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Steinhardt LC, KC A, Tiffany A, Quincer EM, Loerinc L, Laramee N, Large A, Lindblade KA. Reactive Case Detection and Treatment and Reactive Drug Administration for Reducing Malaria Transmission: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2024; 110:82-93. [PMID: 38118166 PMCID: PMC10993791 DOI: 10.4269/ajtmh.22-0720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/09/2023] [Indexed: 12/22/2023] Open
Abstract
Many countries pursuing malaria elimination implement "reactive" strategies targeting household members and neighbors of index cases to reduce transmission. These strategies include reactive case detection and treatment (RACDT; testing and treating those positive) and reactive drug administration (RDA; providing antimalarials without testing). We conducted systematic reviews of RACDT and RDA to assess their effect on reducing malaria transmission and gathered evidence about key contextual factors important to their implementation. Two reviewers screened titles/abstracts and full-text records using defined criteria (Patient = those in malaria-endemic/receptive areas; Intervention = RACDT or RDA; Comparison = standard of care; Outcome = malaria incidence/prevalence) and abstracted data for meta-analyses. The Grading of Recommendations, Assessment, Development, and Evaluations approach was used to rate certainty of evidence (CoE) for each outcome. Of 1,460 records screened, reviewers identified five RACDT studies (three cluster-randomized controlled trials [cRCTs] and two nonrandomized studies [NRS]) and seven RDA studies (six cRCTs and one NRS); three cRCTs comparing RDA to RACDT were included in both reviews. Compared with RDA, RACDT was associated with nonsignificantly higher parasite prevalence (odds ratio [OR] = 1.85; 95% CI: 0.96-3.57; one study) and malaria incidence (rate ratio [RR] = 1.30; 95% CI: 0.94-1.79; three studies), both very low CoE. Compared with control or RACDT, RDA was associated with non-significantly lower parasite incidence (RR = 0.73; 95% CI: 0.36-1.47; 2 studies, moderate CoE), prevalence (OR = 0.78; 95% CI: 0.52-1.17; 4 studies, low CoE), and malaria incidence (RR = 0.93; 95% CI: 0.82-1.05; six studies, moderate CoE). Evidence for reactive strategies' impact on malaria transmission is limited, especially for RACDT, but suggests RDA might be more effective.
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Affiliation(s)
- Laura C. Steinhardt
- Malaria Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Achyut KC
- Malaria Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amanda Tiffany
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Nicolas Laramee
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Amy Large
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kim A. Lindblade
- Malaria Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
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Manzoni G, Try R, Guintran JO, Christiansen-Jucht C, Jacoby E, Sovannaroth S, Zhang Z, Banouvong V, Shortus MS, Reyburn R, Chanthavisouk C, Linn NYY, Thapa B, Khine SK, Sudathip P, Gopinath D, Thieu NQ, Ngon MS, Cong DT, Hui L, Kelley J, Valecha NNK, Bustos MD, Rasmussen C, Tuseo L. Progress towards malaria elimination in the Greater Mekong Subregion: perspectives from the World Health Organization. Malar J 2024; 23:64. [PMID: 38429807 PMCID: PMC10908136 DOI: 10.1186/s12936-024-04851-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/11/2024] [Indexed: 03/03/2024] Open
Abstract
Malaria remains a global health challenge, disproportionately affecting vulnerable communities. Despite substantial progress, the emergence of anti-malarial drug resistance poses a constant threat. The Greater Mekong Subregion (GMS), which includes Cambodia, China's Yunnan province, Lao People's Democratic Republic, Myanmar, Thailand, and Viet Nam has been the epicentre for the emergence of resistance to successive generations of anti-malarial therapies. From the perspective of the World Health Organization (WHO), this article considers the collaborative efforts in the GMS, to contain Plasmodium falciparum artemisinin partial resistance and multi-drug resistance and to advance malaria elimination. The emergence of artemisinin partial resistance in the GMS necessitated urgent action and regional collaboration resulting in the Strategy for Malaria Elimination in the Greater Mekong Subregion (2015-2030), advocating for accelerated malaria elimination interventions tailored to country needs, co-ordinated and supported by the WHO Mekong malaria elimination programme. The strategy has delivered substantial reductions in malaria across all GMS countries, with a 77% reduction in malaria cases and a 97% reduction in malaria deaths across the GMS between 2012 and 2022. Notably, China was certified malaria-free by WHO in 2021. Countries' ownership and accountability have been pivotal, with each GMS country outlining its priorities in strategic and annual work plans. The development of strong networks for anti-malarial drug resistance surveillance and epidemiological surveillance was essential. Harmonization of policies and guidelines enhanced collaboration, ensuring that activities were driven by evidence. Challenges persist, particularly in Myanmar, where security concerns have limited recent progress, though an intensification and acceleration plan aims to regain momentum. Barriers to implementation can slow progress and continuing innovation is needed. Accessing mobile and migrant populations is key to addressing remaining transmission foci, requiring effective cross-border collaboration. In conclusion, the GMS has made significant progress towards malaria elimination, particularly in the east where several countries are close to P. falciparum elimination. New and persisting challenges require sustained efforts and continued close collaboration. The GMS countries have repeatedly risen to every obstacle presented, and now is the time to re-double efforts and achieve the 2030 goal of malaria elimination for the region.
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Affiliation(s)
- Giulia Manzoni
- WHO Mekong Malaria Elimination Programme, Phnom Penh, Cambodia.
- Independent Consultant, Antananarivo, Madagascar.
