中国消除疟疾：监测响应系统的实施与成效分析

doi:10.12140/j.issn.1000-7423.2021.06.003

中国寄生虫学与寄生虫病杂志 ›› 2021, Vol. 39 ›› Issue (6): 733-740.doi: 10.12140/j.issn.1000-7423.2021.06.003

中国消除疟疾：监测响应系统的实施与成效分析

夏志贵¹(), 丰俊¹, 张丽¹, 冯欣宇¹, 黄芳¹, 尹建海¹, 周水森¹, 周升², 杨恒林³, 王善青⁴, 高琪⁵, 汤林华¹, 严俊²^,^*()

1 中国疾病预防控制中心寄生虫病预防控制所（国家热带病研究中心）,国家卫生健康委员会寄生虫病原与媒介生物学重点实验室,世界卫生组织热带病合作中心,国家级热带病国际联合研究中心,上海 200025
2 中国疾病预防控制中心,北京 102206
3 云南省寄生虫病防治所,普洱 665000
4 海南省疾病预防控制中心,海口 570203
5 江苏省血吸虫病防治研究所,无锡 214064

收稿日期:2021-09-22 修回日期:2021-09-24 出版日期:2021-12-30 发布日期:2021-12-21
通讯作者: 严俊
作者简介:夏志贵（1976-）,男,硕士,研究员,从事疟疾流行病学及控制与消除研究。E-mail： xiazg@nipd.chinacdc.cn

Achieving malaria elimination in China: analysis on implementation and effectiveness of the surveillance-response system

XIA Zhi-gui¹(), FENG Jun¹, ZHANG Li¹, FENG Xin-yu¹, HUANG Fang¹, YIN Jian-hai¹, ZHOU Shui-sen¹, ZHOU Sheng², YANG Heng-lin³, WANG Shan-qing⁴, GAO Qi⁵, TANG Lin-hua¹, YAN Jun²^,^*()

1 National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research); NHC Key Laboratory of Parasite and Vector Biology; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Shanghai 200025, China
2 Chinese Center for Disease Control and Prevention, Beijing 102206, China
3 Yunnan Institute of Parasitic Diseases, Pu’er 665000, China
4 Hainan Center for Disease Control and Prevention, Haikou 570203, China
5 Jiangsu Institute of Parasitic Diseases, Wuxi 214064, China

Received:2021-09-22 Revised:2021-09-24 Online:2021-12-30 Published:2021-12-21
Contact: YAN Jun

摘要/Abstract

摘要：

目的分析中国消除疟疾监测响应系统的实施和工作成效,为消除后防止疟疾输入再传播工作提供科学依据。方法系统收集整理消除疟疾监测响应相关的方案和活动记录,以及基于国家传染病报告信息管理系统和寄生虫病防治信息管理系统中2011—2020年全国疟疾病例个案信息和监测指标数据,使用SPSS 25.0和GraphPad Prism 8.4.3软件进行统计分析。结果 2011—2020年,全国共报告疟疾病例30 278例,中国籍28 448例（93.96%）。本地原发感染病例1 732例（5.72%）,为2011—2016年报告;境外输入性病例28 173例（93.05%）;输血感染病例9例（0.03%）;长潜伏期三日疟5例（0.02%）;输入继发间日疟4例（0.01%）;来源不明病例355例（1.17%）,为2011—2013年报告。病例以恶性疟（17 960例,59.32%）为主;主要集中在云南（5 415例,17.88%）、广西（3 193例,10.55%）、江苏（2 797例,9.24%）等省（自治区）;全年均有病例报告,主要集中在5—7月（9 689例,32.00%）。输入性病例主要来自缅甸（4 856例,17.24%）、加纳（2 957例,10.50%）、尼日利亚（2 693例,9.56%）等国。被动监测、人群主动病例侦查和线索追踪病例侦查的血检阳性率分别为0.76‰（28 452/37 500 291）、0.03‰（35/1 215 309）和0.30‰（32/105 384）。2013—2020年,病例诊断后1日内报告率为100%（23 114 / 23 114）,报告后3日内流行病学个案调查率为94.49%（21 840 / 23 114）,7日内疫点调查和处置率为93.30%（20 294 / 21 751）,病例发病到初诊以及初诊到确诊间隔时间中位数均为1 d（四分位距： 0~3 d）。中华按蚊分布广泛,且普遍对溴氰菊酯产生抗性。体内疗效观察双氢青蒿素哌喹片对恶性疟、氯伯喹对间日疟的治愈率分别为92.31%（36/39）和100%（21/21）。结论建设敏感有效的监测响应系统是中国消除疟疾的成功经验,在消除疟疾后应继续把监测响应作为核心措施,积极开展部门合作,加强能力建设,防止输入再传播,巩固消除成果。

关键词: 疟疾, 消除, 监测响应, 中国

Abstract:

