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Tian P, Li S, Zhou Y, Lin Z, Sun X, Guo X, Ding C, Duan K, Chen Q, Zhao Y, Wu J, Bee DY, Xu J. Cooperative Sentinel Surveillance of Malaria in Laiza and Nearby Areas of Myanmar and Importation Threat Monitoring - China, 2019-2023. China CDC Wkly 2024; 6:378-382. [PMID: 38737824 PMCID: PMC11082558 DOI: 10.46234/ccdcw2024.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/17/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction Laiza and nearby areas (LNA) in Myanmar are identified as the primary malaria hotspots in the bordering regions of Yunnan Province, China. Methods Six sentinel surveillance sites were established at the China-Myanmar border in LNA to monitor malaria. Data from 2019 was used as a baseline to analyze malaria incidence and trends in LNA and Myanmar, as well as the importation of malaria cases into China from 2019 to 2023. Results Plasmodium vivax was the predominant species, representing 99.95% (14,060/14,066) of confirmed malaria cases in LNA. A total of 8,356 malaria cases were identified in 2023, with an annual parasite incidence (API) of 19.78 per 100 person-years. Compared to 2019, the incidence rate ratio was 21.47 (95% confidence interval: 18.84, 24.48), indicating that the API in 2023 was 21.47 times higher than that in 2019. In Yunnan, out of 1,016 reported cases, 545 imported cases (53.64%) originated from LNA and spread to 18 (13.95%) out of 129 counties. Ten provinces in China, including Yunnan, reported imported malaria cases from LNA in Myanmar. Conclusions The increase in population, particularly among internally displaced persons, along with inadequate healthcare services, has led to a notable resurgence of malaria in LNA. This resurgence poses a risk to preventing the re-emergence of malaria transmission in China. There is an urgent need for novel collaborative policies, as well as financial and technical assistance, to enhance malaria control efforts in LNA, Myanmar.
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Affiliation(s)
- Peng Tian
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer City, Yunnan Province, China
| | - Shigang Li
- Yingjiang County Center for Disease Control and Prevention, Yingjiang County, Yunnan Province, China
| | - Yaowu Zhou
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer City, Yunnan Province, China
| | - Zurui Lin
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer City, Yunnan Province, China
| | - Xiaodong Sun
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer City, Yunnan Province, China
| | - Xiangrui Guo
- Yingjiang County Center for Disease Control and Prevention, Yingjiang County, Yunnan Province, China
| | - Chunli Ding
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer City, Yunnan Province, China
| | - Kaixia Duan
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer City, Yunnan Province, China
| | - Qiyan Chen
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer City, Yunnan Province, China
| | - Yulong Zhao
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer City, Yunnan Province, China
| | - Jing Wu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer City, Yunnan Province, China
| | - Dakhidam Yaw Bee
- Laiza City Hospital, Laiza Town, Kachin Special Region II, Myanmar
| | - Jianwei Xu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer City, Yunnan Province, China
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2
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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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Liu H, Xu JW, Deng DW, Yaw B, Nbwi HS, Wei C, Zhou XW, Li JX. Artemisinin-naphthoquine plus lower-dose primaquine to treat and prevent recurrence of Plasmodium vivax malaria: an open-label randomized and non-inferiority trial. Parasit Vectors 2024; 17:28. [PMID: 38254128 PMCID: PMC10804781 DOI: 10.1186/s13071-023-06058-8] [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: 07/13/2023] [Accepted: 11/15/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Plasmodium vivax malaria, with the widest geographic distribution, can cause severe disease and death. Primaquine is the main licensed antimalarial drug that can kill hypnozoites. The dose-dependent acute haemolysis in individuals with glucose-6-phospate dehydrogenase (G6PD) deficiency is the main safety concern when using primaquine. The recommended treatment regimen for P. vivax malaria is chloroquine plus primaquine for 14 days (CQPQ14) in Myanmar. The study aimed to evaluate the therapeutic efficacy, safety and adherence for the regimen of artemisinin-naphthoquine plus primaquine for 3 days (ANPQ3) in patients with P. vivax infections compared to those with CQPQ14. METHODS The patients in the ANPQ3 group were given fixed-dose artemisinin-naphthoquine (a total 24.5 mg/kg bodyweight) plus a lower total primaquine dose (0.9 mg/kg bodyweight) for 3 days. The patients in the CQPQ14 group were given a total chloroquine dose of 30 mg/kg body weight for 3 days plus a total primaquine dose of 4.2 mg/kg bodyweight for 14 days. All patients were followed up for 365 days. RESULTS A total of 288 patients completed follow-up, 172 in the ANPQ3 group and 116 in the CQPQ14 group. The first recurrence patients were detected by day 58 in both groups. By day 182, 16 recurrences had been recorded: 12 (7.0%) patients in the ANPQ3 group and 4 (3.4%) in the CQPQ14 group. The difference in recurrence-free patients was 3.5 (-8.6 to 1.5) percentage points between ANPQ3 and CQPQ14 group (P = 0.2946). By day 365, the percentage of recurrence-free patients was not significant between the two groups (P = 0.2257). Mean fever and parasite clearance time of ANPQ3 group were shorter than those in CQPQ14 group (P ≤ 0.001). No severe adverse effect was observed in ANPQ3 group, but five (3.9%) patients had acute haemolysis in CQPQ14 group (P = 0.013). Medication percentage of ANPQ3 group was significantly higher than that of CQPQ14 group (P < 0.0001). CONCLUSIONS Both ANPQ3 and CQPQ14 promised clinical cure efficacy, and the radical cure efficacy was similar between the ANPQ3 and CQPQ14 group. ANPQ3 clears fever and parasites faster than CQPQ14. ANPQ3 is safer and shows better patient adherence to the regimen for treatment of P. vivax malaria along the China-Myanmar border. TRIAL REGISTRATION ChiCTR-INR-17012523. Registered 31 August 2017, https://www.chictr.org.cn/showproj.html?proj=21352.
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Affiliation(s)
- Hui Liu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Pu'er, China, 665000.
| | - Jian-Wei Xu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Pu'er, China, 665000
| | - Dao-Wei Deng
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Pu'er, China, 665000
| | - Bi Yaw
- Laiza City Hospital, Laiza Town, Kachin Special Region II, Myanmar
| | | | - Chun Wei
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Pu'er, China, 665000
| | - Xing-Wu Zhou
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Pu'er, China, 665000
| | - Jian-Xiong Li
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Pu'er, China, 665000
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Liu H, Xu JW, Deng DW, Wang HY, Nie RH, Yin YJ, Li M. Dihydroartemisinin-piperaquine efficacy in Plasmodium falciparum treatment and prevalence of drug-resistant molecular markers along China-Myanmar border in 2014-2023. J Glob Antimicrob Resist 2023; 35:271-278. [PMID: 37816434 DOI: 10.1016/j.jgar.2023.10.001] [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: 03/16/2023] [Revised: 08/23/2023] [Accepted: 10/04/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVES The study aims to monitor dihydroartemisinin-piperaquine (DHA-PPQ) efficacy in Plasmodium falciparum and detect molecular markers associated with its resistance. METHODS The World Health Organization's standard protocol for therapeutic efficacy studies (TES) was performed from 2014 to 2018; integrated drug efficacy surveillance (iDES) was performed from from 2019 to July 2023. Molecular markers were detected by polymerase chain reaction. The association between gene mutations and delayed parasite clearance was analysed by multivariate logistic regression analysis. RESULTS A total of 226 P. falciparum patients were enrolled in the TES from 2014 to 2018, and 26 patients with P. falciparum from Africa were recruited in the iDES from 2019 to July 2023. The PCR-adjusted clinical and parasitological cure rate was 93.7% (95% CI: 92.6-99.5%) in the TES and 96.2% (95% CI: 80.4-99.9%) in the iDEs. Twelve mutants and an overall 55.0% prevalence of pfK13 mutations were detected. Of them, G533S, C447R, C447S, N458Y, C469Y, and A676D were first detected out along the China-Myanmar border. Referred to the wild strain, adjusted odds ratios of treatment failure for G533S, N458Y, and P574L by 42 days were 7.54 (95% CI: 1.605-45.86), 13.68 (95% CI: 1.95-130.72), and 89.00 (95% CI: 1.98-2482.1), respectively. CONCLUSION The efficacy of DHA-PPQ from 2014 to 2018 declined in comparison with 2003 to 2013, but it is still effective for treatment of P. falciparum malaria. Results of the iDES indicate a risk of artemisinin resistance in Africa. G533S, N458Y, and P574L are associated with delayed parasite clearance and treatment failure.
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Affiliation(s)
- Hui Liu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, China
| | - Jian-Wei Xu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, China
| | - Dao-Wei Deng
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, China
| | - Heng-Ye Wang
- People's Hospital of Puer Municipality, Puer, China
| | - Ren-Hua Nie
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, China
| | - Yi-Jie Yin
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, China
| | - Mei Li
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China.
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5
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Xu JW, Deng DW, Wei C, Zhou XW, Li JX. Treatment-seeking behaviours of malaria patients versus non-malaria febrile patients along China-Myanmar border. Malar J 2023; 22:309. [PMID: 37833761 PMCID: PMC10576386 DOI: 10.1186/s12936-023-04747-4] [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: 03/14/2023] [Accepted: 10/08/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Appropriate malaria treatment-seeking behaviour (TSB) is critical for timely detecting malaria, prompt treatment, and prevention of onward transmission of the disease in a community. This study aimed to compare treatment-seeking behaviours between malaria patients and non-malaria febrile patients, and to analyse the factors associated with appropriate TSB along the China-Myanmar border. METHODS A cross-sectional study was carried out to investigate the appropriate TSB of microscopy-confirmed malaria patients versus non-malaria febrile (NMF) patients. An unconditional logistic regression analysis (LRA) was used to identify factors associated with appropriate TSB. RESULTS Among 223 malaria patients and 446 NMF patients, 129 (57.8%) of the malaria patients versus 163 (36.5%) of the NMF patients firstly sought treatment in health facilities without laboratory testing for malaria (P < 0.0001). A total of 85(38.1%) of the malaria patients versus 278 (62.3%) of the NMF patients had appropriate TSB, namely, seeking treatment in health facilities with laboratory testing for malaria within 48 h (P < 0.0001). Multivariate LRA identified that the malaria patients with Chinese nationality had less appropriate TSB compared to those with other nationalities (adjusted odds ratio [AOR]: 0.21, 95% confidence interval CI 0.07-0.68, P = 0.0097), and malaria patients residing in urban areas had more appropriate TSB compared to those living in rural areas (AOR: 2.16, 95%CI 1.06-4.39, P = 0.0337). CONCLUSIONS TSB was not appropriate in malaria patients. Chinese citizenship and rural residence were two independent factors associated with inappropriate malaria TSB. It is urgently necessary to improve appropriate malaria TSB through effective campaigns of information, education, and communication for malaria control in Myanmar and preventing reestablishment of malaria transmission in Yunnan, China.
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Affiliation(s)
- Jian-Wei Xu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research; Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia; Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, 665000, China.
| | - Dao-Wei Deng
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research; Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia; Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, 665000, China
| | - Chun Wei
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research; Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia; Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, 665000, China
| | - Xing-Wu Zhou
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research; Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia; Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, 665000, China
| | - Jian-Xiong Li
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research; Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia; Yunnan International Joint Laboratory of Tropical Infectious Diseases, Puer, 665000, China
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6
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Li X, Snow RW, Lindblade K, Noor AM, Steketee R, Rabinovich R, Gopinath D, Gasimov E, Alonso PL. Border malaria: defining the problem to address the challenge of malaria elimination. Malar J 2023; 22:239. [PMID: 37605226 PMCID: PMC10440889 DOI: 10.1186/s12936-023-04675-3] [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: 04/30/2023] [Accepted: 08/13/2023] [Indexed: 08/23/2023] Open
Abstract
Border malaria is frequently cited as an obstacle to malaria elimination and sometimes used as a justification for the failure of elimination. Numerous border or cross-border meetings and elimination initiatives have been convened to address this bottleneck to elimination. In this Perspective, border malaria is defined as malaria transmission, or the potential for transmission, across or along shared land borders between countries where at least one of them has ongoing malaria transmission. Border malaria is distinct from malaria importation, which can occur anywhere and in any country. The authors' analysis shows that the remaining transmission foci of malaria-eliminating countries tend to occur in the vicinity of international land borders that they share with neighbouring endemic countries. The reasons why international land borders often represent the last mile in malaria elimination are complex. The authors argue that the often higher intrinsic transmission potential, the neglect of investment and development, the constant risk of malaria importation due to cross-border movement, the challenges of implementing interventions in complex environments and uncoordinated action in a cross-border shared transmission focus all contribute to the difficulties of malaria elimination in border areas. Border malaria reflects the limitations of the current tools and interventions for malaria elimination and implies the need for social cohesion, basic health services, community economic conditions, and policy dialogue and coordination to achieve the expected impact of malaria interventions. Given the uniqueness of each border and the complex and multifaceted nature of border malaria, a situation analysis to define and characterize the determinants of transmission is essential to inform a problem-solving mindset and develop appropriate strategies to eliminate malaria in these areas.
