Girod R, Salvan M, Denys J C
Sante. 1995 Nov-Dec;5(6):397-401.
Réunion is currently posed with the operational problem of the last phase of the struggle against malaria, that is the consolidation and the maintenance of the state of cradication. The native parasite was eliminated, but the risk of resurgence of malaria remains on the island. This risk is even increasing from year to year because of the following: 1) the regular increase of the number of travellers originating from countries with malaria and consequently, the increase in the number of imported malaria cases; 2) the appearance of malaria strains resistant to amino-4-quinoleines, in the south-western regions of the Indian Ocean; 3) the persistence of the vector which cannot be eliminated because of its rapid evolutionary cycle and the multiplicity of its larval habitats. Furthermore, the reintroduction of malaria on the island would present serious consequences considering the disappearance of immunity in the population of Réunion. Thus it is necessary to maintain the struggle at a high level of intervention following a strategy based on: 1) the detection and the control of the malaria cases; 2) a targeted anti-vectorial activity based on a systematic anti-larval fight, eventually completed by the eradication of the adapted adult vectors. The reduction of personnel and the difficulties encountered in establishing a mechanization of the adapted tasks lead to a reduction of activities of insect eradication and endanger the existing strategy of the struggle. This strategy has been redefined during these last several years. The malaria situation in Réunion, satisfactory until today, rests on a careful epidemiological surveillance and on an optimized entomological surveillance. Currently, the treatments are abandoned in the least sensitive zones to the benefit of a better surveillance of priority zones (prospecting, entomological studies and treatments). Anopheles gambiae s.l. is present on the island and each year some parasites are imported to the Réunion territory. The requisite conditions for an eventual re-emergence of transmission of the native parasite would seem to be combined. However, this transmission is not observed. The role of the Applied Entomology Group is to evaluate the risk of malaria and to reorient, if necessary, the strategy of the antimalaria struggle in Réunion.
留尼汪岛目前面临着疟疾防治最后阶段的运作问题，即巩固和维持根除状态。本地寄生虫已被消灭，但该岛疟疾复发的风险依然存在。由于以下原因，这种风险逐年增加：1）来自疟疾流行国家的旅行者数量不断增加，因此输入性疟疾病例数量上升；2）在印度洋西南部地区出现了对4-氨基喹啉耐药的疟原虫菌株；3）病媒持续存在，由于其快速的进化周期和幼虫栖息地的多样性，无法将其消灭。此外，考虑到留尼汪岛人口免疫力的消失，疟疾重新传入该岛将带来严重后果。因此，有必要按照以下策略，在高度干预的层面上维持防治工作：1）检测和控制疟疾病例；2）开展有针对性的病媒控制活动，以系统性的灭幼虫斗争为基础，最终通过消灭适应性成蚊来完成。人员减少以及在实现适应性任务机械化方面遇到的困难，导致灭虫活动减少，危及现有的防治策略。在过去几年中，这一策略已重新定义。留尼汪岛目前令人满意的疟疾形势，依赖于细致的流行病学监测和优化的昆虫学监测。目前，在敏感度最低的地区放弃治疗，以便更好地监测重点区域（勘查、昆虫学研究和治疗）。冈比亚按蚊复合体存在于该岛，每年都有一些疟原虫传入留尼汪岛领土。本地寄生虫传播最终重新出现的必要条件似乎已经具备。然而，尚未观察到这种传播。应用昆虫学小组的作用是评估疟疾风险，并在必要时调整留尼汪岛抗疟斗争的策略。