| | - Rady Try
- WHO Mekong Malaria Elimination Programme, Phnom Penh, Cambodia
| | - Jean Olivier Guintran
- World Health Organization Country Office, Phnom Penh, Cambodia
- Independent Consultant, Le Bar sur Loup, France
| | | | - Elodie Jacoby
- WHO Mekong Malaria Elimination Programme, Phnom Penh, Cambodia
- Independent Consultant, Ho Chi Minh, Viet Nam
| | - Siv Sovannaroth
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Zaixing Zhang
- World Health Organization Country Office, Phnom Penh, Cambodia
| | | | | | - Rita Reyburn
- World Health Organization Country Office, Vientiane, Lao PDR
| | | | - Nay Yi Yi Linn
- National Malaria Control Programme, Nay Pyi Taw, Myanmar
| | - Badri Thapa
- World Health Organization Country Office, Yangon, Myanmar
| | | | - Prayuth Sudathip
- Division of Vector Borne Diseases, Department of Disease Control, Bangkok, Thailand
| | - Deyer Gopinath
- World Health Organization Country Office, Bangkok, Thailand
| | - Nguyen Quang Thieu
- National Institute of Malariology, Parasitology and Entomology, Hanoi, Viet Nam
| | | | | | - Liu Hui
- Yunnan Institute of Parasitic Diseases, Yunnan, China
| | - James Kelley
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | | | - Maria Dorina Bustos
- World Health Organization, Regional Office for South-East Asia, New Delhi, India
| | | | - Luciano Tuseo
- WHO Mekong Malaria Elimination Programme, Phnom Penh, Cambodia
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
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3
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Chang W, Cohen J, Wang DQ, Abdulla S, Mahende MK, Gavana T, Scott V, Msuya HM, Mwanyika-Sando M, Njau RJA, Lu SN, Temu S, Masanja H, Anthony W, Aregawi W M, Sunder N, Kun T, Bruxvoort K, Kitau J, Kihwele F, Chila G, Michael M, Castro M, Menzies NA, Kim S, Ning X, Zhou XN, Chaki P, Mlacha YP. Impact of 1,7-malaria reactive community-based testing and response (1,7-mRCTR) approach on malaria prevalence in Tanzania. Infect Dis Poverty 2023; 12:116. [PMID: 38105258 PMCID: PMC10726614 DOI: 10.1186/s40249-023-01166-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Progress in malaria control has stalled in recent years and innovative surveillance and response approaches are needed to accelerate malaria control and elimination efforts in endemic areas of Africa. Building on a previous China-UK-Tanzania pilot study on malaria control, this study aimed to assess the impact of the 1,7-malaria Reactive Community-Based Testing and Response (1,7-mRCTR) approach implemented over two years in three districts of Tanzania. METHODS The 1,7-mRCTR approach provides community-based malaria testing via rapid diagnostic tests and treatment in villages with the highest burden of malaria incidence based on surveillance data from health facilities. We used a difference-in-differences quasi-experimental design with linear probability models and two waves of cross-sectional household surveys to assess the impact of 1,7-mRCTR on malaria prevalence. We conducted sensitivity analyses to assess the robustness of our results, examined how intervention effects varied in subgroups, and explored alternative explanations for the observed results. RESULTS Between October 2019 and September 2021, 244,771 community-based malaria rapid tests were completed in intervention areas, and each intervention village received an average of 3.85 rounds of 1-7mRCTR. Malaria prevalence declined from 27.4% at baseline to 11.7% at endline in the intervention areas and from 26.0% to 16.0% in the control areas. 1,7-mRCTR was associated with a 4.5-percentage-point decrease in malaria prevalence (95% confidence interval: - 0.067, - 0.023), equivalent to a 17% reduction from the baseline. In Rufiji, a district characterized by lower prevalence and where larviciding was additionally provided, 1,7-mRCTR was associated with a 63.9% decline in malaria prevalence. CONCLUSIONS The 1,7-mRCTR approach reduced malaria prevalence. Despite implementation interruptions due to the COVID-19 pandemic and supply chain challenges, the study provided novel evidence on the effectiveness of community-based reactive approaches in moderate- to high-endemicity areas and demonstrated the potential of South-South cooperation in tackling global health challenges.
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Affiliation(s)
- Wei Chang
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jessica Cohen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Duo-Quan Wang
- Chinese Center for Disease Control and Prevention, National Institute of Parasitic Diseases, Shanghai, People's Republic of China
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Chinese Center for Tropical Diseases Research, Shanghai, People's Republic of China
- WHO Collaborating Centre for Tropical Diseases, Shanghai, People's Republic of China
- National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, People's Republic of China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025, People's Republic of China
| | - Salim Abdulla
- Ifakara Health Institute, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78 373, Dar es Salaam, United Republic of Tanzania
| | - Muhidin Kassim Mahende
- Ifakara Health Institute, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78 373, Dar es Salaam, United Republic of Tanzania
| | - Tegemeo Gavana
- Ifakara Health Institute, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78 373, Dar es Salaam, United Republic of Tanzania
| | - Valerie Scott
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Hajirani M Msuya
- Ifakara Health Institute, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78 373, Dar es Salaam, United Republic of Tanzania
| | | | - Ritha John A Njau
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Shen-Ning Lu
- Chinese Center for Disease Control and Prevention, National Institute of Parasitic Diseases, Shanghai, People's Republic of China
- Chinese Center for Tropical Diseases Research, Shanghai, People's Republic of China
- WHO Collaborating Centre for Tropical Diseases, Shanghai, People's Republic of China
- National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, People's Republic of China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025, People's Republic of China
| | - Silas Temu
- Ifakara Health Institute, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78 373, Dar es Salaam, United Republic of Tanzania
| | - Honorati Masanja
- Ifakara Health Institute, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78 373, Dar es Salaam, United Republic of Tanzania
| | | | - Maru Aregawi W
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | | | - Tang Kun
- Vanke School of Public Health, Tsinghua University, Beijing, People's Republic of China
| | - Katia Bruxvoort
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jovin Kitau
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Fadhila Kihwele
- Ifakara Health Institute, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78 373, Dar es Salaam, United Republic of Tanzania
| | - Godlove Chila
- Ifakara Health Institute, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78 373, Dar es Salaam, United Republic of Tanzania
| | - Mihayo Michael
- Ifakara Health Institute, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78 373, Dar es Salaam, United Republic of Tanzania
| | - Marcia Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sein Kim
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Xiao Ning
- Chinese Center for Disease Control and Prevention, National Institute of Parasitic Diseases, Shanghai, People's Republic of China
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Chinese Center for Tropical Diseases Research, Shanghai, People's Republic of China
- WHO Collaborating Centre for Tropical Diseases, Shanghai, People's Republic of China
- National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, People's Republic of China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025, People's Republic of China
| | - Xiao-Nong Zhou
- Chinese Center for Disease Control and Prevention, National Institute of Parasitic Diseases, Shanghai, People's Republic of China
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Chinese Center for Tropical Diseases Research, Shanghai, People's Republic of China
- WHO Collaborating Centre for Tropical Diseases, Shanghai, People's Republic of China
- National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, People's Republic of China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025, People's Republic of China
| | - Prosper Chaki
- Ifakara Health Institute, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78 373, Dar es Salaam, United Republic of Tanzania
- The Pan-African Mosquito Control Association (PAMCA), KEMRI Headquarters, Mbagathi Road, Nairobi, 54840-00200, Kenya
| | - Yeromin P Mlacha
- Ifakara Health Institute, #5 Ifakara Street, Plot 463 Mikocheni, P.O. Box 78 373, Dar es Salaam, United Republic of Tanzania.
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4
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Newby G, Cotter C, Roh ME, Harvard K, Bennett A, Hwang J, Chitnis N, Fine S, Stresman G, Chen I, Gosling R, Hsiang MS. Testing and treatment for malaria elimination: a systematic review. Malar J 2023; 22:254. [PMID: 37661286 PMCID: PMC10476355 DOI: 10.1186/s12936-023-04670-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Global interest in malaria elimination has prompted research on active test and treat (TaT) strategies. METHODS A systematic review and meta-analysis were conducted to assess the effectiveness of TaT strategies to reduce malaria transmission. RESULTS A total of 72 empirical research and 24 modelling studies were identified, mainly focused on proactive mass TaT (MTaT) and reactive case detection (RACD) in higher and lower transmission settings, respectively. Ten intervention studies compared MTaT to no MTaT and the evidence for impact on malaria incidence was weak. No intervention studies compared RACD to no RACD. Compared to passive case detection (PCD) alone, PCD + RACD using standard diagnostics increased infection detection 52.7% and 11.3% in low and very low transmission settings, respectively. Using molecular methods increased this detection of infections by 1.4- and 1.1-fold, respectively. CONCLUSION Results suggest MTaT is not effective for reducing transmission. By increasing case detection, surveillance data provided by RACD may indirectly reduce transmission by informing coordinated responses of intervention targeting.
