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April 25, 2020 Imported Malaria Cases

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April 25, 2020 Imported Malaria Cases China CDC Weekly Announcements Vital Surveillances The 13th World Malaria Day — Imported Malaria Cases — April 25, 2020 China, 2012–2018 Jun Feng1,&; Hong Tu1,&; Li Zhang1; World Malaria Day, established by the World Zhigui Xia1; Shuisen Zhou1,# Health Assembly at its 60th session in May 2007, is commemorated each year on April 25. According to the World Health Organization’s (WHO) World Malaria Report 2019, an estimated ABSTRACT 228 million cases of malaria (95% confidence interval [CI]: 206–258 million) occurred Introduction: In 2017, no indigenous malaria cases worldwide and most of the cases (213 million, 93%) were in the WHO African Region in 2018. were reported in China, but imported malaria was a There were an estimated 405,000 deaths from challenge for the elimination program. This study malaria, of which 272,000 (67%) were children analyzed the status and trends of imported malaria in aged under 5 years old. There were no global gains China from 2012 to 2018 to provide evidence for in reducing new infections over the period of 2014 further strategies and adjustments to current through 2018, and nearly as many people died of interventions. malaria in 2018 as the year before (1). Methods: Data on individuals were collected from On World Malaria Day 2020, the WHO joins the Parasitic Diseases Information Reporting the RBM Partnership to End Malaria in Management System (PDIRMS) from 2012 to 2018. promoting “Zero Malaria Starts with Me”, a Plasmodium species, case classification, temporal grassroots campaign that aims to keep malaria distribution, spatial distribution, and source of high on the political agenda, mobilize additional imported cases were analyzed to investigate imported resources, and empower communities to take malaria characteristics. ownership of malaria prevention and care (2). Results: In total, 21,376 malaria cases were recorded During the COVID-19 pandemic, the malaria in the PDIRMS from 2012 to 2018. Among them, community must remain committed to 20,938 (98.0%) cases were imported malaria cases supporting the prevention of malaria infection, (IMCs). The number and proportion of IMCs illness, and death through preventive and case management services, while maintaining a safe increased from 2012 (n=2,474, 91.0%) to 2018 environment for patients, clients, and staff. Deaths (n=2,511, 99.7%). IMCs consisted of 13,510 (64.5%) due to malaria and its comorbidities (anemia, P. falciparum, 4,803 (22.9%) P. vivax, 1,725 (8.2%) undernutrition, etc.) must continue to be P. ovale, 376 (1.8%) P. malariae, 2 (0.01%) prevented. The National Health Commission of P. knowlesi, 348 (1.7%) mixed infections, and 174 China has announced China’s 2020 National (0.8%) clinically-diagnosed cases. The proportion of Malaria Day theme: “Eliminating malaria and imported P. falciparum cases increased from 2012 containing COVID-19: co-mitigation of imported (n=1403, 57.4%) to 2018 (n=1655, 66.0%), while cases and re-establishment” (3). imported P. vivax cases showed a decreasing trend from 2012 (n = 901, 43.7%) to 2018 (n=352, 14.0%). IMCs were mainly reported in Yunnan (n=2,922, REFERENCES 14.0%), Guangxi (n=2,827, 13.5%), and Jiangsu (2,067, 9.9%). IMCs were reported throughout the 1. World Health Organization. World malaria report 2019. Geneva: WHO. https://www.who.int/malaria/publications/world-malaria- entire year, and the highest number of IMCs was report-2019/en/. [2020-03-30]. reported in June 2013. IMCs originated from 67 2. World Health Organization. World malaria day 2020. https://www. countries from 4 continents, and the largest proportion who.int/news-room/campaigns/world-malaria-day/world-malaria- were from Myanmar (n=3,081, 14.7%) and Ghana day-2020. [2020-03-30]. 3. Health and Health Committee. Announcement from the national (n=2,704, 12.9%). health commission disease control bureau on launching the Conclusion and Implications for Public Health national malaria day 2020 campaign. http://www.gov.cn/xinwen/ Practice: The total number of IMCs increased in 2020-03/30/content_5497081.htm. [2020-03-30]. (In Chinese). China. Therefore, two actions are needed to continue Chinese Center for Disease Control and Prevention CCDC Weekly / Vol. 2 / No. 17 277 China CDC Weekly the elimination of malaria in China: prevent re- recrudesce††)], and source of imported cases were establishment caused by imported P. vivax because analyzed to explore the characteristics of IMCs. Anopheles sinensis is still widely distributed; and ensure Clinically-diagnosed cases§§ and laboratory-confirmed timely diagnosis and appropriate treatment to avoid cases¶¶ were included in this analysis. Data from Hong fatal cases caused by imported P. falciparum. Kong, Macao, and Taiwan were excluded from the study. Moreover, data from foreign nationals were not INTRODUCTION concluded. Statistical analysis was performed using the chi-square test for trends by