Cox M J, Kum D E, Tavul L, Narara A, Raiko A, Baisor M, Alpers M P, Medley G F, Day K P
Papua New Guinea Institute of Medical Research, Madang.
Trans R Soc Trop Med Hyg. 1994 Mar-Apr;88(2):191-7. doi: 10.1016/0035-9203(94)90292-5.
Active community and self-reporting surveillance techniques have been used to describe the dynamics of febrile illness and associated malaria infection in children aged 2 to 15 years from a rural area of Madang Province, Papua New Guinea (PNG). Both history of fever and fever in association with parasitaemia appeared to be reliable indicators of malaria morbidity in this endemic area. Parasite density was observed to be a major determinant of mild malarial disease at both the population level and within an individual. Age-specific prevalence of febrile illness correlated with age-specific patterns of parasite density but not of parasite prevalence. Seasonal changes in fever incidence correlated with parasite density. The transition from afebrile to febrile state within an individual was generally associated with an increase in parasite density. Surveillance and self-reported febrile cases (which differ in severity on the basis of the perceived need for treatment) could be distinguished on the basis of parasite density. Thus surveillance techniques divide clinical malaria in rural PNG into 'mild' and 'very mild' forms. The age-specific pattern of decline of prevalence of malaria-associated febrile illness and parasite density is best explained by induction of strain-specific anti-disease immunity upon infection with a given strain of Plasmodium falciparum. The fever threshold in self-reporting febrile cases was seen to decrease with age and can be explained by an age-specific decline in anti-toxic immunity.
在巴布亚新几内亚马当省的一个农村地区，采用了主动社区监测和自我报告监测技术来描述2至15岁儿童发热性疾病及相关疟疾感染的动态情况。在这个疟疾流行地区，发热病史以及伴有寄生虫血症的发热似乎都是疟疾发病率的可靠指标。在人群层面和个体内部，均观察到寄生虫密度是轻度疟疾疾病的主要决定因素。发热性疾病的年龄特异性患病率与寄生虫密度的年龄特异性模式相关，但与寄生虫感染率无关。发热发病率的季节性变化与寄生虫密度相关。个体从无热状态转变为发热状态通常与寄生虫密度增加有关。根据寄生虫密度可区分监测到的发热病例和自我报告的发热病例（根据对治疗的感知需求，其严重程度有所不同）。因此，监测技术将巴布亚新几内亚农村地区的临床疟疾分为“轻度”和“非常轻度”两种形式。疟疾相关发热性疾病患病率和寄生虫密度随年龄下降的模式，最好用感染特定株恶性疟原虫后诱导的株特异性抗病免疫力来解释。自我报告的发热病例中的发热阈值随年龄降低，这可以用抗毒性免疫力随年龄下降来解释。
