Malaria Epidemiology in Southeast Asia: Intra- and Inter-Country Dynamics

疟疾是东南亚最重要的病媒传播疾病。该地区的疟疾控制面临着一个 一些重大挑战，包括缺乏关于偏远贫穷地区疟疾发病率的信息， 缺乏知识和可行的方法来防止疟疾从高流行地区传入， 低发病率国家向邻近低发病率国家转移，缺乏有效的综合控制战略。我们 在中国、泰国和缅甸战略性地选择疟疾流行程度差异很大的研究地点。 人类旅行者从缅甸引入疟原虫，并在当地传播 异质性是这些国家疟疾控制的最大难题。因此 该项目的首要目标是获得关于国内和国家间疟疾的重要信息 在这些国家制定有效的疟疾控制战略。我们设计以下 五个具体目标：1）进行疟疾监测，以确定疟疾的临床发病率和亚临床发病率， 偏远、贫穷的边境地区和其他哨点的感染率，并审查国家间 传播动力学; 2）研究抗疟药物耐药性的分子流行病学和 恶性疟原虫和间日疟原虫的种群遗传结构; 3）确定疟疾传播疫源地 并确定传播疫源地的关键环境和生物决定因素 4）研究恶性疟原虫和疟原虫的免疫流行病学。 使用高通量蛋白质微阵列的间日疟感染，以及5）开发综合疟疾 管理战略，并系统地评估昆虫学和流行病学的影响， 有不同疟疾流行病学的多个地点。该项目为中国其他项目的实施奠定了重要基础。 ICEMR计划，并将为开发和评估综合疟疾提供关键知识 管理战略。

Malaria is the most important vector-borne disease in Southeast Asia. Malaria control in this region faces a number of important challenges, including a lack of information on malaria incidence in remote impoverished areas, a lack of knowledge and viable methods to prevent malaria introduction from hyperdendemic countries to neighboring low-incidence countries, and a lack of effective, integrated control strategies. We strategically select study sites in China, Thailand and Myanmar that vary significantly in malaria endemicity. Malaria parasite introduction from Myanmar by human travelers, together with local transmission heterogeneity, represents the most difficult problem for malaria control in these countries. Therefore, the overarching objective of this project is to gain critical information on intra-country and inter-country malaria epidemiology for developing effective malaria control strategies in these countries. We design the following five specific aims: 1) to conduct malaria surveillance to determine clinical malaria incidence and sub-clinical infection rates in remote, impoverished border regions and other sentinel sites, and to examine inter-country transmission dynamics; 2) to study the molecular epidemiology of antimalarial drug resistance and the population genetic structure of Plasmodium falciparum and P. vivax; 3) to identify malaria transmission foci at high spatial resolution and determine key environmental and biological determinants for transmission foci in the era of an intensive antimalarial campaign; 4) to examine immuno-epidemiology of P. falciparum and P. vivax infections using high-throughput protein microarrays, and 5) to develop integrated malaria management strategies and systematically evaluate the entomological and epidemiological impacts in multiple sites with distinct malaria epidemiology. This project lays important foundations for other projects of the ICEMR program, and will provide critical knowledge for developing and evaluating integrated malaria management strategies.