Sanchez Juan F, Carnero Andres M, Rivera Esteban, Rosales Luis A, Baldeviano G Christian, Asencios Jorge L, Edgel Kimberly A, Vinetz Joseph M, Lescano Andres G
Department of Parasitology, U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru.
Dirección Regional de Salud de Madre de Dios, Ministerio de Salud del Perú, Puerto Maldonado, Peru.
Am J Trop Med Hyg. 2017 Feb 8;96(2):304-311. doi: 10.4269/ajtmh.16-0030. Epub 2016 Nov 22.
The reemergence of malaria in the last decade in Madre de Dios, southern Peruvian Amazon basin, was accompanied by ecological, political, and socioeconomic changes related to the proliferation of illegal gold mining. We conducted a secondary analysis of passive malaria surveillance data reported by the health networks in Madre de Dios between 2001 and 2012. We calculated the number of cases of malaria by year, geographic location, intensity of illegal mining activities, and proximity of health facilities to the Peru-Brazil Interoceanic Highway. During 2001-2012, 203,773 febrile cases were identified in Madre de Dios, of which 30,811 (15.1%) were confirmed cases of malaria; all but 10 cases were due to Cases of malaria rose rapidly between 2004 and 2007, reached 4,469 cases in 2005, and then declined after 2010 to pre-2004 levels. Health facilities located in areas of intense illegal gold mining reported 30-fold more cases than those in non-mining areas (ratio = 31.54, 95% confidence interval [CI] = 19.28, 51.60). Finally, health facilities located > 1 km from the Interoceanic Highway reported significantly more cases than health facilities within this distance (ratio = 16.20, 95% CI = 8.25, 31.80). Transmission of malaria in Madre de Dios is unstable, geographically heterogeneous, and strongly associated with illegal gold mining. These findings highlight the importance of spatially oriented interventions to control malaria in Madre de Dios, as well as the need for research on malaria transmission in illegal gold mining camps.
过去十年间，秘鲁亚马逊流域南部的马德雷德迪奥斯地区疟疾再度出现，同时伴随着与非法金矿开采激增相关的生态、政治和社会经济变化。我们对2001年至2012年间马德雷德迪奥斯地区卫生网络报告的被动疟疾监测数据进行了二次分析。我们按年份、地理位置、非法采矿活动强度以及卫生设施与秘鲁-巴西跨洋公路的距离计算了疟疾病例数。在2001年至2012年期间，马德雷德迪奥斯地区共发现203,773例发热病例，其中30,811例（15.1%）为确诊疟疾病例；除10例以外，所有病例均由……引起。疟疾病例在2004年至2007年间迅速增加，2005年达到4,469例，然后在2010年后降至2004年前的水平。位于非法金矿开采密集地区的卫生设施报告的病例数比非采矿地区多30倍（比值 = 31.54，95%置信区间[CI] = 19.28，51.60）。最后，距离跨洋公路超过1公里的卫生设施报告的病例数明显多于在此距离内的卫生设施（比值 = 16.20，95%CI = 8.25，31.80）。马德雷德迪奥斯地区的疟疾传播不稳定、地理分布不均，且与非法金矿开采密切相关。这些发现凸显了以空间为导向的干预措施对控制马德雷德迪奥斯地区疟疾的重要性，以及对非法金矿开采营地疟疾传播进行研究的必要性。
