Malaria Elimination Initiative, Institute of Global Health Sciences, University of California, San Francisco, San Francisco, California, USA.
Sisaket Provincial Health Office, Sisaket, Sisaket Province, Thailand.
Malar J. 2021 Dec 7;20(1):458. doi: 10.1186/s12936-021-03995-6.
In April 2017, the Thai Ministry of Public Health (MoPH) was alerted to a potential malaria outbreak among civilians and military personnel in Sisaket Province, a highly forested area bordering Cambodia. The objective of this study was to present findings from the joint civilian-military outbreak response.
A mixed-methods approach was used to assess risk factors among cases reported during the 2017 Sisaket malaria outbreak. Routine malaria surveillance data from January 2013 to March 2018 obtained from public and military medical reporting systems and key informant interviews (KIIs) (n = 72) were used to develop hypotheses about potential factors contributing to the outbreak. Joint civilian-military response activities included entomological surveys, mass screen and treat (MSAT) and vector control campaigns, and scale-up of the "1-3-7" reactive case detection approach among civilians alongside a pilot "1-3-7" study conducted by the Royal Thai Army (RTA).
Between May-July 2017, the monthly number of MoPH-reported cases surpassed the epidemic threshold. Outbreak cases detected through the MoPH mainly consisted of Thai males (87%), working as rubber tappers (62%) or military/border police (15%), and Plasmodium vivax infections (73%). Compared to cases from the previous year (May-July 2016), outbreak cases were more likely to be rubber tappers (OR = 14.89 [95% CI: 5.79-38.29]; p < 0.001) and infected with P. vivax (OR=2.32 [1.27-4.22]; p = 0.006). Themes from KIIs were congruent with findings from routine surveillance data. Though limited risk factor information was available from military cases, findings from RTA's "1-3-7" study indicated transmission was likely occurring outside military bases. Data from entomological surveys and MSAT campaigns support this hypothesis, as vectors were mostly exophagic and parasite prevalence from MSAT campaigns was very low (range: 0-0.7% by PCR/microscopy).
In 2017, an outbreak of mainly P. vivax occurred in Sisaket Province, affecting mainly military and rubber tappers. Vector control use was limited to the home/military barracks, indicating that additional interventions were needed during high-risk forest travel periods. Importantly, this outbreak catalyzed joint civilian-military collaborations and integration of the RTA into the national malaria elimination strategy (NMES). The Sisaket outbreak response serves as an example of how civilian and military public health systems can collaborate to advance national malaria elimination goals in Southeast Asia and beyond.
2017 年 4 月，泰国公共卫生部（MoPH）接到警报，称在毗邻柬埔寨的森林茂密的四色菊府，平民和军人中可能爆发疟疾。本研究旨在介绍军民联合应对疫情的结果。
采用混合方法评估 2017 年四色菊府疟疾疫情期间报告病例的危险因素。利用公共和军事医疗报告系统（n=72）获取 2013 年 1 月至 2018 年 3 月的常规疟疾监测数据，并进行关键知情人访谈（KII），根据这些数据提出可能导致疫情爆发的潜在因素假设。军民联合应对活动包括昆虫学调查、大规模筛查和治疗（MSAT）以及病媒控制运动，以及在平民中扩大“1-3-7”反应性病例发现方法，并在泰国皇家军队（RTA）进行试点“1-3-7”研究。
2017 年 5 月至 7 月期间，MoPH 报告的月病例数超过了疫情阈值。MoPH 发现的疫情病例主要为泰国男性（87%），从事橡胶收割（62%）或军人/边境警察（15%）工作，感染间日疟原虫（73%）。与前一年（2016 年 5 月至 7 月）相比，疫情病例更有可能是橡胶收割者（OR=14.89[95%CI：5.79-38.29]；p<0.001）和感染间日疟原虫（OR=2.32[1.27-4.22]；p=0.006）。KII 的主题与常规监测数据的结果一致。尽管从军事病例中获得的危险因素信息有限，但 RTA 的“1-3-7”研究结果表明，传播可能发生在军事基地之外。昆虫学调查和 MSAT 运动的数据支持这一假设，因为蚊子主要是外吸性的，MSAT 运动中的寄生虫患病率非常低（通过 PCR/显微镜检测，范围为 0-0.7%）。
2017 年，四色菊府发生了以间日疟原虫为主的疫情，主要影响军人和橡胶收割者。病媒控制仅在家庭/军营使用，这表明在高风险森林旅行期间需要采取额外的干预措施。重要的是，此次疫情促使军民合作，并将 RTA 纳入国家消除疟疾战略（NMES）。四色菊府疫情应对行动为军民公共卫生系统如何合作，推进东南亚乃至其他地区国家消除疟疾目标提供了范例。
