化学预防是否应成为在高易感地区预防疟疾再次传入的主要策略？以斯里兰卡为例。
Should chemoprophylaxis be a main strategy for preventing re-introduction of malaria in highly receptive areas? Sri Lanka a case in point.
作者信息
Wickremasinghe A Rajitha, Wickremasinghe Renu, Herath Hemantha D B, Fernando S Deepika
机构信息
Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, 11010, Sri Lanka.
Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
出版信息
Malar J. 2017 Mar 4;16(1):102. doi: 10.1186/s12936-017-1763-6.
BACKGROUND
Imported malaria cases continue to be reported in Sri Lanka, which was declared 'malaria-free' by the World Health Organization in September 2016. Chemoprophylaxis, a recommended strategy for malaria prevention for visitors travelling to malaria-endemic countries from Sri Lanka is available free of charge. The strategy of providing chemoprophylaxis to visitors to a neighbouring malaria-endemic country within the perspective of a country that has successfully eliminated malaria but is highly receptive was assessed, taking Sri Lanka as a case in point.
METHODS
The risk of a Sri Lankan national acquiring malaria during a visit to India, a malaria-endemic country, was calculated for the period 2008-2013. The cost of providing prophylaxis for Sri Lankan nationals travelling to India for 1, 2 and 4 weeks was estimated for that same period.
RESULTS
The risk of a Sri Lankan traveller to India acquiring malaria ranged from 5.25 per 100,000 travellers in 2012 to 13.45 per 100,000 travellers in 2010. If 50% of cases were missed by the Sri Lankan healthcare system, then the risk of acquiring malaria in India among returning Sri Lankans would double. The 95% confidence intervals for both risks are small. As chloroquine is the chemoprophylactic drug recommended for travellers to India by the Anti Malaria Campaign of Sri Lanka, the costs of chemoprophylaxis for travellers for a 1-, 2- and 4-weeks stay in India on average are US$ 41,604, 48,538 and 62,407, respectively. If all Sri Lankan travellers to India are provided with chemoprophylaxis for four weeks, it will comprise 0.65% of the national malaria control programme budget.
CONCLUSIONS
Based on the low risk of acquiring malaria among Sri Lankan travellers returning from India and the high receptivity in previously malarious areas of the country, chemoprophylaxis should not be considered a major strategy in the prevention of re-introduction. In areas with high receptivity, universal access to quality-assured diagnosis and treatment cannot be compromised at whatever cost.
背景
斯里兰卡仍有输入性疟疾病例报告，该国于2016年9月被世界卫生组织宣布为“无疟疾”国家。化学预防是斯里兰卡前往疟疾流行国家的游客预防疟疾的推荐策略，且免费提供。以斯里兰卡为例，评估了在一个已成功消除疟疾但接受度很高的国家向前往邻国疟疾流行国家的游客提供化学预防的策略。
方法
计算了2008 - 2013年期间斯里兰卡国民前往疟疾流行国家印度期间感染疟疾的风险。估算了同一时期为前往印度的斯里兰卡国民提供1周、2周和4周预防措施的成本。
结果
前往印度的斯里兰卡旅行者感染疟疾的风险从2012年的每10万名旅行者5.25例到2010年的每10万名旅行者13.45例不等。如果斯里兰卡医疗系统漏诊50%的病例，那么返回的斯里兰卡人在印度感染疟疾的风险将翻倍。两种风险的95%置信区间都很小。由于氯喹是斯里兰卡抗疟运动推荐给前往印度旅行者的化学预防药物，旅行者在印度停留1周、2周和4周的化学预防平均成本分别为41,604美元、48,538美元和62,407美元。如果为所有前往印度的斯里兰卡旅行者提供四周的化学预防，这将占国家疟疾控制项目预算的0.65%。
结论
基于从印度返回的斯里兰卡旅行者感染疟疾的风险较低以及该国以前疟疾流行地区的高接受度，化学预防不应被视为预防再引入的主要策略。在接受度高的地区，无论如何都不能以任何代价牺牲普及有质量保证诊断和治疗的机会。
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