高度疟疾流行区快速控制疟疾试验

A Pilot Project on Fast Eliminating Malaria by Eradicating Source in A Highly Malaria Endemic Area

【目的】探索在高度疟疾流行区快速控制疟疾的策略与方法。【方法】2004-2005两年期间,选择柬埔寨石居省疟疾高度流行区及其周边地带作为灭源灭疟试验区,共62个自然村21 343人口。在对当地疟疾流行情况进行了细致调查的基础上, 采取三项主要灭源措施:①疟疾现症病人采用复方青蒿素(Artequick,ATQ)方案治疗,发热病人亦以此作假定性治疗;②儿童带虫率≥20％的17个村采用ATQ方案进行一次全民治疗;③儿童带虫率≥6％的27个村采用低剂量伯氨喹全民服药,每10 d 1次,连续6个月。组织村抗疟员执行以上灭源措施。监测17个疫源村的人群带虫率,每6个月监测1次。【结果】采取灭源措施2年后,儿童带虫率从55．8％下降为5．3％:其中恶性疟带虫率由37．0％下降为2．3％;间日疟加三日疟带虫率由 18．9％下降为3．0％;儿童恶性疟配子体带虫率由13．1％下降为1．2％。有8个村儿童恶性疟带虫率由采取措施前的平均46．5％下降至0。成人带虫率的改变与儿童带虫率改变相似,由46．5％降为6．3％;恶性疟带虫率由采取措施前的平均34．2％下降为 2．5％,间日疟加三日疟带虫率由12．3％降为3．8％。【结论】灭源灭疟法有别于以控制蚊媒为主的传统方法,是一种又快又省钱的新方法和新策略,可在较短时间内扭转疟疾的高度流行,直至彻底消灭疟疾,值得在广大高疟区推广应用。

[ Objective] To explore new methods and strategies for rapidly controlling malaria in high transmission areas. [Methods] From the year of 2004 to 2005, a pilot project titled ＂Eliminating Malaria by Eradicating Source＂ was conducted amongst 21, 343 inhabitants of 62 natural villages in the highly malaria endemic area of Kampong Speu Province and its peripheral areas in Cambodia. The following methods were adopted for eliminating source：① All confirmed malaria - infected patients were treated with Artequick （ATQ） regimen, an artemisinin - based combination therapy, and fevered patients were also treated with Artequick under problem treatment; ② A mass treatment of ATQ was conducted among 17 villages where parasite carriage rates in children were ≥120% ; ③ Every 10 days for 6 months, mass medications of a low dosage of primaquine were conducted among 27 villages where parasite carriage rates in children were ≥6%. All these measures were implemented by village malaria volunteers （VMV）. The population parasite carriage rates in 17 malaria source villages were intensively monitored every 6 months. [ Results] Two years after the source elimination measures were initiated, the parasite carriage rate in children declined from 55.8 % to 5.3 %. Of that, the P. falcipannn carriage rate declined from 37.0% to 2.3% while the carriage rate of P. vivax plus P. malariae dropped from 18.9% to 3.0%. The gametocyte carriage rate in children had dropped from 13.1% to 1.2%. Moreover, among 8 villages the P. falcipannn carriage rate in children had declined from 46.5 % to zero averagely since the measures were adopted. The changes of parasite carriage rate in adults were similar to those in the children： the parasite carriage rate declined from 46.5% to 6.3%, and P. falciparum carriage rate declined from 34.2% to 2.5%, and the carriage rate ofP. vivax plus P. malariae dropped from 12.3% to 3.8%. [Conclusion] The method of Eliminating Malaria by Eradicating Source is effective and economic, and high prevalence and intensity of malaria could be reduced substantially and malaria transmission sources could be eradicated within a short period of time through adopting this method, which is different from the traditional eliminating malaria method by controlling the mosquito. It would be a promising strategy to be promoted in highly malaria endemic regions.