PDF(Pubmed)
Abstract：
BACKGROUND: The national malaria programme of Cambodia targets the rapid elimination of all human malaria by 2025. As clinical cases decline to near-elimination levels, a key strategy is the rapid identification of malaria outbreaks triggering effective action to interrupt local transmission. We report a comprehensive, multipronged management approach in response to a 2022 Plasmodium falciparum outbreak in Kravanh district, western Cambodia.
METHODS: The provincial health department of Pursat in conjunction with the Center for Parasitology, Entomology and Malaria Control (CNM) identified villages where transmission was occurring using clinical records, and initiated various interventions, including the distribution of insecticide-treated bed nets, running awareness campaigns, and implementing fever screening with targeted drug administration. Health stations were set up at forest entry points, and later, targeted drug administrations with artesunate-pyronaridine (Pyramax) and intermittent preventive treatment for forest goers (IPTf) were implemented in specific village foci. Data related to adherence and adverse events from IPTf and TDA were collected. The coverage rates of interventions were calculated, and local malaria infections were monitored.
RESULTS: A total of 942 individuals were screened through active fever surveillance in villages where IPTf and TDA were conducted. The study demonstrated high coverage and adherence rates in the targeted villages, with 92% (553/600) coverage in round one and 65% (387/600) in round two. Adherence rate was 99% (551/553) in round one and 98% (377/387) in round two. The study found that forest goers preferred taking Pyramax over repeated testing consistent with the coverage rates: 92% in round one compared to 65% in round two. All individuals reachable through health stations or mobile teams reported complete IPTf uptake. No severe adverse events were reported. Only six individuals reported mild adverse events, such as loss of energy, fever, abdominal pain, diarrhoea, and muscle aches. Two individuals attributed their symptoms to heavy alcohol intake following prophylaxis.
CONCLUSIONS: The targeted malaria outbreak response demonstrated high acceptability, safety, and feasibility of the selected interventions. Malaria transmission was rapidly controlled using the available community resources. This experience suggests the effectiveness of the programmatic response for future outbreaks.
METHODS: The provincial health department of Pursat in conjunction with the Center for Parasitology, Entomology and Malaria Control (CNM) identified villages where transmission was occurring using clinical records, and initiated various interventions, including the distribution of insecticide-treated bed nets, running awareness campaigns, and implementing fever screening with targeted drug administration. Health stations were set up at forest entry points, and later, targeted drug administrations with artesunate-pyronaridine (Pyramax) and intermittent preventive treatment for forest goers (IPTf) were implemented in specific village foci. Data related to adherence and adverse events from IPTf and TDA were collected. The coverage rates of interventions were calculated, and local malaria infections were monitored.
RESULTS: A total of 942 individuals were screened through active fever surveillance in villages where IPTf and TDA were conducted. The study demonstrated high coverage and adherence rates in the targeted villages, with 92% (553/600) coverage in round one and 65% (387/600) in round two. Adherence rate was 99% (551/553) in round one and 98% (377/387) in round two. The study found that forest goers preferred taking Pyramax over repeated testing consistent with the coverage rates: 92% in round one compared to 65% in round two. All individuals reachable through health stations or mobile teams reported complete IPTf uptake. No severe adverse events were reported. Only six individuals reported mild adverse events, such as loss of energy, fever, abdominal pain, diarrhoea, and muscle aches. Two individuals attributed their symptoms to heavy alcohol intake following prophylaxis.
CONCLUSIONS: The targeted malaria outbreak response demonstrated high acceptability, safety, and feasibility of the selected interventions. Malaria transmission was rapidly controlled using the available community resources. This experience suggests the effectiveness of the programmatic response for future outbreaks.
摘要：
背景：柬埔寨国家疟疾计划的目标是到2025年迅速消除所有人类疟疾。随着临床病例下降到接近消除水平，一项关键战略是迅速识别疟疾爆发，引发有效行动，阻断当地传播。我们报告了一个全面的，针对2022年克拉万地区恶性疟原虫爆发的多管齐下的管理方法，柬埔寨西部。
方法：省卫生厅会同寄生虫学中心，昆虫学和疟疾控制（CNM）使用临床记录确定了发生传播的村庄，并发起了各种干预措施，包括分发杀虫剂处理过的蚊帐，开展宣传活动，实施发热筛查及针对性用药。在森林入境点设立了卫生站，后来,在特定的村庄病灶中实施了青蒿琥酯-吡喃萘啶（Pyramax）的靶向药物管理和森林居民的间歇性预防性治疗（IPTf）。收集来自IPTf和TDA的与依从性和不良事件相关的数据。计算了干预措施的覆盖率，和当地的疟疾感染被监测。
结果：在进行IPTf和TDA的村庄，通过主动发热监测，共筛查了942名个体。研究表明，目标村庄的覆盖率和遵守率很高，第一轮覆盖率为92%(553/600)，第二轮覆盖率为65%(387/600)。第一轮的粘附率为99％（551/553），第二轮的粘附率为98％（377/387）。研究发现，森林游客更喜欢服用Pyramax，而不是重复测试，这与覆盖率一致：第一轮为92％，而第二轮为65％。所有通过卫生站或移动团队联系的人都报告了完全的IPTf摄取。未报告严重不良事件。只有6人报告了轻度不良事件，比如能量损失，发烧,腹痛,腹泻,和肌肉疼痛。两个人将他们的症状归因于预防后大量饮酒。
结论：有针对性的疟疾暴发响应显示出较高的可接受性，安全,以及选定干预措施的可行性。利用现有的社区资源迅速控制了疟疾的传播。这一经验表明，方案应对未来疫情的有效性。
方法：省卫生厅会同寄生虫学中心，昆虫学和疟疾控制（CNM）使用临床记录确定了发生传播的村庄，并发起了各种干预措施，包括分发杀虫剂处理过的蚊帐，开展宣传活动，实施发热筛查及针对性用药。在森林入境点设立了卫生站，后来,在特定的村庄病灶中实施了青蒿琥酯-吡喃萘啶（Pyramax）的靶向药物管理和森林居民的间歇性预防性治疗（IPTf）。收集来自IPTf和TDA的与依从性和不良事件相关的数据。计算了干预措施的覆盖率，和当地的疟疾感染被监测。
结果：在进行IPTf和TDA的村庄，通过主动发热监测，共筛查了942名个体。研究表明，目标村庄的覆盖率和遵守率很高，第一轮覆盖率为92%(553/600)，第二轮覆盖率为65%(387/600)。第一轮的粘附率为99％（551/553），第二轮的粘附率为98％（377/387）。研究发现，森林游客更喜欢服用Pyramax，而不是重复测试，这与覆盖率一致：第一轮为92％，而第二轮为65％。所有通过卫生站或移动团队联系的人都报告了完全的IPTf摄取。未报告严重不良事件。只有6人报告了轻度不良事件，比如能量损失，发烧,腹痛,腹泻,和肌肉疼痛。两个人将他们的症状归因于预防后大量饮酒。
结论：有针对性的疟疾暴发响应显示出较高的可接受性，安全,以及选定干预措施的可行性。利用现有的社区资源迅速控制了疟疾的传播。这一经验表明，方案应对未来疫情的有效性。
