The malaria situation in the WHO European region

The number of indigenous malaria cases in European region peaked in 1997, when 77,985 cases were officially reported. These were caused almost exclusively by P. vivax, P. falciparum being restricted to a rather limited number of cases in Tajikistan only. Another important problem in the European Region is the importation of malaria associated with a high fatality rate from tropical endemic countries. There were 841 cases of malaria in Armenia, 567 of which were locally transmitted, 30 out of 81 districts recorded malaria cases. 89% of the indigenous cases were registered in Masis district, in the Ararat valley. In 1998, total number of cases increased to 1156. Of the 542 indigenous cases registered, 376 were in Masis district. 9911 cases were officially reported in 1997 in Azerbaijan and 5175 cases in 1998. Approximately half of malaria cases were reported from seven districts: Nakhichivan (10.4%), Imishli (14.6%), Fizuli (8.1%), Sabirabad (6.8%), Saatly (6%), Bejlagan (5.6%) and Bilasuvar (4.8%). Local transmission is also reported from the periurban areas of Baku, where many displaced people are living in temporary shelters. In 1997, a total of 30,054 malaria cases were officially registered in Tajikistan, of which 85.3% occurred in the Khatlon region, 10.5% in Dushanbe region, 3.5% in Gorno-Badakhshan region and 0.7% in Leninabad region. Following implementation of malaria control activities with WHO assistance, the number of malaria cases officially registered in 1998 dropped to 19,361 (187 were cases of falciparum malaria). A dramatic change occurred in malaria situation in Turkmenistan in 1998, when 115 indigenous cases were registered. The majority of malaria cases (104) were registered in the Kushka district, in south-east of Turkmenistan, among military service personnel. In recent years, the Government of Turkey has renewed its efforts to fight malaria, incorporating them into GAP with support from UNDP and WHO. In 1998, 36,451 cases were reported, 87.1% from southeastern Anatolia, 8.7% from Adana area and 4.2% from other areas of Turkey. The epidemics in Armenia, Azerbaijan, Tajikistan and Turkey are having a considerable impact on the malaria situation in neighbouring countries of the European Region. Malaria cases have been imported from Turkey mainly to western Europe; from Azerbaijan to the Russian Federation, Georgia, and the Republic of Moldova; and from Tajikistan to the central Asian republics and to the Russian Federation. WHO made all possible efforts to mobilize and coordinate assistance from international community. WHO/EURO organized missions to those NIS where there is a risk of malaria epidemics. Most of the very limited funds reserved for epidemic prevention and control were immediatelly used to provide a limited stock of antimalarial drugs and to help the national institutions in Kazakhstan and Uzbekistan implement antimalarial activities. In 1997, with the financial support of the Italian Government and the technical assistance of the Instituto Superiore di Sanità in Rome (WHO collaborating centre for research and training in planning tropical disease control) and of the Martsinovsky Institute of Medical Parasitology and Tropical Medicine in Moscow (WHO collaborating centre on vivax malaria), the training of health personnel in the field of malaria diagnosis, treatment and control was initiated in Armenia, Azerbaijan, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. In 1996-1997, Japan provided financial support for a large malaria control project in Tajikistan, and Norway supported activities carried out in 1997 to tackle the malaria outbreak in Armenia. In 1997-1998, Italy supported malaria prevention activities in Kazakhstan, Kyrgyzstan and Uzbekistan, and some of the malaria activities carried out in Tajikistan under the integrated Management of Childhood Illness initiative. Several training courses and seminars were carried out in Turkey in 1998 by the national malaria contro     

