全球疟疾流行现状及我国输入性疟疾疫情态势分析

了解全球及中国疟疾流行现状,分析我国输人性疟疾疫情态势。全球多数疟疾病例发生在撒哈拉以南的非洲区域,我国输入性恶性疟疫情突出。我们应健全口岸疟疾监测网络,做好出入境人员疟疾防控工作。     

Malaria infections in crews of Japanese ships

Plasmodium falciparum malaria is the most dangerous infection for seafarers in West Africa. In December 1998, five cases of this infection occurred among Japanese seafarers in West Africa, two of them died, one on board ship, and another died five days after the admission to the hospital in Reunion island, East Africa. Six other cases of falciparum malaria infection occurred among Japanese seafarers on another ship in December 1999. Three infected persons were admitted to hospitals in Abidjan (Ivory Coast) and Point Noire (Congo). In Japan, over 100 cases of imported malaria were recorded each year during the period from 1990 to 1997, and about 40% of these cases were falciparum infections. It is not known how many of them occurred among seafarers. We estimate that at least 5% of all malaria cases in Japan are seafarers. Measures to protect crews of ships against malaria are discussed.     

湖南省郴州市2003-2012年疟疾流行特征及监测效果研究

目的 了解郴州市疟疾流行特征及监测效果,为疟疾防治和消除提供科学依据.方法 运用描述性流行病学方法对郴州市2003-2012年疟疾流行病学及监测资料进行统计分析.结果 郴州市2003-2012年共报告疟疾病例41例,年平均发病率为0.09/10万,死亡1例,无暴发疫情;其中间日疟24例（58.54％）,恶性疟15例（36.58％）,三日疟2例（4.88％）;本地病例4例（9.76％）,输入性病例37例（90.24％）,93.33％（14/15）的恶性疟病例均由非洲输入;发热患者血检107 975人次,阳性率为3.43/万,疟疾病例实验室检测率和确诊率均为100％;传疟媒介主要以中华按蚊为主（86.04％）,蚊密度高峰出现在7-8月.结论 郴州市基本消除疟疾后,疟疾疫情控制在较低水平,病例以输入性为主,在今后的疟疾防治和消除工作中,应加强流动人口监测和发热患者血检.     

Imported malaria in Bordeaux: evaluation of the risk of infection with Plasmodium falciparum as a function of country visited

This study of imported cases of malaria, which was carried out in Bordeaux (France) in 1987-89, emphasizes the major part played by Plasmodium falciparum, especially in areas lying south of the Sahara in Africa, from where falciparum malaria is mainly imported to other countries. The study of these imported cases is strengthening our understanding of the epidemiology of malaria in relation to the country or area, whether the transmission occurs without interruptions or seasonally. The number of cases of P. falciparum per 1000 travellers (seen for vaccination against yellow fever at Bordeaux) gives an index for evaluating the risk of malaria. This risk changes with the epidemiological profile of falciparum malaria in the three major African ecosystems (rain forest, savannah, and sahelian belts), and is related to the progression of chloroquine resistance in Africa and influenced by the type of chemoprophylaxis proposed to travellers. The use of mefloquine for stays shorter than one month in Central Africa reduced the risk of malaria in 1988 and 1989, compared to 1987. [Editorial note. Recent data indicate some undesirable side-effects of mefloquine, e.g., its use during early pregnancy could lead to congenital defects.] Appropriate chemoprophylaxis and advice to travellers to areas lying south of the Sahara are therefore more and more necessary in order to arrest the increase in the number of imported falciparum malaria cases and reduce the number of serious cases, which are costly in terms of public health.     