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Affiliation(s)
- Xiaohong Li
- Global Malaria Programme, World Health Organization, Geneva, Switzerland.
| | - Robert W Snow
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Kim Lindblade
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Abdisalan M Noor
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Deyer Gopinath
- World Health Organization Country Office, Bangkok, Thailand
| | - Elkhan Gasimov
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Pedro L Alonso
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
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7
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Sun XD, Zhao YL, Lin ZR, Zhao Y, Zhou YW, Li SG, Guo XR, Tian P, Duan KX, Ding CL, Chen QY, Sui Y, Lu SN, Cotter C, Wang DQ, Zheng Z. Implementing a novel capture and ligation probe-PCR method in mass screen and treatment to support malaria elimination efforts in the China-Myanmar border region. Malar J 2023; 22:21. [PMID: 36658578 PMCID: PMC9854064 DOI: 10.1186/s12936-023-04449-x] [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: 06/30/2022] [Accepted: 01/07/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Mass screening and treatment (MSAT) for malaria elimination lacks an ideal diagnostic tool to allow sensitive and affordable test of the target population in the field. This study evaluated whether Capture and Ligation Probe-PCR (CLIP-PCR) could be used in a field MSAT in Laiza City, Myanmar. METHODS On day 0, two dried blood spots were collected from each participant. On day 1, all samples were screened for Plasmodium in a 20 m2 laboratory with workbench, a biosafety cabinet, a refrigerator, a benchtop shaking incubator and a qPCR machine, by four technicians using CLIP-PCR with sample pooling, at a health clinic of the Chinese bordering town of Nabang. On day 2, all positives were followed up and treated. RESULTS Of 15,038 persons (65% of the total population) screened, 204 (1.36%) were CLIP-PCR positives. Among them, 188, 14, and 2 were infected with Plasmodium vivax, Plasmodium falciparum, and P. vivax/P. falciparum mix, respectively. The testing capacity was 538 persons/day, with a cost of US$0.92 /person. The proportion of submicroscopic infection was 64.7%. All positive individuals received treatment within 72 h after blood collection. CONCLUSION Using CLIP-PCR in MSAT in low transmission settings can support the malaria elimination efforts in the China-Myanmar border region.
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Affiliation(s)
- Xiao-dong Sun
- grid.464500.30000 0004 1758 1139Yunnan Institute of Parasitic Diseases, Yunnan Provincial Collaborative Innovation Centre for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Provincial Centre of Malaria Research, Puer, 665000 China
| | - Ya-ling Zhao
- grid.506261.60000 0001 0706 7839Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences; School of Basic Medicine, Peking Union Medical College, Beijing, 100005 China
| | - Zu-rui Lin
- grid.464500.30000 0004 1758 1139Yunnan Institute of Parasitic Diseases, Yunnan Provincial Collaborative Innovation Centre for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Provincial Centre of Malaria Research, Puer, 665000 China
| | - Ye Zhao
- grid.506261.60000 0001 0706 7839Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences; School of Basic Medicine, Peking Union Medical College, Beijing, 100005 China
| | - Yao-wu Zhou
- grid.464500.30000 0004 1758 1139Yunnan Institute of Parasitic Diseases, Yunnan Provincial Collaborative Innovation Centre for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Provincial Centre of Malaria Research, Puer, 665000 China
| | - Shi-gang Li
- Yingjiang Centre for Disease Control and Prevention, Yingjiang, 679300 China
| | - Xiang-rui Guo
- Yingjiang Centre for Disease Control and Prevention, Yingjiang, 679300 China
| | - Peng Tian
- grid.464500.30000 0004 1758 1139Yunnan Institute of Parasitic Diseases, Yunnan Provincial Collaborative Innovation Centre for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Provincial Centre of Malaria Research, Puer, 665000 China
| | - Kai-xia Duan
- grid.464500.30000 0004 1758 1139Yunnan Institute of Parasitic Diseases, Yunnan Provincial Collaborative Innovation Centre for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Provincial Centre of Malaria Research, Puer, 665000 China
| | - Chun-li Ding
- grid.464500.30000 0004 1758 1139Yunnan Institute of Parasitic Diseases, Yunnan Provincial Collaborative Innovation Centre for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Provincial Centre of Malaria Research, Puer, 665000 China
| | - Qi-yan Chen
- grid.464500.30000 0004 1758 1139Yunnan Institute of Parasitic Diseases, Yunnan Provincial Collaborative Innovation Centre for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Provincial Centre of Malaria Research, Puer, 665000 China
| | - Yuan Sui
- grid.4367.60000 0001 2355 7002Brown School, Washington University, St. Louis, MO USA
| | - Shen-ning Lu
- grid.508378.1WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Key Laboratory of Parasite and Vector Biology, Ministry of Science and Technology, Ministry of Health, National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, Shanghai, 200025 China
| | - Chris Cotter
- grid.266102.10000 0001 2297 6811Malaria Elimination Initiative, Institute for Global Health Sciences, University of California, San Francisco, CA USA ,grid.8993.b0000 0004 1936 9457Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Duo-quan Wang
- grid.4367.60000 0001 2355 7002Brown School, Washington University, St. Louis, MO USA
| | - Zhi Zheng
- grid.506261.60000 0001 0706 7839Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences; School of Basic Medicine, Peking Union Medical College, Beijing, 100005 China
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Lin ZR, Yin SS, Yang J, Guo XR, Dong CL, Lin YK, Ding CL, Sun XD, Yan RX, Yang SL, Zhou XH, Xu JW. The public health response to an outbreak of border-spill malaria along China-Myanmar border. PLoS One 2022; 17:e0275932. [PMID: 36525438 PMCID: PMC9757579 DOI: 10.1371/journal.pone.0275932] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/27/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Malaria importation can be caused by cross-border movement either of both people and anopheline mosquitoes. However, there still lacks robust evidence of imported malaria caused by Plasmodium spp. infected anopheles along international border areas (border-spill malaria). The objectives of this study were to confirm whether an outbreak of Plasmodium vivax malaria is border-spill malaria and assess the effects of China's public health response along China-Myanmar border. METHODS Epidemiological, parasitological and entomological investigations were conducted to investigate the outbreak of border-spill malaria. Meanwhile, comprehensive interventions were carried out to prevent further transmission and reintroduction of malaria. RESULTS Rapid diagnostic testing, microscopy and polymerase chain reaction were performed and the infections were confirmed as P. vivax. A total of 22 (9.21%) of 239 workers contracted P. vivax during the outbreak. Multivariate logistic regression analysis identified that the distance of worker shelters in China within 300 meters to the internally displaced person (IDP) camps in Myanmar was a risk factors associated with malaria infection (adjusted odds ratio 7.5920; 95% confidence interval, 2.6079-22.1013; P = 0.0002). After comprehensive interventions, malaria transmission was successfully interpreted and prevented at the project site till the completion of project on 14 January 2020, and recurrence of P. vivax malaria was not detected by the end of 2020. CONCLUSION This study provided robust evidence of border-spill malaria along China-Myanmar border. Malaria parasite reservoir and distance travelled by female anopheline mosquitoes are two determinants for border-spill malaria. The public health response to the outbreak indicates that the malaria surveillance and response system works well in preventing reintroduction of malaria. However, prevention of border-spill malaria is still a major challenge in the Yunnan border area, China.
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Affiliation(s)
- Zu-Rui Lin
- Malaria Division, Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Pu’er, Yunnan, China
| | - Shan-Shan Yin
- Parasitic Disease Section, Yingjiang County Center for Disease Control and Prevention, Yingjiang, Yunnan, China
| | - Jie Yang
- Parasitic Disease Section, Donghong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan, China
| | - Xiang-Rui Guo
- Parasitic Disease Section, Yingjiang County Center for Disease Control and Prevention, Yingjiang, Yunnan, China
| | - Chao-Liang Dong
- Parasitic Disease Section, Donghong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan, China
| | - Ying-Kun Lin
- Parasitic Disease Section, Donghong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan, China
| | - Chun-Li Ding
- Malaria Division, Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Pu’er, Yunnan, China
| | - Xiao-Dong Sun
- Malaria Division, Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Pu’er, Yunnan, China
| | - Run-Xian Yan
- Parasitic Disease Section, Yingjiang County Center for Disease Control and Prevention, Yingjiang, Yunnan, China
| | - Suo-Lan Yang
- Parasitic Disease Section, Yingjiang County Center for Disease Control and Prevention, Yingjiang, Yunnan, China
| | - Xian-Hua Zhou
- Parasitic Disease Section, Yingjiang County Center for Disease Control and Prevention, Yingjiang, Yunnan, China
| | - Jian-Wei Xu
- Malaria Division, Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Pu’er, Yunnan, China
- * E-mail:
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Xu JW, Deng DW, Wei C, Zhou XW, Li JX. Risk factors associated with malaria infection along China–Myanmar border: a case–control study. Malar J 2022; 21:288. [PMID: 36210453 PMCID: PMC9548336 DOI: 10.1186/s12936-022-04312-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 09/23/2022] [Indexed: 12/02/2022] Open
Abstract
Background The World Health Organization (WHO) has certificated China malaria free, but imported malaria is a continuous challenge in preventing reintroduction of malaria in the border area of China. Understanding risk factors of malaria along China–Myanmar border is benefit for preventing reintroduction of malaria in China and achieving the WHO’s malaria elimination goal in the Greater Mekong Subregion (GMS). Methods This is a case–control study with one malaria case matched to two controls, in which cases were microscopy-confirmed malaria patients and controls were feverish people with microscopy-excluded malaria. A matched logistic regression analysis (LRA) was used to identify risk factors associated with malaria infection. Results From May 2016 through October 2017, the study recruited 223 malaria cases (152 in China and 71 in Myanmar) and 446 controls (304 in China and 142 in Myanmar). All the 152 cases recruited in China were imported malaria. Independent factors associated with malaria infection were overnight out of home in one month prior to attendance of health facilities (adjusted odd ratio [AOR] 13.37, 95% confidence interval [CI]: 6.32–28.28, P < 0.0001), staying overnight in rural lowland and foothill (AOR 2.73, 95% CI: 1.45–5.14, P = 0.0019), staying overnight at altitude < 500 m (AOR 5.66, 95% CI: 3.01–10.71, P < 0.0001) and streamlets ≤ 100 m (AOR9.98, 95% CI: 4.96–20.09, P < 0.0001) in the border areas of Myanmar; and people lacking of knowledge of malaria transmission (AOR 2.17, 95% CI: 1.42–3.32, P = 0.0004). Conclusions Malaria transmission is highly focalized in lowland and foothill in the border areas of Myanmar. The risk factors associated with malaria infection are overnight staying out of home, at low altitude areas, proximity to streamlets and lack of knowledge of malaria transmission. To prevent reintroduction of malaria transmission in China and achieve the WHO goal of malaria elimination in the GMS, cross-border collaboration is continuously necessary, and health education is sorely needed for people in China to maintain their malaria knowledge and vigilance, and in Myanmar to improve their ability of personal protection. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04312-5.
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Liu H, Zhou Y, Deng Y, Lin Z, Zhang C, Chen Q, Wei C, Duan K, Tian P, Zhou H, Xu J. Malaria from hyperendemicity to elimination along international borders in Yunnan, China during 2003‒2020: a case study. Infect Dis Poverty 2022; 11:51. [PMID: 35538510 PMCID: PMC9088148 DOI: 10.1186/s40249-022-00972-2] [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: 11/10/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Border malaria is one of the most intractable problems hindering malaria elimination worldwide. Movement of both the human population and anopheline mosquitoes infected with Plasmodium spp. can cause cross-border malaria transmission. The Yunnan border area was still hyperendemic for malaria in the early part of this century. The objective of this case study was to analyze the strategies, interventions and impacts of malaria control and elimination in the Yunnan border area. MAIN TEXT A total of 10,349 malaria cases and 17.1 per 10,000 person-years of annual parasite incidence (API) were reported in the border area in 2003. Based on natural village-based stratification, integrated interventions, including mass drug administration for radical cures and preventive treatment, clinically presumptive treatment of all febrile patients for malaria and indoor residual spraying or dipping bed nets with insecticides were successfully carried out from 2003 to 2013. The overall API was reduced to 0.6 per 10,000 person-years by 2013, while effective cross-border collaboration interventions dramatically reduced the malaria burden in the neighbouring border areas of Myanmar. From 2014 forward, the comprehensive strategy, including universal coverage of surveillance to detect malaria cases, a rapid response to possible malaria cases and effective border collaboration with neighbouring areas, successfully eliminated malaria and prevented reintroduction of malaria transmission in the Yunnan border area. CONCLUSIONS In Yunnan malaria burden has successfully reduced by dynamically accurate stratification and comprehensive interventions; and then the region achieved elimination and prevented reintroduction of malaria transmission through intensive surveillance, rapid response and border collaboration. Other border areas should perform their own intervention trials to develop their own effective strategy.
