Epidemic status of imported malaria at different stages of malaria elimination in Fujian Province

doi:10.12140/j.issn.1000-7423.2020.06.005

Abstract

Abstract:

Objective To analyze the epidemic status of imported malaria at different stages of malaria elimination program in Fujian Province, in order to provide scientific basis for the formulation of malaria prevention and control strategy and implementation of control measures in later stage of elimination efforts. Methods The process of malaria elimination in Fujian Province was divided into three stages: the pre-elimination stage from 2005 to 2009, the elimination stage from 2010 to 2015, and the post-elimination stage from 2016 to 2019. Data of malaria cases and epidemiological investigations at different stages were collected to analyze the epidemic situation of imported malaria cases using SPSS 17.0 software. Results A total of 1 105 malaria cases were reported in Fujian Province from 2005 to 2019, and all were imported cases except for 3 locally transmitted cases. The annual average number of imported cases reported in the post-elimination stage (116.3 cases per year) was higher than those in the elimination (74.2 cases) and the pre-elimination (38.4 cases) stages. The proportion of falciparum malaria cases increased with staging, from 21.9% (42/192) in the pre-elimination stage, to 60.9% (271/445) in the elimination stage, and to 76.8% (357/465) in the post-elimination stage (P < 0.01). With regard to the infection source, there were cases with a source of local transmission in the pre-elimination and elimination stages, while in the post-elimination stage all cases were imported from abroad, among the imported, the case proportion from Africa increased from 27.1% (52/192) in the pre-elimination stage to 75.7% (337/445) in the elimination stage and to 92.3% (429/465) in the post-elimination stage (P < 0.01). The proportion of cases reported from medical institutions increased, which was significantly higher in the post-elimination stage (95.1%, 442/465) than in the elimination (65.6%, 292/445) and pre-elimination stages (65.1%, 125/192) (P < 0.01). There was an obvious seasonal distribution of reported cases in the pre-elimination stage (peak occurred in summer), but not in the elimination stage, while in the post-elimination stage the reporting peak occurred in the beginning of the year (January-February) and the middle of the year (June-July). The regional distribution of reported cases in three stages found that the reporting was mainly concentrated in Fuzhou, but the proportion increased, showing the proportion in the pre-elimination, elimination and post-elimination stages was 35.9% (69/192), 72.8% (324/445) and 78.1% (363/465) respectively, with statistically significant differences (P < 0.01). The age distribution revealed that the cases were largely in young and middle-aged males (20-59 years old), accounting the proportions in the elimination and post-elimination stages were 96.2% (428/445) and 96.1% (447/465), both higher than 83.3% (160/192) in the pre-elimination stage(P < 0.01). Conclusion During the malaria post-elimination stage, there is a more severe challenge of imported malaria in Fujian Province, especially falciparum malaria imported from Africa, thus public health education to key population and training for medical institutions should be strengthened.

Key words: Malaria elimination, Imported malaria, Epidemiological characteristics, Fujian

CLC Number:

R531.3

CHEN Zhu-yun, OUYANG Rong, XIE Han-guo, LIN Yao-ying, XIAO Li-zhen, ZHANG Shan-ying. Epidemic status of imported malaria at different stages of malaria elimination in Fujian Province[J]. CHINESE JOURNAL OF PARASITOLOGY AND PARASITIC DISEASES, 2020, 38(6): 702-708.

