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Xia J, Wu D, Wu K, Zhu H, Sun L, Lin W, Li K, Zhang J, Wan L, Zhang H, Liu S. Epidemiology of Plasmodium falciparum Malaria and Risk Factors for Severe Disease in Hubei Province, China. Am J Trop Med Hyg 2020; 103:1534-1539. [PMID: 32700677 DOI: 10.4269/ajtmh.20-0299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This study aimed to describe the epidemiology of Plasmodium falciparum malaria and identify risk factors for severe disease in Hubei Province, China, using a case-based survey of retrospective data from 2013 to 2018. From 2013 to 2018, a total of 763 imported malaria cases were reported in Hubei Province; 69.2% (528/763) cases were caused by P. falciparum species. The proportion of malaria caused by P. falciparum increased from 66.7% in 2013 to 74.0% in 2018 (χ2 = 21.378, P < 0.05). Plasmodium falciparum malaria was reported in 77 counties of Hubei Province. The majority of imported P. falciparum cases originated from Africa (98.9%, 522/528); 9.7% (51/528) of patients infected with P. falciparum developed severe malaria. Three deaths (case fatality rate: 0.6%) were related to imported P. falciparum malaria. Risk factors for severe malaria were being female (odds ratio [OR] = 3.593, 95% CI: 1.003-12.874), age ≥ 50 years (OR = 2.674, 95% CI: 1.269-5.634), > 3 days between symptom onset and diagnosis (OR = 2.383, 95% CI: 1.210-4.693), and the first-visit medical institution at the township level or lower (OR = 2.568, 95% CI: 1.344-4.908). Malaria prevention should be undertaken among high-risk groups, infection with P. falciparum should be detected early to prevent severe disease and death, and healthcare providers in health facilities at the township level should be trained on early recognition of malaria.
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Affiliation(s)
- Jing Xia
- Institute of Schistosomiasis Control, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Dongni Wu
- Institute of Schistosomiasis Control, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Kai Wu
- Department of Schistosomiasis and Endemic Diseases, Wuhan City Center for Disease Prevention and Control, Wuhan, China
| | - Hong Zhu
- Institute of Schistosomiasis Control, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Lingcong Sun
- Institute of Schistosomiasis Control, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Wen Lin
- Institute of Schistosomiasis Control, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Kaijie Li
- Institute of Schistosomiasis Control, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Juan Zhang
- Institute of Schistosomiasis Control, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Lun Wan
- Institute of Schistosomiasis Control, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Huaxun Zhang
- Institute of Schistosomiasis Control, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Si Liu
- Institute of Schistosomiasis Control, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
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Shin HI, Ku B, Kim YJ, Kim TY, Cho SH, Lee SE. Diagnosis and Molecular Analysis on Imported Plasmodium ovale curtisi and P. ovale wallikeri Malaria Cases from West and South Africa during 2013-2016. THE KOREAN JOURNAL OF PARASITOLOGY 2020; 58:61-65. [PMID: 32145729 PMCID: PMC7066446 DOI: 10.3347/kjp.2020.58.1.61] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 11/10/2019] [Indexed: 11/26/2022]
Abstract
Majority of the imported malaria cases in Korea is attributed to Plasmodium falciparum and P. vivax infections, whereas P. malariae and P. ovale infections are very rare. Falciparum and ovale malaria are mostly imported from Africa, while most of the vivax malaria cases are imported from Southeast Asia. Here, we report 6 Korean imported ovale malaria cases (4 males and 2 females) who had visited in Africa during 2013–2016. These subjects were diagnosed with P. ovale based on microscopic findings, Plasmodium species-specific nested-PCR, and phylogenetic clade using 18S rRNA gene sequences. We identified 2 P. ovale subtypes, 1 P. ovale curtisi (classic type) and 5 P. ovale wallikeri (variant type). All patients were treated with chloroquine and primaquine, and no relapse or recrudescence was reported for 1 year after treatment. With increase of travelers to the countries where existing Plasmodium species, the risk of Plasmodium infection is also increasing. Molecular monitoring for imported malaria parasites should be rigorously and continuously performed to enable diagnosis and certification of Plasmodium spp.
