河南省疟疾防治研究回顾

本文从病原学、流行病学、诊断学、传播媒介和现场控制等方面回顾了河南省疟疾防治研究所取得的成果，并根据疟疾流行的现状，提出了将来的研究方向。     

河南省嗜人按蚊分布、重要生态习性与传疟作用的调查研究

目的全面了解河南省嗜人按蚊的分布范围、分布特点、生态习性及其传疟作用。方法选择调查点，采用不同捕蚊方法捕获按蚊，以形态学或分子方法鉴定嗜人按蚊，调查其分布；通过采用现场和实验室观察，研究其生态习性及传疟作用。结果与结论嗜人按蚊分布于河南省北纬34^＋以南的11个县、区；分布区普遍种植水稻或其他水生植物；6月中、下旬及8月下旬～9月上旬有两个密度高峰；主吸人血，家栖，传疟能量高，是河南省的主要传疟媒介。     

第五轮河南省全球基金疟疾项目实施效果评价

目的评价河南省全球基金疟疾项目的实施效果,为制定河南省疟疾防治规划和措施提供科学依据。方法收集整理2006～2010年项目县疟疾防治工作资料,评价防治措施及效果。结果 2006～2010年,15个项目县共报告疟疾病例13 329例,平均年发病率2.05/万;项目实施后,居民带虫率由实施前的0.47%降至0.11%;疟疾病人在24h内得到正规治疗的比例由14.40%上升至44.14%;疟疾病例在1周内从村报告到乡镇的比例由27.12%上升至68.87%。结论在第五轮全球基金疟疾项目的支持下,河南省项目县的疟疾疫情得到有效控制,为全省疟疾防治提供了经验。     

2005年云南省疟疾流行与防治监测报告

目的了解目前云南省疟疾流行和防治情况。方法采用全国疟疾监测方案在云南省选择5个点,开展疟疾监测。结果瑞丽等5个疟疾高发县市的年疟疾发病率为34.94,用抗疟药使用量推算的疟疾发病率为314.46,疫情漏报率为88.99%。中华按蚊叮人率为3.20只/人.夜,微小按蚊叮人率为2.00只/人.夜。当地村民蚊帐使用率57.28%。实验室诊断疟疾占总病例数的53.43%,乡村医生诊治的疟疾病例占总例数的61.70%,当地疟疾病人17.61%为境外感染,26.57%为复发病例。结论云南疟疾流行态势依然严峻,境外输入疟疾对边境地区的防治工作造成一定的困难。村医生担负着61.70%的疟疾病人诊断和治疗任务,但各级CDC提供疟疾防治方面的培训和治疗药物的供给等主要还是在乡镇级以上医疗机构。为了更好地防控疟疾,应该选择适合云南流行特点的防治措施,将防治的重点进一步放到村级及流动人员出入境频繁的边境地区。     

广西消除疟疾地区疟疾监测结果分析

目的分析广西壮族自治区消除疟疾地区疟疾监测结果。方法对广西消除疟疾的31市县1999~2008年疟疾监测资料进行分析。结果1999~2008年31市县疟疾年发病率0.007~0.054,共报告疟疾病例525例,均为输入性病例;522例病原学确诊病例中,间日疟480例,恶性疟41例,混合感染1例;常住人口发热病人血检277 344人次,居民带虫调查31 906人,均未查见本地感染者;流动人口发热病人血检153 018人次,阳性516例,阳性率0.34%。525例病人中84.20%的病例为本地居民外地感染。结论广西自治区消除疟疾地区输入性疟疾严重影响疟防成果的巩固;加强流动人口的疟疾监测与控制是巩固疟防成果的关键。     

江苏省疟疾传播媒介控制策略与研究

疟疾曾是江苏省流行的重大传染病之一,中华按蚊和嗜人按蚊是江苏省疟疾传播的主要媒介。经过几十年的积极防治,江苏省于2019年实现了消除疟疾目标,而媒介控制策略在全省消除疟疾过程中发挥了重要作用。本文回顾了江苏省主要疟疾传播媒介中华按蚊和嗜人按蚊的历史分布和生态习性以及不同防治阶段媒介控制策略和措施,并就媒介种类鉴定、品系构建、对疟原虫易感性、对杀虫剂抗性等媒介生物学及其防控研究概况进行了阐述。     

Malaria control by residual insecticide spraying in Chingola and Chililabombwe,Copperbelt Province,Zambia

