Malaria Surveillance - United States, 2014.

IF 37.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Kimberly E Mace, Paul M Arguin
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Malaria surveillance in the United States is conducted to identify episodes of local transmission and to guide prevention recommendations for travelers.</p><p><strong>Period covered: </strong>This report summarizes cases in persons with onset of illness in 2014 and trends during previous years.</p><p><strong>Description of system: </strong>Malaria cases diagnosed by blood film, polymerase chain reaction, or rapid diagnostic tests are reported to local and state health departments by health care providers or laboratory staff. Case investigations are conducted by local and state health departments, and reports are transmitted to CDC through the National Malaria Surveillance System, National Notifiable Diseases Surveillance System, or direct CDC consultations. CDC conducts antimalarial drug resistance marker testing on blood samples submitted by health care providers or local or state health departments. Data from these reporting systems serve as the basis for this report.</p><p><strong>Results: </strong>CDC received reports of 1,724 confirmed malaria cases, including one congenital case and two cryptic cases, with onset of symptoms in 2014 among persons in the United States. The number of confirmed cases in 2014 is consistent with the number of confirmed cases reported in 2013 (n = 1,741; this number has been updated from a previous publication to account for delayed reporting for persons with symptom onset occurring in late 2013). Plasmodium falciparum, P. vivax, P. ovale, and P. malariae were identified in 66.1%, 13.3%, 5.2%, and 2.7% of cases, respectively. Less than 1.0% of patients were infected with two species. The infecting species was unreported or undetermined in 11.7% of cases. CDC provided diagnostic assistance for 14.2% of confirmed cases and tested 12.0% of P. falciparum specimens for antimalarial resistance markers. Of patients who reported purpose of travel, 57.5% were visiting friends and relatives (VFR). Among U.S. residents for whom information on chemoprophylaxis use and travel region was known, 7.8% reported that they initiated and adhered to a chemoprophylaxis drug regimen recommended by CDC for the regions to which they had traveled. Thirty-two cases were among pregnant women, none of whom had adhered to chemoprophylaxis. Among all reported cases, 17.0% were classified as severe illness, and five persons with malaria died. CDC received 137 P. falciparum-positive samples for the detection of antimalarial resistance markers (although some loci for chloroquine and mefloquine were untestable for up to nine samples). 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引用次数: 0

Abstract

Problem/condition: Malaria in humans is caused by intraerythrocytic protozoa of the genus Plasmodium. These parasites are transmitted by the bite of an infective female Anopheles mosquito. The majority of malaria infections in the United States occur among persons who have traveled to regions with ongoing malaria transmission. However, malaria is occasionally acquired by persons who have not traveled out of the country through exposure to infected blood products, congenital transmission, laboratory exposure, or local mosquitoborne transmission. Malaria surveillance in the United States is conducted to identify episodes of local transmission and to guide prevention recommendations for travelers.

Period covered: This report summarizes cases in persons with onset of illness in 2014 and trends during previous years.

Description of system: Malaria cases diagnosed by blood film, polymerase chain reaction, or rapid diagnostic tests are reported to local and state health departments by health care providers or laboratory staff. Case investigations are conducted by local and state health departments, and reports are transmitted to CDC through the National Malaria Surveillance System, National Notifiable Diseases Surveillance System, or direct CDC consultations. CDC conducts antimalarial drug resistance marker testing on blood samples submitted by health care providers or local or state health departments. Data from these reporting systems serve as the basis for this report.