Figures/Tables 4

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References 17

[1]	Yang WZ, Zhou XN. New challenges of malaria elimination in China[J]. Chin J Prev Med, 2016,50(4):289-291. (in Chinese)
	( 杨维中, 周晓农. 中国在疟疾消除阶段面临的新挑战[J]. 中华预防医学杂志, 2016,50(4):289-291.)
[2]	Xu LS, Zhang SY. Control and elimination of malaria in Fujian[M]. Fuzhou: Fujian Science and Technology Press, 2018. (in Chinese)
	( 许龙善, 张山鹰. 福建疟疾的控制与消除[M]. 福州: 福建科学技术出版社. 2018.)
[3]	Yang FZ, Yap PL, Zhang SY, et al. Surveillance and response strategy in the malaria post-elimination stage: case study in Fujian Province[J]. Adv Parasitol, 2014,86:184-205.
[4]	Feng J, Zhang L, Zhang SS, et al. Malaria epidemiological characteristics in China, 2005-2015[J]. Chin Trop Med, 2007,17(4):325-335. (in Chinese)
	( 丰俊, 张丽, 张少森, 等. 全国2005-2015年疟疾疫情分析[J]. 中国热带医学, 2007,17(4):325-335.)
[5]	Ouyang R, Xie HG, Yang FZ, et al. Surveillance analysis of malaria in Fujian Province from 2006 to 2012[J]. Strait J Prev Med, 2013,19(4):73-74. (in Chinese)
	( 欧阳榕, 谢汉国, 杨发柱, 等. 福建省2006-2012年疟疾监测分析[J]. 海峡预防医学杂志, 2013,19(4):73-74.)
[6]	Ouyang R, Chen ZY, Xie HG, et al. Epidemiological analysis of malaria in Fujian Province from 2016 to 2018[J]. Strait J Prev Med, 2019,25(5):20-22. (in Chinese)
	( 欧阳榕, 陈朱云, 谢汉国, 等. 福建省2016-2018年疟疾疫情流行病学分析[J]. 海峡预防医学杂志, 2019,25(5):20-22.)
[7]	Ouyang R, Chen ZY, Xie HG, et al. Prevalent trend and control strategy of imported malaria in Fujian Province, China, 2011-2017[J]. Chin J Zoonoese, 2019,35(4):359-362. (in Chinese)
	( 欧阳榕, 陈朱云, 谢汉国, 等. 2011-2017年福建省输入性疟疾流行态势及防控策略[J]. 中国人兽共患病学报, 2019,35(4):359-362.)
[8]	Cao J, Liu YB, Cao YY, et al. Sustained challenge to malaria elimination in China: imported malaria[J]. Chin J Parasitol Parasit Dis, 2018,36(2):93-96. (in Chinese)
	( 曹俊, 刘耀宝, 曹园园, 等. 中国消除疟疾的持续挑战: 输入性疟疾[J]. 中国寄生虫学与寄生虫病杂志, 2018,36(2):93-96. )
[9]	Zhang L, Feng J, Xia ZG, et al. Epidemiological characteristics of malaria and progress on its elimination in China in 2019[J]. Chin J Parasitol Parasit Dis, 2020,38(2):133-137. (in Chinese)
	( 张丽, 丰俊, 夏志贵, 等. 2019年全国疟疾疫情特征分析及消除工作进展[J]. 中国寄生虫学与寄生虫病杂志, 2020,38(2):133-137.)
[10]	Zhang L, Feng J, Zhang SS, et al. Epidemiological characteristic of malaria and the progress towards its elimination in China in 2018[J]. Chin J Parasitol Parasit Dis, 2019,37(3):241-247. (in Chinese)
	( 张丽, 丰俊, 张少森, 等. 2018年全国疟疾疫情特征及消除工作进展[J]. 中国寄生虫学与寄生虫病杂志, 2019,37(3):241-247.)
[11]	Zhang L, Feng J, Zhang SS, et al. The progress of national malaria elimination and epidemiological characteristic of malaria in China in 2017[J]. Chin J Parasitol Parasit Dis, 2018,36(3):201-209. (in Chinese)
	( 张丽, 丰俊, 张少森, 等. 2017年全国消除疟疾进展及疫情特征分析[J]. 中国寄生虫学与寄生虫病杂志, 2018,36(3):201-209.)
[12]	Sun JL, Lai SJ, Zhang ZK, et al. Comparison of demographical characteristics of malaria cases from malaria control to elimination in China[J]. Chin J Prev Med, 2016,50(4):296-301. (in Chinese)
	( 孙军玲, 赖圣杰, 张子科, 等. 中国疟疾控制与消除阶段疟疾病例人群特征比较[J]. 中华预防医学杂志, 2016,50(4):296-301.)
[13]	Lu SP. It is urgent to prevent and control the import of insect borne infectious diseases to the labor force leaving the contry[J]. Chin Insp Quar, 2017(9):92-93. (in Chinese)
	( 鲁少平. 防控出境劳务人员虫媒传染病输入刻不容缓[J]. 中国检验检疫, 2017(9):92-93.)
[14]	Xian Y, Wang ML, Shao T, et al. Analysis on the evolution and trend of malaria prevention and control policies in China[J]. Chin J Health Policy, 2017,10(3):70-74. (in Chinese)
	( 咸越, 王曼丽, 邵天, 等. 我国疟疾防治政策演变及趋势分析[J]. 中国卫生政策研究, 2017,10(3):70-74.)
[15]	Yang CY, Qian D, Zhang YL, et al. The role of medical institutions in the control of imported malaria since the initiation of malaria elimination program in Henan Province[J]. Chin J Parasitol Parasit Dis, 2016,34(2):123-127. (in Chinese)
	( 杨成运, 钱丹, 张雅兰, 等. 河南省启动消除疟疾行动计划后医疗机构在输入性疟疾防控中的作用[J]. 中国寄生虫学与寄生虫病杂志, 2016,34(2):123-127.)
[16]	Tu H, Feng J, Zhang L, et al. The analysis of deaths due to malaria in China, 2016[J]. Chin Trop Med, 2018,18(7):650-653. (in Chinese)
	( 涂宏, 丰俊, 张丽, 等. 2016年我国疟疾死亡病例分析[J]. 中国热带医学, 2018,18(7):650-653.)
[17]	Liu Y, Zhou RM, Qian D, et al. Analysis of malaria epidemiological characteristics in Henan Province from 2005-2013[J]. Chin J Parasitol Parasit Dis, 2014,32(6):419-422. (in Chinese)
	( 刘颖, 周瑞敏, 钱丹, 等. 河南省2005-2013年疟疾流行特征分析[J]. 中国寄生虫学与寄生虫病杂志, 2014,32(6):419-422.)