Current malaria situation in Turkmenistan

Malaria is one of the main health problems facing most developing countries having a hot climate. It is a problem in Turkmenistan. The country is situated in Central Asia, north of the Kopetdag mountains, between the Caspian Sea to the west and the Amu-Darya river to the east. Turkmenistan stretches for a distance of 1,100 km from west to east and 650 km from north to south. It borders Kazakhstan in the north, Uzbekistan in the east and north-east, Iran in the south, and Afghanistan in the south-east. Seven malaria vector species are found in Turkmenistan, the main ones being Anopheles superpictus, An. pulcherrimus, and An. martinius. The potentially endemic area consists of the floodplains of the Tejen and Murgab rivers, with a long chain of reservoirs built along them. In 1980 most cases of imported malaria were recorded in military personnel who had returned from service in Afghanistan. In the past years, only tertian (Plasmodium vivax) malaria has been recorded and there have been no death from malaria over that period. In the Serkhetabad (Gushgi) district there are currently 5 active foci of malaria infection, with a population of 22,000 people. In 1999, forty nine cases of P. vivax malaria were recorded in Turkmenistan. Of them, 36 cases, including 4 children under 14 years were diagnosed for the first time while 13 were relapses. There were 88 fewer cases than those in the previous year (by a factor of 2.8). There were 17 more cases of imported malaria than those in 1998 (by a factor of 1.7), most of which occurred in the foci of malaria infection (Serkhetabad, Tagtabazar, and Kerki districts), in the city of Ashkhabat and in Lebap, Dashkhovuz and Akhal Regions. The emergence of indigenous malaria in the border areas was due to the importation of the disease at intervals by infected mosquitoes flying in from neighbouring countries (e.g. Afghanistan), the lack of drugs to treat the first cases and the lack of alternative insecticides. Most patients suffer from tertian malaria, which is the most dangerous from the epidemiological point of view since the main vectors in Turkmenistan, are highly susceptible to P. vivax infection. The particular dangerous phenomenon is the higher incidence of imported tertian malaria in rural areas where sick people and those who carry the parasite come into close contact with highly susceptible vectors. Thus, the risk that new malaria outbreaks will occur and the disease will become reestablished in the country is very high. It is also influenced by major changes in water use in the country, which have aggravated the mosquito situation. In the area around the Karakum canal and river basins, 17 large reservoirs have been constructed, with very extensive filtration ponds around them, which have become breeding ground's for malaria mosquitoes. There are 1219 water areas without any economic significance in the country, covering a total area of 1054 ha, which require regular treatment with insecticides. With assistance from the WHO European Regional Office, Dr. Guido Sabatinelli in particular, Turkmenistan has developed a plan for preventive malaria control measures for 1999-2001, which has been approved in a decree issued by the Ministry of Health and Medical Industry. The material support received has made it possible to provide large-scale prophylaxis for people who suffered from malaria in 1997-1999, seasonal treatment for people living near the active foci of the disease and interseasonal prophylaxis for people visiting these areas. Seasonal treatment with Dellaguil was made in 4,590 people living in the active foci of malaria infection, and 2,281 fixed-term military personnel belonging to the units stationed in the active foci of malaria infection. In all foci of infection, every person with malaria or carrying the parasite underwent epidemiological investigation and all cases were entered in health clinic records. In 1999, four seminars were held to train 75 specialists from all administrative areas in ways of improving senior staff's skills in the laboratory diagnosis of malaria. The laboratory equipment which the country has received makes it possible to train high-level specialists and to equip its main malaria diagnosis centers with microscopes and reagents. The received insecticides and sprayers enable mosquitoes to be eliminated in an area of 960,000 sq. km (240 foci of infection): for this, our sincere thanks and gratitude are due to Dr. Guido Sabatinelli. Specialists teams have been created in each region by a decree of the Ministry of Health and Medical Industry to conduct mosquito elimination activities, with personal responsibility for their progress. Three-day vector control seminars have been held for disinfectors in all regions. We should stress that 5 extra posts have been created in the parasitology department of the Central Laboratory of Hygiene and Epidemiology, State Epidemiological Surveillance Service in order to strengthen preventive malaria control activities in Turkmenistan (organizational and methodological support for health facilities, staff training, etc.). To prevent the emergence of new breeding grounds for malaria vectors, the state system of health surveillance over the hygiene and technical status of water facilities and the rules governing their work have been reinforced. Local executive authorities do every effort to eliminate small, economically unprofitable water areas by draining, filling in or cleaning them. All existing and potential mosquito breeding grounds within a three-kilometer radius of any community were identified. These water areas were certified and their previous certifications analyzed, taking into account any changes and additional information which has become available about the area. Seasonal variations in the number of larvae and imagoes were monitored in the specimen areas of water and daytime resting sites. The existing vector species were identified and a list of the main species in all areas was prepared. Water areas were treated in accordance with epidemiological instructions. These activities yielded positive results: only 10 cases of locally transmitted malaria were recorded throughout the country in 1999. To interrupt the endemic process of malaria in Turkmenistan, the following plan for 1999-2001 has been adopted. To improve the equipment and material base of a sanitary and epidemiological surveillance service and malaria diagnosis laboratories (vehicles, sprayers, microscopes, chemical reagents, etc.). To continue effort to recruit staff to fill vacancies for parasitologists, entomologists, and parasitology laboratory physicians in the sanitary and epidemiological surveillance service at regional, subregional, and district level. In April 2000, two six-day seminars were held for epidemiologists, parasitologists, and entomologists, organized jointly with WHO representatives at the Central Laboratory for Hygiene and Epidemiology. Two seminars on the laboratory diagnosis of malaria for laboratory physicians were also intended to be held in April 2000. To continue to treat malaria patients and parasite carriers throughout the year to prevent relapses. To continue activities to eliminate mosquitoes, to monitor seasonal variations in the number of vector larvae and imagoes in the specimen areas of water and daytime resting sites mosquito habitats, to identify the existing vector species, and to prepare a list of main species in all areas. To strengthen preventive health monitoring. To provide effective support of health care service by the state border guard service of Turkmenistan by supplying drugs for curative and preventive treatment of its staff. To provide the quantities of insecticides required for mosquito elimination and support staff training. To improve malaria control activities by reporting all cases of malaria promptly, conducting a high-quality epidemiological investigation of every case and a prompt laboratory diagnosis, and providing the parasitology departments of sanitary and epidemiological surveillance service at all levels with all-terrain vehicles, microscopes, and effective communication systems which they require. We are very happy to be cooperating with WHO and grateful for the help it has provided.     

The malaria situation in the Russian Federation (1997-1999)

