融水县疟疾防治措施与效果

融水苗族自治县位于广西北部 ,属微小按蚊为主要媒介的疟疾流行区。 1993～ 1998年采取综合性防治措施 ,取得较好的效果。1　防治措施1.1　传染源　及时血检 ,发现疟疾病人及时根治 ,净化病灶点。发热病人每年血检率达 10 %以上。1.2　媒介按蚊　每年 7月疟疾流行高峰前期对高发村 (屯 )采用 DDT或溴氰菊酯室内滞留喷洒灭蚊。1.3　假定性治疗　临床疑似疟疾的病人 ,采血镜检时 ,给予氯喹加伯氨喹作假定性治疗。共治疗 385 8人次。期间 1993～ 1994年在低潮期和高峰期对高发村 (屯 )进行大规模全民预防服药和室内喷洒灭蚊 ;1995～ 1998年加…     

感染一年后发病的一个间日疟病例

本文描述了一例外来疟疾。该病例是从也门回国的意大利人,患良性间日疟。回国后由于每周给以氯喹300毫克加伯喹45毫克的抑制性化学预防而导致长达一年的潜伏期。病人曾两次发热,第2次发热是在症状体征完全减退之后,转入了无症状的经过6     

萘酚喹对云南间日疟和抗药性恶性疟的预防效果

目的　评价萘酚喹对云南间日疟和抗药性恶性疟的预防效果 ,指导高危人群预防服药。　方法　在中缅、中老边境地区的云南省勐腊县和景洪市选择发病率 >5 %的村庄 ,随机分为萘酚喹 (A、B)组和空白对照 (C)组。A组成人每月顿服萘酚喹 4片 (4 0 0 mg) ,连服 2月。B组成人顿服萘酚喹 4片 ,观察 1个月。　结果　A组带虫率从服药前的 7.4 0 %(33/ 4 46 )下降到用药后的 0 .6 8% (3/ 4 43) ,下降 90 .81% ;B组带虫率从服药前的 5 .5 0 % (11/ 2 0 0 )下降到用药后的2 .6 9% (5 / 186 ) ,下降 5 1.0 9% ;C组带虫率较观察前上升 6 7.99%。　结论　萘酚喹对云南间日疟和抗药性恶性疟有良好的预防效果 ;在发病率较高地区 A组预防效果优于 B组。     

印度安德拉邦控制恶性疟规划中全民服药的效果观察

印度安德拉邦北部和东北部的山林部族地带属疟疾高发区。1980年,安德拉邦卫生当局制定了一个应急规划,让分属5个不同地区的8个基层卫生中心所辖的51 325人全民服药,以期大幅度降低人群患病率。本文总结了这次实验的结果。在间日疟流行区及恶性疟流行区,分别给予成人氯喹单剂量600mg(基质)或氯喹600mg(基质)加伯喹45mg(基质),按以下方法进行: 1.在81年发病最低时服第一轮药(多在2月份,最晚4月份),随后开始雨季前的喷洒灭蚊。2.根据传播潜势在2或3个月后再服     

1例热带型间日疟治疗分析

患者 ,男 ,1 9岁 ,四川省凉山州德昌县人。1 997年 5月由缅甸打工返回。6月初出现头痛、畏寒、隔日发热等疟疾症状 ,当地诊断为间日疟 ,给予氯喹 1 2 0 0 mg3d分服 ,伯喹 1 80 mg8d治疗 ,症状一度减轻。 2月后 ,再次出现疟疾症状 ,遂以氯喹 1 5 0 0 mg 3d分服 ,伯喹 90 mg4 d治疗 ,症状再次得到缓解。 1个月后即 9月底又发病 ,并到本所门诊进行诊治 ,血检确诊为间日疟 ,镜下可见各期原虫 ,易见双虫感染 ,红细胞受染率达 30 /万。鉴于病人感染程度较重 ,且前两次常规治疗效果不甚理想 ,病人也自感服药后末见任何药物反应 ,病人体重 90 kg,于…     

1299例间日疟患者间接荧光抗体消长的观察

为进一步掌握不同情况下疟疾病人的抗体消长过程,以便为IFA现场调查结果的分析提供依据,我们于1980年6月至1981年3月,在思南县一个已开展综合性抗疟措施的间日疟暴发流行区,对1299例间日疟病人,进行了血清学与寄生虫学追踪观察。 调查方法 1980年6～10月经血检确诊为间日疟现症病例列入观察对象,经氯喹(3d总量1.5g基质)加伯喹(5d总量150mg基质)双疗程(间隔1个月)系统治疗。发病后3个月内每月追踪1次,以后每2～3个月1次,每次取厚血片及滤纸血滴标本各1     

