Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France.
Malar J. 2021 Jan 20;20(1):51. doi: 10.1186/s12936-020-03572-3.
Rapid elimination of Plasmodium falciparum malaria in Cambodia is a goal with both national and international significance. Transmission of malaria in Cambodia is limited to forest environments, and the main population at risk consists of forest-goers who rely on forest products for income or sustenance. The ideal interventions to eliminate malaria from this population are unknown.
In two forested regions of Cambodia, forest-goers were trained to become forest malaria workers (FMWs). In one region, FMWs performed mass screening and treatment, focal screening and treatment, and passive case detection inside the forest. In the other region, FMWs played an observational role for the first year, to inform the choice of intervention for the second year. In both forests, FMWs collected blood samples and questionnaire data from all forest-goers they encountered. Mosquito collections were performed in each forest.
Malaria prevalence by PCR was high in the forest, with 2.3-5.0% positive for P. falciparum and 14.6-25.0% positive for Plasmodium vivax among forest-goers in each study site. In vectors, malaria prevalence ranged from 2.1% to 9.6%, but no P. falciparum was observed. Results showed poor performance of mass screening and treatment, with sensitivity of rapid diagnostic tests equal to 9.1% (95% CI 1.1%, 29.2%) for P. falciparum and 4.4% (95% CI 1.6%, 9.2%) for P. vivax. Malaria infections were observed in all demographics and throughout the studied forests, with no clear risk factors emerging.
Malaria prevalence remains high among Cambodian forest-goers, but performance of rapid diagnostic tests is poor. More adapted strategies to this population, such as intermittent preventive treatment of forest goers, should be considered.
在柬埔寨快速消除恶性疟原虫疟疾具有国家和国际意义。柬埔寨的疟疾传播仅限于森林环境，主要的高危人群是依靠森林产品获取收入或维持生计的森林居民。消除这一人群疟疾的理想干预措施尚不清楚。
在柬埔寨的两个森林地区，培训森林居民成为森林疟疾工作者（FMW）。在一个地区，FMW 在森林内进行了大规模筛查和治疗、重点筛查和治疗以及被动病例检测。在另一个地区，FMW 在第一年发挥观察作用，为第二年的干预措施选择提供信息。在两个森林中，FMW 从他们遇到的所有森林居民那里收集血液样本和问卷调查数据。在每个森林中进行蚊子收集。
森林中疟疾的 PCR 流行率较高，每个研究地点的森林居民中，恶性疟原虫的阳性率为 2.3-5.0%，间日疟原虫的阳性率为 14.6-25.0%。在蚊子中，疟疾流行率从 2.1%到 9.6%不等，但未观察到恶性疟原虫。结果表明大规模筛查和治疗效果不佳，快速诊断检测的敏感性为恶性疟原虫 9.1%（95%CI 1.1%，29.2%），间日疟原虫 4.4%（95%CI 1.6%，9.2%）。在所有人群和整个研究森林中都观察到疟疾感染，没有出现明确的危险因素。
柬埔寨森林居民的疟疾流行率仍然很高，但快速诊断检测的效果不佳。应该考虑针对这一人群的更适应的策略，例如间歇性预防治疗森林居民。