Malaria in refugees from Tanzania--King County, Washington, 2007

Recent immigrants and refugees constitute a substantial proportion of malaria cases in the United States, accounting for nearly one in 10 imported malaria cases involving persons with known resident status in 2006. This report describes three cases of Plasmodium falciparum malaria and two cases of Plasmodium ovale malaria that occurred during June 27-October 15, 2007 in King County, Washington. The infections were diagnosed in Burundian refugees who had recently arrived in the United States from two refugee camps in Tanzania. Since 2005, CDC has recommended presumptive malaria treatment with artemisinin-based combination therapy (ACT) (e.g., artemether-lumefantrine) for refugees from sub-Saharan Africa before their departure for the United States (2). Rising levels of resistance to the previous mainstays of treatment, chloroquine and sulfadoxine-pyrimethamine, prompted CDC to make this recommendation. Implementation has been delayed in some countries, including Tanzania, where predeparture administration of presumptive ACT for refugees started in July 2007. The cases in this report highlight the need for health-care providers who care for recently arrived Burundian and other refugee populations to be vigilant for malaria, even among refugees previously treated for the disease.     

Malaria surveillance in Germany 2000/2001--results and experience with a new reporting system

In Germany, malaria is one of the most frequently imported infectious diseases. In January 2001, the newly implemented Infektionsschutzgesetz (Law for Protection Against Infectious Diseases) brought some important changes in surveillance case notification procedures. After one year, experience shows that the changes did not affect the continuity and representative nature of malaria reporting in Germany. In the years 2000 and 2001, 836 and 1,040 malaria cases, respectively, were reported. In both years, most of the patients were between 30 and 49 years old. 82 % of the infections had been acquired in Africa, and 11 % in Asia. The predominant parasite species was P. falciparum (70 %), followed by P. vivax (12 % in 2000, and 16 % in 2001, respectively). The majority of infections occurred among tourists, fewer in immigrants or business travellers. About two thirds of all patients had not taken any chemoprophylactics. Compared to previous years a decrease in the number of fatal cases was observed (1998: 21, 1999: 18, 2000: 8, 2001: 8). To ameliorate the situation of imported malaria intensified prevention activities are necessary, including efforts to improve choice and compliance of chemoprophylaxis and to facilitate timely diagnosis and treatment.     

2004-2013年广西玉林市疟疾的流行病学分析

摘要:目的　了解和掌握玉林市疟疾的流行特征。方法　采用Excel 2003对2004-2013年玉林市疟疾病例的流行病学特征进行描述性统计分析。结果　2004-2013年玉林市疟疾发病率为0.02/10万～0.33/10万,共报告疟疾病例70例,其中间日疟41例,恶性疟22例,疟疾（未分型）7例,病例分布于全市5县（市）2区,发病季节呈全年分布,男女性别比为16.5∶1,年龄在10～55岁间,职业主要为农民、民工,感染来源地主要为东南亚及非洲国家疟疾流行区。结论　输入性疟疾病例是玉林市疟疾的主要疫情特点,加强对东南亚及非洲国家务工返乡人员的疟疾监测是预防和控制疟疾危重和死亡病例增多的重要措施。     

国境口岸输入性恶性疟的现状与预防控制

目的了解近年来我国境外输入性恶性疟疫情,探讨现阶段恶性疟预防与控制措施。方法查阅了2006年以来所有详细报道我国国境口岸输入性恶性疟的文献,对有关感染地区、诊疗状况等相关资料进行分析。结果输入性恶性疟最主要的感染地为非洲和东南亚地区,其中非洲地区的尼日利亚、安哥拉、几内亚、赤道几内亚,东南亚的缅甸是我国输入性恶性疟来源最多的国家。恶性疟易引起误诊,感染者常因未得到及时有效的抗疟治疗而死亡。疟疾病人的实验室诊断率有待提高,采用疟原虫抗原快速检测法和PCR法等疟疾诊断新技术作为镜检的补充,有助于提高疟疾诊断水平。赴非洲等恶性疟高发区的归国劳务人员,恶性疟发病率高、复燃比例高,采用以青蒿素类药物为主的联合疗法可提高疗效和阻止疾病传播。结论我国国境口岸输入性恶性疟防治重点是加强境外输入性疟疾监测与管理,提升恶性疟的诊疗水平,提高出国人员疟疾的自我防护能力。     