Results: CDC received reports of 1,724 confirmed malaria cases, including one congenital case and two cryptic cases, with onset of symptoms in 2014 among persons in the United States. The number of confirmed cases in 2014 is consistent with the number of confirmed cases reported in 2013 (n = 1,741; this number has been updated from a previous publication to account for delayed reporting for persons with symptom onset occurring in late 2013). Plasmodium falciparum, P. vivax, P. ovale, and P. malariae were identified in 66.1%, 13.3%, 5.2%, and 2.7% of cases, respectively. Less than 1.0% of patients were infected with two species. The infecting species was unreported or undetermined in 11.7% of cases. CDC provided diagnostic assistance for 14.2% of confirmed cases and tested 12.0% of P. falciparum specimens for antimalarial resistance markers. Of patients who reported purpose of travel, 57.5% were visiting friends and relatives (VFR). Among U.S. residents for whom information on chemoprophylaxis use and travel region was known, 7.8% reported that they initiated and adhered to a chemoprophylaxis drug regimen recommended by CDC for the regions to which they had traveled. Thirty-two cases were among pregnant women, none of whom had adhered to chemoprophylaxis. Among all reported cases, 17.0% were classified as severe illness, and five persons with malaria died. CDC received 137 P. falciparum-positive samples for the detection of antimalarial resistance markers (although some loci for chloroquine and mefloquine were untestable for up to nine samples). Of the 137 samples tested, 131 (95.6%) had genetic polymorphisms associated with pyrimethamine drug resistance, 96 (70.0%) with sulfadoxine resistance, 77 (57.5%) with chloroquine resistance, three (2.3%) with mefloquine drug resistance, one (<1.0%) with atovaquone resistance, and two (1.4%) with artemisinin resistance.

Interpretation: The overall trend of malaria cases has been increasing since 1973; the number of cases reported in 2014 is the fourth highest annual total since then. Despite progress in reducing global prevalence of malaria, the disease remains endemic in many regions and use of appropriate prevention measures by travelers is still inadequate.

Public health action: Completion of data elements on the malaria case report form increased slightly in 2014 compared with 2013, but still remains unacceptably low. In 2014, at least one essential element (i.e., species, travel history, or resident status) was missing in 21.3% of case report forms. Incomplete reporting compromises efforts to examine trends in malaria cases and prevent infections. VFR travelers continue to be a difficult population to reach with effective malaria prevention strategies. Evidence-based prevention strategies that effectively target VFR travelers need to be developed and implemented to have a substantial impact on the number of imported malaria cases in the United States. Fewer U.S. resident patients reported taking chemoprophylaxis in 2014 (27.2%) compared with 2013 (28.6%), and adherence was poor among those who did take chemoprophylaxis. Proper use of malaria chemoprophylaxis will prevent the majority of malaria illnesses and reduce risk for severe disease (https://www.cdc.gov/malaria/travelers/drugs.html). Malaria infections can be fatal if not diagnosed and treated promptly with antimalarial medications appropriate for the patient's age and medical history, likely country of malaria acquisition, and previous use of antimalarial chemoprophylaxis. Recent molecular laboratory advances have enabled CDC to identify and conduct molecular surveillance of antimalarial drug resistance markers (https://www.cdc.gov/malaria/features/ars.html) and improve the ability of CDC to track, guide treatment, and manage drug resistance in malaria parasites both domestically and globally. For this effort to be successful, specimens should be submitted for all cases diagnosed in the United States. Clinicians should consult CDC Guidelines for Treatment of Malaria in the United States and contact the CDC Malaria Hotline for case management advice, when needed. Malaria treatment recommendations can be obtained online at https://www.cdc.gov/malaria/diagnosis_treatment/ or by calling the Malaria Hotline at 770-488-7788 or toll-free at 855-856-4713.

