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Background: Following China's official designation as malaria-free country by WHO, the imported malaria has emerged as a significant determinant impacting the malaria reestablishment within China. The objective of this study is to explore the application prospects of machine learning algorithms in imported malaria risk assessment of China., Methods: The data of imported malaria cases in China from 2011 to 2019 was provided by China CDC; historical epidemic data of malaria endemic country was obtained from World Malaria Report, and the other data used in this study are open access data. All the data processing and model construction based on R, and map visualization used ArcGIS software., Results: A total of 27,088 malaria cases imported into China from 85 countries between 2011 and 2019. After data preprocessing and classification, clean dataset has 765 rows (85 * 9) and 11 cols. Six machine learning models was constructed based on the training set, and Random Forest model demonstrated the best performance in model evaluation. According to RF, the highest feature importance were the number of malaria deaths and Indigenous malaria cases. The RF model demonstrated high accuracy in forecasting risk for the year 2019, achieving commendable accuracy rate of 95.3%. This result aligns well with the observed outcomes, indicating the model's reliability in predicting risk levels., Conclusions: Machine learning algorithms have reliable application prospects in risk assessment of imported malaria in China. This study provides a new methodological reference for the risk assessment and control strategies adjusting of imported malaria in China., (© 2024. The Author(s).)

Background: Qualified malaria diagnosis competency has contributed to the great achievement of malaria elimination in China. After eliminating malaria, it is still critical to the prevention of re-establishment of malaria transmission in China. This study was aimed to assess the malaria detection competency at national and provincial levels in China at the beginning of malaria post-elimination phase., Methods: In the present study, different competency assessment activities on the laboratory malaria diagnosis were carried out for national and provincial malaria diagnostic laboratories based on the WHO scoring schedules, including malaria microscopy or nucleic acid amplification tests (NAAT), at the beginning of malaria post-elimination phase (2021-2022) in China., Results: A total of 60 slides for malaria microscopy and 10 specimen for NAAT were included into the WHO External Quality Assessments of malaria parasite qualitative detection and species identification, and the scoring rate was 96.6% (microscopy: 171/177) and 85.0% (NAAT: 17/20), respectively. Moreover, 124 samples were included into the national NAAT quality assessment, and an accuracy of 87.9% (109/124) was found without significance among reference laboratories and non-reference laboratories., Conclusions: The findings suggest that there is still a need for sustained strengthening of malaria detection competency, particularly in the areas of parasite counting and detection of low-density parasitemia, to ensure prompt detection of the sources of infection and accurate identification of Plasmodium species, and contribute to case management and focus disposal, thereby effectively preventing the malaria re-establishment., (© 2024. The Author(s).)

Background: Plasmodium malariae was always neglected compared with P. falciparum and P. vivax. In the present study, we aimed to describe the epidemiology of reported cases infected with P. malariae in the past decade to raise awareness of the potential threat of this malaria parasite in China., Methods: Individual data of malaria cases infected with P. malariae reported in China in the past decade were collected via the China Information System for Disease Control and Prevention and Parasitic Diseases Information Reporting Management System, to explore their epidemiological characteristics. Pearson Chi-square tests or Fisher's Exact Test was used in the statistical analysis., Results: From 2013 to 2022, a total of 581 P. malariae cases were reported in China, and mainly concentrated in 20-59 years old group (P < 0.001), and there was no significant trend in the number of cases reported per month. Moreover, four kinds of P. malariae cases were classified, including 567 imported cases from 41 countries in 8 regions and distributed in 27 provinces (autonomous regions, municipalities) in China, six indigenous cases in a small outbreak in Hainan, seven recurrent cases in Guangdong and Shanghai, and one induced case in Shanghai, respectively. In addition, only 379 cases (65.2%) were diagnosed as malaria on the first visit (P < 0.001), and 413 cases (71.1%) were further confirmed as P. malariae cases (P = 0.002). Meanwhile, most cases sought healthcare first in the health facilities at the county and prefectural levels, but only 76.7% (161/210) and 73.7% (146/198) cases were diagnosed as malaria, and the accuracy of confirmed diagnosis as malaria cases infected with P. malariae was only 77.2% (156/202) and 69.9% (167/239) in these health facilities respectively., Conclusions: Even though malaria cases infected with P. malariae didn't account for a high proportion of reported malaria cases nationwide, the threat posed by widely distributed imported cases, a small number of indigenous cases, recurrent cases and induced case cannot be ignored in China. Therefore, it is necessary to raise awareness and improve the surveillance and response to the non-falciparum species such as P. malariae, and prevent the reestablishment of malaria transmission after elimination., (© 2023. The Author(s).)

Objective: No indigenous malaria cases have been reported since 2017 in China, but a large number of imported cases are still reported every year, including those from the land bordering countries. To characterize their epidemiological profiles will provide evidence for the development of appropriate strategies to effectively address the challenges of border malaria in the post-elimination phase., Methods: Individual-level data of imported malaria cases from the land bordering countries were collected from 2017 to 2021 in China via the web-based surveillance systems, and analyzed by SPSS, ArcGIS and WPS software, to explore their epidemiological profiles., Results: A total of 1170 malaria cases imported into China from six of the fourteen land bordering countries were reported between 2017 and 2021 with a decline trend. Overall, cases were widely distributed in 31-97 counties from 11 to 21 provinces but mainly in Yunnan. Moreover, these imported cases were mainly infected with P. vivax (94.8%), and a total of 68 recurrent cases were reported in 6-14 counties from 4 to 8 provinces. In addition, nearly 57.1% of the total reported cases could seek healthcare within 2 days of getting sick, and 71.3% of the reported cases could be confirmed as malaria on the day they sought medical care., Conclusions: China still needs to attach great importance to the risk and challenge of the imported malaria from bordering countries particularly from Myanmar in preventing reestablishment of malaria transmission in the post-elimination phase. It is necessary not only to strengthen collaboration and cooperation with the bordering countries, but also coordinate multiple departments at home to improve malaria surveillance and response system and prevent the reestablishment of malaria transmission in China., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

China was declared malaria free in June of 2021. In the post-elimination setting, vigilant surveillance is essential to sustain malaria free status. Serological surveillance has been recognized as an efficient tool for assessing the immunity levels and exposure risk in a population. In this study, a cross-sectional serological survey was conducted in Yingjiang County, China, in August-September, 2021. The study sites were villages along the borders with Myanmar, which have no local transmission since the last indigenous case registered in 2016. A total of 923 participants from six villages were enrolled. The majority was aged > 36 years (56.12%) and 12.46% (115/923) participants had experienced malaria infection at least once. A magnetic- bead-based assay was used to test antibodies against Plasmodium vivax antigen PvMSP-1 19 to evaluate the prevalence of antibody positive subjects. A reversible catalytic model was used to assess the risk of exposure. The prevalence of anti-PvMSP-1 19 IgG was 12.84% [95% confidence interval (CI): 9.22%-16.47%], 13.93% (95% CI: 10.11%-17.74%), and 3.57% (95% CI: 1.40%-5.75%) in three different line-of-defense areas, which differed significantly ( P < 0.0001). The prevalence of anti-PvMSP-1 19 IgG increased with age and no statistically significant difference was detected between the sexes. The reversible catalytic model indicated that the seropositive conversion rate and seronegative reversion rate were 0.0042, 0.0034, 0.0032 and 0.0024, 0.0004, 0.0065 in the first-, second-line-of-defense area and total areas, respectively, and the fitted value did not differ significantly from the observed value ( P > 0.1). Although this study found the prevalence of antibody-positive subjects and the seroconversion rate in this post-elimination setting were lower than that in transmission setting, the population still had an exposure risk. Serological surveillance should be considered in post-elimination settings to provide valuable information with which to evaluate the risk of malaria re-establishment., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Huang, Cui, Huang, Wang, Li, Guo, Guo and Xia.)

