title: Endemic malaria: an 'indoor' disease in northern Europe. Historical data analysed.
abstract: BACKGROUND
  Endemic northern malaria reached 68 degrees N latitude in Europe during the 19th century, where the summer mean temperature only irregularly exceeded 16 degrees C, the lower limit needed for sporogony of Plasmodium vivax. Because of the available historical material and little use of quinine, Finland was suitable for an analysis of endemic malaria and temperature.
  
  
  METHODS
  Annual malaria death frequencies during 1800-1870 extracted from parish records were analysed against long-term temperature records in Finland, Russia and Sweden. Supporting data from 1750-1799 were used in the interpretation of the results. The life cycle and behaviour of the anopheline mosquitoes were interpreted according to the literature.
  
  
  RESULTS
  Malaria frequencies correlated strongly with the mean temperature of June and July of the preceding summer, corresponding to larval development of the vector. Hatching of imagoes peaks in the middle of August, when the temperature most years is too low for the sporogony of Plasmodium. After mating some of the females hibernate in human dwellings. If the female gets gametocytes from infective humans, the development of Plasmodium can only continue indoors, in heated buildings.
  
  
  CONCLUSIONS
  Northern malaria existed in a cold climate by means of summer dormancy of hypnozoites in humans and indoor transmission of sporozoites throughout the winter by semiactive hibernating mosquitoes. Variable climatic conditions did not affect this relationship. The epidemics, however, were regulated by the population size of the mosquitoes which, in turn, ultimately was controlled by the temperatures of the preceding summer.
authors.affiliation: Department of Applied Biology, Faculty of Agriculture and Forestry, University of Helsinki, Finland. lena.hulden@helsinki.fi
authors.forename: Lena
authors.initials: L
authors.lastname: Huldén
authors.forename: Larry
authors.initials: L
authors.lastname: Huldén
authors.forename: Kari
authors.initials: K
authors.lastname: Heliövaara
mesh_terms: D000818:Animals; D000852:Anopheles / Q000145:classification / Q000254:growth & development / Q000469:parasitology; D003644:Death Certificates; D004196:Disease Outbreaks / Q000266:history; D019353:Endemic Diseases / Q000266:history*; D005387:Finland / Q000453:epidemiology; D049672:History, 19th Century; D006801:Humans; D007303:Insect Vectors / Q000145:classification / Q000254:growth & development / Q000469:parasitology; D016780:Malaria, Vivax / Q000453:epidemiology / Q000266:history* / Q000401:mortality; D010966:Plasmodium vivax / Q000302:isolation & purification; D012621:Seasons; D013696:Temperature