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。     

盐城市疟疾流行态势及防控对策探讨

目的掌握盐城市疟疾发病特征和流行态势,为疟疾防治决策提供科学依据。方法采用回顾性调查方法,收集1993-2011年全市疟疾确诊病例流行病学资料,分析疟疾病例发病的流行病学特征和流行态势。结果1993-2011年盐城市9个县(市、区)疟疾发病总人数为134例,其中本地间日疟18例,输入性间日疟59例,输入性恶性疟56例,输入性三日疟1例,分别占总病例数的13.43%、44.03%、41.79%和0.75%。19年全市疟疾总发病率为0.03/10万～0.29/10万,本地疟疾发病率为0～0.06/10万,呈低度流行态势,2006年以后全市未发现本地感染疟疾病例。2007-2011年发现境外输入性恶性疟病例56例,并呈逐年上升趋势,同时发现境外输入性三日疟1例。病人发病至就诊时间的间隔中位数为1 d,当天就诊的占58.96%,村卫生室为主要首诊医院,占44.06%;病人发病至血检、确诊和治疗时间间隔中位数均为4 d。结论盐城市本地疟疾发病已趋于逐步消除态势,境外输入性恶性疟明显增加,加强输入病例监测和防控是当前工作的重点。     

2013年广西壮族自治区疟疾监测与控制效果

目的 目的 分析2013年广西壮族自治区疟疾监测和控制效果, 探讨适合本地区输入性疟疾的监测和管理方法, 为 输入性疟疾防控提供科学依据。 方法 方法 收集2013年广西壮族自治区疟疾疫情数据、 控制措施进行统计分析。 结果 结果 2013年广西壮族自治区共检出疟疾1 251例, 恶性疟、 间日疟、 三日疟、 卵形疟和混合感染病例分别占总病例的88.25% （1 104例）、 8.63% （108例）、 0.64% （8例）、 1.52% （19例） 和0.96% （12例）; 职业为农民工的病例数占93.21%（1 166例）; 来 自非洲的病例占96.56% （1 208例）, 以恶性疟为主; 来自东南亚的病例占3.44% （43例）, 以间日疟为主。输入性疟疾病例 数增加, 使广西2013年疟疾发病率 （2.37/10万） 较2012年 （0.42/10万） 增高了464%。 结论 结论 当前广西壮族自治区疟疾疫 情以非洲输入病例为主, 加强健康教育和专业人员疟疾防治技术培训, 早期发现、 治疗是控制输入性疟疾的重要措施。     

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。     

2010-2015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。     

2005-2015年广西壮族自治区河池市疟疾流行病学特征分析

目的 分析2005-2015年广西壮族自治区河池市疟疾流行特征,为进一步调整和制订该市消除疟疾措施提供科学依据。方法 收集2005-2015年河池市11个市、县、区疟疾疫情资料,采用Microsoft Excel 2003和SPSS 17.0软件对数据进行统计和分析。结果 2005-2015年河池市共报告疟疾病例160例,年均发病率为0.36/10万,其中本地感染病例占6.25%（10/160）,输入性疟疾病例占93.75%（150/160）。4种疟原虫均有发现,以间日疟为主,占51.87%（83/160）;恶性疟次之,占34.38%（55/160）;三日疟和卵形疟分别占5.00%（8/160）、1.25%（2/160）;未分型报告12例,占7.50%。11年间疟疾发病率先降后升,2009年后再无本地疟疾病例报告;2010年报告1例输入性恶性疟死亡病例;2013年和2015年各出现1例恶性疟重症病例;2014年出现1例胎传新生儿间日疟重症病例。全部病例分布于10个市、县、区,以青壮年男性为主,以挖矿职业为主;疟疾发病主要集中在4-8月份;感染自非洲和东南亚者占60.00%（96/160）,自国内其他省者占33.75%（54/160）。患者发病到确诊治疗时间中位数为5 d,不同年份疟疾病例的发病至诊断治疗时间差异有统计学意义（c2 = 33.40,P < 0.05）。结论 河池市疟疾疫情仍面临很多挑战,消除疟疾各项工作仍需加强;加强流动人口的疟疾监测管理是巩固疟疾防治成果的关键。     

