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巴西亚马逊河以外地区疟疾的时空流行病学

Spatial and temporal epidemiology of malaria in extra-Amazonian regions of Brazil.

作者信息

Lorenz Camila, Virginio Flávia, Aguiar Breno S, Suesdek Lincoln, Chiaravalloti-Neto Francisco

机构信息

Instituto Butantan, Avenida Vital Brasil, 1500, São Paulo, CEP 05509-300, Brazil.

Biologia da Relação Patógeno-Hospedeiro-Instituto de Ciências Biomédicas-USP, São Paulo, Brazil.

出版信息

Malar J. 2015 Oct 15;14:408. doi: 10.1186/s12936-015-0934-6.

DOI:10.1186/s12936-015-0934-6
PMID:26466889
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4607178/
Abstract

BACKGROUND

Mosquitoes, Plasmodium parasites, and humans live in sympatry in some extra-Amazonian regions of Brazil. Recent migrations of people from Amazonia and other countries to extra-Amazonian regions have led to many malaria outbreaks. Lack of relevant expertise among health professionals in non-endemic areas can lead to a neglect of the disease, which can be dangerous given its high fatality rate. Therefore, understanding the spatial and temporal epidemiology of malaria is essential for developing strategies for disease control and elimination. This study aimed to characterize imported (IMP) and autochthonous/introduced (AU/IN) cases in the extra-Amazonian regions and identify risk areas and groups.

METHODS

Epidemiological data collected between 2007 and 2014 were obtained from the Notifiable Diseases Information System of the Ministry of Health (SINAN) and from the Department of the Unified Health System (DATASUS). High malaria risk areas were determined using the Local Indicator of Spatial Association. IMP and AU/IN malaria incidence rates were corrected by Local Empirical Bayesian rates.

RESULTS

A total of 6092 malaria cases (IMP: 5416, 88.9 %; AU/IN: 676, 11.1 %) was recorded in the extra-Amazonian regions in 2007-2014. The highest numbers of IMP and AU/IN cases were registered in 2007 (n = 862) and 2010 (n = 149), respectively. IMP cases were more frequent than AU/IN cases in all states except for Espírito Santo. Piauí, Espírito Santo, and Paraná states had high incidences of AU/IN malaria. The majority of infections were by Plasmodium falciparum in northeast and southeast regions, while Plasmodium vivax was the predominant species in the south and mid-west showed cases of dual infection. AU/IN malaria cases were concentrated in the coastal region of Brazil, which contains the Atlantic Forest and hosts the Anopheles transmitters. Several malaria clusters were also associated with the Brazilian Pantanal biome and regions bordering the Amazonian biome.

CONCLUSION

Malaria is widespread outside the Amazonian region of Brazil, including in more urbanized and industrialized states. This fact is concerning because these highly populated areas retain favourable conditions for spreading of the parasites and vectors. Control measures for both IMP and AU/IN malaria are essential in these high-risk areas.

摘要

背景

在巴西一些亚马逊河以外的地区，蚊子、疟原虫和人类共生。近期，来自亚马逊地区和其他国家的人口向亚马逊河以外地区迁移，导致了多起疟疾疫情爆发。非流行地区的卫生专业人员缺乏相关专业知识，可能会导致对该疾病的忽视，鉴于其高死亡率，这可能很危险。因此，了解疟疾的时空流行病学对于制定疾病控制和消除策略至关重要。本研究旨在描述亚马逊河以外地区的输入性（IMP）和本地/输入性（AU/IN）病例特征，并确定风险区域和群体。

方法

收集2007年至2014年期间的流行病学数据，这些数据来自卫生部法定传染病信息系统（SINAN）和统一卫生系统部（DATASUS）。使用空间关联局部指标确定高疟疾风险区域。IMP和AU/IN疟疾发病率通过局部经验贝叶斯率进行校正。

结果

2007年至2014年期间，亚马逊河以外地区共记录了6092例疟疾病例（IMP：5416例，88.9%；AU/IN：676例，11.1%）。IMP和AU/IN病例数最多的年份分别为2007年（n = 862）和2010年（n = 149）。除圣埃斯皮里图州外，所有州IMP病例均比AU/IN病例更常见。皮奥伊州、圣埃斯皮里图州和巴拉那州的AU/IN疟疾发病率较高。东北部和东南部地区的大多数感染是由恶性疟原虫引起的，而间日疟原虫是南部的主要种类，中西部地区出现了双重感染病例。AU/IN疟疾病例集中在巴西沿海地区，该地区有大西洋森林且是按蚊传播媒介的宿主地。一些疟疾聚集区还与巴西潘塔纳尔生物群落以及与亚马逊生物群落接壤的地区有关。

结论

疟疾在巴西亚马逊地区以外广泛传播，包括在城市化和工业化程度较高的州。这一事实令人担忧，因为这些人口密集地区具备寄生虫和传播媒介传播的有利条件。在这些高风险地区，对IMP和AU/IN疟疾采取控制措施至关重要。

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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cdae/4607178/1179cd5bf6c3/12936_2015_934_Fig8_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cdae/4607178/82687880e9b3/12936_2015_934_Fig9_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cdae/4607178/0d2bf2b8fd9d/12936_2015_934_Fig10_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cdae/4607178/189349672ad7/12936_2015_934_Fig11_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cdae/4607178/a13f1b8868d5/12936_2015_934_Fig12_HTML.jpg

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