Malaria in Southern Venezuela: The hottest hotspot in Latin America.
Malaria in Southern Venezuela: The hottest hotspot in Latin America.
复制标题
委内瑞拉南部的疟疾：拉丁美洲最热的热点。
DOI：
10.1371/journal.pntd.0008211
复制
发表时间：
2021-01
影响因子：
3.8
通讯作者：
Conn JE
中科院分区：
文献类型：
--
作者：
Grillet ME;Moreno JE;Hernández-Villena JV;Vincenti-González MF;Noya O;Tami A;Paniz-Mondolfi A;Llewellyn M;Lowe R;Escalante AA;Conn JE
在拉丁美洲消灭疟疾正在成为一个难以实现的目标。疟疾病例在2017年和2018年达到历史性的约100万例，委内瑞拉分别占这些病例的53%和51%。从历史上看，委内瑞拉南部的疟疾发病率占该国病例总数的大部分。有效部署疾病预防措施和预测疾病向新区域的传播需要深入了解疟疾传播动态的空间异质性。在此，我们描述了2007年至2017年委内瑞拉南部疟疾的空间流行病学特征，并描述了近年来全国疟疾分布的变化程度。我们发现，疾病传播在委内瑞拉南部的东南部地区是集中的，并且更为普遍，其中间日疟原虫（76%）和恶性疟原虫（18%）的两个持续热点占病例总数的约60%。这些热点与非法采金活动造成的森林砍伐有关。在过去十年中，发病率增加了近十倍，由于严重缺乏疾病控制计划，显示出爆炸性的流行增长。我们的研究结果强调了空间导向的干预措施对遏制委内瑞拉持续的疟疾流行的重要性。这项工作还提供了基线流行病学数据，以评估跨界疟疾动态，并倡导在拉丁美洲区域开展创新的控制努力。尽管过去几年南美洲在控制或消除疟疾方面取得了重大进展，但这种疾病仍然是所有亚马逊流域国家的一个重要公共卫生问题，特别是在2017年和2018年期间，报告了大量疟疾发病率（约100万）。病例增加的主要原因是委内瑞拉疟疾传播的增加。在这个国家，东南部（圭亚那盾）地区的人口一直处于间日疟原虫和恶性疟原虫感染的最高风险。在这项研究中，对该地区2007-2017年报告的疟疾病例进行了分析，以对疾病的空间风险进行分层，并确定了过去几年疟疾激增的主要驱动因素。疟疾风险是高度集中和流行的两个一致的疾病热点，占大多数疟原虫传播在整个地区。非法金矿开采活动似乎是这些疾病区疟疾的驱动力，似乎是全国疟疾激增的关键。对委内瑞拉监测数据的分析表明，从2014年起，当地疟疾传播在该国新的地区重新出现，导致这种疾病的流行病学发生变化。要成功控制委内瑞拉目前的疟疾流行，就需要在国家一级进行有针对性的热点控制，并进行区域协调，以避免疟疾跨界蔓延。
Malaria elimination in Latin America is becoming an elusive goal. Malaria cases reached a historical ~1 million in 2017 and 2018, with Venezuela contributing 53% and 51% of those cases, respectively. Historically, malaria incidence in southern Venezuela has accounted for most of the country's total number of cases. The efficient deployment of disease prevention measures and prediction of disease spread to new regions requires an in-depth understanding of spatial heterogeneity on malaria transmission dynamics. Herein, we characterized the spatial epidemiology of malaria in southern Venezuela from 2007 through 2017 and described the extent to which malaria distribution has changed country-wide over the recent years. We found that disease transmission was focal and more prevalent in the southeast region of southern Venezuela where two persistent hotspots of Plasmodium vivax (76%) and P. falciparum (18%) accounted for ~60% of the total number of cases. Such hotspots are linked to deforestation as a consequence of illegal gold mining activities. Incidence has increased nearly tenfold over the last decade, showing an explosive epidemic growth due to a significant lack of disease control programs. Our findings highlight the importance of spatially oriented interventions to contain the ongoing malaria epidemic in Venezuela. This work also provides baseline epidemiological data to assess cross-border malaria dynamics and advocates for innovative control efforts in the Latin American region. Despite major progress in malaria control or elimination in South America in the last years, this disease is still an important public health concern in all the Amazon basin countries, particularly during 2017 and 2018, when a substantial malaria incidence (~ one million) was reported. Most of the rise in cases has been due to increases in malaria transmission in Venezuela. Within this country, populations in the southeastern (Guiana Shield) region have been at the highest risk of Plasmodium vivax and P. falciparum infection. In this study, reported malaria cases between 2007–2017 in this region were analyzed to stratify the spatial risk of disease and identify the malaria surge's main driver over the last years. Malaria risk was highly focal and prevalent in 2 consistent disease hotspots that accounted for most Plasmodium transmission in the whole region. Illegal gold-mining activities seem to drive malaria in these disease pockets and seem critical in malaria's surge throughout the country. Analyses of the Venezuelan surveillance data showed that from 2014 onwards, local malaria transmission has reemerged in new areas of the country, leading to a shift in this disease's epidemiology. Successful control of Venezuela's ongoing malaria epidemic requires hotspot-targeted control at the national level and regional coordination to avoid cross-border malaria spillover.
登录
查看更多内容
影响因子：
15.8
作者：
Bousema, Teun;Stresman, Gillian;Cox, Jonathan
通讯作者：
Cox, Jonathan
影响因子：
3
作者：
Douine, Maylis;Sanna, Alice;De Laval, Franck
通讯作者：
De Laval, Franck
影响因子：
2.7
作者：
Grillet, Maria-Eugenia;El Souki, Mayida;Rafael Leon, Jose
通讯作者：
Rafael Leon, Jose
影响因子：
3.6
作者：
ANSELIN, L
通讯作者：
ANSELIN, L
DOI：
10.4269/ajtmh.1983.32.203
发表时间：
1983-01-01
影响因子：
3.3
作者：
GABALDON, A
通讯作者：
GABALDON, A