Infection Biology Department, London School of Hygiene and Tropical Medicine, London, UK.
Radboud University Medical Centre, Department of Microbiology, HB Nijmegen, The Netherlands.
Trends Parasitol. 2019 Oct;35(10):822-834. doi: 10.1016/j.pt.2019.07.013. Epub 2019 Aug 29.
As data at progressively granular spatial scales become available, the temptation is to target interventions to areas with higher malaria transmission - so-called hotspots - with the aim of reducing transmission in the wider community. This paper reviews literature to determine if hotspots are an intrinsic feature of malaria epidemiology and whether current evidence supports hotspot-targeted interventions. Hotspots are a consistent feature of malaria transmission at all endemicities. The smallest spatial unit capable of supporting transmission is the household, where peri-domestic transmission occurs. Whilst the value of focusing interventions to high-burden areas is evident, there is currently limited evidence that local-scale hotspots fuel transmission. As boundaries are often uncertain, there is no conclusive evidence that hotspot-targeted interventions accelerate malaria elimination.
随着越来越精细的空间尺度数据的出现，人们倾向于将干预措施针对疟疾传播较高的地区（所谓的热点地区），以达到降低更广泛社区传播的目的。本文综述了文献，以确定热点地区是否是疟疾流行病学的固有特征，以及当前的证据是否支持针对热点地区的干预措施。热点地区是所有流行地区疟疾传播的一个一致特征。能够支持传播的最小空间单位是家庭，家庭内发生户间传播。虽然将干预措施集中在高负担地区的价值是显而易见的，但目前有限的证据表明，局部尺度的热点地区会助长传播。由于边界通常不确定，因此没有确凿的证据表明针对热点地区的干预措施可以加速疟疾的消除。
