Wangdi Kinley, Unwin H Juliette T, Penjor Kinley, Tsheten Tsheten, Clements Archie, Gray Darren, Kotepui Manas, Bhatt Samir, Gething Peter
HEAL Global Research Centre, Health Research Institute, University of Canberra, Bruce, Canberra, ACT 2617, Australia.
National Centre for Epidemiology and Population Health, Australian National University, Canberra, Acton, ACT 2601, Australia.
Lancet Reg Health Southeast Asia. 2024 Oct 15;31:100497. doi: 10.1016/j.lansea.2024.100497. eCollection 2024 Dec.
Bhutan has achieved a substantial reduction in both malaria morbidity and mortality over the last two decades and is aiming for malaria elimination certification in 2025. However, a significant percentage of malaria cases in Bhutan are imported (acquired in another country). The aim of the study was to understand how importation drives local malaria transmission in Bhutan.
Information on geo-located individual-level laboratory-confirmed malaria cases between 2016 and 2020 was obtained from the Bhutan Vector-borne Disease Control Program. Records included the date of diagnosis and treatment, type of cases classified as indigenous or imported, and malaria species. Hawkes Processes were used to study the role of imported malaria in local transmission in Bhutan. We imposed 15 days delay for a mosquito to become infectious in the model.
There were 285 cases during the study period and 58.6% (159) were imported malaria. 71.1% (113) of these imported cases were and 73.6% (117) were from India. The model suggested that a person remains infectious for 8 days for malaria but over 19 days for The background intensity from imported malaria cases was much greater for cases (maximum 0.17) resulting in more importations than cases (maximum 0.06). However, model fitting suggested that local transmission was mainly driven by importations but additional factors such as relapse played a role for .
Imported malaria cases are key drivers of transmission within Bhutan, with most cases since 2016 being . Control programmes should be devised to target interventions towards the strain and test those who are more likely to bring in imported malaria cases or acquire it from returning travellers.
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在过去二十年里，不丹的疟疾发病率和死亡率均大幅下降，目标是在2025年获得疟疾消除认证。然而，不丹相当一部分疟疾病例是输入性的（在其他国家感染）。本研究的目的是了解输入性病例如何推动不丹当地的疟疾传播。
从不丹病媒传播疾病控制项目获取2016年至2020年按地理位置划分的个体层面实验室确诊疟疾病例信息。记录包括诊断和治疗日期、病例类型（分为本地病例或输入性病例）以及疟原虫种类。采用霍克斯过程研究输入性疟疾在不丹当地传播中的作用。在模型中，我们设定蚊子感染需要15天的延迟期。
研究期间共有285例病例，其中58.6%（159例）为输入性疟疾。这些输入性病例中，71.1%（113例）为[具体疟原虫种类1]，73.6%（117例）来自印度。模型表明，感染[具体疟原虫种类1]的人传染性持续8天，而感染[具体疟原虫种类2]的人传染性持续超过19天。输入性疟疾病例的背景强度在[具体疟原虫种类1]病例中更大（最大值为0.17），导致输入病例多于[具体疟原虫种类2]病例（最大值为0.06）。然而，模型拟合表明，当地[具体疟原虫种类1]的传播主要由输入性病例驱动，但复发等其他因素在[具体疟原虫种类2]传播中起作用。
输入性疟疾病例是不丹境内传播的关键驱动因素，自2016年以来大多数病例为[具体疟原虫种类1]。应制定控制方案，针对[具体疟原虫种类1]毒株采取干预措施，并对那些更有可能携带输入性疟疾病例或从回国旅行者处感染疟疾的人进行检测。
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