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

疟疾是东南亚最重要的媒介传播疾病。这一地区的疟疾控制面临着 若干重大挑战，包括缺乏关于边远贫困地区疟疾发病率的信息 一些地区缺乏预防高树突型疟疾传入的知识和可行方法 向邻近低发病率国家转移，并且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差异很大的研究地点。 人类旅行者从缅甸传入疟疾寄生虫，并在当地传播 异质性，是这些国家疟疾控制最困难的问题。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的流行病学。我们设计了以下内容 五个具体目标：1)进行疟疾监测，以确定临床疟疾发病率和亚临床疟疾发病率 边远、贫困的边境地区和其他哨所的感染率，并检查国家间 传播动力学；2)研究抗疟药耐药性的分子流行病学和 恶性疟原虫和间日疟原虫种群遗传结构；3)确定疟疾传播地 在高空间分辨率下，确定传播焦点的关键环境和生物决定因素 在一场密集的抗疟疾运动的时代；4)检查恶性疟原虫和P。 使用高通量蛋白质微阵列进行间日疟感染，以及5)开发综合疟疾 管理战略和系统地评估昆虫学和流行病学的影响 具有不同疟疾流行特征的多个地点。该项目为其他项目奠定了重要的基础。 ICEMR计划，并将为制定和评估综合疟疾提供关键知识 管理策略。

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.