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越来越多的证据表明恶性疟原虫在疟疾流行的非洲广泛存在。

Growing evidence of Plasmodium vivax across malaria-endemic Africa.

机构信息

Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.

Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia.

出版信息

PLoS Negl Trop Dis. 2019 Jan 31;13(1):e0007140. doi: 10.1371/journal.pntd.0007140. eCollection 2019 Jan.

Abstract

Effective malaria control strategies require an accurate understanding of the epidemiology of locally transmitted Plasmodium species. Compared to Plasmodium falciparum infection, Plasmodium vivax has a lower asexual parasitaemia, forms dormant liver-stages (hypnozoites), and is more transmissible. Hence, treatment and diagnostic policies aimed exclusively at P. falciparum are far less efficient against endemic P. vivax. Within sub-Saharan Africa, malaria control programmes justly focus on reducing the morbidity and mortality associated with P. falciparum. However, the recent emphasis on malaria elimination and increased accessibility of more sensitive diagnostic tools have revealed greater intricacies in malaria epidemiology across the continent. Since 2010, the number of studies identifying P. vivax endemic to Africa has expanded considerably, with 88 new scientific reports published since a review of evidence in 2015, approximately doubling the available data. There is evidence of P. vivax in all regions of Africa, apparent from infected vectors, clinical cases, serological indicators, parasite prevalence, exported infections, and P. vivax-infected Duffy-negative individuals. Where the prevalence of microscopic parasitaemia is low, a greater proportion of P. vivax infections were observed relative to P. falciparum. This evidence highlights an underlying widespread presence of P. vivax across all malaria-endemic regions of Africa, further complicating the current practical understanding of malaria epidemiology in this region. Thus, ultimate elimination of malaria in Africa will require national malaria control programmes to adopt policy and practice aimed at all human species of malaria.

摘要

有效的疟疾控制策略需要准确了解当地传播的疟原虫种的流行病学。与恶性疟原虫感染相比,间日疟原虫的无性体寄生虫血症较低,形成休眠的肝脏阶段(休眠子),并且更具传染性。因此,专门针对恶性疟原虫的治疗和诊断策略对地方性间日疟原虫的效果要差得多。在撒哈拉以南非洲,疟疾控制规划公正地侧重于降低与恶性疟原虫相关的发病率和死亡率。然而,最近对消除疟疾的重视以及更敏感的诊断工具的普及,揭示了整个非洲疟疾流行病学的更多复杂性。自 2010 年以来,确定非洲间日疟原虫流行的研究数量大大增加,自 2015 年对证据进行审查以来,已有 88 项新的科学报告发表,这几乎使可用数据翻了一番。从受感染的媒介、临床病例、血清学指标、寄生虫流行率、输出性感染以及感染 Duffy 阴性个体的间日疟原虫,都可以在非洲所有地区看到间日疟原虫的证据。在寄生虫血症低流行率的地区,观察到间日疟原虫感染的比例相对恶性疟原虫更高。这一证据突显了非洲所有疟疾流行地区普遍存在间日疟原虫,这进一步使人们对该地区疟疾流行病学的当前实际认识变得更加复杂。因此,要在非洲消除疟疾,国家疟疾控制规划就必须采取针对所有人类疟疾种的政策和实践。

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