Malaria is a major public health threat worldwide, and it was also widely prevalent in the history in China, seriously endangering people's health and affecting socioeconomic development. China was certified malaria elimination in 2021 with unremitting efforts since the founding of the People's Republic of China in 1949. This great achievement has been another milestone in the fight against major infectious diseases following the elimination of smallpox, poliomyelitis, leprosy, filariasis, neonatal tetanus and blinding trachoma in China. This paper briefly introduces the malaria burden dynamics and the corresponding malaria transmission risk stratificantions, as well as systematically reviews the evolution of anti-malaria policies and measures from severe epidemic to elimination in China. Meanwhile, five key lessons in malaria control and elimination in China are also briefly summarized. All of the above provide evidences for promoting global malaria eradication and preventing reestablishment of malaria transmission, finally benefit all individuals still suffering from the scourge of malaria., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Yin, Zhang, Feng and Xia.)

Malaria is a parasitic disease caused by Plasmodium, and Anopheles sinensis is a vector of malaria. Although malaria is no longer indigenous to China, a high risk remains for local transmission of imported malaria. This study aimed to identify the risk distribution of vector An. sinensis and malaria transmission. Using data collected from routine monitoring in Shanghai from 2010 to 2020, online databases for An. sinensis and malaria, and environmental variables including climate, geography, vegetation, and hosts, we constructed 10 algorithms and developed ensemble models. The ensemble models combining multiple algorithms (An. sinensis: area under the curve [AUC] = 0.981, kappa = 0.920; malaria: AUC = 0.959, kappa = 0.800), with the best out-of-sample performance, were used to identify important environmental predictors for the risk distributions of An. sinensis and malaria transmission. For An. sinensis, the most important predictor in the ensemble model was moisture index, which reflected degree of wetness; the risk of An. sinensis decreased with higher degrees of wetness. For malaria transmission, the most important predictor in the ensemble model was the normalized differential vegetation index, which reflected vegetation cover; the risk of malaria transmission decreased with more vegetation cover. Risk levels for An. sinensis and malaria transmission for each district of Shanghai were presented; however, there was a mismatch between the risk classification maps of An. sinensis and malaria transmission. Facing the challenge of malaria transmission in Shanghai, in addition to precise An. sinensis monitoring in risk areas of malaria transmission, malaria surveillance should occur even in low-risk areas for An. sinensis.

ABSTRACT On 30 June 2021, China was certified malaria-free by the World Health Organization. In this study, the evolution, performance, outcomes, and impact of China's adaptive strategy and approach for malaria elimination from 2011 to 2020 were analysed using 10-year data. The strategy and approach focused on timely detection and rapid responses to individual cases and foci. Indigenous cases declined from 1,308 in 2011 to 36 in 2015, and the last one was reported from Yunnan Province in April 2016, although thousands of imported cases still occur annually. The "1-3-7" approach was implemented successfully between 2013 and 2020, with 100% of cases reported within 24 h, 94.5% of cases investigated within three days of case reporting, and 93.4% of foci responses performed within seven days. Additionally, 81.6% of patients attended the first healthcare visit within 1-3 days of onset and 58.4% were diagnosed as malaria within three days of onset, in 2017-2020. The adaptive strategy and approach, along with their universal implementation, are most critical in malaria elimination. In addition to strengthening surveillance on drug resistance and vectors and border malaria collaboration, a further adapted three-step strategy and the corresponding "3-3-7" model are recommended to address the risks of re-transmission and death by imported cases after elimination. China's successful practice and lessons learnt through long-term efforts provide a reference for countries moving towards elimination.

Malaria cases have dramatically declined in China along the Myanmar border, attributed mainly to adoption of the 1-3-7 surveillance and response approach. No indigenous cases have been reported in China since 2017. Counties in the middle and southern part of the border area have a higher risk for malaria importation and reestablishment after elimination.

Background: Malaria cases have declined significantly along the China-Myanmar border in the past 10 years and this region is going through a process from control to elimination. The aim of this study is to investigate the epidemiology of malaria along the border, will identify challenges in the progress from control to elimination., Methods: National reported malaria cases from China and Myanmar, along with the data of 18 Chinese border counties and 23 townships in Myanmar were obtained from a web-based diseases information reporting system in China and the national malaria control program of Myanmar, respectively. Epidemiological data was analyzed, including the number of reported cases, annual parasite index and proportion of vivax infection. Spatial mapping of the annual parasite index (API) at county or township level in 2014 and 2018 was performed by ArcGIS. The relationship of malaria endemicity on both sides of the border was evaluated by regression analysis., Results: The number of reported malaria cases and API declined in the border counties or townships. In 2014, 392 malaria cases were reported from 18 Chinese border counties, including 8.4% indigenous cases and 91.6% imported cases, while the highest API (0.11) was occurred in Yingjiang County. There have been no indigenous cases reported since 2017, but 164 imported cases were reported in 2018 and 97.6% were imported from Myanmar. The average API in 2014 in 23 Myanmar townships was significantly greater than that of 18 Chinese counties (P < 0.01). However, the API decreased significantly in Myanmar side from 2014 to 2018 (P < 0.01). The number of townships with an API between 0 and 1 increased to 15 in 2018, compared to only five in 2014, while still four townships had API > 10. Plasmodium vivax was the predominant species along the border. The number of reported malaria cases and the proportion of vivax infection in the 18 Chinese counties were strongly correlated with those of the 23 Myanmar townships (P < 0.05)., Conclusions: Malaria elimination is approaching along the China-Myanmar border. However, in order to achieve the malaria elimination in this region and prevent the re-establishment of malaria in China after elimination, continued political, financial and scientific commitment is required.

Although the past decades have seen a remarkable decrease in malaria-caused mortality and morbidity, the infection remains a significant challenge to global health. In the battle against malaria, China has gained notable feat and achievement since the 1940s through the efforts of several generations. Notably, China has not recorded a single indigenous malaria case since August 2016. The National Institute of Parasitic Diseases of the Chinese Center for Disease Control and Prevention (NIPD), as the only specialized institution for parasitic disease at the national level, has played a significant role in the malaria control, prevention, and elimination in China in the different historical periods. In order to transfer Chinese experiences on malaria control and elimination to other Low and Middle Income Countries (LMICs) and to improve global health collaboration, we have summarized and reviewed the contributions and achievements by the NIPD over the past 70 years, covering the epidemic situation; field investigation and laboratory experimental research on both parasite and vector; research and development on diagnostics, drugs, and insecticides; surveillance and response; technical and international. Support and cooperation. In addition, we also focus in particular on malaria retransmission risk, strategies on management of imported malaria cases and mobile populations, surveillance and response capacity to be maintained in post-elimination stage, challenges on diagnosis, drug resistance, and insecticide resistance as future concerns., (© 2020 Elsevier Ltd All rights reserved.)

