2010年江苏省疟疾疫情流行病学分析

目的分析2010年江苏省疟疾疫情及流行特征,为制订适合本省实际的有效消除疟疾策略和措施提供依据。方法对全省网络报告疟疾疫情和流行病学调查资料进行统计分析。结果2010年江苏省共报告疟疾386例,与2009年病例数基本持平,发病率为0.05/万。其中本地感染间日疟病例100例,较2009年下降了47.92%,主要分布在淮河沿岸的徐州、宿迁和淮安3市,占全省病例总数的75%(75/100);输入性疟疾病例286例,其中境外输入性恶性疟病例207例,较2009年上升了104.95%,主要分布在江苏中部和苏北沿海的南通、泰州、扬州、淮安、盐城和连云港6市。286例输入性病例中,国内其他省输入38例,均为间日疟,其中复发病例11例,复发率显著高于本地感染病人;国外输入248例,207例为输入性恶性疟病例,其中82例为回国后再燃,41例间日疟病例中,复发病例23例,复发率显著高于本地感染病例和国内其他省输入病例。结论江苏省本地感染间日疟病例明显下降,但输入性间日疟病例数仍较多,且境外输入性恶性疟病例逐年成倍上升。因此,要在江苏省如期实现消除疟疾目标,一方面要加强重点地区疟疾防治,进一步降低本地感染病例发病率;另一方面要积极探索流动人员中间日疟病例的休止期根治方法,降低复发率,减少输入性间日疟病例对本省疟疾防治成果的影响;同时要进一步加强对劳务输出人员的健康教育,提高务工人员的自我保护意识,并积极开展多部门协作,加强对劳务输出回国人员的监测和管理,做好输入性恶性疟防控工作。     

2011年江苏省疟疾疫情流行病学分析

目的 分析江苏省2011年的疟疾疫情及流行特征,为制订和调整适合本省有效的消除疟疾策略和措施提供科学依据。方法 收集全省网络报告疟疾疫情和专报系统的流行病学调查资料,并进行统计分析。 结果 2011年江苏省共报告疟疾374 例,发病率为0.05/万,与2010 年病例数基本持平。本地感染间日疟病例13 例,较2010 年的100 例下降了87.00%;输入性疟疾病例361例,其中境外输入性恶性疟病例309例,较2010年的207例上升了49.27%,主要分布在江苏中部和苏北沿海的扬州、南通、淮安、泰州市,该4市输入性恶性疟病例数占全省总数的66.02%（204/309）。2011年江苏省首次报告输入性三日疟7例,输入性卵形疟14例。 结论 江苏省本地感染间日疟病例明显下降,流行范围明显缩小;但境外输入性疟疾仍呈明显上升趋势,且感染疟原虫虫种呈多样性。因此,为如期实现全省消除疟疾目标,仍需继续加强对基层医疗机构和疾病预防控制机构相关人员的培训,加强对劳务输出人员的健康教育和回国人员的监测管理。     

2009年江苏省疟疾疫情流行病学分析

目的分析2009年江苏省疟疾流行特征,为制订有效防治措施提供参考依据。方法对全省网络报告的疟疾疫情和流行病学调查资料进行分析。结果 2009年江苏省共报告疟疾389例,发病率为0.05/万,较2008下降41.77%。全省13个市均有疟疾病例报告,徐州、宿迁和淮安3市报告病例数占全省病例总数的44.73%。389例疟疾病例中,本地感染间日疟192例,主要分布于疟疾发病率较高的徐州、宿迁、淮安3市,占全省本地感染间日疟病例总数的73.44%;省外输入性间日疟病例96例,主要分布于外来务工人员较多的苏南地区;国外输入性恶性疟病例101例,较2008年上升71.19%,主要分布于出国务工人员较集中的苏中和苏北地区。结论江苏省疟疾发病呈下降趋势,但淮河以北局部地区疟疾疫情仍不稳定,输入性恶性疟日趋增多。应制订相关政策和措施,加强重点地区疟疾防治,特别要加强对全省劳务输出等归国人员的监测和管理。     

2005～2010年济南市疟疾疫情分析

目的了解济南市疟疾发病情况,探讨流行特征,为制定防治对策提供依据。方法对2005～2010年疟疾疫情资料进行整理。对疟疾疫情进行描述与分析。结果济南市2005～2010年共报告疟疾病例66例,其中恶性疟11例,间日疟32例,未分型23例;实验室确诊32例,临床确诊34例;本地病例和外地病例各33例;当地感染病例5例,占7.58%,输入性病例61例,占92.42%,11例恶性疟均为输入性病例。结论济南市疟疾病例以输入性病例为主;关口前移,把好疟疾输入关,加强疟区入济人员的疟疾监测,防止输入病例引起本市疟疾暴发流行应是济南市疟防工作的重点。     

