Trape J F
Laboratoire de paludologie, Institut de Recherche pour le Développement, anciennement ORSTOM, B.P. 1386, Dakar, Sénégal et B.P. 5045, Montpellier, France.
Bull Soc Pathol Exot. 2001 Jul;94(2 Pt 2):174-9.
There is no direct relationship between malaria transmission intensity and the burden of the disease. Due to acquired immunity there is little difference both in potential malaria mortality and the total number of malaria attacks over an entire lifetime between individuals bitten by infected anophelines a few times a year and those bitten by infected anophelines hundreds of times a year: It is only for low levels of transmission that there exists a relation between the entomological inoculation rate, the disease incidence rate and potential malaria mortality. Even if impregnation by insecticides improves bednet efficiency the vector capacity of Anopheles gambiae, An. arabiensis and An. funestus is too high for impregnated bednets to be an efficient means of malaria control in most rural areas of tropical Africa. The reduction of malaria mortality observed during several pilot projects is probably a short term effect. We propose focussing vector control on low and/or unstable malaria transmission areas, i.e. where these activities have proved crucial for the reduction or even eradication of malaria. In moderate or high transmission areas, better access to health care and improvement of malaria case management are currently the only means for reducing durably the burden of malaria.
疟疾传播强度与疾病负担之间没有直接关系。由于获得性免疫，每年被感染按蚊叮咬几次的人和每年被感染按蚊叮咬数百次的人相比，在潜在疟疾死亡率和一生中疟疾发作的总数方面几乎没有差异：只有在低传播水平时，昆虫学接种率、疾病发病率和潜在疟疾死亡率之间才存在关联。即使使用杀虫剂浸渍提高了蚊帐的效率，但冈比亚按蚊、阿拉伯按蚊和富氏按蚊的媒介能力过高，以至于在热带非洲的大多数农村地区，浸渍蚊帐并不是控制疟疾的有效手段。在几个试点项目中观察到的疟疾死亡率降低可能只是短期效应。我们建议将病媒控制重点放在低传播和/或不稳定的疟疾传播地区，即这些活动已被证明对减少甚至根除疟疾至关重要的地区。在中度或高传播地区，目前更好地获得医疗保健和改善疟疾病例管理是持久减轻疟疾负担的唯一手段。
