tropical Medicine and Hygiene |year=2005 |volume=73 |issue=1 |pages=214–221 |doi=10.4269/ajtmh.2005.73.214 |pmid=16014862 |bibcode=2005AJTMH..73..214T }}</ref>
Advances in modeling and artificial intelligence have further improved the accuracy of malaria predictions by incorporating real-time climate and environmental data.<ref>{{cite journal |last1=Ryan |first1=SJ |last2=Carlson |first2=CJ |last3=Mordecai |first3=EA |last4=Johnson |first4=LR |title=Global expansion and redistribution of vector-borne disease risk with climate change |journal=Nature Climate Change |year=2020 |volume=10 |pages=1056–1061}}</ref> These approaches are increasingly used in malaria-endemic regions, particularly in sub-Saharan Africa, to support proactive disease control strategies. Ongoing research aims to refine these tools and integrate them into national health systems to enhance preparedness and reduce malaria burden.<ref name="worldmalariareport" />
=== Emerging Technologies === Recent advances in genetic technologies offer new approaches to malaria control. One potential strategy is the genetic modification of mosquitoes using gene drive technologies, such as CRISPR-Cas9.<ref name="Naidoo-2025">{{cite journal |last1=Naidoo |first1=Kubendran |last2=Oliver |first2=Shüné V. |title=Gene drives: an alternative approach to malaria control? |journal=Gene Therapy |date=January 2025 |volume=32 |issue=1 |pages=25–37 |doi=10.1038/s41434-024-00468-8 |pmc=11785527 |pmid=39039203 }}</ref><ref name="Phillips-2017">{{cite journal |last1=Phillips |first1=Margaret A. |last2=Burrows |first2=Jeremy N. |last3=Manyando |first3=Christine |last4=van Huijsduijnen |first4=Rob Hooft |last5=Van Voorhis |first5=Wesley C. |last6=Wells |first6=Timothy N. C. |title=Malaria |journal=Nature Reviews Disease Primers |date=3 August 2017 |volume=3 |issue=1 |article-number=17050 |doi=10.1038/nrdp.2017.50 |pmid=28770814 }}</ref> Through CRISPR-Cas9 gene editing, scientists can introduce genes into mosquito populations that either make them resistant to ''Plasmodium'' parasites or enable population suppression, where mosquitoes are modified so that any progeny are sterile.<ref name="Naidoo-2025" /><ref name="Phillips-2017" />
Gene drive technologies increase the probability that a modified gene will be inherited by offspring, allowing traits such as malaria resistance or sterility to spread rapidly through mosquito populations over generations.<ref name="Naidoo-2025" /><ref name="Phillips-2017" /> This rapid spread is driven by the short life cycle and high reproductive rate of ''Anopheles'' mosquitoes.<ref name="CDC-2024">{{Cite web |last=CDC |date=14 May 2024 |title=Life Cycle of Anopheles Mosquitoes |url=https://www.cdc.gov/mosquitoes/about/life-cycle-of-anopheles-mosquitoes.html |access-date=23 April 2026 |website=Mosquitoes |language=en-us |archive-date=26 April 2026 |archive-url=https://web.archive.org/web/20260426162054/https://www.cdc.gov/mosquitoes/about/life-cycle-of-anopheles-mosquitoes.html |url-status=live }}</ref> They can complete development from egg to adult in approximately 10 to 14 days, with female mosquitoes laying 50-200 eggs at a time.<ref name="CDC-2024" /> While these approaches remain in early stages of development and raise ecological and ethical considerations, they present a promising strategy in addition to current interventions.
==Other animals== While none of the main four species of malaria parasite that cause human infections are known to have animal reservoirs,<ref>{{cite web |title=Facts about malaria |url=https://www.ecdc.europa.eu/en/malaria/facts |publisher=European Centre for Disease Prevention and Control |date=9 June 2017 |access-date=16 July 2021 |archive-date=6 July 2021 |archive-url=https://web.archive.org/web/20210706064110/https://www.ecdc.europa.eu/en/malaria/facts |url-status=live}}</ref> ''P. knowlesi'' is known to infect both humans and non-human primates.<ref name="Collins-2012"/> Other non-human primate malarias (particularly ''P. cynomolgi'' and ''P. simium'') have also been found to have spilled over into humans.<ref>{{cite journal | vauthors=Brasil P, Zalis MG, de Pina-Costa A, Siqueira AM, Júnior CB, Silva S, Areas AL, Pelajo-Machado M, de Alvarenga DA, da Silva Santelli AC, Albuquerque HG, Cravo P, Santos de Abreu FV, Peterka CL, Zanini GM, Suárez Mutis MC, Pissinatti A, Lourenço-de-Oliveira R, de Brito CF, de Fátima Ferreira-da-Cruz M, Culleton R, Daniel-Ribeiro CT | title=Outbreak of human malaria caused by ''Plasmodium simium'' in the Atlantic Forest in Rio de Janeiro: a molecular epidemiological investigation | journal=The Lancet Global Health | volume=5 | issue=10 | pages=e1038–e1046 | date=October 2017 | pmid=28867401 | doi=10.1016/S2214-109X(17)30333-9 | doi-access=free}}</ref> Nearly 200 ''Plasmodium'' species have been identified that infect birds, reptiles, and other mammals,<ref name="Rich-2006" /> and about 30 of them naturally infect non-human primates.