Background: The China-Myanmar border region presents a great challenge in malaria elimination in China, and it is essential to understand the relationship between malaria vulnerability and population mobility in this region., Methods: A community-based, cross-sectional survey was performed in five villages of Yingjiang county during September 2016. Finger-prick blood samples were obtained to identify asymptomatic infections, and imported cases were identified in each village (between January 2013 and September 2016). A stochastic simulation model (SSM) was used to test the relationship between population mobility and malaria vulnerability, according to the mechanisms of malaria importation., Results: Thirty-two imported cases were identified in the five villages, with a 4-year average of 1 case/year (range: 0-5 cases/year). No parasites were detected in the 353 blood samples from 2016. The median density of malaria vulnerability was 0.012 (range: 0.000-0.033). The average proportion of mobile members of the study population was 32.56% (range: 28.38-71.95%). Most mobile individuals lived indoors at night with mosquito protection. The SSM model fit the investigated data (χ 2  = 0.487, P = 0.485). The average probability of infection in the members of the population that moved to Myanmar was 0.011 (range: 0.0048-0.1585). The values for simulated vulnerability increased with greater population mobility in each village., Conclusions: A high proportion of population mobility was associated with greater malaria vulnerability in the China-Myanmar border region. Mobile population-specific measures should be used to decrease the risk of malaria re-establishment in China.

Objective: To provide scientific basis for malaria surveillance in the elimination phase by retrospectively analyzing the diagnosis and reporting of imported malaria in Jiangxi Province., Methods: Data on malaria endemic situation and individual cases during 2012-2015 were collected through the National Information Management System for Infectious Diseases and the Report and Information Management System for Parasitic Diseases Control and Prevention. Detailed information on primary medical units, laboratory testing units, reporting units, diagnostic methods, time from onset to first medical visit, time from first medical visit to reporting, and time from onset to reporting was analyzed with the descriptive analysis method., Results: A total of 207 malaria cases were reported during 2012-2015 in Jiangxi, all were imported cases and 96.62%(200/207) were diagnosed with laboratory tests. The main primary medical units were found to be county-level (29.95%, 62/207) and prefecture-level (25.60%, 53/207) medical institutions, while the main laboratory testing units were prefecture-level medical institutions(35.27%,73/207) and county-level CDCs (20.29%, 42/207). There was a significant difference in the proportion of different laboratory testing units among the years(P < 0.05). The median time from onset to first medical visit was 1 d (0-149 d), from first medical visit to reporting was 3 d (0-144 d), and from onset to reporting was 5 d (0-149 d)., Conclusions: The first visit and the laboratory testing of malaria cases mainly occur in the prefecture-level and county-level medical institutions.

The 2015 malaria epidemiological data reported through the annual malaria statistics reporting system were collected and analyzed. Totally 3 288 malaria cases were reported in 664 counties of 31 Provinces/Municipalities/Autonomous Regions （P/M/A） in 2015, which increased by 6.8% in comparison to that of 2014 （3 078 cases）, and the incidence in 2015 was 0.024 0/10 000. The cases were reported primarily from Provinces of Yunnan （18.4%, 606/3 288）, Jiangsu （12.3%, 405/3 288）, Sichuan （8.8%, 290/3 288）, Guangxi （7.2%, 236/3 288） and Shandong（6.4%, 212/3 288）. Of all the cases, 40（1.2%, 40/3 288） were indigenous cases, mainly distributed in the border area of Yunnan （six counties）, Tibet （one county）, Liaoning （one county） and Hainan （one county）. There was one case of whom the source of infection was unknown. The locally-infected falciparum malaria was only found in Cangyuan County of Yunnan（1 case）. The prevalence of indigenous malaria in Motuo County of the Tibet Autonomous Region was over 1/10 000. Meanwhile, there were 3 248（98.8%, 3 248/3 288） abroad-imported cases which widely distributed in the 31 P/M/As. In addition, 3 265（99.3%, 3 265/3 288） of the reported cases were confirmed in reference laboratories, comprising 878 cases of Plasmodium vivax（26.9%, 878/3 265） 1 992 cases of P. falciparum（61.0%, 1 992/3 265）, 76 cases of P. malariae（2.3%, 76/3 265）, 272 cases of P. ovale（8.3%, 272/3 265） and 47 cases of mixed infection（1.4%, 47/3 265）. Furthermore, 163 cases（5.0%, 163/3 288） with severe clinical symptoms were reported in 14 P/M/As, with 20 deaths（0.6%, 20/3 288） in 10 P/M/As. Totally 3 116 malaria cases were reported through the China Information System for Disease Control and Prevention, including 39 indigenous cases. These data reflect achievements in malaria elimination, despite that challenges remain in boarder areas of Yunnan Province and in Motuo County of the Tibet Autonomous Region. Efforts are still needed in risk assesment for malaria re-transmission.

Background: For many countries where malaria is endemic, the burden of malaria is high in border regions. In ethnic minority areas along the Myanmar-China border, residents have poor access to medical care for diagnosis and treatment, and there have been many malaria outbreaks in such areas. Since 2007, with the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), a malaria control project was introduced to reduce the malaria burden in several ethnic minority regions., Methods: A malaria control network was established during the period from 2007 to 2014. Multiple malaria interventions, including diagnosis, treatment, distribution of LLINs and health education, were conducted to improve the accessibility and quality of malaria control services for local residents. Annual cross-sectional surveys were conducted to evaluate intervention coverage and indicators of malaria transmission., Results: In ethnic minority regions where a malaria control network was established, both the annual malaria incidence (19.1 per thousand per year, in 2009; 8.7, in 2014) and malaria prevalence (13.6 % in 2008; 0.43 % in 2014) decreased dramatically during the past 5-6 years. A total of 851 393 febrile patients were detected, 202 598 malaria cases (including confirmed cases and suspected cases) were treated, and 759 574 LLINs were delivered to populations at risk. Of households in 2012, 73.9 % had at least one ITNs/LLINs (vs. 28.3 %, in 2008), and 50.7 % of children less than 5 years and 50.3 % of pregnant women slept under LLINs the night prior to their visit. Additionally, malaria knowledge was improved in 68.4 % of residents., Conclusion: There has been great success in improving malaria control in these regions from 2007 to 2014. Malaria burdens have decreased, especially in KOK and WA. The continued maintenance of sustainable malaria control networks in these regions may be a long-term process, due to regional conflicts and the lack of funds, technology, and health workers. Furthermore, information and scientific support from the international community should be offered to these ethnic minority regions to uphold recent achievements.