Profound socio-economic changes within the CIS countries in the 1990s brought a lot of negative changes in malaria prevention in targeted countries. The previously stable connection and cooperation in prophylactic activities have been interrupted. Supply of antimalarials, insecticides and equipment had been stopped. Many qualified cadres in the sanitary-epidemiological services in the countries were lost. Because of difficult economic situation they had to change their occupation and place of job. After prolonged period of a stable benign epidemiological situation within Russia the number of imported cases started to grow up. The sharp increase of imported malaria cases from Azerbaijan and Tajikistan had been noticed since 1994 (Tab. 1). For the first time in the history of malaria registration the number of cases imported from the CIS countries has been exceeded the number of malaria cases imported from all other countries in the world in 1995. Later in the end of the 1990s the imported malaria cases has been registered in Russia from some other CIS countries apart from Azerbaijan and Tajikistan. There were malaria cases imported from Armenia (13 cases), Moldavia (2), Turkmenistan (2), and Uzbekistan (2) in 1998. The number of imported malaria cases in Russia in 1999 (Jan-July) is 437. There is no information about introduced or indigenous malaria cases registered until now] within Russia. There were 13 introduced malaria cases as the result of numerous imported ones. 13 introduced cases have been registered in 10 oblasts (administrative regions of Russia). This number has been increased to 53 (!) in 1998 in 20 oblasts. There was one local outbreak of P. vivax malaria in Izberbash settlement (Dagestan). Number of indigenous malaria cases were 5 (1996), 18 (1997), 1 (1998). The contra-epidemic measures in Izberbash have included active cases detection and treatment indoor insecticide spaying and one tour of mass primaguine treatment during interseasonal period of time. Additional indigenous cases after imported and introduced ones have been detected in Krasnodar (1 cases), Samara (1), Tolyaty (1), and Cherkessk (5) in 1998. One induced P. falciparum malaria case has been detected Moscow in 1998. Medical nurse from urological branch of the Moscow hospital No. 29 has penetrated by syringe needle her hand after performing of intravenous injection to the patient with imported P. falciparum malaria. No other induced cases have been detected. Because of local administrative problems with primaquine supply not all P. vivax malaria cases have received complete treatment. As the result of these events there was malaria relapsed cases registered every year. The actual number was 20 (1993), 37 (1994), 45 (1995), 59 (1996), 99 (1997). Due to late appearance of patient with P. falciparum malaria before medical staff and as a result late diagnosis and late and some time inappropriate treatment there were several lethal malaria cases registered [table: see text] every year. Inappropriate treatment means that treatment of P. falciparum malaria cases was consisted of chloroquine only. The cumulative number of lethal cases in 1994-1997 was 12, and the same number in 1998 was 6. One should mention that one lethal case in 1998 in Volgograd was due to P. vivax. The subject was chronic alcoholic and combination with P. vivax malaria brings him to death. Some calculation reveals the risk of resurgence of malaria in Russia. If one analyses all P. vivax imported cases from the point of view of time and place of detection the following picture would be emerged: 83% of all imported cases has been localized within cities, and 17% only--in rural areas. Half of the latter has been appeared during cold part of years when transmission was impossible. The result of approximately 200 imported cases has been appeared in a right time and place there were 75 introduced cases.     

Armenia: implementation of national program of malaria control

Malaria has been existing in Armenia since antiquity. In the 1920"s to 1930s, thousands of people suffered from this disease in the country. Enormous efforts were required to prevent further spread of the disease. A network was set up, which consisted of a research institute and stations. A total of 200,000 cases of malaria were still notified in 1934. Rapid development of the health infrastructure and better socioeconomic conditions improved the malaria situation and reduced the number of cases in 1946. Malaria was completely eradicated in Armenia in 1963, and the malaria-free situation retained till 1994. During that period, comprehensive activities were undertaken in the country to prevent and control malaria. Since 1990, following the collapse of the Soviet Union, the situation became critical in many newly independent states. Economic crisis, human migration, worsening levels of health services, and the lack of necessary medicines, equipment, and insecticides significantly affected the malaria epidemiological situation in the country. Malaria cases started to penetrate into Armenia from neighboring countries. In 1994, a hundred ninety six military men contacted malaria in Karabakh, which was unfavorable in terms of malaria, as well on as the border with Iran and along the Araks river. The first cases recorded in Armenia were imported, afterwards they led to the incidence of indigenous cases, given the fact that all the prerequisites for malaria mosquito breeding and development were encountered in 17 regions and 3 towns of the country. In 1995, there were 502 imported cases and in 1996 the situation changed: out of 347 registered cases, 149 were indigenous. The Ministry of Health undertook a range of preventive measures. In 1997 versus 1996, the total number of malaria cases increased 2.3-fold: 841 registered cases of which 567 were indigenous (a 3.8-fold increase). The overwhelming majority of cases were recorded in the Ararat and Armavir marzes. In 1998, there were a total of 1156 cases, of them 542 being locally contacted. The situation became stable thanks to joint efforts of WHO, IFRX, the Armenian Red Cross Society, UNICEF, the Ministry of Health of Armenia and its Government. Under Minister's Decree No. 292 of May 17, 1999, a malaria project implementation office was established in the Masis Sanitary and Epidemiological Surveillance Center of Hygienic and Antiepidemic Surveillance to improve progress of the malaria control programme in Armenia. WHO allocated some 7,700 USD for 5-month maintenance and work of the office. Thus, analyzing the malaria cases registered in 1999 and 1998 indicates a 1.9-fold decrease (616/77). The setting up the malaria programme field office under the Minister's decree was instrumental in planning and implementing activities in situ. In 1999, four cases of tropical malaria were recorded in Armenia. The patients were Armenian pilots who contacted malaria during duty travels: 1 in Sudan and 3 in Congo. The list of pilots making flying to endemic countries was submitted to the Republican Center to implement preventive measures in the future. In Armenia malaria surveillance has been improved to ensure timely detection of all suspected cases and to carry out malaria control activities. In this regard, a seminar was held for 21 entomologists and 12 parasitologists. UNICEF and WHO Armenian offices provided a substantial support to organize seminars. To facilitate the seminars, the manual "Malaria parasitology and entomology" was published and distributed among their participants. On April 19, 1999, the session of the Ministry's Executive Board (Collegium) gave recommendations to reinforce malaria control activities in the country. Decrees No. 256 of May 31, 1999, No. 47 of May 29, 1999, and No. 245 of April 30, 1999, "On malaria and preventive and control activities" were issued by the Ministry of Health, the Ministry of Defense, and the Ministry of Internal Affairs and National Security to serve as a guideline for planning and implementing activities. The Ministry of Agriculture undertook to clean the collective irrigation (drainage) system covering 102 and 77 km in the Ararat and Armavir marzes, the Ministry of Health provided a list of endemic foci where cleaning was a priority. Taking into account the importance of the people's participation in ensuring effective prevention and control, emphasis was laid on health education activities: publication of leaflets, as well as articles in local newspapers, radio broadcasts and TV shows. Throughout the season, the early detection of malaria cases, timely hospitalization (in no later than 1-3 days) for at least 5 days and subsequent treatment under direct supervision of a physician were successfully carried out due to home-to-home visits. Entomological studies conducted in the malaria foci show an increase in the presence and density of a malaria vector in the buildings. As far as treatment is concerned, the overall surface of stagnant waters comprised 2642 ha in 1999 (2733 ha in 1998), including 1285 ha of anophelogenic stagnant waters (2276 ha in 1998). The biggest stagnant water surfaces were in the Ararat and Armavir marzes--2209 ha, where the majority of malaria cases were recorded. A total of 1,283,111 and 559,213 sq. m. of constructions were treated in 1999 and 1998, respectively, out them there were 1,259,637 sq. m. in 5 endemic regions. Stagnant water surfaces were treated with bacticulicides on 250.7 and 743.8 (almost 3 times more) in 1998 and 1999, respectively. In 1999, 740 ha of surface were biologically treated using Gambusia compared to 900 ha treated in 1998. There is no highly qualified diagnostic specialists in many regions of the country, which necessitates the holding of further seminars involving relevant specialists, in all malaria regions. There is a tendency of geographical spread of malaria: malaria cases occur in new regions and dwellings. A country-wide action plan was drafted for 2000, mainly focusing on staff training. With WHO assistance, a seminar was held for 324 specialists from endemic regions. During the first quarter of 2000, 13 cases of tertian malaria were recorded as compared 59 cases during the same period of last year. All these patients contacted malaria in the previous season and demonstrated long incubation periods. Thus, the malaria control plan recommended by WHO and the rational and targeted use of its assistance has shown a 2-fold decrease in the incidence of malaria.     