宾阳县基本消灭疟疾后的监测结果与分析

宾阳县曾是间日疟与恶性疟混合流行区 ,2 0世纪 60年代居民血检疟原虫率为 4.61 % (862 / 1 8698) ,其中间日疟占 5 4.87% ,恶性疟占 44.2 0 % ,混合感染占 0 .93 %。经过 40余年的反复查治 ,于 90年代初期发热病人和居民血检疟原虫率已降至 0 .0 0 2 % (3 / 1 2 3 749) ,1 993年经自治区卫生厅组织考核达到卫生部颁布的《基本消灭疟疾标准》,现将基本消灭疟疾后的 1 994年至 2 0 0 1年疟疾监测结果分析如下。1　方法主要是县级卫生单位和乡 (镇 )卫生院以及村卫生所的防疫人员 ,通过主动和被动侦察 ,随时对当地居民临床初诊为疟疾、疑似疟…     

长兴县12年疟疾监测措施及效果

疟疾是长兴县的主要寄生虫病之一,1963年曾发生间日疟和恶性疟混合暴发流行,总发病率为14.50%,其中恶性疟病例占病例总数的7.56%,死亡率高达3.99/万.经过20多年的综合防治,发病率逐年大幅度下降,1982年降至2.43/万.自1983年起转入监测.现将1983—1994年疟疾监测的情况报告如下.监测方法     

2017年北京市输入性疟疾疫情分析

目的 对2017年北京市输入性疟疾疫情和流行特征进行分析,为制定疟疾防控措施提供参考依据。方法 收集2017年北京市疟疾病例个案调查信息,采用描述性流行病学方法进行统计分析。 结果 2017年北京市共报告疟疾病例90例,均为输入性病例,其中恶性疟74例（82.22%）、间日疟10例（11.11%）、卵形疟4例（4.45%）、三日疟2例（2.22%）;81例（90.00%）来自非洲地区,年龄在19～61岁的病例占全部病例的97.78%,44例（48.89%）有2次及以上的患病史。66例回国后发病的病例中,53例恶性疟病例在2周内发病（80.30%）。发病人群出境事由主要为务工（46.34%）和商务（41.46%）。81例在境外居住时使用了蚊帐,59例同时使用了蚊帐和蚊虫驱避剂。结论 输入性疟疾防控仍是北京市疟疾监测工作的重点,应持续保持高效的疟疾监测体系并提高境外务工人员的防疟意识。     

广西疟疾防治及消灭恶性疟的措施与效果评价

目的　研究广西疟疾流行特征及防治措施 ,控制疟疾流行和消灭恶性疟。　方法　以自然村庄划分疟区 ,分类防治 ;攻击期 ,采取以上年疟史率高低分类防治的“三根治、一预防和两喷洒”的综合性措施 ;灭疟后期 ,则采取以血检发热病人为主的“查源拔灶”措施 ,年血检率 10 %以上。　结果　全区疟疾发病率从 2 96.7 降至 0 .0 7 ,1997～ 2 0 0 1年 ,发热病人和疫点居民血检 62 410 11人 ,只查出间日疟 485例 ,没有发现恶性疟。　结论　所采取的防治措施行之有效 ,达到基本消灭疟疾和消灭恶性疟。     

Diagnostic criteria and risk factors for Plasmodium ovale malaria

Plasmodium ovale is a common malaria parasite in Africa, but the epidemiology of P. ovale malaria is poorly known. Exposure to malaria, parasitemia, and morbidity were monitored for 6 years among the residents of a village in Senegal. The relationship between the level of P. ovale parasitemia and fever risk were analyzed, and diagnostic criteria for clinical P. ovale malaria were established. Then the relationships between the occurrence of P. ovale clinical malaria and a series of entomological, epidemiological, and genetic factors were investigated. There was no increased risk of fever when the P. ovale parasite count was <800 parasites/microL of blood. Of 6621 episodes of illness, 114 (1.7%) were attributable to P. ovale. Although most clinical episodes occurred during early childhood, a low incidence of the disease persisted among adults. Sickle cell trait carriers had increased susceptibility to the disease.     

