背景:尽管世界卫生组织在2021年确认中国无疟疾,但由输入性疟疾病例引起的本地传播风险仍然是一个重要的临床和公共卫生问题。有必要介绍中国疟疾的变化趋势,并讨论旅行医学服务在巩固消除疟疾中的作用。
方法:本研究系统回顾了2013年至2022年在国际和中国数据库中发表的与人类疟疾有关的文章和报告。疟疾数据(即病例数,疟原虫。,诊断方法,收购的国家,重新引入和传播风险高的省份)被收集和综合,然后使用描述性统计数据进行汇总。
结果:总体而言,24758例疟疾病例(实验室确诊>99.5%,>99.2%进口,从2013年到2022年,中国报告了0.5%的致死率),多年来呈下降趋势(2013年为4128例,2022年为843例;χ2趋势p值=0.005)。最后一例当地病例是在2017年报告的。恶性疟原虫(65.5%)是最常见的物种,其次是间日疟原虫(20.9%)和卵卵圆虫(10.0%)。2014年和2017年还在马来西亚和印度尼西亚的返回旅客中发现了两例PheidoleKnowlesi病例,分别。疟疾感染最常见的国家是加纳,安哥拉,和缅甸。间日疟原虫主要在从缅甸返回的旅客中发现,而在来自撒哈拉以南非洲的旅行者中发现了恶性疟原虫和卵卵圆虫。输入病例主要报告在云南,江苏,四川,广西,山东,浙江,和河南省,大量的中国人出国工作。
结论:从疟疾流行国家返回的旅行者构成了疟疾再次传入中国的重大风险。应加强旅行医学,以提高旅行前和旅行后服务的能力和可及性,包括预防疟疾和迅速诊断返回旅客的疾病。
BACKGROUND: Despite the World Health Organisation certifying
China malaria-free in 2021, the risk of local transmission caused by imported malaria cases remains a significant clinical and public health issue. It is necessary to present the changing trends of malaria in
China and discuss the role of travel medicine services in consolidating malaria elimination.
METHODS: This study systematically reviewed articles and reports related to human malaria from 2013 to 2022 published in international and Chinese databases. Data on malaria (i.e. number of cases, Plasmodium spp., diagnostic method, country of acquisition, provinces with high risk of re-introduction and transmission) were collected and synthesised, then summarised using descriptive statistics.
RESULTS: Overall, 24 758 cases of malaria (>99.5% laboratory confirmed, > 99.2% imported, 0.5% fatal) were reported in
China from 2013 to 2022, with a downward trend over the years (4128 cases in 2013 compared to 843 cases in 2022; χ2 trend p-value = 0.005). The last locally acquired case was reported in 2017. P. falciparum (65.5%) was the most common species identified, followed by P. vivax (20.9%) and P. ovale (10.0%). Two Pheidole knowlesi cases were also identified in 2014 and 2017 in returned travellers from Malaysia and Indonesia, respectively. The most common countries of malaria acquisition were Ghana, Angola, and Myanmar. P. vivax was mainly detected in returned travellers from Myanmar, while P. falciparum and P. ovale were detected in travellers from Sub-Saharan Africa. Imported cases were mainly reported in Yunnan, Jiangsu, Sichuan, Guangxi, Shandong, Zhejiang, and Henan provinces, where large numbers of Chinese people travel overseas for work.
CONCLUSIONS: Returned travellers from malaria-endemic countries pose a significant risk of malaria re-introduction to
China. Travel medicine should be strengthened to improve the capacity and accessibility of both pre- and post-travel services, including malaria prophylaxis and prompt diagnosis of illness in returned travellers.