Malaria in the Republic of Tajikistan

There were 200-300 malaria cases registered annually in the republic up to 1992. Due to civil war, interruption of antimalarial control measures and mass returning of refugees from Afghanistan epidemiological situation deteriorated since 1994. In 1997, 29,794 malaria cases were officially registered. Estimated number of cases were 200,000-500,000. There were local transmission of falciparum malaria. Since 1998, Tadjikistan receives financial support from Japan, Italy, Norway, and technical support from WHO. National Programme of malaria control has been designed and adopted by the Government in 1997. Laboratory diagnostics of malaria was implemented. Network of special antimalarial centres were established on central, regional and district levels. Mass treatment of population with primaquine and indoor residual spaying with piretroid have been performed in 1998 and 1999. In 1998, there were 19,351 malaria cases of which 10,268 were microscopically confirmed. During 6 months of 1999 2531 malaria cases were registered, 2246 among them were microscopically confirmed.     

山东省疟疾基本消灭后鲁南滨湖地区疟疾病灶点的分布及其传播作用的调查研究

鲁南滨湖地区微山县1986～1991年共发生疟疾41例,分布在16个乡镇的32个自然村。其中输入病例1986～1989年仅1例,1990～1991年5例;当地感染病例1986～1987年19例,1988～1989年未发现,1990～1991年5例;不明病例1986～1988年与1989～1991年分别为6例和5例。1989～1991年有病灶点11个,其中外源性灶点5个,内源性灶点1个,来源不明灶点5个。在调查的10个灶点中,活动或有潜在活动的灶点共7个。调查显示,当地疟疾灶点呈广泛散在,近年输入性病例有明显增加,当地感染病例也有回升趋势,多数灶点有传播或潜在传播存在,在当前情况下,不应放松对当地疟疾的监测。     

The epidemic situation with malaria in Uzbekistan

In the past five years (1994-1998), 223 cases of imported malaria were recorded in the Republic (Table 1), 190 of which were from countries in the Commonwealth of Independent States (CIS) and 33 from other countries. It is noteworthy that the number of cases imported from Tadjikistan--a country that borders eight of the Republic's 12 regions (oblasts)--has increased each year (12 in 1994, 69 in 1998). Some 25% of the population of our Republic live in the 67 cities and regions bordering Tadjikistan, Turkmenistan, Kazakhstan, Kyrgyzstan and Afghanistan. 35.5% of the cases of imported malaria have been registered in Surkhandarin region, which borders Afghanistan and Tadjikistan. Seventy-four (imported) cases of malaria were registered in the Republic in 1998, of which 17 (23%) were children under 14 years of age. Cases were registered in eight regions of the Republic and in the city of Tashkent. Thirty-six patients were detected in Surkhandarin region. Malaria was imported mainly from Tajikistan (69 cases) and Azerbaijan (two cases), as well as from Afghanistan (two cases) and India (one case). The infectious agent of vivax malaria was identified in 94.6% of cases, while in four cases it was found to be that of falciparum malaria. Three cases of falciparum malaria were registered for the first time in Surkhandarin region (imported from Tadjikistan) and one in the city of Tashkent (imported from Afghanistan). A large proportion of malaria cases (53, or 71.6%) were detected in the period from June to September, which is the time of high risk of infection. In the first six months of 1999, 15 cases of imported tertian malaria were recorded in the country as a whole, with six in Tashkent and Surkhandarin region, two in Fergana region and one in Samarkand region. Importation occurred mainly from Tajikistan (12 cases), with Azerbaijan, Kazakhstan and Afghanistan each accounting for one case. In order to prevent the spread of the infection from neighbouring malarious countries, steps are being taken to make medical personnel more alert to this threat, with the aims of ensuring prompt detection of people suspected of having malaria, improving the quality of laboratory diagnosis and treatment, and strengthening vector control.     