<ref name="Baird-2009" /> Some malaria parasites of non-human primates (NHP) serve as model organisms for human malarial parasites, such as ''P. coatneyi'' (a model for ''P. falciparum'') and ''P. cynomolgi'' (a model for ''P. vivax''). Diagnostic techniques used to detect parasites in NHP are similar to those employed for humans.<ref name="Ameri-2010" /> Malaria parasites that infect rodents are widely used as models in research, such as ''P. berghei''.<ref name="Mlambo-2008"/> Avian malaria primarily affects species of the order Passeriformes, and poses a substantial threat to birds of Hawaii, the Galapagos, and other archipelagoes. The parasite ''P. relictum'' is known to play a role in limiting the distribution and abundance of endemic Hawaiian birds. Global warming is expected to increase the prevalence and global distribution of avian malaria, as elevated temperatures provide optimal conditions for parasite reproduction.<ref name="Lapointe-2012"/>
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==Sources== * {{Cite book |author={{Text|World Health Organization}} |author-mask=[World Health Organization] |title=Guidelines for the Treatment of Malaria |publisher=World Health Organization |date=2015 |isbn=978-92-4-154912-7 |hdl=10665/162441 |hdl-access=free |ref={{SfnRef|WHO|2015}}}} * {{Cite book |author={{Text|World Health Organization}} |author-mask=[World Health Organization] |title=World Malaria Report 2022 |publisher=World Health Organization |date=2022 |hdl=10665/365169 |hdl-access=free |isbn=978-92-4-006489-8 |ref={{SfnRef|WHO|2022}}}}
== Further reading == {{refbegin}} * {{Cite journal |last=Barber |first=Marshall Albert |title=The history of malaria in the United States |journal=Public Health Reports |volume=44 |issue=43 |pages=2575–87 |date=1929 |doi=10.2307/4579430 |jstor=4579430 |url=}} * {{Cite book |editor-last=Bynum |editor-first=W.F. |editor2-first=C. |editor2-last=Overy |title=The Beast in the Mosquito: The Correspondence of Ronald Ross and Patrick Manson |publisher=Rodopi |location= |date=1998 |isbn=978-90-420-0721-5 |url=https://books.google.com/books?id=af_0DwAAQBAJ&pg=PR1 |archive-date=1 December 2025 |access-date=28 January 2025 |archive-url=https://web.archive.org/web/20251201054731/https://books.google.com/books?pg=PR1&id=af_0DwAAQBAJ |url-status=live }} * {{Cite magazine |last=Jarvis |first=B. |title=How Mosquitoes Changed Everything |url=https://www.newyorker.com/magazine/2019/08/05/how-mosquitoes-changed-everything |magazine=The New Yorker |access-date=8 August 2019 |date=29 July 2019 |archive-date=7 August 2019 |archive-url=https://web.archive.org/web/20190807195030/https://www.newyorker.com/magazine/2019/08/05/how-mosquitoes-changed-everything |url-status=live }} * {{Cite book |last1=Karunaweera |first1=Nadira D. |last2=Silva |first2=N. Hermali |year=2022 |editor-last=Parija |editor-first=Subhash Chandra |title=Textbook of Parasitic Zoonoses |publisher=Springer |location=Singapore |pages=151–161 |chapter=Malaria |doi=10.1007/978-981-16-7204-0_14 |editor-last2=Chaudhury |editor-first2=Abhijit |isbn=978-981-16-7204-0}} * {{Cite encyclopedia|title=Encyclopedia of Malaria|publisher=Springer|year=2025|isbn=978-1-4614-8325-0|editor1-last=Kremsner|editor1-first=Peter G.|editor2-last=Krishna|editor2-first=Sanjeev|location=New York, NY|doi=10.1007/978-1-4614-8326-7}} * {{Cite journal |last1=Li |first1=Qilong |last2=Liu |first2=Tong |last3=Lv |first3=Kunying |last4=Liao |first4=Fulong |last5=Wang |first5=Jigang |last6=Tu |first6=Youyou |last7=Chen |first7=Qijun |title=Malaria: past, present, and future |journal=Signal Transduction and Targeted Therapy |date=2025 |volume=10 |issue=1 |page=188 |doi=10.1038/s41392-025-02246-3 |pmid=40523953 |doi-access=free |pmc=12170910}} * {{Cite journal |first=Maurizio |last=Malpede |title=Malaria and economic activity: Evidence from US agriculture |journal=American Journal of Agricultural Economics |volume=105 |issue=5 |pages=1516–42 |date=2023 |doi=10.1111/ajae.12363 }} * {{Cite journal |title=Tightening the handle on malaria |journal=Nature Methods |volume=16 |issue=4 |page=271 |date=April 2019 |pmid=30923375 |doi=10.1038/s41592-019-0390-2 |type=Editorial |doi-access=free |quote=A day dedicated to raising awareness of the disease is a good opportunity to ask how far malaria research has come and which methods are needed for further breakthroughs.