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Affiliation(s)
- Hui Liu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China
| | - Yaowu Zhou
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China
| | - Yan Deng
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China
| | - Zurui Lin
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China
| | - Canglin Zhang
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China
| | - Qiyan Chen
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China
| | - Chun Wei
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China
| | - Kaixia Duan
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China
| | - Peng Tian
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China
| | - Hongning Zhou
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China.
| | - Jianwei Xu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China
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Liu H, Zhou YW, Deng Y, Lin ZR, Zhang CL, Chen QY, Wei C, Duan KX, Zhou HN, Xu JW. Historical review of malaria control and elimination in the border areas of China: A case study of Yunnan Province. ADVANCES IN PARASITOLOGY 2022; 116:33-67. [PMID: 35752449 DOI: 10.1016/bs.apar.2021.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
To understand how malaria could be eliminated in the original hyperendmic area for malaria along international borders in Yunnan Province, malaria situation and control were described on the basis of seven phases. At last the experiences and lessons of the program that reduced border malaria from hyperendmicity to malaria-free status were summarized. Malaria control and elimination area were particularly difficult in the Yunnan border. The achievement can be attributed to high political commitment, strategic and technical innovations based on the actual locality, effective collaboration and communication with neighbouring countries to carry out cross border interventions. Other border areas might perform their own pilot interventions based on their local context, including malaria burden, governing system, health service structure contextualized based on their socioeconomic development and ecology, and then a local decision could be made according to their own trial results.
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Affiliation(s)
- Hui Liu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, Yunnan, PR China
| | - Yao-Wu Zhou
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, Yunnan, PR China
| | - Yan Deng
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, Yunnan, PR China
| | - Zu-Rui Lin
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, Yunnan, PR China
| | - Cang-Lin Zhang
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, Yunnan, PR China
| | - Qi-Yan Chen
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, Yunnan, PR China
| | - Chun Wei
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, Yunnan, PR China
| | - Kai-Xia Duan
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, Yunnan, PR China
| | - Hong-Ning Zhou
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, Yunnan, PR China.
| | - Jian-Wei Xu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention, Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, Yunnan, PR China
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Lin ZR, Li SG, Sun XD, Guo XR, Zheng Z, Yang J, Pian HR, Tian P, Chen QY, Sun XY, Ding CL, Duan KX, Chen HW, Bee DY, Zhou HN. Effectiveness of joint 3 + 1 malaria strategy along China-Myanmar cross border areas. BMC Infect Dis 2021; 21:1246. [PMID: 34906092 PMCID: PMC8670156 DOI: 10.1186/s12879-021-06920-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cross-border malaria in Laiza City of Myanmar seriously affected Yingjiang County of China and compromised reaching the goal of malaria elimination by 2020. Since 2017, a pilot project on 3 + 1 strategy of joint cross-border malaria prevention and control was carried out for building a malaria buffer in these border areas. Here, 3 were the three preventive lines in China where different focalized approaches of malaria elimination were applied and + 1 was a defined border area in Myanmar where the integrated measures of malaria control were adopted. METHODS A 5-year retrospective analysis (2015 to 2019) was conducted that included case detection, parasite prevalence and vector surveillance. Descriptive statistics was used and the incidence or rates were compared. The annual parasite incidence and the parasite prevalence rate in + 1 area of Myanmar, the annual importation rate in Yingjiang County of China and the density of An. minimus were statistically significant indictors to assess the effectiveness of the 3 + 1 strategy. RESULTS In + 1 area of Myanmar from 2015 to 2019, the averaged annual parasite incidence was (59.11 ± 40.73)/1000 and Plasmodium vivax accounted for 96.27% of the total confirmed cases. After the pilot project, the annual parasite incidence dropped 89% from 104.77/1000 in 2016 to 12.18/1000 in 2019, the microscopic parasite prevalence rate dropped 100% from 0.34% in 2017 to zero in 2019 and the averaged density of An. Minimus per trap-night dropped 93% from 1.92 in June to 0.13 in September. The submicroscopic parasite prevalence rate increased from 1.15% in 2017 to 1.66% in 2019 without significant difference between the two surveys (P = 0.084). In Yingjiang County of China, neither indigenous nor introduced case was reported and 100% cases were imported from Myanmar since 2017. The averaged annual importation rate from 2015 to 2019 was (0.47 ± 0.15)/1000. After the pilot project, the annual importation rate dropped from 0.59/1000 in 2016 to 0.28/1000 in 2019 with an overall reduction of 53% in the whole county. The reduction was 67% (57.63/1000 to 18.01/1000) in the first preventive line, 52% (0.20/1000 to 0.10/1000) in the second preventive line and 36% (0.32/1000 to 0.22/1000) in the third preventive line. The averaged density of An. Minimus per trap-night in the first preventive line dropped 94% from 2.55 in June to 0.14 in September, without significant difference from that of + 1 area of Myanmar (Z value = - 1.18, P value = 0.24). CONCLUSION The pilot project on 3 + 1 strategy has been significantly effective in the study areas and a buffer zone of border malaria was successfully established between Laiza City of Myanmar and Yingjiang County of China.
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Affiliation(s)
- Zu-Rui Lin
- Yunnan Institute of Parasitic Diseases; Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Collaborative Innovation Centre for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Pu'er, 665000, China
| | - Shi-Gang Li
- Yangjiang Centre for Disease Control and Prevention, Yangjiang, 679300, China
| | - Xiao-Dong Sun
- Yunnan Institute of Parasitic Diseases; Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Collaborative Innovation Centre for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Pu'er, 665000, China.
| | - Xiang-Rui Guo
- Yangjiang Centre for Disease Control and Prevention, Yangjiang, 679300, China
| | - Zhi Zheng
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100730, China.
| | - Jie Yang
- Dehong Centre for Disease Control and Prevention, Mangshi, 678400, China
| | - Hong-Ru Pian
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100730, China
| | - Peng Tian
- Yunnan Institute of Parasitic Diseases; Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Collaborative Innovation Centre for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Pu'er, 665000, China
| | - Qi-Yan Chen
- Yunnan Institute of Parasitic Diseases; Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Collaborative Innovation Centre for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Pu'er, 665000, China
| | | | - Chun-Li Ding
- Yunnan Institute of Parasitic Diseases; Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Collaborative Innovation Centre for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Pu'er, 665000, China
| | - Kai-Xia Duan
- Yunnan Institute of Parasitic Diseases; Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Collaborative Innovation Centre for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Pu'er, 665000, China
| | - Hong-Wei Chen
- Nangbang Township Central Hospital, Yingjiang, 679300, China
| | - Dakhidam Yaw Bee
- Malaria Project Office, Health Department of Kachin Special Region II, Laiza City, Myanmar
| | - Hong-Ning Zhou
- Yunnan Institute of Parasitic Diseases; Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Collaborative Innovation Centre for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Pu'er, 665000, China.
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Liu H, Fang CJ, Xu JW. The health perceptions, dengue knowledge and control willingness among Dai ethnic minority in Yunnan Province, China. BMC Public Health 2021; 21:1843. [PMID: 34641853 PMCID: PMC8507394 DOI: 10.1186/s12889-021-11864-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 09/27/2021] [Indexed: 11/21/2022] Open
Abstract
Background Outbreaks of dengue fever are often found among Dai ethnical communities along China-Myanmar border. The objective of this study was: 1) to investigate residents’ health perceptions, knowledge and control willingness to participate in dengue control and 2) to identify factors associated with control willingness among the Dai ethnic community. Methods This is a mixed method study of a cross-sectional design, in which qualitative in-depth interviews and quantitative household questionnaire surveys are included. Results Questionnaire was administered to 261 household heads, and in-depth interview was conducted with 18 key informants. Of them, many participants (70%, 182/259) and 12 key informants (66.7%) from the two rural communities believed that the Lord Buddha would protect the good people. Majority of the participants (81.4%, 206/253) knew that fever was one of dengue fever symptoms and most of them (82.2%, 213/259) indicated that mosquitoes could transmit dengue fever. However, only one third of the participants (30.1%, 78/259) indicated the perceived susceptibility of dengue fever, and only a half of them (50.2%, 130/259) indicated the perceived severity of dengue fever. Multivariate logistic analysis (MLA) indicated that the participants with family wealth index (FWI) 4–5 (OR: 22.9728; 95%CI: 2.4257–217.5688, p = 0.0063) were more likely to turn containers upside down (TCUD) compared to those with FWI 1–3; and the participants in the urban community (OR: 0.0239; 95%CI: 0.0019–0.3032, p = 0.004) were less likely to TCUD compared to those in the two rural communities. Around one third of the participants (36.8%, 96/239) reported that they were willing to seek treatment first for dengue fever from public health facilities. The MLA identified that the participants with the perceived severity of dengue fever (OR: 5.0564; 95%CI: 2.0672–12.3683, p = 0.0004), and with beliefs of sound hygiene helpful to people’s health (OR: 11.5671; 95%CI: 2.0505–65.2502, p = 0.0055) were more likely to seek treatment first for dengue fever from the public health facilities. Conclusion The study finds that most of Dai people have sound knowledge. However, health educational interventions should target to promote the perceived susceptibility and the perceived severity of dengue fever among Dai people. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11864-9.
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Affiliation(s)
- Hui Liu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Xiyuan Road, Pu'er City, 665000, China.,Institute of Pathogens and Vectors, Basic Medical College, Dali University, Wanhua Road, Xiaguang District, Dali City, 671000, China
| | - Cheng-Jiang Fang
- Pu'er Blood Bank, Chayuan Road, Pu'er City, 665000, Yunnan Province, China
| | - Jian-Wei Xu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Xiyuan Road, Pu'er City, 665000, China. .,Institute of Pathogens and Vectors, Basic Medical College, Dali University, Wanhua Road, Xiaguang District, Dali City, 671000, China.
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Xu JW, Lin ZR, Zhou YW, Lee R, Shen HM, Sun XD, Chen QY, Duan KX, Tian P, Ding CL, Xu SY, Liu H, Zhou HN. Intensive surveillance, rapid response and border collaboration for malaria elimination: China Yunnan's ''3 + 1''strategy. Malar J 2021; 20:396. [PMID: 34627264 PMCID: PMC8502357 DOI: 10.1186/s12936-021-03931-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background Eliminating malaria and preventing re-establishment of malaria transmission in border areas requires universal coverage of malaria surveillance and a rapid response to any threats (i.e. malaria cues) of re-establishing transmission. Main text Strategy 1: Intensive interventions within 2.5 km-wide perimeter along the border to prevent border-spill malaria. The area within 2.5 km along the international border is the travel radius of anopheline mosquitoes. Comprehensive interventions should include: (1) proactive and passive case detection, (2) intensive vector surveillance, (3) evidence-based vector control, and (4) evidence-based preventative treatment with anti-malarial drugs. Strategy 2: Community-based malaria detection and screening of migrants and travellers in frontier townships. Un-permitted travellers cross borders frequently and present in frontier townships. Maintenance of intensified malaria surveillance should include: (1) passive malaria detection in the township hospitals, (2) seek assistance from villager leaders and health workers to monitor cross border travellers, and refer febrile patients to the township hospitals and (3) the county’s Centre for Disease Control and Prevention maintain regular proactive case detection. Strategy 3: Universal coverage of malaria surveillance to detect malaria cues. Passive detection should be consolidated into the normal health service. Health services personnel should remain vigilant to ensure universal coverage of malaria detection and react promptly to any malaria cues. Strategy + 1: Strong collaborative support with neighbouring countries. Based on the agreement between the two countries, integrated control strategies should be carried out to reduce malaria burden for both countries. There should be a clear focus on the border areas between neighbouring countries. Conclusion The 3 + 1 strategy is an experience summary of border malaria control and elimination, and then contributed to malaria elimination in Yunnan’s border areas, China. Nevertheless, Yunnan still has remaining challenges of re-establishment of malaria transmission in the border areas, and the 3 + 1 strategy should still be carried out.
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Affiliation(s)
- Jian-Wei Xu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention (Developing), Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China
| | - Zu-Rui Lin
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention (Developing), Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China
| | - Yao-Wu Zhou
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention (Developing), Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China
| | - Rogan Lee
- The Centre for Infectious Diseases and Microbiology, New South Wales Health Pathology and Westmead Clinical School, The University of Sydney, Westmead Hospital, Sydney, NSW, 214, Australia
| | - Hai-Mo Shen
- Chinese Center for Disease Control and Prevention, National Institute of Parasitic Diseases, Shanghai, 200025, China
| | - Xiao-Dong Sun
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention (Developing), Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China
| | - Qi-Yan Chen
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention (Developing), Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China
| | - Kai-Xia Duan
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention (Developing), Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China
| | - Peng Tian
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention (Developing), Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China
| | - Chun-Li Ding
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention (Developing), Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China
| | - Shi-Yan Xu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention (Developing), Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China
| | - Hui Liu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention (Developing), Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China
| | - Hong-Ning Zhou
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention (Developing), Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China.