Early treatment of childhood fevers with pre-packaged antimalarial drugs in the home reduces severe malaria morbidity in Burkina Faso

In rural, malaria-endemic Burkina Faso, we evaluated the impact of the use of pre-packaged antimalarial drugs (PPAM), by mothers in the home, on the progression of disease in children from uncomplicated fever to severe malaria. In each village of one province, a core group of opinion leaders (mainly older mothers) was trained in the management of uncomplicated malaria, including the administration of PPAM. Full courses of antimalarial (chloroquine) and antipyretic (aspirin) drugs were packaged in age-specific bags and made widely available through community health workers who were supplied through the existing drug distribution system. Drugs were sold under a cost-recovery scheme. Local schoolteachers conducted surveys in a random sample of 32 villages at the end of the high transmission seasons in 1998 and 1999. Disease history and the treatment received were investigated for all children under the age of 6 years having suffered from a fever episode in the previous 4 weeks. 'Uncomplicated malaria' was defined as every episode of fever and 'severe malaria' as every episode of fever followed by convulsions or loss of consciousness. During the study period, 56%[95% confidence interval (CI) 50-62%] of 3202 fever episodes in children under 6 years of age were treated promptly by mothers with the pre-packaged drugs made available by the study. A total of 59% of children receiving PPAM were reported to have received the drugs over the prescribed 3-day period, while 52% received the correct age-specific dose. PPAM use was similar among literate (61%) and non-literate mothers (55%) (P = 0.08). The overall reported risk of developing severe malaria was 8%. This risk was lower in children treated with PPAM (5%) than in children not treated with PPAM (11%) (risk ratio = 0.47; 95% CI 0.37, 0.60; P < 0.0001). This estimate of the impact of PPAM was largely unchanged when account was taken of potential confounding by age, sex, maternal literacy status, year or village. Our findings support the view that, after appropriate training and with adequately packaged drugs made available, mothers can recognize and treat promptly and correctly malarial episodes in their children and, by doing so, reduce the incidence of severe disease.     

Malaria control and fever management in Henan Province, China, 1992

Henan Province, which once had the highest malaria prevalence in China, had only 318 reported cases in 1992. Our purpose was to investigate this late 'consolidation phase' of malaria control in Henan with reference to malaria surveillance. We conducted a questionnaire survey of village doctors in Shang Shi Qiao Township during the transmission period of 1992. Of the 732 recorded fever cases, 16 were probable malaria cases by clinical and treatment response criteria, but only one received a full course of antimalarials. Of the 732 patients, 61% had fever every day, 37% went for treatment the first day, 52% waited 2–3 days and 10% waited longer. One hundred and twenty‐eight patients took self‐medication before seeing the doctor. Blood examination was carried out in 526 (71%) fever cases but only four were positive, all for Plasmodium vivax . Our findings highlight problems relating to patient behaviour and motivation of village doctors, malaria treatment, surveillance and microscopy, rural migration, economic development and malaria transmission. All need to be considered for reforming the malaria control strategy in Henan Province.     

Malaria morbidity,treatment-seeking behaviour,and mortality in a cohort of young children in rural Burkina Faso

OBJECTIVE: To describe the pattern of fever-associated morbidity, treatment-seeking behaviour for fever episodes, and cause-specific mortality in young children of a malaria-holoendemic area in rural Burkina Faso. METHODS: In a longitudinal community-based intervention study, 709 representative children aged 6-31 months were followed daily over 6 months (including the main malaria transmission period) through village-based field staff. RESULTS: Of 1848 disease episodes, 1640 (89%) were fever episodes, and of those, 894 (55%) were attributed to malaria (fever + > or =5000 parasites/microl). Eighty-five percent of fever episodes were treated, mainly with chloroquine and paracetamol, 69% of treatments took place in households, 16% in local health centres, 13% in villages, and 1% in hospitals. Treatment-seeking in a health centre or hospital was associated with accessibility and disease severity. Cerebral malaria and malnutrition-associated diarrhoea were the most frequently diagnosed causes of death. While most children with a post-mortem diagnosis of diarrhoea had not received any treatment, children who died of malaria had often received insufficient treatment. In particular, there was a lack of an appropriate second-line treatment at formal health services after chloroquine treatment had failed to resolve symptoms. CONCLUSIONS: These findings call for more effective prevention and treatment of malaria, malnutrition and diarrhoea in rural African communities, as well as for better supervision of existing malaria treatment guidelines in formal health services.     

