Surveillance and response systems for elimination of tropical diseases: summary of a thematic series in Infectious Diseases of Poverty

The peer-reviewed journal Infectious Diseases of Poverty provides a new platform to engage with,and disseminate in an open-access format,science outside traditional disciplinary boundaries.The current piece reviews a thematic series on surveillance-response systems for elimination of tropical diseases.Overall,22 contributions covering a broad array of diseases are featured–i.e.clonorchiasis,dengue,hepatitis,human immunodeficiency virus/acquired immune deficiency syndrome(HIV/AIDS),H7N9 avian influenza,lymphatic filariasis,malaria,Middle East respiratory syndrome(MERS),rabies,schistosomiasis and tuberculosis(TB).There are five scoping reviews,a commentary,a letter to the editor,an opinion piece and an editorial pertaining to the theme“Elimination of tropical disease through surveillance and response”.The remaining 13 articles are original contributions mainly covering(i)drug resistance;(ii)innovation and validation in the field of mathematical modelling;(iii)elimination of infectious diseases;and(iv)social media reports on disease outbreak notifications released by national health authorities.Analysis of the authors’affiliations reveals that scientists from the People’s Republic of China(P.R.China)are prominently represented.Possible explanations include the fact that the 2012 and 2014 international conferences pertaining to surveillance-response mechanisms were both hosted by the National Institute of Parasitic Diseases(NIPD)in Shanghai,coupled with P.R.China’s growing importance with regard to the control of infectious diseases.Within 4 to 22 months of publication,three of the 22 contributions were viewed more than 10000 times each.With sustained efforts focusing on relevant and strategic information towards control and elimination of infectious diseases,Infectious Diseases of Poverty has become a leading journal in the field of surveillance and response systems in infectious diseases and beyond.

China’s 1-3-7 surveillance and response strategy for malaria elimination: Is case reporting, investigation and foci response happening according to plan?

Background:The China’s 1-3-7 strategy was initiated and extensively adopted in different types of counties(geographic regions)for reporting of malaria cases within 1 day,their confirmation and investigation within 3 days,and the appropriate public health response to prevent further transmission within 7 days.Assessing the level of compliance to the 1-3-7 strategy at the county level is a first step towards determining whether the surveillance and response strategy is happening according to plan.This study assessed if the time-bound targets of the 1-3-7 strategy were being sustained over time.Such information would be useful to improve implementation of the 1-3-7 strategy in China.Methods:This cross-sectional study involved country-wide programmatic data for the period January 1st 2013 to June 30th 2014.Data variables were extracted from the national malaria information system and included socio-demographic information,type of county,date of diagnosis,date of reporting,date of case investigation,case classification(indigenous,or imported,or unknown),focus investigation,date of reactive case detection(RACD),and date of indoor residual spraying(IRS).Summary statistics and proportions were used and comparisons between groups were assessed using the chi-square test.Level of significance was set at a P-value≤0.05.Results:Of a total of 5,688 malaria cases from 731 counties,there were 55(1%)indigenous cases(only in Type 1 and Type 2 counties)and 5,633(99%)imported cases from all types of counties.There was no delay in reporting malaria cases by type of county.In terms of case investigation,97.5%cases were investigated within 3 days with the proportion of delays(1.5%)in type 2 counties,being significantly lower than type 1 counties(4.1%).Regarding active foci,96.4%were treated by RACD and/or IRS.Conclusions:The performance of 1-3-7 strategy was encouraging but identified some challenges that if addressed can further improve implementation.

Challenges in and lessons learned during the implementation of the 1-3-7 malaria surveillance and response strategy in China: a qualitative study