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Affiliation(s)
- Gretchen Newby
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco (UCSF), 550 16th Street, San Francisco, CA, 94143, USA
| | - Chris Cotter
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco (UCSF), 550 16th Street, San Francisco, CA, 94143, USA
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Michelle E Roh
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco (UCSF), 550 16th Street, San Francisco, CA, 94143, USA
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA
| | - Kelly Harvard
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco (UCSF), 550 16th Street, San Francisco, CA, 94143, USA
| | - Adam Bennett
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco (UCSF), 550 16th Street, San Francisco, CA, 94143, USA
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA
- PATH, Seattle, WA, USA
| | - Jimee Hwang
- Malaria Branch, Centers for Disease Control and Prevention, U.S. President's Malaria Initiative, Atlanta, GA, USA
| | - Nakul Chitnis
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Sydney Fine
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco (UCSF), 550 16th Street, San Francisco, CA, 94143, USA
| | - Gillian Stresman
- College of Public Health, University of South Florida, Tampa, FL, USA
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ingrid Chen
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco (UCSF), 550 16th Street, San Francisco, CA, 94143, USA
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA
| | - Roly Gosling
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco (UCSF), 550 16th Street, San Francisco, CA, 94143, USA
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Michelle S Hsiang
- Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco (UCSF), 550 16th Street, San Francisco, CA, 94143, USA.
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA.
- Department of Pediatrics, UCSF, San Francisco, CA, USA.
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5
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Win Han Oo, Nguyen XT, Ngo TVA, Ngo DT, Win Htike, Aye Tun N, Kaung Myat Thu, Cutts J, Nguyen THP, May Chan Oo, Ei Phyu Htwe, Aung Khine Zaw, O'Flaherty K, Agius PA, Fowkes FJI. Performance and feasibility of reactive surveillance and response strategies for malaria elimination in Vietnam: a mixed-methods study. Malar J 2023; 22:229. [PMID: 37545009 PMCID: PMC10405448 DOI: 10.1186/s12936-023-04660-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND To enhance malaria elimination, Vietnam adopted a Reactive Surveillance and Response (RASR) Strategy in which malaria case notification and investigation must be completed within 2 days followed by a focus investigation within 7 days. The nationwide performance of Vietnam's RASR strategy has yet to be evaluated. This study aims to evaluate the performance and feasibility of RASR in Vietnam, thereby providing recommendations for improved RASR. METHODS To assess malaria RASR in Vietnam, a mixed-methods study of (1) secondary data analysis of nationwide malaria case-based dataset from 2017 to 2021; (2) a quantitative survey, and (3) qualitative in-depth interviews and focus group discussions administered to central, provincial and district level stakeholders/staff and to the commune and community level front line health services providers was conducted. RESULTS In Vietnam, there are guidelines and procedures for implementation of each step of RASR. The completeness of case notification on the reported monthly aggregated data was very high in both the paper-based (12,463/12,498, 99.7% in 2017-2020) and electronic reporting systems (467/467, 100% in 2021 when electronic reporting was introduced); however, there were delays in notification while using the paper-based system (timely notification-7,978/12,498, 63.8%). In 2021, the completeness (453/467, 97.0%) and timeliness (371/467, 79.4%) of case investigation were found to be high. Reactive case detection was the major focus investigation response, with fever screening achievement of 88.6% (11,481 / 12,965) and 88.5% (11,471 / 12,965) among index case and neighbouring household members, respectively. CONCLUSIONS Overall, there was policy commitment for implementation of RASR in Vietnam. The completeness and timeliness of case notification and case investigation were high and improved after the introduction of the electronic reporting system. More evidence is required for reactive case detection in defining the screening area or population.
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Affiliation(s)
- Win Han Oo
- Disease Elimination Programme, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, Australia.
- Health Security Programme, Burnet Institute Myanmar, 226 U Wisara Road, Yangon, Myanmar.
| | - Xuan Thang Nguyen
- Department of Epidemiology, National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | | | - Duc Thang Ngo
- Department of Epidemiology, National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | - Win Htike
- Health Security Programme, Burnet Institute Myanmar, 226 U Wisara Road, Yangon, Myanmar
| | - Nilar Aye Tun
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Kaung Myat Thu
- Health Security Programme, Burnet Institute Myanmar, 226 U Wisara Road, Yangon, Myanmar
| | - Julia Cutts
- Disease Elimination Programme, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, Australia
| | - T Hong Phuc Nguyen
- Department of Epidemiology, National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | - May Chan Oo
- Health Security Programme, Burnet Institute Myanmar, 226 U Wisara Road, Yangon, Myanmar
| | - Ei Phyu Htwe
- Health Security Programme, Burnet Institute Myanmar, 226 U Wisara Road, Yangon, Myanmar
| | - Aung Khine Zaw
- Health Security Programme, Burnet Institute Myanmar, 226 U Wisara Road, Yangon, Myanmar
| | - Katherine O'Flaherty
- Disease Elimination Programme, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, Australia
| | - Paul A Agius
- Disease Elimination Programme, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Freya J I Fowkes
- Disease Elimination Programme, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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6
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Yi B, Zhang L, Yin J, Zhou S, Xia Z. 1-3-7 surveillance and response approach in malaria elimination: China's practice and global adaptions. Malar J 2023; 22:152. [PMID: 37161379 PMCID: PMC10169118 DOI: 10.1186/s12936-023-04580-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/28/2023] [Indexed: 05/11/2023] Open
Abstract
There has been a significant reduction in malaria morbidity and mortality worldwide from 2000 to 2019. However, the incidence and mortality increased again in 2020 due to the disruption to services during the COVID-19 pandemic. Surveillance to reduce the burden of malaria, eliminate the disease and prevent its retransmission is, therefore, crucial. The 1-3-7 approach proposed by China has played an important role in eliminating malaria, which has been internationally popularized and adopted in some countries to help eliminate malaria. This review summarizes the experience and lessons of 1-3-7 approach in China and its application in other malaria-endemic countries, so as to provide references for its role in eliminating malaria and preventing retransmission. This approach needs to be tailored and adapted according to the region condition, considering the completion, timeliness and limitation of case-based reactive surveillance and response. It is very important to popularize malaria knowledge, train staff, improve the capacity of health centres and monitor high-risk groups to improve the performance in eliminating settings. After all, remaining vigilance in detecting malaria cases and optimizing surveillance and response systems are critical to achieving and sustaining malaria elimination.
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Affiliation(s)
- Boyu Yi
- 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 Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025, China
| | - Li Zhang
- 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 Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025, China
| | - Jianhai Yin
- 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 Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025, China
| | - Shuisen Zhou
- 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 Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025, China
| | - Zhigui Xia
- 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 Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025, China.
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7
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Huang F, Zhang L, Xia ZG. Insights into the elimination of vivax malaria in China. Infect Dis Poverty 2023; 12:23. [PMID: 36941701 PMCID: PMC10025774 DOI: 10.1186/s40249-023-01077-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/09/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Malaria is caused by multiple parasitic species of the genus Plasmodium. Plasmodium vivax is the most geographically widespread and poses challenges in elimination due to its unique biological and epidemiological characteristics. The aim of study was to highlight the practices and experience targeting vivax malaria control and elimination in China. MAIN BODY P. vivax malaria was historically endemic in more than 70% of counties in China, with reported vivax malaria cases as high as 26 million a year. After around 70 years of effort, China was certified as malaria-free in June of 2021. The key insights into China's vivax malaria control and elimination were offered, including radical cure strategies, comprehensive but adaptive strategies targeting species of Plasmodium and Anopheles, mass drug administration, and case-/focus-centred surveillance and response systems. CONCLUSION The complete global eradication of P. vivax and eventually malaria will be more difficult, and China's practices and experience could be a valuable reference in this campaign.
