Abstract

BackgroundChina is implementing a National Malaria Elimination Programme. A high proportion of clinically diagnosed malaria cases is reported in some provinces of China. In order to understand the exact situation and make clear the nature of these patients, it is of much importance to make case verifications, particularly from the pathogenic perspective.MethodsGuizhou Province was targeted because of its high proportion of clinically diagnosed malaria cases. After random selection of around 10% of malaria cases from 1 May 2011 to 30 April 2012, reported through the national web-based case reporting system from this province, field verifications were made on 14–17 May 2012 as follows. Firstly, the reported information of each case was rechecked with the onsite case registrations and investigation forms, and an in-depth interview was conducted with each patient. Secondly, the patient’s blood smears kept by local CDC were cross-checked microscopically by a national experienced microscopist. Thirdly, two kinds of polymerase chain reaction (PCRs). including Tag-primer nested/multiplex PCR (UT-PCR) based on cytochrome oxidase gene (cox I) and nested PCR based on 18s rRNA gene were performed simultaneously using local CDC kept filter paper of dry blood samples to identify the Plasmodium spp.ResultsTwelve out of 152 malaria cases were selected, including nine clinically diagnosed malaria cases, two confirmed falciparum malaria cases and one confirmed vivax malaria case. The original case documents on the site were completely in conformity with their reported data, and all the patients recalled their malaria symptoms and being cured only after consuming the corresponding anti-malarial drugs. Moreover, the re-examination results of microscopy and PCR were exactly in agreement with the original tests.DiscussionNo inconsistent results were found against the reported case information in the present study and the reasons for clinically diagnosed patients remains unclear. Uniform and standardized sample collection and processing should be trained among clinicians, more sensitive and specific techniques should be explored to used in malaria diagnosis. A further study is needed in order to be more observationally focussed rather than retrospective.

Highlights

  • China is implementing a National Malaria Elimination Programme

  • Two confirmed imported falciparum malaria cases were from Guiyang City; nine clinically diagnosed local malaria cases were from Sandu County, Luodian County and Ceheng County; and one confirmed local vivax malaria case from Congjiang County (Figure 1 and Table 1)

  • Malaria has been a major public health problem historically in China, and China has made an impact on malaria disease burden with successful large-scale malaria control activities nationwide [10,11] and is entering an age of malaria elimination since the Action Plan of China Malaria Elimination (2010–2020) was presented

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Summary

Introduction

China is implementing a National Malaria Elimination Programme. A high proportion of clinically diagnosed malaria cases is reported in some provinces of China. There were 56.7% vivax malaria and 40.2% falciparum malaria among the cases with laboratory confirmation [2]. The definition of malaria case in an elimination programme is very different from a control programme. It is defined as a person in whom, regardless of the presence or absence of clinical symptoms, malaria parasites have been confirmed by quality controlled laboratory diagnosis [3,4]. According to the national web-based case reporting system, it was noted that the proportion of clinically diagnosed malaria cases were over 25% in about one-third (10/34); Provinces/ Municipalities/Autonomous Regions in China; and almost reached 90% in the key malaria-prevalent Province of Guizhou

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