Yunnan Institute of Parasitic Diseases Control, Yunnan Provincial Key Laboratory, Yunnan Centre of Malaria Research, Pu'er, 665000, China.
National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, China.
Malar J. 2020 Nov 12;19(1):409. doi: 10.1186/s12936-020-03477-1.
According to China's Malaria Eradication Action Plan, malaria cases diagnosed and reported by health authorities at the county level must be further re-confirmed by provincial laboratories. The Yunnan Province Malaria Diagnostic Reference Laboratory (YPMDRL) began the synchronous implementation of microscopic examinations and nested polymerase chain reaction (nested-PCR) testing to re-test the malaria cases initially diagnosed by county-level laboratories and to evaluate the consistency of Plasmodium species identified between by YPMDRL and by the county-level laboratories from 2013 to 2018 in Yunnan Province.
Data on malaria initial diagnosis completed by county-level laboratories in Yunnan Province were collected weekly from the "China Disease Prevention and Control Information System" from 2013 to 2018. The YPMDRL performed Plasmodium microscopic examination and 18S rRNA gene nested-PCR testing on every malaria case managed by the China Disease Prevention and Control Information System. The re-testing detection results were fed back to the initial diagnosis and reporting unit for revision of malaria case types.
A total of 2,869 malaria cases were diagnosed and reported by county-level laboratories in Yunnan Province from 2013 to 2018. The re-testing rate was 95.6% (2,742/2,869), and the re-testing rate increased from 2013 to 2018. Among the re-tested 2,742 cases, 96.7% (2651/2742), 2.2% (59/2742), and 1.1% (32/2742) were doubly examined by microscopy and by nested-PCR, only by microscopy, and only by nested-PCR, respectively. The total Plasmodium species accuracy rate at county-level laboratories was 92.6% (2,543/2,742) reference to the diagnosis by YPMDRL. Among the inconsistent 199 cases, they were identified as including 103 negative cases, 45 falciparum malaria cases, 30 vivax malaria cases, 11 ovale malaria cases, and 10 malariae malaria cases by YPMDRL. From 2013 to 2018, the revised and registered malaria cases by the China Disease Prevention and Control Information System in Yunnan Province was 2,747 cases, including 2,305 vivax malaria cases, 421 falciparum malaria cases, 11 ovale malaria cases, and 10 malariae malaria cases.
The double re-testing strategy by microscopy and by gene testing increases the accuracy of diagnoses malaria in Yunnan Province, and gene testing can reliably differentiate Plasmodium species. The re-testing results provided by YPMDRL are the authoritative basis for revising malaria kind in Yunnan Province.
根据中国的《疟疾消除行动计划》，县级卫生部门诊断和报告的疟疾病例必须由省级实验室进一步确认。云南省疟疾诊断参考实验室（YPMDRL）从 2013 年开始同步实施显微镜检查和巢式聚合酶链反应（nested-PCR）检测，对县级实验室初步诊断的疟疾病例进行重新检测，并评估 2013 年至 2018 年 YPMDRL 与县级实验室鉴定的疟疾病种之间的一致性。
从 2013 年至 2018 年，每周从“中国疾病预防控制信息系统”收集云南省县级实验室完成的疟疾初步诊断数据。YPMDRL 对中国疾病预防控制信息系统管理的每例疟疾病例进行疟原虫显微镜检查和 18S rRNA 基因巢式-PCR 检测。重新检测的检测结果反馈给初始诊断和报告单位，以修改疟疾病例类型。
2013 年至 2018 年，云南省县级实验室共诊断和报告 2869 例疟疾病例。重新检测率为 95.6%（2742/2869），重新检测率从 2013 年到 2018 年逐渐增加。在重新检测的 2742 例中，96.7%（2651/2742）、2.2%（59/2742）和 1.1%（32/2742）分别通过显微镜和巢式-PCR 双重检查、仅通过显微镜检查和仅通过巢式-PCR 检查。县级实验室总疟原虫种准确率为 92.6%（2543/2742），以 YPMDRL 诊断为准。在 199 例不一致的病例中，YPMDRL 鉴定为 103 例阴性病例、45 例恶性疟原虫病例、30 例间日疟原虫病例、11 例卵形疟原虫病例和 10 例三日疟原虫病例。2013 年至 2018 年，云南省中国疾病预防控制信息系统修订和登记的疟疾病例为 2747 例，包括 2305 例间日疟原虫病例、421 例恶性疟原虫病例、11 例卵形疟原虫病例和 10 例三日疟原虫病例。
通过显微镜和基因检测的双重重新检测策略提高了云南省疟疾诊断的准确性，基因检测可以可靠地区分疟原虫种类。YPMDRL 提供的重新检测结果是云南省修订疟疾种类的权威依据。
