Global Health Group, University of California, San Francisco, 50 Beale Street, Suite 1200, San Francisco, CA USA.
Malar J. 2013 Oct 9;12:358. doi: 10.1186/1475-2875-12-358.
Moving from malaria control to elimination requires national malaria control programmes to implement strategies to detect both symptomatic and asymptomatic cases in the community. In order to do this, malaria elimination programmes follow up malaria cases reported by health facilities to carry out case investigations that will determine the origin of the infection, whether it has been imported or is due to local malaria transmission. If necessary, the malaria programme will also carry out active surveillance to find additional malaria cases in the locality to prevent further transmission. To understand current practices and share information on malaria elimination strategies, a survey specifically addressing country policies on case investigation and reactive case detection was carried out among fourteen countries of the Asia Pacific Malaria Elimination Network (APMEN).
A questionnaire was distributed to the malaria control programme managers amongst 14 countries in the Asia Pacific who have national or sub-national malaria elimination goals.
Results indicate that there are a wide variety of case investigation and active case detection activities employed by the 13 countries that responded to the survey. All respondents report conducting case investigation as part of surveillance activities. More than half of these countries conduct investigations for each case. Over half aim to accomplish the investigation within one to two days of a case report. Programmes collect a broad array of demographic data during investigation procedures and definitions for imported cases are varied across respondents. Some countries report intra-national (from a different province or district) importation while others report only international importation (from a different country). Reactive case detection in respondent countries is defined as screening households within a pre-determined radius in order to identify other locally acquired infections, whether symptomatic or asymptomatic. Respondents report that reactive case detection can be triggered in different ways, in some cases with only a single case report and in others if a defined threshold of multiple cases occurs. The spatial range of screening conducted varies from a certain number of households to an entire administrative unit (e g, village). Some countries target symptomatic people whereas others target all people in order to detect asymptomatic infections. The majority of respondent programmes collect a range of information from those screened for malaria, similar to the range of information collected during case investigation.
Case investigation and reactive case detection are implemented in the malaria elimination programmes in the Asia Pacific, however practices vary widely from country to country. There is little evidence available to support countries in deciding which methods to maintain, change or adopt for improved effectiveness and efficiency. The development and use of common evaluation metrics for these activities will allow malaria programmes to assess performance and results of resource-intensive surveillance measures and may benefit other countries that are considering implementing these activities.
从疟疾控制转向消除需要国家疟疾控制规划实施策略,以便在社区中发现有症状和无症状的病例。为了做到这一点,疟疾消除规划会对卫生机构报告的疟疾病例进行后续调查,以确定感染的来源,是输入性的还是由于当地疟疾传播引起的。如果有必要,疟疾规划还将开展主动监测,以发现当地的其他疟疾病例,防止进一步传播。为了了解当前的做法并分享消除疟疾策略的信息,在亚太疟疾消除网络(APMEN)的 14 个国家中专门针对病例调查和反应性病例检测的国家政策进行了一项调查。
向亚太地区 14 个有国家或次国家疟疾消除目标的疟疾控制规划管理人员分发了一份问卷。
结果表明,13 个对调查作出回应的国家采用了各种各样的病例调查和主动病例检测活动。所有答复者都报告说,作为监测活动的一部分,正在进行病例调查。超过一半的国家对每个病例进行调查。超过一半的国家希望在病例报告后的一到两天内完成调查。方案在调查过程中收集了广泛的人口统计数据,对输入病例的定义因答复者而异。一些国家报告国内(来自不同的省或区)输入,而另一些国家只报告国际输入(来自不同的国家)。答复国的反应性病例检测被定义为在预先确定的半径内对家庭进行筛查,以发现其他本地获得的感染,无论是否有症状。答复者报告说,反应性病例检测可以通过不同的方式触发,在某些情况下,只需一个病例报告,而在其他情况下,如果发生多个病例的定义阈值,则会触发。筛查的空间范围从一定数量的家庭到整个行政单位(例如,村庄)不等。一些国家的目标是有症状的人,而另一些国家的目标是所有人,以发现无症状感染。大多数答复方案从接受疟疾筛查的人那里收集了一系列信息,与病例调查中收集的信息范围相似。
在亚太地区的疟疾消除规划中实施了病例调查和反应性病例检测,但各国的做法差异很大。几乎没有证据支持各国决定保留、改变或采用哪些方法来提高效果和效率。为这些活动制定和使用共同的评估指标将使疟疾规划能够评估资源密集型监测措施的绩效和结果,并可能使其他正在考虑实施这些措施的国家受益。