2010-2015年泰州市海陵区输入性疟疾流行病学分析

目的 目的 分析泰州市海陵区输入性疟疾病例的流行病学特征, 为制定相应防控策略提供参考依据。 方法 方法 收集 2010-2015年海陵区境外输入性疟疾网络直报数据、 个案调查表及疫点处置报告资料, 进行回顾性调查和分类统计。 结 结 果 果 2010-2015年海陵区共报告境外输入性疟疾病例46例, 其中恶性疟40例 （占86.96%）, 卵形疟4例 （占8.70%）, 三日 疟1例 （占2.17%）, 间日疟、 恶性疟混合感染1例 （占2.17%）。病例发病时间无季节性趋势。所有病例均为从非洲高疟区 回国的人员, 有明确的流行区生活史。患者发病到确诊的间隔时间平均为2 d, 8例在24 h内确诊, 46例病例全部治愈。 结论 结论 泰州市海陵区近5年来报告的疟疾病例均为境外输入性病例, 采取有效防控措施是当前疟疾消除工作的关键。     

1990-2010年河北省疟疾流行特征分析

目的 对河北省1990-2010年疟疾病例分布特征和变化情况进行探讨和分析.方法 收集1990-2010年河北省疟疾疫情资料,统计病例的时间、地区和职业分布,分析疟疾年发病趋势.率的比较采用卡方检验.结果 1990-2010年河北省共报告疟疾病例342例,其中间日疟110例,恶性疟38例,未分型疟疾194例.2006-2010年恶性疟平均年报告病例数高于1990-2005年；疟疾月发病趋势由每年疟疾流行月份有病例报告高峰演变为发病趋于平均.1990-2005年病例分布区域主要集中在河北省东部和南部地区；2006-2010年则显示出全省平均分布的趋势,病例职业分布始终以工人和农民为最高,94.23％的被调查病例被证实为输入性病例.结论 河北省疟疾发病率仍维持极低水平,病例呈现出全年和全省范围平均分布的趋势,输入性病例将是河北省疟疾病例的主要来源.     

2015年江苏省疟疾疫情流行病学分析

目的 掌握江苏省2015年疟疾疫情及流行特征,为如期实现本省的消除疟疾目标提供依据。方法 对2015年全省网络报告疟疾疫情和专报系统的流行病学调查资料进行统计分析。结果 2015年江苏省共报告疟疾405例,较2014年（355例）上升14.08%。均为境外输入病例,5例（1.23%）来自东南亚,400例（98.77%）来自25个非洲国家或地区。全省13个市均有输入性疟疾病例报告,其中泰州市、连云港、南通市、淮安市和扬州市报告病例数占全省总数的68.64%（278/405）。省疟疾诊断参比实验室对405份样本进行复核,发现恶性疟299例、间日疟13例、三日疟18例、卵形疟71例、混合感染4例。结论 江苏省已连续4年无本地感染疟疾病例,但境外输入性疟疾病例仍呈上升趋势,且输入性间日疟病例较2014年明显增加。加强境外输入性疟疾监测,提高各级医疗机构相关人员对疟疾的诊断和治疗能力、提升疾控机构专业人员病原复核、疫点调查和处置能力是本省疟疾防控工作的重点。     

2008-201年南京市输入性恶性疟疫情

目的 目的 了解南京市输入性恶性疟疫情, 为制定疟疾防控措施提供依据。方法 方法 统计2008-2012年全市输入性恶 性疟疫情资料, 结合流行病学调查进行描述性分析。结果 结果 2008-2012年, 南京市共报告58例输入性恶性疟病例, 逐年分 别为3、 5、 15、 17、 18例, 呈逐年增多趋势, 其中94.8%的病例为从非洲疟疾流行区回国人员。2012年输入性恶性疟病例占 全市报告病例的81.2%。结论 结论 南京市输入性恶性疟逐年增多, 应加强监测与防控。     

