Epidemiology of Plasmodium vivax Malaria in Peru
Epidemiology of Plasmodium vivax Malaria in Peru
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DOI：
10.4269/ajtmh.16-0268
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发表时间：
2016-01-01
影响因子：
3.3
通讯作者：
Vinetz, Joseph M.
中科院分区：
文献类型：
--
作者：
Rosas-Aguirre, Angel;Gamboa, Dionicia;Vinetz, Joseph M.
在秘鲁，以间日疟原虫为主的疟疾仍然是一个公共卫生问题。20世纪90年代出现了新的疟疾流行病，主要是在亚马逊地区的洛雷托省，包括首都伊基托斯附近的地区，但20世纪90年代至21世纪初，秘鲁北部沿海地区和秘鲁东南部的金矿区也出现了零星的疟疾传播。虽然全球基金支助的干预措施（PAMAFRO，2005-2010年）与疟疾传播减少有时间关联，但从2012年至今，间日疟原虫和恶性疟原虫疟疾病例都迅速增加。秘鲁卫生部继续为经显微镜检查确诊的恶性疟原虫病例提供青蒿素类复方疗法，并为间日疟原虫提供氯喹-伯氨喹疗法。尽管如此，疟疾在偏远地区仍在继续传播，那里人类和寄生虫的流动性有利于在正在进行的监测活动之外继续重新引入，这对于解决未来的疟疾控制和消除工作至关重要。秘鲁正在进行的间日疟原虫研究的差距包括：无症状的寄生虫血症，专利和亚专利寄生虫蚊子传播的贡献，诊断nonparasitemic催眠虫载体，并实施监测潜在的氯喹和8-氨基喹啉耐药间日疟原虫的鉴定。他非诺喹在秘鲁的临床试验前景看好，该地区的葡萄糖-6-磷酸脱氢酶缺乏症未被观察到限制其使用。在秘鲁，间日疟原虫（和一般疟疾）面临的更大规模挑战包括：在接触偏远的河流人口方面存在后勤困难、政府政策和贫穷趋势的后果以及为控制和消除疟疾获得国际资金。
Malaria in Peru, dominated by Plasmodium vivax, remains a public health problem. The 1990s saw newly epidemic malaria emerge, primarily in the Loreto Department in the Amazon region, including areas near to Iquitos, the capital city, but sporadic malaria transmission also occurred in the 1990s-2000s in both north-coastal Peru and the gold mining regions of southeastern Peru. Although a Global Fund-supported intervention (PAMAFRO, 2005-2010) was temporally associated with a decrease of malaria transmission, from 2012 to the present, both P.vivax and Plasmodium falciparum malaria cases have rapidly increased. The Peruvian Ministry of Health continues to provide artemesinin-based combination therapy for microscopy-confirmed cases of P.falciparum and chloroquine-primaquine for P.vivax. Malaria transmission continues in remote areas nonetheless, where the mobility of humans and parasites facilitates continued reintroduction outside of ongoing surveillance activities, which is critical to address for future malaria control and elimination efforts. Ongoing P.vivax research gaps in Peru include the following: identification of asymptomatic parasitemics, quantification of the contribution of patent and subpatent parasitemics to mosquito transmission, diagnosis of nonparasitemic hypnozoite carriers, and implementation of surveillance for potential emergence of chloroquine-and 8-aminoquinoline-resistant P.vivax. Clinical trials of tafenoquine in Peru have been promising, and glucose-6-phosphate dehydrogenase deficiency in the region has not been observed to be a limitation to its use. Larger-scale challenges for P.vivax (and malaria in general) in Peru include logistical difficulties in accessing remote riverine populations, consequences of government policy and poverty trends, and obtaining international funding for malaria control and elimination.