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Zheng J, Shi B, Xia S, Yang G, Zhou XN. Spatial patterns of <em>Plasmodium vivax</em> transmission explored by multivariate auto-regressive state-space modelling - A case study in Baoshan Prefecture in southern China. GEOSPATIAL HEALTH 2021; 16. [PMID: 33733649 DOI: 10.4081/gh.2021.879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 08/21/2020] [Indexed: 06/12/2023]
Abstract
The transition from the control phase to elimination of malaria in China through the national malaria elimination programme has focussed attention on the need for improvement of the surveillance- response systems. It is now understood that routine passive surveillance is inadequate in the parasite elimination phase that requires supplementation by active surveillance in foci where cluster cases have occurred. This study aims to explore the spatial clusters and temporal trends of malaria cases by the multivariate auto-regressive state-space model (MARSS) along the border to Myanmar in southern China. Data for indigenous cases spanning the period from 2007 to 2010 were extracted from the China's Infectious Diseases Information Reporting Management System (IDIRMS). The best MARSS model indicated that malaria transmission in the study area during 36 months could be grouped into three clusters. The estimation of malaria transmission patterns showed a downward trend across all clusters. The proposed methodology used in this study offers a simple and rapid, yet effective way to categorize patterns of foci which provide assistance for active monitoring of malaria in the elimination phase.
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Affiliation(s)
- Jinxin Zheng
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China; Key Laboratory of Parasite and Vector Biology, National Health Commission, Shanghai, China; National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, China; Chinese Center for Tropical Diseases Research, Shanghai.
| | - Benyun Shi
- School of Computer Science and Technology, Nanjing Tech University, Nanjing, Jiangsu.
| | - Shang Xia
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China; Key Laboratory of Parasite and Vector Biology, National Health Commission, Shanghai, China; National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, China; Chinese Center for Tropical Diseases Research, Shanghai.
| | - Guojing Yang
- Hainan Medical University, Laboratory of Tropical Environment and Health, Haikou, Hainan, China; Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute; University of Basel, Basel.
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China; Key Laboratory of Parasite and Vector Biology, National Health Commission, Shanghai, China; National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, China; Chinese Center for Tropical Diseases Research, Shanghai.
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16
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Li XH, Zhou HN, Xu JW, Lin ZR, Sun XD, Li JY, Lin XX, Xie Y, Alonso P, Yang HL. Seven decades towards malaria elimination in Yunnan, China. Malar J 2021; 20:147. [PMID: 33711990 PMCID: PMC7953382 DOI: 10.1186/s12936-021-03672-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/25/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Yunnan Province was considered the most difficult place in China for malaria elimination because of its complex malaria epidemiology, heterogeneous ecological features, relatively modest economic development, and long, porous border with three malaria endemic countries: Lao People's Democratic Republic, Myanmar, and Viet Nam. METHODS Academic publications and grey literature relevant to malaria elimination in Yunnan covering the period from 1950 until 2020 inclusive were considered. The following academic indexes were searched: China Science Periodical Database, China National Knowledge Infrastructure Database, and MEDLINE. Grey literature sources were mainly available from the National Institute of Parasitic Diseases (NIPD), the Chinese Center for Diseases Control and Prevention, and the Yunnan Institute of Parasitic Diseases (YIPD). RESULTS A malaria elimination campaign in the 1950-1960s, based mainly on mass administration of antimalarial drugs and large-scale vector control, reduced morbidity and mortality from malaria and interrupted transmission in some areas, although elimination was not achieved. Similar strategies were used to contain outbreaks and a resurgence of disease during the 1970s, when malaria services were discontinued. From the 1980s, malaria incidence declined, despite the challenges of large numbers of mobile and migrant populations and an unstable primary health care system in rural areas following economic transformation. Launch of the national malaria elimination programme in 2010 led to adoption of the '1-3-7' surveillance and response strategy specifying timely detection of and response for every case, supported by the establishment of a real-time web-based disease surveillance system and a new primary health care system in rural areas. Border malaria was addressed in Yunnan by strengthening the surveillance system down to the lowest level, cross-border collaboration with neighbouring countries and non-governmental organizations, and the involvement of other sectors. CONCLUSIONS Seven decades of work to eliminate malaria in Yunnan have shown the importance of political commitment, technically sound strategies with high quality implementation, a robust surveillance and response system at all levels, community participation and effective management of border malaria. The experiences and lessons learned from elimination remain important for prevention re-establishment of malaria transmission in the Province.
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Affiliation(s)
- Xiao-Hong Li
- Global Malaria Programme, World Health Organization, Geneva, Switzerland.
| | - Hong-Ning Zhou
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Pu'er City, China
| | - Jian-Wei Xu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Pu'er City, China
| | - Zu-Rui Lin
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Pu'er City, China
| | - Xiao-Dong Sun
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Pu'er City, China
| | - Jia-Yin Li
- Yunnan Representative Office, Health Poverty Action (UK), Kunming, China
| | - Xian-Xian Lin
- Yunnan Representative Office, Health Poverty Action (UK), Kunming, China
| | - Yan Xie
- School of Public Health, Peking University, Beijing, China
| | - Pedro Alonso
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Heng-Lin Yang
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Pu'er City, China
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Xu JW, Lee R, Li XH, Liu H. Transition of radical, preventive and presumptive treatment regimens for malaria in China: a systematic review. Malar J 2021; 20:10. [PMID: 33407512 PMCID: PMC7788889 DOI: 10.1186/s12936-020-03535-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 12/07/2020] [Indexed: 12/31/2022] Open
Abstract
Background Globally, malaria is still a major public health challenge. Drug-based treatment is the primary intervention in malaria control and elimination. However, optimal use of mass or targeted treatments remains unclear. A variety of radical, preventive and presumptive treatment regimens have been administrated in China and a systematic review was conducted to evaluate effectiveness, and discuss experiences, limitations, and lessons learnt in relation to the use of these regimens. Methods The search for information includes both paper documents, such as books, malaria control annals and guidelines for malaria prevention and treatment, as well as three computer-based databases in Chinese (CNKI, WanFangdata and Xueshu.baidu) and two databases in English (PubMed and Google Scholar), to identify original articles and reports associated with drug administration for malaria in China. Results Starting from hyperendemicity to elimination of malaria in China, a large number of radical, preventive and presumptive treatment regimens had been tried. Those effective regimens were scaled up for malaria control and elimination programmes in China. Between 1949 and 1959, presumptive treatment with available anti-malarial drugs was given to people with enlarged spleens and those who had symptoms suggestive of malaria within the last 6 months. Between 1960 and 1999, mass drug administration (MDA) was given for preventive and radical treatment. Between 2000 and 2009, the approach was more targeted, and drugs were administed only to prevent malaria infection in those at high risk of exposure and those who needed radical treatment for suspected malaria. Presumptive therapy was only given to febrile patients. From 2010, the malaria programme changed into elimination phase, radical treatment changed to target individuals with confirmed either Plasmodium vivax or Plasmodium ovale within the last year. Preventive treatment was given to those who will travel to other endemic countries. Presumptive treatment was normally not given during this elimination phase. All cases of suspected were confirmed by either microscopy or rapid diagnosis tests for malaria antigens before drugs were administered. The engagement of the broader community ensured high coverage of these drug-based interventions, and the directly-observed therapy improved patient safety during drug administration. Conclusion A large number of radical, preventive and presumptive treatment regimens for malaria had been tried in China with reported success, but the impact of drug-based interventions has been difficult to quantify because they are just a part of an integrated malaria control strategy. The historical experiences of China suggest that intervention trials should be done by the local health facilities with community involvement, and a local decision is made according to their own trial results.
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Affiliation(s)
- Jian-Wei Xu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention (Developing), Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China
| | - Rogan Lee
- The Centre for Infectious Diseases and Microbiology, New South Wales Health Pathology, and Westmead Clinical School, The University of Sydney, Westmead Hospital, Sydney, NSW, 214, Australia
| | - Xiao-Hong Li
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, China
| | - Hui Liu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention (Developing), Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China.
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The health beliefs, dengue knowledge and control behaviors among internally displaced persons versus local residents in Kachin Special Region II, Myanmar. PLoS Negl Trop Dis 2020; 14:e0008321. [PMID: 32584822 PMCID: PMC7343181 DOI: 10.1371/journal.pntd.0008321] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 07/08/2020] [Accepted: 04/24/2020] [Indexed: 12/03/2022] Open
Abstract
Dengue fever (DF) is one of main public health problems along the China-Myanmar border, however, data about DF is still lacking in Kachin Special Region II (KSR2), Myanmar. To understand health beliefs in general, and knowledge and treatment-seeking and prevention behaviors related to DF among the neglected population, the study was carried out by using a combination of quantitative household questionnaire surveys (HHSs) and qualitative semi-structured in-depth interviews (SDIs). The HHS questionnaire was administered to a total of 258 household heads. The 215 (83.3%) HHS respondents believed in Christianity and Catholicism. However, the 141 (54.7%,) of the total respondents thought that people with evil practices might be punished by diseases. More respondents believed that too rainy weather and water were more related to disease in the internally displaced person (IDP) camp than the local community (P<0.01). Most of the HHS respondents had sound knowledge of dengue symptoms, causes, vectors, transmission and prevention. The 257 (99.6%) HHS respondents reported that their families went to the public health facilities first to seek treatment. The 210 (84.1%) respondents reported that they turned containers upside down within five days. The key informants (n = 18) identified that the appropriate knowledge and behaviors were attributable to formal school education and specific health education campaign during the outbreak response in 2017, and that Kachin people enjoy conversing with each other, neighbors talked about the dengue information they received. The study results indicated that Kachin people have a good knowledge and behaviors of dengue control. The actual situation of dengue is still not clear due to lacking data of laboratory test. In the context of resources shortage, more international assistance is still needed to promote local dengue control and prevention efforts. The conflict between the Kachin Independence Army and the Myanmar government armed forces has lasted for more than eight years in the Kachin State (since 9th June 2011). Control of vector-borne diseases is especially important in emergency settings of tropical regions. In 2017, a dengue outbreak occurred and then was successfully controlled in Kachin Special Region (KSR2), Myanmar. To understand further preparedness at the community level for future possible re-emergence of DF, one IDP camp and a local community were sampled to investigate people’s health beliefs in general, knowledge and treatment-seeking and prevention behaviors related to dengue control from August to December, the local dengue transmission season in 2018. This study found that the IDPs and local Kachin residents have sound knowledge about dengue, treatment-seeking and prevention behaviors; an inconsistency exists between their religious and health beliefs due to pressure from various diseases and health problems. The community members perceived DF as a serious and life-threatening disease; however, the local health authority did not think dengue was a priority health problem. The actual situation of dengue is still not clear due to lacking laboratory test and surveillance data. In the emergency context, dengue may still be a local health threat and dengue control is particularly important. The local capacity for dengue laboratory testing and control and prevention activities should be promoted urgently. This should get more international attention and assistance.
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Zhao X, Thanapongtharm W, Lawawirojwong S, Wei C, Tang Y, Zhou Y, Sun X, Cui L, Sattabongkot J, Kaewkungwal J. Malaria Risk Map Using Spatial Multi-Criteria Decision Analysis along Yunnan Border During the Pre-elimination Period. Am J Trop Med Hyg 2020; 103:793-809. [PMID: 32602435 PMCID: PMC7410425 DOI: 10.4269/ajtmh.19-0854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
In moving toward malaria elimination, finer scale malaria risk maps are required to identify hotspots for implementing surveillance–response activities, allocating resources, and preparing health facilities based on the needs and necessities at each specific area. This study aimed to demonstrate the use of multi-criteria decision analysis (MCDA) in conjunction with geographic information systems (GISs) to create a spatial model and risk maps by integrating satellite remote-sensing and malaria surveillance data from 18 counties of Yunnan Province along the China–Myanmar border. The MCDA composite and annual models and risk maps were created from the consensus among the experts who have been working and know situations in the study areas. The experts identified and provided relative factor weights for nine socioeconomic and disease ecology factors as a weighted linear combination model of the following: ([Forest coverage × 0.041] + [Cropland × 0.086] + [Water body × 0.175] + [Elevation × 0.297] + [Human population density × 0.043] + [Imported case × 0.258] + [Distance to road × 0.030] + [Distance to health facility × 0.033] + [Urbanization × 0.036]). The expert-based model had a good prediction capacity with a high area under curve. The study has demonstrated the novel integrated use of spatial MCDA which combines multiple environmental factors in estimating disease risk by using decision rules derived from existing knowledge or hypothesized understanding of the risk factors via diverse quantitative and qualitative criteria using both data-driven and qualitative indicators from the experts. The model and fine MCDA risk map developed in this study could assist in focusing the elimination efforts in the specifically identified locations with high risks.