氯喹和伯氨喹治疗缅甸拉咱地区间日疟的效果评价

目的了解氯喹加伯氨喹治疗缅甸拉咱地区间日疟的效果。方法按随机数字表将入选的病人随机分成两组(A组和B组)。A组采用氯、伯氨喹8 d疗法治疗,即成人给予氯喹口服总剂量1 200 mg和伯氨喹口服总剂量180mg;B组采用氯、伯氨喹14 d疗法治疗,即成人给予氯喹口服总剂量1 500 mg或25 mg(基质)/kg体重、伯氨喹口服总剂量210 mg[或0.25 mg(基质)/kg体重]。观察D0(服药后第1 d,之后类推)、D1、D2、D3、D7、D14、D21、D28,及2~6个月的临床疗效和复发情况。结果纳入的129例间日疟患者,111例完成D28随访观察。A、B两组原虫无性体平均转阴时间为(41.05±14.01)h和(35.93±12.62)h,差异有统计学意义(t=2.02,P0.05);两组平均退热时间为(26.29±10.72)h和(23.46±11.40)h,差异无统计学意义(t=1.454,P0.05)。A组与B组D1、D2、D3较D0无性体密度下降率分别为92.80%、99.90%、100.0%和94.18%、99.50%、100%。B组在D14随访复查1例原虫复现。A组随访复发率为3.51%(2/57),B组为90.26%(5/54),差异无统计学意义(χ2=0.607,P0.05)。结论氯喹加伯氨喹两种疗法对缅甸拉咱地区间日疟患者预防复发的效果相同;对该地区的现症间日疟患者采用上述两种疗法治疗效果良好。     

新疆察布查尔县疟疾发病现状

伊犁地区是新疆疟疾发病最严重的地区 ,察布查尔县疟疾流行已久 ,上世纪 5 0年代就属于稳定性高疟区。 195 4年调查的 2～ 9岁脾肿率为 6. 42 % ,居民带原虫率为 2 . 2 3 %。自195 9年全伊犁地区采取大规模地普查普治疟疾现症病人、DDT滞留喷洒灭蚊的综合抗疟措施后 ,疟疾发病率大幅度下降 ,到 1986年察布查尔县疟疾带虫发病率已降到 2 . 3 /万。 1992年我县进行了居民原虫率和人群间接荧光抗体 (IFA)水平调查。血检 2 15人 ,原虫率为 0。IFA血清抗体滴度为 6. 5 0 % ( 13 /2 0 0 ) ,结果表明 ,察布查尔县疟疾发病已处于休止期 ,但疟疾…     

萘酚喹治疗间日疟的疗效观察

在海南省疟疾流行区，用萘酚喹６００ｍｇ顿服和氯喹１．５ｇ标准疗法各治疗间日疟病人３５例，服药后两组病例均获即时治愈。萘酚喹组平均退热和原虫转阴时间分别为（２２．７±７．４）ｈ和（４６．４±９．７）ｈ；氯喹组平均退热和原虫转阴时间分别为（１９．１±８．３）ｈ和（４１．６±８．２）ｈ。随访６ｗｋ，萘酚喹组的治愈率为１００％，氯喹组为７４．３％。结果表明，萘酚喹治疗间日疟的远期效果明显优于氯喹（Ｐ＜０．０１）。     

间日疟的治疗和并发症

本文报告的121例来自越南的间日疟患者中,118例用氯喹和伯喹治疗。氯喹开始服1克,以后每天2次,每次0.5克,服5次;同时并服伯喹每天25毫克(基质15毫克),连服14天。在越南和返美后8周,每周继续预防服用氯—伯片剂1次(氯喹300毫克,伯喹基质45毫克)。其余3例用氯喹(剂量如上述)、乙胺嘧啶(每天3次,每次25毫克,连服3天)和磺胺异恶唑(每天4次,每次500毫克,连服6天)治疗。     

Efficacy of primaquine regimens for primaquine-resistant Plasmodium vivax malaria in Thailand