Malaria is endemic in the whole of Zambia and is the leading cause of morbidity and mortality. Prior to 1980, effective malaria control was achieved in the northern mining towns of Chingola and Chililabombwe by means of annual residual spraying programmes. In the 1970s, incidence rates were as low as 20/1000 p.a., but by 2000 had increased to 68/1000 p.a. in Chingola and to 158/1000 p.a.in Chililabombwe. Konkola Copper Mines (KCM) initiated a malaria control programme in which all dwellings in the two towns and within a 10-km radius were sprayed with either dichlorodiphenyltrichloroethane or a synthetic pyrethroid (Icon by ZENECA or Deltamethrin by Aventis). Houses were sprayed in November and December 2000, at the start of the peak transmission period. There was a statistically significant reduction in malaria incidence recorded at KCM health facilities in the two towns, representing a protective incidence rate ratio of 0.65 (95% CI 0.44, 0.97) when comparing the post-spraying period with the corresponding period of the previous 2 years. This reduction followed a single round of house spraying during a year with higher rainfall than the preceding two and in an area where chloroquine was first-line treatment. This house-spraying programme is an example of private/public sector collaboration in malaria control.     

New irrigation methods sustain malaria control in Sichuan Province, China

Malaria appears to have been all but eradicated from certain areas of Sichuan Province mainly as a consequence of draining a sufficient proportion of rice paddy fields. The two main malaria vectors, both members of the Anopheles hyrcanus group, breed prolifically in rice paddy fields, which farmers have traditionally kept flooded all year round to ensure an adequate water supply. Over the last three decades, the irrigation network has been gradually extended, thus ensuring water security and increasing the area of arable land that could be farmed by intermittent wet/dry irrigation (IWDI). In addition, rice fields that had been left flooded but fallow throughout the winter are now under an annual cycle of wet crop/dry crop rotation (WDCR) to maximise productivity. Accordingly, vector breeding has been greatly reduced. It would appear that vector populations have now fallen below the level required to sustain malaria transmission.     

Malaria control reinvented: health sector reform and strategy development in Colombia

The consequences of health sector reforms on control of malaria were analysed using Colombia as an example. One of the most complex health sector reform programmes in Latin America took place in the 1990s; it included transferring the vertical vector-borne disease control (VBDC) programme into health systems at state and district levels. A series of studies was undertaken in 1998-2000 at the national level (Ministry of Health Study), at the state level (Departamento Study) and at the health district level (District Study) using formal and informal interviews among control staff and document analysis as data collection tools. A government-financed national training programme for VBDC staff - which included direct observation of control operations - was also used to analyse health workers' performance in the postreform period (longitudinal study). The results showed that some shortcomings of the old vertical system, such as the negative aspects of trade union activity, have not been overcome while some positive aspects of the old system, such as capacity building, operational planning and supervision have been lost. This has contributed to a decrease in control activity which, in turn, has been associated with more malaria cases. Malaria control had to be reinvented at a much larger scale than anticipated by the reformers caused by a whole series of problems: complex financing of public health interventions in the new system, massive staff reductions, the difficulty of gaining access to district and state budgets, redefining entire organizations and - in addition to the reforms - introducing alternative strategies based on insecticide-treated materials and the growth of areas of general insecurity in many parts of Colombia itself. However, positive signs in the transformed system include: the strengthening of central control staff (albeit insufficient in numbers) when transferred from the Ministry of Health to the National Institute of Health, the opportunities offered by the Basic Health Plan (PAB) for new planning initiatives and intersectoral co-operation and the integration of malaria diagnosis and treatment into the general health services (associated with a decrease of malaria mortality). The potentials of the new system have not yet been fully exploited: capacity building, communication and management skills need to be improved and it require guidance from the national level.     

云南省孟连县溪络渡电站移民疟疾流行情况调查

目的 了解移民和移民区的疟疾流行情况，为防治提供依据。方法 调查移民和当地居民的疟疾发病情况、居住房屋及防蚊情况、小学生和当地居民疟疾带虫情况，收集全县疟疾疫情和移民点周围发热患者血检资料，媒介情况和防治措施。结果 近6年全县的疟疾发病率波动在15．25／万～31．19／万之间，2002～2003年42．48％的疟疾病例为境外感染，2004年勐马地区恶性疟占17．39％，小学生和当地村民的带虫率为O；移民的住房和防蚊条件好于村民，移民疟史率为0，当地居民为21．28％；查获微小按蚊等9种按蚊，微小按蚊占总数的3．350／0。结论 移民具有良好的居住及生活环境，免受疟疾感染。鉴于当地是疟疾高发区，又受境外疟疾高度流行的影响，要继续做好移民的疟疾防范工作。     

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。     

Malaria control using indoor residual spraying and larvivorous fish: a case study in Betul, central India

OBJECTIVES: To assess the impact of intensified malaria control interventions in an ethnic minority community in Betul using existing tools. METHODS: Two rounds of indoor residual spraying with synthetic pyrethroid insecticide were applied and larvivorous fish introduced, followed by intensive surveillance for early detection of Plasmodium falciparum with rapid diagnostic tests and prompt treatment with sulphadoxine pyrimethamine. RESULTS: Pre-intervention surveys revealed a very high fever rate in the community in all age groups with a slide positivity rate of >50% with >90%P. falciparum. The post-intervention phase showed a sharp steady decline in number of malaria cases (beta 0.972; P < 0.0001, 95% CI 0.35-0.47). Monitoring of entomological results revealed a significant decline in both Anopheles species and An. culicifacies (P < 0.0001). CONCLUSION: A combination of indoor residual spraying and early detection and prompt treatment complemented by rapid diagnostic tests and larvivorous fishes successfully brought malaria under control. These approaches could be applied in other regions of different endemicity to control malaria in India.     