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Affiliation(s)
- Xiaotao Zhao
- Yunnan Institute of Parasitic Diseases, Pu'er, P. R. China.,Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Weerapong Thanapongtharm
- Department of Livestock Development, Veterinary Epidemiological Center, Bureau of Disease Control and Veterinary Services, Bangkok, Thailand
| | - Siam Lawawirojwong
- Geo-Informatics and Space Technology Development Agency, Bangkok, Thailand
| | - Chun Wei
- Yunnan Institute of Parasitic Diseases, Pu'er, P. R. China
| | - Yerong Tang
- Yunnan Institute of Parasitic Diseases, Pu'er, P. R. China
| | - Yaowu Zhou
- Yunnan Institute of Parasitic Diseases, Pu'er, P. R. China
| | - Xiaodong Sun
- Yunnan Institute of Parasitic Diseases, Pu'er, P. R. China
| | - Liwang Cui
- Division of Infectious Diseases and Internal Medicine, Department of Internal Medicine, University of South Florida, Tampa, Florida
| | - Jetsumon Sattabongkot
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jaranit Kaewkungwal
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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20
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Zhao X, Thanapongtharm W, Lawawirojwong S, Wei C, Tang Y, Zhou Y, Sun X, Sattabongkot J, Kaewkungwal J. Spatiotemporal Trends of Malaria in Relation to Economic Development and Cross-Border Movement along the China-Myanmar Border in Yunnan Province. THE KOREAN JOURNAL OF PARASITOLOGY 2020; 58:267-278. [PMID: 32615740 PMCID: PMC7338897 DOI: 10.3347/kjp.2020.58.3.267] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/02/2020] [Accepted: 04/06/2020] [Indexed: 12/01/2022]
Abstract
The heterogeneity and complexity of malaria involves political and natural environments, socioeconomic development, cross-border movement, and vector biology; factors that cannot be changed in a short time. This study aimed to assess the impact of economic growth and cross-border movement, toward elimination of malaria in Yunnan Province during its pre-elimination phase. Malaria data during 2011-2016 were extracted from 18 counties of Yunnan and from 7 villages, 11 displaced person camps of the Kachin Special Region II of Myanmar. Data of per-capita gross domestic product (GDP) were obtained from Yunnan Bureau of Statistics. Data were analyzed and mapped to determine spatiotemporal heterogeneity at county and village levels. There were a total 2,117 malaria cases with 85.2% imported cases; most imported cases came from Myanmar (78.5%). Along the demarcation line, malaria incidence rates in villages/camps in Myanmar were significantly higher than those of the neighboring villages in China. The spatial and temporal trends suggested that increasing per-capita GDP may have an indirect effect on the reduction of malaria cases when observed at macro level; however, malaria persists owing to complex, multi-faceted factors including poverty at individual level and cross-border movement of the workforce. In moving toward malaria elimination, despite economic growth, cooperative efforts with neighboring countries are critical to interrupt local transmission and prevent reintroduction of malaria via imported cases. Cross-border workers should be educated in preventive measures through effective behavior change communication, and investment is needed in active surveillance systems and novel diagnostic and treatment services during the elimination phase.
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Affiliation(s)
- Xiaotao Zhao
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Yunnan Institute of Parasitic Diseases, Puer, Yunnan, China
| | - Weerapong Thanapongtharm
- Veterinary Epidemiological Center, Bureau of Disease Control and Veterinary Services, Department of Livestock Development, Bangkok, Thailand
| | - Siam Lawawirojwong
- Geo-Informatics and Space Technology Development Agency, Bangkok, Thailand
| | - Chun Wei
- Yunnan Institute of Parasitic Diseases, Puer, Yunnan, China
| | - Yerong Tang
- Yunnan Institute of Parasitic Diseases, Puer, Yunnan, China
| | - Yaowu Zhou
- Yunnan Institute of Parasitic Diseases, Puer, Yunnan, China
| | - Xiaodong Sun
- Yunnan Institute of Parasitic Diseases, Puer, Yunnan, China
| | - Jestumon Sattabongkot
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jaranit Kaewkungwal
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Liu H, Xu JW, Ai Z, Yu Y, Yu B. Treatment seeking behavior and associated factors of suspected dengue fever among Shan people in eastern Shan special region IV, Myanmar: a cross-sectional study. BMC Health Serv Res 2020; 20:318. [PMID: 32299436 PMCID: PMC7164341 DOI: 10.1186/s12913-020-05163-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/26/2020] [Indexed: 02/01/2023] Open
Abstract
Background Dengue fever (DF) is a rapidly spreading mosquito-borne disease along the China-Myanmar border. Understanding treatment-seeking behaviors (TSBs) and associated factors of suspected DF patients in local communities helps to improve health services via promoting prompt treatment, improving patients’ prognosis, finding DF information and timely response to DF foci. Methods A combination of qualitative semi-structured in-depth interview (SDIs) included 18 key-informants, and quantitative household questionnaire survey (HHSs) involved 259 households was carried out to investigate TSBs and associated factors of suspected DF patients in the Eastern Shan Special Region IV (ESSR4), Myanmar. Results The key informants mentioned that most of their fellow villagers did not seek treatment in public health facilities first. The HHS questionnaires were distributed to household heads, and 241 of the 259 HHS respondents were valid after data auditing. Only 102 (43.2%) household heads reported that their family sought treatment for suspected DF at a public health facility immediately; 111 (46.1%) respondents said that they chose self-medication first. The adjusted odds ratio of multivariate logistic analysis (MLA) predicting household heads’ first seeking healthcare at a public hospital were 1.91 (95%CI: 1.03–3.53) for those who knew DF and 5.11 (95%CI: 2.08–12.58) for those who regarded DF as a deadly disease, indicating that families who knew DF and regarded DF as a deadly disease were more likely to seek treatment for suspected DF at a public health facility immediately. Conclusion The inappropriateness of treatment-seeking behaviors for suspected DF hinders the improvement of the patient prognosis and dengue control in ESSR4, Myanmar. People’s awareness of the potential seriousness of DF is a factor influencing appropriate healthcare-seeking behavior among Shan People.
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Affiliation(s)
- Hui Liu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Pu'er City, 665000, China
| | - Jian-Wei Xu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Pu'er City, 665000, China. .,Institute of Pathogens and Vectors, Dali University, Xiaguang, 671000, China.
| | - Zadan Ai
- The Hospital of Eastern Shan Special Region IV, Mengla Township, Myanmar
| | - Yan Yu
- The Hospital of Eastern Shan Special Region IV, Mengla Township, Myanmar
| | - Bian Yu
- The Hospital of Eastern Shan Special Region IV, Mengla Township, Myanmar
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Zhang SS, Feng J, Zhang L, Ren X, Geoffroy E, Manguin S, Frutos R, Zhou SS. Imported malaria cases in former endemic and non-malaria endemic areas in China: are there differences in case profile and time to response? Infect Dis Poverty 2019; 8:61. [PMID: 31272497 PMCID: PMC6610923 DOI: 10.1186/s40249-019-0571-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/18/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND China has achieved zero indigenous malaria case report in 2017. However, along with the increasing of international cooperation development, there is an increasing number of imported malaria cases from Chinese nationals returning from malaria-affected countries. Previous studies have focused on malaria endemic areas in China. There is thus limited information on non-endemic areas in China, especially on the performance of malaria surveillance and response in health facilities. METHODS A comparative retrospective study was carried out based on routine malaria surveillance data collected from 2013 to 2017. All imported malaria cases reported within the mainland of China were included. Variables used in the comparative analysis between cases in former endemic and former non-endemic areas, included age, gender and occupation, destination of overseas travel, Plasmodium species and patient health outcome. Monthly aggregated data was used to compare seasonal and spatial characteristics. Geographical distribution and spatial-temporal aggregation analyses were conducted. Time to diagnosis and report, method of diagnosis, and level of reporting/diagnosing health facilities were used to assess performance of health facilities. RESULTS A total of 16 733 malaria cases, out of which 90 were fatal, were recorded in 31 provinces. The majority of cases (96.2%) were reported from former malaria endemic areas while 3.8% were reported from former non-malaria endemic areas. Patients in the age class from 19 to 59 years and males made the highest proportion of cases in both areas. There were significant differences between occupational categories in the two areas (P < 0.001). In former endemic areas, the largest proportion of cases was among outdoor workers (80%). Two peaks (June, January) and three peaks (June, September and January) were found in former endemic and former non-endemic areas, respectively. Time between the onset of symptoms and diagnosis at clinics was significantly different between the two areas at different level of health facilities (P < 0.05). CONCLUSIONS All the former non-endemic areas are now reporting imported malaria cases. However, the largest proportion of imported cases is still reported from former endemic areas. Health facilities in former endemic areas outperformed those in former non-endemic areas. Information, treatment, and surveillance must be provided for expatriates while capacity building and continuous training must be implemented at health facilities in China.
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Affiliation(s)
- Shao-Sen Zhang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; Key Laboratory of Parasite and Vector Biology, Ministry of Health; National Center for International Research on Tropical Diseases, Ministry of Science and Technology; WHO Collaborating Center for Tropical Diseases, Shanghai, China
- HydroSciences Montpellier (HSM), Institut de Recherche pour le Développement (IRD), CNRS, Université de Montpellier, 34093 Montpellier, France
- IES Université de Montpellier, CNRS, 34059 Montpellier Cedex 5, France
- Cirad, UMR 17, Intertryp, Campus international de Baillarguet, 34398 Montpellier Cedex 5, France
| | - Jun Feng
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; Key Laboratory of Parasite and Vector Biology, Ministry of Health; National Center for International Research on Tropical Diseases, Ministry of Science and Technology; WHO Collaborating Center for Tropical Diseases, Shanghai, China
| | - Li Zhang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; Key Laboratory of Parasite and Vector Biology, Ministry of Health; National Center for International Research on Tropical Diseases, Ministry of Science and Technology; WHO Collaborating Center for Tropical Diseases, Shanghai, China
| | - Xiang Ren
- Division of Infectious Diseases, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | | | - Sylvie Manguin
- HydroSciences Montpellier (HSM), Institut de Recherche pour le Développement (IRD), CNRS, Université de Montpellier, 34093 Montpellier, France
| | - Roger Frutos
- IES Université de Montpellier, CNRS, 34059 Montpellier Cedex 5, France
- Cirad, UMR 17, Intertryp, Campus international de Baillarguet, 34398 Montpellier Cedex 5, France
| | - Shui-Sen Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; Key Laboratory of Parasite and Vector Biology, Ministry of Health; National Center for International Research on Tropical Diseases, Ministry of Science and Technology; WHO Collaborating Center for Tropical Diseases, Shanghai, China
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Xu JW, Liu H, Ai D, Yu Y, Yu B. The Shan people's health beliefs, knowledge and perceptions of dengue in Eastern Shan Special Region IV, Myanmar. PLoS Negl Trop Dis 2019; 13:e0007498. [PMID: 31247022 PMCID: PMC6619833 DOI: 10.1371/journal.pntd.0007498] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 07/10/2019] [Accepted: 05/29/2019] [Indexed: 12/30/2022] Open
Abstract
Sustainable dengue intervention requires the participation of communities. Therefore, understanding the health beliefs, knowledge and perceptions of dengue among the local people can help to design locally appropriate strategies for effective interventions. A combination of qualitative semi-structured in-depth interviews (SDIs) and quantitative household questionnaire surveys (HHSs) was used to investigate the beliefs, knowledge and perceptions of dengue among the Shan people in Eastern Shan Special Region IV (ESSR4), Myanmar. The SDI was administered to 18 key informants, and the HHS was administered to 259 respondents. Only 14.7% (95% CI: 10.6–19.6%) of the HHS respondents could confirm that mosquitoes transmit dengue; 14.3% (95% CI: 10.3–19.1%) knew that piebald or Aedes mosquitoes transmit dengue; and 24.3% (95% CI: 19.2–30.0%) believed that dengue-transmitting mosquitoes mainly lived in small ponds. Merely ten (0.4%) of the 259 respondents of the HHS thought that dengue-transmitting mosquitoes bite in the day time. The people in the villages where there were outbreaks of dengue had more knowledge about dengue. This study demonstrates that the health beliefs of the Shan people were closely associated with their lifestyles, social and natural environments. To stay healthy, the Shan people clean their houses and surroundings regularly. However, their knowledge about dengue was not adequate for effective dengue control because it was mostly learned from previous dengue experiences and in a context that lacks systematic health education. Thus, in this setting, with a weak public health structure, more international support should be provided to promote the knowledge of the Shan people about dengue and to increase their sensitive awareness to dengue, which might be beneficial for social mobilization and community participation during future dengue prevention. The burden of dengue has been increasing over the last five decades, and dengue fever (DF) has become one of the most rapidly spreading mosquito-borne diseases. DF has become another disease that threatens public health after malaria has become successfully controlled along the China-Myanmar border. However, it is currently not easy to contain epidemics of the dengue virus. As part of an integrated vector management approach, a community-based method is effective in the prevention of DF by tailoring the approach in a local context. Consequently, mixed methods comprising qualitative semi-structured in-depth interviews (SDIs) and quantitative household questionnaire surveys (HHSs) were used to study the health beliefs, knowledge and perceptions about dengue among the Shan people in Eastern Shan Special Region IV, Myanmar. This study found that the Shan people believed that their health was closely associated with their lifestyle and the social and physical environment in which they lived. Their beliefs originated from their primary social activities and cultural heritage. Most of their knowledge about DF was learned from previous outbreaks and interventions for the disease. The Shan people had a relatively higher level of knowledge about adult mosquito control, which they learned from previous malaria control programs, but they lacked knowledge on DF symptoms, transmission, vectors and Aedes larval breeding sites. Their knowledge about the methods of adult mosquito control could not effectively control DF. More sound health education is urgently needed to increase the local people’s knowledge of dengue and to rouse community awareness and participation in cleaning vector breeding sites. In the context of a lack of the necessary technical and financial resources, these interventions might rely more on international aid and help from neighboring countries, such as China.