2006—2013年菏泽市输入性恶性疟的临床特点与处置分析

目的探讨2006—2013年25例输入性恶性疟的流行特征及临床诊断和治疗效果。方法回顾性分析恶性疟病例的流行病学资料及临床资料。结果 25例恶性疟病例均有蚊虫叮咬史和有非洲地区居留史,临床症状主要为发热、畏寒、大汗、呕吐、贫血、血小板数减少、和肝肾功能异常等。在蒿甲醚联合伯氨喹治疗后,25例恶性疟均获痊愈,无输入性恶性疟传播。结论菏泽市输入性恶性疟以有非洲旅居史,青年、中年男性为主,近年来发病有所增加;恶性疟诊断主要依靠反复外周血涂片检测;蒿甲醚联合伯氨喹治疗方案治疗效果可靠。     

Hospital-based surveillance of malaria-related paediatric morbidity and mortality in Kinshasa, Zaire

Although Plasmodium falciparum malaria is a leading cause of paediatric morbidity and mortality in Africa, few quantitative estimates are available about the impact of malaria on childhood health. To quantify the impact of the disease in an urban African setting, we reviewed the paediatric ward and mortuary records at Mama Yemo Hospital in Kinshasa, Zaire. From June 1985 to May 1986, 6208 children were admitted to the hospital, 2374 (38.2%) of whom had malaria; 500 of those with malaria died (case fatality rate, 21.1%). During this same period, there were 10,036 paediatric deaths, 1323 (13.2%) of which were attributed to malaria; 823 (62.2%) of these occurred in the emergency ward prior to hospitalization. Minimum population-based malaria mortality rates were highest for children aged less than 1 year (4.0 per 1000 per year). Over 70% of children admitted with malaria and greater than 80% of children who died from the disease were less than 5 years old. The total number of paediatric admissions and deaths remained relatively constant between 1982 and 1986; however, the proportional malaria admission rate increased from 29.5% in 1983 to 56.4% in 1986, and the proportional malaria mortality rate, from 4.8% in 1982 to 15.3% in 1986. These increases were temporally related to the emergence of chloroquine-resistant Plasmodium falciparum malaria in Kinshasa. Malaria is therefore a major cause of paediatric morbidity and mortality in the city, and this study indicates that hospital-based surveillance may be useful in monitoring disease-specific morbidity and mortality elsewhere in Africa.     

Standardized data collection for multi-center clinical studies of severe malaria in African children: establishing the SMAC network

The Severe Malaria in African Children (SMAC) network was established to conduct mortality-based trials. Although falciparum malaria kills more than one million children each year, single centers cannot enroll enough patients to detect reductions of 20-30% in mortality rates. Our aim was to quantify and describe severe malaria across a variety of epidemiological settings so that we could design intervention studies with more precise sample size estimates. We used a standardized surveillance mechanism to capture clinical, laboratory and outcome data on all parasitemic children admitted to hospital. Between December 2000 and December 2003, 20333 patients were enrolled at five sites. The frequency of severe malaria syndromes (cerebral malaria, severe malarial anemia and acidosis) differed between sites, as did the syndrome-specific mortality rates. Intervention studies targeted at reducing mortality in one or a combination of severe malaria syndromes would require 3-4 years to complete within the existing network. These data provide more accurate estimates of the disease burden of children hospitalized for malaria in sub-Saharan Africa. Networks are required to recruit enough patients for mortality-based studies and to encompass the epidemiological diversity of malaria in sub-Saharan Africa. SMAC represents the first effort to develop this capacity.     

Direct health costs of occupationally acquired malaria in a military population in Europe

BACKGROUND: We reviewed imported malaria cases in British troops stationed in Germany, to quantify the occupational health burden of malaria and audit the quality of local care. METHODS: We used a capture-recapture technique to ascertain imported malaria infections acquired by our military population during a 2-year period of surveillance (2001 and 2002). We retrieved and analysed all hospital discharge summaries. We calculated direct treatment costs from bills raised by the admitting German hospitals. RESULTS: Out of 24 600 British troops stationed in Germany, approximately 800 were occupationally exposed to malaria during 2001 and 800 during 2002. The mean duration of exposure was 1.5 months. All the occupational exposures in this period occurred during routine training exercises in the tropics and subtropics, or during short-term peacekeeping missions in endemic areas. There were three imported malaria cases in British soldiers during 2001 and 12 during 2002 (crude acquisition rates 3.75 and 15/1000). Two soldiers (one with Plasmodium vivax, the other with Plasmodium falciparum infection) required intensive hospital therapy. The median length of hospital inpatient stay was 7 days (for P. vivax infection) and 8.5 days (for P. falciparum). The direct treatment costs of the hospitalizations totalled 27,760. CONCLUSIONS: Comparing crude acquisition rates, non-immune soldiers carrying out peacetime activities in endemic areas may be at around 2-10 times greater risk of acquiring malaria than civilian travellers to the tropics. All military branches are at some risk, and the Royal Engineers may be at an especially high risk of occupationally acquired malaria. Better prevention is mandatory.     

