中国的疟疾:从控制走向消除

该文主要就新中国成立以来各阶段的疟疾防治策略、防治效果以及近年中国消除疟疾行动计划的背景与实施目的作了综述,并对今后我国疟疾防治策略实施过程中面临的问题提出对策性建议.     

南京市近10年疟疾流行特点及防治效果

目的本文对南京市近10年疟疾流行特点及防治效果进行了分析.南京市原为疟疾高发地区,1985年全市疟疾发病率高达307.94/万,经过多年防治,90年代后逐渐下降到1/万以下.1996年以后间日疟为单一流行虫种.1996年、1998年六合县和江宁县相继出现暴发点,市区和市郊流动人口疟疾病例已占相当的比例(47.70%).南京市的疟疾防治仍应坚持以消灭传染源、控制媒介为主的综合防治措施.结论今后重点应提高基层疟疾镜检站镜检质量,建立健全报病奖励制度,加强流动人口监测管理.     

《中国寄生虫病防治杂志》2005年第18卷文题索引

疟疾恶性疟原虫海南株FEN-1基因的克隆及序列分析………………………………………………………(1):16清流县疟疾监测结果分析……………………………(1):66内江市1994~2003年疟疾防治效果分析…………(1):80信阳市浉河区疟疾流行特征分析………………(1):附页2间日疟原虫MSP-1和CSP基因遗传多样性的分析……………………………………………………(2):108 2000~2003年杭州市疟疾疫情分析………………(2):119湖北省30年疟疾防治效果与流行态势分析………(2):141磷酸咯萘啶与双氢青蒿素联合治疗非洲重症恶性疟的疗效观察…………………………     

缅甸拉咱市恶性疟原虫对6种抗疟药的敏感性体外测定

目的了解中缅边境缅甸拉咱市恶性疟药物抗性现状,为中国第六轮全球基金疟疾项目制定防治策略提供依据。方法在缅甸拉咱市城区建立研究站,镜检发热病人和/或疑似疟疾病例,筛查疟疾患者。选择城区及郊区4村的单纯恶性疟现症患者,用WHO推荐的体外微量试验测定恶性疟原虫对6种抗疟药的敏感性。结果体外微量测定43例,成功27例,测得恶性疟原虫对氯喹、哌喹、咯萘啶、青蒿琥酯、双氢青蒿素和双氢青蒿素/哌喹的抗性率分别为100%、0、25.9%、22.2%、7.4%和0,半数抑制浓度(IC50)分别为298.0、49.4、22.3、24.3、11.8和5.6/44.8nmol/L。结论缅甸拉咱市流行株恶性疟原虫对氯喹100%抗性,对咯萘啶、青蒿琥酯和双氢青蒿素具有一定程度抗性,对氯喹、咯萘啶和青蒿琥酯抗性呈逐渐增强趋势,对哌喹和双氢青蒿素/哌喹敏感。     

双氢青蒿素与氯喹治疗妊娠疟疾的疗效比较

目的 观察双氢青蒿素及氯喹治疗妊娠疟疾的疗效,对胎盘原虫血症及先天性疟疾的影响以及孕期用药安全。方法 选择妊娠疟疾患者102例,随机分成双氢青蒿素治疗组（治疗组）48例和氯喹治疗组（对照组）54例,比较2组疗效和用药安全性的差异。结果 ①治疗组治愈率93.8%,对照组治愈率79.6%;治疗组的平均退热时间、平均原虫转阴时间均短于对照组,24h平均原虫下降率治疗组高于对照组,复燃率治疗组低于对照组（P均〈0.05）;②2组病例胎盘原虫血症和先天性疟疾的发生率比较差异无统计学意义（P〉0.05）;③用药后不良反应发生率治疗组低于对照组（P〈0.05）,但2组均未发现新生儿畸形病例,用药安全性比较差异无统计学意义。结论 双氢青蒿素治疗妊娠疟疾疗效强于氯喹,但双氢青蒿素不能减少胎盘原虫血症及先天性疟疾的发生,其孕期安全性使用问题尚有待进一步研究证实。     

江苏省献血员疟疾防治的效果观察

目的观察对献血员疟疾防治的效果,控制献血员疟疾的传播.方法对80年代末期献血员疟疾发病率较高的茅山地区4县(市)和扬州市的邗江县实施传染源管理、主动侦查病例、献血员服药、血站规范管理等一系列针对性抗疟措施,进行防治效果观察.结果1996年至今无献血员疟疾病例报告.门诊发热病人血检阳性率、流行季节走访发病率、IFA阳性率等指标也显示献血员疟疾流行程度已下降到较低水平.结论所应用措施效果良好,在当地献血员不再是疟疾高发人群.     

