Objective: To understand the epidemiological characteristics of imported malaria and the control and diagnostic capacities of the medical institutions in Wuhan City, so as to offer the evidence for formulating the surveillance and control strategies.
Methods: From 2008 to 2017, the epidemiological data of imported malaria were collected. The information including gender, age, distribution, vocational background, positive rate of fever patients, and time of final diagnosis was analyzed with the descriptive statistic method. The Plasmodium species composition and infection source were analyzed by chi square test. The initial and confirmed diagnosis abilities of medical institutions were analyzed by rank sum test.
Results: Totally, 424 imported malaria cases were reported, including 301 falciparum malaria cases (70.99%). The male population aged 20 to 49 years was the main morbidity group, and the incidence was not related to seasons. For the parasite species, there was a significant difference between African countries and Southeast Asian countries (χ2 = 205.83, P < 0.01). Plasmodium ovale and P. malariae were all imported from sub-Saharan Africa. For diagnostic capacities of the medical institutions at different levels, the initial diagnosis (Z = -3.89, P < 0.01) and confirmed diagnosis (χ2 = 53.88, P < 0.01) were significantly different, respectively. The ability of malaria diagnosis was improved rapidly in the clinical laboratory after 2008 and achieved to 100% in 2010. The detection rate within 24 hours increased to at least 90% and the detection rate within 6 days decreased to 0 in 2016.
Conclusions: Although the medical institutions in Wuhan City have strong ability to treat imported malaria, they are still faced with a serious situation for malaria control and elimination. The capacity building should be strengthened constantly.
[摘要] 目的 分析湖北省武汉市境外输入性疟疾流行特征、医疗机构防治和诊断能力, 为输入性疟疾监测和制定防控 策略提供科学依据。方法 收集2008-2017年武汉市境外输入性疟疾病例流行病学资料, 对病例性别、年龄、地区、职 业、发病时间、血检阳性率、入院-检出时间采用描述性分析, 对虫种、疫源地、就诊情况进行统计分析。结果 2008-2017 年武汉市共报告境外输入性疟疾424例, 其中恶性疟301例 (70.99%), 20 ~ 49岁男性为主要发病群体, 发病无季节相关 性。非洲和东南亚地区输入性病例的疟原虫感染类型不同 (χ2 = 205.83, P < 0.01), 卵形疟和三日疟均来自非洲撒哈拉沙 漠以南国家。不同级别医疗机构初诊 (Z = -3.89, P < 0.01) 和确诊 (χ2 = 53.88, P < 0.01) 能力差异有统计学意义。2008年 后医院发热门诊血检能力快速提升, 至2010年实现所有疟疾病例均在实验室 (镜检) 诊断, 且24 h检出率逐年提高至 90%以上, 而6 d检出率降至0 (2016年) 。结论 虽然武汉市医疗机构应对境外输入性疟疾能力已处于较高水平, 但输 入性疟疾防控形势依然较严重, 须持续加强医疗机构的相关能力建设。.
Keywords: Diagnostic capability; Epidemic situation; Imported malaria; Wuhan City.