Present status and origin of drug resistant malaria parasites in Indonesia

印度尼西亚是一个幅员辽阔的群岛国家，由不同的种族和环境组成，导致不同岛屿的疟疾流行情况不同，甚至往往在一个岛屿上。到目前为止，这种多样性一直依赖于上述因素，但它已被社会经济变化迅速改变。城市化大大减少了疟疾的流行，特别是在爪哇和巴厘岛。在我们的调查区，在龙目岛和松巴瓦岛，沿海的主要疟疾流行由于经济发展而减少，但一些偏远的农村地区除外，但经济发展和随之而来的人口增加将人类的生活范围扩大到周围的山脉(或森林丘陵)。现在，在我们龙目岛的调查地区，大多数疟疾病例都是在森林覆盖的山丘上发现的。在松巴瓦地区南部的新移民村庄也发现了同样的情况。涉及新定居点疟疾流行的因素正在调查中。在所有疟疾流行地区看到的一个共同因素是，它们的位置远离医疗设施。有趣的是，与非洲流行程度较高的地区相比，流行区10岁以上的大多数村民都获得了抗疟疾免疫，尽管流行程度较低。在非洲，大多数居民随着年龄的增长逐渐获得抗疟疾免疫。在一个有7到8年历史的新定居点中，15岁以上的村民也表现出明显的疟疾免疫，表明疟疾免疫依赖于年龄。通过对相关基因的分析，证实了各调查区恶性疟原虫对氯喹的抗性普遍存在。

Indonesia is a big archipelago country consisting of various races and environments, resulting in diverse malaria endemic situations according to different islands, and often even in a single island. So far, this diversity had been dependent upon the above factors, but it has been rapidly changed by the socio-economical change. Urbanization dramatically reduced malaria endemics, especially in Java and Bali island. In our survey areas, in Lombok and Sumbawa island, the major malaria endemics along the coasts have decreased due to economical development except some remote, rural areas, but the economical development and resultant increase in population expanded the human life range to surrounding mountains (or forested hills). Now, in our survey areas in Lombok, most of malaria cases are found in forested hills. The same situation was found in new transmigrant villages in the south of Sumbawa district. Factors involving malaria epidemic in new settlements are under investigation. A common factor seen in all the malaria endemic areas is their location far separated from medical facilities. Interesting points are that most of villagers over 10 years old in endemic areas have acquired anti-malaria immunity regardless of less degree of endemicity compared with high degree of endemicity in Africa where most of residents gradually acquire anti-malaria immunity with increasing age. In a new settlement with 7 or 8 years history, villagers over 15 years old also showed apparent malaria immunity, indicating age-dependent malaria immunity. In all the survey areas prevalent chloroquine resistance of Plasmodium falciparum was demonstrated by analyzation of related genes.