In 2015, WHO issued the Global Technical Strategy for Malaria 2016-2030, which sets the target of reducing global malaria incidence and mortality rates by at least 90% by 2030. Although many countries have successfully achieved malaria elimination, they are facing the risk of imported malaria. In China, despite the acceleration of malaria elimination, imported malaria has become a potential threat to achieving complete malaria elimination. This paper reviews the worldwide research progress on risk assessment of secondary transmission of imported malaria, in the aim of providing reference for risk assessment of imported malaria and preventing secondary transmission in China.

Objective: To assess the malaria transmission risk in the border area of Yunnan Province and provide evidence for adjustment of malaria intervention and elimination strategies., Method: Data concerning malaria prevalence, vector distribution, and institutional intervention capacity were collected in 197 towns of 20 counties in the border area of Yunnan Province during 2012-2014. The malaria transmission potential index （TPI）, intervention capacity index (ICI) and malaria risk index (MRI) were calculated for each town, based on the criteria formulated by a professional committee. The towns were categorized according to the indices aforementioned. The risk map was created with GIS software., Results: Based on the TPI, the 197 towns comprised of 2 grade-I towns (including Nabang in Yingjiang and Banlao in Cangyuan) with high transmission potential, 11 grade-II towns with moderate transmission potential and 184 grade-III towns with low transmission potential. Based on the ICI, the 197 towns comprised of 4 grade-III towns (including Zhongke in Ximen, Zhonghe and Diantan in Tengchong, and Menghan in Jinghong) with a weak control capacity, 20 grade-II towns with a moderate control capacity and 173 grade-I towns with a strong control capacity. Based on the MRI, the 197 towns comprised of 2 grade-I towns (including Nabang in Yingjiang, and Banlao in Cangyuan) with a high transmission risk level, 12 grade-II towns with a moderate level and 183 grade-III towns with a low level distributed in 20 counties., Conclusion: The grade I or II towns with moderate and high transmission risk constitute <5% of the 197 towns in the border area, suggesting a relatively low level of malaria transmission risk in most counties.

Background: Remarkable progress has been made towards the elimination of malaria in China since the National Malaria Elimination Programme (NMEP) was launched in 2010. The incidence of locally-acquired malaria cases has declined rapidly and endemic areas have also dramatically shrunk. In total, 3 078 malaria cases were reported in 2014, but only 56 cases were indigenous. In order to further promote the elimination programme, we reviewed the progress of and experiences associated with malaria elimination in China, and identified the challenges and priorities for the next stage of the programme., Methods: Data were collected from the web-based China Information System for Disease Control and Prevention, and the China Annual Report of Malaria Elimination. The progress towards the elimination of malaria from 2010 to 2014 was measured., Results: During the implementation of the NMEP from 2010 to 2014, local malaria incidence has declined continuously, only remaining in the Yunnan Province and Tibet Autonomous Region in 2014. By the end of 2015, 75.6 % (1 636/2 163) of the malaria-endemic counties passed the sub-national elimination assessment. The main challenges are cases of border malaria and imported malaria from other countries. Sustainable support and investment from the government, the establishment of an effective surveillance and response system, and risk assessments for the potential reintroduction of malaria are priorities for the next stage of the elimination programme., Conclusions: The NMEP in China has been successfully implemented thus far and the malaria map has shrunk dramatically. The priorities for malaria elimination are interventions to block transmission at border areas, management of imported malaria cases, preventing malaria reintroduction, capacity building, and sustainability of malaria surveillance and response.

Background: The China's 1-3-7 strategy was initiated and extensively adopted in different types of counties (geographic regions) for reporting of malaria cases within 1 day, their confirmation and investigation within 3 days, and the appropriate public health response to prevent further transmission within 7 days. Assessing the level of compliance to the 1-3-7 strategy at the county level is a first step towards determining whether the surveillance and response strategy is happening according to plan. This study assessed if the time-bound targets of the 1-3-7 strategy were being sustained over time. Such information would be useful to improve implementation of the 1-3-7 strategy in China., Methods: This cross-sectional study involved country-wide programmatic data for the period January 1st 2013 to June 30th 2014. Data variables were extracted from the national malaria information system and included socio-demographic information, type of county, date of diagnosis, date of reporting, date of case investigation, case classification (indigenous, or imported, or unknown), focus investigation, date of reactive case detection (RACD), and date of indoor residual spraying (IRS). Summary statistics and proportions were used and comparisons between groups were assessed using the chi-square test. Level of significance was set at a P-value ≤ 0.05., Results: Of a total of 5,688 malaria cases from 731 counties, there were 55 (1 %) indigenous cases (only in Type 1 and Type 2 counties) and 5,633 (99 %) imported cases from all types of counties. There was no delay in reporting malaria cases by type of county. In terms of case investigation, 97.5 % cases were investigated within 3 days with the proportion of delays (1.5 %) in type 2 counties, being significantly lower than type 1 counties (4.1 %). Regarding active foci, 96.4 % were treated by RACD and/or IRS., Conclusions: The performance of 1-3-7 strategy was encouraging but identified some challenges that if addressed can further improve implementation.

This review summarizes the endemic characteristics and influencing factors of malaria in the Tibet Autonomous Region of China, as well as the opportunities and challenges for malaria elimination in this region. Recommendations on strategies for malaria control are also made.

The 2014 malaria epidemiological data reported through the annual malaria statistics reporting system were collected and analyzed. A total of 3 078 malaria cases were reported in 680 counties of 30 Provinces/ Municipalities/Autonomous Regions (P/M/A)(except Inner Mongolia) in 2014, decreased by 25.4% compared with the 4 128 cases in 2013. The incidence rate was 0.022 6/10 000. More cases distributed in Yunnan (17.3%, 533/3 078), Jiangsu (11.5%, 355/3 078), Sichuan (8.6%, 266/3 078), Henan (7.0%, 216/3 078) and Zhejiang (7.0%, 215/3 078) Provinces. Of all the cases, 56 (1.8%) were indigenous cases, mainly from the border area of Yunnan (comprising 9 counties) and the Tibet Autonomous Region (one county). Locally-infected falciparum malaria was only found in Yingjiang County (4 cases) and Cangyuan County (2 cases) of Yunnan. Indigenous malaria prevalence was of over 1/10 000 in Motuo County and Yingjiang County. There were 3 021 abroad-imported cases of malaria (98.1% ), which widely distributed in the 30 P/M/As. In addition, one case of quartan malaria with long latency was reported' in Guangdong Province. Of all the reported cases, 3 057 (99.3%) were further confirmed by plasmodium species, comprising 846 cases of vivax malaria (27.7%), 1 882 cases of falciparum malaria (61.6%), 3 cases of quartan malaria (1.7%), 231 cases of ovale malaria (7.6%), 44 cases of mixed infections, and one case of P. knowlesi malaria. Furthermore, 170 cases (5.5%) with severe conditions were reported in 16 P/M/As, and 25 deaths were reported in 15 P/M/As. In summary, remarkable achievements have been made in eliminating malaria in China, despite increases in imported cases. The border areas of Yunnan and Motuo County of Tibet Autonomous Region remain the key regions for malaria elimination. Efforts are needed to reinforce the management of imported cases and the treatment of complicated malaria.