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Affiliation(s)
- Fang Huang
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China
| | - Li Zhang
- 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 Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025, China
| | - Zhi-Gui Xia
- 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 Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025, China.
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Aidoo EK, Aboagye FT, Botchway FA, Osei-Adjei G, Appiah M, Duku-Takyi R, Sakyi SA, Amoah L, Badu K, Asmah RH, Lawson BW, Krogfelt KA. Reactive Case Detection Strategy for Malaria Control and Elimination: A 12 Year Systematic Review and Meta-Analysis from 25 Malaria-Endemic Countries. Trop Med Infect Dis 2023; 8:tropicalmed8030180. [PMID: 36977181 PMCID: PMC10058581 DOI: 10.3390/tropicalmed8030180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/23/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
Reactive case detection (RACD) is the screening of household members and neighbors of index cases reported in passive surveillance. This strategy seeks asymptomatic infections and provides treatment to break transmission without testing or treating the entire population. This review discusses and highlights RACD as a recommended strategy for the detection and elimination of asymptomatic malaria as it pertains in different countries. Relevant studies published between January 2010 and September 2022 were identified mainly through PubMed and Google Scholar. Search terms included "malaria and reactive case detection", "contact tracing", "focal screening", "case investigation", "focal screen and treat". MedCalc Software was used for data analysis, and the findings from the pooled studies were analyzed using a fixed-effect model. Summary outcomes were then presented using forest plots and tables. Fifty-four (54) studies were systematically reviewed. Of these studies, 7 met the eligibility criteria based on risk of malaria infection in individuals living with an index case < 5 years old, 13 met the eligibility criteria based on risk of malaria infection in an index case household member compared with a neighbor of an index case, and 29 met the eligibility criteria based on risk of malaria infection in individuals living with index cases, and were included in the meta-analysis. Individuals living in index case households with an average risk of 2.576 (2.540-2.612) were more at risk of malaria infection and showed pooled results of high variation heterogeneity chi-square = 235.600, (p < 0.0001) I2 = 98.88 [97.87-99.89]. The pooled results showed that neighbors of index cases were 0.352 [0.301-0.412] times more likely to have a malaria infection relative to index case household members, and this result was statistically significant (p < 0.001). The identification and treatment of infectious reservoirs is critical to successful malaria elimination. Evidence to support the clustering of infections in neighborhoods, which necessitates the inclusion of neighboring households as part of the RACD strategy, was presented in this review.
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Affiliation(s)
- Ebenezer Krampah Aidoo
- Department of Medical Laboratory Technology, Accra Technical University, Accra GP 561, Ghana
| | - Frank Twum Aboagye
- Biomedical and Public Health Research Unit, Council for Scientific and Industrial Research-Water Research Institute, Accra AH 38, Ghana
| | - Felix Abekah Botchway
- Department of Medical Laboratory Technology, Accra Technical University, Accra GP 561, Ghana
| | - George Osei-Adjei
- Department of Medical Laboratory Technology, Accra Technical University, Accra GP 561, Ghana
| | - Michael Appiah
- Department of Medical Laboratory Technology, Accra Technical University, Accra GP 561, Ghana
| | - Ruth Duku-Takyi
- Department of Medical Laboratory Technology, Accra Technical University, Accra GP 561, Ghana
| | - Samuel Asamoah Sakyi
- Department of Molecular Medicine, Kwame Nkrumah University of Science & Technology, University Post Office, Kumasi AK 039, Ghana
| | - Linda Amoah
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra LG 581, Ghana
| | - Kingsley Badu
- Department of Theoretical & Applied Biology, Kwame Nkrumah University of Science & Technology, University Post Office, Kumasi AK 039, Ghana
| | - Richard Harry Asmah
- Department of Biomedical Sciences, School of Basic and Biomedical Science, University of Health & Allied Sciences, Ho PMB 31, Ghana
| | - Bernard Walter Lawson
- Department of Theoretical & Applied Biology, Kwame Nkrumah University of Science & Technology, University Post Office, Kumasi AK 039, Ghana
| | - Karen Angeliki Krogfelt
- Department of Science and Environment, Unit of Molecular and Medical Biology, The PandemiX Center, Roskilde University, 4000 Roskilde, Denmark
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, 2300 Copenhagen, Denmark
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Survey of malaria vectors on the Cambodia, Thailand and China-Laos Borders. Malar J 2022; 21:399. [PMID: 36585690 PMCID: PMC9801360 DOI: 10.1186/s12936-022-04418-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Anopheles maculatus, Anopheles minimus and Anopheles dirus are the major vectors of malaria transmission in the Greater Mekong Subregion (GMS). The malaria burden in this region has decreased significantly in recent years as all GMS countries progress towards malaria elimination. It is necessary to investigate the Anopheles diversity and abundance status and assess the Plasmodium infection rates to understand the malaria transmission potential of these vector species in GMS countries to guide the development of up-to-date vector control strategies and interventions. METHODS A survey of mosquitoes was conducted in Stung Treng, Sainyabuli and Phongsaly Provinces on the Cambodia-Laos, Thailand-Laos and China-Laos borders, respectively. Mosquito collection was done by overnight trapping at sentinel sites in each province. After morphological identification, the 18S rRNA-based nested-PCR was performed to detect malaria parasites in the captured Anopheles mosquitoes. RESULTS A total of 18 965 mosquitoes comprising of 35 species of 2 subgenera (Subgenus Anopheles and Subgenus Cellia) and 4 tribes (Tribes Culicini, Aedini, Armigerini and Mansoniini) were captured. Tribe Culicini accounted for 85.66% of captures, followed by Subgenus Anopheles (8.15%). Anopheles sinensis dominated the Subgenus Anopheles by 99.81%. Plasmodium-infection was found in 25 out of the 1 683 individual or pooled samples of Anopheles. Among the 25 positive samples, 19, 5 and 1 were collected from Loum, Pangkhom and Siem Pang village, respectively. Eight Anopheles species were found infected with Plasmodium, i.e., An. sinensis, Anopheles kochi, Anopheles vagus, An. minimus, Anopheles annularis, Anopheles philippinensis, Anopheles tessellatus and An. dirus. The infection rates of Plasmodium falciparum, Plasmodium vivax and mixture of Plasmodium parasite species were 0.12% (2/1 683), 1.31% (22/1 683) and 0.06% (1/1 683), respectively. CONCLUSIONS Overall, this survey re-confirmed that multiple Anopheles species carry malaria parasites in the international border areas of the GMS countries. Anopheles sinensis dominated the Anopheles collections and as carriers of malaria parasites, therefore may play a significant role in malaria transmission. More extensive investigations of malaria vectors are required to reveal the detailed vector biology, ecology, behaviour, and genetics in GMS regions in order to assist with the planning and implementation of improved malaria control strategies.