Malaria preventive measures, health care seeking behaviour and malaria burden in different epidemiological settings in Sudan

Objectives  To provide information about preventive measures and treatment seeking behaviour as well as an estimate of the malaria burden in different epidemiological settings for effective monitoring and evaluation of the ongoing efforts.
Methods  Cross-sectional survey carried out in four areas representing different levels of transmission to explore the use of preventive measures, care-seeking behaviour and accessibility in addition to point prevalence was followed by a follow-up phase in which the health workers registered and reported all fever cases including malaria. The relation between the reported malaria incidence, the product of symptomatic/asymptomatic ratio and the prevalence of confirmed malaria cases was used to develop the equation that could predict the true malaria incidence.
Results  Thousand households and 3628 individuals were surveyed. The presence of any net varied between 6.6% and 40%; the percentage of people who reportedly slept under mosquito nets in the previous night varied between 35 and 80. Prompt use of medications ranged between 14 and 48% with a delay of more than 24 h noticed in different areas. The mean number of individuals per household who reported use of anti-malarial drugs in the last 2 weeks ranged between 0.6 (SD = 0.92) and 1.2 (SD = 1.1), with variable cost per treatment and affordability. The prevalence of asymptomatic parasitaemia, fever and confirmed malaria at time of the survey differed by area. The incidence of malaria during the follow-up period was estimated to be 8.5, 178.6, 23.7 and 10.3 episodes per 1000 population in Malakal, Elrank, Elhosh and El Matama, respectively. Based on this, a prediction equation was developed.
Conclusion  We found suboptimal health care seeking behaviour, coverage and use of preventive measures with a high malaria burden. We developed a model for future estimation of malaria episodes.     

云南省疟疾流行情况及药物治疗、抗药性研究现状

本文综述了近10年来云南省疟疾流行情况,介绍了疟疾的药物治疗及抗药性的研究进展。     

河南省人间狂犬病流行特征与防控策略探讨

目的 总结和分析河南省人间狂犬病流行特征,探讨防控策略。方法 收集并整理河南省1951-2015年人间狂犬病疫情相关资料,对2007-2015年病例进行流行病学调查,用SPSS17.0建立数据库并进行统计分析。结果 河南省人间狂犬病上世纪80年代曾严重流行、90年代得到有效控制。本世纪初以来疫情上升明显,近10年又有下降趋势。病例以农村地区居民为主,男多于女,多为35-65岁组及15岁以下组人群。7-9月份是发病高峰期。豫东和豫南是人间狂犬病病例较为集中区域。病例平均潜伏期为60 d,平均病程为3 d。病例暴露后约45.9%未作任何伤口处理,76.5%未曾接种疫苗,伤口肉眼可见出血的占93.6%,抗狂犬病免疫球蛋白注射率仅为0.64%。传染源98.7%是犬只,其中非栓养犬占82.1%以上。犬只狂犬病毒感染率为0.63%~6.00%。农村地区犬只免疫率为0.64%,人犬比值平均为6.50。结论 河南省是狂犬病流行地区,应开展以农村地区为重点的综合防控。     

2011-2017年福建省输入性疟疾流行态势及防控策略

目的 分析福建省2011-2017年输入性疟疾流行特征,为福建省顺利实现消除疟疾提供科学依据。方法 收集2011-2017年福建省输入性疟疾流行病学调查资料,运用SPSS 18.0软件对输入性疟疾的虫种、输入来源以及三间分布进行统计分析;对输入性疟疾首诊确诊的影响因素进行多因素logistic回归分析。结果 2011-2017年福建省共报告输入性疟疾病例632例,以恶性疟为主,占总病例数的67.6%(427/632)。输入来源地主要为非洲,占总比例数的85.1%(533/632);病例主要分布在福州,占总病例数的50.6%(320/632),其余地区散在分布。发病时间无明显季节性,全年均有输入性病例报告;发病人群多为青壮年,约占总病例的85.1%(533/632),男女性别比例为9.2:1(570/62)。从发病到确诊的时间大多在10 d以内,占总病例数的82.9%(524/632);首诊确诊455例,约占总比例的72%.首诊确诊的影响因素中,患者就诊前服用抗疟药物与首诊确诊率呈负相关[OR=0.175,95%CI(0.061~0.509)], 就诊前告知去过疟区[OR=132.964,95%CI(41.601~424.973)]及首诊机构为县级以上医疗机构[OR=27.951,95%CI(13.285~58.806)]这两个因素与首诊确诊率呈正相关;就诊前是否患过疟疾对首诊确诊率无影响(OR=1.496,95%CI(0.735~3.044))结论为适应我省目前的疟疾流行态势,制定了相应的防控策略:做好传染源的管理和控制,加强外出务工人员的疟疾防治知识健康教育,提高基层首诊医生对疟区回国人员的疟疾诊断意识,做到早发现、早诊断、早治疗。最大限度降低继发性传播风险,确保我省消除疟疾目标的顺利实现。     

