Macauley Cameron
International Health, Boston University School of Public Health, 8 Feneno Terrace, #2, Allston, MA 02134, USA.
Soc Sci Med. 2005 Feb;60(3):563-73. doi: 10.1016/j.socscimed.2004.05.025.
Since 1996, the Brazilian Ministry of Health has adopted a malaria control strategy known as aggressive active case detection (AACD) in which most or all members of every community are tested and treated for malaria on a monthly basis. The strategy attempts to identify and treat cases of asymptomatic malaria, which, if untreated, continue to transmit the infection. Malaria remains uncontrolled because almost all health care systems in the world rely on passive case detection: the treatment of only symptomatic cases of malaria. Research has shown conclusively that asymptomatic cases exist in any population where malaria transmission is stable and incidence is high: therefore passive case detection simply will not succeed in breaking the cycle of transmission. Numerous case studies show that malaria has been successfully controlled on a regional or national level by mass blood surveys. AACD is an effective malaria control strategy if used in conjunction with other methods, especially when (1) an effective treatment exists, (2) influx of potential carriers of the infection can be monitored, and (3) people are inclined to cooperate with monthly blood testing. AACD requires access to rapid diagnostic tests (RDTs), microscopy supplies, extensive human resources, and prompt, affordable, and effective treatment. AACD is compared to PCD in terms of clinical efficacy and cost effectiveness in a case study of malaria in the Brazilian Yanomami Indians. Where it is feasible, AACD could drastically reduce the incidence of malaria and should be an integral part of the World Health Organization's Roll Back Malaria strategy.
自1996年以来，巴西卫生部采用了一种名为积极主动病例检测（AACD）的疟疾控制策略，即每个社区的大多数或所有成员每月都接受疟疾检测和治疗。该策略旨在识别和治疗无症状疟疾病例，这些病例若不治疗，会持续传播感染。疟疾仍未得到控制，因为世界上几乎所有医疗系统都依赖被动病例检测：仅治疗有症状的疟疾病例。研究已确凿表明，在疟疾传播稳定且发病率高的任何人群中都存在无症状病例：因此，被动病例检测根本无法成功打破传播循环。众多案例研究表明，通过大规模血液检测，疟疾已在区域或国家层面得到成功控制。如果与其他方法结合使用，AACD是一种有效的疟疾控制策略，特别是当（1）存在有效治疗方法，（2）可以监测感染潜在携带者的流入情况，以及（3）人们愿意配合每月的血液检测时。AACD需要使用快速诊断检测（RDT）、显微镜设备、大量人力资源，以及及时、可负担且有效的治疗。在巴西亚诺马米印第安人的疟疾案例研究中，对AACD和被动病例检测（PCD）在临床疗效和成本效益方面进行了比较。在可行的情况下，AACD可大幅降低疟疾发病率，应成为世界卫生组织“遏制疟疾”战略的一个组成部分。