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Phok S, Tesfazghi K, Tompsett A, Thavrine B, Ly P, Hassan SED, Avrakotos A, Malster J, Felker-Kantor E. Behavioural determinants of malaria risk, prevention, and care-seeking behaviours among forest-goers in Cambodia. Malar J 2022; 21:362. [PMID: 36457085 PMCID: PMC9716661 DOI: 10.1186/s12936-022-04390-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cambodia has made significant progress towards achieving malaria elimination by 2025. Cases continue to decrease and are primarily concentrated in forested areas. Forest-goers are most at risk of malaria due to their proximity to the forest, poor sleeping conditions, frequent mobility, and distance from health services. Consistent use of long-lasting insecticidal nets or hammock nets (LLINs/LLIHNs), early diagnosis and treatment of cases are central to reducing disease burden. The aim of this study was to understand forest-goers' knowledge, attitudes, and practices related to malaria prevention and care-seeking, and to identify key behavioural determinants of LLIN/LLIHN use and prompt care-seeking within 24 h of developing a fever. METHODS A mixed-methods study design consisting of a cross-sectional survey and qualitative in-depth interviews was implemented in two Cambodian provinces. Survey participants (N = 654) were recruited using respondent driven sampling. Interview participants (N = 28) were selected using purposive sampling. Findings from the survey were analysed using univariate and bivariate analysis and multivariate weighted logistic regression. Interviews were coded and analysed using thematic content analysis. RESULTS All study participants had heard of malaria and 98% knew that malaria was transmitted by mosquitoes. LLIN/LLIHN ownership was high (94%). Although 99% of participants perceived LLIN/LLIHN use as an important malaria prevention measure, only 76% reported using one during their last visit to the forest. Only 39% of survey participants who reported seeking care did so within the recommended 24 h from fever onset during their last febrile illness. Among all study participants, 43% did not seek any healthcare during their last febrile episode. In controlled regression models, perceived community social norms were significantly associated with LLIN/LLIHN use (OR: 2.7, 96% CI 1.99-2.64) and care-seeking within 24 h of fever onset (OR: 1.7, 95% CI 1.00-2.88). Social support from other forest-goers was also significantly associated with LLIN/LLIHN use (OR: 4.9, 95% CI 1.32-18.12). CONCLUSIONS Study findings are consistent with other studies on LLIN/LLIHN use and care-seeking behaviours. While rates of LLIN/LLIHN ownership were high among the study population, rates of use were not as high. More concerning were the delayed care-seeking behaviours. Social behaviour change activities should incorporate social norms and social support as mechanisms for behaviour change given the identified positive correlations with LLIN/LLIHN use and prompt care-seeking.
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Affiliation(s)
- Sochea Phok
- Population Services International, Phnom Penh, Cambodia
| | - Kemi Tesfazghi
- grid.423224.10000 0001 0020 3631Population Services International, Washington, DC USA
| | - Andy Tompsett
- grid.423224.10000 0001 0020 3631Population Services International, Washington, DC USA
| | - Boukheng Thavrine
- grid.452707.3National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Po Ly
- grid.452707.3National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Saad El-Din Hassan
- US President’s Malaria Initiative, United States Agency for International Development, Phnom Penh, Cambodia
| | - Avery Avrakotos
- grid.420285.90000 0001 1955 0561US President’s Malaria Initiative, United States Agency for International Development, Washington, DC USA
| | - Jim Malster
- Population Services International, Phnom Penh, Cambodia
| | - Erica Felker-Kantor
- grid.423224.10000 0001 0020 3631Population Services International, Washington, DC USA
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Sudathip P, Naowarat S, Kitchakarn S, Gopinath D, Bisanzio D, Pinyajeerapat N, Sintasath D, Shah JA. Assessing Thailand's 1-3-7 surveillance strategy in accelerating malaria elimination. Malar J 2022; 21:222. [PMID: 35850687 PMCID: PMC9294779 DOI: 10.1186/s12936-022-04229-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/21/2022] [Indexed: 12/19/2022] Open
Abstract
Background Thailand’s strong malaria elimination programme relies on effective implementation of its 1-3-7 surveillance strategy, which was endorsed and implemented nationwide in 2016. For each confirmed malaria patient, the Ministry of Public Health’s Division of Vector Borne Diseases (DVBD) ensures completion of case notification within 1 day, case investigation within 3 days, and foci investigation within 7 days. To date, there has not been a comprehensive assessment of the performance and achievements of the 1-3-7 surveillance strategy although such results could help Thailand’s future malaria elimination strategic planning. Methods This study examined adherence to the 1-3-7 protocols, tracked progress against set targets, and examined geographic variations in implementation of the 1-3-7 strategy in the programme’s initial 5 years. An auto-regressive integrated moving average (ARIMA) time series analysis with seasonal decomposition assessed the plausible implementation effect of the 1-3-7 strategy on malaria incidence in the programme’s initial 5 years. The quantitative analysis included all confirmed malaria cases from public health and non-governmental community facilities from October 2014 to September 2021 (fiscal year [FY] 2015 to FY 2021) (n = 77,405). The spatial analysis included active foci with known geocoordinates that reported more than five cases from FY 2018 to FY 2021. Results From FY 2017 to FY 2021, on-time case notification improved from 24.4% to 89.3%, case investigations from 58.0% to 96.5%, and foci investigations from 37.9% to 87.2%. Adherence to timeliness protocols did not show statistically significant variation by area risk classification. However, adherence to 1-3-7 protocols showed a marked spatial heterogeneity among active foci, and the ARIMA model showed a statistically significant acceleration in the reduction of malaria incidence. The 1-3-7 strategy national indicators and targets in Thailand have shown progressive success, and most targets were achieved for FY 2021. Conclusion The results of Thailand’s 1-3-7 surveillance strategy are associated with a decreased incidence in the period following the adoption of the strategy although there is notable geographic variation. The DVBD will continue to implement and adapt the 1-3-7 strategy to accelerate progress toward malaria elimination. This assessment may be useful for domestic strategic planning and to other countries considering more intensive case and foci investigation and response strategies.
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Affiliation(s)
- Prayuth Sudathip
- Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Sathapana Naowarat
- Inform Asia: USAID's Health Research Program, RTI International, Bangkok, Thailand
| | - Suravadee Kitchakarn
- Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Donal Bisanzio
- Inform Asia: USAID's Health Research Program, RTI International, Bangkok, Thailand
| | - Niparueradee Pinyajeerapat
- U.S. President's Malaria Initiative, United States Agency for International Development (USAID), Regional Development Mission for Asia, Bangkok, Thailand
| | - David Sintasath
- U.S. President's Malaria Initiative, United States Agency for International Development (USAID), Regional Development Mission for Asia, Bangkok, Thailand
| | - Jui A Shah
- Inform Asia: USAID's Health Research Program, RTI International, Bangkok, Thailand.
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Feng X, Huang F, Yin J, Wang R, Xia Z. Key takeaways from China's success in eliminating malaria: leveraging existing evidence for a malaria-free world. BMJ Glob Health 2022; 7:bmjgh-2021-008351. [PMID: 35487673 PMCID: PMC9058700 DOI: 10.1136/bmjgh-2021-008351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/27/2022] [Indexed: 12/16/2022] Open
Abstract
Although the total number of malaria cases and fatalities have declined globally since 2010, there were still 241 million malaria cases identified across 85 countries and territories in 2020. As the global malaria eradication process accelerates, more countries have launched their own initiatives of elimination. Notably, China achieved this goal by 2021, ending thousands of years of endemic. Undoubtedly, tremendous experience and vital lessons have been accrued en route to the malaria-free goal in malaria-eliminated countries including China. To enhance prospects of a malaria-free world by bridging the key evidence from a malaria-eliminated country to the contexts of affected, this personal view highlights concerted commitments and universal investment in healthcare, improved surveillance and response system, constant capacity building, demand-oriented scientific research, and multiway cooperation, which have helped China to eliminate this ancient scourge. We discuss how these key takeaways could be leveraged to different contexts. We also argue the long-term challenges and barriers on the pathway to malaria elimination and underline the needs for consistent efforts to maintain zero indigenous cases and prevent re-introduction of malaria. Through concerted efforts from global collaboration, a malaria-free world can become a reality.