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Affiliation(s)
- Hyun-Il Shin
- Division of Vectors and Parasitic Diseases, Center for Laboratory Control of Infectious Disease, Korea Centers for Disease Control and Prevention, Chungbuk 28159, Korea
| | - Bora Ku
- Division of Vectors and Parasitic Diseases, Center for Laboratory Control of Infectious Disease, Korea Centers for Disease Control and Prevention, Chungbuk 28159, Korea
| | - Yu Jung Kim
- Division of Vectors and Parasitic Diseases, Center for Laboratory Control of Infectious Disease, Korea Centers for Disease Control and Prevention, Chungbuk 28159, Korea
| | - Tae Yun Kim
- Division of Vectors and Parasitic Diseases, Center for Laboratory Control of Infectious Disease, Korea Centers for Disease Control and Prevention, Chungbuk 28159, Korea
| | - Shin-Hyeong Cho
- Division of Vectors and Parasitic Diseases, Center for Laboratory Control of Infectious Disease, Korea Centers for Disease Control and Prevention, Chungbuk 28159, Korea
| | - Sang-Eun Lee
- Division of Vectors and Parasitic Diseases, Center for Laboratory Control of Infectious Disease, Korea Centers for Disease Control and Prevention, Chungbuk 28159, Korea
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Wang T, Zhou SS, Feng J, Oo MM, Chen J, Yan CF, Zhang Y, Tie P. Monitoring and evaluation of intervals from onset of fever to diagnosis before "1-3-7" approach in malaria elimination: a retrospective study in Shanxi Province, China from 2013 to 2018. Malar J 2019; 18:235. [PMID: 31299985 PMCID: PMC6626373 DOI: 10.1186/s12936-019-2865-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China's 1-3-7 approach was extensively implemented to monitor the timeframe of case reporting, case investigation and foci response in the malaria elimination. However, activities before diagnosis and reporting (before '1') would counteract the efficiency of 1-3-7 approach but few data have evaluated this issue. This study aims to evaluate the timelines between onset of fever and diagnosis at healthcare facilities in Shanxi Province. METHODS Routine data were extracted from IDIRMS and NMISM database from 2013 to 2018. Time intervals between onset of fever and healthcare-seeking and between healthcare-seeking and diagnosis were calculated. Each of the documented malaria cases was geo-coded and paired to the county-level layers of polygon. RESULTS A total of 90 cases were reported in 2013-2018 in Shanxi Province, and 73% of cases reported at provincial health facilities. All malaria cases were imported from Africa (90%) and Southeast Asia (10%) especially around the Chinese Spring Festival (n = 46, 51%). The median days between fever and healthcare-seeking and between healthcare-seeking and diagnosis of malaria were 3 and 2, respectively. CONCLUSIONS The current "1-3-7" approach is well executed in Shanxi Province, but delays intervals observed in case finding before 1-3-7 approach occurred in all levels of facilities in Shanxi Province, which imply that more efforts are highlighted for timely case finding. Health education should be provided for improving awareness of healthcare-seeking, and various technical training aiming at the physicians should be carried out to improve diagnosis of malaria.
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Affiliation(s)
- Ting Wang
- Shanxi Center for Disease Control and Prevention, Taiyuan, 030012, China
| | - Shui-Sen Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, China
| | - Jun Feng
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, China
| | - Myo Minn Oo
- Center for Operational Research, International Union Against Tuberculosis and Lung Disease, Mandalay, 05021, Myanmar
| | - Jing Chen
- Shanxi Center for Disease Control and Prevention, Taiyuan, 030012, China
| | - Chang-Fu Yan
- Shanxi Center for Disease Control and Prevention, Taiyuan, 030012, China
| | - Yi Zhang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Ping Tie
- Shanxi Center for Disease Control and Prevention, Taiyuan, 030012, China.
