Malaria Surveillance - United States, 2014
Malaria Surveillance - United States, 2014
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DOI：
10.15585/mmwr.ss6612a1
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发表时间：
2017-05-26
影响因子：
24.9
通讯作者：
Arguin, Paul M.
中科院分区：
文献类型：
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作者：
Mace, Kimberly E.;Arguin, Paul M.
问题/状况：人类疟疾是由疟原虫属红细胞内原生动物引起的。这些寄生虫通过受感染的雌性按蚊叮咬传播。在美国，大多数疟疾感染发生在前往疟疾持续传播地区的人群中。然而，没有出国旅行的人偶尔也会因接触受感染的血液制品、先天性传播、实验室接触或当地蚊子传播而感染疟疾。在美国进行疟疾监测是为了确定当地传播的事件，并为旅行者提供指导预防建议。所涵盖期间：本报告总结了2014年发病病例和前几年的趋势。系统描述：通过血膜、聚合酶链反应或快速诊断测试诊断出的疟疾病例由卫生保健提供者或实验室工作人员报告给地方和州卫生部门。病例调查由地方和州卫生部门进行，报告通过国家疟疾监测系统、国家法定疾病监测系统或直接疾病预防控制中心咨询传递给疾病预防控制中心。疾病预防控制中心对卫生保健提供者或地方或州卫生部门提交的血液样本进行抗疟疾药物耐药性标记检测。来自这些报告系统的数据是本报告的基础。结果：美国疾病控制与预防中心收到了1 724例确诊疟疾病例的报告，其中包括1例先天性病例和2例隐性病例，这些病例于2014年在美国出现症状。2014年确诊病例数与2013年报告的确诊病例数一致（n = 1,741；这一数字是根据以前的出版物更新的，以解释2013年底出现症状的人报告延迟的情况）。恶性疟原虫、间日疟原虫、卵形疟原虫和疟疾疟原虫的检出率分别为66.1%、13.3%、5.2%和2.7%。不到1.0%的患者同时感染两种细菌。11.7%的病例未报告或未确定感染种类。疾病预防控制中心为14.2%的确诊病例提供了诊断协助，并对12.0%的恶性疟原虫标本进行了抗疟标志物检测。在报告旅行目的的患者中，57.5%为探亲访友。在了解化学预防药物使用和旅行地区信息的美国居民中，7.8%的人报告说他们开始并遵守了疾病预防控制中心为他们旅行的地区推荐的化学预防药物方案。32例是孕妇，没有一个人坚持化学预防。在所有报告病例中，17.0%被列为严重疾病，5名疟疾患者死亡。疾病预防控制中心收到137份恶性疟原虫阳性样本，用于检测抗疟药标记物（尽管氯喹和甲氟喹的一些位点在多达9个样本中无法检测）。其中，乙胺嘧啶耐药基因多态性131例（95.6%），磺胺多辛耐药基因多态性96例（70.0%），氯喹耐药基因多态性77例（57.5%），甲氟喹耐药基因多态性3例（2.3%），甲氟喹耐药基因多态性1例(
Problem/Condition: Malaria in humans is caused by intraerythrocytic protozoa of the genus Plasmodium. These parasites are transmitted by the bite of an infective female Anopheles mosquito. The majority of malaria infections in the United States occur among persons who have traveled to regions with ongoing malaria transmission. However, malaria is occasionally acquired by persons who have not traveled out of the country through exposure to infected blood products, congenital transmission, laboratory exposure, or local mosquitoborne transmission. Malaria surveillance in the United States is conducted to identify episodes of local transmission and to guide prevention recommendations for travelers.Period Covered: This report summarizes cases in persons with onset of illness in 2014 and trends during previous years.Description of System: Malaria cases diagnosed by blood film, polymerase chain reaction, or rapid diagnostic tests are reported to local and state health departments by health care providers or laboratory staff Case investigations are conducted by local and state health departments, and reports are transmitted to CDC through the National Malaria Surveillance System, National Notifiable Diseases Surveillance System, or direct CDC consultations. CDC conducts antimalarial drug resistance marker testing on blood samples submitted by health care providers or local or state health departments. Data from these reporting systems serve as the basis for this report.Results: CDC received reports of 1,724 confirmed malaria cases, including one congenital case and two cryptic cases, with onset of symptoms in 2014 among persons in the United States. The number of confirmed cases in 2014 is consistent with the number of confirmed cases reported in 2013 (n = 1,741; this number has been updated from a previous publication to account for delayed reporting for persons with symptom onset occurring in late 2013). Plasmodium falciparum, P. vivax, P. ovale, and P. malariae were identified in 66.1%, 13.3%, 5.2%, and 2.7% of cases, respectively. Less than 1.0% of patients were infected with two species. The infecting species was unreported or undetermined in 11.7% of cases. CDC provided diagnostic assistance for 14.2% of confirmed cases and tested 12.0% of P. falciparum specimens for antimalarial resistance markers. Of patients who reported purpose of travel, 57.5% were visiting friends and relatives (VFR). Among U.S. residents for whom information on chemoprophylaxis use and travel region was known, 7.8% reported that they initiated and adhered to a chemoprophylaxis drug regimen recommended by CDC for the regions to which they had traveled. Thirty-two cases were among pregnant women, none of whom had adhered to chemoprophylaxis. Among all reported cases, 17.0% were classified as severe illness, and five persons with malaria died. CDC received 137 P. falciparum-positive samples for the detection of antimalarial resistance markers (although some loci for chloroquine and mefloquine were untestable for up to nine samples). Of the 137 samples tested, 131 (95.6%) had genetic polymorphisms associated with pyrimethamine drug resistance, 96 (70.0%) with sulfadoxine resistance, 77 (57.5%) with chloroquine resistance, three (2.3%) with mefloquine drug resistance, one (