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Affiliation(s)
- Xinyu Feng
- 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, China
| | - Fang Huang
- 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, China
| | - Jianhai Yin
- 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, China
| | - Rubo Wang
- 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, China
| | - Zhigui Xia
- 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, China
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Developing sero-diagnostic tests to facilitate Plasmodium vivax Serological Test-and-Treat approaches: modeling the balance between public health impact and overtreatment. BMC Med 2022; 20:98. [PMID: 35300700 PMCID: PMC8932240 DOI: 10.1186/s12916-022-02285-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/07/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Eliminating Plasmodium vivax will require targeting the hidden liver-stage reservoir of hypnozoites. This necessitates new interventions balancing the benefit of reducing vivax transmission against the risk of over-treating some individuals with drugs which may induce haemolysis. By measuring antibodies to a panel of vivax antigens, a strategy of serological-testing-and-treatment (PvSeroTAT) can identify individuals with recent blood-stage infections who are likely to carry hypnozoites and target them for radical cure. This provides a potential solution to selectively treat the vivax reservoir with 8-aminoquinolines. METHODS PvSeroTAT can identify likely hypnozoite carriers with ~80% sensitivity and specificity. Diagnostic test sensitivities and specificities ranging 50-100% were incorporated into a mathematical model of vivax transmission to explore how they affect the risks and benefits of different PvSeroTAT strategies involving hypnozoiticidal regimens. Risk was measured as the rate of overtreatment and benefit as reduction of community-level vivax transmission. RESULTS Across a wide range of combinations of diagnostic sensitivity and specificity, PvSeroTAT was substantially more effective than bloodstage mass screen and treat strategies and only marginally less effective than mass drug administration. The key test characteristic determining of the benefit of PvSeroTAT strategies is diagnostic sensitivity, with higher values leading to more hypnozoite carriers effectively treated and greater reductions in vivax transmission. The key determinant of risk is diagnostic specificity: higher specificity ensures that a lower proportion of uninfected individuals are unnecessarily treated with primaquine. These relationships are maintained in both moderate and low transmission settings (qPCR prevalence 10% and 2%). Increased treatment efficacy and adherence can partially compensate for lower test performance. Multiple rounds of PvSeroTAT with a lower performing test may lead to similar or higher reductions in vivax transmission than fewer rounds with a higher performing test, albeit with higher rate of overtreatment. CONCLUSIONS At current performance, PvSeroTAT is predicted to be a safe and efficacious option for targeting the hypnozoite reservoir towards vivax elimination. P. vivax sero-diagnostic tests should aim for both high performance and ease of use in the field. The target product profiles informing such development should thus reflect the trade-offs between impact, overtreatment, and ease of programmatic implementation.
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Cao Y, Lu G, Cotter C, Wang W, Yang M, Liu Y, Liang C, Zhou H, Lu Y, Yan J, Zhu G, Cao J. Improving the surveillance and response system to achieve and maintain malaria elimination: a retrospective analysis in Jiangsu Province, China. Infect Dis Poverty 2022; 11:20. [PMID: 35184760 PMCID: PMC8858722 DOI: 10.1186/s40249-022-00939-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/18/2022] [Indexed: 12/17/2022] Open
Abstract
Background Following initiation of China’s National Malaria Elimination Action Plan (NMEAP) in 2010, the ‘1-3-7’ approach was developed and rolled out in China to facilitate the malaria elimination programme and accelerate malaria elimination. This study aims to summarize and condense these experiences through a retrospective analysis in Jiangsu Province, which could be adapted and applied in other malaria elimination settings worldwide. Methods A retrospective analysis of imported malaria cases into China identified through an improved surveillance and response system in Jiangsu Province was carried out for the period of 2001–2020. To improve the malaria surveillance and response system, Centers for Diseases Control and Prevention from the prefectures and counties in Jiangsu province conducted population-level health education to improve healthcare seeking behavior, strengthened capacity of health facilities to improve performance of malaria diagnosis and treatment, and raised the capacity of public health providers to improve implementation of the ‘1-3-7’ approach. Categorical variables were carried out by Chi square tests with Fisher’s exact correction. Results From 2001 to 2020, a total of 9,879 malaria cases were reported in Jiangsu Province. Since 2012, no indigenous malaria cases have been reported in Jiangsu Province. However, in recent years, there has been a substantial increase of imported falciparum malaria cases. Between 2012 and 2020, an estimated 61.57 million individuals have benefited from population-level health education in Jiangsu Province. For healthcare-seeking services among the 2,423 imported malaria cases, 687 (28.4%) and 1,104 (45.6%) cases visited hospitals on the first day and the second day from symptom onset, respectively. A total of 1,502 (61.9%) cases were diagnosed on the first day at medical facilities. Jiangsu Province achieved 100%, 99.4% and 98.3% completion rate in terms of case detection and notification (within one day), case investigation (within three days) and foci response and disposition (within seven days), respectively. The improved surveillance and response system in Jiangsu Province plays an important role in preventing the re-introduction of malaria and maintaining the malaria-free status. Conclusions Jiangsu Province has maintained its malaria-free status since 2012. The continuous improvement of a surveillance and response system plays an important role in the early detection and rapid response of potential malaria-related outbreaks in Jiangsu, China, and has important lessons for other malaria eliminating settings. Remaining vigilant in the detection of imported malaria cases and maintaining an active surveillance and response system is critical to sustain the success of malaria elimination. Graphic Abstract ![]()
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Measurements of 5,6 orthoquinone, surrogate for presumed active primaquine metabolite 5-hydroxyprimaquine, in the urine of Cambodian adults. Antimicrob Agents Chemother 2022; 66:e0182121. [DOI: 10.1128/aac.01821-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The active metabolites of primaquine, in particular 5-hydroxyprimaquine, likely responsible for clearance of dormant hypnozoites, are produced through the hepatic CYP450 2D6 (CYP2D6) enzymatic pathway. With the inherent instability of 5-hydroxyprimaquine, a stable surrogate, 5,6 orthoquinone, can now be detected and measured in the urine as part of primaquine pharmacokinetic studies. This study performed CYP450 2D6 genotyping and primaquine pharmacokinetic testing, to include urine 5,6 orthoquinone, in 27 healthy adult Cambodians, as a preliminary step to prepare for future clinical studies assessing primaquine efficacy for
Plasmodium vivax
infections. The CYP2D6 *10 reduced activity allele was found in 57% of volunteers, and the CYP2D6 genotypes were dominated by *1/*10 (33%) and *10/*10 (30%). Predicted phenotypes were evenly split between Normal Metabolizer (NM) and Intermediate Metabolizer (IM) except one volunteer with a gene duplication and unclear phenotype, classifying as either IM or NM. Median plasma PQ area under the curve (AUC) was lower in the NM group (460 hr*ng/mL) compared to the IM group (561 hr*ng/mL), although not statistically significant. Similar to what has been found in the US study, no 5,6 orthoquinone was detected in the plasma. The urine creatinine-corrected 5,6 orthoquinone AUC in the NM group was almost three times higher than in the IM group, with peak measurements (T
max
) at 4 hours. Although there is variation among individuals, future studies examining the relationship between the levels of urine 5,6 orthoquinone and primaquine radical cure efficacy could result in a metabolism biomarker predictive of radical cure.
