rofessor of Infectious Diseases and UNESCO Chairholder “Training and empowering human resources for health development in resource-limited countries”, University of Brescia, Italy
Division of Infectious and Tropical Diseases, ASST Spedali Civili di Brescia, Italy
New Microbiol. 2022 Apr;45(2):83-98.
Malaria is long known as a deadly vector borne infection, caused by five parasite species of the coccidian genus Plasmodia that are present in as many as 85 countries. Despite significant progresses have been achieved to control the infection by early diagnosis and artemisinin combination treatment, insecticide-treated nets and indoor residual spraying, malaria still represents a major public health issue in many endemic low-income countries. New diagnostic tools of higher sensitivity and specificity are now available for use in endemic countries to better guide diagnosis and treatment. In particular, highly sensitive rapid antigenic tests are now available and the loop-mediated isothermal amplification is a very promising and highly sensitive diagnostic tool. After 2015, decreasing morbidity and mortality trends have been stagnating because of limited funding, emergence of parasite and vector resistance to drugs and insecticides respectively and, recently, by the disrupting effect of COVID-19 pandemic. The incomplete knowledge of the complex immunity of malaria infection has slowed the development of an effective vaccine. However, in 2021, the RTS-S vaccine, however of suboptimal protective efficacy, has been made available for routine use in children above 5 months of age. Population movements has increased the chance of observing imported malaria in non-endemic areas, where malaria competent vectors may still exist.
疟疾长期以来一直被认为是一种致命的虫媒传染病，由 85 个国家中存在的五种疟原虫引起。尽管在早期诊断和青蒿素联合治疗、驱虫蚊帐和室内滞留喷洒方面取得了重大进展来控制感染，但疟疾在许多地方性低收入国家仍然是一个主要的公共卫生问题。现在有更高敏感性和特异性的新诊断工具可供在地方性国家使用，以更好地指导诊断和治疗。特别是，现在有高度敏感的快速抗原检测，而环介导的等温扩增是一种非常有前途和高度敏感的诊断工具。自 2015 年以来，由于资金有限、寄生虫和蚊子对药物和杀虫剂的耐药性出现，以及最近 COVID-19 大流行的干扰效应，发病率和死亡率的下降趋势已经停滞不前。对疟疾感染复杂免疫的不完全了解，阻碍了有效疫苗的开发。然而，2021 年，RTS-S 疫苗虽然保护效果不佳，但已可用于常规接种 5 个月以上儿童。人口流动增加了在非地方性地区观察到输入性疟疾的机会，而疟疾媒介蚊子可能仍在那里存在。
