巴西与法属圭亚那国际边境地区复杂的疟疾流行情况：消除疟疾面临的挑战
Complex malaria epidemiology in an international border area between Brazil and French Guiana: challenges for elimination.
作者信息
da Cruz Franco Vivian, Peiter Paulo Cesar, Carvajal-Cortés José Joaquim, Dos Santos Pereira Rafael, Mendonça Gomes Margarete do Socorro, Suárez-Mutis Martha Cecilia
机构信息
Laboratory of Parasitic Diseases, Institute Oswaldo Cruz/Fiocruz, Av Brasil 4365. Pavilhão Arthur Neiva, Rio de Janeiro, RJ 21040-900 Brazil.
Biology of Infectious and Parasitic Agent, UFPA, Superintendence of Health Surveillance, Goverment of Amapá State, Rua Tancredo Neves, 1118. São Lázaro, Macapá, AP 68908530 Brazil.
出版信息
Trop Med Health. 2019 Apr 11;47:24. doi: 10.1186/s41182-019-0150-0. eCollection 2019.
BACKGROUND
The epidemiological surveillance of malaria is a necessary intervention for eliminating the disease from the planet. The international border zones of the Amazon continue to be highly vulnerable to malaria since population mobility impedes elimination. Although in the past few years, cases of malaria have had an essential reduction in Brazil, this trend was not confirmed in municipalities along the border. This study aimed to establish the epidemiology of the disease during the last 13 years in Oiapoque, a Brazilian municipality at the international border with French Guiana, an overseas department, to develop strategies for the control/elimination of malaria in these areas.
RESULTS
Data collected from 2003 to 2015 from the Malaria Epidemiological Surveillance System was used. It was found that, despite the important reduction in cases (68.1%), the annual parasite index remained a high epidemiological risk. The disease is seasonal in that the period of highest transmission occurs between September and December. Between 2003 and 2015, eight outbreaks were identified, with one of these lasting 15 months between August 2006 and October 2007. There were changes in the epidemiological profile, with imported cases representing 67.7% of cases from 2003 to 2007 and representing 32.9% of cases from 2008 to 2015 ( < 0.01). The greatest number of cases was among Brazilians coming from the artisanal gold mines of French Guiana. There were also changes in the profile of autochthonous malaria with an increase in urban cases from 14.3% in 2003 to 32.3% in 2015 ( < 0 .01). The burden of malaria in indigenous areas was also very high (67.3% in rural areas) in 2015. There were changes in the parasite species profile with a significant decrease of cases of ( = 0.01). Children under 15 years old, representing 9.7% of cases at the onset of the study, accounted for 34.2% of case notifications ( < 0.01) in 2015. Also, 74% of cases in 2003 and 55.9% in 2015 ( < 0.01) were among men.
CONCLUSIONS
The fragility of local health services in cross-border areas continues to be an obstacle for malaria elimination.
背景
疟疾的流行病学监测是在全球消除该疾病的必要干预措施。亚马逊地区的国际边境地带仍然极易受到疟疾影响，因为人口流动阻碍了消除工作。尽管在过去几年中，巴西的疟疾病例已大幅减少，但边境沿线各市的这一趋势并未得到证实。本研究旨在确定位于与法属圭亚那（一个海外省）接壤的国际边境的巴西奥亚波克市过去13年的疟疾流行病学情况，以制定这些地区疟疾控制/消除策略。
结果
使用了从2003年至2015年疟疾流行病学监测系统收集的数据。结果发现，尽管病例数大幅减少（68.1%），但年度寄生虫指数仍处于较高的流行病学风险水平。该疾病具有季节性，传播高峰期出现在9月至12月之间。2003年至2015年期间，共发现8次疫情，其中一次在2006年8月至2007年10月间持续了15个月。流行病学特征发生了变化，输入性病例在2003年至2007年的病例中占67.7%，在2008年至2015年的病例中占32.9%（<0.01）。病例数最多的是来自法属圭亚那手工金矿的巴西人。本地疟疾的特征也发生了变化，城市病例从2003年的14.3%增加到2015年的32.3%（<0.01）。2015年，土著地区的疟疾负担也非常高（农村地区为67.3%）。疟原虫种类特征发生了变化， 病例显著减少（=0.01）。15岁以下儿童在研究开始时占病例的9.7%，在2015年占病例报告的34.2%（<0.01）。此外，2003年74%的病例和2015年55.9%的病例（<0.01）为男性。
结论
跨境地区当地卫生服务的薄弱仍然是消除疟疾的障碍。
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