我国海南省抗药性恶性疟流行情况的变迁

Epidemic History of Drug_resistant Falciparum Malaria in Hainan Province

由于恶性疟原虫多种抗药性的不断产生和蔓延，给疟疾防治带来了困难。本文以调查研究和科学实验相结合的方法，对我国高疟区海南省抗药性恶性疟流行情况的变迁作一系统报导。１９５５年该岛２７７万人口患疟疾者有２８６７４５人，因疟疾而致死者２８７人。１９５９年进行了Ｄ．Ｄ．Ｔ．滞留喷洒，效果良好，主要传疟媒介微小按蚊由原占蚊群组成６７．５％下降到０．９％。此后疟疾发病率逐年下降，至１９６５年带虫率已低于０．９％和０．２％。１９７３年作者等在该岛三亚市发现了抗氯喹恶性疟病例，至１９７８年岛内各地先后发现抗氯喹恶性疟存在，其中约１／３属于ＲⅡ＿ＲⅢ级抗性。１９７９年该岛以哌喹全面取代氯喹应用于疟疾防治。但到了１９８２年抗哌喹恶性疟病例又不断出现，抗性率为１０％～２０％，其中有５％为ＲⅡ＿ＲⅢ级抗性。１９７８～１９９０年作者等在三亚市建立了体外测试方法，以监测恶性疟原虫的敏感性。试验证明，恶性疟原虫分离株抗氯喹程度已下降，对哌喹则具有抗性，但在哌喹与氯喹之间未见明显交叉抗性，而对蒿甲醚和咯萘啶则显示敏感。近年来海南省恶性疟发病率已大幅度下降，１９９６年仅为５４．９３／１０万人口，但对疟原虫抗药性问题仍需继续监测。

おhe development and spread of multi_drug_resistance in falciparum malaria have brought new obstacles on the promotion of malaria control measures in the tropics.Under this circumstance,it is urgently required for the establishment of a consecutive monitoring system of sensitivity of Plasmodium falciparum to various antimalarial drugs for effective chemoprophylaxis and treatment of the disease.Epidemic history of drug_resistant falciparum malaria in Hainan province was reported in this study.Malaria is the most important tropical disease in Hainan province and the malaria incidence ranks the first in the whole country.A record of highest incidence was that of 1955,the actually detected morbidity was 286 745 with a mortality of 287 in 2.77millions population.The introduction of residual spraying with D.D.T.in 1959 showed very promising results;distribution of main vector mosquito Anopheles minimus reduced from65.7% to 0.9%in the Island.In 1965 the annual parasite rate was less than 0.9%and0.2%which had maintained last decade.However the first case of chloroquine_resistant P.falciparum was found in 1973 at Nanbin Farm of Sanya and then it was found nearly in the whole Island up to 1978.More than 80% of malaria cases were resistant to chloroquine,1/3 of them were of RⅡ to RⅢ grade and 500 000 population were involved in these regions.In 1973 piperaquine was applied for preventing and treating falciparum malaria in Hainan island and proved to be a successful candidate of antimalarial drug in China.Since 1979,piperaquine had been used in Hainan to replace chloroquine for both prevention and treatment of falciparum malaria.In 1982,however,the piperaquine_resistant P.falciparum appeared in succession.The resistant rate was about 10%～20% at present and its degree was still lower than that of chloroquine and 5% of cases showed RⅡ to RⅢ grade resistance.Now the malaria incidence in Hainan province has been greatly dropping down and in 1996 only 54 935 per one hundred thousand cases were reported.But it is still necessary to monitor the drug_resistance of falciparum malaria.