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Zhang T, Xu X, Liu B, Wang D, Ye X, Jiang J, Wang S, Lyu X, Yu C, Tian C, Liu Z, Lu X, Li S, Li W. Establishing and applying an adaptive framework for imported malaria: a field practice in Anhui Province, China from 2012 to 2022. BMC Public Health 2024; 24:695. [PMID: 38438874 PMCID: PMC10913610 DOI: 10.1186/s12889-024-18239-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/29/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Anhui Province is currently facing an increase in imported malaria cases as a result of globalization and international travel. In response, Anhui Province has implemented a comprehensive adaptive framework to effectively address this threat. METHODS This study collected surveillance data from 2012 to 2022 in Anhui Province. Descriptive statistics were used to analyze the epidemiological characteristics of imported malaria cases. Additionally, multivariate logistic regression was employed to identify factors associated with severe malaria. Documents were reviewed to document the evolution of the adaptive framework designed to combat imported malaria. The effectiveness of the adaptive framework was evaluated based on the rates of timely medical visits, timely diagnosis, and species identification. RESULTS During the study period, a total of 1008 imported malaria cases were reported across 77 out of 105 counties in Anhui Province, representing a coverage of 73.33%. It was found that 10.52% of imported cases went undiagnosed for more than seven days after onset. The multivariate analysis revealed several potential risk factors for severe malaria, including increasing age (OR = 1.049, 95%CI:1.015-1.083), occupation (waitperson vs. worker, OR = 2.698, 95%CI:1.054-6.906), a longer time interval between onset and the initial medical visit (OR = 1.061, 95%CI:1.011-1.114), and misdiagnosis during the first medical visit (OR = 5.167, 95%CI:2.535-10.533). Following the implementation of the adaptive framework, the rates of timely medical visits, timely diagnosis, and species identification reached 100.00%, 78.57%, and 100.00%, respectively. CONCLUSIONS Anhui Province has successfully developed and implemented an adaptive framework for addressing imported malaria, focusing on robust surveillance, prompt diagnosis, and standardized treatment. The experiences gained from this initiative can serve as a valuable reference for other non-endemic areas.
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Affiliation(s)
- Tao Zhang
- Anhui Provincial Center for Disease Control and Prevention, 12560 Fanhua Road, 230601, Anhui, Hefei, China
| | - Xian Xu
- Anhui Provincial Center for Disease Control and Prevention, 12560 Fanhua Road, 230601, Anhui, Hefei, China
| | - Bowen Liu
- School of Global Health, Chinese Centre for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, 200025, Shanghai, China
| | - Duoquan Wang
- School of Global Health, Chinese Centre for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, 200025, Shanghai, China
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute of Parasitic Diseases at Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research; NHC Key Laboratory of Parasite and Vector Biology; WHO Collaborating Center for Tropical Diseases, National Center for International Research on Tropical Diseases, 200025, Shanghai, China
| | - Xiangguang Ye
- Anhui Intermational Travel Healthcare Center, 230002, Hefei, China
| | - Jingjing Jiang
- Anhui Provincial Center for Disease Control and Prevention, 12560 Fanhua Road, 230601, Anhui, Hefei, China
| | - Shuqi Wang
- Anhui Provincial Center for Disease Control and Prevention, 12560 Fanhua Road, 230601, Anhui, Hefei, China
| | - Xiaofeng Lyu
- Anhui Provincial Center for Disease Control and Prevention, 12560 Fanhua Road, 230601, Anhui, Hefei, China
| | - Chen Yu
- Anhui Provincial Center for Disease Control and Prevention, 12560 Fanhua Road, 230601, Anhui, Hefei, China
| | - Cuicui Tian
- Anhui Provincial Center for Disease Control and Prevention, 12560 Fanhua Road, 230601, Anhui, Hefei, China
| | - Zijian Liu
- Anhui Provincial Center for Disease Control and Prevention, 12560 Fanhua Road, 230601, Anhui, Hefei, China
| | - Xuechun Lu
- Anhui Provincial Center for Disease Control and Prevention, 12560 Fanhua Road, 230601, Anhui, Hefei, China
| | - Shizhu Li
- School of Global Health, Chinese Centre for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, 200025, Shanghai, China.
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute of Parasitic Diseases at Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research; NHC Key Laboratory of Parasite and Vector Biology; WHO Collaborating Center for Tropical Diseases, National Center for International Research on Tropical Diseases, 200025, Shanghai, China.
| | - Weidong Li
- Anhui Provincial Center for Disease Control and Prevention, 12560 Fanhua Road, 230601, Anhui, Hefei, China.
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Etiology of acute febrile illnesses in Southern China: Findings from a two-year sentinel surveillance project, 2017–2019. PLoS One 2022; 17:e0270586. [PMID: 35763515 PMCID: PMC9239456 DOI: 10.1371/journal.pone.0270586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/13/2022] [Indexed: 11/19/2022] Open
Abstract
Background Southern China is at risk for arborvirus disease transmission, including Zika virus and dengue. Patients often present to clinical care with non-specific acute febrile illnesses (AFI). To better describe the etiology of AFI, we implemented a two-year AFI surveillance project at five sentinel hospitals in Yunnan and Guangdong Provinces. Methods Between June 2017 and August 2019, we enrolled patients between 2 and 65 years of age presenting at one sentinel hospital in Mengla County, Yunnan, and four in Jiangmen City, Guangdong, with symptoms of AFI (acute onset of fever ≥ 37.5°C within the past 7 days) without respiratory symptoms or diarrhea. Demographic, epidemiologic, and clinical information was obtained and entered into a web-based AFI surveillance database. A custom TaqMan Array card (TAC) was used to test patients’ whole blood specimens for 27 different pathogens using real-time polymerase chain reaction assays. Results During the two-year project period, 836 patients were enrolled; 443 patients from Mengla County and 393 patients from Jiangmen City. The median age was 33 years [range: 2–65], and most were hospitalized [641, 77%]. Of 796 patients with valid TAC results, 341 (43%) were positive for at least one of the 10 unique pathogens detected. This included 205 (26%) patients positive for dengue virus, 60 (8%) for Orientia tsutsugamushi, and 42 (5%) for Coxiella burnetii. Ten patients (1%) in Jiangmen City tested positive for malaria, 8 of whom reported recent travel outside of China. TAC results were negative for 455 (57%) patients. None of the patients had a positive TAC detection for Zika virus. Conclusions The project detected variability in the etiology of AFI in Southern China and highlighted the importance of differential diagnosis. Dengue, O. tsutsugamushi, and C. burnetii were the most frequently identified pathogens among enrolled AFI patients. As a non-notifiable disease, the frequent detection of C. burnetii is noteworthy and warrants additional investigation. The project provided a framework for routine surveillance for persons presenting with AFI.
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