Global Malaria Programme, World Health Organization, Geneva, Switzerland.
Yunnan Institute of Parasitic Diseases, Yunnan Provincial Centre of Malaria Research, Yunnan Provincial Key Laboratory of Vector-Borne Disease Control and Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Pu'er City, China.
Malar J. 2021 Mar 12;20(1):147. doi: 10.1186/s12936-021-03672-8.
Yunnan Province was considered the most difficult place in China for malaria elimination because of its complex malaria epidemiology, heterogeneous ecological features, relatively modest economic development, and long, porous border with three malaria endemic countries: Lao People's Democratic Republic, Myanmar, and Viet Nam.
Academic publications and grey literature relevant to malaria elimination in Yunnan covering the period from 1950 until 2020 inclusive were considered. The following academic indexes were searched: China Science Periodical Database, China National Knowledge Infrastructure Database, and MEDLINE. Grey literature sources were mainly available from the National Institute of Parasitic Diseases (NIPD), the Chinese Center for Diseases Control and Prevention, and the Yunnan Institute of Parasitic Diseases (YIPD).
A malaria elimination campaign in the 1950-1960s, based mainly on mass administration of antimalarial drugs and large-scale vector control, reduced morbidity and mortality from malaria and interrupted transmission in some areas, although elimination was not achieved. Similar strategies were used to contain outbreaks and a resurgence of disease during the 1970s, when malaria services were discontinued. From the 1980s, malaria incidence declined, despite the challenges of large numbers of mobile and migrant populations and an unstable primary health care system in rural areas following economic transformation. Launch of the national malaria elimination programme in 2010 led to adoption of the '1-3-7' surveillance and response strategy specifying timely detection of and response for every case, supported by the establishment of a real-time web-based disease surveillance system and a new primary health care system in rural areas. Border malaria was addressed in Yunnan by strengthening the surveillance system down to the lowest level, cross-border collaboration with neighbouring countries and non-governmental organizations, and the involvement of other sectors.
Seven decades of work to eliminate malaria in Yunnan have shown the importance of political commitment, technically sound strategies with high quality implementation, a robust surveillance and response system at all levels, community participation and effective management of border malaria. The experiences and lessons learned from elimination remain important for prevention re-establishment of malaria transmission in the Province.
云南省被认为是中国消除疟疾最困难的地区，因为其疟疾流行病学复杂、生态特征多样、经济发展相对落后，与老挝人民民主共和国、缅甸和越南三个疟疾流行国家接壤，边境线长且漏洞多。
纳入了 1950 年至 2020 年期间与云南省消除疟疾相关的学术出版物和灰色文献。检索了以下学术索引：中国科学期刊数据库、中国国家知识基础设施数据库和 MEDLINE。灰色文献来源主要来自国家寄生虫病研究所（NIPD）、中国疾病预防控制中心和云南省寄生虫病研究所（YIPD）。
20 世纪 50 年代至 60 年代，以大规模使用抗疟药物和大规模控制病媒为主的消除疟疾运动降低了疟疾的发病率和死亡率，并在某些地区阻断了疟疾的传播，但未能实现消除疟疾的目标。在 70 年代，疟疾服务中断时，类似的策略被用于控制疫情爆发和疾病的死灰复燃。80 年代以来，尽管面临大量流动人口和农村地区基本医疗保健系统不稳定的挑战，但疟疾发病率仍有所下降。2010 年启动的国家消除疟疾规划采用了“1-3-7”监测和应对策略，规定及时发现和应对每一例病例，支持建立实时在线疾病监测系统和农村地区新的初级卫生保健系统。云南省通过加强最低级别的监测系统、与邻国和非政府组织的跨境合作以及其他部门的参与，解决了边境疟疾问题。
云南省 70 年来消除疟疾的工作表明，政治承诺、技术上合理的策略以及高质量的实施、各级强大的监测和应对系统、社区参与和有效管理边境疟疾都非常重要。消除疟疾的经验教训对预防该省疟疾再次传播仍然很重要。
