Indigenous Malaria Cases Research Articles

Epidemiological profile of imported malaria cases in Colombia

Despite the significant progress made in reducing morbidity and mortality in recent years, malaria remains a critical global health challenge. In Colombia, we are working towards eliminating malaria to achieve zero indigenous cases of human malaria. In this effort, it is also essential to understand the epidemiological profile of imported cases. This study aimed to determine the epidemiological situation of imported malaria cases in Colombia from 2007 to 2020. An observational, descriptive, and retrospective study used secondary sources for data analysis. A total of 7,583 imported malaria cases (0.8% of total burden) were recorded. 85% (6,507/7,583) were caused by Plasmodium vivax, and 89% (6,772/7,583) were imported from Venezuela. Imported malaria trend varied, contributing minimally to the national burden. Venezuela was identified as the main source of imported cases. These findings will contribute to improving disease surveillance and preventing the reintroduction of malaria in areas undergoing elimination.

Assessing receptivity to malaria using case surveillance and forest data in a near-elimination setting in northeast Thailand

BackgroundThailand aimed to eliminate malaria by 2024, and as such is planning for future prevention of re-establishment in malaria free provinces. Understanding the receptivity of local areas to malaria allows the appropriate targeting of interventions. Current approaches to assessing receptivity involve collecting entomological data. Forest coverage is known to be associated with malaria risk, as an environment conducive to both vector breeding and high-risk human behaviours.MethodsGeolocated, anonymized, individual-level surveillance data from 2011 to 2021 from the Thai Division of Vector-Borne Disease (DVBD) was used to calculate incidence and estimated Rc at village level. Forest cover was calculated using raster maps of tree crown cover density and year of forest loss from the publicly available Hansen dataset. Incidence and forest cover were compared graphically and using Spearman’s rho. The current foci classification system was applied to data from the last 5 years (2017–2021) and forest cover for 2021 compared between the classifications. A simple risk score was developed to identify villages with high receptivity.ResultsThere was a non-linear decrease in annual cases by 96.6% (1061 to 36) across the two provinces from 2011 to 2021. Indigenous Annual Parasite Index (API) and approximated Rc were higher in villages in highly forested subdistricts, and with higher forest cover within 5 km. Forest cover was also higher in malaria foci which consistently reported malaria cases each year than those which did not. An Rc > 1 was only reported in villages in subdistricts with > 25% forest cover. When applying a simple risk score using forest cover and recent case history, the classifications were comparable to those of the risk stratification system currently used by the DVBD.ConclusionsThere was a positive association between forest coverage around a village and indigenous malaria cases. Most local transmission was observed in the heavily forested subdistricts on the international borders with Laos and Cambodia, which are where the most receptive villages are located. These areas are at greater risk of importation of malaria due to population mobility and forest-going activities. Combining forest cover and recent case surveillance data with measures of vulnerability may be useful for prediction of malaria recurrence risk.

Risk assessment of imported malaria in China: a machine learning perspective

BackgroundFollowing China’s official designation as malaria-free country by WHO, the imported malaria has emerged as a significant determinant impacting the malaria reestablishment within China. The objective of this study is to explore the application prospects of machine learning algorithms in imported malaria risk assessment of China.MethodsThe data of imported malaria cases in China from 2011 to 2019 was provided by China CDC; historical epidemic data of malaria endemic country was obtained from World Malaria Report, and the other data used in this study are open access data. All the data processing and model construction based on R, and map visualization used ArcGIS software.ResultsA total of 27,088 malaria cases imported into China from 85 countries between 2011 and 2019. After data preprocessing and classification, clean dataset has 765 rows (85 * 9) and 11 cols. Six machine learning models was constructed based on the training set, and Random Forest model demonstrated the best performance in model evaluation. According to RF, the highest feature importance were the number of malaria deaths and Indigenous malaria cases. The RF model demonstrated high accuracy in forecasting risk for the year 2019, achieving commendable accuracy rate of 95.3%. This result aligns well with the observed outcomes, indicating the model’s reliability in predicting risk levels.ConclusionsMachine learning algorithms have reliable application prospects in risk assessment of imported malaria in China. This study provides a new methodological reference for the risk assessment and control strategies adjusting of imported malaria in China.