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Zhang X, Chu R, Xu S, Fu H, Tang J, Chen L, Shi X, Chen J, Li Y, Zhu G, Han ET, Xuan Y, Cao J, Cheng Y. Immunogenicity analysis of genetically conserved segments in Plasmodium ovale merozoite surface protein-8. Parasit Vectors 2019; 12:164. [PMID: 30975200 PMCID: PMC6460738 DOI: 10.1186/s13071-019-3412-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 03/26/2019] [Indexed: 12/02/2022] Open
Abstract
Background Plasmodium ovale is widely distributed across tropical regions and has two closely related but distinct species, namely P. ovale curtisi and P. ovale wallikeri. Combining genetic characterization with the immunogenicity of merozoite surface protein-8 (MSP-8) supports considering MSP-8 as a candidate target for blood-stage vaccines against malaria. However, no previous studies have focused on characterizing the genetic diversity and immunogenicity of PoMSP-8. Methods Blood samples were collected from 42 patients infected with P. ovale. The patients were migrant workers returning to the Jiangsu Province from Africa; genomic DNA was extracted from their blood samples for sequencing and protein expression. The recombinant PoMSP-8 (rPoMSP-8) proteins were expressed and purified to assess their immune responses in BALB/c mice. Results The sequences of the P. ovale curtisi and P. ovale wallikeri msp8 genes were completely conserved in each isolate. The rPoMSP-8 proteins were successfully expressed and purified as ~70 kDa proteins. Antibodies raised against rPoMSP-8 in mice showed appropriate immunoreactivity, as evidenced by immunoblotting. These specific antibodies were detected at day 7 post-immunization, and their levels increased throughout the whole immunization period. rPoMSP-8-raised antibodies had high endpoint titers (1:5,120,000) and high avidity (PocMSP-8: 94.84%, PowMSP-8: 92.69%). Cross-reactivity between rPocMSP-8 and rPowMSP-8 was observed with each anti-PoMSP8-specific antibody. Conclusions Remarkable conservation and high immunogenicity was observed in both rPoMSP-8s. Intriguingly, cross-reaction between rPocMSP-8 and rPowMSP-8 was detected, suggesting that a single PoMSP8-based construction might be applicable for both species. Electronic supplementary material The online version of this article (10.1186/s13071-019-3412-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xinxin Zhang
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, People's Republic of China
| | - Ruilin Chu
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, People's Republic of China
| | - Sui Xu
- Key Laboratory of National Health and Family Planning Commission on Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasite Diseases, Wuxi, Jiangsu, People's Republic of China
| | - Haitian Fu
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, People's Republic of China
| | - Jianxia Tang
- Key Laboratory of National Health and Family Planning Commission on Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasite Diseases, Wuxi, Jiangsu, People's Republic of China
| | - Limei Chen
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, People's Republic of China
| | - Xiaodan Shi
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, People's Republic of China
| | - Jing Chen
- Key Laboratory of National Health and Family Planning Commission on Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasite Diseases, Wuxi, Jiangsu, People's Republic of China
| | - Yuhong Li
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, People's Republic of China
| | - Guoding Zhu
- Key Laboratory of National Health and Family Planning Commission on Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasite Diseases, Wuxi, Jiangsu, People's Republic of China
| | - Eun-Taek Han
- Department of Medical Environmental Biology and Tropical Medicine, School of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea
| | - Yinghua Xuan
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, People's Republic of China.
| | - Jun Cao
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, People's Republic of China. .,Key Laboratory of National Health and Family Planning Commission on Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasite Diseases, Wuxi, Jiangsu, People's Republic of China.
| | - Yang Cheng
- Laboratory of Pathogen Infection and Immunity, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, People's Republic of China.
