Epidemiological characteristics of Plasmodium malariae malaria in China: a malaria that should not be neglected post elimination.

BACKGROUND: Plasmodium malariae was always neglected compared with P. falciparum and P. vivax. In the present study, we aimed to describe the epidemiology of reported cases infected with P. malariae in the past decade to raise awareness of the potential threat of this malaria parasite in China. METHODS: Individual data of malaria cases infected with P. malariae reported in China in the past decade were collected via the China Information System for Disease Control and Prevention and Parasitic Diseases Information Reporting Management System, to explore their epidemiological characteristics. Pearson Chi-square tests or Fisher's Exact Test was used in the statistical analysis. RESULTS: From 2013 to 2022, a total of 581 P. malariae cases were reported in China, and mainly concentrated in 20-59 years old group (P < 0.001), and there was no significant trend in the number of cases reported per month. Moreover, four kinds of P. malariae cases were classified, including 567 imported cases from 41 countries in 8 regions and distributed in 27 provinces (autonomous regions, municipalities) in China, six indigenous cases in a small outbreak in Hainan, seven recurrent cases in Guangdong and Shanghai, and one induced case in Shanghai, respectively. In addition, only 379 cases (65.2%) were diagnosed as malaria on the first visit (P < 0.001), and 413 cases (71.1%) were further confirmed as P. malariae cases (P = 0.002). Meanwhile, most cases sought healthcare first in the health facilities at the county and prefectural levels, but only 76.7% (161/210) and 73.7% (146/198) cases were diagnosed as malaria, and the accuracy of confirmed diagnosis as malaria cases infected with P. malariae was only 77.2% (156/202) and 69.9% (167/239) in these health facilities respectively. CONCLUSIONS: Even though malaria cases infected with P. malariae didn't account for a high proportion of reported malaria cases nationwide, the threat posed by widely distributed imported cases, a small number of indigenous cases, recurrent cases and induced case cannot be ignored in China. Therefore, it is necessary to raise awareness and improve the surveillance and response to the non-falciparum species such as P. malariae, and prevent the reestablishment of malaria transmission after elimination.

1-3-7 surveillance and response approach in malaria elimination: China's practice and global adaptions.

There has been a significant reduction in malaria morbidity and mortality worldwide from 2000 to 2019. However, the incidence and mortality increased again in 2020 due to the disruption to services during the COVID-19 pandemic. Surveillance to reduce the burden of malaria, eliminate the disease and prevent its retransmission is, therefore, crucial. The 1-3-7 approach proposed by China has played an important role in eliminating malaria, which has been internationally popularized and adopted in some countries to help eliminate malaria. This review summarizes the experience and lessons of 1-3-7 approach in China and its application in other malaria-endemic countries, so as to provide references for its role in eliminating malaria and preventing retransmission. This approach needs to be tailored and adapted according to the region condition, considering the completion, timeliness and limitation of case-based reactive surveillance and response. It is very important to popularize malaria knowledge, train staff, improve the capacity of health centres and monitor high-risk groups to improve the performance in eliminating settings. After all, remaining vigilance in detecting malaria cases and optimizing surveillance and response systems are critical to achieving and sustaining malaria elimination.

Imported malaria from land bordering countries in China: A challenge in preventing the reestablishment of malaria transmission.

OBJECTIVE: No indigenous malaria cases have been reported since 2017 in China, but a large number of imported cases are still reported every year, including those from the land bordering countries. To characterize their epidemiological profiles will provide evidence for the development of appropriate strategies to effectively address the challenges of border malaria in the post-elimination phase. METHODS: Individual-level data of imported malaria cases from the land bordering countries were collected from 2017 to 2021 in China via the web-based surveillance systems, and analyzed by SPSS, ArcGIS and WPS software, to explore their epidemiological profiles. RESULTS: A total of 1170 malaria cases imported into China from six of the fourteen land bordering countries were reported between 2017 and 2021 with a decline trend. Overall, cases were widely distributed in 31-97 counties from 11 to 21 provinces but mainly in Yunnan. Moreover, these imported cases were mainly infected with P. vivax (94.8%), and a total of 68 recurrent cases were reported in 6-14 counties from 4 to 8 provinces. In addition, nearly 57.1% of the total reported cases could seek healthcare within 2 days of getting sick, and 71.3% of the reported cases could be confirmed as malaria on the day they sought medical care. CONCLUSIONS: China still needs to attach great importance to the risk and challenge of the imported malaria from bordering countries particularly from Myanmar in preventing reestablishment of malaria transmission in the post-elimination phase. It is necessary not only to strengthen collaboration and cooperation with the bordering countries, but also coordinate multiple departments at home to improve malaria surveillance and response system and prevent the reestablishment of malaria transmission in China.

