中国消除疟疾:监测响应系统的实施与成效分析

Achieving malaria elimination in China:analysis on implementation and effectiveness of the surveillance-response system

目的分析中国消除疟疾监测响应系统的实施和工作成效,为消除后防止疟疾输入再传播工作提供科学依据。方法系统收集整理消除疟疾监测响应相关的方案和活动记录,以及基于国家传染病报告信息管理系统和寄生虫病防治信息管理系统中2011—2020年全国疟疾病例个案信息和监测指标数据,使用SPSS 25.0和GraphPad Prism 8.4.3软件进行统计分析。结果2011—2020年,全国共报告疟疾病例30278例,中国籍28448例(93.96%)。本地原发感染病例1732例(5.72%),为2011—2016年报告;境外输入性病例28173例(93.05%);输血感染病例9例(0.03%);长潜伏期三日疟5例(0.02%);输入继发间日疟4例(0.01%);来源不明病例355例(1.17%),为2011—2013年报告。病例以恶性疟(17960例,59.32%)为主;主要集中在云南(5415例,17.88%)、广西(3193例,10.55%)、江苏(2797例,9.24%)等省(自治区);全年均有病例报告,主要集中在5—7月(9689例,32.00%)。输入性病例主要来自缅甸(4856例,17.24%)、加纳(2957例,10.50%)、尼日利亚(2693例,9.56%)等国。被动监测、人群主动病例侦查和线索追踪病例侦查的血检阳性率分别为0.76‰(28452/37500291)、0.03‰(35/1215309)和0.30‰(32/105384)。2013—2020年,病例诊断后1日内报告率为100%(23114/23114),报告后3日内流行病学个案调查率为94.49%(21840/23114),7日内疫点调查和处置率为93.30%(20294/21751),病例发病到初诊以及初诊到确诊间隔时间中位数均为1 d(四分位距:0~3 d)。中华按蚊分布广泛,且普遍对溴氰菊酯产生抗性。体内疗效观察双氢青蒿素哌喹片对恶性疟、氯伯喹对间日疟的治愈率分别为92.31%(36/39)和100%(21/21)。结论建设敏感有效的监测响应系统是中国消除疟疾的成功经验,在消除疟疾后应继续把监测响应作为核心措施,积极开展部门合作,加强能力建设,防止输入再传播,巩固消除成果。

Objective To analyze the implementation and effectiveness of surveillance-response system in eliminating malaria in China,and to provide scientific basis for preventing re-establishment of transmission by imported malaria in the post-elimination phase.Methods The national scheme and activities records in malaria elimination program were systematically collected and sorted,and the data of individual malaria cases and indicators in 2011—2020 from web-based National Information System for Infectious Diseases Surveillance and National Information System for Parasitic Diseases Control and Prevention were analyzed using SPSS 25.0 and GraphPad Prism 8.4.3.Results From 2011 to 2020,a total of 30278 malaria cases were reported nationwide,93.96%(28448 cases)of them were Chinese nationality.The total cases included 1732(5.72%)indigenous cases reported from 2011 to 2016,28173(93.05%)imported cases from abroad,9(0.03%)induced cases,5(0.02%)long incubation malariae malaria cases,4(0.01%)introduced vivax malaria cases,as well as 355(1.17%)cases with unreported origin from 2011 to 2013.The cases were mainly falciparum malaria cases(17960 cases,59.32%)and mainly reported by Yunnan(5415 cases,17.88%),Guangxi(3193 cases,10.55%),and Jiangsu(2797 cases,9.24%)provinces.The cases were reported yearround,with the majority in May and July(9689 cases,32.00%).The imported cases were mainly from Myanmar(4856 cases,17.24%),Ghana(2957 cases,10.50%),and Nigeria(2693 cases,9.56%).The positive rates of blood tests for malaria by passive case detection,proactive case detection and reactive case detection were 0.76‰(28452/37500291),0.03‰(35/1215309)and 0.30‰(32/105384),respectively.From 2013 to 2020,case reporting rate within 1 day after diagnosis was 100%(23114/23114),the rate of epidemiological investigation for individual case within 3 days after reporting was 94.49%(21840/23114),the rate of foci investigated and disposed within 7 days was 93.30%(20294/21751),and the median time from the illness onset to first diagnosis and from first diagnosis to confirmed diagnosis of the patients were both 1 d(IQR:0~3 d).Anopheles sinensis was widely distributed and commonly resistant to deltamethrin.In vivo efficacy of dihydro-artemisinin-piperaquine against uncomplicated falciparum malaria and chloroquine and primaquine against vivax malaria was 92.31%(36/39)and 100%(21/21),respectively.Conclusion Establishment of the sensitive and effective surveillance-response system is a vital experience for the success of malaria elimination in China.In the post-elimination phase,surveillance-response should continue to be the key measure,and active cooperation between different sectors and capacity building should be strengthened,to prevent re-establishment of transmission and consolidate the accomplishments of elimination.