百色市一例境下输入性重症恶性疟流行病学调查

目的　对百色市报告的1例输入性重症恶性疟病例进行流行病学调查,为巩固消除疟疾成果并防止输入性病例出现死亡提供参考依据。方法　对患者的流行病学史、诊疗经过等资料进行收集、整理和分析。结果　该例患者有明确的外出非洲史,驻地为疟疾流行区,回国后发病,血检、PCR证实恶性疟原虫感染阳性。百色市2009年至2017年未发现本地感染疟疾病例,推断病例为境外感染本地发病,回国后多次就诊未能及时诊断是导致患者发展成为重症疟疾的主要原因。结论　百色市辖区内需加强临床医生对疟疾知识的培训以及境外返乡人员的监测力度,尽早发现输入性疟疾病例并及时治疗,以防止输入性继发病例以及重症甚至死亡病例的出现。     

Imported severe malaria in adults: a retrospective study of ten cases admitted to intensive care units in Casablanca

INTRODUCTION: We report a retrospective study in the medical intensive care unit of the Casablanca Ibn-Rochd University hospital. MATERIAL AND METHODS: All patients over 14 years of age with falciparum malaria, who were admitted to ICUs between 1996 and 2001, were included. The main epidemiological features, criteria of admission, treatment, and outcome were investigated. RESULTS: Ten patients were included for severe imported malaria. The mean age was 32+/-4 years. All patients had acquired falciparum malaria in sub-Saharan Africa. Chemoprophylaxis was inadequate in all patients. The mean time from symptom onset to treatment initiation was 9+/-2 days. Criteria of admission were impaired consciousness (7), acute renal failure (4), and respiratory distress (3). The most worrying factors were the severity of consciousness disorders, the acute respiratory distress syndrome, the metabolic acidosis, and the refractory shock. All patients presented with nosocomial respiratory infection related to Gram-negative bacilli, in the evolution. All patients received quinine therapy with loading dose and symptomatic treatment. Five patients died. CONCLUSION: The lethality of severe imported malaria is still high despite optimal management in ICUs. Improving chemoprophylaxis and an earlier diagnosis may reduce significantly the mortality rate.     

常州市2006～2010年输入性恶性疟调查分析

目的通过对常州市输入性恶性疟进行个案分析,研究该病的流行趋势。方法对常州市2006～2010年27例输入性恶性疟病例的个案资料进行回顾性调查和分类统计。结果 27例输入性恶性疟病例均为从非洲高疟区回国人员,无明显的发病季节,部分恶性疟病人因未及时就诊而出现重症表现。结论对来往于非洲等高疫区人员加强疟疾监测,从高疟区回归人员发热临床医生应提高首先考虑恶性疟的意识。     

2005-2017年北京市海淀区疟疾病例特征

  目的  了解北京市海淀区2005-2017年疟疾病例流行特征。  方法  利用北京市海淀区各级医疗机构的传染病上报系统，导出2005-2017年疟疾的流行病学资料，用描述性流行病学方法分析疟疾在时间、地区及人群的分布情况。  结果  北京市海淀区2005-2017年期间共报告疟疾发病111例，死亡病例1例，年平均发病率0.26/10万；在报告的恶性疟、间日疟、三日疟及未分型疟疾中，恶性疟最多（54.5%，60/111），无混合感染；发病高峰期集中在6-9月的夏秋季节（52.0%，58/111）；病例主要集中在20~59岁的青壮年（93.7%，104/111），且男性发病高于女性（χ2=52.9，P < 0.001）；发病以干部职员为主（33.3%，37/111）；海淀区26个街道和乡镇都有疟疾病例报道。国外输入性病例81例，占总病例的71.4%，其中74例（91.36%）感染来源于非洲。  结论  疟疾发病呈散发性，以输入性病例为主，应加强出入境对疟疾的监控，防止二代病例发生。     

