Imported Falciparum Malaria Cases Research Articles

Respiratory Distress Complicating Falciparum Malaria Imported to Berlin, Germany: Incidence, Burden, and Risk Factors.

While European healthcare systems face resource shortages as a consequence of the coronavirus pandemic, numbers of imported falciparum malaria cases increased again with re-intensifying international travel. The aim of the study was to identify malaria-specific complications associated with a prolonged intensive care unit (ICU) length of stay (ICU-LOS) in the pre-COVID-19 era and to determine targets for their prevention. This retrospective observational investigation included all the cases treated from 2001 to 2015 at the Charité University Hospital, Berlin. The association of malaria-specific complications with the ICU-LOS was assessed using a multivariate Cox proportional hazard regression. The risk factors for the individual complications were determined using a multivariate Bayesian logistic regression. Among the 536 included cases, 68 (12.7%) required intensive care and 55 (10.3%) suffered from severe malaria (SM). The median ICU-LOS was 61 h (IQR 38-91 h). Respiratory distress, which occurred in 11 individuals (2.1% of the total cases, 16.2% of the ICU patients, and 20% of the SM cases), was the only complication independently associated with ICU-LOS (adjusted hazard ratio for ICU discharge by 61 h 0.24, 95% confidence interval, 95%CI, 0.08-0.75). Shock (adjusted odds ratio, aOR, 11.5; 95%CI, 1.5-113.3), co-infections (aOR 7.5, 95%CI 1.2-62.8), and each mL/kg/h fluid intake in the first 24 treatment hours (aOR 2.2, 95%CI 1.1-5.1) were the independent risk factors for its development. Respiratory distress is not rare in severe imported falciparum malaria, and it is associated with a substantial burden. Cautious fluid management, including in shocked individuals, and the control of co-infections may help prevent its development and thereby reduce the ICU-LOS.

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

Malaria epidemic and control effect in Rizhao City of Shandong, 1951 – 2019

Objective To Analyze the epidemic characteristics, prevention and treatment process of malaria in Rizhao City, we summarize the prevention and control effect experience, put forward how to deal with challenges in the new situation and further consolidate the achievements of malaria prevention. Methods Data of malaria control in Rizhao City, 1951-2019 were collected, and the epidemic situation, control measures and effects were analyzed by descriptive statistics. Results From 1951 to 2019, a total of 519 057 cases of malaria were reported in Rizhao. Locally vivax malaria cases were dominated before 2004. Imported falciparum malaria cases accounted for 69.44%(50/72), followed by vivax malaria for 19.44%(14/72) after 2004. Malaria prevention and control has achieved phased results. It has gone through five stages, that is the stage of sporadic epidemics in the early days of foundation of the People ′ s Republic of China, outbreak and control, basic malaria eradication, consolidating the achievements of prevention and control, comprehensive elimination. The peak incidence dropped from 15 396.01/10 5 in 1961 to less than 1/10 5 in 1986, the objective of basic malaria eradication was reached in 1988, and no local malaria cases have been found since 1994. and the provincial standard for malaria elimination was reached in 2016. Conclusion Rizhao has achieved its goal of eliminating malaria, but the transmission and epidemic factors still remains, so the prevention and control of imported malaria is the key to maintain the achievements of malaria elimination. 摘要：目的 分析新中国成立以来日照市疟疾流行特征和防治历程, 总结防控经验,提出新形势下应如何应对挑 战, 进一步巩固疟防成果。 方法 收集日照市 1951—2019 年疟疾防治资料, 用描述性统计学方法总结分析每个时期疟 疾的流行情况、采取的防控措施及效果。 结果 1951—2019 年日照市累计报告疟疾 519 057 例, 2004 年以前均为本地 感染的间日疟, 2004 年以后以输入性恶性疟为主占 69.44%(50/72), 其次是间日疟占 19.44%(14/72) 。整个防治经历了 建国初期散发流行、疟疾暴发与控制、基本消灭疟疾、巩固防治成果、消除疟疾五个防治阶段, 取得了阶段性的成果。 1986 年疟疾发病率从 1961 年的 15 396.01/10 万下降到 1/10 万以下, 1988 年达到“基本消灭疟疾”的目标, 1994 年后未再 出现本地感染病例, 2016 年通过消除疟疾的省级考核。 结论 日照市已达到消除疟疾目标, 但疟疾传播和流行因素依 然存在, 做好输入性疟疾的防控是持续保持消除疟疾成果的关键。

