中国防止疟疾输入再传播的成效与挑战分析

Analysis of effectiveness and challenges in preventing the re-establishment of malaria transmission in China

目的分析我国2021—2023年疟疾疫情特征及“1-3-7”工作指标,了解防止疟疾输入再传播工作成效及面临的挑战,提出应对策略,为巩固消除疟疾成果提供参考。方法收集“监测报告管理系统”和“寄生虫病防治信息系统”中2021—2023年的疟疾病例流行病学个案调查表及疫点调查与处置表,对病例流行病学特征及“1-3-7”工作指标进行分析。结果2021—2023年,全国31个省(直辖市、自治区)和新疆生产建设兵团累计报告疟疾病例4132例。其中以恶性疟为主(59.2%,2445/4132),2021年799例为历史最低水平,2023年大幅反弹至2488例。病例数排名前5位分别为云南、广东、河南、四川和山东省,共占49.4%(2043/4132)。除2例长潜伏期再燃三日疟病例及1例非蚊传疟疾病例外,其余均为境外输入性病例,主要来自非洲国家(81.7%,3374/4129),间日疟主要来自缅甸(63.7%,638/1001)。疟疾病例以男性青壮年和出境务工人员为主;危重症病例142例、死亡病例21例;81.8%(3378/4132)的病例在发病3 d内就诊,初诊机构以县级、地市级、省级医疗机构为主(77.2%),其疟疾诊断准确率在80.0%以上。“1-3-7”指标完成率均在90.0%以上。结论消除后全国未发生疟疾再传播,监测响应能力维持较高水平,但输入性疟疾疫情不断上升,仍在严重危害我国公众健康,特别是中缅边境等地区再传播风险高。当前需进一步提高重点人群疟疾及时求诊意识以及医务人员对疟疾的警觉性、诊断能力和及时转诊的意识,维持疫情调查处置能力,加强云南中缅边境等重点地区防控,持续巩固消除成果。

Objective To analyze the characteristics of the malaria epidemic and the indicators for"1-3-7"from 2021 to 2023 in China,understand the effectiveness and challenges in preventing re-establishment malaria in China,propose response strategies,and provide references for consolidating the achievements of malaria elimination.Methods The individual malaria case data and focus data from 2021 to 2023 in the"Information System for Infectious Disease Surveillance"and the"Information System for Parasitic Diseases Prevention and Control"were collected,and epidemiological characteristics and indicators for“1-3-7”were analyzed.Results From 2021 to 2023,a total of 4132 malaria cases were reported in 31 provinces and Xinjiang Production and Construction Corps,with mainly falciparum malaria(59.2%,2445/4132).The national malaria epidemic reached a historical low of 799 cases in 2021,before rebounding significantly to 2488 cases in 2023.The top five provinces for malaria cases were Yunnan,Guangdong,Henan,Sichuan,and Shandong,accounting for 49.4%of the total(2043/4132)cases.Except for two long incubation cases infected with P.malariae and one non-mosquito-transmitted case,the remaining cases were imported from abroad,mainly from African countries(81.7%,3374/4129),with P.vivax malaria mainly coming from Myanmar(63.7%,638/1001).Malaria cases mainly occur in middle-aged men and migrant overseas workers.142 severe cases and 21 deaths of malaria were reported.81.8%(3378/4132)of malaria cases sought medical attention within 3 days of symptom onset,and the initial diagnosis institutions were mainly county-level,municipal,and provincial hospitals(77.2%),with an accuracy malaria diagnosis rate of above 80.0%.The completion rates of the malaria indicators for"1-3-7"were all above 90.0%.Conclusions Since the malaria elimination in China,there has been no reestablishment of malaria,and the surveillance response capability has been maintained at a high level.However,the epidemic of imported malaria continued to rise,severely endangering public health in China,especially in areas such as the China-Myanmar border where the risk of re-establishment was high.Currently,it is necessary to further enhance the awareness of the key populations about timely medical consultation for malaria,as well as healthcare workers'vigilance,diagnostic capabilities,and awareness of timely referrals.Efforts should be maintained to investigate and manage epidemics,strengthen prevention and control in key areas such as the China-Myanmar border in Yunnan,and continuously consolidate elimination achievements.