我国17例输入性疟疾死亡病例临床特征分析

Analysis on clinical features of 17 death cases of imported malaria in China

目的 我国在2021年由WHO认证为无疟疾国家,疟疾已成为一种罕见传染性疾病,防止输入性疟疾再传播和减少因输入性疟疾死亡是中国消除疟疾后面临的主要挑战。本文分析输入性疟疾死亡病例特征,为境外务工的民众和医务工作者提供预防和治疗建议。方法 收集国家重症疟疾救治专家组2016—2020年疟疾死亡病例分析研讨会上报告17例疟疾死亡病例的数据,分析相关临床流行病学资料和病例资料。结果 17例疟疾死亡病例均为非洲输入的恶性疟原虫感染(疟疾脑型),发病月份无明显规律,其中男性16例,5例合并糖尿病等基础疾病,首诊机构为二级及以下医院10例。排除在救护车上呼吸心脏骤停的死亡病例外,16例初次发病至疟疾确诊的平均时间为6.8 d(中位数5.5 d),初次发病到服用抗疟药物治疗的平均时间为7.4 d(中位数6 d),初次发病到病例死亡的平均时间为10.3 d(中位数8.5 d)。排除国外发病和回国时间不明的病例,14例病例均于回国后30 d内发病。结论 死亡病例均为非洲输入的恶性疟原虫感染(疟疾脑型),患者积极就诊意识薄弱,乡镇级及以下卫生机构诊治能力不足所导致就医延迟是死亡病例发生的主要原因。建议加强境外疟疾流行地区务工人员自我保护意识,提升对疟疾危害的认知。基层医疗机构对来自疟疾高风险地区的归国人员,应关注患者的非洲旅行史,提升诊断疟疾的意识、疟疾诊断和处理能力,遵循抗疟治疗全程、足量的个体化治疗方案。

Objective China was certified by World Health Organization as a malaria-free country in 2021. Malaria has become a rare infectious disease, and preventing the re-transmission of imported malaria and reducing deaths are the main challenges facing China after elimination of malaria. To analyze and clarify the characteristics of imported malaria deaths, and to provide prevention and treatment recommendations for overseas workers and health care workers.Methods The data of 17imported malaria deaths in the analysis of malaria deaths from 2016 to 2020 by the National Severe Malaria Treatment Expert Group were collected, and the relevant clinical epidemiological data and disease course records were analyzed.Results The17 malaria deaths were all imported from Africa with Plasmodium falciparum infection(malarial cerebral type), with no obvious regularity in the month of onset. Among them, 16 were male patients, 5 cases with underlying diseases such as diabetes mellitus, and 10 patients were first diagnosed in a second-level or lower hospital. Excluding patients who died of respiratory cardiac arrest in ambulances, the mean time difference between first onset and malaria diagnosis in 16 patients was 6.8 days(median5.5 days), and the mean time between first onset and antimalarial treatment was 7.4 days(median 6 days), the mean time difference from initial onset to death was 10.3 days(median 8.5 days). Excluding cases with onset abroad and unknown time of return, all 14 patients developed the disease within 30 days after returning to China.Conclusion All the fatal cases were infected with Plasmodium falciparum imported from Africa. The patients’ awareness of actively seeking medical treatment is weak,and the delay in seeking medical treatment caused by the insufficient diagnosis and treatment capacity of health institutions at the township level and below is the main reason for the deaths. It is recommended to strengthen the self-protection awareness of staff in malaria-endemic areas overseas and raise their awareness of malaria. For returnees from areas with high malaria risk,primary medical institutions should pay attention to the patient’s travel history in Africa, improve the awareness of malaria diagnosis, malaria diagnosis and treatment capabilities.