To define the current efficacy of Fansidar (F. Hoffmann-La Roche Ltd., Basel Switzerland) (pyrimethamine and sulfadoxine), primaquine in a high dose, and artesunate for treating acute Plasmodium vivax malaria, we conducted a comparative clinical trial of these 3 drugs in an open-label study. Patients (15-65 years old) were assigned to 1 of 4 treatments regimens in a serial order. Ninety percent of the patients were infected at Thailand-Myanmar border. Patients in group I (n = 23) received Fansidar (3 tablets, 75 mg of pyrimethamine and 1,500 mg of sulfadoxine, a single dose on the first day), group II (n = 23) received Fansidar (3 tablets, 75 mg of pyrimethamine and 1,500 mg of sulfadoxine, a single dose on the first day) and then received primaquine (30 mg a day for 14 days), group III (n = 23) received primaquine (30 mg a day for 14 days), and group IV (n = 23) received artesunate (200 mg once a day for 3 days) and then primaquine (30 mg a day for 14 days). Cure rates on day 28 of follow-up were 40%, 100%, 100%, and 100% in groups I, II, II, and IV, respectively. There were 4 and 5 patients in group I showing post-treatment reappearance of parasitemia at < or = 16 days and between 17 and 28 days, respectively. Patients in the other 3 groups showed negative parasitemias within 7 days after treatment. Artesunate plus primaquine (group IV) cleared parasitemia faster than the other 3 regimens. There is a high proportion of ineffectiveness of Fansidar for treatment of P. vivax malaria and it should be no longer used for treatment of P. vivax malaria acquired at the Thailand-Myanmar border. A high dose of primaquine is safe and effective in the treatment of P. vivax malaria during the 28-day follow-up period.     

Efficacy of Artequick versus artesunate-mefloquine in the treatment of acute uncomplicated falciparum malaria in Thailand

To determine the efficacy, safety and tolerability of an alternative short-course, artemisinin-based combination therapy for acute uncomplicated Plasmodium falciparum malaria, we compared Artequick--a fixed-dosed combination of artemisinin (80 mg), piperaquine (400 mg), and primaquine (4 mg), per tablet--with a standard regimen of artesunate-mefloquine. A total of 130 patients were randomly assigned to treatment with an orally administered, once-daily, 3-day regimen of either Artequick (Group A: 3.2 mg/Kg/day of artemisinin, 16 mg/Kg/day of piperaquine, and 0.16 mg/Kg/day of primaquine) or artesunate-mefloquine (Group B: artesunate, 4 mg/Kg/day, with mefloquine, 8 mg/Kg/day). Patients receiving each regimen had a rapid clinical and parasitological response. All treatments were well tolerated, and no serious adverse effects occurred. No significant differences were found in fever- and parasite-clearance times between the two study groups. The 28-day cure rates were similarly high, at 98.5% and 100%, in groups A and B, respectively. We conclude that Artequick was as effective and well tolerated as artesunate-mefloquine and could be used as an alternative treatment for multidrug-resistant Plasmodium falciparum malaria in Southeast Asia.     

Comparative drug trial of a sulfadoxine/pyrimethamine and a sulfalene/pyrimethamine combination against Plasmodium falciparum infections in semi-immune populations of Burma

The antiplasmodial effect of a single dose treatment with a sulfadoxine/pyrimethamine combination as compared to a sulfalene/pyrimethamine combination against falciparum malaria was assessed in semi-immune populations in Burma in early 1980. Parasite clearance rates on Day 7 after treatment were 99.2% for the sulfadoxine/pyrimethamine combination and 98.6% for the sulfalene/pyrimethamine combination for all age-groups. The earlier recrudescence rates within one month were 3.7% and 9.2% respectively, while the later recrudescence rates between 1 and 2 months were 9% and 8.3% respectively. Hence, both combinations were equally effective for treatment of falciparum malaria as no significant difference in the parasite clearance rates was observed. However, the earlier recrudescence rates showed a significant difference with a higher rate for the sulfalene/pyrimethamine combination. This is thought to be due to the shorter half-life of sulfalene compared to sulfadoxine and to its being unable therefore to suppress the falciparum infections for as long a period as sulfadoxine. But there was not much difference in the later recrudescence rates. These combinations have a stimulating effect on the production of falciparum gametocytes; and, in order to minimize transmission, an effective gametocytocide such as primaquine should be given along with them, as well as with the chloroquine/pyrimethamine combination, in areas with efficient malaria vectors. Recrudescence rates and gametocyte rates were highest among children in the 1-4 years age-group and this could be attributed to their lower level of acquired immunity compared to the older children and adults. Vivax malaria was also found to be effectively suppressed for about 4 weeks with both combinations.(ABSTRACT TRUNCATED AT 400 WORDS)     

