公共卫生挑战与疟疾防控和消除前景。

Public health challenges and prospects for malaria control and elimination.

机构信息

Barcelona Centre for International Health Research, Hospital Clinic, Universitat de Barcelona, Spain.

出版信息

Nat Med. 2013 Feb;19(2):150-5. doi: 10.1038/nm.3077. Epub 2013 Feb 6.

Abstract

The past decade witnessed unprecedented efforts to control malaria, including renewed political and financial commitment and increased availability of both old and new strategies and tools. However, malaria still represents a major health burden, particularly in Africa. Important challenges such as the fragility of many health systems, the rise of insecticide and drug resistance, and particularly the expected decline both in funding and in the coverage of key interventions if they are not replaced as needed, urgently need to be addressed. Further research and development is also becoming increasingly crucial. Among other needs, common methodologies for estimating and tracking the malaria burden, new strategies to measure transmission, better understanding of immunity, and increased knowledge of the mechanisms and effects of resistance to drugs and insecticides stand out. The ongoing efforts in research and development for new antimalarial drugs, more sensitive point-of-care rapid diagnostic tests and new insecticides need further innovation and substantial strengthening. Clearly, efforts should focus not only on Plasmodium falciparum but also and increasingly on Plasmodium vivax, the neglected human malaria parasite. Addressing these challenges in a comprehensive and timely way will allow us to sustain the gains made so far and make further progress in control and progressive elimination.

摘要

过去十年见证了控制疟疾的空前努力,包括重新做出政治和财政承诺,以及旧策略和新工具的可用性都有所增加。然而,疟疾仍然是一个主要的健康负担,特别是在非洲。重要的挑战包括许多卫生系统的脆弱性、杀虫剂和药物耐药性的上升,特别是如果不根据需要进行替代,预计资金和关键干预措施的覆盖范围都会下降,这迫切需要得到解决。进一步的研究和开发也变得越来越重要。除其他需求外,疟疾负担的估算和跟踪的通用方法、衡量传播的新策略、对免疫的更好理解,以及对药物和杀虫剂耐药性机制和效果的更多了解,都非常突出。新抗疟药物、更敏感的即时诊断检测和新杀虫剂的研发工作正在进行中,需要进一步创新和大力加强。显然,努力不仅应集中于恶性疟原虫,而且还应越来越多地集中于被忽视的人类疟原虫寄生虫间日疟原虫。全面和及时地应对这些挑战将使我们能够维持迄今取得的成果,并在控制和逐步消除方面取得进一步进展。

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