Analysis of laboratory detection capability for imported malaria in Hubei Province before and after malaria elimination

doi:10.12140/j.issn.1000-7423.2024.02.007

Abstract

Abstract:

Objective To understand the laboratory detection capability of imported malaria before and after malaria elimination in Hubei Province. Methods Data of malaria cases reported in Hubei Province from 2017 to 2022 were collected from National Infectious Disease Surveillance Reporting and Management System. The blood samples and detection review record forms of malaria cases reported in Hubei Province from 2017 to 2022 were collected. A review of the blood smears and blood samples was conducted by the professional technicians from the Hubei Provincial Malaria Diagnosis Reference Laboratory to identify malaria parasites. The blood smears were reviewed using microscopic examination, and the preparation, staining, and cleanliness of the blood smears were evaluated. The blood samples were reviewed for Plasmodium nucleic acids using fluorescence quantitative PCR. Using the retest results from the Provincial Malaria Diagnosis Reference Laboratory as the standard to analyze and compare the detection results provided by the malaria laboratories at the city (prefecture) levels on the positive qualification rate, parasite species coincidence rate, blood smear qualification rate, and sample delivery timeliness before (from 2017 to 2019) and after (from 2020 to 2022) malaria elimination. Results From 2017 to 2022, 501 cases of imported malaria were reported in Hubei Province, with 409 cases reported from 2017 to 2019 and 92 cases reported from 2020 to 2022. The sample collection rate from 2017 to 2019 was 99.3% (406/409), with a sample qualification rate of 99.3% (403/406). From 2020 to 2022, the sample collection rate was 94.6% (87/92), with a sample qualification rate of 82.8% (72/87). Among the 501 reported cases, 451 were confirmed as malaria by provincial malaria diagnosis review. From 2017 to 2019, a total of 373 confirmed malaria cases were reviewed, including 261 cases of falciparum malaria (70.0%), 48 cases of vivax malaria (12.9%), 52 cases of ovale malaria (13.9%), and 12 cases of malariae malaria (3.2%); from 2020 to 2022, a total of 78 confirmed malaria cases were reviewed, including 34 cases of falciparum malaria (43.6%), 20 cases of vivax malaria (25.6%), 19 cases of ovale malaria (24.4%), and 5 cases of malariae malaria (6.4%). There was a statistically significant difference in the composition of the 4 types of malaria before and after malaria elimination (χ² = 20.037, P < 0.05). The median sample submission time was 3 days (0-16 d) from 2017 to 2019, with an average of 4 days. From 2020 to 2022, the median sample submission time was 4 days (0-224 d), with an average of 8 days. The sample submission time was longer in all regions after malaria elimination (χ² = 25.591, P < 0.05). The positive compliance rates of the reported malaria cases in Hubei Province from 2017 to 2019 and from 2020 to 2022 were 91.9% (373/406) and 89.7% (78/87), respectively (χ² = 0.452, P > 0.05). The parasite specie compliance rates were 88.7% (331/373) and 78.2% (61/78), respectively, with a higher parasite compliance rate before malaria elimination (χ² = 6.296, P < 0.05). A total of 75 cases were misdiagnosed by city (prefecture) level malaria laboratories from 2017 to 2019, with a misdiagnosis rate of 18.5% (75/406), including 33 cases of qualitative misdiagnosis and 42 cases of species misdiagnosis; from 2020 to 2022, a total of 26 cases were misdiagnosed, with a misdiagnosis rate of 29.9% (26/87), including 9 cases of qualitative misdiagnosis and 17 cases of species misdiagnosis. There was a statistically significant difference in the species compliance rate for falciparum malaria before and after malaria elimination (χ² = 4.571, P < 0.05). A total of 492 blood smears were reviewed from 2017 to 2019, with a slide preparation qualification rate of 85.2% (419/492), staining qualification rate of 83.3% (410/492), and cleanliness qualification rate of 85.8% (422/492). From 2020 to 2022, a total of 209 blood smears were reviewed, with a slide preparation qualification rate of 71.8% (150/209), staining qualification rate of 76.1% (159/209), and cleanliness qualification rate of 76.6% (160/209). There were statistically significant differences in blood smear preparation, staining, and cleanliness evaluations before and after malaria elimination (χ² = 17.213, 5.054, 8.842, all P < 0.05). Conclusion After the elimination of malaria, the number of imported cases in Hubei Province has decreased. The laboratory detection capability of malaria has reduced slightly but remains stable.

Key words: Malaria, Elimination, Reference laboratory, Detection

CLC Number:

R531.3

YI Jia, WU Dongni, DONG Xiaorong, ZHU Hong, LIN Wen, ZHANG Cong, SUN Lingcong. Analysis of laboratory detection capability for imported malaria in Hubei Province before and after malaria elimination[J]. CHINESE JOURNAL OF PARASITOLOGY AND PARASITIC DISEASES, 2024, 42(2): 177-181.

