Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan Institute of Parasitic Diseases Innovative Team of Key Techniques for Vector Borne Disease Control and Prevention (Developing), Training Base of International Scientific Exchange and Education in Tropical Diseases for South and Southeast Asia, Puer, 665000, China.
The Centre for Infectious Diseases and Microbiology, New South Wales Health Pathology, and Westmead Clinical School, The University of Sydney, Westmead Hospital, Sydney, NSW, 214, Australia.
Malar J. 2021 Jan 6;20(1):10. doi: 10.1186/s12936-020-03535-8.
Globally, malaria is still a major public health challenge. Drug-based treatment is the primary intervention in malaria control and elimination. However, optimal use of mass or targeted treatments remains unclear. A variety of radical, preventive and presumptive treatment regimens have been administrated in China and a systematic review was conducted to evaluate effectiveness, and discuss experiences, limitations, and lessons learnt in relation to the use of these regimens.
The search for information includes both paper documents, such as books, malaria control annals and guidelines for malaria prevention and treatment, as well as three computer-based databases in Chinese (CNKI, WanFangdata and Xueshu.baidu) and two databases in English (PubMed and Google Scholar), to identify original articles and reports associated with drug administration for malaria in China.
Starting from hyperendemicity to elimination of malaria in China, a large number of radical, preventive and presumptive treatment regimens had been tried. Those effective regimens were scaled up for malaria control and elimination programmes in China. Between 1949 and 1959, presumptive treatment with available anti-malarial drugs was given to people with enlarged spleens and those who had symptoms suggestive of malaria within the last 6 months. Between 1960 and 1999, mass drug administration (MDA) was given for preventive and radical treatment. Between 2000 and 2009, the approach was more targeted, and drugs were administed only to prevent malaria infection in those at high risk of exposure and those who needed radical treatment for suspected malaria. Presumptive therapy was only given to febrile patients. From 2010, the malaria programme changed into elimination phase, radical treatment changed to target individuals with confirmed either Plasmodium vivax or Plasmodium ovale within the last year. Preventive treatment was given to those who will travel to other endemic countries. Presumptive treatment was normally not given during this elimination phase. All cases of suspected were confirmed by either microscopy or rapid diagnosis tests for malaria antigens before drugs were administered. The engagement of the broader community ensured high coverage of these drug-based interventions, and the directly-observed therapy improved patient safety during drug administration.
A large number of radical, preventive and presumptive treatment regimens for malaria had been tried in China with reported success, but the impact of drug-based interventions has been difficult to quantify because they are just a part of an integrated malaria control strategy. The historical experiences of China suggest that intervention trials should be done by the local health facilities with community involvement, and a local decision is made according to their own trial results.
在全球范围内，疟疾仍然是一个主要的公共卫生挑战。基于药物的治疗是疟疾控制和消除的主要干预措施。然而，最佳的大规模或有针对性的治疗方法仍不清楚。中国曾实施过各种根治性、预防性和推定性治疗方案，本系统评价旨在评估这些方案的有效性，并讨论在中国使用这些方案的经验、局限性和教训。
信息检索包括纸质文件，如书籍、疟疾控制年鉴和疟疾防治指南，以及三个中文计算机数据库（中国知网、万方数据和学术百度）和两个英文数据库（PubMed 和 Google Scholar），以确定与中国药物治疗疟疾相关的原始文章和报告。
从疟疾高度流行到在中国消除疟疾，中国曾尝试过大量的根治性、预防性和推定性治疗方案。这些有效的方案在中国的疟疾控制和消除规划中得到了推广。1949 年至 1959 年期间，对脾脏肿大者和 6 个月内有疟疾症状者，给予现有抗疟药物进行推定治疗。1960 年至 1999 年期间，采用大规模药物治疗（MDA）进行预防和根治性治疗。2000 年至 2009 年期间，方法更加有针对性，仅对高暴露风险的疟疾感染预防和疑似疟疾需要根治性治疗的人群给予药物治疗。仅对发热患者进行推定治疗。2010 年以来，疟疾项目进入消除阶段，根治性治疗改为对过去一年内确诊为间日疟或卵形疟的个体进行针对性治疗。对将前往其他流行国家的旅行者给予预防治疗。在消除阶段，通常不进行推定治疗。所有疑似病例均在给予药物治疗前通过显微镜或快速诊断试验检测疟原虫抗原进行确诊。更广泛的社区参与确保了这些基于药物的干预措施的高覆盖率，直接观察治疗提高了药物治疗期间患者的安全性。
中国曾尝试过大量的疟疾根治性、预防性和推定性治疗方案，取得了成功，但由于这些方案只是综合疟疾控制策略的一部分，因此难以量化药物干预的影响。中国的历史经验表明，应在社区参与的情况下由当地卫生机构开展干预试验，并根据自身试验结果做出决策。