The treatment of falciparum malaria in African children

More than 80% of all cases of malaria and malaria-related mortality worldwide occur in Africa, due mostly to infection with Plasmodium falciparum. Up to half of all mortality among African children aged 6 months to 5 years may be due to malaria. While prevention measures against malaria infection remain important, the prompt diagnosis and treatment of the disease remain key to reducing the high incidence of malaria-related mortality. It is possible that any patient with a febrile illness in a malaria-endemic area and parasites on the peripheral blood film has malaria. All patients who present with fever and parasites on peripheral blood film need to be carefully clinically assessed, with care given to exclude other causes of fever which could be mistaken for malaria. Both microscopy and the available dipstick tests to detect malaria have limited practical use in diagnosing malaria in febrile African children. First-line treatment, severe malaria, and the future are discussed. A cheap, effective, and safe alternative to chloroquine, Fansidar, and amodiaquine is needed to treat malaria in children in Africa. Multi-drug therapy may be necessary to reduce the emergence of drug-resistant organisms.     

成都地区输入性恶性疟疾临床分析

目的探讨成都地区输入性恶性疟疾的临床特点及其诊断与治疗。方法回顾性分析12例输入性恶性疟疾的临床资料。结果12例输入性恶性疟疾均有蚊虫叮咬史,但其中有1例未到过恶性疟疾高发区。临床表现复杂多样,可出现畏寒、发热、头疼、恶心或呕吐、腹痛、腹泻、黑便、腹水、黄疸、贫血、肾功能衰竭、肝功能损害、黑尿热等表现。使用"双疗程"抗疟治疗,治愈10例,死亡2例。结论恶性疟疾早期临床表现复杂,且合并症繁杂多样,易误诊。临床上遇有在疟区生活、工作、旅游过的人员,一但出现发热,应及时行血涂片或骨髓穿刺检查,以免延误诊治。使用"双疗程"抗疟治疗,可有效减少再燃。此外成都地区存在传播恶性疟疾的按蚊,出现输入性恶性疟疾继发病例甚而流行的危险性不容忽视。     

2006—2020年睢宁县疟疾病例流行病学特征分析

目的 分析2006—2020年睢宁县疟疾病例流行病学特征,为睢宁县制定疟疾防治措施提供科学依据。方法 通过中国疾病预防控制信息系统导出睢宁县2006—2020年疟疾病例的信息,采用回顾性的调查方法分析疟疾病例的时间分布、地区分布、人群分布情况。结果 2006—2020年睢宁县共报告疟疾病例230例,其中间日疟214例(93.04%)、恶性疟15例(6.52%)、三日疟1例(0.44%)。本地病例212例(92.17%),输入性病例18例(7.83%),输入病例主要来源于非洲(17例)和南亚(1例)。发病均为散在分布,除2011年和2017年外各年均有病例发现,以4 —10月为主,7— 9月为高峰期;人群感染以男性为主(男∶女=1.74∶1);年龄集中在30～40岁(44例)和60岁以上(46例)两个年龄段,占39.13%;职业以农民为主,有162例(70.43%);除古邳和刘圩外均有疟疾病例报告,官山镇、李集镇、朱集乡为睢宁县报告前三的乡(镇)。结论 2010年后无本地病例出现,本地疟疾病例得到有效控制,但是境外输入性疟疾病例时有发生,需加大监测和宣传力度,防止出现输入性病例引起的本地感染。     

Malaria imported by immigrants

The immigrants from endemic zones who live in Europe are those with the greatest risk of acquiring malaria during trips to their countries, since they usually travel for longer than other travellers and to zones and under conditions of greater risk. The figures for the years 2002-2004 in Spain indicate that P. falciparum is the most diagnosed species. Africa is the continent from which most cases are imported and immigrants contribute 34-41% of all cases.