Epidemiologic Analysis of Efforts to Achieve and Sustain Malaria Elimination along the China-Myanmar Border.

Malaria cases have dramatically declined in China along the Myanmar border, attributed mainly to adoption of the 1-3-7 surveillance and response approach. No indigenous cases have been reported in China since 2017. Counties in the middle and southern part of the border area have a higher risk for malaria importation and reestablishment after elimination.

[Analysis report of the national technique competition for diagnosis of parasitic diseases in 2012: I. Capability analysis of Plasmodium detection].

OBJECTIVE: To analyze the result of the national technique competition for diagnosis of parasitic diseases in 2012, so as to understand the capability of detection on Plasmodium parasites among professionals from institutes for disease control and prevention at different levels. METHODS: Four professionals from institution were selected as contestants (age < or = 45 and at least two contestants from county-level institution). The content of the competition included making thick and thin blood slides of Plasmodium (3 slides in 30 min, 10 scores as full marks and 6 as passing score) and identification of species and number with microscopy (5 slides, 8 min per slide, 30 scores as full marks and 18 as passing score). All contestants were grouped by gender, age, professional title, level of institution, classification according to malaria endemicity, geographical location and economic development of the province. Their scores were statistically analyzed by SPSS 16.0 software. RESULTS: The average score of blood smear making test in 120 contestants from 30 provinces was 8.7, the highest was 10 and the lowest was 5.8, 118 (98.3%) contestants passed the test. The average score of blood smear reading was 16.0, the highest was 29 and the lowest was 0, 52 (43.3%) contestants passed the test. There were no significant differences for the scores among genders, ages (< or = 30, 31-40, > 40), professional titles (junior, intermediate and senior), institution levels (provincial, municipal or county level) (P > 0.05). However, there was a significant difference among provinces with different malaria endemicity, geographical location and development status (P < 0.05). For the blood slide-making and film-reading, scores of contestants from malaria endemic provinces including Class I (9.29 +/- 0.41, 18.17 +/- 6.42), Class II (8.92 +/- 0.79, 18.31 +/- 6.94) and Class III (8.61 +/- 0.89, 15.63 +/- 7.52) were higher than those from non-endemic provinces (7.95 +/- 1.00, 10.19 +/- 7.01) (P < 0.01). Scores of contestants from southern provinces (9.16 +/- 0.61, 18.82 +/- 6.78) were significantly higher than that from northern ones (8.30 +/- 0.99, 13.23 +/- 7.45) (P < 0.01). The film-reading scores were significantly higher in those from eastern provinces (18.20 +/- 6.88) than those from western (13.39 +/- 7.60) (P < 0.05), while no significant difference was found in blood slide-making (P > 0.05). CONCLUSION: The capability of malaria parasite detection is imbalanced.

Insights into the elimination of vivax malaria in China.

BACKGROUND: Malaria is caused by multiple parasitic species of the genus Plasmodium. Plasmodium vivax is the most geographically widespread and poses challenges in elimination due to its unique biological and epidemiological characteristics. The aim of study was to highlight the practices and experience targeting vivax malaria control and elimination in China. MAIN BODY: P. vivax malaria was historically endemic in more than 70% of counties in China, with reported vivax malaria cases as high as 26 million a year. After around 70 years of effort, China was certified as malaria-free in June of 2021. The key insights into China's vivax malaria control and elimination were offered, including radical cure strategies, comprehensive but adaptive strategies targeting species of Plasmodium and Anopheles, mass drug administration, and case-/focus-centred surveillance and response systems. CONCLUSION: The complete global eradication of P. vivax and eventually malaria will be more difficult, and China's practices and experience could be a valuable reference in this campaign.

Evolution of anti-malaria policies and measures in P.R. China for achieving and sustaining malaria-free.

