Doumbo Ogobara, Fall Ibrahima Socé, Niaré Doumbo
Bull Acad Natl Med. 2016 Mar;200(3):453-66.
The prevalence and morbidity of P. vivax, P. ovale (curisi et wallikeri) and P. malariae remain underestimated. However important progress has been made. According to the WHO World Malaria report between 2000 and 2015 the malaria incidence has decreased by 42% while the incidence of malaria deaths has decreased by 66%. This is the result of the important progress made in scaling up the main interventions such the rapid diagnosis test, Artemisinin-based combination therapies, long lasting insecticide treated nets, indoor residual house spraying, intermittent preventive treatment during pregnancy (IPTp-SP), Seasonal Malaria Chemoprophylaxis with combined antimalarial (SMClAQ-SP). In the Sahel region with a highly seasonal transmission, the use of SMC resulted in a reduction of malaria morbidity for 80% and a reduce mortality for 58%. Malaria elimination efforts are going on in many countries in Swaziland, South Africa, Namibia, Zanzibar (United Republic of Tanzania), Bioko Island (Equatorial Guinea), Sao Tome and Principe, Cape Verde, and maybe Senegal. For the time being only countries in Northern Africa and few in East Africa (Mauritius) have reached the elimination of local transmission. Despite the progress made near 500,000 malaria deaths occur annually in the African Region with 10-15% leading to disabling sequels and low school performance in children. Reaching the target of 80% for preventive and treatment interventions remain a challenge in many countries in Africa. It's important to keep in mind that the Abuja targets and MGDs were not reached by most African countries. In addition, among 12 million children eligible for SMC only 35% were covered despite the availability of resources in 2014. A huge global stock out of ACT. AQ-SP is possible. The development of an effective vaccine has been disappointing with a limited effectiveness of the RTS,S. The emerging resistance to Artemisinin derivate in South-East Asia and its possible expansion to Africa is of big concern. Anopheles gambiae resistance to pyrethroid make to situation even more complex. The situation can worsen because of factor such as climate change and socio-political crisis. Therefore the malaria situation in Africa is still of big concern despite the progress highlighted. Innovative a robust approach is needed with strong government commitment and partners support to lead battle. A new hope is emerging with the development of candidate vaccine from whole sporozoïte, the other candidates vaccines blocking the transmission in phase 1b and the new SMC Plus strategy (AQ-SP+Azithromycine). Conclusion: lessons learnt from the malaria eradication era in the 50s must be factored in while developing the malaria elimination strategy for Africa by 2030.
间日疟原虫、卵形疟原虫（库氏疟原虫和沃氏疟原虫）和三日疟原虫的流行率和发病率仍然被低估。然而，已经取得了重要进展。根据世界卫生组织的《世界疟疾报告》，2000年至2015年间，疟疾发病率下降了42%，而疟疾死亡发病率下降了66%。这是扩大主要干预措施（如快速诊断检测、以青蒿素为基础的联合疗法、长效驱虫蚊帐、室内滞留喷洒杀虫剂、孕期间歇性预防治疗（IPTp-SP）、联合抗疟季节性疟疾化学预防（SMClAQ-SP））所取得重要进展的结果。在传播具有高度季节性的萨赫勒地区，使用季节性疟疾化学预防措施使疟疾发病率降低了80%，死亡率降低了58%。许多国家正在开展疟疾消除工作，如斯威士兰、南非、纳米比亚、桑给巴尔（坦桑尼亚联合共和国）、比奥科岛（赤道几内亚）、圣多美和普林西比、佛得角，也许还有塞内加尔。目前，只有北非国家和东非少数国家（毛里求斯）实现了本地传播的消除。尽管取得了进展，但非洲地区每年仍有近50万人死于疟疾，其中10%-15%会导致残疾后遗症，儿童学业成绩低下。在非洲许多国家，实现预防和治疗干预措施80%的目标仍然是一项挑战。必须牢记，大多数非洲国家尚未实现阿布贾目标和千年发展目标。此外，在2014年尽管有资源可用，但在1200万 eligible for SMC only 35% were covered despite the availability of resources in 2014. A huge global stock out of ACT. AQ-SP is possible. The development of an effective vaccine has been disappointing with a limited effectiveness of the RTS,S.The emerging resistance to Artemisinin derivate in South-East Asia and its possible expansion to Africa is of big concern. Anopheles gambiae resistance to pyrethroid make to situation even more complex. The situation can worsen because of factor such as climate change and socio-political crisis. Therefore the malaria situation in Africa is still of big concern despite the progress highlighted. Innovative a robust approach is needed with strong government commitment and partners support to lead battle. A new hope is emerging with the development of candidate vaccine from whole sporozoïte, the other candidates vaccines blocking the transmission in phase 1b and the new SMC Plus strategy (AQ-SP+Azithromycine). Conclusion: lessons learnt from the malaria eradication era in the 50s must be factored in while developing the malaria elimination strategy for Africa by 2030.（这段英文原文似乎有误，推测正确内容为“eligible for SMC, only 35% were covered”，即“符合季节性疟疾化学预防条件的人群中，只有35%得到了覆盖”）符合季节性疟疾化学预防条件的儿童中，只有35%得到了覆盖。全球存在青蒿素类复方疗法的严重缺货情况。有可能出现青蒿素哌喹缺货。有效疫苗的研发令人失望，RTS,S疫苗的有效性有限。东南亚出现的对青蒿素衍生物的耐药性及其可能向非洲的扩散令人高度担忧。冈比亚按蚊对拟除虫菊酯的耐药性使情况更加复杂。由于气候变化和社会政治危机等因素，情况可能会恶化。因此，尽管有上述突出进展，非洲的疟疾形势仍然令人高度担忧。需要采取创新且有力的方法，要有政府的坚定承诺和合作伙伴的支持来引领这场战斗。随着全子孢子候选疫苗、其他在1b期阻断传播的候选疫苗以及新的季节性疟疾化学预防强化策略（青蒿素哌喹+阿奇霉素）的研发，新的希望正在出现。结论：在制定到2030年非洲疟疾消除战略时，必须考虑从50年代疟疾根除时代吸取的经验教训。