Background:China has made great progress in malaria control over the last century and now aims to eliminate malaria by 2020.In 2012,the country launched its 1-3-7 surveillance and response strategy for malaria elimination.The strategy involves to case reporting within 1 day,case investigation within 3 days,and focus investigation and public health actions within 7 days.The aim of this study was to evaluate the challenges in and lessons learned during the implementation of the 1-3-7 strategy in China so far.Methods:This qualitative study was conducted in two provinces in China:Gansu province(northwestern China)and Jiangsu province(southeastern China)in 2014.Key informant interviews(n=6)and in-depth interviews(n=36)about the implementation aspects of the 1-3-7 strategy were conducted with malaria experts,health staff,laboratory practitioners,and village doctors at the provincial,city,county,township,and village levels.Results:Broad themes related to the challenges in and lessons learned during the implementation of the 1-3-7 strategy were identified according to:case reporting within 1 day,case investigation within 3 days,focus investigation within 7 days,and the overall strategy.The major challenges outlined were related to respecting the timeline of surveillance procedures,the absence of or difficulties in following guidelines on conducting focus investigations,diagnostics,and the increasing number of returning migrant workers from malaria-endemic countries.Important lessons learned revolve around the importance of continuous capacity building,supervision and motivation,quality control,information technology support,applied research,governmental commitment,and intersectoral collaboration.Conclusions:Surveillance is a key intervention in malaria elimination programs.The Chinese 1-3-7 strategy has already proven to be successful but still needs to be improved.In particular,dealing appropriately with imported malaria cases through the screening of migrant workers from malaria-endemic countries is essential for achieving and sustaining malaria elimination in China.China has perfect preconditions for successful malaria elimination provided political commitment and financial investment are guaranteed.The 1-3-7 strategy may also be considered as a model for other countries.

Challenges in early phase of implementing the 1-3-7 surveillance and response approach in malaria elimination setting:A field study from Myanmar

Background:The National Plan for Malaria Elimination(NPME)in Myanmar(2016–2030)aims to eliminate indigenous Plasmodium falciparum malaria in six states/regions of low endemicity by 2020 and countrywide by 2030.To achieve this goal,in 2016 the National Malaria Control Program(NMCP)implemented the“1-3-7”surveillance and response strategy.This study aims to identify the barriers to successful implementation of the NPME which emerged during the early phase of the“1-3-7”approach deployment.Methods:A mixed-methods study was conducted with basic health staff(BHS)and Vector Born Disease Control Program(VBDC)staff between 2017 and 2018 in six townships of six states/regions targeted for sub-national elimination by 2020.A self-administered questionnaire,designed to assess the knowledge required to implement the“1-3-7”approach,was completed by 544 respondents.Bivariate analysis was performed for quantitative findings and thematic analysis was conducted for qualitative findings using Atals.ti software.Results:Although 83%of participants reported performing the key activities in the“1-3-7”surveillance and response approach,less than half could report performing those activities within 3 days and 7 days(40 and 43%,respectively).Low proportion of BHS correctly identified six categories of malaria cases and three types of foci(22 and 26%,respectively).In contrast,nearly 80%of respondents correctly named three types of case detection methods.Most cited challenges included‘low community knowledge on health’(43%),‘inadequate supplies’(22%),and‘transportation difficulty’(21%).Qualitative data identified poor knowledge of key surveillance activities,delays in reporting,and differences in reporting systems as the primary challenges.The dominant perceived barrier to success was inability to control the influx of migrant workers into target jurisdictions especially in hard-to-reach areas.Interviews with township medical officers and the NMCP team leaders further highlighted the necessity of refresher training for every step in the“1-3-7”surveillance and response approach.Conclusions:The performance of the“1-3-7”surveillance and response approach in Myanmar delivers promising results.However,numerous challenges are likely to slow down malaria elimination progress in accordance with the NPME.Multi-stakeholder engagement and health system readiness is critical for malaria elimination at the subnational level.

Role of international network on surveillance and response system leading to malaria elimination: China’s engagement in global health

China has accumulated multiple practices and experiences in building and enhancing malaria surveillance and response system. As China’s engagement into global health has gathered stronger momentum than ever, China together with the Swiss Tropical and Public Health Institute and WHO has organised five sessions of the International Forum on Surveillance-Response System Leading to Tropical Diseases Elimination during 2012–2020, in which malaria elimination has always been one of the hottest topics. In this study, the roles of international network on the surveillance and response system were explored to achieve a global malaria-free goal. China’s approach to malaria elimination has demonstrated significance of global collaboration on taking joint prevention and control, and building a worldwide institutional-based network.

Imported malaria cases in former endemic and non-malaria endemic areas in China:are there differences in case profile and time to response?