Malaria is a major public health threat worldwide, and it was also widely prevalent in the history in China, seriously endangering people's health and affecting socioeconomic development. China was certified malaria elimination in 2021 with unremitting efforts since the founding of the People's Republic of China in 1949. This great achievement has been another milestone in the fight against major infectious diseases following the elimination of smallpox, poliomyelitis, leprosy, filariasis, neonatal tetanus and blinding trachoma in China. This paper briefly introduces the malaria burden dynamics and the corresponding malaria transmission risk stratificantions, as well as systematically reviews the evolution of anti-malaria policies and measures from severe epidemic to elimination in China. Meanwhile, five key lessons in malaria control and elimination in China are also briefly summarized. All of the above provide evidences for promoting global malaria eradication and preventing reestablishment of malaria transmission, finally benefit all individuals still suffering from the scourge of malaria.

Epidemiological characteristics of Plasmodium malariae malaria in China: a malaria that should not be neglected post elimination.

BACKGROUND: Plasmodium malariae was always neglected compared with P. falciparum and P. vivax. In the present study, we aimed to describe the epidemiology of reported cases infected with P. malariae in the past decade to raise awareness of the potential threat of this malaria parasite in China. METHODS: Individual data of malaria cases infected with P. malariae reported in China in the past decade were collected via the China Information System for Disease Control and Prevention and Parasitic Diseases Information Reporting Management System, to explore their epidemiological characteristics. Pearson Chi-square tests or Fisher's Exact Test was used in the statistical analysis. RESULTS: From 2013 to 2022, a total of 581 P. malariae cases were reported in China, and mainly concentrated in 20-59 years old group (P < 0.001), and there was no significant trend in the number of cases reported per month. Moreover, four kinds of P. malariae cases were classified, including 567 imported cases from 41 countries in 8 regions and distributed in 27 provinces (autonomous regions, municipalities) in China, six indigenous cases in a small outbreak in Hainan, seven recurrent cases in Guangdong and Shanghai, and one induced case in Shanghai, respectively. In addition, only 379 cases (65.2%) were diagnosed as malaria on the first visit (P < 0.001), and 413 cases (71.1%) were further confirmed as P. malariae cases (P = 0.002). Meanwhile, most cases sought healthcare first in the health facilities at the county and prefectural levels, but only 76.7% (161/210) and 73.7% (146/198) cases were diagnosed as malaria, and the accuracy of confirmed diagnosis as malaria cases infected with P. malariae was only 77.2% (156/202) and 69.9% (167/239) in these health facilities respectively. CONCLUSIONS: Even though malaria cases infected with P. malariae didn't account for a high proportion of reported malaria cases nationwide, the threat posed by widely distributed imported cases, a small number of indigenous cases, recurrent cases and induced case cannot be ignored in China. Therefore, it is necessary to raise awareness and improve the surveillance and response to the non-falciparum species such as P. malariae, and prevent the reestablishment of malaria transmission after elimination.

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

OBJECTIVE: No 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. METHODS: Individual-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. RESULTS: A 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. CONCLUSIONS: China 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.

Establishing and applying an adaptive strategy and approach to eliminating malaria: practice and lessons learnt from China from 2011 to 2020.

ABSTRACTOn 30 June 2021, China was certified malaria-free by the World Health Organization. In this study, the evolution, performance, outcomes, and impact of China's adaptive strategy and approach for malaria elimination from 2011 to 2020 were analysed using 10-year data. The strategy and approach focused on timely detection and rapid responses to individual cases and foci. Indigenous cases declined from 1,308 in 2011 to 36 in 2015, and the last one was reported from Yunnan Province in April 2016, although thousands of imported cases still occur annually. The "1-3-7" approach was implemented successfully between 2013 and 2020, with 100% of cases reported within 24 h, 94.5% of cases investigated within three days of case reporting, and 93.4% of foci responses performed within seven days. Additionally, 81.6% of patients attended the first healthcare visit within 1-3 days of onset and 58.4% were diagnosed as malaria within three days of onset, in 2017-2020. The adaptive strategy and approach, along with their universal implementation, are most critical in malaria elimination. In addition to strengthening surveillance on drug resistance and vectors and border malaria collaboration, a further adapted three-step strategy and the corresponding "3-3-7" model are recommended to address the risks of re-transmission and death by imported cases after elimination. China's successful practice and lessons learnt through long-term efforts provide a reference for countries moving towards elimination.

[Malaria situation in the People's Republic Of China in 2009].

