目的 了解2019－2023年湖北省输入性非恶性疟流行病学特征及实验室诊断情况,为提高非恶性疟的诊断水平和防控能力提供科学依据。方法 通过中国疾病预防控制信息系统的传染病报告信息管理系统收集2019－2023年湖北省报告的非恶性疟病例资料。应用SPSS 22.0软件进行统计学分析,采用χ2检验进行率的差异比较。结果 2019－2023年湖北省共输入非恶性疟112例,占输入性疟疾病例的30.35%（112/369）。其中间日疟48例（42.86%）,卵形疟47例（41.96%）,三日疟17例（15.18%）,无混合感染病例。病例以男性青壮年为主,年龄中位数为42.5岁,男性占比97.32%；职业以务工为主,占92.86%。每月均有非恶性疟病例输入,发病时间无明显季节性,报告病例数较多的是武汉（29例）、黄石（20例）、宜昌（20例）和十堰市（11例）。90.18%（101/112）的输入性非恶性疟病例来自非洲21个国家,主要来自埃塞俄比亚（32例）、刚果金（21例）和乌干达（9例）3个国家。3种非恶性疟病例构成比在非洲与其他洲之间差异有统计学意义（χ2=15.442,P<0.001）。病例初诊单位主要集中在地市级医疗机构,占45.53%（51/112）,56.25%的病例在发病后24 h内就诊。初诊确诊率为67.86%（76/112）,地市级医疗机构的初诊确诊率较高,为88.24%（45/51）,不同医疗机构间的初诊确诊率差异有统计学意义（χ2=27.981,P<0.001）。24 h内确诊的病例占60.72%（68/112）,初诊至确诊时间间隔≥4 d的病例占19.64%（22/112）。疟疾病例主要由医疗机构确诊,占96.43%（108/112）。各医疗机构对间日疟、卵形疟和三日疟的虫种鉴定符合率分别是93.75%、57.45%和64.71%。3种疟原虫虫种符合率差异有统计学意义（χ2=18.809,P<0.001）。结论 2019－2023年湖北省每年均有输入性非恶性疟病例报告,输入源主要在非洲,医疗机构疟原虫的虫种分型鉴定能力有待提高。今后应加强对输入性非恶性疟的鉴别诊断,尤其是针对卵形疟和三日疟的虫种分型鉴定。
Objective To investigate the epidemiological characteristics and laboratory diagnosis of imported non-falciparum malaria in Hubei Province, China, from 2019 to 2023, so as to provide a scientific basis for enhancing the capabilities to diagnose, prevent, and control non-falciparum malaria. Methods Data on non-falciparum malaria cases reported in Hubei Province from 2019 to 2023 were collected from the Infectious Disease Report Information Management System of China Information System for Disease Control and Prevention. The data were statistically analyzed using SPSS 22.0. Rates or proportions were compared using the Chi-square test. Results A total of 112 imported non-falciparum malaria cases were reported in Hubei Province from 2019 to 2023, accounting for 30.35% (112/369) of imported malaria cases of Hubei Province. Specifically, there were 48 cases (42.86%) of Plasmodium vivax, 47 cases (41.96%) of P. ovale, 17 cases (15.18%) of P. malariae, and no cases of mixed infection. Median age of cases was 42.5 and males accounted for 97.32% of the imported cases. The majority of cases were migrant workers, accounting for 92.86%. Non-falciparum malaria was imported every month, with no seasonal fluctuation in onset time. Most cases were reported in Wuhan (29 cases), Huangshi (20 cases), Yichang (20 cases), and Shiyan (11 cases). Notably, 90.18% (101/112) of non-falciparum malaria cases were imported from 21 African countries, mainly Ethiopia (32 cases), the Democratic Republic of the Congo (21 cases), and Uganda (9 cases). There were significant differences in constituent ratio of the three types of non-falciparum malaria cases between African and other continents (χ2=15.442, P<0.001). Most cases (51/112, 45.53%) were initially diagnosed at the medical institutions in prefecture-level cities, and 56.25% of the cases saw a doctor within 24 hours after disease onset. The diagnosis rate at the initial visit was 67.86% (76/112) for the overall cases and 88.24% (45/51) for the medical institutions in prefecture-level cities, demonstrating a significant difference between medical institutions (χ2=27.981, P<0.001). Additionally, 60.72% (68/112) of the cases were diagnosed within 24 hours, and 19.64% (22/112) of the cases had a time span of ≥4 days from the initial visit to confirmed diagnosis. Most cases (96.43%, 108/112) were diagnosed at medical institutions. The coincidence rates in the identification of P. vivax, P. ovale, and P. malariae among medical institutions were 93.75%, 57.45%, and 64.71%, respectively, with a significant difference (χ2=18.809, P<0.001). Conclusions Non-falciparum malaria cases were reported every year in Hubei Province from 2019 to 2023, with most cases imported from Africa. The ability to identify and type Plasmodium species needs improvement. In the future, the differentiation and diagnosis of imported non-falciparum malaria should be strengthened, especially for the species typing of P. ovale and P. malariae.
