Abstract
BackgroundChina has initiated the National Malaria Elimination Action Plan, which aims to eliminate malaria by 2020. However, the transmission of malaria occurs sporadically or in distinct foci, which greatly hampers progress toward elimination in China and other countries. The object of this study was to foci categorization and evaluates whether the response met the requirements issued by the nation or WHO.MethodsResidual transmissions were investigated and located with fine spatial resolution mapping from parasitological confirmed malaria cases by use of routine national surveillance data. The “1–3-7” timeframes were monitored for each focus between 2012 and 2015. Each focus was identified, and the application of appropriate measures was evaluated.ResultsA total of 5996 indigenous cases were recorded between 2010 and 2015; during this period, the number of cases declined by 99.1% (2010, n = 4262; 2015, n = 39). Most indigenous cases (92.5%) were reported in Anhui (n = 2326), Yunnan (n = 1373), Henan (n = 930), Hubei (n = 459), and Guizhou (n = 458). The temporal distribution showed that the indigenous malaria cases were clustered during the period of May to August. A total of 320 foci were carefully investigated and analyzed: 24 were active foci; 72, residual non-active foci; and 224 cleared-up foci. For the foci response evaluation, all the active foci were investigated within 7 days, while 80.2% of the residual non-active foci were responded within 7 days. In addition, reactive case detection (RACD) was carried out with 92.9% of the active foci and vector investigation carried out with 75%. For residual non-active foci, RACD was carried out with 83.2% and vector investigation with 78.2% of the foci.ConclusionsThis study used nationwide data to categorize foci in China and evaluate the response of these areas during the control and elimination phases. Our approach stratifies future control responses by identifying those locations where the elimination of endemic transmission is needed, such as in the counties at the China–Myanmar border and in Tibet. In addition, this study will help local CDC staff to reassess their needs and responses against different types of foci during the elimination and post-elimination phases.
Highlights
China has initiated the National Malaria Elimination Action Plan, which aims to eliminate malaria by 2020
Since 2010, transmissions mainly occurred in the counties along the China–Myanmar border and in Motuo County of the Tibetan Autonomous Region of China
The foci were classified into 3 types according to the guidelines issued by the World Health Organization (WHO) [6]
Summary
China has initiated the National Malaria Elimination Action Plan, which aims to eliminate malaria by 2020. The transmission of malaria occurs sporadically or in distinct foci, which greatly hampers progress toward elimination in China and other countries. China initiated the National Malaria Elimination Action Plan (NMEAP) in 2010, which aimed to eliminate indigenous malaria in non-border areas by the end of 2015, and eliminate it nationwide by the end of 2020 [1]. To achieve the national goal of malaria elimination, China has made great strides in controlling indigenous malaria over the past several decades [3]. After implementing an integrated control strategy and interventions, along with socio-economic development, urbanization progress, and changes in the natural environment and malaria vectors, the incidence of indigenous malaria in China has sharply declined, and the malariaendemic areas have dramatically shrunk [4]. The elimination of residual foci is a dynamic process, taking place mainly during the late stage of malaria elimination
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