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疟疾监测 - 美国,2014 年。
问题/条件:人类疟疾是由疟原虫属红细胞内原生动物引起的。这些寄生虫通过有传染性的雌性按蚊叮咬传播。在美国,大多数疟疾感染者都曾到过疟疾传播地区。不过,偶尔也会有未出国旅行的人因接触受感染的血液制品、先天性传播、实验室接触或当地蚊媒传播而感染疟疾。在美国开展疟疾监测是为了确定当地的传播情况,并为旅行者的预防建议提供指导:本报告总结了2014年发病者的病例以及往年的趋势:通过血片、聚合酶链反应或快速诊断检测确诊的疟疾病例由医疗服务提供者或实验室工作人员向地方和州卫生部门报告。病例调查由地方和州卫生部门进行,报告通过国家疟疾监测系统、国家应报告疾病监测系统或直接咨询疾病预防控制中心转交疾病预防控制中心。疾病预防控制中心对医疗服务提供者或地方或州卫生部门提交的血液样本进行抗疟药物耐药性标记检测。本报告以这些报告系统的数据为基础:2014 年,美国疾病预防控制中心收到了 1724 例疟疾确诊病例的报告,其中包括 1 例先天性病例和 2 例隐性病例,这些病例均在 2014 年出现症状。2014 年的确诊病例数与 2013 年报告的确诊病例数一致(n = 1,741 例;这一数字已根据之前的出版物进行了更新,以考虑到 2013 年末出现症状者的延迟报告情况)。在66.1%、13.3%、5.2%和2.7%的病例中分别发现了恶性疟原虫、间日疟原虫、卵形疟原虫和疟疾疟原虫。只有不到 1.0% 的患者感染了两种病原体。11.7%的病例未报告或未确定感染物种。疾病预防控制中心为 14.2% 的确诊病例提供了诊断协助,并对 12.0% 的恶性疟原虫标本进行了抗疟药物耐药性标记检测。在报告旅行目的的患者中,57.5%是探亲访友(VFR)。在已知使用化学预防药物和旅行地区信息的美国居民中,有7.8%的人报告说,他们在旅行地区开始并坚持使用了美国疾病预防控制中心推荐的化学预防药物治疗方案。有 32 例病例发生在孕妇中,她们都没有坚持进行化学预防。在所有报告病例中,17.0%被列为重症病例,5名疟疾患者死亡。疾病预防控制中心收到了 137 份恶性疟原虫阳性样本,用于检测抗疟药物抗药性标记物(尽管有多达 9 份样本无法检测氯喹和甲氟喹的某些位点)。在检测的 137 个样本中,131 个样本(95.6%)的基因多态性与乙胺嘧啶抗药性有关,96 个样本(70.0%)与磺胺多辛抗药性有关,77 个样本(57.5%)与氯喹抗药性有关,3 个样本(2.3%)与甲氟喹抗药性有关,1 个样本(1.5%)与氯喹抗药性有关:自 1973 年以来,疟疾病例总体呈上升趋势;2014 年报告的病例数是自 1973 年以来第四高的年度总数。尽管在降低全球疟疾流行率方面取得了进展,但该疾病在许多地区仍然流行,旅行者对适当预防措施的使用仍然不足:与2013年相比,2014年疟疾病例报告表中数据元素的完成率略有上升,但仍然低得令人无法接受。2014年,21.3%的病例报告表至少缺少一项基本要素(即物种、旅行史或居民身份)。不完整的报告影响了疟疾病例趋势的研究和感染的预防工作。通过有效的疟疾预防策略来预防疟疾的难度仍然很大。需要制定和实施以证据为基础的预防策略,有效地针对VFR旅行者,才能对美国的输入性疟疾病例数量产生实质性影响。与2013年(28.6%)相比,2014年报告服用化学预防药物的美国居民患者人数较少(27.2%),而且服用化学预防药物的患者依从性较差。正确使用疟疾化学预防可预防大多数疟疾疾病,并降低患严重疾病的风险 (https://www.cdc.gov/malaria/travelers/drugs.html)。如果不根据患者的年龄和病史、可能感染疟疾的国家以及以前使用抗疟药物的情况及时诊断和治疗疟疾,疟疾感染可能是致命的。
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来源期刊
Mmwr Surveillance Summaries
Mmwr Surveillance Summaries PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
60.50
自引率
1.20%
发文量
9
期刊介绍: The Morbidity and Mortality Weekly Report (MMWR) Series, produced by the Centers for Disease Control and Prevention (CDC), is commonly referred to as "the voice of CDC." Serving as the primary outlet for timely, reliable, authoritative, accurate, objective, and practical public health information and recommendations, the MMWR is a crucial publication. Its readership primarily includes physicians, nurses, public health practitioners, epidemiologists, scientists, researchers, educators, and laboratorians.
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