Impact of DDT spraying on malaria transmission in Bareilly District, Uttar Pradesh, India

BACKGROUND & OBJECTIVES: Impact of indoor residual spraying of DDT on malaria transmission and vector density was evaluated in six villages of Shergarh PHC, Bareilly district, Uttar Pradesh under the operational condition of National Vector Borne Disease Control Programme (NVBDCP) from July 2001 to March 2002 (one transmission season only). METHODS: Two rounds of DDT (50% WDP) spraying @ 1 g/m2 were done both in the experimental and control villages by the state health authorities. The spraying in experimental villages was supervised by Malaria Research Centre (MRC) whereas the district health authorities supervised the operation in control villages. Mass blood surveys were made three times--before the first round, in between the first and second rounds and after the second round of spraying. The blood smears were examined by the trained microscopists of MRC, Haldwani. From the above examinations epidemiological indicators such as slide positivity rate (SPR), slide falciparum rate (SFR) and infant parasite rate (IPR) were calculated. All malaria positive cases were given radical treatment as per NVBDCP schedule. Entomological parameters such as per man hour mosquito density, parity rate, gonotrophic condition and adult susceptibility status of Anopheles culicifacies to diagnostic dosages of DDT (4%) were monitored as per the standard techniques. RESULTS: A total of 988.5 kg of DDT was consumed during two rounds of spray. The house coverage varied from 87 to 95.3%. Parasitological evaluation revealed significant reduction in malaria cases (p < 0.0005) and infant parasite rate declined from 2.9 to 0%. Entomological observations revealed considerable reduction in the density of malaria vector An. culicifacies despite of its 21.4% mortality against DDT test papers. INTERPRETATION & CONCLUSION: The overall results of the study revealed that DDT is still a viable insecticide in indoor residual spraying owing to its effectivity in well supervised spray operation and high excito-repellency factor.     

DDT indoor residual spray, still an effective tool to control Anopheles fluviatilis-transmitted Plasmodium falciparum malaria in India

This study from two districts of Orissa State which are endemic for Plasmodium falciparum transmitted by Anopheles fluviatilis and A. culicifacies investigated the impact of dichlorodiphenyl trichloroethane (DDT) indoor residual spraying, in view of the ongoing discussion on phasing out DDT in India. Based on their high annual parasite incidence and logistical considerations, 26 villages in Malkangiri and 28 in Koraput district were selected for DDT spraying. For comparison, six and four unsprayed villages were chosen from the same districts. In each district, the prevalence of malaria infection and incidence of malaria fever, indoor resting density and parous rate of the vectors, and their susceptibility to DDT were monitored in six and three villages selected randomly from the sprayed and unsprayed groups respectively. Anopheles fluviatilis was susceptible to DDT while A. culicifacies was resistant. DDT residual spraying with 1 g/m(2), was carried out in October-November 2001. Spraying 74-86% of human dwellings and 100% of cattle sheds brought down the indoor resting density of A. fluviatilis by 93-95%. This was associated with a significant reduction of incidence of malaria fever as well as prevalence of malaria infection from November to February in both districts. The spraying also seemed to impact on vector longevity, and a residual effect of DDT on the sprayed walls was observed up to 10-12 weeks despite re-plastering. Hence DDT spraying can still be an effective tool for controlling fluviatilis-transmitted malaria. Although this species is exophilic, its nocturnal resting behaviour facilitates its contact with the sprayed surfaces. DDT is still useful for residual spraying in India, particularly in areas where the vectors are endophilic and not resistant.     

江苏省中华按蚊媒介地区推广简化的疟疾监测措施的成本-效果评价

目的对江苏省中华接蚊单一媒介区实施简化的疟疾监测措施4年后的成本-效果进行评价。方法观察简化的疟疾监测措施推广前后的疟疾发病率、间接荧光抗体阳性率;计算减少支出的血检补助费、疫点处理费及病人血检化验费。结果推广区67个县（市、区）1995～1998年疟疾发病率在0．021／万～0．036／万之间,与推广前相比呈稳定或下降趋势,IFA检测结果与疫情报告基本一致。推广简化监测措施4年来共减少血检补助费、疫点处理费257．51万元,减少血检化验费3217．10万元。结论在江苏省推广简化的疟疾监测措施不仅使疫情稳定下降,而且具有巨大的经济效益。     

Cost-effectiveness and sustainability of lambdacyhalothrin-treated mosquito nets in comparison to DDT spraying for malaria control in western Thailand.