[1] World Health Organization. World malaria report 2023[R]. Geneva：WHO, 2023.
[2] World Health Organization. World malaria report 2022[R]. Geneva：WHO, 2022.
[3] Huang GQ, Hu LQ, Zhang HX, et al. Potential infection of imported malaria and control measures in Hubei Province[J]. Chin Trop Med, 2013, 13（12）：1490-1493. DOI：10.13604/j.cnki.46-1064/r.2013.12.020.（in Chinese） 黄光全, 胡乐群, 张华勋, 等. 湖北省输入性疟疾发病态势及防控措施分析[J]. 中国热带医学, 2013, 13（12）：1490-1493. DOI：10.13604/j.cnki.46-1064/r.2013.12.020.
[4] Xia J, Zhang HX, Liu S, et al. Epidemiological analysis of malaria in Hubei Province from 2015 to 2018[J]. Chin J Parasitol Parasit Dis, 2020, 38（4）：429-434, 439. DOI：10.12140/j.issn.1000-7423.2020.04.005.（in Chinese） 夏菁, 张华勋, 刘斯, 等. 2015－2018年湖北省报告疟疾疫情分析[J]. 中国寄生虫学与寄生虫病杂志, 2020, 38（4）：429-434, 439. DOI：10.12140/j.issn.1000-7423.2020.04.005.
[5] Xin YF, Chen F, Yang Y, et al. Blood test index in imported non-falciparum malaria cases in Wuhan, 2009-2018[J]. Chin Trop Med, 2019, 19（8）：804-806. DOI：10.13604/j.cnki.46-1064/r.2019.08.23.（in Chinese） 辛艳芳, 陈芳, 杨燕, 等. 武汉市2009－2018年输入性非恶性疟病例血液检验指标[J]. 中国热带医学, 2019, 19（8）：804-806. DOI：10.13604/j.cnki.46-1064/r.2019.08.23.
[6] Chen F, Zou CY, Zeng WL, et al. Advances in research on the prevalence and prevention of Plasmodium vivax in Southeast Asia[J]. J Trop Med, 2019, 19（4）：523-526. DOI：10.3969/j.issn.1672-3619.2019.04.033.（in Chinese） 陈芳, 邹春燕, 曾炜林, 等. 东南亚地区间日疟流行情况及防治研究进展[J]. 热带医学杂志, 2019, 19（4）：523-526. DOI：10.3969/j.issn.1672-3619.2019.04.033.
[7] Sun YW, Yu DM, Chen J, et al. Two individual incidences of vivax malaria in Dandong Municipality of Liaoning Province[J]. Chin J Public Health, 2017, 33（2）：314-316. DOI：10.11847/zgggws2017-33-02-38.（in Chinese） 孙英伟, 于丹梅, 陈君, 等. 辽宁省丹东市两例间日疟病例报告疫情分析[J]. 中国公共卫生, 2017, 33（2）：314-316. DOI：10.11847/zgggws2017-33-02-38.
[8] Wang ZY, Zhang YG, Jiang L, et al. Laboratory analysis and diagnosis of one transfusion-transmitted quartan malaria case in Shanghai City[J]. Chin J Schisto Control, 2015, 27（4）：362-366. DOI：10.16250/j.32.1374.2014262.（in Chinese） 王真瑜, 张耀光, 江莉, 等. 上海市1例输血性三日疟病例的实验室检测分析与诊断[J]. 中国血吸虫病防治杂志, 2015, 27（4）：362-366. DOI：10.16250/j.32.1374.2014262.
[9] World Health Organization. From 30 million cases to zero：China is certified malaria-free by WHO[EB/OL]. （2021-06-30）[2024-01-12]. https：//www.who.int/news/item/30-06-2021-from-30-million-cases-to-zero-china-is-certified-malaria-free-by-who.
