微小按蚊分布区灭疟后期疟疾流行病学特点和监测方法研究

Study of malaria epidemiological features and surveillance methods in the late-stage of malaria eradication in the Anopheles minimus areas

目的 探讨广东省微小按蚊分布区灭疟后期流行病学特点和简化疟疾监测方法的可行性。方法 于 1998～ 2 0 0 0年选择微小按蚊分布区并已经省考核验收达到基本消灭疟疾标准 ,每年疟疾年发病率相对稳定的开平、台山、高州和怀集 4个县 (市 )为试验区 ,实行只是“三热”患者血检、疫点不处理的简化监测措施 ,并对监测结果进行成本—效益分析。结果 经过 3年的简化监测措施 ,4个试点县 (市 )共血检“三热”患者 4 7347例次 ,检出疟原虫阳性 174例 ,且疟疾年发病率继续下降 ,2 0 0 0年均降至 1/10万或以下 ,输入病例减少 ,没有暴发流行点出现 ,所有病例均呈散发性 ,病例之间不存在继发关系。 99 4 3%疟疾患者都是在临床初诊为疟疾和疑似疟疾中发现 ,其中初诊是疟疾者可发现 73 5 6 %病例 ;初诊是疑似疟疾者可发现 2 5 86 %病例 ;只有 1例是在初诊为不明原因发热患者中发现。成本效益分析显示 ,若实行“二热”患者血检 ,则每发现 1例疟疾患者可节省血检费用1777 82元。结论 建议在微小按蚊分布区灭疟后期 ,疟疾监测可实行“三热”患者血检 ,并把“二热”血检作为重点中的重点 ;只处理现症患者 ,不处理疫点。

Objective To assess the features of malaria epidemiology and the possibility of simplified surveillance methods in the late stage of malaria eradication in Anopheles minimus areas in Guangdong. Methods Four counties, located in Anopheles minimus areas, met the standard of basically malaria eradication and with stable annual malaria incidences were selected. Simplified surveillance method was implemented from 1998 to 2000, blood films tests for the three kinds of fever patients without epidemic spot treatment, meanwhile the cost benefit analysis was carried out. Results 47 347 blood samples from three kinds of fever patients were tested and 174 samples were confirmed plasmodium positive. The annual incidences of malaria decreased steadily after implementation of simplified surveillance for three years, the incidence of malaria was less than 1/100 000 in 2000. The number of imported malaria case decreased and no malaria outbreak reported. All malaria cases were sporadic without secondary malaria case. 99.43% malaria cases were found from the patient diagnosed as malaria cases or suspected malaria cases at the first visit to a doctor. Of the 174 positive samples,73.56% from malaria cases and 25.86% from suspected malaria cases. The cost benefit analysis showed that blood films test for two kinds of fever was much more effective and cheaper than test for three kind of fever patients, the cost of one malaria case detected can save 1,777.82 RMB Yuan. Conclusion Simplified surveillance method, blood films tests for three kinds of fever patients(the key is two kinds of fever patients)without epidemic spot treatment can have economic advantages in the late stage of malaria eradication in Anopheles minimus areas.