Laboratory diagnosis for malaria in the elimination phase in China: efforts and challenges
Jianhai Yin(), Mei Li, He Yan, Shuisen Zhou, Zhigui Xia()
National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research); NHC Key Laboratory of Parasite and Vector Biology; WHO Collaborating Center for Tropical Diseases; National Center for International Research on Tropical Diseases, Shanghai 200025, China
Malaria remains a global health challenge, although an increasing number of countries will enter pre-elimination and elimination stages. The prompt and precise diagnosis of symptomatic and asymptomatic carriers of Plasmodium parasites is the key aspect of malaria elimination. Since the launch of the China Malaria Elimination Action Plan in 2010, China has formulated clear goals for malaria diagnosis and has established a network of malaria diagnostic laboratories within medical and health institutions at all levels. Various external quality assessments were implemented, and a national malaria diagnosis reference laboratory network was established to strengthen the quality assurance in malaria diagnosis. Notably, no indigenous malaria cases have been reported since 2017, but the risk of re-establishment of malaria transmission cannot be ignored. This review summarizes the lessons about malaria diagnosis in the elimination phase, primarily including the establishments of laboratory networks and quality control in China, to better improve malaria diagnosis and maintain a malaria-free status. A reference is also provided for countries experiencing malaria elimination.
. [J]. Frontiers of Medicine, 2022, 16(1): 10-16.
Jianhai Yin, Mei Li, He Yan, Shuisen Zhou, Zhigui Xia. Laboratory diagnosis for malaria in the elimination phase in China: efforts and challenges. Front. Med., 2022, 16(1): 10-16.
Malaria screening by entry–?exit inspection and quarantine ?agencies
By 2012
General hospitals and CDCs at ?the provincial, prefecture level ?reach 100% General hospitals and CDCs in ?the Category I, II, and III ?counties reach 100% Township medical institutions ?in Category I and II counties ?reach 90%
Not be less than 2% and 1% ?of the population in the ?jurisdiction of towns and ?townships in Category I and ?II counties, respectively Not be less than 2‰ of the ?population in the jurisdiction? of Category III counties Tests in the malaria ?transmission season should ?not be less than 80%
Laboratory test rate of malaria ?cases reaches 100% Laboratory confirmed rate ?reaches 75%
100% of fever patients entering ?from overseas malaria endemic ?areas
By 2015
General hospitals and CDCs at ?the provincial, prefecture level ?remain 100% General hospitals and CDCs in ?the Category I, II, and III ?counties remain 100% Township medical institutions ?in Category I and II counties ?reach 100%
Not be less than 1% and 2‰ of ?the population in the jurisdiction ?of towns and townships in ?Category I and II counties, ?respectively Not be less than 2‰ of the ?population in the jurisdiction ?of Category III counties Tests in the malaria ?transmission season should ?not be less than 80%
Laboratory confirmed rate ?reaches 100%
100% of fever patients entering ?from overseas malaria endemic ?areas
By 2020
Medical and health institutions ?and CDCs at the county level ?and above in the original ?endemic counties all have ?facilities and capabilities ?for blood testing of malaria ?parasites
All people suspected of malaria ?get a laboratory blood test for ?malaria parasites; malaria cases ?whose source of infection cannot ?be determined by epidemiology ?should be genetically traced and ?identified by national laboratories
Tab.1
Fig.1
Definition
Diagnostic Criteria for Malaria (WS259-2006)
Diagnosis of Malaria (WS259-2015)
Carrier
Asymptomatic Test positive: microscopy
−
Suspected case
Epidemiological history of malaria Atypical symptoms of malaria
−
Clinically diagnosed case
Epidemiological history of malaria Typical symptoms of malaria, or atypical symptoms of ?malaria; and presumptive treatment is effective
History Typical symptoms of malaria, or atypical symptoms of ?malaria
Confirmed case
Epidemiological history of malaria Clinical manifestations Test positive: microscopy and/or RDTs
Clinically diagnosed case Test positive: microscopy and/or RDTs and/or NAATsa
Asymptomatic infection
−
Asymptomatic Test positive: microscopy and/or RDTs and/or NAATs
Severe case
−
Confirmed case Severe symptoms
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