Factors impacting sustained coverage inthe context ofdonor transitions: experience from Sri Lanka.

Although not reliant on donor funding for health, the external assistance that Sri Lanka receives contributes to the improvement of the health system and health outcomes. In this study, we evaluated transition experiences of the expanded programme on immunization (EPI) that received Gavi funding to expand the vaccine portfolio and the Anti-Malaria Campaign (AMC) that received funding from the Global Fund for AIDS, Tuberculosis and Malaria to scale-up interventions to target and achieve malaria elimination. We assessed if EPI and AMC programmes were able to sustain coverage of previously donor-funded interventions post-transition and explain the facilitators and barriers that contribute to this. We used a mixed methods approach using quantitative data to assess coverage indicators and the financing mix of the health programmes and qualitative analysis guided by a framework informed by the Walt and Gilson policy triangle that brought together document review and in-depth interviews to identify facilitators and barriers to transition success. The EPI programme showed sustained coverage of Gavi-funded vaccines post-transition and the funding gap was bridged by mobilizing domestic financing facilitated by the Gavi co-financing mechanism, full integration within existing service delivery structures, well-established and favourable pharmaceutical procurement processes for the public sector and stewardship and financial advocacy by technically competent managers. Although the absence of indigenous cases of malaria since 2012 suggests overall programme success, the AMC showed mixed transition success in relation to its different programme components. Donor-supported programme components requiring mobilization of operational expenses, facilitated by early financial planning, were successfully transitioned (e.g. entomological and parasitological surveillance) given COVID-19-related constraints. Other key programme components, such as research, training, education and awareness that are dependent on non-operational expenses are lagging behind. Additionally, concerns of AMC's future financial sustainability within the current structure remain in the context of low malaria burden.

Malaria elimination in Ghana: recommendations for reactive case detection strategy implementation in a low endemic area of Asutsuare, Ghana.

Progress toward malaria elimination is increasing as many countries near zero indigenous malaria cases. In settings nearing elimination, interventions will be most effective at interrupting transmission when targeted at the residual foci of transmission. These foci may be missed due to asymptomatic infections. To solve this problem, the World Health Organization recommends reactive case detection (RACD). This case study was conducted to identify individuals with asymptomatic malaria, their predisposing risk factors and recommend RACD in Asutsuare, Ghana based on literature review and a cross sectional study. The study involved a search on PubMed and Google Scholar of literature published between 1st January, 2009-14th August, 2023 using the search terms "malaria" in "Asutsuare". Furthermore, structured questionnaires were administered to one hundred individuals without symptoms of malaria and screened using rapid diagnostic test (RDT) kits, microscopy and real-time polymerase chain reaction (rt-PCR). Malaria prevalence based on the three diagnostic techniques as well as potential malaria risk factors were assessed through questionnaires in a cross-sectional study. Cumulatively, sixty-four (64) studies (Google Scholar, 57 and PubMed, 7) were reviewed and 22 studies included in the literature on malaria in Asutsuare, Ghana. Significant risk factors were occupation, distance from a house to a waterbody, age group and educational level. Out of the 100 samples, 3 (3%) were positive by RDT, 6 (6%) by microscopy and 9 (9%) by rt-PCR. Ages 5-14.9 years had the highest mean malaria parasite densities of 560 parasites/µl with Plasmodium falciparum as the dominant species in 4 participants. Moreover, in the age group ≥ 15, 2 participants (1 each) harboured P. falciparum and Plasmodium malariae parasites. RDT had a higher sensitivity (76.54%; CI95 66.82-85.54) than rt-PCR (33.33%; CI95 4.33-77.72), while both rt-PCR and RDT were observed to have a higher specificity (92.55; CI95 85.26-96.95) and (97.30; CI95 93.87-99.13), respectively in the diagnosis of malaria. In Asutsuare, Ghana, a low endemic area, the elimination of malaria may require finding individuals with asymptomatic infections. Given the low prevalence of asymptomatic individuals identified in this study and as repleted in the literature review, which favours RACD, Asutsuare is a possible setting receptive for RACD implementation.