2010-2013年徐州市疟疾疫情

目的 目的 掌握徐州市疟疾发病情况和趋势, 为制定疟疾防治措施提供科学依据。方法 方法 收集2010-2013年徐州 市网络报告疟疾病例信息和流行病学调查资料进行统计分析。结果 结果 2010-2013年徐州市共报告疟疾109例, 其中间日 疟44例, 占40.37％; 恶性疟62例, 占56.88％; 三日疟2例, 占1.83％; 卵形疟1例, 占0.92％; 恶性疟、 三日疟、 卵形疟均为 境外输入。93例为实验室确诊病例, 占85.32％, 16例为临床诊断病例, 占14.68％。全年均有发病, 无明显季节性。流动 人口血检阳性率为0.276%, 明显高于本地人口的0.005% （χ2 ＝868.23, P＜0.01）。结论 结论 徐州市疟疾疫情处于稳定下降 期, 本地感染病例明显下降, 境外输入性恶性疟病例逐年上升, 须加强流动人口和发热病人管理。     

2010年河南省疟疾疫情分析

目的了解2010年河南省疟疾疫情特征,为制定防治策略提供依据。方法收集2010年河南省疟疾病例的资料并进行统计描述和分析。结果 2010年河南省共报告疟疾896例,其中本地病例为790例(占88.17%),均为间日疟;输入性病例106例,其中间日疟25例(占2.79%),输入性恶性疟81例(占9.04%)。男性病例579例,女性317例;病例中以青壮年农民为主。全年均有病例发生,以流行季节的5～10月(649例)为发病高峰。结论 2010年河南省疟疾疫情明显下降,但是输入性疟疾呈上升趋势。     

Parasite-specific lactate dehydrogenase for the diagnosis of Plasmodium falciparum infection in an endemic area in West Uganda

The measurement of parasite lactate dehydrogenase (pLDH) has been presented as an easy and rapid method for the diagnosis of malaria in humans. In order to evaluate the sensitivity and specificity of such a test we examined blood samples from 429 Ugandan patients. While pLDH activity was significantly linked to parasitaemia, sensitivity and specificity were found to be rather low at 58.8 and 62.2% respectively. The positive and negative predictive values failed to meet necessary standards. We conclude that the methods of measurement of pLDH activity in malaria infection, although potentially useful for the fast diagnosis of malaria, need to be improved to be of true value in endemic areas.     

Effectiveness of chemoprophylaxis and other determinants of malaria in travellers to Kenya

Summary objective  To investigate the effectiveness of chemoprophylaxis and the determinants of malaria importation from Kenya.
method  In a population-based case-control study, 51 travellers from Bavaria diagnosed with falciparum malaria imported from Kenya (cases) and a sample of 383 healthy Bavarian travellers returning from Kenya (controls) were interviewed. Data were analysed by multiple logistic regression.
results  Mefloquine (OR = 0.055; 95% Cl 0.019-0.16) and chloroquine combined with proguanil (OR = 0.128; 95% CI 0.039-0.419) were highly protective against P. falciparum malaria, whereas other drugs were ineffective (OR = 1.225; 95% CI 0.536-2.803). Ineffective prophylaxis (10.4%) and non-prophylaxis (11.2%) were the main reasons for malaria importation. Travelling alone or with friends, male sex, and travel duration over 4 weeks could be identified as additional risk factors. The main reason for inadequate chemoprophylaxis was inappropriate medical advice (87.5%). Prophylaxis refusal occurred frequently despite correct advice (58.1%). Diagnosis was often delayed unnecessarily (27.5%).
conclusion  Malaria importation from Kenya could be reduced substantially (34%) by eliminating inappropriate medical advice.     

Mononeme: a new secretory organelle in Plasmodium falciparum merozoites identified by localization of rhomboid-1 protease

Compartmentalization of proteins into subcellular organelles in eukaryotic cells is a fundamental mechanism of regulating complex cellular functions. Many proteins of Plasmodium falciparum merozoites involved in invasion are compartmentalized into apical organelles. We have identified a new merozoite organelle that contains P. falciparum rhomboid-1 (PfROM1), a protease that cleaves the transmembrane regions of proteins involved in invasion. By immunoconfocal microscopy, PfROM1 was localized to a single, thread-like structure on one side of the merozoites that appears to be in close proximity to the subpellicular microtubules. PfROM1 was not found associated with micronemes, rhoptries, or dense granules, the three identified secretory organelles of invasion. Release of merozoites from schizonts resulted in the movement of PfROM1 from the lateral asymmetric localization to the merozoite apical pole and the posterior pole. We have named this single thread-like organelle in merozoites, the mononeme.     