Figures/Tables 3

Table 1

Table 2

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References 18

[1]	Xu LQ. Distribution and pathogenic impact of human parasites in China[M]. Beijing: People’s Medical Publishing House, 2000: 75. (in Chinese)
	(许隆祺. 中国人体寄生虫分布与危害[M]. 北京: 人民卫生出版社, 2000: 75.)
[2]	Xia J, Huang XB, Sun LC, et al. Epidemiological characteristics of malaria from control to elimination in Hubei Province, China, 2005—2016[J]. Malar J, 2018, 17(1): 81.
[3]	Wu DN, Zhang HX, Zhu H, et al. Characteristics of imported malaria cases in Hubei Province from 2016 to 2020[J]. Chin J Parasitol Parasit Dis, 2021, 39(5): 585-591. (in Chinese)
	(吴冬妮, 张华勋, 朱红, 等. 2016—2020年湖北省输入性疟疾病例特征分析[J]. 中国寄生虫学与寄生虫病杂志, 2021, 39(5): 585-591.) doi: 10.12140/j.issn.1000-7423.2021.05.004
[4]	National Health and Family Planning Commission, People’s Republic of China. Diagnosis of malaria: WS 259—2015[S]. Beijing: Standards Press of China, 2016. (in Chinese)
	(中华人民共和国国家卫生和计划生育委员会. 疟疾的诊断: WS 259—2015[S]. 北京: 中国标准出版社, 2016.)
[5]	The Ministry of Health Disease Control Bureau. Handbook of malaria control[M]. 3rd ed. Beijing: People’s Medical Publishing House, 2007: 179-185. (in Chinese)
	(卫生部疾病预防控制局. 疟疾防治手册[M]. 3版. 北京: 人民卫生出版社, 2007: 179-185.)
[6]	Yi J, Sun LC, Zhang C, et al. Quality of malaria blood smears of microscopic examinations in Hubei Provincial Malaria Diagnostic Reference Laboratory, 2020—2021[J]. China Trop Med, 2022, 22(4): 324-328. (in Chinese)
	(易佳, 孙凌聪, 张聪, 等. 湖北省2020—2021年疟疾诊断参比实验室血片镜检质量分析[J]. 中国热带医学, 2022, 22(4): 324-328.) doi: 10.13604/j.cnki.46-1064/r.2022.04.07
[7]	World Health Organization. From 30 million cases to zero: China is certified malaria-free by WHO[R/OL]. (2021-06-30) [2023-08-10]. https://www.who.int/news/item/30-06-2021-from-30-million-cases-to-zero-china-is-certified-malaria-free-by-who.
[8]	Landier J, Parker DM, Thu AM, et al. The role of early detection and treatment in malaria elimination[J]. Malar J, 2016, 15: 363.
[9]	Du FY, Wang JE, Wang H. The impacts of COVID-19 on the connectivity of China’s international air transport network and the spatial differences[J]. Trop Geogr, 2020, 40(3): 386-395. (in Chinese)
	(杜方叶, 王姣娥, 王涵. 新冠疫情对中国国际航空网络连通性的影响及空间差异[J]. 热带地理, 2020, 40(3): 386-395.) doi: 10.13284/j.cnki.rddl.003248
[10]	Zhang L, Feng J, Tu H, et al. Malaria epidemiology in China in 2020[J]. Chin J Parasitol Parasit Dis, 2021, 39(2): 195-199. (in Chinese)
	(张丽, 丰俊, 涂宏, 等. 2020年全国疟疾疫情分析[J]. 中国寄生虫学与寄生虫病杂志, 2021, 39(2): 195-199.) doi: 10.12140/j.issn.1000-7423.2021.02.012
[11]	Shen SR, Ma ZC, Xu YL, et al. Influence of novel coronavirus’s overseas import on China’s epidemic situation[J]. J Zhejiang Norm Univ Nat Sci, 2021, 44(2): 197-205. (in Chinese)
	(沈淑容, 马紫程, 许以灵, 等. 新型冠状病毒境外输入对我国疫情的影响[J]. 浙江师范大学学报(自然科学版), 2021, 44(2): 197-205.)
[12]	Gao Q. Challenge and response of imported malaria for preventing malaria re-establishment[J]. China Trop Med, 2021, 21(1): 1-4. (in Chinese)
	(高琪. 输入性疟疾对巩固消除疟疾成果防止再传播的挑战和对策[J]. 中国热带医学, 2021, 21(1): 1-4.) doi: 10.13604/j.cnki.46-1064/r.2021.01.01
[13]	Chen F, Wu K, Yang Y, et al. Analysis of epidemiological characteristics of imported non-falciparum malaria in Wuhan (2011—2017)[J]. J Public Health Prev Med, 2019, 30(1): 51-55. (in Chinese)
	(陈芳, 吴凯, 杨燕, 等. 2011—2017年武汉市输入性非恶性疟流行特征分析[J]. 公共卫生与预防医学, 2019, 30(1): 51-55.)
[14]	Zhu GD, Cao J. Challenges and countermeasures on Chinese malaria elimination programme during the coronavirus disease 2019 (COVID-19) outbreak[J]. Chin J Schisto Control, 2020, 32(1): 7-9. (in Chinese)
	(朱国鼎, 曹俊. 新型冠状病毒肺炎疫情对我国消除疟疾工作的挑战及应对策略[J]. 中国血吸虫病防治杂志, 2020, 32(1): 7-9.)
[15]	Li M, Xia ZG, Zhou SS. Analysis of inconsistence of Plasmodium detection in some malaria cases[J]. Chin J Parasitol Parasit Dis, 2019, 37(4): 464-471. (in Chinese)
	(李美, 夏志贵, 周水森. 疟疾病例复核确认过程中检测结果不一致常见问题分析[J]. 中国寄生虫学与寄生虫病杂志, 2019, 37(4): 464-471.) doi: 10.12140/j.issn.1000-7423.2019.04.017
[16]	Zhang JF, Zhou YZ. Comparison of three different detection methods in malaria diagnosis[J]. Chin J Control Endem Dis, 2016, 31(2): 201-202. (in Chinese)
	(张金飞, 周燕珍. 三种不同检测方法在疟疾诊断中的应用比较[J]. 中国地方病防治杂志, 2016, 31(2): 201-202.)
[17]	Turki H, Raeisi A, Malekzadeh K, et al. Efficiency of nested-PCR in detecting asymptomatic cases toward malaria elimination program in an endemic area of Iran[J]. Iran J Parasitol, 2015, 10(1): 39-45. pmid: 25904944
[18]	Wu DN, Sun LC, Zhang HX, et al. Analysis of laboratory detection capabilities for imported Plasmodium ovale in Hubei Province[J]. Chin J Parasitol Parasit Dis, 2021, 39(3): 406-409. (in Chinese)
	(吴冬妮, 孙凌聪, 张华勋, 等. 湖北省输入性卵形疟的实验室检测能力分析[J]. 中国寄生虫学与寄生虫病杂志, 2021, 39(3): 406-409.) doi: 10.12140/j.issn.1000-7423.2021.03.021