The public health response to a Plasmodium malariae outbreak in Penampang district, Sabah during a COVID-19 movement control order

BackgroundSince 2018, no indigenous human malaria cases has been reported in Malaysia. However, during the recent COVID-19 pandemic the World Health Organization is concerned that the pandemic might erode the success of malaria control as there are reports of increase malaria cases in resource limited countries. Little is known how the COVID-19 pandemic has impacted malaria in middle-income countries like Malaysia. Here the public health response to a Plasmodium malariae outbreak occurred in a village in Sabah state, Malaysia, during a COVID-19 movement control order is reported.MethodsAn outbreak was declared following the detection of P. malariae in July 2020 and active case detection for malaria was performed by collecting blood samples from residents residing within 2 km radius of Moyog village. Vector prevalence and the efficacy of residual insecticides were determined. Health awareness programmes were implemented to prevent future outbreaks. A survey was conducted among villagers to understand risk behaviour and beliefs concerning malaria.ResultsA total of 5254 blood samples collected from 19 villages. Among them, 19 P. malariae cases were identified, including the index case, which originated from a man who returned from Indonesia. His return from Indonesia and healthcare facilities visit coincided with the movement control order during COVID-19 pandemic when the healthcare facilities stretched its capacity and only serious cases were given priority. Despite the index case being a returnee from a malaria endemic area presenting with mild fever, no malaria test was performed at local healthcare facilities. All cases were symptomatic and uncomplicated except for a pregnant woman with severe malaria. There were no deaths; all patients recovered following treatment with artemether-lumefantrine combination therapy. Anopheles balabacensis and Anopheles barbirostris were detected in ponds, puddles and riverbeds. The survey revealed that fishing and hunting during night, and self-treatment for mild symptoms contributed to the outbreak. Despite the index case being a returnee from a malaria-endemic area presenting with mild fever, no malaria test was performed at local healthcare facilities.ConclusionThe outbreak occurred during a COVID-19 movement control order, which strained healthcare facilities, prioritizing only serious cases. Healthcare workers need to be more aware of the risk of malaria from individuals who return from malaria endemic areas. To achieve malaria elimination and prevention of disease reintroduction, new strategies that include multisectoral agencies and active community participation are essential for a more sustainable malaria control programme.

Environmental determinants and risk behaviour in the case of indigenous malaria in Muara Enim Regency, Indonesia: A case-control design.

Malaria is a significant public health concern in Indonesia. Muara Enim Regency is one of the districts in South Sumatra with the most important number of indigenous malaria cases in the last three years (2018-2020). Therefore, this study aimed to identify determinants of indigenous malaria in the Muara Enim Regency. This study was designed as a case-control study. A stratified random sample in 2018, 2019, and 2020 was used at the Primary Health Centres (PHCs) areas of Tanjung Enim and Tanjung Agung. The sample included 49 cases and 49 controls. Indigenous malaria determinants were discovered using both bivariable and multivariable logistic regression models. The multivariable logistic regression model results show that mosquito repellent reduces malaria risk by 71% (AOR = 0.29, 95% CI: 0.11-0.64). Besides, the presence of wire mesh on ventilation reduces the risk of malaria by 76% (AOR = 0.24, 95% CI: 0.10-0.57), and the distance from mosquito breeding sites near hundred meters and fewer increases the risk of malaria by 3.88 fold (AOR = 3.88; 95% CI: 1.67-8.97). Multivariable analysis revealed distance from mosquito breeding sites as a risk factor for malaria. Besides, the study shows that using insect repellent, wire netting in ventilation, eliminating mosquito breeding sites, mosquito repellent or protective clothing, and improving house conditions were protective factors for indigenous malaria. Therefore, preventive and promotional efforts are essential as the first step toward malaria elimination at the study site, including avoiding direct contact between residents and vectors near mosquito breeding sites.

