Turkey

The number of malaria cases in Turkey and their active foci have decreased dramatically in recent years. Since 2012, the country is reporting only introduced cases related to importation. While population movement can increase the risk for reintroduction and localized outbreaks of malaria in Turkey, the country's experience shows that a well-prepared health system can prevent reintroduction of vector-borne diseases. 

In 1945, more than 2 million patients were treated for malaria, although the first control programme had been launched in 1925. Residual spraying of houses using DDT was introduced in 1956, and a national malaria eradication programme was established in 1957. By 1968, the disease was largely under control. Prior to the introduction of control activities, P. falciparum was the predominant species, but only P. vivax cases have been reported since the early 1970s.

From 1971 onwards, the number of malaria cases in the Çukurova and Amikova plains began to increase, reaching epidemic proportions in 1976 and 1977, when 37 320 and 115 512 cases were reported, respectively. Many factors contributed to the deterioration of the situation, including a sharp increase in the density of Anopheles sacharovi and the internal migration of workers from areas of Turkey where malaria was, at that time, more prevalent. Insufficient coverage by the surveillance system in 1970–1975 also played a major role.

Through concentrated efforts and at considerable cost, the incidence of malaria began to decline in this area in 1978, following the reintroduction of large-scale control operations. By 1979, the reported number of malaria cases had dropped to 29 324, and the epidemic was contained.

The situation deteriorated again, however, with over 34 000 cases in 1980 and 66 673 in 1983. The main reasons for these large figures included insecticide resistance in An. sacharovi populations and increased refusals to accept house spraying by inhabitants, due to objections to the unpleasant odour of the insecticides.

From 1990 to 1996, the malaria situation remained critical. Case numbers peaked at 84 321 in 1994. The situation began to improve only in 1997, when case numbers were cut in half from the previous year.

Incidence increased particularly significantly in areas where the Southeastern Anatolia Project (GAP) irrigation programme was being implemented. However, outbreaks cannot be attributed solely to the impact of expanding the irrigation network, as they occurred in areas where construction had not yet begun. The rise in the number of cases reported in other regions most likely resulted from importation of malaria by migrant workers.

Epidemiological characteristics

The transmission of malaria is seasonal, lasting from March to October. An. sacharovi is the most important vector in Turkey, followed by An. superpictus. An. maculipennis and An. sulbapinus are regarded as secondary vectors. Only P. vivax is being transmitted. Malaria risk exists only in the south-eastern part of the country. There is no malaria risk in the western and south-western areas where tourism is concentrated.