Current malaria situation and its control in Tadjikistan

Malaria was a widespread disease in Tajikistan in the past. Many travellers who visited eastern Bukhara last century wrote about this serious disease in their accounts. Surveys conducted in 1925-1926 showed that the whole population in the valleys was affected by malaria. Its control campaign was launched in the 1930s when the annual incidence of malaria reached 100-200 thousand persons. It is well known that malaria was virtually eradicated in Tajikistan in the late 1950s, as in the other republics of the USSR. It was only in the late 1970s and early 1980s, there was tertian malaria resurgence showing very low rates in the regions bordering Afghanistan. In some years, the number of malaria cases were as many as 200-500 cases a year, but due to the efforts of local health services that had used a whole range of methods for controlling the infection, the good situation remained until 1994. However, given the fact that the county is an high-risk area and malaria is endemic in neighbouring Afghanistan, its epidemic potential remained high. The epidemiological situation has become progressively worse since 1995. Its reasons are serious social conflicts which has taken the form of civil war. In 1997 with the support of WHO, ECHO (European Community Humanitarian Office), UNICEF (United Nations Children's Fund), WFP (World Food Programme), a number of international non-governmental organizations, the National Tropical Disease Control Programme for 1997-2005 was drafted and energetic actions were taken to implement malaria control measures in the country. In 1998-1999 great efforts were made to halt the spread of the serious epidemic outbreak in the country. During this period, a great deal of attention was paid to staff training for parasitology service, the Center for Tropical Disease Control and the general medical network. A large number of malaria control measures were taken, including vector control with special emphasis on treatment of buildings with persistent contact insecticides, mass preventive treatment with primaquine, and on the diagnosis of radical treatment of all identified malaria patients. The application of these preventive, therapeutical and vector control measures, together with an improvement in organization, resulted in a more than 2-fold fall in the incidence over 2 years (29,794, 19,351, and 13,493 cases in 1997, 1998, and 1999, respectively). The malaria control measures taken in the country in such a short period yielded positive results. A further reduction in the incidence of malaria and in the number of foci in Tajikistan can be achieved. Work towards this end should be systemic and goal-oriented by using a scientifically grounded and adequate range of prevention and control measures within the framework of the National Tropical Disease (Malaria) Control Programme and WHO "Roll Back Malaria" Programme. Improvements in parasitological service, tropical disease control centers and general health care network should form the basis of any future implementation of malaria control measures in the country at a regional level; monitoring the local malaria situation should be planned by constantly and qualitatively assessing the measures being implemented. It is very important to develop a system for preventing the spread of malaria throughout the country and its importation from foreign countries.     

上海市疟疾基本消灭后的流行特征分析

目的　分析上海市基本消灭疟疾后 ,1994～ 1999年疟疾流行的变化趋势。　方法　对全市 1994～ 1999年多项疟疾监测指标、调查结果资料进行回顾性研究。　结果　 6年共发现 74 7例疟疾病例 ,总发病率本地居民为 0 .31/10万 ,外来流动人口为 8.88/10万 ,差别有统计学意义 (χ2 =4 312 .31,P<0 .0 0 1) ;两者 1999年发病率较 1994年分别下降了6 7.4 4 %和 95 .2 5 %。输入病例占病例总数的 82 .4 6 % ;市区只有输入病例 ,5 7.94 %外省输入病例和 5 5 .73%本地感染病例相对集中在流动人口较为聚集的 4个区 (县 ) ,前者的发病高峰约较本地病例提前 1个月。本地居民未查见带虫者 ,纵向监测点青少年儿童 IFAT抗体阳性率为 0 .31%。82 .5 0 %为非活动性病灶点 ,99.4 0 %病灶点仅有 1个病例。　结论　上海市疟疾以输入病例为主 ,虽然市郊区 (县 )仍发生低水平的本地传播和感染 ,但未引起局部流行或暴发流行     

广西壮族自治区柳北3县少数民族地区2000-2007年疟疾流行状况分析

目的 调杳分析原为疟疾高度流行区的柳北3县少数民族地区2000--2007年的疟疾流行状况及其与紧邻蒯边省疟疾流行区和暴发点的关系.方法 埘该地区2000-2007年当地居民及流动人口发热患者血检率、血榆阳性率和所发现的疟疾患者资料进行收集、整理和统计分析,对流动人口疾患者感染地进行分类和统计分析,描述疟疾患者在3个县、乡、村和屯的分布状况,对病例感染的疟原虫虫种进行分类比较,并对流动人口疟疾患荇的米源地进行分析.结果 3个县8年间共查出疟疾患者202例,其中当地居民患者23例,均为间开口疟患者;流动人口疟疾患者179例,以问开疟患者为主,并有恶性疟和混合感染患者.三江县流动人口疟疾患者主要足在东南亚困家感染,占当地流动人口患者的69.7%,而融水和融安两县流动人口则以在海南感染为主,占当地流动人口疟疾患者的90.9%和100%.结论 2000-2007年柳北3县少数民族地区疟疾患者以当地居民由外地感染带回为卡,与邻近省份疟疾流行区无密切关系,受疟疾威胁人口仅占总人口的1.34%,在该地区疟疾发病仍控制在2/万以下.     