The First Case Series of Malaria Overlapped with COVID-19 in Iran

Introduction: Although indigenous malaria cases have dramatically declined over the past decades, the COVID pandemic has continued to affect the programs designed to combat malaria, particularly in those countries where hydroxychloroquine and chloroquine have been used as medications for treating COVID. Two immigrants entered Iran illegally from neighboring countries (i.e., Afghanistan and Pakistan). This study mainly aimed to assess the effects of coronavirus disease (COVID-19) on these cases from all aspects (i.e., case-finding, diagnosis, and treatment). Case Presentation: Both cases presented with common symptoms such as fever and shaking chills. In addition, they had no sign of COVID-19, and their oxygen level and CT images were normal in some cases, but they were mistakenly treated as COVID-19 patients long after the onset of malaria symptoms. One of the suspected coronavirus cases was given chloroquine on a voluntary basis for one day, which may have been responsible for the possible relapse in vivax or resistance of plasmodium vivax to chloroquine and the recurrence of parasitemia in falciparum. Conclusions: The active case detection of malaria was affected by the COVID-19 pandemic. Case finding was dramatically decreased with the onset of coronavirus, thereby causing a spurt in malaria incidence. Moreover, the malaria treatment strategy was negatively affected by the misdiagnosis of COVID-19.

Imported malaria from land bordering countries in China: A challenge in preventing the reestablishment of malaria transmission

ObjectiveNo indigenous malaria cases have been reported since 2017 in China, but a large number of imported cases are still reported every year, including those from the land bordering countries. To characterize their epidemiological profiles will provide evidence for the development of appropriate strategies to effectively address the challenges of border malaria in the post-elimination phase. MethodsIndividual-level data of imported malaria cases from the land bordering countries were collected from 2017 to 2021 in China via the web-based surveillance systems, and analyzed by SPSS, ArcGIS and WPS software, to explore their epidemiological profiles. ResultsA total of 1170 malaria cases imported into China from six of the fourteen land bordering countries were reported between 2017 and 2021 with a decline trend. Overall, cases were widely distributed in 31–97 counties from 11 to 21 provinces but mainly in Yunnan. Moreover, these imported cases were mainly infected with P. vivax (94.8%), and a total of 68 recurrent cases were reported in 6–14 counties from 4 to 8 provinces. In addition, nearly 57.1% of the total reported cases could seek healthcare within 2 days of getting sick, and 71.3% of the reported cases could be confirmed as malaria on the day they sought medical care. ConclusionsChina still needs to attach great importance to the risk and challenge of the imported malaria from bordering countries particularly from Myanmar in preventing reestablishment of malaria transmission in the post-elimination phase. It is necessary not only to strengthen collaboration and cooperation with the bordering countries, but also coordinate multiple departments at home to improve malaria surveillance and response system and prevent the reestablishment of malaria transmission in China.

Naturally acquired antibody response to Plasmodium falciparum and Plasmodium vivax among indigenous Orang Asli communities in Peninsular Malaysia.