年份 Year	网络报告病例数/例 No. reported case	确诊病例数/例（构成比/%） No. confirmed case (Composition rate/%)
年份 Year	网络报告病例数/例 No. reported case	恶性疟 Falciparum malaria	间日疟 Vivax malaria	卵形疟 Ovale malaria	三日疟 Malariae malaria	合计 Total
2017—2019	409	261（70.0）	48（12.9）	52（13.9）	12（3.2）	373
2020—2022	92	34（43.6）	20（25.6）	19（24.4）	5（6.4）	78
合计 Total	501	295（65.4）	68（15.1）	71（15.7）	17（3.8）	451

送样时长/d Time for delivery/d	2017—2019		2020—2022
送样时长/d Time for delivery/d	收集样品数/份 No. collected sample	构成比/% Composition rate/%	收集样品数/份 No. collected sample	构成比/% Composition rate/%
≤ 1	98	24.1	16	18.4
2~3	113	27.8	24	27.6
4~7	139	34.2	16	18.4
> 7	56	13.8	31	35.6
合计 Total	406	100.00	87	100.0

市（州） City (prefecture)	2017—2019					2020—2022
市（州） City (prefecture)	复核病例数/例 No. rechecked case	确诊病例数/例 No. confirmed case	阳性符合率/% Coincidence rate/%	虫种符合病例数/例 No. species coincidenced case	虫种符合率/% Species coincidence rate/%	复核病例数/例 No. rechecked case	确诊病例数/例 No. confirmed case	阳性符合率/% Coincidence rate/%	虫种符合病例数/例 No. species coincidenced case	虫种符合率/% Species coincidence rate/%
武汉 Wuhan	117	116	99.2	116	100	23	22	95.7	20	90.9
黄石 Huangshi	50	43	86.0	34	79.1	16	13	13/16	9	9/13
十堰 Shiyan	31	25	80.6	24	96.0	8	7	7/8	7	7/7
荆州 Jingzhou	10	10	10/10	10	10/10	4	4	4/4	2	2/4
宜昌 Yichang	58	53	91.4	40	75.5	13	12	12/13	8	8/12
襄阳 Xiangyang	32	31	96.9	29	93.5	4	4	4/4	4	4/4
鄂州 E’zhou	3	2	2/3	2	2/2	1	1	1/1	0	0/1
荆门 Jingmen	12	12	12/12	12	12/12	4	4	4/4	2	2/4
黄冈 Huanggang	30	23	76.7	17	73.9	7	7	7/7	5	5/7
孝感 Xiaogan	16	16	16/16	13	13/16	3	1	1/3	1	1/1
咸宁 Xianning	7	6	6/7	4	4/6	3	2	2/3	2	2/2
随州 Suizhou	17	17	17/17	13	13/17	-	-	-	-	-
恩施 Enshi	14	11	11/14	10	10/11	1	1	1/1	1	1/1
仙桃 Xiantao	2	1	1/2	1	1/1	-	-	-	-	-
潜江 Qianjiang	3	3	3/3	3	3/3	-	-	-	-	-
天门 Tianmen	4	4	4/4	3	3/4	-	-	-	-	-
神农架 Shennongjia	-	-	-	-	-	-	-	-	-	-
合计 Total	406	373	91.9	331	88.7	87	78	89.7	61	78.2