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Sitali L, Miller JM, Mwenda MC, Bridges DJ, Hawela MB, Hamainza B, Chizema-Kawesha E, Eisele TP, Chipeta J, Lindtjørn B. Distribution of Plasmodium species and assessment of performance of diagnostic tools used during a malaria survey in Southern and Western Provinces of Zambia. Malar J 2019; 18:130. [PMID: 30971231 PMCID: PMC6458729 DOI: 10.1186/s12936-019-2766-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 04/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Zambia continues to make strides in reducing malaria burden through the use of proven malaria interventions and has recently pledged to eliminate malaria by 2021. Case management services have been scaled up at community level with rapid diagnostic tests (RDTs) providing antigen-based detection of falciparum malaria only. Key to national malaria elimination goals is the ability to identify, treat and eliminate all Plasmodium species. This study sought to determine the distribution of non-falciparum malaria and assess the performance of diagnostic tests for Plasmodium falciparum in Western and Southern Provinces of Zambia, two provinces planned for early malaria elimination. Methods A sub-set of individuals’ data and samples from a cross-sectional household survey, conducted during peak malaria transmission season in April and May 2017, was used. The survey collected socio-demographic information on household members and coverage of malaria interventions. Malaria testing was done on respondents of all ages using blood smears and RDTs while dried blood spots were collected on filter papers for analysis using photo-induced electron transfer polymerase chain reaction (PET-PCR). Slides were stained using Giemsa stain and examined by microscopy for malaria parasites. Results From the 1567 individuals included, the overall prevalence of malaria was 19.4% (CI 17.5–21.4) by PCR, 19.3% (CI 17.4–21.4) by RDT and 12.9% (CI 11.3–14.7) by microscopy. Using PET-PCR as the gold standard, RDTs showed a sensitivity of 75.7% (CI 70.4–80.4) and specificity of 94.2% (CI 92.8–95.4). The positive predictive value (PPV) was 75.9% (CI 70.7–80.6) and negative predictive value (NPV) was 94.1% (CI 92.1–95.4). In contrast, microscopy for sensitivity, specificity, PPV, and NPV values were 56.9% (CI 51.1–62.5), 97.7% (CI 96.7–98.5), 85.6% (CI 80.0–90.2), 90.4% (CI 88.7–91.9), respectively. Non-falciparum infections were found only in Western Province, where 11.6% of P. falciparum infections were co-infections with Plasmodium ovale or Plasmodium malariae. Conclusion From the sub-set of survey data analysed, non-falciparum species are present and occurred as mixed infections. As expected, PET-PCR was slightly more sensitive than both malaria RDTs and microscopy to detecting malaria infections.
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Affiliation(s)
- Lungowe Sitali
- Centre for International Health, Faculty of Medicine, University of Bergen, Bergen, Norway. .,Department of Biomedical Science, School of Health Sciences, University of Zambia, Lusaka, Zambia. .,School of Medicine and University Teaching Hospital Malaria Research Unit (SMUTH-MRU), Lusaka, Zambia.
| | - John M Miller
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Elimination Centre, Ministry of Health, Chainama Grounds, Lusaka, Zambia
| | - Mulenga C Mwenda
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Elimination Centre, Ministry of Health, Chainama Grounds, Lusaka, Zambia
| | - Daniel J Bridges
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Elimination Centre, Ministry of Health, Chainama Grounds, Lusaka, Zambia
| | - Moonga B Hawela
- National Malaria Elimination Centre, Ministry of Health, Chainama Hospital and College Grounds, Lusaka, Zambia
| | - Busiku Hamainza
- National Malaria Elimination Centre, Ministry of Health, Chainama Hospital and College Grounds, Lusaka, Zambia
| | - Elizabeth Chizema-Kawesha
- National Malaria Elimination Centre, Ministry of Health, Chainama Hospital and College Grounds, Lusaka, Zambia
| | - Thomas P Eisele
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.,Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - James Chipeta
- School of Medicine and University Teaching Hospital Malaria Research Unit (SMUTH-MRU), Lusaka, Zambia.,Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia
| | - Bernt Lindtjørn
- Centre for International Health, Faculty of Medicine, University of Bergen, Bergen, Norway
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