[10] Zhang L, Feng J, Xia ZG, et al. Epidemiological characteristics of malaria and progress on its elimination in China in 2019[J]. Chin J Parasitol Parasit Dis, 2020, 38（2）：133-138. DOI：10.12140/j.issn.1000-7423.2020.02.001.（in Chinese） 张丽, 丰俊, 夏志贵, 等. 2019年全国疟疾疫情特征分析及消除工作进展[J]. 中国寄生虫学与寄生虫病杂志, 2020, 38（2）：133-138. DOI：10.12140/j.issn.1000-7423.2020.02.001.
[11] Zhang L, Feng J, Tu H, et al. Malaria epidemiology in China in 2020[J]. Chin J Parasitol Parasit Dis, 2021, 39（2）：195-199. DOI：10.12140/j.issn.1000-7423.2021.02.012.（in Chinese） 张丽, 丰俊, 涂宏, 等. 2020年全国疟疾疫情分析[J]. 中国寄生虫学与寄生虫病杂志, 2021, 39（2）：195-199. DOI：10.12140/j.issn.1000-7423.2021.02.012.
[12] Zhang L, Yi BY, Xia ZG, et al. Epidemiological characteristics of malaria in China, 2021[J]. Chin J Parasitol Parasit Dis, 2022, 40（2）：135-139. DOI：10.12140/j.issn.1000-7423.2022.02.001.（in Chinese） 张丽, 易博禹, 夏志贵, 等. 2021年全国疟疾疫情特征分析[J]. 中国寄生虫学与寄生虫病杂志, 2022, 40（2）：135-139. DOI：10.12140/j.issn.1000-7423.2022.02.001.
[13] Zhang L, Yi BY, Yin JH, et al. Epidemiological characteristics of malaria in China, 2022[J]. Chin J Parasitol Parasit Dis, 2023, 41（2）：137-141. DOI：10.12140/j.issn.1000-7423.2023.02.002.（in Chinese） 张丽, 易博禹, 尹建海, 等. 2022年全国疟疾疫情特征分析[J]. 中国寄生虫学与寄生虫病杂志, 2023, 41（2）：137-141. DOI：10.12140/j.issn.1000-7423.2023.02.002.
[14] National Health and Family Planning Commission of the People's Republic of China. WS 259-2015Diagnosis of malaria[S]. Beijing：Standards Press of China, 2016：3-4. （in Chinese） 中华人民共和国国家卫生和计划生育委员会. WS 259-2015疟疾的诊断[S]. 北京：中国标准出版社, 2016：3-4.
[15] Wu DN, Zhang HX, Zhu H, et al. Characteristics of imported malaria cases in Hubei Province from 2016 to 2020[J]. Chin J Parasitol Parasit Dis, 2021, 39（5）：585-591. DOI：10.12140/j.issn.1000-7423.2021.05.004.（in Chinese） 吴冬妮, 张华勋, 朱红, 等. 2016－2020年湖北省输入性疟疾病例特征分析[J]. 中国寄生虫学与寄生虫病杂志, 2021, 39（5）：585-591. DOI：10.12140/j.issn.1000-7423.2021.05.004.
[16] Habtamu K, Petros B, Yan GY. Plasmodium vivax：The potential obstacles it presents to malaria elimination and eradication[J]. Trop Dis Travel Med Vaccines, 2022, 8（1）：27. DOI：10.1186/s40794-022-00185-3.
[17] Doderer-Lang C, Atchade PS, Meckert L, et al. The ears of the African elephant：Unexpected high seroprevalence of Plasmodiumovale and Plasmodiummalariae in healthy populations in western Africa[J]. Malar J, 2014, 13：240. DOI：10.1186/1475-2875-13-240.
[18] Betson M, Sousa-Figueiredo JC, Atuhaire A, et al. Detection of persistent Plasmodium spp. infections in Ugandan children after artemether-lumefantrine treatment[J]. Parasitology, 2014, 141（14）：1880-1890. DOI：10.1017/S003118201400033X.
[19] Yang CY, Qian D, Lu DL, et al. Epidemiological analysis of malaria in Henan Province during 2016-2018[J]. Chin J Parasitol Parasit Dis, 2019, 37（5）：619-622. DOI：10.12140/j.issn.1000-7423.2019.05.022.（in Chinese） 杨成运, 钱丹, 鲁德领, 等. 2016－2018年河南省疟疾疫情分析[J]. 中国寄生虫学与寄生虫病杂志, 2019, 37（5）：619-622. DOI：10.12140/j.issn.1000-7423.2019.05.022.