Totally 14,491 malaria cases and 59 741 suspected cases with 12 deaths were reported by the annual case reporting system in 1171 counties of 23 Provinces/Municipalities/Autonomous Regions (P/M/A) in 2009, and the annual incidence was 0.11/10,000. Through the internet reporting system, 14,140 malaria cases were reported from 956 counties of 30 P/M/ A. The number of malaria cases and the rank of P/M/A were basically in concordance in the two systems. Among the 1171 counties with reported malaria cases, 4 counties with an incidence of more than 10/10,000 distributed in Yunnan (3 counties) and Tibet (1). There were 59 counties in which the malaria incidence was between 1/ 10,000 and 10/10,000. A total of 1027 Plasmodium falciparum malaria cases accounted for 7.1% of the total cases, of which 87.3% (897) were imported cases reported in 326 counties/cities of 21 P/M/A. Indigenous falciparum malaria was found in 18 counties/cities of Yunnan and Hainan Provinces, of which 16 counties/cities were in Yunnan and 2 counties/cities were in Hainan, 3 or 6 less respectively in comparison to that of 2008. No focal outbreaks occurred in the whole country in 2009. Although a considerable decrease in malaria incidence contributed to the implementation of the National Malaria Control Program and the project supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria, Yunnan and Hainan Provinces are still the relatively high transmission areas. Yunnan ranked No.2 in the country in terms of the number of cases, while Hainan ranked down to No.6 by malaria incidence in 2009. Three thousand nine hundred and twenty two malaria cases were reported from the two provinces in 2009, accounting for 27.1% of the total reported cases in the country. There were 3 237 cases with 3 deaths reported from Yunnan, the incidence was 0.96/10,000, a decrease of 17.2% than that in the last year. Among the reported cases, 567 were falciparum malaria with 49.7% imported cases. The number of reported cases in Hainan was 685, with an incidence of 0.79/10,000, 63.8% decrease than the last year. In central China, the resurgence of malaria was suppressed and the number of malaria cases was considerably decreased in 2009, but the incidence in Anhui Province has still been the first in the country. A total of 5 918 malaria cases were reported from Anhui Province in 2009, accounting for 40.8% of the total cases in the country, with an incidence of 1.19/10,000 which decreased by 50.8% than that in 2008. The number of reported cases in Henan Province was 1 611, decreased by 40.8% in incidence. Hubei Province reported 709 malaria cases with an incidence of 0.12/10,000, decreased by 34.8%. There were 389 cases reported from Jiangsu Province, decreased by 41.8% compared to that in 2008. Cases reported from other P/M/A occupied about 13.4% of the total. Above hundred were reported from Shandong and less than 100 cases were reported from each of Fujian, Chongqing, Shanghai, Jiangxi, Liaoning, Shaanxi, Jilin, Heilongjiang, Gansu and Tibet in 2009. In summary, the re-emergence of malaria has been restrained through several years' efforts, but malaria is still an important problem of public health in China, especially in the southern and central parts. Yunnan and Hainan still face the spread of Plasmodium falciparum, especially imported malaria in the border areas. In the central parts of the country, Anhui Province is still with the highest incidence in 2009. In addition, imported malaria cases in those provinces with a low transmission or without local transmission may become a new challenge to the National Malaria Control Program.

Contribution of NIPD-CTDR to the parasitic diseases control and elimination in China: Memory of the 70th anniversary for NIPD-CTDR.

China has achieved a great success in control and elimination of key parasitic diseases. In 2007, the elimination of lymphatic filariasis was verified by WHO. The schistosomiasis incidence and snail-distributed areas have reduced to the lowest level in the history. The transmission and disease burden of echinococcosis have been contained largely, and the populations infected with soil-transmitted trematode and food-borne parasites have also shown a significantly declining trend. Because of rapid globalization and climate changes, however, many new challenges have arisen. In his paper, the 2020-2030 roadmaps towards the control and elimination of these key parasitic diseases are described. Moreover, China is actively implementing its global health strategy, and will be more and more engaged into global health affairs, in which a series of China-Africa health cooperation projects have been in planning with a wish of making a greater contribution to the SDGs.

[Determination of key interventions for the transition from control to elimination of malaria in China].