Association between blood test parameters and intensity of Plasmodium falciparum infections in imported falciparum malaria cases in Tianjin City from 2015 to 2019

To evaluate the association between blood test parameters and intensity of Plasmodium falciparum infections among imported falciparum malaria cases in Tianjin City from 2015 to 2019, so as to provide insights into the early diagnosis of imported P. falciparum malaria. The epidemiological data of 37 imported cases with confirmed diagnosis of P. falciparum malaria in Tianjin City from 2015 to 2019 were collected, and the epidemiological features and clinical manifestations were retrospectively analyzed. In addition, the association between blood test parameters and intensity of P. falciparum infections was evaluated among the imported P. falciparum malaria cases. Among the 31 imported P. falciparum malaria cases, there were 31 cases (83.8%) with a reduction in platelet (PLT) counts, 16 cases (43.2%) with a reduction in red blood cell (RBC) counts, 16 cases (43.2%) with a reduction in hemoglobin (Hb) concentrations, 23 cases (62.2%) with a rise in neutrophil percentage (NEUT%), 32 cases (86.5%) with a rise in total bilirubin (TBIL) concentrations, 29 cases (78.4%) with a rise in alanine aminotransferase (ALT) concentrations, 28 cases (75.7%) with a rise in aspartate transaminase (AST) concentrations, and 23 cases (62.2%) with a rise in gamma-glutamyl transpetidase (GGT) concentrations. The PLT count and Hb concentration correlated negatively with the intensity of P. falciparum infections (Goodman-Kruskal γ = -0.568 and -0.521, both P values < 0.05) and the TBIL concentration and NEUT% correlated positively with the intensity of P. falciparum infections (Goodman-Kruskal γ = 0.496 and 0.610, both P values < 0.05) among imported falciparum malaria cases; however, there were no associations of ALT, AST, GGT levels or RBC count with the intensity of P. falciparum infections among the imported falciparum malaria cases (Goodman-Kruskal γ = 0.370, 0.497, 0.314 and -0.434, all P values > 0.05). PLT, Hb, TBIL and NEUT% may serve as markers for early auxiliary diagnosis of imported P. falciparum malaria, and PLT and TBIL may provide valuable information for the diagnosis of severe imported P. falciparum malaria.

Polymorphisms of pfcrt, pfmdr1, and K13-propeller genes in imported falciparum malaria isolates from Africa in Guizhou province, China

BackgroundImported falciparum malaria from Africa has become a key public health challenge in Guizhou Province since 2012. Understanding the polymorphisms of molecular markers of drug resistance can guide selection of antimalarial drugs for the treatment of malaria. This study was aimed to analyze the polymorphisms of pfcrt, pfmdr1, and K13-propeller among imported falciparum malaria cases in Guizhou Province, China.MethodFifty-five imported falciparum malaria cases in Guizhou Province during 2012–2016 were included in this study. Their demographic information and filter paper blood samples were collected. Genomic DNA of Plasmodium falciparum was extracted from the blood samples, and polymorphisms of pfcrt, pfmdr1, and K13-propeller were analyzed with nested PCR amplification followed by sequencing. Data were analyzed with the SPSS17.0 software.ResultsThe prevalence of pfcrt K76T, pfmdr1 N86Y, and pfmdr1 Y184F mutation was 56.6, 22.2, and 72.2%, respectively, in imported falciparum malaria cases in Guizhou Province. We detected two mutant haplotypes of pfcrt, IET and MNT, with IET being more commonly found (54.7%), and five mutant haplotypes of pfmdr1, of which NFD was the most frequent (53.7%). There were totally 10 combined haplotypes of pfcrt and pfmdr1, of which the haplotype IETNFD possessed a predominance of 28.8%. In addition, three nonsynonymous mutations (S459T, C469F, and V692L) and two synonymous mutations (R471R and V589V) were detected in K13-propeller, all having prevalence less than 6.0%. In particular, a candidate K13 resistance mutation, C469F, was identified for the first time from Democratic Republic of the Congo with the prevalence of 2.0%.ConclusionsThe high prevalence of IET haplotype of pfcrt and NFD haplotype of pfmdr1 suggests the presence of chloroquine, artemether/lumefantrine, and dihydroartemisinin/piperaquine resistance in these cases. Therefore cautions should be made to artemisinin therapy for P. falciparum in Africa. Continuous monitoring of anti-malarial drug efficacy in imported malaria cases is helpful for optimizing antimalarial drug therapy in Guizhou Province, China.