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Clustering of malaria in households in the Greater Mekong Subregion: operational implications for reactive case detection. Malar J 2021; 20:351. [PMID: 34446009 PMCID: PMC8393740 DOI: 10.1186/s12936-021-03879-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Malaria reactive case detection is the testing and, if positive, treatment of close contacts of index cases. It is included in national malaria control programmes of countries in the Greater Mekong Subregion to accelerate malaria elimination. Yet the value of reactive case detection in the control and elimination of malaria remains controversial because of the low yield, limited evidence for impact, and high demands on resources. Methods Data from the epidemiological assessments of large mass drug administration (MDA) studies in Myanmar, Vietnam, Cambodia and Laos were analysed to explore malaria infection clustering in households. The proportion of malaria positive cases among contacts screened in a hypothetical reactive case detection programme was then determined. The parasite density thresholds for rapid diagnostic test (RDT) detection was assumed to be > 50/µL (50,000/mL), for dried-blood-spot (DBS) based PCR > 5/µL (5000/mL), and for ultrasensitive PCR (uPCR) with a validated limit of detection at 0.0022/µL (22/mL). Results At baseline, before MDA, 1223 Plasmodium infections were detected by uPCR in 693 households. There was clustering of Plasmodium infections. In 637 households with asymptomatic infections 44% (278/637) had more than one member with Plasmodium infections. In the 132 households with symptomatic infections, 65% (86/132) had more than one member with Plasmodium infections. At baseline 4% of households had more than one Plasmodium falciparum infection, but three months after MDA no household had more than one P. falciparum infected member. Reactive case detection using DBS PCR would have detected ten additional cases in six households, and an RDT screen would have detected five additional cases in three households among the 169 households with at least one RDT positive case. This translates to 19 and 9 additional cases identified per 1000 people screened, respectively. Overall, assuming all febrile RDT positive patients would seek treatment and provoke reactive case detection using RDTs, then 1047 of 1052 (99.5%) Plasmodium infections in these communities would have remained undetected. Conclusion Reactive case detection in the Greater Mekong subregion is predicted to have a negligible impact on the malaria burden, but it has substantial costs in terms of human and financial resources. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03879-9.
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A retrospective analysis of malaria epidemiological characteristics in Yingjiang County on the China-Myanmar border. Sci Rep 2021; 11:14129. [PMID: 34239003 PMCID: PMC8266812 DOI: 10.1038/s41598-021-93734-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/15/2021] [Indexed: 11/08/2022] Open
Abstract
Yingjiang County, which is on the China–Myanmar border, is the main focus for malaria elimination in China. The epidemiological characteristics of malaria in Yingjiang County were analysed in a retrospective analysis. A total of 895 malaria cases were reported in Yingjiang County between 2013 and 2019. The majority of cases occurred in males (70.7%) and individuals aged 19–59 years (77.3%). Plasmodium vivax was the predominant species (96.6%). The number of indigenous cases decreased gradually and since 2017, no indigenous cases have been reported. Malaria cases were mainly distributed in the southern and southwestern areas of the county; 55.6% of the indigenous cases were reported in Nabang Township, which also had the highest risk of imported malaria. The “1–3–7” approach has been implemented effectively, with 100% of cases reported within 24 h, 88.9% cases investigated and confirmed within 3 days and 98.5% of foci responded to within 7 days. Although malaria elimination has been achieved in Yingjiang County, sustaining elimination and preventing the re-establishment of malaria require the continued strengthening of case detection, surveillance and response systems targeting the migrant population in border areas.
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Deen J, Mukaka M, von Seidlein L. What is the yield of malaria reactive case detection in the Greater Mekong Sub-region? A review of published data and meta-analysis. Malar J 2021; 20:131. [PMID: 33663484 PMCID: PMC7934542 DOI: 10.1186/s12936-021-03667-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/24/2021] [Indexed: 01/01/2023] Open
Abstract
Background Reactive malaria case detection involves the screening of those in contact with index cases and is used in countries in the Greater Mekong Sub-region. The yield of reactive case detection, defined here as the percentage of positive malaria cases among potential contacts who were screened, was assessed. Methods A literature search was conducted on PubMed to identify studies on reactive case detection in the Greater Mekong Sub-region. Eligible published articles were reviewed and pooled estimates from the studies were calculated, by type of malaria test used. Results Eighty-five publications were retrieved, of which 8 (9.4%) eligible articles were included in the analysis. The yield from reactive case detection ranged from 0.1 to 4.2%, with higher rates from PCR testing compared with microscopy and/or rapid diagnostic test. The overall yield from microscopy and/or rapid diagnostic test was 0.56% (95% CI 0.31–0.88%), while that from PCR was 2.35% (95% CI 1.19–3.87%). The two studies comparing different target groups showed higher yield from co-workers/co-travellers, compared with household contacts. Conclusion In low malaria transmission settings, the effectiveness of reactive case detection is diminishing. In the Greater Mekong Sub-region, modifying reactive case detection from household contacts to co-workers/co-travellers and from testing to presumptive treatment of targeted contacts, could increase the impact of this approach.
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Affiliation(s)
- Jacqueline Deen
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, 623 P. Gil St, 1000, Manila, Philippines.
| | - Mavuto Mukaka
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lorenz von Seidlein
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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A foci cohort analysis to monitor successful and persistent foci under Thailand's Malaria Elimination Strategy. Malar J 2021; 20:118. [PMID: 33639951 PMCID: PMC7910787 DOI: 10.1186/s12936-021-03648-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 12/04/2022] Open
Abstract
Background Thailand’s success in reducing malaria burden is built on the efficient “1-3-7” strategy applied to the surveillance system. The strategy is based on rapid case notification within 1 day, case investigation within 3 days, and targeted foci response to reduce the spread of Plasmodium spp. within 7 days. Autochthonous transmission is still occurring in the country, threatening the goal of reaching malaria-free status by 2024. This study aimed to assess the effectiveness of the 1-3-7 strategy and identify factors associated with presence of active foci. Methods Data from the national malaria information system were extracted from fiscal years 2013 to 2019; after data cleaning, the final dataset included 81,012 foci. A Cox’s proportional hazards model was built to investigate factors linked with the probability of becoming an active focus from 2015 to 2019 among foci that changed status from non-active to active focus during the study period. We performed a model selection technique based on the Akaike Information Criteria (AIC). Results The number of yearly active foci decreased from 2227 to 2013 to 700 in 2019 (68.5 %), and the number of autochthonous cases declined from 17,553 to 3,787 (78.4 %). The best Cox’s hazard model showed that foci in which vector control interventions were required were 18 % more likely to become an active focus. Increasing compliance with the 1-3-7 strategy had a protective effect, with a 22 % risk reduction among foci with over 80 % adherence to 1-3-7 timeliness protocols. Other factors associated with likelihood to become or remain an active focus include previous classification as an active focus, presence of Plasmodium falciparum infections, level of forest disturbance, and location in border provinces. Conclusions These results identified factors that favored regression of non-active foci to active foci during the study period. The model and relative risk map align with the national malaria program’s district stratification and shows strong spatial heterogeneity, with high probability to record active foci in border provinces. The results of the study may be useful for honing Thailand’s program to eliminate malaria and for other countries aiming to accelerate malaria elimination.