software SPSS ( version China has succeeded in controlling indigenous 21.0, IBM Corp., New York, US), and p < 0.05 was malaria and has reached milestones towards malaria considered statistically significant. elimination since the National Malaria Elimination Action Plan has launched in 2010 (1–3). In 2017, for RESULTS the first time, no indigenous cases were reported in China (4). However, with increasing globalization, In total, 21,376 malaria cases were recorded in the larger numbers of people go to or return from malaria PDIRMS from 2012 to 2018. Among them, 20,938 endemic areas and present challenges to malaria (98.0%) cases were IMCs. The number and proportion elimination in China (5). of IMCs increased from 2012 (n=2,474, 91.0%) to Imported malaria cases (IMCs) may increase risks in 2018 (n=2,511, 99.7%) with statistical significance malaria-free localities where Anopheles mosquitoes still (evaluated by chi-square test for trends, χ2 = 435.423, exist. In addition, severe malaria infections caused by p < 0.001). IMCs consisted of 20,764 laboratory- Plasmodium falciparum are catastrophic if diagnosis confirm cases and 174 clinically-diagnosed cases. The and treatment are not timely. laboratory-confirmed cases consisted of 13,510 (64.5%) In 2012, the Parasitic Diseases Information P. falciparum cases, 4,803 (22.9%) P. vivax cases, Reporting Management System (PDIRMS) was set up 1,725 (8.2%) P. ovale cases, 376 (1.8%) P. malariae to determine whether every case was indigenous or imported. Therefore, the objective of this study was to cases, 2 (0.01%) P. knowlesi cases, 348 (1.7%) mixed characterize the epidemiological status and trends of infection cases (Table 1). Among these cases, the IMCs from 2012 to 2018 to provide evidence-based proportion of imported P. falciparum cases increased data to support the adjustment of appropriate strategies from 2012 (n=1,403, 57.4%) to 2018 (n=1,655, and activities towards the achievement of malaria 66.0%), while imported P. vivax cases decreased from elimination not only in China but also in other 2012 (n=901, 43.7%) to 2018 (n=352, 14.0%). In countries with similar elimination processes. addition, imported P. malariae and P. ovale cases also increased during the same timeframe. In 2012, the METHODS proportion of P. malariae and P. ovale cases was 2.3% (n=56), while in 2018, this proportion peaked at Data from 31 provincial-level administrative 18.0% (n=453). Most IMCs were male (n=19,877, divisions (PLADs) were collected via the PDIRMS 94.9%), and 1,061 cases (5.1%) were female. The from 2012 to 2018 and carefully reviewed. Plasmodium highest number of IMCs was observed in the age group species, case classification [indigenous*, imported†, of 46 to 50 years, and most IMCs occurred in migrant or other (induced§, introduced¶, relapse** or workers (n=14,300, 68.3%). * Indigenous case: a case contracted locally with no evidence of importation and no direct link to transmission from an imported case. In this study, an indigenous case refers to malaria acquired by mosquito transmission in the People’s Republic of China. † Imported case: a malaria case or infection in which the infection was acquired outside the area in which it was diagnosed. Here, it refers to the patient who acquired the illness from a known malaria-prevalent region outside the People’s Republic of China. § Induced case: a case in which the origin of the illness can be traced to a blood transfusion or other form of parenteral inoculation of the parasite but not to transmission by a natural mosquito-borne inoculation. ¶ Introduced case: a case contracted locally with strong epidemiological evidence linking it directly to a known imported case (first-generation local transmission). ** Relapse case: a malaria case attributed to activation of hypnozoites of P. vivax or P. ovale acquired previously. †† Recrudescent case: recurrence of asexual parasitaemia of the same genotype(s) that caused the original illness due to incomplete clearance of asexual parasites after antimalarial treatment. §§ Clinically diagnosed case: an individual with malaria-related symptoms (fever [axillary temperature ≥37.5 °C], chills, severe malaise, headache, or vomiting) at the time of examination. ¶¶ Laboratory-diagnosed case: a clinical case confirmed by microscopy, polymerase chain reaction, or rapid diagnostic tests in the laboratory. 278 CCDC Weekly / Vol. 2 / No. 17 Chinese Center for Disease Control and Prevention China CDC Weekly TABLE 1. Clinically-diagnosed and laboratory-confirmed imported malaria cases in China (2012–2018). Laboratory-confirmed cases Clinically-diagnosed Year Subtotal P. vivax P. falciparum P. ovale P. malariae P. knowlesi Mixed cases 2012 2,474 901 1,403 56* 0 0 39 2013 4,042 859 2,899 133 51 0 65 35 2014 3,022 798 1,876 231 53 1 44 19 2015 3,077 779 1,895 266 65 0 55 17 2016 3,139 622 2,066 315 64 0 59 14 2017 2,672 496 1,716 350 65 1 35 9 2018 2,511 348 1,655 374 78 0 51 5 Total 20,938 4,803 13,510 1,725 376 2 348 174 * The number of imported P.
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