Microgeography and molecular epidemiology of malaria at the Thailand-Myanmar border in the malaria pre-elimination phase
Microgeography and molecular epidemiology of malaria at the Thailand-Myanmar border in the malaria pre-elimination phase
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DOI：
10.1186/s12936-015-0712-5
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发表时间：
2015-05-13
期刊：
影响因子：
3
通讯作者：
Cui, Liwang
中科院分区：
文献类型：
--
作者：
Parker, Daniel M.;Matthews, Stephen A.;Cui, Liwang
背景：泰国的地方性疟疾仍然只存在于沿着的国际边界。这种模式通常归因于从周边国家输入疟疾。一个微地理的方法被用来调查疟疾病例在一个研究村庄沿着泰国-缅甸边境。方法：三个大规模的血液调查进行了研究期间（2011年7月和12月，2012年5月），并匹配到队列为基础的人口监测系统。从每位参与者身上采集血液载玻片和滤纸。由专家显微镜检查员交叉验证载玻片，并使用巢式PCR分析滤纸。然后将病例映射到家庭，并使用空间统计进行分析。采用混合效应logistic regression.Results进行危险因素分析：共55例间日疟原虫和20例恶性疟原虫（出547名参与者）通过PCR检测，相比6和2（分别）现场显微镜检测的情况下。感染的最大风险因素是公民身份。许多研究参与者是克伦族人，在泰国或缅甸都没有公民身份。与泰国公民相比，这一亚群感染疟疾的几率是泰国公民的八倍多。病例也出现集群附近的一个主要排水系统和全年的水源在studyvillage.Conclusion：这项研究表明，许多疟疾病例仍然未确诊的地区。病例在人口亚组中的空间和人口聚集性表明，要么是在泰国村庄内传播，要么是在村庄外共同接触疟疾病媒。虽然疟疾有可能是从缅甸输入泰国的，但存在未被发现的感染，加上有利于疟疾传播的生态环境，意味着在泰国边境一侧也可能发生本土传播。改进、及时和主动的病例检测是必要的。
Background: Endemic malaria in Thailand continues to only exist along international borders. This pattern is frequently attributed to importation of malaria from surrounding nations. A microgeographical approach was used to investigate malaria cases in a study village along the Thailand-Myanmar border.Methods: Three mass blood surveys were conducted during the study period (July and December 2011, and May 2012) and were matched to a cohort-based demographic surveillance system. Blood slides and filter papers were taken from each participant. Slides were cross-verified by an expert microscopist and filter papers were analysed using nested PCR. Cases were then mapped to households and analysed using spatial statistics. A risk factor analysis was done using mixed effects logistic regression.Results: In total, 55 Plasmodium vivax and 20 Plasmodium falciparum cases (out of 547 participants) were detected through PCR, compared to six and two (respectively) cases detected by field microscopy. The single largest risk factor for infection was citizenship. Many study participants were ethnic Karen people with no citizenship in either Thailand or Myanmar. This subpopulation had over eight times the odds of malaria infection when compared to Thai citizens. Cases also appeared to cluster near a major drainage system and year-round water source within the study village.Conclusion: This research indicates that many cases of malaria remain undiagnosed in the region. The spatial and demographic clustering of cases in a sub-group of the population indicates either transmission within the Thai village or shared exposure to malaria vectors outside of the village. While it is possible that malaria is imported to Thailand from Myanmar, the existence of undetected infections, coupled with an ecological setting that is conducive to malaria transmission, means that indigenous transmission could also occur on the Thai side of the border. Improved, timely, and active case detection is warranted.