Objective: To evaluate the transmission risk and the prevalence potential of malaria in Cangyuan ounty after earthquake., Methods: The malaria epidemiological data were collected through the web-based reporting system and the malaria statistics annual reporting system from 2005 to April 2015, and the epidemic factors of nalaria after earthquake in the recent three years in Cangyuan County of Yunnan Province were analyzed., Results: according to the web-based reporting system, 799 malaria cases were reported in Cangyuan County from 2005 to April 2015, of which 652 w6re vivax malaria, 127 falciparum malaria, and 20 unclassified. The highest number of cases occurred in 2006 (n=326), and one indigenous falciparum malaria case was reported after earchquake. In iddition, the cases were mainly distributed in Mangka (n=320, 40.1%), Banlao (n=191, 23.9%), Banhong (n=98, 12.3%) and Mengdong (n=92, 11.5%). According to the annual reporting system, there were a total of 519 ndigenous cases (58.4%) and 370 imported cases (41.6%) from 2005 to April 2015. The proportion of indigenous ,ase was above 65% in each year except for 2006, when it was less than 15%. The risk indicator in western ownships of Canyuan County was higher, especially in Mangka and Mengjiao., Conclusions: There is a potential isk of malaria transmission in Cangyuan County of Yunnan province, due to the huge natural, social and biological ilterations after earthquake and the yet presence of malaria transmission vehicle.

Objective: To establish a multiplex PCR detection system for identifying 4 human Plasmodium species and evaluate its applicability., Methods: The sequences of 18S rDNA gene of the 4 human Plasmodium species were compared using DNAman software, and 4 downstream primers were designed using Oligo 6.0 software, which targeted the region of variability between conserved regions 5 and 6 of the sequences. Using these primers, the specificity and sensitivity of the multiplex PCR system were evaluated, with plasmids containing the 18S rDNA gene sequence as a template. Further, a new nest PCR system (M-Nest) was established by combining the multiplex PCR system with the first-cycle genus-specific primer of the NP-1993 system. The sensitivities of the multiplex PCR system and the M-nest system were evaluated in serial dilutions of blood DNA samples from patients infected by P. falciparum and P. vivax. In addition, the NP-1993 and M-Nest systems were applied to screen the Plasmodium species in 307 blood samples from people returning to Guangxi from Ghana, a malaria epidemic area. And the NP-2002 and M-Nest systems were applied to re-check Plasmodium species in 66 blood samples collected in Guangxi from 2014 January to May, which were identified by microscopy to be infected mainly by P. ovale., Results: The sizes of multiplex PCR products for P. falciparum, P. vivax, P. ovale, and P. malariae were 268 bp, 323 bp, 394 bp, and 446 bp, respectively, located in-between 50-bp DNA ladders. However, their melting curves had similar Tm values, thus could not be used to identify the 4 species. The minimum detection limits of P. falciparum, P. malariae, P. ovale, and P. vivax 18S rDNA gene by the multiplex PCR system were 5.58x102, 1.56x103, 1.66x103, and 1.80 x 10(2) copies/[A. The minimum detection limit of blood DNA from falciparum malaria patients by the multiplex PCR system was 1.43 x 10(2)-8.84 x 10(3) copies/p.1 or 5.10 x 10-4.92 x 10(2) parasites/µl, higher than that of P. vivax (17.4-69.1 copies/L or 13.5-83.2 parasites/p). Compared with this multiples PCR system, The M-Nest system further reduced the minimum detection limit of Plasmodium by 10-100 folds. Further, the M-Nest and NP-1993 systems reached inconsistent detection results in 307 blood samples from people returned to from Ghana; the former detected 2 cases of P. ovale infection while the latter failed. In addition, the NP-2002 and M-Nest systems came to the same results in re-checking Plasmodium species in the 66 blood samples., Conclusion: The established multiplex PCR system can identify 4 human Plasmodium species simultaneously and has good applicability in practice.

Objective: To explore the effective screening radii of active case detection of the 1-3-7 surveillance and response strategy, and investigate the malaria parasite rate of carriers in China-Myanmar border., Methods: Three villages with indigenous malaria cases in Yingjiang County of Yunan Province were selected as study sites. The persons lived around the indigenous cases (index case) within the radius of 100 m, 300 m, 500 m, and 1 km were screened by microscopy and nested PCR. Parasite rate of asymptomatic carriers at different radii were calculated., Results: Among 278 blood samples, the parasite rate of asymptomatic carriers was 1.1% (3/278) and 2.2% (6/278) using microscopy and nested PCR, respectively. Based on the results of nested PCR, all the asymptomatic carriers could be detected within a 300 m radius around the index case, and with the highest proportion (66.7%) in the radius of 101-300 m., Conclusion: The asymptomatic carriers of malaria parasites in the China-Myanmar border area can be effectively detected within a 300 m screening radius of index case by using nested PCR.

Background: To reveal the spatio-temporal distribution of malaria vectors in the national malaria surveillance sites from 2005 to 2010 and provide reference for the current National Malaria Elimination Programme (NMEP) in China., Methods: A 6-year longitudinal surveillance on density of malaria vectors was carried out in the 62 national malaria surveillance sites. The spatial and temporal analyses of the four primary vectors distribution were conducted by the methods of kernel k-means and the cluster distribution of the most widely distribution vector of An.sinensis was identified using the empirical mode decomposition (EMD)., Results: Totally 4 species of Anopheles mosquitoes including An.sinensis, An.lesteri, An.dirus and An.minimus were captured with significant difference of distribution as well as density. An. sinensis was the most widely distributed, accounting for 96.25% of all collections, and its distribution was divided into three different clusters with a significant increase of density observed in the second cluster which located mostly in the central parts of China., Conclusion: This study first described the spatio-temporal distribution of malaria vectors based on the nationwide surveillance during 2005-2010, which served as a baseline for the ongoing national malaria elimination program.

Background: In China, the prevalence of malaria has reduced dramatically due to the elimination programme. The continued success of the programme will depend upon the accurate diagnosis of the disease in the laboratory. The basic requirements for this are a reliable malaria diagnosis laboratory network and quality management system to support case verification and source tracking., Methods: The baseline information of provincial malaria laboratories in the China malaria diagnosis reference laboratory network was collected and analysed, and a quality-assurance activity was carried out to assess their accuracies in malaria diagnosis by microscopy using WHO standards and PCR., Results: By the end of 2013, nineteen of 24 provincial laboratories have been included in the network. In the study, a total of 168 staff were registered and there was no bias in their age, gender, education level, and position. Generally Plasmodium species were identified with great accuracy by microscopy and PCR. However, Plasmodium ovale was likely to be misdiagnosed as Plasmodium vivax by microscopy., Conclusions: China has established a laboratory network for primary malaria diagnosis which will cover a larger area. Currently, Plasmodium species can be identified fairly accurately by microscopy and PCR. However, laboratory staff need additional trainings on accurate identification of P. ovale microscopically and good performance of PCR operations.