Background:China has achieved zero indigenous malaria case report in 2017.However,along with the increasing of international cooperation development,there is an increasing number of imported malaria cases from Chinese nationals returning from malaria-affeaed countries.Previous studies have focused on malaria endemic areas in China.There is thus limited information on non-endemic areas in China,especially on the performance of malaria surveillance and response in health facilities.Methods:A comparative retrospective study was carried out based on routine malaria surveillance data collected from 2013 to 2017.All imported malaria cases reported within the mainland of China were included.Variables used in the comparative analysis between cases in former endemic and former non-endemic areas,included age,gender and occupation,destination of overseas travel,Plasmodium species and patient health outcome.Monthly aggregated data was used to compare seasonal and spatial characteristics.Geographical distribution and spatial-temporal aggregation analyses were conducted.Time to diagnosis and report,method of diagnosis,and level of reporting/diagnosing health facilities were used to assess performance of health facilities.Results:A total of 16733 malaria cases,out of which 90 were fatal,were recorded in 31 provinces.The majority of cases(96.2%)were reported from former malaria endemic areas while 3.8%were reported from former non-malaria endemic areas.Patients in the age class from 19 to 59 years and males made the highest proportion of cases in both areas.There were significant differences between occupational categories in the two areas(P c 0.001).In former endemic areas,the largest proportion of cases was among outdoor workers(80%).Two peaks(June,January)and three peaks(June,September and January)were found in former endemic and former non-endemic areas,respeaively.Time between the onset of symptoms and diagnosis at clinics was significantly different between the two areas at different level of health facilities(P<0.05).Conclusions:All the former non-endemic areas are now reporting imported malaria cases.However,the largest proportion of imported cases is still reported from former endemic areas.Health facilities in former endemic areas outperformed those in former non-endemic areas.Information,treatment,and surveillance must be provided for expatriates while capacity building and continuous training must be implemented at health facilities in China.

Impact of 1,7-malaria reactive community-based testing and response(1,7-mRCTR)approach on malaria prevalence inTanzania

Background Progress in malaria control has stalled in recent years and innovative surveillance and response approaches are needed to accelerate malaria control and elimination eforts in endemic areas of Africa.Build‑ing on a previous China-UK-Tanzania pilot study on malaria control,this study aimed to assess the impact of the 1,7-malaria Reactive Community-Based Testing and Response(1,7-mRCTR)approach implemented over two years in three districts of Tanzania.Methods The 1,7-mRCTR approach provides community-based malaria testing via rapid diagnostic tests and treat‑ment in villages with the highest burden of malaria incidence based on surveillance data from health facilities.We used a diference-in-diferences quasi-experimental design with linear probability models and two waves of crosssectional household surveys to assess the impact of 1,7-mRCTR on malaria prevalence.We conducted sensitivity analyses to assess the robustness of our results,examined how intervention efects varied in subgroups,and explored alternative explanations for the observed results.Results Between October 2019 and September 2021,244,771 community-based malaria rapid tests were com‑pleted in intervention areas,and each intervention village received an average of 3.85 rounds of 1-7mRCTR.Malaria prevalence declined from 27.4%at baseline to 11.7%at endline in the intervention areas and from 26.0%to 16.0%in the control areas.1,7-mRCTR was associated with a 4.5-percentage-point decrease in malaria prevalence(95%confdence interval:−0.067,−0.023),equivalent to a 17%reduction from the baseline.In Rufji,a district characterized by lower prevalence and where larviciding was additionally provided,1,7-mRCTR was associated with a 63.9%decline in malaria prevalence.Conclusions The 1,7-mRCTR approach reduced malaria prevalence.Despite implementation interruptions due to the COVID-19 pandemic and supply chain challenges,the study provided novel evidence on the efectiveness of community-based reactive approaches in moderate-to high-endemicity areas and demonstrated the potential of South-South cooperation in tackling global health challenges.

Combating infectious diseases of poverty: a year on

The Infectious Diseases of Poverty journal,launched a year ago,is a platform to engage outside the traditional disciplinary boundaries,and disseminate high quality science towards the improvement of health.This paper reviews the milestone achievements during its first year of operation.The journal has filled an important niche,addressing some of the main priorities in the Global Report for Research on Infectious Diseases of Poverty.Highlights include the publication of three thematic issues on health systems,surveillance and response systems,as well as co-infection and syndemics.The thematic issues have foregrounded the importance and innovation that can be achieved through transdisciplinary research.The journal has been indexed by PubMed since April 2013,with the publication of a total of 38 articles.Finally,the journal is delivering to wider range readers both in developing and developed countries with sustained efforts with a focus on relevant and strategic information towards elimination of infectious diseases of poverty.