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Malaria in Cambodia: A Retrospective Analysis of a Changing Epidemiology 2006-2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041960. [PMID: 33670471 PMCID: PMC7922556 DOI: 10.3390/ijerph18041960] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/22/2021] [Accepted: 02/12/2021] [Indexed: 11/17/2022]
Abstract
Background: In Cambodia, malaria persists with changing epidemiology and resistance to antimalarials. This study aimed to describe how malaria has evolved spatially from 2006 to 2019 in Cambodia. Methods: We undertook a secondary analysis of existing malaria data from all government healthcare facilities in Cambodia. The epidemiology of malaria was described by sex, age, seasonality, and species. Spatial clusters at the district level were identified with a Poisson model. Results: Overall, incidence decreased from 7.4 cases/1000 population in 2006 to 1.9 in 2019. The decrease has been drastic for females, from 6.7 to 0.6/1000. Adults aged 15–49 years had the highest malaria incidence among all age groups. The proportion of Plasmodium (P.) falciparum + Mixed among confirmed cases declined from 87.9% (n = 67,489) in 2006 to 16.6% (n = 5290) in 2019. Clusters of P. falciparum + Mixed and P. vivax + Mixed were detected in forested provinces along all national borders. Conclusions: There has been a noted decrease in P. falciparum cases in 2019, suggesting that an intensification plan should be maintained. A decline in P. vivax cases was also noted, although less pronounced. Interventions aimed at preventing new infections of P. vivax and relapses should be prioritized. All detected malaria cases should be captured by the national surveillance system to avoid misleading trends.
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Choosing interventions to eliminate forest malaria: preliminary results of two operational research studies inside Cambodian forests. Malar J 2021; 20:51. [PMID: 33472630 PMCID: PMC7818569 DOI: 10.1186/s12936-020-03572-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/24/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Rapid elimination of Plasmodium falciparum malaria in Cambodia is a goal with both national and international significance. Transmission of malaria in Cambodia is limited to forest environments, and the main population at risk consists of forest-goers who rely on forest products for income or sustenance. The ideal interventions to eliminate malaria from this population are unknown. METHODS In two forested regions of Cambodia, forest-goers were trained to become forest malaria workers (FMWs). In one region, FMWs performed mass screening and treatment, focal screening and treatment, and passive case detection inside the forest. In the other region, FMWs played an observational role for the first year, to inform the choice of intervention for the second year. In both forests, FMWs collected blood samples and questionnaire data from all forest-goers they encountered. Mosquito collections were performed in each forest. RESULTS Malaria prevalence by PCR was high in the forest, with 2.3-5.0% positive for P. falciparum and 14.6-25.0% positive for Plasmodium vivax among forest-goers in each study site. In vectors, malaria prevalence ranged from 2.1% to 9.6%, but no P. falciparum was observed. Results showed poor performance of mass screening and treatment, with sensitivity of rapid diagnostic tests equal to 9.1% (95% CI 1.1%, 29.2%) for P. falciparum and 4.4% (95% CI 1.6%, 9.2%) for P. vivax. Malaria infections were observed in all demographics and throughout the studied forests, with no clear risk factors emerging. CONCLUSIONS Malaria prevalence remains high among Cambodian forest-goers, but performance of rapid diagnostic tests is poor. More adapted strategies to this population, such as intermittent preventive treatment of forest goers, should be considered.
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Huang F, Zhang L, Xue JB, Zhou HN, Thi A, Zhang J, Zhou SS, Xia ZG, Zhou XN. From control to elimination: a spatial-temporal analysis of malaria along the China-Myanmar border. Infect Dis Poverty 2020; 9:158. [PMID: 33213516 PMCID: PMC7676414 DOI: 10.1186/s40249-020-00777-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/06/2020] [Indexed: 01/27/2023] Open
Abstract
Background Malaria cases have declined significantly along the China-Myanmar border in the past 10 years and this region is going through a process from control to elimination. The aim of this study is to investigate the epidemiology of malaria along the border, will identify challenges in the progress from control to elimination. Methods National reported malaria cases from China and Myanmar, along with the data of 18 Chinese border counties and 23 townships in Myanmar were obtained from a web-based diseases information reporting system in China and the national malaria control program of Myanmar, respectively. Epidemiological data was analyzed, including the number of reported cases, annual parasite index and proportion of vivax infection. Spatial mapping of the annual parasite index (API) at county or township level in 2014 and 2018 was performed by ArcGIS. The relationship of malaria endemicity on both sides of the border was evaluated by regression analysis. Results The number of reported malaria cases and API declined in the border counties or townships. In 2014, 392 malaria cases were reported from 18 Chinese border counties, including 8.4% indigenous cases and 91.6% imported cases, while the highest API (0.11) was occurred in Yingjiang County. There have been no indigenous cases reported since 2017, but 164 imported cases were reported in 2018 and 97.6% were imported from Myanmar. The average API in 2014 in 23 Myanmar townships was significantly greater than that of 18 Chinese counties (P < 0.01). However, the API decreased significantly in Myanmar side from 2014 to 2018 (P < 0.01). The number of townships with an API between 0 and 1 increased to 15 in 2018, compared to only five in 2014, while still four townships had API > 10. Plasmodium vivax was the predominant species along the border. The number of reported malaria cases and the proportion of vivax infection in the 18 Chinese counties were strongly correlated with those of the 23 Myanmar townships (P < 0.05). Conclusions Malaria elimination is approaching along the China-Myanmar border. However, in order to achieve the malaria elimination in this region and prevent the re-establishment of malaria in China after elimination, continued political, financial and scientific commitment is required.
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Affiliation(s)
- Fang Huang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, WHO Collaborating Center for Tropical Diseases, National Centre for International Research on Tropical Diseases, Ministry of Science and Technology, Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025, China
| | - Li Zhang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, WHO Collaborating Center for Tropical Diseases, National Centre for International Research on Tropical Diseases, Ministry of Science and Technology, Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025, China
| | - Jing-Bo Xue
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, WHO Collaborating Center for Tropical Diseases, National Centre for International Research on Tropical Diseases, Ministry of Science and Technology, Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025, China
| | - Hong-Ning Zhou
- Yunnan Institute of Parasitic Diseases, Puer, 665000, China
| | - Aung Thi
- Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, 15011, Myanmar
| | - Jun Zhang
- Health Poverty Action East Asia Programme Office, Kunming, 650000, China
| | - Shui-Sen Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, WHO Collaborating Center for Tropical Diseases, National Centre for International Research on Tropical Diseases, Ministry of Science and Technology, Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025, China
| | - Zhi-Gui Xia
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, WHO Collaborating Center for Tropical Diseases, National Centre for International Research on Tropical Diseases, Ministry of Science and Technology, Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025, China.
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, WHO Collaborating Center for Tropical Diseases, National Centre for International Research on Tropical Diseases, Ministry of Science and Technology, Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025, China.
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