Objective: To identify the risk area in China during the malaria elimination process, and provide the evidence for promotion of the national malaria elimination programme and implementation of elimination strategy., Methods: Data collection was conducted in 24 endemic provinces in 2010, including data of transmission capacity, potential risk of malaria transmission and the capacity of health professional team at county level. Quantitative assessment of the malaria transmission risk as well as the capacity of health facilities were conducted based on the calculation of malaria transmission risk index (MTI) and health facilities capacity index (CI). ArcGIS 10.0 was used to develop the risk map based on the outcome of quantitative assessment., Results: The data of transmission capacity, potential risk of transmission and the capacity of health professional team were collected from 2147 counties in 24 provinces. Based on MTI and CI calculated for each county, statistic results showed that about 40% of the counties were under the average level of both MTI and CI. The relationship among potential risk of transmission, the capacity of health professional team and malaria incidence were analyzed in three dimensions, and four types were categorized among 2147 counties. Type I (super-high risk area) counties (20) distributed in Yunnan (9), Guangxi (5), Henan (1), Hunan (1), Hebei (1), Sichuan (1), Chongqing (1), and Tibet (1). 17 counties were classified into type II (high risk area) area, distributed in Yunnan (3), Guangxi (2), Guizhou (2), Shaanxi (2), Guangdong (1), Jiangxi (1), Hubei (1), Sichuan (1), Gansu (1), Hebei (1), Fujian (1) and Tibet (1). A total of 170 type III (moderate risk area) counties distributed in 19 provinces including Yunnan (15), Guizhou (14), Hebei (14), Sichuan (13), Shanxi (10), Guangxi (9), Hunan (9), Anhui (9), Jiangsu (9), Shaanxi (9), Shandong (9), Chongqing (8), Gansu (8), Jiangxi (7), Henan (7), Fujian (6), Guangdong (5), Hubei (5), and Zhejiang (4). 1940 type IV (low risk area) counties distributed in 24 provinces., Conclusion: The distribution of four types of risk area for malaria elimination is identified in China.

More attention has increasingly been given to asymptomatic carriers of plasmodium parasites as a source of infection in malaria elimination settings. However, asymptomatic infections can hardly be detected by microscopy and rapid diagnostic tests (RDTs) because of no symptoms and low parasitemia. This review summarizes the evolution of methods or tests which are currently used in the field.

Objective: To analyze the malaria situation and epidemic characteristics in 2013 in China, and provide evidence for implementing the National Malaria Elimination Program (NMEP)., Methods: The epidemiological data of malaria cases reported through the annual malaria statistics reporting system in 2013 were collected, and analyzed by using Microsoft Excel 2010 and ArcGIS 10.0., Results: A total of 4128 malaria cases were reported from 605 counties of 31 Provinces/Municipalities/Autonomous Regions (P/M/A) in 2013, representing 51.9% increase compared with 2718 cases in 2012, and the annual incidence was 0.0305/10,000. The cases were mainly reported from Guangxi (30.3%, 1251/4128), Yunnan (14.0%, 576/4128), Jiangsu (8.3%, 341/4128), Sichuan (5.8%, 238/4128), and Zhejiang (5.0%, 208/4128). The laboratory confirmed cases took 99.0% (4087/4128) while the other 1.0% (41/4128) were clinically diagnosed. Among the laboratory confirmed cases, 22.8% (930/4087) were vivax malaria cases, 71.2% (2908/4087) were falciparum malaria cases, 1.2% (51/4087) were quartan malaria cases, 3.3% (133/4087) were ovale malaria cases, and 1.6% (65/4087) were mixed infection cases. A total of 48 (1.2%, 48/4128) indigenous cases were reported from 12 counties in 3 provinces including 10 counties of Yunnan, 1 county of Tibet, and 1 county of Anhui. The indigenous falciparum malaria cases were reported in Cangyuan (4), Ruili (1), and Yingjiang (1) of Yunnan Province. The incidence of indigenous cases between 1/10,000 and 10/10,000 was found only in Motuo County of Tibet. Out of the 4128 malaria cases, a proportion of 97.9% (4042/4128) were reported as the abroad-imported cases who distributed in 30 provinces, and the remaining 0.9% (38/4128) were domestically-mobile cases reported from 9 provinces. Totally 156 (37.8%, 156/4128) severe cases were reported from 16 provinces and 23 (0.6%, 23/4128) malaria deaths were from 14 provinces. The monitoring and evaluation result of "1-3-7" indicators demonstrated that the proportion of cases reported within 1 day and investigated within 3 days after diagnosis was 100.0% and 96.1%, respectively, and the number of malaria foci disposed within 7 days were 1678., Conclusion: NMEP have yielded remarkable achievements in 2013, while the abroad-imported cases have increased significantly. The border areas of Yunnan and Motuo County of Tibet are still the key areas for malaria elimination in China. At the same time, domestically-mobile cases should be further managed.

In recent years, some microscopy-positive but nest-PCR negative (based on small subunit ribosomal RNA gene) ovale malaria cases were reported. The detection failure was due to the genetic variations between Plasomdoium ovale wallikeri and P. ovale curtisi. This paper reviews the discovery and validation processes of P. ovale wallikeri and the detection systems for identification of P. ovale.

To understand the current status of the malaria control programme at the county level in accordance with the criteria of the World Health Organisation, the gaps and feasibility of malaria elimination at the county and national levels were analysed based on three kinds of indicators: transmission capacity, capacity of the professional team, and the intensity of intervention. Finally, a roadmap for national malaria elimination in the People's Republic of China is proposed based on the results of a feasibility assessment at the national level., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Malaria has affected human health globally with a significant burden of disease, and also has impeded social and economic development in the areas where it is present. In Africa, many countries have faced serious challenges in controlling malaria, in part due to major limitations in public health systems and primary health care infrastructure. Although China is a developing country, a set of control strategies and measures in different local settings have been implemented successfully by the National Malaria Control Programme over the last 60 years, with a low cost of investment. It is expected that Chinese experience may benefit malaria control in Africa. This review will address the importance and possibility of China-Africa collaboration in control of malaria in targeted African countries, as well as how to proceed toward the goal of elimination where this is technically feasible., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

