Garcia Klauss Kleydmann Sabino, Laporta Gabriel Z, Soremekun Seyi, Bottomley Christian, Abrahão Amanda Amaral, Moresco Gilberto Gilmar, Drakeley Chris, Costa Anielle de Pina, Siqueira André M
Faculty of Health Sciences, University of Brasilia, Brasilia, Federal District, Brazil.
Nucleus of Tropical Medicine, University of Brasilia, Brasilia, Federal District, Brazil.
PLOS Glob Public Health. 2024 Oct 11;4(10):e0003822. doi: 10.1371/journal.pgph.0003822. eCollection 2024.
Malaria is a global health challenge, and international efforts are underway to alleviate its impact by 2035. Within the 249 million global cases, 0.6 million occur in the Americas, mainly in Venezuela, Brazil, and Colombia. Considering Brazil's geographical proximity to malaria-endemic countries in South America, this study objective is to analyze the epidemiological characteristics and time trends of imported malaria cases in Brazil from 2007 to 2022, discussing their influence on the elimination process. This is an ecological time-series study that analyses malaria imported cases (infected in other countries) notified in Brazil, from 2007 to 2022. Brazil's Ministry of Health data were used. Descriptive statistics were employed to analyze sociodemographic and spatial patterns, while the impact of the Covid-19 pandemic on imported malaria trends was assessed using Prais-Winsten regression methods. In the study period there was a total of 109,914 imported cases (2.6% of Brazil's total malaria burden). There was an annual reduction of 515.3 cases (p = 0.001) prior to the Covid-19 pandemic. During the pandemics there was an overall reduction of -3,301.8 cases (p = 0.001). In the Amazon region P. vivax imported infections predominated, whereas in the extra-Amazon region P. falciparum imported infections were more prevalent. Most imported cases were males (67.8%), of Black ethnicity (47.5%), with incomplete primary education (45.1%), aged 20-39 (61.1%), and primarily gold miners (54.0%). Most cases are from French Guiana (31.7%), Venezuela (30.0%), and Guyana (17.9%). African nations, notably Angola and Nigeria, were primary sources of imported cases to the extra-Amazon region. The imported cases flux, predominantly from Latin America, threatens Brazil's elimination goals by potentially reintroducing the disease into previously cleared areas and sustaining the transmission in endemic areas. Strengthening epidemiological surveillance at the borders and fostering international cooperation are imperative steps in addressing this challenge.
疟疾是一项全球性的健康挑战，国际社会正在努力到2035年减轻其影响。在全球2.49亿疟疾病例中，有60万例发生在美洲，主要在委内瑞拉、巴西和哥伦比亚。考虑到巴西与南美洲疟疾流行国家地理位置接近，本研究的目的是分析2007年至2022年巴西输入性疟疾病例的流行病学特征和时间趋势，探讨它们对消除疟疾进程的影响。这是一项生态时间序列研究，分析了2007年至2022年巴西通报的输入性疟疾病例（在其他国家感染）。使用了巴西卫生部的数据。采用描述性统计分析社会人口统计学和空间模式，同时使用普赖斯-温斯顿回归方法评估新冠疫情对输入性疟疾趋势的影响。在研究期间，共有109,914例输入性病例（占巴西疟疾总负担的2.6%）。在新冠疫情之前，每年减少515.3例（p = 0.001）。在疫情期间，总体减少了3301.8例（p = 0.001）。在亚马逊地区，间日疟原虫输入性感染占主导，而在亚马逊以外地区，恶性疟原虫输入性感染更为普遍。大多数输入性病例为男性（67.8%），黑人（47.5%），小学教育不完全（45.1%），年龄在20至39岁之间（61.1%），主要是金矿工人（54.0%）。大多数病例来自法属圭亚那（31.7%）、委内瑞拉（30.0%）和圭亚那（17.9%）。非洲国家，特别是安哥拉和尼日利亚，是亚马逊以外地区输入性病例的主要来源。主要来自拉丁美洲的输入性病例流动，可能会将疾病重新引入以前已消除疟疾的地区，并在流行地区维持传播，从而威胁到巴西的消除疟疾目标。加强边境的流行病学监测和促进国际合作是应对这一挑战的必要步骤。