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Affiliation(s)
- Jian-Wei Xu
- Malaria Department,Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Pu’er City, China
- Institute of Pathogens and Vectors, Basic Medical College, Dali University, Xiaguang District, Dali City, China
| | - Hui Liu
- Malaria Department,Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Disease Control and Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Pu’er City, China
- * E-mail:
| | - Didan Ai
- Disease Prevention Department, The Hospital of Eastern Shan Special Region IV, Mengla Township, Shan State, Myanmar
| | - Yan Yu
- Disease Prevention Department, The Hospital of Eastern Shan Special Region IV, Mengla Township, Shan State, Myanmar
| | - Bian Yu
- Disease Prevention Department, The Hospital of Eastern Shan Special Region IV, Mengla Township, Shan State, Myanmar
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Wang Y, Wang X, Liu X, Ren R, Zhou L, Li C, Tu W, Ni D, Li Q, Feng Z, Zhang Y. Epidemiology of Imported Infectious Diseases, China, 2005-2016. Emerg Infect Dis 2019; 25:33-41. [PMID: 30560778 PMCID: PMC6302593 DOI: 10.3201/eid2501.180178] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Imported infectious diseases are becoming a serious public health threat in China. However, limited information concerning the epidemiologic characteristics of imported infectious diseases is available. In this study, we collected data related to imported infectious diseases in mainland China from the National Information Reporting System of Infectious Diseases and analyzed demographic, temporal, and spatial distributions. The number of types of imported infectious diseases reported increased from 2 in 2005 to 11 in 2016. A total of 31,740 cases of infectious disease were imported to mainland China during 2005–2016; most of them were found in Yunnan Province. The cases were imported mainly from Africa and Asia. As a key and effective measure, pretravel education should be strengthened for all migrant workers and tourists in China, and border screening, cross-border international cooperation, and early warning should be further improved.
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Rejeki DSS, Fuad A, Widartono BS, Murhandarwati EEH, Kusnanto H. Spatiotemporal patterns of malaria at cross-boundaries area in Menoreh Hills, Java, Indonesia. Malar J 2019; 18:80. [PMID: 30876422 PMCID: PMC6419851 DOI: 10.1186/s12936-019-2717-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background Comprehensive reports of malaria in Menoreh Hills, Central Java, Indonesia, a unique district cross-boundaries area under three districts and two provinces have been published previously. However, no study was performed to identify the hotspots of malaria in this cross-boundaries area, Kaligesing and Bagelen Subdistricts in Purworejo, Jawa Tengah Province and Kokap Subdistrict in Kulon Progo, Yogyakarta Province, using a longitudinal spatial data. Methods Monthly reports of malaria cases at primary health centres during 2005–2015 were collected and processed with ArcGIS and SaTScan to identify the malaria distribution at the village level. Malaria distribution was analysed using global spatial autocorrelation (Moran index) in ArcGIS. Cluster analysis was conducted using SaTScan purely spatial clustering and purely temporal clustering. Cluster characteristics resulted from three different approach were compared and analysed. Results During the last 11 years, 3812 malaria cases were reported and the number of high case incidence (HCI) villages were increased continuously. Malaria spatial distribution in Menoreh Hills was clustered spatially. Using three different approaches of time period ranges, consistent conclusion was found i.e. most likely clusters always occurred in the Purworejo district while the secondary clusters appeared later in the cross-boundaries districts. Conclusion Spatiotemporal analysis of an 11 years surveillance data showed that hotspots of malaria cases in Menoreh Hills were continuously located in Purworejo district. The success of malaria elimination in the cross boundaries area of Menoreh Hills might be depended on the success in malaria case management and surveillance in this hotspot area.
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Affiliation(s)
- Dwi Sarwani Sri Rejeki
- Department of Public Health, Faculty of Health Sciences, Universitas Jenderal Soedirman, Purwokerto, Indonesia
| | - Anis Fuad
- Graduate Program of Public Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Barandi Sapta Widartono
- Cartography and Remote Sensing Study Program, Department of Geographic Information Science, Faculty of Geography, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - E Elsa Herdiana Murhandarwati
- Department of Parasitology and Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Hari Kusnanto
- Graduate Program of Public Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Shen HM, Chen SB, Cui YB, Xu B, Kassegne K, Abe EM, Wang Y, Chen JH. Whole-genome sequencing and analysis of Plasmodium falciparum isolates from China-Myanmar border area. Infect Dis Poverty 2018; 7:118. [PMID: 30445995 PMCID: PMC6240207 DOI: 10.1186/s40249-018-0493-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/16/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND China has made progress in malaria control and aims to eliminate malaria nationwide, but implementing effective interventions along the border regions remain a huge task. The Plasmodium falciparum cases imported from Southeast Asia has frequently reported especially in the China-Myanmar border (CMB) area. Though, information is scant on P. falciparum genetic variability in this area. METHODS This study reported P. falciparum isolates genome sequence of six clinical isolates in the CMB area. Furthermore, we estimated the nucleotide diversity, Watterson's estimator and Tajima's D value for the whole genome mutation rate in slide window. RESULTS Our data were aligned onto 96.05-98.61% of the reference 3D7 genome in high fold coverages. Principal component analysis result showed that P. falciparum clustered generally according to their geographic origin. A total of 91 genes were identified as positive selection with Ka/Ks ratio significantly higher than 1, and most of them were multigene families encoding variant surface antigens (VSAs) such as var, rif and stevor. The enrichment of the positive selection on VSA genes implied that the environment complexity subjected CMB's P. falciparum to more pressure for survival. CONCLUSIONS Our research suggests that greater genetic diversity in CMB area and the positive selection signals in VSA genes, which allow P. falciparum to fit the host immune system well and aggravate the difficulty of treatment. Meanwhile, results obtained from this study will provide the fundamental basis for P. falciparum population genomic research in CMB area.
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Affiliation(s)
- Hai-Mo Shen
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; WHO Collaborating Centre for Tropical Diseases, Shanghai, 200025 China
- National Center for International Research on Tropical Diseases, Ministry of Science and Technology; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025 China
| | - Shen-Bo Chen
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; WHO Collaborating Centre for Tropical Diseases, Shanghai, 200025 China
- National Center for International Research on Tropical Diseases, Ministry of Science and Technology; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025 China
| | - Yan-Bing Cui
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; WHO Collaborating Centre for Tropical Diseases, Shanghai, 200025 China
- National Center for International Research on Tropical Diseases, Ministry of Science and Technology; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025 China
| | - Bin Xu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; WHO Collaborating Centre for Tropical Diseases, Shanghai, 200025 China
- National Center for International Research on Tropical Diseases, Ministry of Science and Technology; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025 China
| | - Kokouvi Kassegne
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; WHO Collaborating Centre for Tropical Diseases, Shanghai, 200025 China
- National Center for International Research on Tropical Diseases, Ministry of Science and Technology; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025 China
| | - Eniola Michael Abe
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; WHO Collaborating Centre for Tropical Diseases, Shanghai, 200025 China
- National Center for International Research on Tropical Diseases, Ministry of Science and Technology; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025 China
| | - Yue Wang
- Institute of Parasitic Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, 310013 China
- Department of Microbiology and Microbial Engineering, School of Life Science, Fudan University, Shanghai, 200433 China
| | - Jun-Hu Chen
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; WHO Collaborating Centre for Tropical Diseases, Shanghai, 200025 China
- National Center 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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Herdiana H, Sari JFK, Whittaker M. Intersectoral collaboration for the prevention and control of vector borne diseases to support the implementation of a global strategy: A systematic review. PLoS One 2018; 13:e0204659. [PMID: 30303996 PMCID: PMC6179246 DOI: 10.1371/journal.pone.0204659] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 09/12/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction Vector Borne Diseases (VBDs) have a major impact on public health and socio-economic development. Inter-sectoral collaboration was recommended as one of the key elements of Integrated Vector Management (IVM), however limited evidence measures the effect and contribution of intersectoral approaches including but not only IVM. This systematic review aims to assess the existing evidence on all forms of inter-sectoral collaboration in VBD control and prevention, identify any gaps and develop a framework from a global perspective. Methods Articles were identified through a search of PUBMED, Science of Direct, Web of Knowledge, Google Scholar and WHO archives using key words and excluded duplications (n = 2,034). The exclusion of non-VBDs control and prevention interventions resulted in 194 eligible titles/abstract/keywords for full text assessment. Further exclusion of non-peer reviewed articles, non-declaration of ethical clearance, reviews and expert opinion articles resulted in 50 articles finally being included for analysis with the extraction of data on outcome, factor/s influencing the effectiveness, indicators of collaboration and sustainability. Results Of the 50 articles included in the analysis, 19 articles were categorized as of moderate-strong quality. All articles compared pre- and post-intervention outcomes against disease or vector variables. Three papers included outcome variables on intersectoral collaboration and participation indicator. However, no paper undertook component analysis by different sectors or different activities. Only one paper compared cost data for community-intersectoral intervention for IRS and traditional “vertical” IRS. Six factors were identified as influencing the effectiveness of inter-sectoral collaboration. Five of six factors are the main ones, namely the approach (37/47), resources (34/47), relationships (33/47), management (29/47) and shared vision (20/47) factors. A conceptual framework has been developed based on this review. Conclusion This review shows the importance of inter-sectoral collaboration to reduce VBDs or vector densities. However, very few studies measured how much inter-sectoral collaboration contributes to the impact. Further high-quality studies using inter-sectoral collaboration indicators are recommended to be undertaken.
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Affiliation(s)
| | | | - Maxine Whittaker
- College of Public Health, Medical and Veterinary Sciences, The Australian Institute of Tropical Health and Medicine (AITHM) at James Cook University, Jakarta, Australia
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Monitoring of malaria vectors at the China-Myanmar border while approaching malaria elimination. Parasit Vectors 2018; 11:511. [PMID: 30219093 PMCID: PMC6139178 DOI: 10.1186/s13071-018-3073-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/21/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Tengchong County was one of the counties located at the China-Myanmar border with high malaria incidence in the previous decades. As the pilot county for malaria elimination at the border area, Tengchong County is aiming to be the first county to achieve malaria elimination goal. A cross-sectional entomological survey was carried out to evaluate the feasibility of elimination approach and assess the receptivity of malaria reintroduction. METHODS Light traps associated with live baits were used to investigate the abundance of adult mosquitoes in nine villages in Tengchong County. Light traps were set to collect adult mosquitoes in both human houses and cowsheds from dusk till dawn in each site. RESULTS A total of 4948 adult Anopheles mosquitoes were collected from May to December in two villages. Of the mosquitoes were captured, 24.2% were in human houses and 75.8% in cowsheds. The peak of abundance occurred in July for An. sinensis and in September-October for An. minimus (s.l.) Ten Anopheles species were collected, the most prevalent being An. sinensis (50.3%), An. peditaeniatus (31.6%) and An. minimus (s.l.) (15.8%), contributing to 97.6% of the sample. Potential breeding sites were also investigated and a total of 407 larvae were collected, with An. sinensis (50.1%) and An. minimus (s.l.) (46.2%) as predominant species. Ponds and rice fields were the two preferred breeding sites for Anopheles mosquitoes; however, the difference between the number of adults and larvae captured suggest other breeding sites might exist. Both An. sinensis and An. minimus (s.l.) were found zoophilic with human blood index as 0.21 and 0.26, respectively. No Plasmodium positive Anopheles specimens were found by PCR among 4,000 trapped mosquitoes. CONCLUSIONS Although no indigenous malaria cases have been reported in Tengchong County since 2013, there is still a risk from the presence of vectors in the context of human population movements from neighboring malaria endemic areas. The presence of An. sinensis, associated to rice fields, is particularly worrying. Sustained entomological surveillance is strongly suggested even after malaria elimination certification.
