Malaria surveillance--United States, 1995.
Malaria surveillance--United States, 1995.
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发表时间：
1999-02
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通讯作者：
Holly A. Williams;Jacquelin M. Roberts;S. Kachur;A. Barber;L. M. Barat;Peter B. Bloland;Ruebush Tk nd;E. Wolfe
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作者：
Holly A. Williams;Jacquelin M. Roberts;S. Kachur;A. Barber;L. M. Barat;Peter B. Bloland;Ruebush Tk nd;E. Wolfe
疟疾是由四种疟原虫（即恶性疟原虫、间日疟原虫、卵形疟原虫或疟疾疟原虫）引起的，它们是通过雌性疟蚊叮咬传播的。在美国，大多数疟疾感染发生在前往持续传播地区的人群中。在美国，偶尔也会有接触受感染血液制品、先天性传播或当地蚊子传播的病例。开展疟疾监测以确定当地传播事件并指导对旅行者提出预防建议。报告期间1995年发病病例。卫生保健提供者和/或实验室工作人员向地方和/或州卫生部门报告经血液涂片确诊的疟疾病例。病例调查由地方和/或州卫生部门进行，报告通过国家疟疾监测系统（NMSS）传送给疾病预防控制中心。国家气象局的数据是本报告的基础。结果：1995年期间，美国疾病控制与预防中心收到了在美国或其领土上发生的1,167例出现症状的疟疾病例的报告。这一数字比1994年报告的1 014例增加了15%。间日疟原虫、恶性疟原虫、疟疾疟原虫和卵形疟原虫的检出率分别为48.2%、38.6%、3.9%和2.2%。3例患者（占总数的0.3%）存在一种以上的细菌。80例（6.9%）未确定感染菌种。非洲报告的疟疾病例数（519例）与1994年大致相同（517例）；亚洲病例增加了32.4% (n=335)；美洲的病例增加了37.4% （n=246）。在591名在国外感染疟疾的美国平民中，15.6%的人遵循了疾病预防控制中心为他们旅行过的地区推荐的化学预防药物治疗方案。在美国有9名患者被感染。在这9个病例中，5个是先天性的；一个是通过器官移植获得的；一个是通过输血获得的。9例中有2例感染源不明。6人死于疟疾。与1994年相比，1995年疟疾病例增加了15%，主要原因是亚洲和美洲的病例增加，最显著的是南美洲报告的病例数增加了100%。这一变化可能是由于疾病传播、旅行模式、报告错误或有效的抗疟化学预防使用减少造成的。在大多数报告的病例中，在国外感染疟疾的美国平民没有在感染疟疾的国家接受适当的化学预防治疗。所采取的行动获得了有关美国6例死亡病例和9例感染的额外信息。疟疾预防准则得到更新，并分发给保健提供者。前往疟疾疫区的人员应采取建议的化学预防方案，并采取个人防护措施，防止蚊虫叮咬。去过疟疾流行地区的任何人，如其后出现发烧或流感样症状，应求医；调查应包括疟疾的血液涂片。如果不及时诊断和治疗，疟疾感染可能是致命的。有关预防和治疗疟疾的建议可从疾病预防控制中心获得。
PROBLEM/CONDITION Malaria is caused by four species of Plasmodium (i.e., P. falciparum, P. vivax, P. ovale, or P. malariae), which are transmitted by the bite of an infective female Anopheles sp. mosquito. Most malaria infections in the United States occur among persons who have traveled to areas with ongoing transmission. Occasionally, cases occur in the United States through exposure to infected blood products, by congenital transmission, or by local mosquito-borne transmission. Malaria surveillance is conducted to identify episodes of local transmission and to guide prevention recommendations for travelers. REPORTING PERIOD Cases with onset of illness during 1995. DESCRIPTION OF SYSTEM Malaria cases confirmed by blood smears are reported to local and/or state health departments by health-care providers and/or laboratory staff. Case investigations are conducted by local and/or state health departments, and reports are transmitted to CDC through the National Malaria Surveillance System (NMSS). Data from NMSS serve as the basis for this report. RESULTS CDC received reports of 1,167 cases of malaria with onset of symptoms during 1995 among persons in the United States or one of its territories. This number represents an increase of 15% from the 1,014 cases reported for 1994. P. vivax, P. falciparum, P. malariae, and P. ovale were identified in 48.2%, 38.6%, 3.9%, and 2.2% of cases, respectively. More than one species was present in three patients (0.3% of total). The infecting species was not determined in 80 (6.9%) cases. The number of reported malaria cases acquired in Africa (n=519) remained approximately the same as in 1994 (n=517); cases acquired in Asia increased by 32.4% (n=335); and cases acquired in the Americas increased by 37.4 % (n=246). Of 591 U.S. civilians who acquired malaria abroad, 15.6% had followed a chemoprophylactic drug regimen recommended by CDC for the area where they had traveled. Nine patients became infected in the United States. Of these nine cases, five were congenitally acquired; one was acquired by organ transplantation; and one was acquired by a blood transfusion. For two of the nine cases, the source of infection was unknown. Six deaths were attributed to malaria. INTERPRETATION The 15% increase in malaria cases in 1995 compared with 1994 resulted primarily from increases in cases acquired in Asia and the Americas, most notably a 100% increase in the number of cases reported from South America. This change could have resulted from local changes in disease transmission, travel patterns, reporting errors, or a decreased use of effective antimalarial chemoprophylaxis. In most reported cases, U.S. civilians who acquired infection abroad were not on an appropriate chemoprophylaxis regimen for the country where they acquired malaria. ACTIONS TAKEN Additional information was obtained concerning the six fatal cases and the nine infections acquired in the United States. Malaria prevention guidelines were updated and distributed to health-care providers. Persons traveling to a malarious area should take the recommended chemoprophylaxis regimen and use personal protection measures to prevent mosquito bites. Any person who has been to a malarious area and who subsequently develops a fever or influenza-like symptoms should seek medical care; investigation should include a blood smear for malaria. Malaria infections can be fatal if not diagnosed and treated promptly. Recommendations concerning prevention and treatment of malaria can be obtained from CDC.