2021年,世界卫生组织正式宣布中华人民共和国为无疟疾国家。然而,尽管取得了这一里程碑式的成就,中国持续发生严重和致命的输入性疟疾病例,由于全球化和国际交流的增加,仍然是一个重大的公共卫生问题。
■本研究的目的是阐明2014年至2021年中国5个省的输入性疟疾流行病学特征,并确定影响输入性疟疾病例并发症的因素。研究结果将为加强防控措施提供依据,从而巩固中国在消除疟疾方面的成就。
■进行了一项基于病例的回顾性研究,使用2014年至2021年从中国代表性省份收集的监测数据。流行病学特征采用描述性统计分析。采用Logistic回归分析确定影响并发症发生的因素。
■在研究期间共纳入5559例疟疾病例。优势种为恶性疟原虫(3940/5559,70.9%),其次是卵形疟原虫(1054/5559,19%),间日疟原虫(407/5559,7.3%),疟原虫(157/5559,2.8%),诺氏疟原虫1例。大多数病例为男性(5343/5559,96.1%)。恶性疟原虫和卵圆虫的并发症发生率分别为11.4%和3.3%,分别。疟疾并发症相关因素的多因素logistic回归分析揭示了潜在的保护因素,包括先前的疟原虫感染(P<.001;比值比[OR]0.512,95%CI0.422-0.621),和风险因素,包括年龄增加(P=0.004;OR1.014,95%CI1.004-1.024),首次临床就诊时误诊(P<.001;OR3.553,95%CI2.886-4.375),和从发病到治疗的时间间隔(P=.001;OR1.026,95%CI1.011-1.042)。亚组分析确定了与恶性疟原虫相关的危险因素,其中包括高龄(P=0.004;OR1.015,95%CI1.005-1.026),首次临床就诊时的初始误诊(P<.001;OR3.549,95%CI2.827-4.455),从发病到治疗的时间间隔(P<.001;OR1.043,95%CI1.022-1.063),从首次治疗到诊断延迟超过3天(P<.001;OR2.403,95%CI1.823-3.164)。此外,与卵圆周症有关的危险因素涉及初次临床就诊时的误诊(P=0.01;OR2.901,95%CI1.336-6.298),从发病到治疗的时间间隔(P=0.002;OR1.095,95%CI1.033-1.160),以及从初始治疗到诊断的持续时间(P=.43;OR1.032,95%CI0.953-1.118)。先前的感染可以预防恶性疟原虫和卵圆虫的进展。
■这项研究表明,近年来卵形卵圆中比例的增加不容忽视。此外,有必要提高诊断意识,提高医疗机构的能力,为高危人群提供健康教育。
UNASSIGNED: In 2021, the World Health Organization officially declared the People\'s Republic of China as malaria-free. However, despite this milestone achievement, the continued occurrence of severe and fatal cases of imported malaria in China, due to globalization and increased international communication, remains a significant public health concern.
UNASSIGNED: The aim of this study was to elucidate the epidemiological characteristics of imported malaria in 5 Chinese provinces from 2014 to 2021 and to identify the factors that influence complications in imported malaria cases. The findings will provide a basis for enhancing prevention and control measures, thereby consolidating China\'s achievements in malaria elimination.
UNASSIGNED: A case-based retrospective study was performed, using surveillance data collected from the representative provinces of China from 2014 to 2021. Epidemiological characteristics were analyzed using descriptive statistics. Logistic regression was used to identify the factors influencing the occurrence of complications.
UNASSIGNED: A total of 5559 malaria cases were included during the study period. The predominant species was Plasmodium falciparum (3940/5559, 70.9%), followed by Plasmodium ovale (1054/5559, 19%), Plasmodium vivax (407/5559, 7.3%), Plasmodium malariae (157/5559, 2.8%), and 1 case of Plasmodium knowlesi. Most of the cases were male (5343/5559, 96.1%). The complication rates for P falciparum and P ovale were 11.4% and 3.3%, respectively. Multivariate logistic regression analysis of the relevant factors of malaria complications revealed potential protective factors, including a previous infection by Plasmodium (P<.001; odds ratio [OR] 0.512, 95% CI 0.422-0.621), and risk factors, including increased age (P=.004; OR 1.014, 95% CI 1.004-1.024), misdiagnosis at the first clinical visit (P<.001; OR 3.553, 95% CI 2.886-4.375), and the time interval from onset to treatment (P=.001; OR 1.026, 95% CI 1.011-1.042). Subgroup analyses identified risk factors associated with P falciparum, which include advanced age (P=.004; OR 1.015, 95% CI 1.005-1.026), initial misdiagnosis during the first clinical visit (P<.001; OR 3.549, 95% CI 2.827-4.455), the time interval from onset to treatment (P<.001; OR 1.043, 95% CI 1.022-1.063), and a delay of more than 3 days from the first treatment to diagnosis (P<.001; OR 2.403, 95% CI 1.823-3.164). Additionally, the risk factors pertaining to P ovale involve misdiagnosis at the initial clinical visit (P=.01; OR 2.901, 95% CI 1.336-6.298), the time interval from onset to treatment (P=.002; OR 1.095, 95% CI 1.033-1.160), and the duration from the initial treatment to diagnosis (P=.43; OR 1.032, 95% CI 0.953-1.118). Previous infections can prevent the progression of both P falciparum and P ovale.
UNASSIGNED: This study showed that the increasing proportion of P ovale in recent years should not be ignored. Furthermore, there is a need to improve diagnostic awareness, enhance the capacity of medical institutions, and provide health education for high-risk groups.