以皮疹、腹泻为首发症状的脑型疟1例

非洲地区是疟疾的高流行地区,其中恶性疟的发病率和病死率最高.本文通过报道我国援坦桑尼亚医疗队诊治的1例以皮疹和腹泻为首发症状的脑型恶性疟患者的体会,以期为临床医生在诊治疟疾时提供参考、借鉴.     

People's perception of malaria in Mbarara,Uganda

To understand people's perceptions of malaria and their implications for control programmes, we held focus group discussions (FGDs) and conducted semi-structured interviews (SSIs) with community members in Mbarara, Uganda. Mosquitoes were perceived as the cause or transmitters of malaria but the causation/transmission model of people differed from biomedical facts. Convulsions, a common complication of malaria, were perceived as a supernatural ailment, best treated by traditional medicine, as was splenomegaly. More than 70% of the patients with malaria had treatment from non-public health sources. This included self-treatment (13%), use of traditional healers (12%) and use of private medical practitioners/pharmacists (69%). Although 26% (887/3309) used bednets to prevent malaria, only 7% of the nets were impregnated with insecticide. People who did not use bednets cited discomfort because of heat/humidity and their high cost as reasons. To improve malaria control in this area, people need to be educated on the connection between mosquitoes and malaria and on seeking biomedical treatment for convulsions. The malaria control programme could collaborate with traditional and private health care providers to increase promotion of insecticide-impregnated mosquito nets.     

江汉平原控制间日疟对策的研究

从１９８６年开始，在江汉平原有代表性的江陵县境内２５万人口范围地区，研究控制间日疟的对策，经过实施以根治传染源和消除病灶点为主的综合性措施，该范围内的发病率由１９８６年的１１．５６‰下降到１９９１年的０．２８‰，为江汉平原广大流行区控制疟疾提供了科学依据。     

Malaria diagnosis and treatment administered by teachers in primary schools in Tanzania

A school health programme in Mwera Division, Pangani District included treatment of malaria attacks occurring in children during school time. A combination of symptoms (headache, muscle/joint pains, feeling feverish) and oral temperature > or = 37.5 degrees C was used for the diagnosis of malaria. Chloroquine (25 mg/kg given over 3 days) was used for treatment. Malariometric surveys on children aged 7-15 years (mean 10 years) were conducted once a year (1995-1997). Plasmodium falciparum accounted for 100% of infections and the parasite prevalence varied between 32.7 and 35.3% from 1995 to 1997. The number of malaria cases (cases/1000 registered school children) diagnosed and treated by school teachers was 159 (67) in 1995, 324 (124) in 1996, 348 (128) in 1997 and 339 (108) in 1998. Children in grades 1-4 (age 7-13) accounted for 64.6% of cases. Symptoms and oral temperature were recorded for 1258 children. Of those, 992 (78.9%) complained of fever and at least one other symptom when presenting to teachers, 98 (7.8%) had fever as their only complaint and 168 (13.5%) presented without a perception of fever, but with other symptoms. Of these children, 36 (21.4%) had a temperature > or =37.5 degrees C. The sensitivity of "feeling feverish" was 96.5% with a specificity of 54.5%. The positive predictive value of feeling feverish was 89.9% and the negative predictive value 78.6%. Blood slides were prepared from 55.3 and 37.2% of children diagnosed by teachers during 1995 and 1996, respectively, and 71.4% were found positive. Among children who fulfilled the algorithm criteria 75.0% had a positive blood slide. With little training and regular supervision it was feasible for school teachers to make a presumptive diagnosis of malaria. We conclude that teachers can play a major role in school health programmes and are willing to be involved in health matters as long as they are supported by health and educational authorities.     

Intramuscular artemether vs intravenous quinine: an open,randomized trial in Malawian children with cerebral malaria

objectives To compare artemether (by intramuscular injection) and quinine (by intravenous infusion) as treatments for cerebral malaria in African children.methods An open, randomized trial conducted at the Queen Elizabeth Central Hospital in Blantyre, Malawi. This trial was part of a multicentre study designed to determine if treatment with artemether would significantly lower mortality rates compared with quinine. Data from 83 artemether recipients and 81 quinine recipients are reported here.results Overall mortality rates and coma resolution times were not significantly different in the two treatment groups. Parasite and fever clearance times were significantly more rapid in the artemether recipients. Analyses which took into account the possible confounding variables did not significantly alter the findings of these unadjusted analyses.conclusion These results do not suggest that treatment with artemether would confer a survival advantage in children with life-threatening malaria. The power and precision of the estimated treatment effects of artemether would be enhanced by a meta-analysis of all relevant clinical trials.