Malaria remains a public health problem in many parts of the world. In Malaysia, the significant progress towards the national elimination programme and effective disease notification on malaria has resulted in zero indigenous human malaria cases since 2018. However, the country still needs to determine the extent of malaria exposure and transmission patterns, particularly in high-risk populations. In this study, a serological method was used to measure transmission levels of Plasmodium falciparum and Plasmodium vivax among indigenous Orang Asli communities in Kelantan, Peninsular Malaysia. A community-based cross-sectional survey was conducted in three Orang Asli communities (i.e., Pos Bihai, Pos Gob, and Pos Kuala Betis) in Kelantan from June to July 2019. Antibody responses to malaria were assessed by enzyme-linked immunosorbent assay (ELISA) using two P. falciparum (PfAMA-1 and PfMSP-119) and two P. vivax (PvAMA-1 and PvMSP-119) antigens. Age-adjusted antibody responses were analysed using a reversible catalytic model to calculate seroconversion rates (SCRs). Multiple logistic regression was used to investigate factors associated with malaria exposure. The overall malaria seroprevalence was 38.8% for PfAMA-1, 36.4% for PfMSP-119, 2.2% for PvAMA-1, and 9.3% for PvMSP-119. Between study areas, the proportion of seropositivity for any P. falciparum and P. vivax antigens was significantly highest in Pos Kuala Betis with 34.7% (p < 0.001) and 13.6% (p < 0.001), respectively. For all parasite antigens except for PvAMA-1, the proportion of seropositive individuals significantly increased with age (all p < 0.001). Based on the SCR, there was a higher level of P. falciparum transmission than P. vivax in the study area. Multivariate regression analyses showed that living in Pos Kuala Betis was associated with both P. falciparum (adjusted odds ratio [aOR] 5.6, p < 0.001) and P. vivax (aOR 2.1, p < 0.001) seropositivities. Significant associations were also found between age and seropositivity to P. falciparum and P. vivax antigens. Analysis of community-based serological data helps describe the level of transmission, heterogeneity, and factors associated with malaria exposure among indigenous communities in Peninsular Malaysia. This approach could be an important adjunct tool for malaria monitoring and surveillance in low malaria transmission settings in the country.

Profiling the imported human malaria in Sarawak, Malaysia in 2011-2019.

Malaysia has achieved the status of zero indigenous human malaria cases. Nevertheless, imported human malaria has increasingly been reported in Sarawak, Malaysian Borneo. As zoonotic malaria caused by Plasmodium knowlesi remains a major public health problem in Sarawak, the threat of imported malaria must be addressed as it can cause human malaria reintroduction, sustain transmission, and lead to complications. The objectives of this study were to investigate the epidemiological characteristics of imported malaria cases reported in Sarawak and to underline the challenge posed by imported malaria towards malaria elimination efforts. Imported malaria cases reported in Sarawak from 2011 to 2019 were collected from Sarawak State Health Department and analysed in this longitudinal retrospective study. A total of 2058 imported malaria cases were registered in all districts in Sarawak. Highest number of cases were reported in Kapit (n = 559; 27.16%), followed by Sibu (n = 424; 20.6%), and Miri (n = 166; 8.07%). Based on the demographic profile, most of the patients constituted of either male sex (98.49%), age group of 40-49 years (39.6%), Iban ethnic (57.92%), worked in logging industry (88.58%), Malaysian nationals (91.84%), contracted malaria in Papua New Guinea (46.11%), uncomplicated disease (77.89%), or hospitalised cases (97.86%). The most prominent Plasmodium species diagnosed were P. vivax (52.67%) and P. falciparum (35.81%). Surveillance, disease detection, and medical follow-up must be carried out thoroughly for individuals who returned from malaria-endemic countries. It is also necessary to promote pre-travel preventive education as well as chemoprophylaxis to travellers heading to endemic areas.

Analysis of the Presence of Anopheles Larvae in the City Areas in DKI Jakarta on the Risk of Indigenous Malaria Cases in 2022

Malaria is one of the diseases that until now is still a special concern for tropical countries such as Indonesia. Prevention of non-indigenous malaria transmission has recently become a priority for the Indonesian government's program to minimize the incidence. This study aims to analyze the presence of anopheles larvae in city areas in DKI Jakarta province which have the potential to be at risk of causing the emergence of indigenous malaria cases in 2022 by observational survey methods and strengthened by literature studies. The results were obtained by discovering anopheles in such “empang” in Marunda Village, Cilincing, North Jakarta, which is adjacent to the Navy Special Forces Command Headquarters dormitory. This is very potential for malaria to spread considering the mobility of troops who often go in and out of endemic areas both at home and abroad. Thus, it is necessary to improve coordination and cooperation between various stakeholders, especially the Province Health Department, the Navy Health Service, or other related agencies.