Plasmodium falciparum clinical malaria in Dielmo, a holoendemic area in Senegal: no influence of acquired immunity on initial symptomatology and severity of malaria attacks.

Six hundred eighty-nine Plasmodium falciparum malaria attacks were observed during a three-year period among 226 inhabitants of the village of Dielmo, Senegal, an area of high malaria transmission. Malaria attacks were defined as clinical episodes with fever (body temperature > or = 38.0 degrees C) or reporting of fever or headache or vomiting, associated with a parasite:leukocyte ratio above an age-dependent pyrogenic threshold identified in this population. The symptom frequencies were tested against age, gender, and parasite density using a random-effect logistic regression model and the study of distinguishable clinical presentations was carried out by multi-correspondence analysis. There was little difference between the severity of symptoms during the initial course of attacks in young children and adults, and this severity was not correlated with the duration of the pathologic episode. It was not possible to distinguish objectively different malaria attack types according to the severity of clinical manifestations. In contrast, the duration of fever, symptoms, and parasite clearance were significantly longer among the youngest children than among the oldest children and adults. These findings suggest that of the two components of protective immunity, anti-parasite immunity and anti-toxic immunity, only the first would play a major role as age increases. They suggest also that the initial clinical presentation of malaria attacks is not predictive of the level of protective immunity.     

Etiology and outcome of fever after a stay in the tropics

BACKGROUND: Information on epidemiology and prognosis of imported fever is scarce and almost exclusively limited to hospital settings. METHODS: From 2000 to 2005, all travelers presenting at our referral outpatient and inpatient centers with ongoing fever within 12 months after a stay in the tropics were prospectively followed. Case definitions and treatment were based on international recommendations. Outcome was assessed by at least 1 follow-up consultation or telephone call within 3 months after initial contact. RESULTS: A total of 1842 fever episodes were included, involving 1743 patients. Regions of exposure were mainly sub-Saharan Africa (68%) and the Southeast Asia-Pacific region (12%). Tropical diseases accounted for 39% of all cases and cosmopolitan infections for 34%. Diagnosis often remained unknown (24%). The pattern of tropical diseases was mainly influenced by the travel destination, with malaria (35%, mainly Plasmodium falciparum) and rickettsial infection (4%) as the leading diagnoses after a stay in Africa; dengue (12%), malaria (9%), and enteric fever (4%) after travel to Asia; and dengue (8%) and malaria (4%) on return from Latin America. Disease pattern varied also according to the category of travelers, the delay between exposure and fever onset, and the setting. Hospitalization was required for 503 fever episodes (27%). Plasmodium falciparum malaria accounted for 36% of all admissions and was the only tropical cause of death (5 of 9 patients). Fever of unknown cause had invariably a favorable outcome. CONCLUSION: The clinical spectrum of imported fever is highly destination specific but also depends on other factors. Plasmodium falciparum malaria was the leading cause of mortality in the study population.     

