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首页> 外文期刊>BMC Medicine >From high to low malaria transmission in Zanzibar—challenges and opportunities to achieve elimination
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From high to low malaria transmission in Zanzibar—challenges and opportunities to achieve elimination

机译：从桑给巴尔疟疾的高传播到低传播—消除疟疾的挑战和机遇

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Abstract BackgroundSubstantial global progress in the control of malaria in recent years has led to increased commitment to its potential elimination. Whether this is possible in high transmission areas of sub-Saharan Africa remains unclear. Zanzibar represents a unique case study of such attempt, where modern tools and strategies for malaria treatment and vector control have been deployed since 2003.MethodsWe have studied temporal trends of comprehensive malariometric indices in two districts with over 100,000 inhabitants each. The analyses included triangulation of data from annual community-based cross-sectional surveys, health management information systems, vital registry and entomological sentinel surveys.ResultsThe interventions, with sustained high-community uptake, were temporally associated with a major malaria decline, most pronounced between 2004 and 2007 and followed by a sustained state of low transmission. In 2015, the Plasmodium falciparum community prevalence of 0.43% (95% CI 0.23–0.73) by microscopy or rapid diagnostic test represented 96% reduction compared with that in 2003. The P. falciparum and P. malariae prevalence by PCR was 1.8% (95% CI 1.3–2.3), and the annual P. falciparum incidence was estimated to 8 infections including 2.8 clinical episodes per 1000 inhabitants. The total parasite load decreased over 1000-fold (99.9%) between 2003 and 2015. The incidence of symptomatic malaria at health facilities decreased by 94% with a trend towards relatively higher incidence in age groups ?5?years, a more pronounced seasonality and with reported travel history to/from Tanzania mainland as a higher risk factor. All-cause mortality among children ?5?years decreased by 72% between 2002 and 2007 mainly following the introduction of artemisinin-based combination therapies whereas the main reduction in malaria incidence followed upon the vector control interventions from 2006. Human biting rates decreased by 98% with a major shift towards outdoor biting by Anopheles arabiensis. ConclusionsZanzibar provides new evidence of the feasibility of reaching uniquely significant and sustainable malaria reduction (pre-elimination) in a previously high endemic region in sub-Saharan Africa. The data highlight constraints of optimistic prognostic modelling studies. New challenges, mainly with outdoor transmission, a large asymptomatic parasite reservoir and imported infections, require novel tools and reoriented strategies to prevent a rebound effect and achieve elimination.
机译：摘要背景近年来，全球在控制疟疾方面取得了实质性进展，这促使人们更加致力于消除疟疾。尚不清楚在撒哈拉以南非洲的高传播地区是否可能。桑给巴尔代表了这种尝试的独特案例研究，自2003年以来已部署了用于疟疾治疗和病媒控制的现代工具和策略。方法我们研究了两个地区的综合疟疾指数的时间趋势，每个地区居民超过100,000。这些分析包括对来自社区的年度横断面调查，健康管理信息系统，生命登记和昆虫学前哨调查的数据进行三角测量。结果干预措施在持续高社区摄取的情况下在时间上与疟疾的严重减少有关，其中最明显的是2004年和2007年，随后一直处于低速传播状态。 2015年，通过显微镜检查或快速诊断测试，恶性疟原虫的社区患病率为0.43％（95％CI 0.23–0.73），与2003年相比减少了96％。恶性疟原虫和疟疾的PCR患病率为1.8％（ 95％CI为1.3–2.3），每年恶性疟原虫的发病率估计为8次感染，包括每1000名居民2.8次临床发作。在2003年至2015年期间，总的寄生虫负荷下降了1000倍以上（99.9％）。卫生机构中有症状疟疾的发病率下降了94％，并且在> 5岁以下的年龄组中发病率相对较高，这是一个季节性因素并且据报往/返坦桑尼亚大陆的旅行经历是一个较高的风险因素。在2002至2007年间，<5岁儿童的全因死亡率下降了72％，这主要是由于引入了基于青蒿素的联合疗法，而疟疾发病率的主要下降则是从2006年开始进行了媒介控制干预之后。 98％的人主要将阿拉伯按蚊向户外叮咬转移。结论桑给巴尔提供了新的证据，证明了在撒哈拉以南非洲以前的高流行地区实现独特的，重大的，可持续的减少疟疾（消除疟疾）的可行性。数据强调了乐观的预后建模研究的局限性。新的挑战，主要是户外传播，大型无症状寄生虫库和外来感染，需要新的工具和重新定位的策略来防止反弹效果并消除。

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