福建省将乐县灭疟后期媒介监测效果分析

在原嗜人按蚊密度较高的将乐县会石村监测媒介,监测中仅捕获到中华按蚊;6~10月份人饵平均叮人率为0.90只/人.夜;人房搜捕法平均叮人率为1.01只/人.夜;中华按蚊趋吸人、牛血率分别为0.57%和99.43%;经产蚊比率为50.74%。     

From the Cover: International population movements and regional Plasmodium falciparum malaria elimination strategies

Calls for the eradication of malaria require the development of global and regional strategies based on a strong and consistent evidence base. Evidence from the previous global malaria eradication program and more recent transborder control campaigns have shown the importance of accounting for human movement in introducing infections to areas targeted for elimination. Here, census-based migration data were analyzed with network analysis tools, Plasmodium falciparum malaria transmission maps, and global population databases to map globally communities of countries linked by relatively high levels of infection movements. The likely principal sources and destinations of imported cases in each region were also mapped. Results indicate that certain groups of countries, such as those in West Africa and central Asia are much more strongly connected by relatively high levels of population and infection movement than others. In contrast, countries such as Ethiopia and Myanmar display significantly greater isolation in terms of likely infection movements in and out. The mapping here of both communities of countries linked by likely higher levels of infection movement, and “natural” migration boundaries that display reduced movement of people and infections between regions has practical utility. These maps can inform the design of malaria elimination strategies by identifying regional communities of countries afforded protection from recolonization by surrounding regions of reduced migration. For more isolated countries, a nationally focused control or elimination program is likely to stand a better chance of success than those receiving high levels of visitors and migrants from high-transmission regions.     

A Piot model to analyse case management in malaria control programmes

At the beginning of the 21st century, malaria remains one of the most important public health problems in the world. An important control strategy to address this burden is adequate case management of malaria patients. The success of this strategy, however, does not solely depend on diagnosis and treatment, but also on a sequence of steps that patients have to take when they are ill. Only when patients go through all these steps successfully will they be cured. In this paper, a model is presented in which these steps are described. The model provides a framework for analysing this type of malaria control strategy and for identifying the most critical challenges faced. Furthermore, the model is used to analyse recent literature on case management as part of malaria control programmes in order to highlight current knowledge, core issues and constraints, and to make recommendations for programme development and research.     

Do we still need a malaria vaccine?

An unexpectedly large reduction in the burden of malaria has recently been achieved in a number of malaria endemic countries following the scaling up of effective treatment and simple vector control programmes. These achievements question the need for a partially effective malaria vaccine targeted at disease prevention. If an anti-disease vaccine is to replace or supplement existing control measures a high level of efficacy, sustained over a number of years, will be required. Recent successes in malaria control have re-awakened interest in the possibility of malaria elimination in areas where this was not previously considered to be a feasible objective. Malaria vaccines with transmission-blocking properties could play a key role in future elimination programmes.     

泉州市输入性疟疾现状及防制对策

目的 了解泉州市输入性疟疾流行现状,为制订防治策略、实现2014年全市消除疟疾目标提供依据。方法 收 集2007-2011年泉州市疟疾疫情资料、个案调查表及年报表等进行统计分析。结果 2007-2011年全市共发现输入性疟疾15例,均为男性,以40～49岁居多,占46.67%。发病无明显季节性,病例主要分布在泉港、晋江、石狮和惠安等地。“三热”病人血检未发现疟原虫阳性者。结论 泉州市输入性疟疾疫情平稳。但仍要加强对出入境人员的健康教育和监测,做好输入性疟疾的防控与管理。     

Enhanced gametocyte production in Fansidar-treated Plasmodium falciparum malaria patients: implications for malaria transmission control programmes

Gametocytes are the agents in malaria transmissible between the vertebrate host and the mosquito vector, and an increase in their incidence would be expected to have a corresponding impact on the prevalence of malaria, particularly in areas of high transmission. The purpose of this study was to determine whether there is an association between the type of antimalarial drug administered and the production of gametocytes. Two commonly used drugs, Fansidar and chloroquine, were compared in this respect. A total of 94 people (mean age±s.d. 16.94±19.03 years), from a highly endemic malaria area of Zambia, were treated with either Fansidar or chloroquine (Fansidar, n =46, chloroquine, n =48). The percentages of gametocytes generated after treatment were 23.9 for Fansidar and 6.2 for chloroquine. A 2×2 table analysis of the data shows that the P values, both by χ² and Z analysis, were less than 0.02, suggesting a statistically significant difference in the propagation of gametocytes between the two treatment groups. There was no significant difference in the quantitative gametocyte count per 200 white blood cells (Fansidar, 7.5±8.57; chloroquine, 4.5±1.64; P >0.10), probably because of the small size of the 'gametocyte ' sample ( n =14).     