Evaluation of the model malaria elimination strategy in Mandla district along with its neighbouring districts: a time series analysis from 2008 to 2020

BackgroundCompared to 2017, India achieved a significant reduction in malaria cases in 2020. Madhya Pradesh (MP) is a tribal dominated state of India with history of high malaria burden in some districts. District Mandla of MP state showed a considerable decline in malaria cases between 2000 and 2013, except in 2007. Subsequently, a resurgence of malaria cases was observed during 2014 and 2015. The Malaria Elimination Demonstration Project (MEDP) was launched in 2017 in Mandla with the goal to achieve zero indigenous malaria cases. This project used: (1) active surveillance and case management using T4 (Track fever, Test fever, Treat patient, and Track patient); (2) vector control using indoor residual sprays and long-lasting insecticidal nets; (3) information education communication and behaviour change communication; and (4) regular monitoring and evaluation with an emphasis on operational and management accountability. This study has investigated malaria prevalence trends from 2008 to 2020, and has predicted trends for the next 5 years for Mandla and its bordering districts.MethodsThe malaria prevalence data of the district Mandla for the period of January 2008 to August 2017 was obtained from District Malaria Office (DMO) Mandla and data for the period of September 2017 to December 2020 was taken from MEDP data repository. Further, the malaria prevalence data for the period of January 2008 to December 2020 was collected from DMOs of the neighbouring districts of Mandla. A univariate time series and forecast analysis was performed using seasonal autoregressive integrated moving average model.FindingsMalaria prevalence in Mandla showed a sharp decline [− 87% (95% CI − 90%, − 84%)] from 2017 to 2020. The malaria forecast for Mandla predicts zero cases in the next 5 years (2021–2025), provided current interventions are sustained. By contrast, the model has forecasted a risk of resurgence of malaria in other districts in MP (Balaghat, Dindori, Jabalpur, Seoni, and Kawardha) that were not the part of MEDP.ConclusionThe interventions deployed as part of MEDP have resulted in a sustainable zero indigenous malaria cases in Mandla. Use of similar strategies in neighbouring and other malaria-endemic districts in India could achieve similar results. However, without adding extra cost to the existing intervention, sincere efforts are needed to sustain these interventions and their impact using accountability framework, data transparency, and programme ownership from state to district level.

Tracking district-level performance in the context of achieving zero indigenous case status by 2027.

India has committed to zero indigenous malaria cases by 2027 and elimination by 2030. Of 28 states and 8 union territories of India, eleven states were targeted to reach the elimination phase by 2020. However, state-level epidemiology indicates that several states of India may not be on the optimum track, and few goals set in National Framework for Malaria Elimination (NFME) for 2020 remain to be addressed. Therefore, tracking the current progress of malaria elimination in India at the district level, and identifying districts that are off track is important in understanding possible shortfalls to malaria elimination. Annual malaria case data from 2017-20 of 686 districts of India were obtained from the National Center for Vector-Borne Diseases Control (NCVBDC) and analysed to evaluate the performance of districts to achieve zero case status by 2027. A district's performance was evaluated by calculating the annual percentage change in the total number of malaria cases for the years 2018, 2019 and 2020 considering the previous year as a base year. The mean, median and maximum of these annual changes were then used to project the number of malaria cases in 2027. Based on these, districts were classified into four groups: 1) districts that are expected to reach zero case status by 2027, 2) districts that would achieve zero case status between 2028 and 2030, 3) districts that would arrive at zero case status after 2030, and 4) districts where malaria cases are on the rise. Analysis suggest, a cohort of fifteen districts require urgent modification or improvement in their malaria control strategies by identifying foci of infection and customizing interventions. They may also require new interventional tools that are being developed recently so that malaria case reduction over the years may be increased.

The role of chemoprophylaxis in eliminating forest malaria and preventing simian malaria in humans

The role of chemoprophylaxis in eliminating forest malaria and preventing simian malaria in humans

Epidemiology of indigenous Plasmodium knowlesi infection in Sarawak, 2011-2019.