广西壮族自治区柳北3县少数民族地区2000-2007年疟疾流行状况分析

目的 调杳分析原为疟疾高度流行区的柳北3县少数民族地区2000--2007年的疟疾流行状况及其与紧邻蒯边省疟疾流行区和暴发点的关系.方法 埘该地区2000-2007年当地居民及流动人口发热患者血检率、血榆阳性率和所发现的疟疾患者资料进行收集、整理和统计分析,对流动人口疾患者感染地进行分类和统计分析,描述疟疾患者在3个县、乡、村和屯的分布状况,对病例感染的疟原虫虫种进行分类比较,并对流动人口疟疾患荇的米源地进行分析.结果 3个县8年间共查出疟疾患者202例,其中当地居民患者23例,均为间开口疟患者;流动人口疟疾患者179例,以问开疟患者为主,并有恶性疟和混合感染患者.三江县流动人口疟疾患者主要足在东南亚困家感染,占当地流动人口患者的69.7%,而融水和融安两县流动人口则以在海南感染为主,占当地流动人口疟疾患者的90.9%和100%.结论 2000-2007年柳北3县少数民族地区疟疾患者以当地居民由外地感染带回为卡,与邻近省份疟疾流行区无密切关系,受疟疾威胁人口仅占总人口的1.34%,在该地区疟疾发病仍控制在2/万以下.     

广西壮族自治区柳北3县少数民族地区2000-2007年疟疾流行状况分析

目的 调杳分析原为疟疾高度流行区的柳北3县少数民族地区2000--2007年的疟疾流行状况及其与紧邻蒯边省疟疾流行区和暴发点的关系.方法 埘该地区2000-2007年当地居民及流动人口发热患者血检率、血榆阳性率和所发现的疟疾患者资料进行收集、整理和统计分析,对流动人口疾患者感染地进行分类和统计分析,描述疟疾患者在3个县、乡、村和屯的分布状况,对病例感染的疟原虫虫种进行分类比较,并对流动人口疟疾患荇的米源地进行分析.结果 3个县8年间共查出疟疾患者202例,其中当地居民患者23例,均为间开口疟患者;流动人口疟疾患者179例,以问开疟患者为主,并有恶性疟和混合感染患者.三江县流动人口疟疾患者主要足在东南亚困家感染,占当地流动人口患者的69.7%,而融水和融安两县流动人口则以在海南感染为主,占当地流动人口疟疾患者的90.9%和100%.结论 2000-2007年柳北3县少数民族地区疟疾患者以当地居民由外地感染带回为卡,与邻近省份疟疾流行区无密切关系,受疟疾威胁人口仅占总人口的1.34%,在该地区疟疾发病仍控制在2/万以下.     

广西壮族自治区柳北3县少数民族地区2000-2007年疟疾流行状况分析

目的 调杳分析原为疟疾高度流行区的柳北3县少数民族地区2000--2007年的疟疾流行状况及其与紧邻蒯边省疟疾流行区和暴发点的关系.方法 埘该地区2000-2007年当地居民及流动人口发热患者血检率、血榆阳性率和所发现的疟疾患者资料进行收集、整理和统计分析,对流动人口疾患者感染地进行分类和统计分析,描述疟疾患者在3个县、乡、村和屯的分布状况,对病例感染的疟原虫虫种进行分类比较,并对流动人口疟疾患荇的米源地进行分析.结果 3个县8年间共查出疟疾患者202例,其中当地居民患者23例,均为间开口疟患者;流动人口疟疾患者179例,以问开疟患者为主,并有恶性疟和混合感染患者.三江县流动人口疟疾患者主要足在东南亚困家感染,占当地流动人口患者的69.7%,而融水和融安两县流动人口则以在海南感染为主,占当地流动人口疟疾患者的90.9%和100%.结论 2000-2007年柳北3县少数民族地区疟疾患者以当地居民由外地感染带回为卡,与邻近省份疟疾流行区无密切关系,受疟疾威胁人口仅占总人口的1.34%,在该地区疟疾发病仍控制在2/万以下.     

广西壮族自治区柳北3县少数民族地区2000-2007年疟疾流行状况分析

目的 调杳分析原为疟疾高度流行区的柳北3县少数民族地区2000--2007年的疟疾流行状况及其与紧邻蒯边省疟疾流行区和暴发点的关系.方法 埘该地区2000-2007年当地居民及流动人口发热患者血检率、血榆阳性率和所发现的疟疾患者资料进行收集、整理和统计分析,对流动人口疾患者感染地进行分类和统计分析,描述疟疾患者在3个县、乡、村和屯的分布状况,对病例感染的疟原虫虫种进行分类比较,并对流动人口疟疾患荇的米源地进行分析.结果 3个县8年间共查出疟疾患者202例,其中当地居民患者23例,均为间开口疟患者;流动人口疟疾患者179例,以问开疟患者为主,并有恶性疟和混合感染患者.三江县流动人口疟疾患者主要足在东南亚困家感染,占当地流动人口患者的69.7%,而融水和融安两县流动人口则以在海南感染为主,占当地流动人口疟疾患者的90.9%和100%.结论 2000-2007年柳北3县少数民族地区疟疾患者以当地居民由外地感染带回为卡,与邻近省份疟疾流行区无密切关系,受疟疾威胁人口仅占总人口的1.34%,在该地区疟疾发病仍控制在2/万以下.     

广西壮族自治区柳北3县少数民族地区2000-2007年疟疾流行状况分析

目的 调杳分析原为疟疾高度流行区的柳北3县少数民族地区2000--2007年的疟疾流行状况及其与紧邻蒯边省疟疾流行区和暴发点的关系.方法 埘该地区2000-2007年当地居民及流动人口发热患者血检率、血榆阳性率和所发现的疟疾患者资料进行收集、整理和统计分析,对流动人口疾患者感染地进行分类和统计分析,描述疟疾患者在3个县、乡、村和屯的分布状况,对病例感染的疟原虫虫种进行分类比较,并对流动人口疟疾患荇的米源地进行分析.结果 3个县8年间共查出疟疾患者202例,其中当地居民患者23例,均为间开口疟患者;流动人口疟疾患者179例,以问开疟患者为主,并有恶性疟和混合感染患者.三江县流动人口疟疾患者主要足在东南亚困家感染,占当地流动人口患者的69.7%,而融水和融安两县流动人口则以在海南感染为主,占当地流动人口疟疾患者的90.9%和100%.结论 2000-2007年柳北3县少数民族地区疟疾患者以当地居民由外地感染带回为卡,与邻近省份疟疾流行区无密切关系,受疟疾威胁人口仅占总人口的1.34%,在该地区疟疾发病仍控制在2/万以下.     