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Feng J, Zhang L, Huang F, Yin JH, Tu H, Xia ZG, Zhou SS, Xiao N, Zhou XN. Ready for malaria elimination: zero indigenous case reported in the People's Republic of China. Malar J 2018; 17:315. [PMID: 30157876 PMCID: PMC6116478 DOI: 10.1186/s12936-018-2444-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/04/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Malaria was once one of the most serious public health problems in China. However, the disease burden has sharply declined and epidemic areas have shrunk after the implementation of an integrated malaria control and elimination strategy, especially since 2000. In this review, the lessons were distilled from the Chinese national malaria elimination programme and further efforts to mitigate the challenges of malaria resurgence are being discussed. METHODS A retrospective evaluation was performed to assess the changes in malaria epidemic patterns from 1950 to 2017 at national level. The malaria data before 2004 were collected from paper-based annual reports. After 2004, each of the different cases from the Infectious Diseases Information Reporting Management System (IDIRMS) was closely examined and scrutinized. An additional documenting system, the National Information Management System for Malaria, established in 2012 to document the interventions of three parasitic diseases, was also examined to complete the missing data from IDIRMS. RESULTS From 1950 to 2017, the occurrence of indigenous malaria has been steeply reduced, and malaria-epidemic regions have substantially shrunk, especially after the launch of the national malaria elimination programme. There were approximately 30 million malaria cases annually before 1949 with a mortality rate of 1%. A total of 5999 indigenous cases were documented from 2010 to 2016, with a drastic reduction of 99% over the 6 years (2010, n = 4262; 2016, n = 3). There were indigenous cases reported in 303 counties from 18 provinces in 2010, but only 3 indigenous cases were reported in 2 provinces nationwide in 2016. While in 2017, for the first time, zero indigenous case was reported in China, and only 7 of imported cases were in individuals who died of Plasmodium falciparum infection. CONCLUSION Malaria elimination in China is a country-led and country-owned endeavour. The country-own efforts were a clear national elimination strategy, supported by two systems, namely a case-based surveillance and response system and reference laboratory system. The country-led efforts were regional and inter-sectoral collaboration as well as sustained monitoring and evaluation. However, there are still some challenges, such as the maintenance of non-transmission status, the implementation of a qualified verification and assessment system, and the management of imported cases in border areas, through regional cooperation. The findings from this review can probably help improving malaria surveillance systems in China, but also in other elimination countries.
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Affiliation(s)
- Jun Feng
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, People's Republic of China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, 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, Shanghai, People's Republic of China
| | - Li Zhang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, People's Republic of China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, 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, Shanghai, People's Republic of China
| | - Fang Huang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, People's Republic of China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, 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, Shanghai, People's Republic of China
| | - Jian-Hai Yin
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, People's Republic of China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, 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, Shanghai, People's Republic of China
| | - Hong Tu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, People's Republic of China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, 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, Shanghai, People's Republic of China
| | - Zhi-Gui Xia
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, People's Republic of China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, 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, Shanghai, People's Republic of China
| | - Shui-Sen Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, People's Republic of China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, 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, Shanghai, People's Republic of China
| | - Ning Xiao
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, People's Republic of China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, 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, Shanghai, People's Republic of China
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, People's Republic of China.
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, 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, Shanghai, People's Republic of China.
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Liu H, Xu JW, Xu QZ, Zeng YR. Retrospective analysis of risk factors of slide positivity among febrile patients in the Salween river valley of Shan Special Region II, northern Myanmar. BMC Public Health 2018; 18:560. [PMID: 29703185 PMCID: PMC5924485 DOI: 10.1186/s12889-018-5469-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 04/17/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In Myanmar, epidemiological conditions have been unclear due to a lack of accurate data. In 2014 and 2016, malaria outbreaks occurred in the Shan Special Region II (SSR2). It was reported that these outbreaks were caused by malaria patients from the Salween River Valley (SRV), but further research is needed to confirm these reports. To examine the risks of malaria infection in the SSR2 section of the SRV, this paper offers a retrospective analysis based on the data we collected in 2009. METHODS A multivariate logistic model was utilized to analyze risk factors associated with the slide positivity of 2009. Results of the investigation in 2009 were compared with updated data. RESULTS The number of slide positivity was 91 (24.7%, 95% confidence interval [CI], 20.3-29.4%) among 369 people who had fever 2 weeks ago of the survey, including 74 (20.1%; 95%CI, 16.1-24.5%) cases of P. falciparum, 13 (3.5%; 95%CI, 1.9-5.9%) of P.vivax and 4 (1.1%, 95%CI, 0.3-2.8%) of P. malariae. The adjusted odds ratio (OR) was 99.8 (95% CI, 24.7-887.7) for patients' age < 15 years, 6.61 (95%CI, 3.57-10.49) for people living at an altitude of < 800 m, 6.35 (95%CI, 2.45-23.27) for people lacking knowledge on malaria transmission and knowledge on symptoms, 2.10 (95%CI, 1.22-5.11) for people taking no measures against mosquito bites and 5.55 (95%CI, 2.65-13.05) for people delaying treatment. Compared with annual parasitic incidences 13.80 per 10,000 person-years (422/305733) in 2014, 2.36 per 10,000 person-years (73/309004) in 2015 and 5.25 per 10,000 person-years (164/312310) in 2015, malaria burden is reduced. CONCLUSION Age, lower altitude, a lack of knowledge about malaria transmission and symptoms, inaction of measures against mosquito bites and delayed treatment-seeking were independent risk factors for slide positivity. These results indicate that malaria transmission was likely within housing settlements in the SRV, and that the transmission rates within the SRV are higher than in other areas. In order to eliminate malaria, it is important for people to obtain qualified treatment to contain artemisinin resistance. TRIAL REGISTRATION Trial registration number: ChiCTR-COC-17012522 . Retrospectively registered 31 August 2017.
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Affiliation(s)
- Hui Liu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Puer, 665000, China
| | - Jian-Wei Xu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Puer, 665000, China.
| | - Qi-Zhang Xu
- People's Hospital of Taikang County, Taikang, 475400, Henan Province, China
| | - Yi-Rou Zeng
- Mengmao County Hospital, Mengmao, Shan Special Region II, Myanmar
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Malaria burden and treatment targets in Kachin Special Region II, Myanmar from 2008 to 2016: A retrospective analysis. PLoS One 2018; 13:e0195032. [PMID: 29614088 PMCID: PMC5882093 DOI: 10.1371/journal.pone.0195032] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 03/15/2018] [Indexed: 01/02/2023] Open
Abstract
Although drug-based treatment is the primary intervention for malaria control and elimination, optimal use of targeted treatments remains unclear. From 2008 to 2016, three targeted programs on treatment were undertaken in Kachin Special Region II (KR2), Myanmar. Program I (2008–2011) treated all confirmed, clinical and suspected cases; program II (2012–2013) treated confirmed and clinical cases; and program III (2014–2016) targeted confirmed cases only. This study aims to evaluate the impacts of the three programs on malaria burden individually based on the annual parasite incidence (API), slide positivity rate (SPR) and their relative values. The API is calculated from original collected data and the incidence rate ratio (IRR) for each year is calculated by using the first-year API as a reference in each program phase across the KR2. Same method is applied to calculate SPR and risk ratio (RR) at the sentinel hospital too. During program I (2008–2011), malaria burden was reduced by 61% (95%CI: 58%-74%) and the actual API decreased from 9.8 (95%CI: 9.6–10.1) per 100 person-years in 2008 to 3.8 (3.6–4.1) per 100 person-years in 2011. Amid program II (2012–2013), the malaria burden increased by 33% (95%CI: 22%-46%) and the actual API increased from 2.1(95%CI: 2.0–2.3) per 100 person-years in 2012 to 2.8 (95%CI: 2.7–2.9) per 100 person-years in 2013. During program III (2014–2016) the malaria burden increased furtherly by 60% (95%CI: 51% - 69%) and the actual API increased from 3.2(95%CI: 3.0–3.3) per 100 person-years in 2014 to 5.1 (95%CI: 4.9–5.2) per 100 person-years in 2016. Results of the slide positivity of the sentinel hospital also confirm these results. Resurgence of malaria was mainly due to Plasmodium vivax during program II and III. This study indicates that strategy adopted in program I (2008–2011) should be more appropriate for the KR2. Quality-assured treatment of all confirmed, clinical and suspected malaria cases may be helpful for the reduction of malaria burden.
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Hundessa S, Li S, Liu DL, Guo J, Guo Y, Zhang W, Williams G. Projecting environmental suitable areas for malaria transmission in China under climate change scenarios. ENVIRONMENTAL RESEARCH 2018; 162:203-210. [PMID: 29353124 DOI: 10.1016/j.envres.2017.12.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 11/23/2017] [Accepted: 12/22/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The proportion of imported malaria cases in China has increased over recent years, and has presented challenges for the malaria elimination program in China. However, little is known about the geographic distribution and environmental suitability for malaria transmission under projected climate change scenarios. METHODS Using the MaxEnt model based on malaria presence-only records, we produced environmental suitability maps and examined the relative contribution of topographic, demographic, and environmental risk factors for P. vivax and P. falciparum malaria in China. RESULTS The MaxEnt model estimated that environmental suitability areas (ESAs) for malaria cover the central, south, southwest, east and northern regions, with a slightly wider range of ESAs extending to the northeast region for P. falciparum. There was spatial agreement between the location of imported cases and area environmentally suitable for malaria transmission. The ESAs of P. vivax and P. falciparum are projected to increase in some parts of southwest, south, central, north and northeast regions in the 2030s, 2050s, and 2080s, by a greater amount for P. falciparum under the RCP8.5 scenario. Temperature and NDVI values were the most influential in defining the ESAs for P. vivax, and temperature and precipitation the most influential for P. falciparum malaria. CONCLUSION This study estimated that the ESA for malaria transmission in China will increase with climate change and highlights the potential establishment of further local transmission. This model should be used to support malaria control by targeting areas where interventions on malaria transmission need to be enhanced.
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Affiliation(s)
- Samuel Hundessa
- Division of Epidemiology and Biostatistics, School of Public Health, University of Queensland, Brisbane 4006, Australia
| | - Shanshan Li
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - De Li Liu
- NSW Department of Primary Industries, WaggaWagga Agricultural Institute, New South Wales 2650, Wagga Wagga, Australia
| | - Jinpeng Guo
- Institutefor Disease Control and Prevention of PLA, Beijing 100039, People's Republic of China
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
| | - Wenyi Zhang
- Institutefor Disease Control and Prevention of PLA, Beijing 100039, People's Republic of China.
| | - Gail Williams
- Division of Epidemiology and Biostatistics, School of Public Health, University of Queensland, Brisbane 4006, Australia
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Maung TM, Oo T, Wai KT, Hlaing T, Owiti P, Kumar B, Shewade HD, Zachariah R, Thi A. Assessment of household ownership of bed nets in areas with and without artemisinin resistance containment measures in Myanmar. Infect Dis Poverty 2018; 7:19. [PMID: 29571301 PMCID: PMC5865351 DOI: 10.1186/s40249-018-0399-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 03/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Myanmar lies in the Greater Mekong Subregion where there is artemisinin-resistant Plasmodium falciparum malaria. As the artemisinin compound is the pillar of effective antimalarial therapies, containing the spread of artemisinin resistance is a national and global priority. The use of insecticide-treated bed nets/long-lasting insecticidal nets (ITNs/LLINs) is the key intervention for ensuring the reduction of malaria transmission and the spread of resistant strains, and for eventually eliminating malaria. This study aimed at assessing household ownership of, access to, and utilization of bed nets in areas of Myanmar with and without artemisinin resistance containment measures. METHODS Secondary data from a nationwide community-based malaria survey conducted by the National Malaria Control Program in 2014 were analyzed. Based on evidence of artemisinin resistance, Myanmar was divided into tiers 1, 2, and 3: townships in tiers 1 and 2 were aggregated as the Myanmar Artemisinin Resistance Containment (MARC) areas and were compared with tier 3 townships, which were defined as non-MARC areas. The chi-square test was used to compare groups, and the level of significance was set at P ≤ 0.05. RESULTS Of the 6328 households assessed, 97.2% in both MARC and non-MARC areas had at least one bed net (any type), but only 63% of households had ITNs/LLINs. Only 44% of households in MARC areas and 24% in non-MARC areas had adequate numbers of ITNs/LLINs (one ITN/LLIN per two persons, P < 0.001). Nearly 44% of household members had access to ITNs/LLINs. Regarding the utilization of ITNs/LLINs, 45% of household members used them in MARC areas and 36% used them in non-MARC areas (P < 0.001, desired target = 100%). Utilization of ITNs/LLINs among children aged below five years and pregnant women (high malaria risk groups) was low, at 44% and 42%, respectively. CONCLUSIONS This study highlights the nationwide shortfalls in the ownership of, access to, and utilization of ITNs/LLINs in Myanmar, which is of particular concern in terms of containing the spread of artemisinin resistance. It highlights the need for priority attention to be paid and mobilization of resources in order to improve bed net coverage and utilization through bed net distribution and/or social marketing, information dissemination, and awareness-raising.