Plasmodium vivax in the Elimination Phase - China, 2013-2020.

What is already known about this topic?: Plasmodium vivax (P. vivax) was the most widely distributed and major human malaria parasite in China, considered the last parasite to be eliminated. What is added by this report?: The last domestic P. vivax case was reported in 2016, while hundreds of imported cases were reported annually from 2013-2020, predominantly from Southeast Asia. What are the implications for public health practice?: In the post-elimination phase, adaptive and practical strategies focusing on imported P. vivax cases should be updated and adopted to prevent malaria resurgence.

A Case-Control Study of the Dose-Response Relationship Between Thrombin Activatable Fibrinolysis Inhibitor and Acute Myocardial Infarction.

Background: Acute myocardial infarction (AMI) is considered an acute coronary syndrome (ACS), which is caused by the death of myocardial cells after prolonged ischemia, and there is a high risk of sudden death during AMI. Therefore, the purpose of this study is to explore the relationship between thrombin activatable fibrinolysis inhibitor (TAFI) and AMI and provide evidence for their association and potentially the prevention of AMI. Methods: There were 228 subjects included in this retrospective study, which included 78 AMI patients and 150 controls. The immune turbidimetry was used to measure TAFI concentration in the serum. Mann-Whitney U test was used to compare serum TAFI levels. The logistic regression analysis was used to construct a model of influencing factors of AMI. The dose-response relationship between serum TAFI level and AMI was explored by using the restricted cubic spline (RCS) functions combined with logistic regression analysis. Results: The serum TAFI levels of the AMI group were higher than the control group's (P = 0.003). The risk of AMI in the high-TAFI level group was 2.24 times higher than the low-TAFI level group (P = 0.007) and it was 2.74 times higher after adjustment of other risk factors (P = 0.025). According to the dose-response curve, the risk of AMI increased significantly with an increase of serum TAFI concentration (P = 0.0387). Conclusion: Acute myocardial infarction patients had higher serum TAFI levels, and TAFI was an independent risk factor for AMI patients. Serum TAFI levels demonstrated a dose- dependent response to the risk of AMI. Our study provides evidence that TAFI could be used for risk stratification of AMI patients.

Awareness of chronic diseases prevention and control among high school students in ethnic minority areas / 预防医学

Objective @#To learn the awareness of chronic diseases prevention and control and its influencing factors among high school students in regions inhabited by ethnic groups,so as to strengthen the prevention of chronic diseases among adolescents in these regions. @*Methods@#Totally 1 050 high school students in Tuquan County,Hinggan League,Inner Mongolia were selected by cluster sampling method. The general information,family factors,attitude to learning,psychological factors,behavioral styles and awareness of chronic diseases prevention and control were investigated,and the influencing factors for the awareness were analyzed by multivariate logistic regression model.@*Results@#There were 1 001 valid questionnaires recovered,with a response rate of 95.33%. There were 685 Han students,accounting for 68.43%,241 Mongol students,accounting for 24.08%,and 75 students with other ethnic minorities,accounting for 7.49%. The average awareness rate of chronic diseases prevention and control was 53.25%;the awareness rates of hypertension prevention measures,smoking and drinking hazards,food susceptible to aflatoxin pollution and high cholesterol food were high,all more than 70%;while the awareness rates of long-term high lipid hazards,high blood pressure diagnosis standard and diabetes symptoms was low,all less than 40%. There was no significant difference in the awareness rate of chronic diseases prevention and control among different nationalities（P>0.05）. The results of multivariate logistic regression analysis showed that the students who were female（OR=1.309,95%CI：1.008-1.700）,had high achievement（OR=1.509,95%CI：1.055-2.159）,and thought exams were important（OR=1.570,95%CI：1.204-2.046）were more likely to have high awareness,while the students who spent five to less than eight hours a day on screens（OR=0.514,95%CI：0.335-0.789）were less likely to have high awareness. @*Conclusions@#The awareness rate of chronic diseases prevention and control of high school students in Tuquan County is 53.25%,and there is no significant difference between Mongol and Han students. Gender,academic performance,attitude to examination and time spent on screens can affect the awareness rate.