To characterise the state-wide epidemiology of indigenous knowlesi malaria in Sarawak from 2011 to 2019. Longitudinal retrospective study was conducted based on Sarawak knowlesi malaria surveillance data recorded from 2011-2019. Only indigenous cases were included and information extracted for analysis comprised age, sex, occupation, ethnicity, case severity, hospital admission and parasite density. Over the 9 years, 8473 indigenous knowlesi malaria cases were recorded. Age group 40-49 years, males, plantation workers and Iban communities recorded the highest percentage of cases in each demographic variable. Most of the cases were uncomplicated (n = 7292; 86.1%) and 89.6% (n = 7589) of the total cases were reported with ≤20 000 parasites/μl of blood. Age group and ethnic group are associated with the severity of knowlesi malaria in Sarawak. Multivariable logistic regression indicated that the age group 60+ years had the highest odds of developing severe knowlesi malaria compared with other age groups (AOR 2.48; 95% CI 1.22, 5.02; p=0.012). Bidayuh patients were more likely to develop severe knowlesi malaria than Ibans, the largest ethnic group among knowlesi malaria patients (AOR 1.97; 95% CI 1.31, 2.97; p=0.001). Identification of risk groups is important for the implementation of prevention programs and treatments targeting at specific group to combat knowlesi malaria effectively.

Prevention of indigenous malaria cases by strengthening migration surveillance at village level in Purbalingga Regency, Central Java Province, Indonesia.

Purbalingga Regency had achieved zero indigenous malaria cases in April 2016, 3 years before the targeted deadline for elimination. Currently, the biggest threat to elimination efforts is the risk of local malaria reintroduction due to imported cases in the receptive areas. The aim of this study was to describe the implementation of village level migration surveillance and identify the areas for improvement in it. We performed the study in four malaria-free focus villages in Purbalingga Regency, i.e., Pengadegan, Sidareja, Panusupan, and Rembang, from March to October 2019. A total of 108 participants were involved in the processes. Data on malaria vector species, community mobility from malaria-endemic areas, and implementation of malaria migration surveillance (MMS) were collected. We use descriptive analysis for quantitative data and thematic content for qualitative data. Socialization of migration surveillance in Pengadegan and Sidareja villages has been carried out to the wider community, whereas in Panusupan and Tunjungmuli villages, it is still limited to neighbors. Communities in Pengadegan and Sidareja villages have participated in reporting the arrivals of migrant workers, and the village malaria interpreter conducts blood tests on all migrants. Community participation in reporting migrant workers arriving in Panusupan and Tunjungmuli villages is still low. Recording of migrant data reporting has been carried out by MMS officers, but malaria checks are only carried out before Eid al-Fitr to prevent importation of malaria cases. The program needs to strengthen the community mobilization and case-finding efforts.

Rapid Visual Detection of Plasmodium Using Recombinase-Aided Amplification With Lateral Flow Dipstick Assay.

BackgroundMalaria is a global public health problem. China has had no case of indigenous malaria since 2016. However, imported cases of malaria remain an issue among travelers, overseas workers, and foreign traders. Although these cases are always asymptomatic, if they donate blood, there is a great risk of transfusion transmitted-malaria (TTM). Therefore, blood banks need a rapid screening tool to detect Plasmodium species.MethodsWe designed an assay using recombinase-aided amplification (RAA) and a lateral-flow dipstick (LFD) (RAA-LFD) to detect the 18S ribosomal RNA gene of Plasmodium species. Sensitivity was evaluated using a recombinant plasmid and Plasmodium genomic DNA. Specificity was evaluated using DNA extracted from the blood of patients with malaria or other infectious parasites. For clinical assessment, blood samples from patients with malaria and blood donors were evaluated.ResultsThe RAA-LFD assay was performed in an incubator block at 37°C for 15 min, and the amplicons were visible to the naked eye on the flow dipsticks within 3 min. The sensitivity was 1 copy/μL of recombinant plasmid. For genomic DNA from whole blood of malaria patients infected with P. falciparum, P. vivax, P. ovale, and P. malariae, the sensitivity was 0.1 pg/μL, 10 pg/μL, 10-100 pg/μL, and 100pg/μL, respectively. The sensitivity of this assay was 100pg/μL. No cross-reaction with other transfusion-transmissible parasites was detected.ConclusionsThe results demonstrated that this RAA-LFD assay was suitable for reliable field detection of Plasmodium species in low-resource settings with limited laboratory capabilities.

