Centro de Investigación Científica Caucaseco, Colombia.
Acta Trop. 2012 Mar;121(3):303-14. doi: 10.1016/j.actatropica.2011.06.008. Epub 2011 Jul 1.
Approximately 170 million inhabitants of the American continent live at risk of malaria transmission. Although the continent's contribution to the global malaria burden is small, at least 1-1.2 million malaria cases are reported annually. Sixty percent of the malaria cases occur in Brazil and the other 40% are distributed in 20 other countries of Central and South America. Plasmodium vivax is the predominant species (74.2%) followed by P. falciparum (25.7%) and P. malariae (0.1%), and no less than 10 Anopheles species have been identified as primary or secondary malaria vectors. Rapid deforestation and agricultural practices are directly related to increases in Anopheles species diversity and abundance, as well as in the number of malaria cases. Additionally, climate changes profoundly affect malaria transmission and are responsible for malaria epidemics in some regions of South America. Parasite drug resistance is increasing, but due to bio-geographic barriers there is extraordinary genetic differentiation of parasites with limited dispersion. Although the clinical spectrum ranges from uncomplicated to severe malaria cases, due to the generally low to middle transmission intensity, features such as severe anemia, cerebral malaria and other complications appear to be less frequent than in other endemic regions and asymptomatic infections are a common feature. Although the National Malaria Control Programs (NMCP) of different countries differ in their control activities these are all directed to reduce morbidity and mortality by using strategies like health promotion, vector control and impregnate bed nets among others. Recently, international initiatives such as the Malaria Control Program in Andean-country Border Regions (PAMAFRO) (implemented by the Andean Organism for Health (ORAS) and sponsored by The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM)) and The Amazon Network for the Surveillance of Antimalarial Drug Resistance (RAVREDA) (sponsored by the Pan American Health Organization/World Health Organization (PAHO/WHO) and several other partners), have made great investments for malaria control in the region. We describe here the current status of malaria in a non-Amazonian region comprising several countries of South and Central America participating in the Centro Latino Americano de Investigación en Malaria (CLAIM), an International Center of Excellence for Malaria Research (ICEMR) sponsored by the National Institutes of Health (NIH) National Institute of Allergy and Infectious Diseases (NIAID).
大约有 1.7 亿美洲大陆居民生活在疟疾传播的风险之中。尽管该大陆对全球疟疾负担的贡献很小，但每年仍报告至少 100 万至 120 万例疟疾病例。60%的疟疾病例发生在巴西，其余 40%分布在中美洲和南美洲的 20 个其他国家。间日疟原虫是主要物种（74.2%），其次是恶性疟原虫（25.7%）和疟原虫（0.1%），至少有 10 种按蚊被确定为主要或次要疟疾传播媒介。快速的森林砍伐和农业活动直接导致按蚊物种多样性和数量的增加，以及疟疾病例的增加。此外，气候变化深刻影响疟疾的传播，并导致南美洲一些地区发生疟疾流行。寄生虫耐药性正在增加，但由于生物地理障碍，寄生虫的遗传分化非常显著，扩散范围有限。尽管临床谱从无并发症到严重疟疾病例不等，但由于传播强度普遍较低，因此严重贫血、脑型疟疾和其他并发症等特征似乎比其他流行地区少见，无症状感染是一个常见特征。尽管不同国家的国家疟疾控制规划（NMCP）在控制活动方面存在差异，但所有这些规划都旨在通过健康促进、病媒控制和使用驱虫蚊帐等策略来降低发病率和死亡率。最近，诸如安第斯国家边境地区疟疾控制规划（PAMAFRO）（由安第斯卫生组织（ORAS）实施，由全球抗击艾滋病、结核病和疟疾基金（GFATM）赞助）和亚马逊抗疟药耐药性监测网络（RAVREDA）（由泛美卫生组织/世界卫生组织（PAHO/WHO）和其他几个合作伙伴赞助）等国际倡议，为该地区的疟疾控制做出了巨大投资。我们在这里描述了一个非亚马逊地区的疟疾现状，该地区由参与拉丁美洲疟疾研究卓越中心（CLAIM）的几个中美洲和南美洲国家组成，CLAIM 是一个由美国国立卫生研究院（NIH）过敏和传染病研究所（NIAID）赞助的国际疟疾卓越研究中心（ICEMR）。