With the shrinking of indigenous malaria cases and endemic areas in the People's Republic of China (P.R. China), imported malaria predominates over all reported cases accounting for more than 90% of the total. On the way to eliminate malaria, prompt detection and rapid response to the imported cases are crucial for the prevention of secondary transmission in previous endemic areas. Through a comprehensive literature review, this chapter aims to identify risk determinants of potential local transmission caused by the imported malaria cases and discusses gaps to be addressed to reach the elimination goal by 2020. Current main gaps with respect to dealing with potential malaria resurgence in P.R. China include lack of cross-sectoral cooperation, lack of rapid response and risk assessment, poor public awareness, and inadequate research and development in the national malaria elimination programme., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Reduction patterns of Plasmodium falciparum and P. vivax malaria transmission and the role of an integrated strategy of case management and vector control are compared between different ecological zones. The epidemiology of malaria in Hainan and Yunnan provinces was disparate, even though distinct malaria control strategies have been adapted to different situations based on risk group, vector behaviours, local health infrastructure, and environmental conditions. The island Hainan appears to be victorious in eliminating malaria. However, there is still a long way to go to prevent the reintroduction of malaria in Hainan province and eliminating malaria in the border areas of Yunnan province. This review of the experiences and challenges from malaria control to elimination in Hainan and Yunnan provinces of southern China will provide a basis for the future elimination of malaria in the whole country., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The national action plan for malaria elimination in China (2010-2020) was issued by the Chinese Ministry of Health along with other 13 ministries and commissions in 2010. The ultimate goal of the national action plan was to eliminate local transmission of malaria by the end of 2020. Surveillance and response are the most important components driving the whole process of the national malaria elimination programme (NMEP), under the technical guidance used in NMEP. This chapter introduces the evolution of the surveillance from the control to the elimination stages and the current structure of national surveillance system in China. When the NMEP launched, both routine surveillance and sentinel surveillance played critical role in monitoring the process of NMEP. In addition, the current response strategy of NMEP was also reviewed, including the generally developed "1-3-7 Strategy". More effective and sensitive risk assessment tools were introduced, which cannot only predict the trends of malaria, but also are important for the design and adjustment of the surveillance and response systems in the malaria elimination stage. Therefore, this review presents the landscape of malaria surveillance and response in China as well as their contribution to the NMEP, with a focus on activities for early detection of malaria cases, timely control of malaria foci and epidemics, and risk prediction. Furthermore, challenges and recommendations for accelerating NMEP through surveillance are put forward., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The historical patterns of malaria transmission in the People's Republic of China from 1949 to 2010 are presented in this chapter to illustrate the changes in epidemiological features and malaria burden during five decades. A significant reduction of malaria incidence has resulted in initiation of a national malaria elimination programme. However, challenges in malaria elimination have been identified. Foci (or hot spots) have occurred in unstable transmission areas, indicating an urgent need for strengthened surveillance and response in the transition stage from control to elimination., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) supported a project on the control and elimination of malaria in People's Republic of China which was one of the biggest-scale international cooperation programmes to control malaria in the country during the past 10 years. The project promoted the effective implementation of the Chinese national malaria control programme. On the basis of epidemiologic data, an overview of the project activities and key performance indicators, the overall impact of the GFATM project was evaluated. We also reviewed relevant programme features including technological and management approaches, with a focus on best practice, innovations in implementation and the introduction of international standards. Last, we summarised the multi-stakeholder cooperation mechanism and comments on its sustainability in the post-GFATM period. Recommendations for the future management of the Chinese national malaria elimination programme are put forward after considering the challenges, shortcomings and lessons learnt during the implementation of the GFATM project in China to sustain past achievements and foster the attainment of the ultimate goal of malaria elimination for the country., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Malaria is the most important parasitic protozoan infection that has caused serious threats to human health globally. China has had success in reducing the morbidity and mortality of malaria to the lowest level through sustained and large-scale interventions. Although the total number of malaria cases declined gradually, the burden of the imported malaria cases mainly from Southeast Asian and African countries has increased substantially since 2000, posing a severe threat to public health in China. This review explores and analyses the epidemiological characteristics of the imported malaria based on data from 2000 to 2012, in order to provide theoretical bases and insights into effective prevention, avoid the resurgence of malaria in malaria-susceptible areas and develop appropriate strategies to protect people's health in China. This review also intends to offer the useful information of innovative approaches and tools that are required for malaria elimination in various settings., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: To analyze malaria situation and epidemic characteristics in 2012 in China, and provide evidence and reference for National Malaria Elimination Programme (NMEP) performance., Methods: The epidemiological data of malaria cases reported through the annual malaria statistics reporting system in 2012 were collected and analyzed using Microsoft Excel 2010 and ArcGIS 10.0., Results: Totally 2,718 malaria cases were reported from 620 counties of 31 Provinces/Municipalities/Autonomous Regions (P/M/A) in 2012, representing 39.3% reduction compared with 4,479 cases in 2011, and the annual incidence was 0.020 2/10,000. The cases were mainly reported from provinces of Yunnan (31.4%, 853/2,718), Guangxi (8.1%, 220/2,718), Jiangsu (7.3%, 198/2,718), Hunan (5.8%, 158/2,718), and Sichuan (5.7%, 155/2,718). Among the 620 counties with reported cases, 8 counties including Motuo (8.1818/10,000) in Tibet, Ruili (8.248 9/10,000), Yingjiang (3.021 4/10,000), Longchuan (1.4778/10,000), Mangshi (1.4244/10,000), Tengchong (3.1601/10,000) and Cangyuan (1.340 0/10,000) in Yunnan, and Shanglin (2.355 1/10,000) in Guangxi had an incidence between 1/10,000 and 10/10,000, 96 counties had an incidence between 0.1/10,000 and 1/10,000, and that of the others was below 0.1/10,000. The laboratory confirmed cases took 95.6% (2.599/2,718) while the other 4.4% (119/2,718) were clinically diagnosed. In detail, 39.7% (1080/2,718) were P. vivax cases, 52.2% (1.419/2,718) were P. falciparum cases, 1.6%(44/2,718) were mixed infection of P. vivax and P. falciparum, and 2.1% (56/2,718) were P. ovale and P. malariae cases. However, the proportions of lab-confirmed cases in Xinjiang, Jilin, Heilongjiang, Tibet, Ningxia, Shanxi and Qinghai were below 75.0%. A total of 182 (6.7%, 182/2,718) indigenous cases were reported from 41 counties in 5 provinces including 20 counties of Yunnan, 15 counties of Anhui, 4 counties of Hubei, 1 county of Tibet and 1 county of Guangxi, consisting of 38 (20.9%, 38/182) clinically diagnosed cases (30 cases from Yunnan and 8 from Tibet), 133 (73.1%, 133/182) P. vivax cases (92 cases from Yunnan, 30 from Anhui, 9 from Hubei, 1 from Guangxi and 1 from Tibet), and 9 (4.9%, 9/182) P. falciparum cases as well as 2 (1.1%, 2/182) mixed infections from Yunnan. The incidence of indigenous cases between 1/10,000 and 10/10,000 was found only in Motuo County of Tibet, and that of the others was below 1/10,000. Out of the 2,718 malaria cases, a proportion of 91.0% (2,474/2,718) were reported as the abroad-imported cases who distributed in 29 provinces, and the remaining 2.3% (62/2,718) were domestically-mobile cases reported from 10 provinces. Totally 145 (5.3%, 145/2,718) severe cases were reported from 15 provinces and 15 (0.6%, 15/2,718) malaria deaths were from 11 provinces., Conclusion: Generally the indigenous malaria was reduced closer to the NMEP target, while malaria importation becomes an increasing challenge.