Improving the surveillance and response system to achieve and maintain malaria elimination: a retrospective analysis in Jiangsu Province, China

BackgroundFollowing initiation of China’s National Malaria Elimination Action Plan (NMEAP) in 2010, the ‘1-3-7’ approach was developed and rolled out in China to facilitate the malaria elimination programme and accelerate malaria elimination. This study aims to summarize and condense these experiences through a retrospective analysis in Jiangsu Province, which could be adapted and applied in other malaria elimination settings worldwide.MethodsA retrospective analysis of imported malaria cases into China identified through an improved surveillance and response system in Jiangsu Province was carried out for the period of 2001–2020. To improve the malaria surveillance and response system, Centers for Diseases Control and Prevention from the prefectures and counties in Jiangsu province conducted population-level health education to improve healthcare seeking behavior, strengthened capacity of health facilities to improve performance of malaria diagnosis and treatment, and raised the capacity of public health providers to improve implementation of the ‘1-3-7’ approach. Categorical variables were carried out by Chi square tests with Fisher’s exact correction.ResultsFrom 2001 to 2020, a total of 9,879 malaria cases were reported in Jiangsu Province. Since 2012, no indigenous malaria cases have been reported in Jiangsu Province. However, in recent years, there has been a substantial increase of imported falciparum malaria cases. Between 2012 and 2020, an estimated 61.57 million individuals have benefited from population-level health education in Jiangsu Province. For healthcare-seeking services among the 2,423 imported malaria cases, 687 (28.4%) and 1,104 (45.6%) cases visited hospitals on the first day and the second day from symptom onset, respectively. A total of 1,502 (61.9%) cases were diagnosed on the first day at medical facilities. Jiangsu Province achieved 100%, 99.4% and 98.3% completion rate in terms of case detection and notification (within one day), case investigation (within three days) and foci response and disposition (within seven days), respectively. The improved surveillance and response system in Jiangsu Province plays an important role in preventing the re-introduction of malaria and maintaining the malaria-free status.ConclusionsJiangsu Province has maintained its malaria-free status since 2012. The continuous improvement of a surveillance and response system plays an important role in the early detection and rapid response of potential malaria-related outbreaks in Jiangsu, China, and has important lessons for other malaria eliminating settings. Remaining vigilant in the detection of imported malaria cases and maintaining an active surveillance and response system is critical to sustain the success of malaria elimination.Graphic

Laboratory diagnosis for malaria in the elimination phase in China: efforts and challenges.

Malaria remains a global health challenge, although an increasing number of countries will enter pre-elimination and elimination stages. The prompt and precise diagnosis of symptomatic and asymptomatic carriers of Plasmodium parasites is the key aspect of malaria elimination. Since the launch of the China Malaria Elimination Action Plan in 2010, China has formulated clear goals for malaria diagnosis and has established a network of malaria diagnostic laboratories within medical and health institutions at all levels. Various external quality assessments were implemented, and a national malaria diagnosis reference laboratory network was established to strengthen the quality assurance in malaria diagnosis. Notably, no indigenous malaria cases have been reported since 2017, but the risk of re-establishment of malaria transmission cannot be ignored. This review summarizes the lessons about malaria diagnosis in the elimination phase, primarily including the establishments of laboratory networks and quality control in China, to better improve malaria diagnosis and maintain a malaria-free status. A reference is also provided for countries experiencing malaria elimination.