Monthly antimalarial chemotherapy to children in a holoendemic area of Liberia

Two hundred and eighty-two children, two to nine years old, were included in a prospective three-year study in four villages with holoendemic malaria. In three villages the children received monthly doses of either chloroquine, pyrimethamine or chlorproguanil respectively for two years. In the fourth, vitamin tablets were used as placebo. Presumptive treatment with chloroquine (10 mg base kg-1) was given to all children with fever of suspected malarial origin. The two-year drug distribution was satisfactorily fulfilled to 168 children. Surveys, including physical and laboratory examinations were performed every six months, four weeks after medication. A fifth village was only visited at the start of the study and after two years. The mean crude parasite rate was initially 92%. Plasmodium falciparum was the main species. Splenomegaly was recorded in all children. In the chloroquine-treated children, the parasite rates varied between 30% and 50% during the study. By the end of the second year the spleen rate was reduced from 100% to 50%. Reported episodes of fever were reduced to half and mean haematocrit levels increased by 6% in comparison with children receiving the placebo. Total IgG concentrations were reduced from 36.7 g l-1 to 25.9 g l-1, whereas no significant decrease was observed in malarial seropositivity as measured by indirect immunofluorescence. Chlorproguanil had a weaker impact on parasitaemia with parasite rates between 50% and 90%. However, the spleen rate was reduced to 67% and there was a significant reduction of reported fever episodes. Mean haematocrits increased by 4%. Total IgG decreased from 31.8 g l-1 to 23.8 g l-1. In contrast, in the pyrimethamine group, the placebo group and the untreated group from the fifth village, the malariometric indices after two years were comparable to each other and to the initial values. During the third year only presumptive chloroquine treatment was given, and by the end of the study all malariometric indices were again comparable. From clinical observations there was no apparent impairment of protective immunity to malaria from the two years of regular distribution of the drugs. We conclude that a certain degree of malaria control could be achieved in Liberian children by the administration of monthly doses of chloroquine 10 mg base kg-1. The administration of chlorproguanil (1.5 mg kg-1) represents an alternative regimen.     

Incidence of malaria and efficacy of oral quinine in patients recently infected with human immunodeficiency virus in Kinshasa, Zaire

There is concern that the impaired cell mediated immunity caused by the human immunodeficiency virus may increase the risk of severity of Plasmodium falciparum infection and could lead eventually to a decreased response to standard antimalarial treatment. In 1986, at Mama Yemo Hospital, Kinshasa, Zaire, the incidence of malaria was determined in a cohort of 59 patients who had recently acquired HIV-I infection through blood transfusion and in a cohort of 83 HIV-I seronegative controls who were recipients of HIV-I seronegative blood. All cohort patients were asked to visit the study physician whenever they developed fever. On each of these occasions thick film was examined for the presence of malarial parasites. HIV-I seropositive patients presented more often with episodes of fever per person month observation than HIV-I seronegative patients (P = 0.003). The total number of positive thick films per person months observation was significantly higher among HIV-I seropositive patients than among the HIV-I seronegative ones, but percentages of positive thick films per episode of fever were the same in both groups (46%). During a 5 month period, cohort patients presenting with a moderate attack of malaria were treated with oral quinine 20 mg/kg daily in two doses for 5 days. Twenty-three (92%) of 25 HIV-I seropositive patients and 28 (82%) of 34 HIV-I seronegative patients had a negative film 7 days after starting treatment. This study suggests that there seems to be no direct interaction of major clinical importance between HIV infection and malaria.     

Case definitions of clinical malaria under different transmission conditions in Kilifi District, Kenya

BACKGROUND: Clear case definitions of malaria are an essential means of evaluating the effectiveness of present and proposed interventions in malaria. The clinical signs of malaria are nonspecific, and parasitemia accompanied by a fever may not be sufficient to define an episode of clinical malaria in endemic areas. We defined and quantified cases of malaria in people of different age groups from 2 areas with different rates of transmission of malaria. METHODS: A total of 1602 people were followed up weekly for 2 years, and all the cases of fever accompanied by parasitemia were identified. Logistic regression methods were used to derive case definitions of malaria. RESULTS: Two case definitions of malaria were derived: 1 for children 1-14 years old and 1 for infants (<1 year old) and older children and adults (> or =15 years old). We also found a higher number of episodes of clinical malaria per person per year in people from an area of low transmission of malaria, compared with the number of episodes in those from an area of higher transmission (0.84 vs. 0.55 episodes/person/year; incidence rate ratio, 0.66 [95% confidence interval, 0.61-0.72]; P<.001). CONCLUSIONS: Case definitions of malaria are bound to be altered by factors that affect immunity, such as age and transmission. Case definitions may, however, be affected by other immunity-altering factors, such as HIV and vaccination status, and this needs to be borne in mind during vaccine trials.