Malaria in China: a longitudinal population-based surveillance study

Ding, Cheng; Huang, Chenyang; Zhou, Yuqing; Fu, Xiaofang; Liu, Xiaoxiao; Wu, Jie; Deng, Min; Li, Lanjuan; Yang, Shigui

and deaths between actual and prediction were very close. In 2017, there were 2 697 malaria cases reported, among which six patients died [27] . The predicted number of malaria cases was 2 914 for 2017 and 2 562 for 2020. The predicted number of deaths would decrease from 13 in 2017 to 10 in 2020. Among those cases, most of which were imported cases and became the major source of disease burden. There will be none indigenous cases during 2016 and 2020 by the prediction compared to the actual three indigenous cases from areas bordering Yunnan and Tibet in 2016, and zero in 2017 [8] . In short, the goal of eliminating malaria by 2020 will be highly probable in China. Along with the vector controlling (insecticide-treated mosquito nets and indoor residual spraying) nationwide [1] , China should give more attention to cross-border areas and imported malaria cases recently [28] . Yunnan and the Tibet Autonomous Region were the only regions that reported locally acquired malaria cases in 2014 [7] . Several high-risk counties in the long international land border still face a persistent risk of malaria introduction and transmission [22] . The imported malaria cases are the key challenges to achieve malaria elimination in China [29] . Since the majority of malaria infections are asymptomatic, active case detection methods in community should also be conducted to overcome the limitations of passive surveillance [30] . A recent study revealed that African ape parasites in the wild are 10-fold more diverse than human P. vivax and exhibit no evidence of species specificity, which means that P. vivax will never be eradicated unless to eliminate malaria from apes, or it can cross the border at any time and cause new malaria outbreaks [31] . Resurgence of malaria may occur if control and surveillance measures are scaled back too early [32] . Historically, a marked increase in malaria incidence worldwide occurred as the funding was cut further [3] . For China, a practical strategy should focus on the investigation and disposal of malaria case and foci in the specific areas and among the high-risk population [33] .