疟防后期间接荧光抗体试验的应用研究

间接荧光抗体试验(IFA),当疟疾发病率在一定水平时用来了解人群中的抗体情况,评价防治效果,其应用价值已被国内外所肯定,但当在疟疾基本消灭以后的长期疟疾监测中,其应用研究报导尚     

1973～2003年江苏省疟疾的流行及控制

目的讨论江苏省近30年来不同阶段的疟疾控制策略及其防治效果,探讨适合当前疟防形势的抗疟措施.方法回顾性收集近30年来全省疟防工作历史资料和疫情资料,进行分析和研究.结果 1973年全省报告疟疾6 216 128例,发病率1 136.34/万.30年来经过5个阶段的防治,疟疾流行逐步得到有效的控制.2003年全省报告疟疾638例,发病率0.09/万,并连续16年未发现本地感染的恶性疟病例.结论 5个阶段的抗疟策略基本适合江苏省疟疾防治工作的实际,对当前的疟防工作有重要的参考价值.     

安徽阜阳市1952～2005年疟疾疫情与防治对策

目的分析阜阳市1952～2005年疟疾流行规律,评价疟疾防治措施及防治成果,总结疟疾防治经验。结果收集1952～2005年疟疾流行状况、防治措施落实、防治效果评价等。结论通过消除疟疾传染源、防蚊灭蚊等综合性防治措施地落实,阜阳市疟疾疫情由上世纪50至80年代中期持续高发状态,并每十年一次大爆发的流行规律得到了彻底遏制,上世纪末疟疾发病率曾下降到0.1/十万以下。结论阜阳市实施的疟防措施扎实可靠,疟疾发病率明显下降。但近几年疟疾发病又出现上升势头,应引起高度重视,疟疾控制工作十分艰巨,任重道远。     

人的社会行为因素对疟疾防治效果的影响

人的社会行为因素对疟疾防治效果的影响@黄勇$山东省寄生虫病防治研究所!济宁272033~~     

蒿甲醚伍用伯氨喹治疗恶性疟的研究

目的　观察蒿甲醚伍用伯氨喹治疗恶性疟的疗效和副作用。　方法　在中非共和国选择恶性疟12 1例 ,随机分为两组。伍用组 :口服蒿甲醚 80mg ,qd× 5d ,首日蒿甲醚 16 0mg加服伯氨喹 3片 (含基质 7 5mg ,qd× 3～ 4d)治疗 32例 ;肌注蒿甲醚加服伯氨喹 ,治疗 2 9例 ;对照组 :单用口服蒿甲醚治疗 33例和肌注蒿甲醚治疗 2 7例 ,B组、C组和D组所用剂量与疗程均同A组。上述病例于用药前及后 6、 14、 2 1、及 2 8d各随访1次 ,密切观察病例的临床症状与体征变化。　结果　A组、B组、C组和D组病例的平均退热时间分别为(47 6± 15 7)、 (36 9± 10 7)、 (48 5± 18 4 )和 (42 2± 9 5 )h。其临床治愈率依次为 84 4 %、 10 0 %、 90 1和96 3% ,其复燃率依次为 6 3%、 3 4 %、 2 1 2 %和 18 5 %。 4组药物副作用均轻。　结论　蒿甲醚伍用伯氨喹及单用蒿甲醚 (口服或肌注 )对恶性疟治疗作用均良好 ,但联合使用药物能降低恶性疟的复燃率     

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.     

A randomized controlled trial comparing artemether and quinine in the treatment of cerebral malaria in Bangladesh

A randomized controlled trial on 51 patients receiving artemether and 54 patients receiving quinine was undertaken to compare the effectiveness of intramuscular artemether and parenteral quinine in the treatment of cerebral malaria in adults in Bangladesh. Case fatality, fever and parasite clearance times were not significantly different in the two treatment groups. Coma resolution time was significantly delayed in artemether recipients. Results of the study suggest that treatment with artemether is as effective as parenteral quinine in the treatment of cerebral malaria in adults.     

Efficacy of six doses of artemether-lumefantrine (benflumetol) in multidrug-resistant Plasmodium falciparum malaria.

The new oral fixed combination artemether-lumefantrine (CGP 56697) has proved to be an effective and well-tolerated treatment of multi-drug resistant Plasmodium falciparum malaria, although cure rates using the four-dose regimen have been lower than with the currently recommended alternative of artesunate-mefloquine. Two six-dose schedules (total adult dose = 480 mg of artemether and 2,880 mg of lumefantrine) were therefore compared with the previously used four-dose regimen (320 mg of artemether and 1,920 mg of lumefantrine) in a double-blind trial involving 359 patients with uncomplicated multidrug-resistant falciparum malaria. There were no differences between the three treatment groups in parasite and fever clearance times, and reported adverse effects. The two six-dose regimens gave adjusted 28-day cure rates of 96.9% and 99.12%, respectively, compared with 83.3% for the four-dose regimen (P < 0.001). These six-dose regimens of artemether-lumefantrine provide a highly effective and very well-tolerated treatment for multidrug-resistant falciparum malaria.     