Toward elimination and eradication of hepatitis B

Hepatitis B virus (HBV) causes important human health problems. It has infected one-third of the world's population and approximately 360 million people are chronic carriers. Worldwide, 0.5–1.2 million deaths are attributed to HBV infection annually. Therefore, global control of HBV infection is important. HBV infection can be intervened by interrupting routes of transmission, treating the chronically infected, and preventing the susceptibles with immunoprophylaxis. All these measures are effective. Nevertheless, although pegylated interferons or nucleos(t)ide analogs are effective for the treatment of chronic hepatitis B, chronic carriage of HBV is not easy to eliminate, as revealed by the frequent persistence of hepatitis B surface antigen, despite satisfactory responses to these treatments. On the other hand, hepatitis B vaccination has been shown to preclude HBV infection effectively. This is particularly true for pre-exposure prophylaxis. Worthy of note is the universal vaccination of newborn infants. This is the most effective means of preventing HBV infection, especially for those born to HBV carrier mothers. To eliminate and eradicate hepatitis B, first, HBV in the chronically infected should be eradicated or strongly and efficiently suppressed, so that the infection does not spread rampantly. Second, all the transmission routes should be interrupted. Lastly, but most effectively, is to immunize all susceptibles. The difficulties and possible solutions of each approach are discussed. In conclusion, the existing means to prevent and treat HBV infection render our goal toward eliminating and eradicating hepatitis B possible, although it will take much time and effort to achieve this objective.     

Patterns of treatment for malaria in Tayabas, The Philippines: Implications for control

This paper describes local understandings of illness and documents treatment-seeking behaviour in Tayabas, Quezon, The Philippines. Data were collected using focus group discussions and narrative interviews with adults, and with mothers of children, who had had confirmed malaria during a two-month surveillance period. Signs and symptoms of malaria are important in directing individual diagnosis, treatment-seeking and therapy. Household therapy with antimalarials, and more commonly antipyretics and herbs, as used before seeking care from either the formal or informal sector. Care outside the home was sought where symptoms continued and/or worsened, with an average period of time from onset of symptoms to presentation to a clinic of six days. Accessibility to clinics is not a problem in the study area and hence the primary reason for delay was propensity to self-treat first and to discontinue medication when feeling better. These factors affect the control of malaria and the potential to reduce transmission. Better advice to the community regarding the importance of diagnosis and compliance with antimalarial therapy is indicated.     

Co-infection of malaria with HIV: an immunological perspective

Human immunodeficiency virus (HIV) and Plasmodium parasites are pathogens that induce significant perturbation and activation of the immune system. Due to their geographical overlap, there have been concerns that co-infection with the two pathogens may be a factor in the modification of their development, and in the severity and rate of disease progression that they induce. In this article, we have reviewed some of the studies that have addressed this topic and we have tried to provide immunological mechanisms to explain these potential interactions.     

Reliability of malaria microscopy in epidemiological studies: results of quality control

To assess the interrater reproducibility of malaria microscopy in epidemiological studies, 711 thick blood films from population-based surveys were randomly selected and reread by 4 experienced microscopists. Sample estimates of the prevalence of P. falciparum infection, geometric mean parasite density and the proportion of samples above various parasite density cut-off levels were almost identical in the routine and quality control readings. Differences were, however, encountered in the sample estimates for gametocyte ratio, proportion of mixed infection and average density index. In all three cases the quality control result was significantly higher than the routine evaluation. On the level of the individual slide there was good interrater agreement for the presence of P. falciparum infections (Kappa index kappa = 0.79) which was even better when parasite densities between 4 and 100/microl were excluded (kappa = 0.94). With respect to the assessment of parasite density, a high level of disagreement was found. While the mean difference between the two readings was not different from 0, the second reading was between 0.12 and 10 times that of the first. However, the level of disagreement significantly fell with increasing parasite densities. Thus malaria microscopy is very reliable for the estimation of parasite ratios and geometric mean parasite densities within and between studies as long as the same methodology is used, but tends to underestimate the gametocyte ratio and proportion of mixed infections. Care must be taken, however, when individual parasite density is related to other explanatory variables, due to the high degree of variability in the parasite enumeration.     

河南省2006年疟疾疫情及防治措施评价

目的了解并分析河南省2006年的疟疾疫情,评价疟疾防治措施,为疟疾防治提供依据。方法收集河南省2006年的疟疾疫情报告数据进行分析,评价防治措施。结果全省2006年共报告疟疾病例5 090例,平均年发病率为0.52%,较2005年的2 304例上升120.92%。病例集中在永城、夏邑和桐柏等15个县.共发生疟疾4 769例,占全省疟疾发病数的93.69%,较上年的2 085例上升128.73%。其中豫东地区的永城和夏邑两县上升幅度明显,分别较上年上升307.04%和360.94%。全省发现36个暴发点均分布在永城市,发病2 890例,占全省发病数的56.8%。全省2006年共血检发热病人332 853人,镜检阳性3 204例,阳性率为0.96%,占全部报告病例的62.95%。疟疾休止期服药15 470人,正规服药率97.12%。流行季节对疟疾高发区的8 567人进行了预防性服药。现症病人正规服药率95%。在暴发点采取全民预防服药11 953人次、菊酯类杀虫剂灭蚊室内外喷洒82万m~2等措施后控制暴发。结论河南省疟疾疫情处于快速回升状态,应当采取超常规措施防止豫东地区大范围疟疾暴发流行。     

From control to eradication of malaria: the end of being stuck in second gear?