山东省控制华支睾吸虫病的研究

目的调查华支睾吸虫病流行范围,流行规律和危害程度,探索华支睾吸虫病的诊断与防治方法,采取有效的防治技术措施,降低人群感染率及其危害,达到阻断传播控制流行。方法使用回顾性研究方法,对全省40年来有关华支睾吸虫病的调查、研究、防治资料等进行统计分析研究。结果山东省1962年发现华支睾吸虫病,全省132个县（市、区）中的107个有不同程度的流行,人群感染率为1.51%,村感染率为1%～30%,个别学校高达40%以上,85.7%的感染者为15岁以下少年儿童。经过几十年的综合防治,至上世纪90年代人群感染率降至0.3%,91.6%的流行村感染率降至1%以下,以县为单位统计40%的原流行县未检出感染者,2002年重点县区人群感染率降至0.04%。结论山东省已成功控制华支睾吸虫病流行。传染源查治与健康教育相结合是主要的控制措施。     

安徽淮南中华按蚊溴氰菊酯抗药性和P450单加氧酶活性随蚊龄变化的研究

目的 目的 研究蚊龄对安徽淮南中华按蚊溴氰菊酯抗性和P450单加氧酶活性的影响以及其抗性产生的分子机制。方法 方法 在安徽省淮南市现场采集中华按蚊幼虫, 饲养羽化, 分别在雌蚊羽化后1、 3、 6、 9、 12、 15 d和20 d时, 测定其抗药性和P450单加氧酶活性, 并以实验室敏感蚊作为对照组, 比较二者抗药性和P450单加氧酶活性。结果 结果 随蚊龄增长, 安徽中华按蚊溴氰菊酯抗性和P450单加氧酶活性曲线均呈不对称倒U形变化。1 d龄时, 抗性和P450单加氧酶活性较低; 其后迅速增加, 至3～9 d时达到顶峰, 进入平台期; 随后, 抗性和P450单加氧酶活性均逐渐降低。3～12 d龄蚊虫P450单加氧酶活性高于敏感蚊, 15 d与20 d龄蚊虫与敏感蚊类似, 1 d龄蚊虫则低于敏感蚊。 结论 结论 蚊龄是蚊虫抗性和酶活性检测的混杂因素。P450单加氧酶活性增强可能是当地中华按蚊溴氰菊酯抗性产生的原因之一。采用蚊龄不一致的现场蚊作为测试对象可能会低估其抗性水平, 误导杀虫剂的使用。     

江苏省境外输入性疟疾疫情分析及防控策略探讨

目的 分析江苏省境外输入性疟疾的流行病学特征并探讨其防控策略,为进一步提高输入性疟疾诊治和管理水平提供科学依据。方法 收集2011年7月18日至2012年6月30日江苏省境外输入性疟疾病例信息及个案流行病学资料,对境外输入性疟疾的虫种、来源、人群分布、地区分布、发病及诊治情况、出国途径及同行回国人员情况等进行描述性分析。结果 2011年7月18日至2012年6月30日江苏省共报告境外输入性疟疾病例233例,其中226例（97.0%）来自非洲国家,208例（89.3%）为恶性疟,224例（96.1%）为实验室确诊病例。发病人群主要为青壮年男性农民工和技术工人,发病时间无明显季节变化,145例（62.2%）病例在回国后20 d内发病。从发病到就诊时间的中位数为2 d,从就诊到确诊时间的中位数为1 d。首诊单位相对分散,确诊单位主要为县级以上医疗和疾控机构（220例,占94.4%）,病例确诊后规范治疗率为100%。205例（88.0%）患者系经公司劳务派遣出国务工人员,142例（60.9%）患者有同行回国人员。结论 江苏省境外输入性疟疾疫情严峻,需进一步强化业务培训和多部门合作,针对高危人群建立协查机制,采取有力防控措施降低境外输入性疟疾的危害。