Preliminary report: a comparative clinical trial of artemether and quinine in severe falciparum malaria.

Twenty-six patients with severe falciparum malaria were randomized to be treated with quinine or artemether. Twelve patients received quinine at the standard dose and fourteen patients received artemether intramuscularly at a total dose of 640 mg over 7 days. The patients were kept in the hospital for at least 7 days. Peripheral smear was performed 6-hourly until there was no parasitemia, then daily until discharged. Adverse effects were monitored through physical examination, laboratory findings and questionnaires. Laboratory examination was performed on admission, day 2, day 4 weekly until discharged. The patients in both groups were comparable in age, body weight, admission parasitemia, hemoglobin and white blood cell count. The survival rates were 93% and 58% in artemether and quinine groups, respectively (p = 0.052 at 95% confidence, using Fisher's exact test). The parasite and fever clearance times, and the time taken to gain consciousness in cerebral malaria patients were not significantly different between the two groups. Adverse effects in the quinine group consisted of dizziness and vertigo which were found in 4 patients. No adverse effects were noticed in the artemether group. This preliminary report suggests that artemether is a good alternative drug for severe falciparum malaria and seems to be better than quinine regarding survival rate and side effects. Confirmation of these findings in a larger study size is needed.     

Artemether vs quinine therapy in Plasmodium falciparum malaria in Manipur--a preliminary report

Qinghaosu and its derivatives are rapidly effective antimalarial drugs derived from a Chinese plant (sweet worm wood). Preliminary studies suggest that these drugs may be more effective than quinine in the treatment of Plasmodium falciparum malaria. A randomised double blind trial was conducted in 52 cases of Plasmodium falciparum malaria cases. In all 26 cases were given artemether and another 26 were given quinine. There were 2 (7.5%) deaths in artemether group and 4 (15%) deaths in quinine group. The parasites were cleared more quickly from the blood in artemether group when compared to quinine group (mean-72 hrs vs 96 hrs). Resolution of fever was comparable in both artemether and quinine group (mean-84 hrs vs 78 hrs) and also the average time of recovery from coma was more earlier in artemether group (mean-60 hrs vs 72 hrs). The only side effect noticed with artemether therapy was gastrointestinal (GI) intolerance while quinine therapy was associated with myocarditis, hypotension, hypoglycemia and GI intolerance.     

Clinical trial of artesunate and artemether on multidrug resistant falciparum malaria in Thailand. A preliminary report.

A 5-day course of oral artesunate at total doses of 1200, 600, 650 mg and intramuscular artemether 480 mg proved effective (90-100% cured) in the treatment of multidrug resistant falciparum malaria in Thailand. Shorter courses yielded high recrudescence rates. The fever clearance and parasite clearance times were short. The side effects were mild and transient including occasional abnormal electrocardiograms and pain at the injection site. Slight reduction of neutrophil leucocytes and reticulocytes was observed. Further studies of artesunate and artemether should be carried out to find the optimum dosage regimen and to clarify the hematological effects.     

Artemether treatment of recrudescent Plasmodium falciparum malaria in children

Summary Intramuscular artemether given for five days was evaluated prospectively in 32 patients with acute recrudescent Plasmodium falciparum malaria. All patients had experienced one or more treatment failures with one or more courses of the following drugs: chloroquine, amodiaquine, sulphadoxine-pyrimethamine and erythromycin given alone or in combination. There was a prompt response to treatment with fever and parasite clearance times of 10.7 (3.6) h (range 6–24) and 32.3 (8.3) h (range 24–48) respectively. Parasite reduction at 24 h was 93.2 (7.8)% (range 75–100). The cure rate on day 14 was 100%. The drug was well tolerated. These results suggest that artemether is rapidly effective in acute recrudescent Plasmodium falciparum malaria and is without deleterious side effects.     

Neuropathological assessment of artemether-treated severe malaria

In animals, high doses of intramuscular artemether and artemotil have been shown to cause an unusual pattern of selective damage to certain brainstem nuclei, especially those implicated in hearing and balance. We aimed to investigate whether a similar pattern arises in human adults. We examined the brainstems of adults who died after treatment with high dose artemether or quinine for severe falciparum malaria for evidence of a pattern of selective neuronal damage. Neuropathological findings were similar in recipients of quinine (n=15) and artemether (n=6; total artemether doses received 4-44 mg/kg). No evidence was recorded for artemether-induced neurotoxic effects.     

蒿甲醚在血吸虫病防治中的研究和应用进展

蒿甲醚是青蒿素的衍生物,不仅具有抗疟作用,还有抗血吸虫作用,特别是抗血吸虫童虫,在上世纪末已被发展为预防血吸虫病的药物。该文就蒿甲醚的抗血吸虫作用、抗血吸虫的作用机制、毒性、药代动力学、与吡喹酮联合用药和现场人群应用蒿甲醚预防血吸虫感染的效果及其应用前景等作一简要综述。