ObjectiveMore than 2 billion people are at risk of malaria, which primarily affects poor populations in tropical and subtropical areas, including Southern Asia. As malaria incidence has been reduced strongly in some parts of endemic regions by combinations of interventions, including artemisinin-based therapies and insecticide-treated bed nets, a new goal has been established recently by charity foundations which support research on malaria: the worldwide eradication of the pathology. Doing away with control approaches which have been applied for the last 50 years and more focus on elimination objectives will deeply change priorities in the area of malaria treatment, chemoprevention, vector control, vaccine research and health system assessment. In this review, actual knowledge on pathogenesis and pharmacology is discussed, and new drugs, vaccines and insecticides are described.     

Analysis of epidemiological changes and elimination effects for malaria in Handan city,the north China

The elimination of malaria requires high-quality surveillance data to quickly detect and respond to individual cases. This study aims to analyze the epidemiological characteristics of malaria and ascertain the long-term epidemic trends of malaria by 2020 in Handan China. Case-level data for the period 2011 to 2020 were extracted from Chinese Information System for Disease Control and Prevention. The lamp trap method was used to capture mosquitoes so that the characteristics of mosquitoes can be analyzed. The incidence, accuracy, and timeliness of malaria case diagnosis, reporting and investigation were evaluated at the elimination stage (2011–2020) in Handan City, China. Between 2011 and 2020, 94 malaria cases were reported in Handan City, of which 93 malaria cases were male and all of which were imported from abroad. The annual average incidence decreased from 622.33/100,000 to 0.11/100,000 in the elimination stage. Since the initiation of the National Malaria Elimination Program in 2010, malaria cases have been consistent with the increase in overseas export channels and labor personnel service. There is a need to strengthen malaria surveillance of returning workers from Africa and to conduct timely blood tests to diagnose and treat imported infections. Local authorities ensure that imported malaria cases can be timely diagnosed, reported, treated and investigated at local level.     

1992-2008年粤桂琼流动人口疟疾联合管理区广西玉林市疟疾监测措施与联防效果评价

目的分析粤桂琼流动人口疟疾联合管理区广西玉林市1992-2008年疟疾监测结果,评价联防联控措施。方法收集1992～2008年广西玉林市辖7县（区）当地居民发热病人、病灶点居民和流动人口及重点人群疟疾间接荧光抗体（IFAT）监测资料进行流行病学描述和统计分析。结果17年间玉林市共血检当地居民发热病人75．84万人次,重点居民913万人次,流动人口发热病人10．17万人次．流动人口非发热人群6．71万人次,四类人群血检阳性率分别为0．004％、0．001％、0．704％和0．003％,共检出疟疾病例747例,本地感染病例占总病例的3．75％（28／747）,输入性病例占96．25％（719／747）,重点人群IFAT抗体阳性率为006％（211／368746）。结论玉林市参加三省疟疾联防17年来．疟疾年带虫发病率一直控制在1／万以下,1999年起至今无当地感染疟疾病例和输入继发病例发生．流动人口发热病人血检阳性率从1992年的3．230％降至2008年的0．036％,流动人口疟疾管理与监测措施得当,联防效果显著。     

2017—2021年福建省输入性疟疾疫情分析

目的 分析2017—2021年福建省输入性疟疾的疫情特征,为消除疟疾后的防控工作提供科学参考。方法 收集2017—2021年福建省输入性疟疾的疫情资料,运用Microsoft Excel 2010软件对病例的感染分型、感染来源、三间分布、就诊和诊断情况等进行描述性分析。结果 2017—2021年福建省共报告境外输入性疟疾病例407例,均为实验室确诊病例,其中恶性疟307例(75.43%)、间日疟46例(11.30%)、卵形疟34例(8.36%)、三日疟16例(3.93%)、混合感染4例(0.98%)。感染来源为非洲30个国家(376例,92.38%)、亚洲5个国家(18例,4.42%)、大洋洲1个国家(12例,2.95%)和南美洲1个国家(1例,0.25% );主要由福州市(314例,77.15%)报告。人群分布以男性为主(363例,89.19%),年龄主要集中在30~50岁(256例,62.90%)。病例主要在医疗机构初诊(389例,95.58%)、确诊(377例,92.63%)和报告(393例,96.56%),初诊正确率为71.25%(290/407)。发病-初诊、初诊-确诊、发病-确诊的时间间隔中位数分别为2 d、0 d和3 d。 结论 福建省仍面临严峻的境外输入性疟疾的持续性挑战,需继续加强对输入性疫情的监测,巩固疟疾消除成果。