	消除前期Pre-elimination		消除中期Elimination		消除后期Post-elimination
	病例数 No. cases	构成比/% Proportion/%	病例数 No. cases	构成比/% Proportion/%	病例数 No. cases	构成比/% Proportion/%
虫种分类Plasmodium species
恶性疟原虫P. falciparum	42	21.9	271	60.9	357	76.8
间日疟原虫P. vivax	90	46.9	142	31.9	56	12.0
卵形疟原虫P. ovale	0	0	8	1.8	29	6.2
三日疟原虫P. malariae	0	0	2	0.5	20	4.3
混合感染Mixed infection	1	0.5	0	0	3	0.7
未分型Unknow species	59	30.7	22	4.9	0	0
合计Total	192	100	445	100	465	100
感染来源Infection source
非洲Africa	52	27.1	337	75.7	429	92.3
亚洲Asia	78	40.6	90	20.2	22	4.7
大洋洲Oceania	0	0	10	2.3	14	3.0
美洲America	4	2.1	0	0	0	0
境内Inland	58	30.2	8	1.8	0	0
合计Total	192	100	445	100	465	100
报告单位Report agency
医疗机构Medical institutions
省级Provincial-level	16	8.3	17	3.8	10	2.2
地市级City-level	64	33.3	245	55.1	408	87.7
县级County-level	40	20.8	30	6.7	24	5.2
乡（镇）级Township-level	5	2.6	0	0	0	0
小计 Total	125	65.1	292	65.6	442	95.1
疾控机构 CDC
省级Provincial-level	22	11.5	120	27.0	4	0.9
地市级City-level	20	10.4	11	2.5	1	0.2
县级County-level	25	13.0	20	4.5	5	1.1
小计Total	67	34.9	151	33.9	10	2.2
海关 Customs	0	0	2	0.5	13	2.8
合计 Total	192	100	445	100	465	100