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Affiliation(s)
- Thae Maung Maung
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar.
| | - Tin Oo
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Khin Thet Wai
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Thaung Hlaing
- Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Philip Owiti
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Binay Kumar
- Gavi, the Vaccine Alliance, Geneva, Switzerland
| | - Hemant Deepak Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - Rony Zachariah
- Médecins Sans Frontières, Brussels Operational Centre, Luxembourg city, Luxembourg
| | - Aung Thi
- National Malaria Control Program, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
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Feng J, Tu H, Zhang L, Zhang S, Jiang S, Xia Z, Zhou S. Mapping transmission foci to eliminate malaria in the People's Republic of China, 2010-2015: a retrospective analysis. BMC Infect Dis 2018; 18:115. [PMID: 29514598 PMCID: PMC5840925 DOI: 10.1186/s12879-018-3018-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 02/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China has initiated the National Malaria Elimination Action Plan, which aims to eliminate malaria by 2020. However, the transmission of malaria occurs sporadically or in distinct foci, which greatly hampers progress toward elimination in China and other countries. The object of this study was to foci categorization and evaluates whether the response met the requirements issued by the nation or WHO. METHODS Residual transmissions were investigated and located with fine spatial resolution mapping from parasitological confirmed malaria cases by use of routine national surveillance data. The "1-3-7" timeframes were monitored for each focus between 2012 and 2015. Each focus was identified, and the application of appropriate measures was evaluated. RESULTS A total of 5996 indigenous cases were recorded between 2010 and 2015; during this period, the number of cases declined by 99.1% (2010, n = 4262; 2015, n = 39). Most indigenous cases (92.5%) were reported in Anhui (n = 2326), Yunnan (n = 1373), Henan (n = 930), Hubei (n = 459), and Guizhou (n = 458). The temporal distribution showed that the indigenous malaria cases were clustered during the period of May to August. A total of 320 foci were carefully investigated and analyzed: 24 were active foci; 72, residual non-active foci; and 224 cleared-up foci. For the foci response evaluation, all the active foci were investigated within 7 days, while 80.2% of the residual non-active foci were responded within 7 days. In addition, reactive case detection (RACD) was carried out with 92.9% of the active foci and vector investigation carried out with 75%. For residual non-active foci, RACD was carried out with 83.2% and vector investigation with 78.2% of the foci. CONCLUSIONS This study used nationwide data to categorize foci in China and evaluate the response of these areas during the control and elimination phases. Our approach stratifies future control responses by identifying those locations where the elimination of endemic transmission is needed, such as in the counties at the China-Myanmar border and in Tibet. In addition, this study will help local CDC staff to reassess their needs and responses against different types of foci during the elimination and post-elimination phases.
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Affiliation(s)
- Jun Feng
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, Ministry of Health; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Shanghai, 200025 People’s Republic of China
| | - Hong Tu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, Ministry of Health; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Shanghai, 200025 People’s Republic of China
| | - Li Zhang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, Ministry of Health; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Shanghai, 200025 People’s Republic of China
| | - Shaosen Zhang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, Ministry of Health; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Shanghai, 200025 People’s Republic of China
| | - Shan Jiang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, Ministry of Health; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Shanghai, 200025 People’s Republic of China
| | - Zhigui Xia
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, Ministry of Health; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Shanghai, 200025 People’s Republic of China
| | - Shuisen Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, Ministry of Health; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Shanghai, 200025 People’s Republic of China
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Mbenda HGN, Zeng W, Bai Y, Siddiqui FA, Yang Z, Cui L. Genetic diversity of the Plasmodium vivax phosphatidylinositol 3-kinase gene in two regions of the China-Myanmar border. INFECTION GENETICS AND EVOLUTION 2018; 61:45-52. [PMID: 29462718 DOI: 10.1016/j.meegid.2018.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/12/2018] [Accepted: 02/14/2018] [Indexed: 12/25/2022]
Abstract
Artemisinin resistance in Plasmodium falciparum was associated with mutations in the propeller domain of the PfK13 gene and increased phosphatidylinositol-3'-kinase (PfPI3K) activity. Assessment of the genetic diversity of the PfK13 ortholog PvK12 in Plasmodium vivax field samples from the same hotspots of P. falciparum artemisinin resistance revealed a limited genetic diversity of PvK12. Following the same logic, we analyzed genetic variations of the PvPI3K gene in 188 P. vivax field isolates from two geographic locations along the China-Myanmar border. Overall, high genetic diversity of PvPI3K was observed; parasites from Yunnan's Tengchong County had higher genetic diversity than those from Laiza Township, Kachin State, Myanmar. Almost all the neutrality tests applied detected statistically significant deviation from zero. The negative Tajima's D values in both populations implicated that PvPI3K gene might have experienced either a directional selection or an expansion in population size. There was low linkage disequilibrium between the PvPI3K mutations in both populations, suggesting the existence of large, almost panmictic, parasite populations that enabled effective recombination. This later result was confirmed by the detection of a minimum of five recombination events in each population with two major breakpoints. Multiple tests for selection confirmed a signature of purifying selection on PvPI3K. All the amino acid mutations were predicted to be neutral for the PI3K protein's function. These findings provide insights on the genetic diversity of P. vivax populations along the China-Myanmar border.
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Affiliation(s)
| | - Weilin Zeng
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Yao Bai
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Faiza Amber Siddiqui
- Department of Entomology, Pennsylvania State University, 501 ASI Building, University Park, PA 16802, USA
| | - Zhaoqing Yang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China.
| | - Liwang Cui
- Department of Entomology, Pennsylvania State University, 501 ASI Building, University Park, PA 16802, USA.
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Shi B, Zheng J, Qiu H, Yang GJ, Xia S, Zhou XN. Risk assessment of malaria transmission at the border area of China and Myanmar. Infect Dis Poverty 2017; 6:108. [PMID: 28679420 PMCID: PMC5499046 DOI: 10.1186/s40249-017-0322-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/01/2017] [Indexed: 01/03/2023] Open
Abstract
Background In order to achieve the goal of malaria elimination, the Chinese government launched the National Malaria Elimination Programme in 2010. However, as a result of increasing cross-border population movements, the risk of imported malaria cases still exists at the border areas of China, resulting in a potential threat of local transmission. The focus of this paper is to assess the Plasmodium vivax incidences in Tengchong, Yunnan Province, at the border areas of China and Myanmar. Methods Time series of P. vivax incidences in Tengchong from 2006 to 2010 are collected from the web-based China Information System for Disease Control and Prevention, which are further separated into time series of imported and local cases. First, the seasonal and trend decomposition are performed on time series of imported cases using Loess method. Then, the impact of climatic factors on the local transmission of P. vivax is assessed using both linear regression models (LRM) and generalized additive models (GAM). Specifically, the notion of vectorial capacity (VCAP) is used to estimate the transmission potential of P. vivax at different locations, which is calculated based on temperature and rainfall collected from China Meteorological Administration. Results Comparing with Ruili County, the seasonal pattern of imported cases in Tengchong is different: Tengchong has only one peak, while Ruili has two peaks during each year. This may be due to the different cross-border behaviors of peoples in two locations. The vectorial capacity together with the imported cases and the average humidity, can well explain the local incidences of P. vivax through both LRM and GAM methods. Moreover, the maximum daily temperature is verified to be more suitable to calculate VCAP than the minimal and average temperature in Tengchong County. Conclusion To achieve malaria elimination in China, the assessment results in this paper will provide further guidance in active surveillance and control of malaria at the border areas of China and Myanmar. Electronic supplementary material The online version of this article (doi:10.1186/s40249-017-0322-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Benyun Shi
- School of Cyberspace, Hangzhou Dianzi University, Hangzhou, 310018, China.
| | - Jinxin Zheng
- Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China
| | - Hongjun Qiu
- School of Cyberspace, Hangzhou Dianzi University, Hangzhou, 310018, China
| | - Guo-Jing Yang
- Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China.
| | - Shang Xia
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China.,Key Laboratory of Parasite and Vector Biology, MOH; WHO Collaborating Center for Tropical Diseases, Shanghai, 200025, China
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Xu JW, Li JJ, Guo HP, Pu SW, Li SM, Wang RH, Liu H, Wang WJ. Malaria from hyperendemicity to elimination in Hekou County on China-Vietnam border: an ecological study. Malar J 2017; 16:66. [PMID: 28173802 PMCID: PMC5297092 DOI: 10.1186/s12936-017-1709-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 01/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria control and elimination are challenged by diversity and complexity of the determinants on the international border in the Great Mekong Sub-region. Hekou, a Chinese county on the China-Vietnam border, was used to document Chinese experiences and lessons for malaria control and elimination. METHODS The design was an ecological study. Malaria burden before 1951 and procedures of 64 years (1952-2015) from malaria hyperendemicity to elimination are described. Single and bilinear regression analysis was utilized to analyse the relationship between the annual malaria incidence (AMI) and gross domestic product (GDP), urbanization rate, and banana planting area (BPA). RESULTS There was a huge malaria burden before 1951. AMI was reduced from 358.62 per 1000 person-years in 1953 to 5.69 per 1000 person-years in 1960. A system of primary health services, comprising three levels of county township hospitals and village health stations maintained malaria control and surveillance activities in changing political and social-economic settings. However, potential under-reported of malaria and market-oriented healthcare led to a malaria epidemic in 1987. Strong political commitment reoriented malaria from a control to an elimination programme. High coverage of malaria intervention and population access to intervention was crucial for malaria control and elimination; meanwhile, AMI was closely associated with socio-economic development, correlation coefficients (R) -0.6845 (95% CI -0.7978, -0.6845) for national GDP, -0.7014 (-0.8093, -0.7014) for national urbanization rate and -0.5563 (-0.7147, -0.3437) for BPA. CONCLUSIONS Multifactor, including political commitment, effective interventions, social and economic development and changing ecological environment, and the complicated interactions between these factors contribute to malaria elimination in Hekou County.
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Affiliation(s)
- Jian-Wei Xu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Puer, 665000, China
| | - Jian-Jie Li
- Honghe Prefecture Centre for Disease Prevention and Control, Mengzi, China
| | - Hong-Ping Guo
- Honghe Prefecture Centre for Disease Prevention and Control, Mengzi, China
| | - Shu-Wei Pu
- Honghe Prefecture Centre for Disease Prevention and Control, Mengzi, China
| | - Shu-Mei Li
- Hekou County Centre for Disease Prevention and Control, Hekou, China
| | - Rong-Hua Wang
- Hekou County Centre for Disease Prevention and Control, Hekou, China
| | - Hui Liu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Puer, 665000, China.
| | - Wei-Jia Wang
- Honghe Prefecture Centre for Disease Prevention and Control, Mengzi, China
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Xu JW, Liu H. The relationship of malaria between Chinese side and Myanmar's five special regions along China-Myanmar border: a linear regression analysis. Malar J 2016; 15:368. [PMID: 27430217 PMCID: PMC4949750 DOI: 10.1186/s12936-016-1413-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 07/01/2016] [Indexed: 11/26/2022] Open
Abstract
Background Understanding malaria along the international border of two countries is important for malaria control and elimination; however, it is difficult to investigate a quantitative relationship between two countries’ border areas due to a shortage of malaria surveillance data. Methods A linear regression analysis was conducted to investigate the logarithmic annual parasite incidence (API), numbers of imported cases and local infections in 19 Chinese border counties, with logarithmic API and parasitic prevalence in Myanmar’s five special regions. Results API in 19 Chinese counties was stronger correlated with parasite prevalence than with API in five special regions of Myanmar, correlation coefficient (R) 0.8322 (95 % CI 0.0636–0.9084) versus 0.9914 (95 % CI 0.9204–0.9914). Numbers of imported malaria cases and local malaria infections in 19 Chinese counties were also closer correlated with parasite prevalence than with API in five special regions of Myanmar. Conclusions There is a strong correlation of malaria between China’s side and Myanmar’s side along the international border. Parasite prevalence is a better indicator of the true malaria situation in a setting without sound surveillance and reporting system. China should reconsider its definition of imported malaria which neglects imported malaria by mosquitoes and asymptomatic parasite carriers. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1413-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jian-Wei Xu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Collaborative Innovation Centre for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, 665000, Puer, China
| | - Hui Liu
- Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Collaborative Innovation Centre for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, 665000, Puer, China.
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