广西壮族自治区柳北3县少数民族地区2000-2007年疟疾流行状况分析

目的 调杳分析原为疟疾高度流行区的柳北3县少数民族地区2000--2007年的疟疾流行状况及其与紧邻蒯边省疟疾流行区和暴发点的关系.方法 埘该地区2000-2007年当地居民及流动人口发热患者血检率、血榆阳性率和所发现的疟疾患者资料进行收集、整理和统计分析,对流动人口疾患者感染地进行分类和统计分析,描述疟疾患者在3个县、乡、村和屯的分布状况,对病例感染的疟原虫虫种进行分类比较,并对流动人口疟疾患荇的米源地进行分析.结果 3个县8年间共查出疟疾患者202例,其中当地居民患者23例,均为间开口疟患者;流动人口疟疾患者179例,以问开疟患者为主,并有恶性疟和混合感染患者.三江县流动人口疟疾患者主要足在东南亚困家感染,占当地流动人口患者的69.7%,而融水和融安两县流动人口则以在海南感染为主,占当地流动人口疟疾患者的90.9%和100%.结论 2000-2007年柳北3县少数民族地区疟疾患者以当地居民由外地感染带回为卡,与邻近省份疟疾流行区无密切关系,受疟疾威胁人口仅占总人口的1.34%,在该地区疟疾发病仍控制在2/万以下.     

广西壮族自治区柳北3县少数民族地区2000-2007年疟疾流行状况分析

目的 调杳分析原为疟疾高度流行区的柳北3县少数民族地区2000--2007年的疟疾流行状况及其与紧邻蒯边省疟疾流行区和暴发点的关系.方法 埘该地区2000-2007年当地居民及流动人口发热患者血检率、血榆阳性率和所发现的疟疾患者资料进行收集、整理和统计分析,对流动人口疾患者感染地进行分类和统计分析,描述疟疾患者在3个县、乡、村和屯的分布状况,对病例感染的疟原虫虫种进行分类比较,并对流动人口疟疾患荇的米源地进行分析.结果 3个县8年间共查出疟疾患者202例,其中当地居民患者23例,均为间开口疟患者;流动人口疟疾患者179例,以问开疟患者为主,并有恶性疟和混合感染患者.三江县流动人口疟疾患者主要足在东南亚困家感染,占当地流动人口患者的69.7%,而融水和融安两县流动人口则以在海南感染为主,占当地流动人口疟疾患者的90.9%和100%.结论 2000-2007年柳北3县少数民族地区疟疾患者以当地居民由外地感染带回为卡,与邻近省份疟疾流行区无密切关系,受疟疾威胁人口仅占总人口的1.34%,在该地区疟疾发病仍控制在2/万以下.     

Current malaria situation in Azerbaijan

The malaria epidemiological situation has substantially improved in Azerbaijan. In 1999, the incidence of malaria has been 2.2 times less than in 1998 (2,315 versus 5,175 cases). This reduction has been seen in all endemic areas of the country: the incidence of malaria reduced by a factor of 1.5 to 10, including its border regions where it is by 4 times less (633 versus 2,534 cases). There was a 1.8-fold decrease in the number of new foci in 1999 as compared to 1998 (165 versus 92). All malaria cases had local features. Of the imported cases in 1999, there were 3 cases of tropical malaria from Sudan and one case of P. vivax malaria from Georgia. Priority measures to implement the National Malaria Control Programme are as follows: Early detection, diagnosis, and radical treatment of malaria patients. Strengthening of laboratory service. Chemoprophylaxis for high-risk groups. Vector control. Improvement of knowledge among health workers. Increase in social mobilization.     

Malaria in Moscow in 2000-2004

Malaria was eradicated on the territory of Moscow in 1960; its imported cases mainly from the countries of Asia and Africa and sporadic cases secondary to the imported ones were recorded during the following 40 years. Mass migration of the population (businessmen, seasonal workers, etc.) from the endemic CIS countries in the late 1990s, particularly to the Moscow Region, increased cases of tertian malaria, resulting from the transmission of the infection by the mosquitoes Anopheles. A total of 793 cases of malaria, including 27 parasitic carriers, were recorded from 2000 to 2004. The proportion of Muscovites was 24.1% of the total cases of malaria in 2002 and increased up to 50% in 2004. The causative agents of tertian malaria (Plasmodium vivax) were detected in 74.8% of the total number of cases. The ongoing importation of malaria from Tadjikistan and Azerbaijan, the late establishment of final diagnosis, the shortage of antimalarial drugs make the malaria situation worse in Moscow, which requires that antiepidemic measures should be intensified in the coming 3 years.     

