马来西亚雪兰莪州存在疟疾在郊区传播的风险吗？
Is there a risk of suburban transmission of malaria in Selangor, Malaysia?
作者信息
Braima Kamil A, Sum Jia-Siang, Ghazali Amir-Ridhwan M, Muslimin Mustakiza, Jeffery John, Lee Wenn-Chyau, Shaker Mohammed R, Elamin Alaa-Eldeen M, Jamaiah Ibrahim, Lau Yee-Ling, Rohela Mahmud, Kamarulzaman Adeeba, Sitam Frankie, Mohd-Noh Rosnida, Abdul-Aziz Noraishah M
机构信息
Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
出版信息
PLoS One. 2013 Oct 23;8(10):e77924. doi: 10.1371/journal.pone.0077924. eCollection 2013.
BACKGROUND
The suburban transmission of malaria in Selangor, Malaysia's most developed and populous state still remains a concern for public health in this region. Despite much successful control efforts directed at its reduction, sporadic cases, mostly brought in by foreigners have continued to occur. In addition, cases of simian malaria caused by Plasmodium knowlesi, some with fatal outcome have caused grave concern to health workers. The aim of this study was to investigate the possibility of local malaria transmission in suburban regions of Selangor, which are adjacent to secondary rainforests.
FINDINGS
A malaria survey spanning 7 years (2006 - 2012) was conducted in Selangor. A total of 1623 laboratory confirmed malaria cases were reported from Selangor's nine districts. While 72.6% of these cases (1178/1623) were attributed to imported malaria (cases originating from other countries), 25.5% (414/1623) were local cases and 1.9% (31/1623) were considered as relapse and unclassified cases combined. In this study, the most prevalent infection was P. vivax (1239 cases, prevalence 76.3%) followed by P. falciparum (211, 13.0%), P. knowlesi (75, 4.6%), P. malariae (71, 4.4%) and P. ovale (1, 0.06%). Mixed infections comprising of P. vivax and P. falciparum were confirmed (26, 1.6%). Entomological surveys targeting the residences of malaria patients' showed that the most commonly trapped Anopheles species was An. maculatus. No oocysts or sporozoites were found in the An. maculatus collected. Nevertheless, the possibility of An. maculatus being the malaria vector in the investigated locations was high due to its persistent occurrence in these areas.
CONCLUSIONS
Malaria cases reported in this study were mostly imported cases. However the co-existence of local cases and potential Plasmodium spp. vectors should be cause for concern. The results of this survey reflect the need of maintaining closely monitored malaria control programs and continuous extensive malaria surveillance in Peninsula Malaysia.
背景
马来西亚最发达且人口最多的雪兰莪州存在疟疾的郊区传播情况，这仍是该地区公共卫生领域的一大担忧。尽管为减少疟疾传播付出了诸多成功的防控努力，但仍有散发病例持续出现，其中大多数是由外国人带入的。此外，诺氏疟原虫引起的猴疟病例，有些导致了致命后果，这引起了卫生工作者的严重关切。本研究的目的是调查雪兰莪州与次生雨林相邻的郊区存在本地疟疾传播的可能性。
研究结果
在雪兰莪州开展了一项为期7年（2006 - 2012年）的疟疾调查。雪兰莪州的9个区共报告了1623例实验室确诊的疟疾病例。其中72.6%（1178/1623）的病例归因于输入性疟疾（源自其他国家的病例），25.5%（414/1623）为本地病例，1.9%（31/1623）被视为复发和未分类病例的总和。在本研究中，最常见的感染是间日疟原虫（1239例，患病率76.3%），其次是恶性疟原虫（211例，13.0%）、诺氏疟原虫（75例，4.6%）、三日疟原虫（71例，4.4%）和卵形疟原虫（1例，0.06%）。确认存在间日疟原虫和恶性疟原虫的混合感染（26例，1.6%）。针对疟疾病例患者住所进行的昆虫学调查显示，最常捕获的按蚊种类是大劣按蚊。在所收集的大劣按蚊中未发现卵囊或子孢子。然而，由于大劣按蚊在这些地区持续存在，其在调查地点成为疟疾传播媒介的可能性很高。
结论
本研究报告的疟疾病例大多是输入性病例。然而，本地病例和潜在疟原虫传播媒介的共存应引起关注。本次调查结果反映出在马来西亚半岛维持密切监测的疟疾防控项目以及持续广泛开展疟疾监测的必要性。
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