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

doi:10.12140/j.issn.1000-7423.2021.06.003

Abstract

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

CLC Number:

R531.3

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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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）