}}<!-- This is something of a very brief annual review of key research and should be supplanted by more up to date items when they emerge. --> * {{Cite book |last1=Poser |first1=Charles M. |first2=George W. |last2=Bruyn |title=An Illustrated History of Malaria |publisher=Parthenon |date=1999 |isbn=1-85070-068-0 |oclc=537843745 |url=}} Review: {{cite journal |last1=Humphreys |first1=Margaret |title=An Illustrated History of Malaria (review) |journal=Bulletin of the History of Medicine |date=March 2001 |volume=75 |issue=1 |page=148 |id={{Project MUSE|4623}} |doi=10.1353/bhm.2001.0024 }} * {{Cite book |editor1-last=Qidwai |editor1-first=Tabish |title=Falciparum Malaria: Diagnostic Tools, Therapeutic Advances, and Future Opportunities |date=2024 |publisher=Academic Press |isbn=978-0-323-95328-3 |language=en}} * {{Cite book |last1=Warrell |first1=David A. |title=Essential Malariology |last2=Gilles |first2=Herbert M. |publisher=CRC Press |year=2019 |isbn=978-0-367-39616-9 |location=London |edition=4th |orig-date=2002}} * {{Cite book |last=Watts |first=Sheldon J |chapter=6. Yellow Fever, Malaria and Development: Atlantic Africa and the New World, 1647 to 1928 |chapter-url={{GBurl|AVX7NInQraoC|p=213}} |title=Epidemics and history: disease, power, and imperialism |publisher=Yale University Press |date=1999 |isbn=0-300-08087-5 |jstor=j.ctt1nq8qw |oclc=55142577 |pages=213–268 |url=https://books.google.com/books?id=AVX7NInQraoC&pg=PR5 |archive-date=27 November 2025 |access-date=28 January 2025 |archive-url=https://web.archive.org/web/20251127172514/https://books.google.com/books?id=AVX7NInQraoC&pg=PR5 |url-status=live }} * {{Cite report |author={{Text|World Health Organization}} |author-mask=[World Health Organization] |title=Guidelines for the Treatment of Malaria |edition=2nd |year=2010 |publisher=World Health Organization |isbn=978-92-4-154792-5 |url=http://whqlibdoc.who.int/publications/2010/9789241547925_eng.pdf |archive-url=https://web.archive.org/web/20100311024041/http://whqlibdoc.who.int/publications/2010/9789241547925_eng.pdf |archive-date=11 March 2010 }} * {{Cite book |author={{Text|World Health Organization}} |author-mask=[World Health Organization] |title=WHO Guidelines for Malaria |date=2023 |publisher=World Health Organization |hdl=10665/373339 |hdl-access=free}} * {{Cite journal |last=Williams |first=Louis L. |title=Malaria Eradication in the United States |journal=American Journal of Public Health and the Nation's Health |volume=53 |issue=1 |pages=17–21 |date=1963 |doi=10.2105/AJPH.53.1.17 |pmid=14000898 |pmc=1253858}} {{refend}}
== External links == {{offline|med}} * [https://www.who.int/campaigns/world-malaria-day/2026 Driven to End Malaria.] Now We Can. Now We Must. * [https://www.who.int/news-room/fact-sheets/detail/malaria WHO site on malaria] ({{Webarchive|url=https://web.archive.org/web/20200502021814/https://www.who.int/news-room/fact-sheets/detail/malaria |date=2 May 2020}}) * [https://www.cdc.gov/parasites/malaria/index.html CDC site on malaria] ({{Webarchive|url=https://web.archive.org/web/20211128151730/https://www.cdc.gov/parasites/malaria/index.html |date=28 November 2021}}) * [https://www.paho.org/en/topics/malaria PAHO site on malaria] ({{Webarchive|url=https://web.archive.org/web/20211128172601/https://www.paho.org/en/topics/malaria |date=28 November 2021}})
{{Medical condition classification and resources | ICD11 = {{ICD11|1F40}}–{{ICD11|1F45}} | ICD10 = {{ICD10|B50}}–{{ICD10|B54}} | ICD9 = {{ICD9|084}} | DiseasesDB = 7728 | MedlinePlus = 000621 | OMIM = 248310 | eMedicineSubj = med | eMedicineTopic = 1385 | eMedicine_mult = {{eMedicine2|emerg|305}} {{eMedicine2|ped|1357}} | MeshName = Malaria | MeshNumber = C03.752.250.552 | Orphanet = 673 | Scholia = Q12156 }} {{Malaria}} {{Chromalveolate diseases}} {{Diseases of Poverty}} {{Effective altruism}} {{Eradication of infectious disease}} {{Subject bar |auto=yes |portal1=Medicine |wikt=malaria |commons=Category:Malaria |n=Malaria |q=Malaria |s=Malaria |b=Malaria |voy=Malaria |v=Malaria}} {{Authority control}}
Category:Malaria Category:Articles containing video clips Category:Insect-borne diseases Category:Infectious diseases with eradication efforts *Malaria Category:Protozoal diseases Category:Tropical diseases Category:Vaccine-preventable diseases