Malaria in the Greater Mekong Subregion: heterogeneity and complexity.
Malaria in the Greater Mekong Subregion: heterogeneity and complexity.
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DOI：
10.1016/j.actatropica.2011.02.016
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发表时间：
2012-03
期刊：
影响因子：
2.7
通讯作者：
Zhou, Guofa
中科院分区：
文献类型：
--
作者：
Cui, Liwang;Yan, Guiyun;Sattabongkot, Jetsumon;Cao, Yaming;Chen, Bin;Chen, Xiaoguang;Fan, Qi;Fang, Qiang;Jongwutiwes, Somchai;Parker, Daniel;Sirichaisinthop, Jeeraphat;Kyaw, Myat Phone;Su, Xin-zhuan;Yang, Henglin;Yang, Zhaoqing;Wang, Baomin;Xu, Jianwei;Zheng, Bin;Zhong, Daibin;Zhou, Guofa
关键词：
大湄公河次区域（GMS）由柬埔寨、中国云南省、老挝人民民主共和国、缅甸、泰国和越南等六个国家组成，是最具威胁性的疟疾疫源地之一。自10年前世卫组织湄公河疟疾项目启动以来，大湄公河次区域的疟疾状况已大大改善，这反映在每年疟疾发病率和死亡人数持续下降。然而，由于许多国家正在努力消除疟疾，大湄公河次区域国家仍然面临巨大挑战。该区域的疟疾流行病学表现出巨大的地理异质性，缅甸和柬埔寨仍然是高负担国家。在每个国家内，疟疾的分布也是不均匀的，例如“边境疟疾”和“森林疟疾”，它们的高传播率分别发生在沿着国际边界和森林或森林边缘。“边境疟疾”极难监测，经常由流动人口引入的疟疾对邻近的消除疟疾的国家构成了重大威胁。因此，邻国之间的协调对于在整个地区消除疟疾至关重要。除了这些业务上的困难外，大湄公河次区域的疟疾防治工作还面临若干技术挑战。现代疟疾控制措施在很大程度上依赖于对病媒蚊子的有效化疗和杀虫剂控制。然而，恶性疟原虫多药耐药性的蔓延和青蒿素耐药性的潜在出现使耐药性管理成为GMS的高度优先事项。假冒伪劣青蒿素类药物的流通使这种情况进一步恶化。在大湄公河次区域的大多数流行区，恶性疟原虫和间日疟原虫共存，在最近的疟疾控制历史中，间日疟原虫对控制措施表现出显著的适应力。由于目标人群中葡萄糖-6-磷酸脱氢酶缺乏症的高发病率，用于根治间日疟的唯一注册药物（伯氨喹）的部署受到严重影响。在大湄公河次区域，截然不同的生态、多样的病媒系统和杀虫剂抗药性使传统的蚊虫控制效率降低。在这里，我们试图审查GMS中不断变化的疟疾流行病学，分析疟疾传播的媒介系统和模式，并确定疟疾控制社区在消除疟疾的道路上面临的主要挑战。
The Greater Mekong Subregion (GMS), comprised of six countries including Cambodia, China's Yunnan Province, Lao PDR, Myanmar (Burma), Thailand and Vietnam, is one of the most threatening foci of malaria. Since the initiation of the WHO's Mekong Malaria Program a decade ago, malaria situation in the GMS has greatly improved, reflected in the continuous decline in annual malaria incidence and deaths. However, as many nations are moving towards malaria elimination, the GMS nations still face great challenges. Malaria epidemiology in this region exhibits enormous geographical heterogeneity with Myanmar and Cambodia remaining high-burden countries. Within each country, malaria distribution is also patchy, exemplified by ‘border malaria’ and ‘forest malaria’ with high transmission occurring along international borders and in forests or forest fringes, respectively. ‘Border malaria’ is extremely difficult to monitor, and frequent malaria introductions by migratory human populations constitute a major threat to neighboring, malaria-eliminating countries. Therefore, coordination between neighboring countries is essential for malaria elimination from the entire region. In addition to these operational difficulties, malaria control in the GMS also encounters several technological challenges. Contemporary malaria control measures rely heavily on effective chemotherapy and insecticide control of vector mosquitoes. However, the spread of multidrug resistance and potential emergence of artemisinin resistance in Plasmodium falciparum make resistance management a high priority in the GMS. This situation is further worsened by the circulation of counterfeit and substandard artemisinin-related drugs. In most endemic areas of the GMS, P. falciparum and P. vivax coexist, and in recent malaria control history, P. vivax has demonstrated remarkable resilience to control measures. Deployment of the only registered drug (primaquine) for the radical cure of vivax malaria is severely undermined due to high prevalence of glucose-6-phosphate dehydrogenase deficiency in target human populations. In the GMS, the dramatically different ecologies, diverse vector systems, and insecticide resistance render traditional mosquito control less efficient. Here we attempt to review the changing malaria epidemiology in the GMS, analyze the vector systems and patterns of malaria transmission, and identify the major challenges the malaria control community faces on its way to malaria elimination.
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