Objective To analyze the implementation and effectiveness of surveillance-response system in eliminating malaria in China, and to provide scientific basis for preventing re-establishment of transmission by imported malaria in the post-elimination phase. Methods The national scheme and activities records in malaria elimination program were systematically collected and sorted, and the data of individual malaria cases and indicators in 2011—2020 from web-based National Information System for Infectious Diseases Surveillance and National Information System for Parasitic Diseases Control and Prevention were analyzed using SPSS 25.0 and GraphPad Prism 8.4.3. Results From 2011 to 2020, a total of 30 278 malaria cases were reported nationwide, 93.96% (28 448 cases) of them were Chinese nationality. The total cases included 1 732(5.72%) indigenous cases reported from 2011 to 2016, 28 173(93.05%) imported cases from abroad, 9(0.03%) induced cases, 5(0.02%) long incubation malariae malaria cases, 4 (0.01%) introduced vivax malaria cases, as well as 355 (1.17%) cases with unreported origin from 2011 to 2013. The cases were mainly falciparum malaria cases (17 960 cases, 59.32%) and mainly reported by Yunnan(5 415 cases, 17.88%), Guangxi (3 193 cases, 10.55%), and Jiangsu(2 797 cases, 9.24%) provinces. The cases were reported year-round, with the majority in May and July (9 689 cases, 32.00%). The imported cases were mainly from Myanmar (4 856 cases, 17.24%), Ghana (2 957 cases, 10.50%), and Nigeria (2 693 cases, 9.56%). The positive rates of blood tests for malaria by passive case detection, proactive case detection and reactive case detection were 0.76‰ (28 452/37 500 291), 0.03‰ (35/1 215 309) and 0.30‰ (32/105 384), respectively. From 2013 to 2020, case reporting rate within 1 day after diagnosis was 100% (23 114/23 114), the rate of epidemiological investigation for individual case within 3 days after reporting was 94.49% (21 840/23 114), the rate of foci investigated and disposed within 7 days was 93.30% (20 294/21 751), and the median time from the illness onset to first diagnosis and from first diagnosis to confirmed diagnosis of the patients were both 1 d (IQR: 0~3 d). Anopheles sinensis was widely distributed and commonly resistant to deltamethrin. In vivo efficacy of dihydro-artemisinin-piperaquine against uncomplicated falciparum malaria and chloroquine and primaquine against vivax malaria was 92.31%(36/39) and 100%(21/21), respectively. Conclusion Establishment of the sensitive and effective surveillance-response system is a vital experience for the success of malaria elimination in China. In the post-elimination phase, surveillance-response should continue to be the key measure, and active cooperation between different sectors and capacity building should be strengthened, to prevent re-establishment of transmission and consolidate the accomplishments of elimination.

Key words: Malaria, Elimination, Surveillance and response, China

中图分类号:

R531.3

夏志贵, 丰俊, 张丽, 冯欣宇, 黄芳, 尹建海, 周水森, 周升, 杨恒林, 王善青, 高琪, 汤林华, 严俊. 中国消除疟疾：监测响应系统的实施与成效分析[J]. 中国寄生虫学与寄生虫病杂志, 2021, 39(6): 733-740.

XIA Zhi-gui, FENG Jun, ZHANG Li, FENG Xin-yu, HUANG Fang, YIN Jian-hai, ZHOU Shui-sen, ZHOU Sheng, YANG Heng-lin, WANG Shan-qing, GAO Qi, TANG Lin-hua, YAN Jun. Achieving malaria elimination in China: analysis on implementation and effectiveness of the surveillance-response system[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2021, 39(6): 733-740.

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参考文献 31

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年份 Year	被动监测 Passive case detection			主动病例侦查 Proactive case detection			线索病例侦查 Reactive case detection			合计 Total
年份 Year	血检数No. blood test	阳性数（占比/‰）Positive （Proportion/‰）	P	血检数No. blood test	阳性数（占比/‰）Positive（Proportion/‰）	P	血检数No. blood test	阳性数（占比/‰）Positive（Proportion/‰）	P	血检数No. blood test	阳性数（占比/‰）Positive（Proportion/‰）	P
2011— 2016	30 736 627	19 389（0.63）	< 0.01	785 010	13（0.02）	< 0.01	91 622	21（0.23）	< 0.01	31 613 259	19 423（0.61）	< 0.01
2017—2020	6 763 664	9 063（1.34）		430 299	22（0.05）		13 762	11（0.80）		7 207 725	9 096（1.26）
合计Total	37 500 291	28 452（0.76）		1 215 309	35（0.03）		105 384	32（0.30）		38 820 984	28 519（0.73）

年份 Year	病例报告与流调情况 Case reporting and investigation			疫点调查处置情况 Foci investigation and disposal
年份 Year	病例数 No. case	24 h报告率/% Rate of cases reported within 24 h/%	3日内流调完成病例数（百分率（%） No. case investigated within 3 d (%)	总疫点数 No. foci	7日内疫点调查与处置疫点数（%） No. foci investigated and disposed within 7 d (%)
2013	4 137	100	4 009（96.91）	3 827	3 364（87.90）
2014	3 081	100	2 723（88.38）	2 843	2 701（95.01）
2015	3 277	100	3 272（99.85）	2 959	2 838（95.91）
2016	3 320	100	3 270（98.49）	3 501	3 147（89.89）
2017	2 861	100	2 395（83.71）	2 652	2 477（93.40）
2018	2 678	100	2 491（93.02）	2 468	2 364（95.79）
2019	2 674	100	2 619（97.94）	2 474	2 402（97.09）
2020	1 086	100	1 062（97.79）	1 027	1 000（97.37）
合计 Total	23 114	100	21 840（94.49）	21 751	20 294（93.30）

中国消除疟疾：监测响应系统的实施与成效分析

Achieving malaria elimination in China: analysis on implementation and effectiveness of the surveillance-response system

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