Confirmation of the absence of local transmission and geographic assignment of imported falciparum malaria cases to China using microsatellite panel

BackgroundCurrent methods to classify local and imported malaria infections depend primarily on patient travel history, which can have limited accuracy. Genotyping has been investigated as a complementary approach to track the spread of malaria and identify the origin of imported infections.MethodsAn extended panel of 26 microsatellites (16 new microsatellites) for Plasmodium falciparum was evaluated in 602 imported infections from 26 sub-Saharan African countries to the Jiangsu Province of People’s Republic of China. The potential of the 26 microsatellite markers to assign imported parasites to their geographic origin was assessed using a Bayesian method with Markov Chain Monte Carlo (MCMC) as implemented in the program Smoothed and Continuous Assignments (SCAT) with a modification to incorporate haploid genotype data.ResultsThe newly designed microsatellites were polymorphic and are not in linkage disequilibrium with the existing microsatellites, supporting previous findings of high rate of recombination in sub-Saharan Africa. Consistent with epidemiology inferred from patients’ travel history, no evidence for local transmission was found; nearly all genetically related infections were identified in people who travelled to the same country near the same time. The smoothing assignment method assigned imported cases to their likely geographic origin with an accuracy (Angola: 59%; Nigeria: 51%; Equatorial Guinea: 40%) higher than would be achieved at random, reaching statistical significance for Angola and Equatorial Guinea.ConclusionsGenotyping using an extended microsatellite panel is valuable for malaria case classification and programme evaluation in an elimination setting. A Bayesian method for assigning geographic origin of mammals based on genetic data was adapted for malaria and showed potential for identification of the origin of imported infections.

Epidemic characteristics of imported falciparum malaria in Huai'an City

To understand the situation and epidemic characteristics of imported falciparum malaria in Huai'an City from 2010 to 2016, so as to provide the evidence for formulating the prevention and control strategies of imported falciparum malaria in the city. The epidemic data of imported falciparum malaria in Huai'an City from 2010 to 2016 were analyzed by using the descriptive epidemiological method. A total of 308 malaria cases were reported in Huai'an City from 2010 to 2016 with the average annual incidence of 0.88/105. A total of 240 imported falciparum malaria cases were reported, of which 18 cases (7.50%) developed into severe illness, and 2 severe patients died. The cases were reported in every county (district), and the incidence rates of Qingpu District and Huai'an District were higher than the city average level. The cases occurred every month, so there was no significant seasonal variation in the reporting time of the cases. Most of the patients were young men and aged 30-49 years. The occupational distribution revealed that the patients were mainly farmers, workers and migrant workers. The main source of infection was from African countries. The median interval from symptom appearing to definite diagnosis was 1 day, and the longest interval was 236 days. Twenty-nine cases were diagnosed within 24 hours, accounting for 12.08%. The epidemic situation of imported falciparum malaria in Huai'an City is grim. In order to consolidate the achievements of malaria eradication, it is necessary to further improve the multi-sectoral cooperation mechanism, strengthen the management of floating population and take effective measures to reduce the risk of imported falciparum malaria.