Current malaria situation in the Republic of Uzbekistan

Malaria was once one of the most common diseases in Uzbekistan. There were massive epidemics with high mortality rates, wherein 140,000 to 700,000 cases of malaria were recorded. Following large-scale malaria control measures, the disease was eradicated in Uzbekistan in 1961 and the epidemiological situation is still favorable. The natural and climatic conditions that prevail in the Republic of Uzbekistan mean that the country is very susceptible to malaria. There are large water areas varying in type and origin, which provide a habitat for a number of epidemiologically dangerous species of malaria-transmitting mosquitoes in a single area. These are Anopheles maculipennis, An. pulcherrimus and An. superpictus. The prevailing temperatures promote rapid growth of vector mosquitoes and parasites and the malaria transmission season is over 5 months long. Seven malaria-transmitting mosquito species have been recently recorded in the Republic. DDT resistance has been so far noted in Anopheles maculipennis, An. hyrcanus and An. bifurcatus. An. superpictus is sensitive to all insecticides used in clinical practice (organophosphorus and organochlorine compounds, HOS, carbamates, pyrethroids). The most dangerous areas for transmitting malaria by importation are the flood plains of the country's main rivers, such as Syrdarya, Amudarya, Chirchik, Surkhana, etc., and rice-growing areas (an area of about 150,000 ha was under rice cultivation in 1999). The Republic is still very subjected to large-scale importations of malaria particularly in the towns and areas along the border with Tajikistan. There has been recently an increase in the incidence of infections imported into the Republic: 27 cases in 1995, 51 in 1996, 52 in 1997, 74 in 1998, and 78 in 1999. Eight regions of Uzbekistan border Tajikistan, their population is over 5.6 million people. In addition, close family ties between the populations of the frontier towns and regions further increase the risk for malaria to be imported and passed on. Noteworthy is the Surkhandaryin region that accounted for 60% of the cases recorded in 1999. The number of towns and villages where malaria occurs for the first time increased (49 and 46 cases in 1999 and 1998, respectively). The number of cases imported into rural areas also increased (70 (83%) cases in 1999 versus 48 (65%) cases in 1998); due to the large populations of malaria mosquitoes, there is a real danger that the disease may spread. In 1999, most cases of malaria were imported from Tajikistan (65 cases or 76% of all cases). There was a case from each of the following countries: Afghanistan, Pakistan, and Kazakhstan and 5 cases from Azerbaijan and Kyrgyzstan. The recorded cases included slighly more men than women (54% vs 46%). There were 10 infected children under 14 years, which was 23.5% of all notified cases. Analyzing various populations showed that 67.1% of the patients visited their relatives in malaria-endemic countries (mostly Tajikistan) and 25.8% migrated from Tajikistan. All the detected cases were confirmed by laboratory tests. As in the past, most cases were tertian (P. vivax) malaria (n = 82 or 96.4% of all cases). Tropical (P. falciparum) malaria was confirmed in 3 (3.5%) cases. These cases had been imported from Tajikistan into the Surkhandaryin region. Seventy seven (91%) cases were detected in the epidemical season. Of them 58 (68.2%) cases were detected during a malaria transmission season. Seven cases who contacted the patients with imported malaria and were infected were recorded in 1999. They included 4 and 3 cases in the Surkhandaryin and Kashkadaryin Regions, respectively. In 1999, there was a decline in the number of malaria patients who needed health care and in the diagnosed malaria cases in therapeutical and prophylactic institutions. Throughout the country, 34 (40%) of the 85 detected cases presented within 3 days of malaria outbreak (68.9% in 1998). Malaria was immediate diagnosed in 43.5% of cases (64.9% in 1998). The remaining cases were diagnosed as having acute respiratory viral infections, tropical and parasitic diseases, viral hepatitis, or influenza. Early diagnosis of malaria was made in 60% of cases (77% in 1998). Three cases of imported tertian malaria were recorded in the Tashkent Region in the first quarter of 2000. They were imported from Tajikistan into rural areas and the patients had been infected during the 1999 season. Epidemiological surveillance of malaria in Uzbekistan is regularly carried out by the general network of health facilities and by the departments of parasitology of state epidemiological surveillance centers in collaboration with medical administrative departments, the Ministry of Agriculture and Fisheries, the L.M. Isayev Research Institute of Medical Parasitology, and other agencies. Active links are maintained with WHO under the Roll Back Malaria programme. Great emphasis is laid on medical staff training at all levels. During the 1999 epidemiological survey, 672,536 laboratory tests were performed on blood samples from suspected malaria patients and individuals who had visited malaria-endemic countries, 55% of them suffering from fever. A total area of 17 million m2 of dwelling and nondwelling buildings 20 ha of water areas were treated against mosquitoes and the larvivorous fish Gambusia was put into the water areas occupying 6,500 ha. In all cases of malaria, the focus of infection was epidemiologically surveyed and required epidemic preventive measures were implemented. All malaria patients received a full course of radical therapy and recovered completely. The epidemiological surveillance system for malaria is affected by staff shortages at the parasitology departments of state epidemiological surveillance centers and by shortages of microscopes, reagents, sterilizing equipment, insecticides, etc. There are still difficulties in obtaining supplies of primaquine although a small stock is locally available as due to WHO humanitarian assistance. The Epidemiological Malaria Surveillance Programme for the Republic of Uzbekistan for 2000-2004, intended to strengthen the epidemic control capacity of health care facilities, Ministry of Health, is under adoption. The following activities are scheduled for 2000: to plan malaria control activities, including the zoning of the country by the risk of malaria transmission in accordance with republic-leveled directives, instructions, and methodology and WHO recommendations: adjustments to these plans to be made as necessary; to fill vacant posts in the parasitology departments of state epidemiological surveillance centers; to procure stocks of antimalarial drugs, reagents, insecticides, sterilizing equipment, etc., to be paid for from epidemiological service resources; to include malaria issues into certifying tests for physicians, as appropriate for the posts to be occupied and their level of qualifications; to publish posters, brochures, and leaflets about malaria prevention before the malaria transmission season for health education; to hold seminars and meetings for health workers on the etiology of malaria, its clinical features, diagnosis, treatment, and prevention.