The cost-effectiveness of lambdacyhalothrin-treated nets in comparison with conventional DDT spraying for malaria control among migrant populations was evaluated in a malaria hyperendemic area along the Thai-Myanmar border. Ten hamlets of 243 houses with 948 inhabitants were given only treated nets. Twelve hamlets of 294 houses and 1,315 population were in the DDT area, and another 6 hamlets with 171 houses and 695 inhabitants were in the non-DDT-treated area. The impregnated net program was most cost-effective (US$1.54 per 1 case of prevented malaria). Spraying with DDT was more cost-effective than malaria surveillance alone ($1.87 versus $2.50 per 1 case of prevented malaria). These data suggest that personal protection measures with insecticide-impregnated mosquito net are justified in their use to control malaria in highly malaria-endemic areas in western Thailand.     

CV8, a new combination of dihydroartemisinin, piperaquine, trimethoprim and primaquine, compared with atovaquone-proguanil against falciparum malaria in Vietnam

OBJECTIVES: To study a new combination, based on dihydroartemisinin and piperaquine (CV8) and atovaquone/proguanil (Malarone) for treatment of uncomplicated falciparum malaria in Vietnam. METHODS: Vietnamese adults with falciparum malaria were allocated randomly to treatment with dihydroartemisinin/piperaquine/trimethoprim/primaquine 256/2560/720/40 mg (CV8, n = 84) or Malarone 3000/1200 mg (n = 81), both over 3 days. Patients were followed-up for 28 days. RESULTS: All patients recovered rapidly. The mean (95% CI) parasite elimination half-life of CV8 was 6.8 h (6.2-7.4) and of Malarone 6.5 h (6.1-6.9) (P = 0.4). Complete parasite clearance time was 35 (31-39) and 34 h (31-38) (P = 0.9). The 28-day cure rate was 94% and 95%, respectively (odds ratio 0.84, 95% CI 0.18-3.81). No significant side-effects were found. CONCLUSION: CV8 and Malarone are effective combinations against multi-drug resistant falciparum malaria. CV8 has the advantage of a low price.     

High-dose primaquine regimens against relapse of Plasmodium vivax malaria

Plasmodium vivax causes debilitating but usually non-lethal malaria in most of Asia and South America. Prevention of relapse after otherwise effective therapy for the acute attack requires a standard daily dose of primaquine administered over 14 days. This regimen has < 90% efficacy in Thailand, and is widely regarded as ineffective because of poor compliance over the relatively long duration of dosing. We evaluated the efficacy, safety, and tolerability of alternative primaquine dosing regimens combined with artesunate among 399 Thai patients with acute, symptomatic P. vivax malaria. Patients were randomly assigned to one of six treatment groups: all patients received artesunate, 100 mg once a day for 5 days. Groups 1-5 then received primaquine, 30 mg a day for 5, 7, 9, 11, and 14 days, respectively. Group 6 received primaquine, 30 mg twice a day for 7 days. The 28-day cure rates were 85%, 89%, 94%, 100%, and 96%, respectively. Treatment of P. vivax malaria with artesunate for 5 days followed by high-dose primaquine, 30 mg twice a day for 7 days, was highly effective, well-tolerated, and equivalent or superior to the standard regimen of primaquine therapy.     

Molecular analysis of Plasmodium falciparum from drug treatment failure patients in Papua New Guinea

A study was conducted in Papua New Guinea to analyze Plasmodium falciparum drug resistance polymorphisms in patients presenting with resistant malaria. One hundred ninety-nine P. falciparum-positive patients were recruited at two sites, Madang and Maprik. Exposure to the 4-aminoquinolines chloroquine and amodiaquine was uniformly high, at 84% overall. However, 59% of these were taken in various combinations of sulfadoxine/pyrimethamine and/or primaquine and/or quinine. Two markers for 4-aminoquinoline resistance, P. falciparum chloroquine resistance transporter 76T and P. falciparum multidrug resistance 1, were fixed in the population and two markers for pyrimethamine resistance, dihydrofolate reductase (dhps) 59R and 108N, were found at moderate to high levels, overall 60% and 75%, respectively. No polymorphisms in dhps associated with sulfadoxine resistance were present. Differences between the two sites are analyzed. The study period encompasses a change in standard malaria treatment policy. These findings stress the need for regular monitoring of the effects of standard drug treatment of uncomplicated malaria in Papua New Guinea.