OBJECTIVE: To determine the key interventions transferring from the control to elimination of malaria in China so as to provide the basic information for achieving malaria elimination. METHODS: Based on the data collected from the document entitled of The National Annual Report on Schistosomiasis, Malaria and Echinococcosis, published by the National Institute of Parasitic Diseases of Chinese Center for Disease Control and Prevention, the malaria incidence and intervention data were selected only in the typical endemic provinces during the period of 2004-2010. The correlation between the incidence and interventions in the target provinces was analyzed based on the Panel Data Regression Model, and the key interventions were determined. RESULTS: Four provinces namely Anhui, Yunnan, Hainan and Henan were targeted with 87.56% of the national malaria figures from 2004 to 2010. When Y was given as vivax malaria incidence, X1 as the log of the number of historical cases receiving radical treatment in the pre-transmission stage (RTPT) (F = 14.53, P < 0.01, R2 = 0.72), X2 as the log of risk population receiving RTPR (F = 15.90, P < 0.01, R2 = 0.71) and X3 as the number of technicians trained in microscopy (F = 11.53, P < 0.01, R2 = 0.61), three space-fixed effect models were established respectively, and X1, X2, as well as X3 had negative effects on Y value. When Y was given as falciparum malaria incidence, X1 as the accumulated technicians trained in microscopy (F = 11.06, P < 0.01, R2 = 0.87), X2 as the log of technicians trained in entomology (F = 15.28, P < 0.01, R2 = 0.89) , two two-way (space and time) fixed effect models were established respectively, and both X1 and X2 had negative effects on Y value. CONCLUSION: RTPT among historical patients and at-risk populations as well as microscopy training influences the variation of vivax malaria incidence, while the significant interventions of microscopy training and vector control training indicate that the integrated measures with strengthened capacity in diagnosis and vector control are of importance in the control of falciparum malaria transmission.

Transition from control to elimination: impact of the 10-year global fund project on malaria control and elimination in China.

The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) supported a project on the control and elimination of malaria in People's Republic of China which was one of the biggest-scale international cooperation programmes to control malaria in the country during the past 10 years. The project promoted the effective implementation of the Chinese national malaria control programme. On the basis of epidemiologic data, an overview of the project activities and key performance indicators, the overall impact of the GFATM project was evaluated. We also reviewed relevant programme features including technological and management approaches, with a focus on best practice, innovations in implementation and the introduction of international standards. Last, we summarised the multi-stakeholder cooperation mechanism and comments on its sustainability in the post-GFATM period. Recommendations for the future management of the Chinese national malaria elimination programme are put forward after considering the challenges, shortcomings and lessons learnt during the implementation of the GFATM project in China to sustain past achievements and foster the attainment of the ultimate goal of malaria elimination for the country.

Lessons from malaria control to elimination: case study in Hainan and Yunnan provinces.

Reduction patterns of Plasmodium falciparum and P. vivax malaria transmission and the role of an integrated strategy of case management and vector control are compared between different ecological zones. The epidemiology of malaria in Hainan and Yunnan provinces was disparate, even though distinct malaria control strategies have been adapted to different situations based on risk group, vector behaviours, local health infrastructure, and environmental conditions. The island Hainan appears to be victorious in eliminating malaria. However, there is still a long way to go to prevent the reintroduction of malaria in Hainan province and eliminating malaria in the border areas of Yunnan province. This review of the experiences and challenges from malaria control to elimination in Hainan and Yunnan provinces of southern China will provide a basis for the future elimination of malaria in the whole country.

China-Africa cooperation initiatives in malaria control and elimination.

Malaria has affected human health globally with a significant burden of disease, and also has impeded social and economic development in the areas where it is present. In Africa, many countries have faced serious challenges in controlling malaria, in part due to major limitations in public health systems and primary health care infrastructure. Although China is a developing country, a set of control strategies and measures in different local settings have been implemented successfully by the National Malaria Control Programme over the last 60 years, with a low cost of investment. It is expected that Chinese experience may benefit malaria control in Africa. This review will address the importance and possibility of China-Africa collaboration in control of malaria in targeted African countries, as well as how to proceed toward the goal of elimination where this is technically feasible.