Background: In the battle against malaria in China, the rate of elementary and high school students' awareness on malaria knowledge is an important index for malaria elimination, but only rare data is available. This study aimed to investigate the level of malaria awareness in students at elementary and high schools in malaria endemic areas of China, and to provide the baseline information for the malaria elimination., Methods: This cross-sectional survey was conducted in 20 different malaria-endemic provinces in the first year of China's National Malaria Elimination Programme (NMEP). A structured questionnaire was administrated to students at elementary and high schools enrolled. A total of 44,519 questionnaires were effective while 1,220 were excluded because of incomplete survey responses., Results: More than 60% of students were aware of malaria, but only 9,013 of them answered correctly to all five questions, and there were still 1,862 students unaware of malaria. There were significant differences of the awareness of malaria among different age groups, between male and female, between two different education levels., Discussion: The study reveals that students at elementary and high school levels did not have adequate knowledge of malaria about biology, pathogenicity, transmitting vectors and preventive methods and so on at the beginning of NMEP in China. Further emphasis should be paid on health education campaigns in China to increase students' public awareness of malaria about vector control, treatment, prevention.

Background: Insecticide resistance in malaria vectors is a growing concern in many countries and requires immediate attention because of the limited chemical arsenal available for vector control. There is lack of systematic and standard monitoring data of malaria vector resistance in the endemic areas, which is essential for the ambitious goal of malaria elimination programme of China., Methods: In 2010, eight provinces from different malaria endemic region were selected for study areas. Bioassays were performed on F1 progeny of Anopheles sinensis reared from wild-caught females using the standard WHO susceptibility test with diagnostic concentrations of 0.25% deltamethrin and 4% DDT., Results: For An. sinensis, the results indicated that exposure to 0.25% deltamethrin of F1 families with mortalities ranging from 5.96% to 64.54% and less than 80% mortality to DDT at the diagnostic concentration of 4% across the study areas., Conclusions: Anopheles sinensis was completely resistant to both deltamethrin and DDT, and resistance to pyrethroid has risen strikingly compared to that recorded during 1990s. The results highlight the importance of longitudinal insecticide resistance monitoring and the urgent need for a better understanding of the status of insecticide resistance in this region.

Objective: To analyze the results of the National Technique Competition for Diagnosis of Parasitic Diseases in 2011, so as to understand the capability of detection on Plasmodium among professionals from institutes for disease control and prevention at different levels., Methods: All the contestants were grouped by the gender, age, professional title, level of institution, epidemic degree of malaria of provinces, coverage status of the project of the global fund to fight malaria, and geographical location of the provinces, and their scores were statistically analyzed by SPSS 17.0 software., Results: There were no significantly differences among the scores grouped by the different genders, ages, professional titles, and levels of institution (all P > 0.05). However, there were significantly differences among the scores grouped by the different epidemic degrees of malaria of the province, coverage statuses of the project of the global fund to fight malaria, and geographical locations of the province (all P < 0.05). For the contestants who came from the provinces with malaria epidemic counties of Class I and Class II types, provinces covered by the project of the global fund to fight malaria, and provinces located in the south, their scores of blood slides making and films reading under a microscope were significantly higher than those of the contestants from the provinces without epidemic counties of Class I and II types, not covered by the project of the global fund, and provinces located in the north, respectively., Conclusions: The overall level of the capabilities of detection on Plasmodium is imbalanced, and the capability of films reading under a microscope is especially low. It is urgent to promote the personnel training and strengthen the capability of pathogenic detection of parasitic diseases.

Objective: To study the thresholds and potential of malaria transmission by Anopheles anthropophagus in Hubei Province and provide indicators for the disease surveillance, early warning, prevention and control in the locality., Methods: From July to August 2001, field investigations on vectors and malaria situation were carried out in the village of Yanjiafan, Suizhou City, where the malaria incidence was high. The entomological investigations included the man-biting rate, the proportion of parous anophelines, the human blood index and the blood preference. The others included malaria incidence and parasite rate in human population, the intervals from episode to treatment of the cases, and collection of data on the mean temperature in the area. Based on the formula of basic reproductive rate, the critical man-biting rate was estimated., Results: 92.6% (63/68) of An. anthropophagus were found to have human blood meals, it occupied 91.5% (97/106) of the mosquitoes in human dwellings, its human blood index and vectorial capacity were 12.5 times (0.50/0.04) and 6.5 times (0.9448/0.1449) higher than those of An. sinensis. The critical man-biting rate was 0.2823 and the adjusted man-biting rate was 3.5 times of its critical man-biting rate (0.9892/0.2823). The malaria incidence was 0.65% (12/1844) and the parasite rate in pupils was 0.51%(1/198)., Conclusion: A reduction of the adjusted man-biting rate of An. anthropophagus by 71.5% is needed for interrupting malaria transmission by this vector in the study area.

Malaria cases have dramatically declined in China along the Myanmar border, attributed mainly to adoption of the 1-3-7 surveillance and response approach. No indigenous cases have been reported in China since 2017. Counties in the middle and southern part of the border area have a higher risk for malaria importation and reestablishment after elimination. [ABSTRACT FROM AUTHOR]

Background: Sulfadoxine-pyrimethamine (SP) is recommended for intermittent preventive treatment in Africa against Plasmodium falciparum infection. However, increasing SP resistance (SPR) of P. falciparum affects the therapeutic efficacy of SP, and pfdhfr (encoding dihydrofolate reductase) and pfdhps (encoding dihydropteroate synthase) genes are widely used as molecular markers for SPR surveillance. In the present study, we analyzed single nucleotide polymorphisms (SNPs) of pfdhfr and pfdhps in P. falciparum isolated from infected Chinese migrant workers returning from Africa. Methods: In total, 159 blood samples from P. falciparum -infected workers who had returned from Africa to Anhui, Shangdong, and Guangxi provinces were successfully detected and analyzed from 2017 to 2019. The SNPs in pfdhfr and pfdhps were analyzed using nested PCR. The genotypes and linkage disequilibrium (LD) were analyzed using Haploview. Results: High frequencies of the Asn51Ile (N51I), Cys59Arg(C59R), and Ser108Asn(S108N) mutant alleles were observed, with mutation frequencies of 97.60, 87.43, and 97.01% in pfdhfr , respectively. A triple mutation (IRN) in pfdhfr was the most prevalent haplotype (86.83%). Six point mutations were detected in pfdhps DNA fragment, Ile431Val (I431V), Ser436Ala (S436A), Ala437Gly (A437G), Lys540Glu(K540E), Ala581Gly(A581G), Ala613Ser(A613S). The pfdhps K540E (27.67%) was the most predominant allele, followed by S436A (27.04%), and a single mutant haplotype (SGKAA; 62.66%) was predominant in pfdhps. In total, 5 haplotypes of the pfdhfr gene and 13 haplotypes of the pfdhps gene were identified. A total of 130 isolates with 12 unique haplotypes were found in the pfdhfr-pfdhps combined haplotypes, most of them (n = 85, 65.38%) carried quadruple allele combinations (CIRNI-SGKAA). Conclusion: A high prevalence of point mutations in the pfdhfr and pfdhps genes of P. falciparum isolates was detected among Chinese migrant workers returning from Africa. Therefore, continuous in vitro molecular monitoring of Sulfadoxine-Pyrimethemine combined in vivo therapeutic monitoring of artemisinin combination therapy (ACT) efficacy and additional control efforts among migrant workers are urgently needed. [ABSTRACT FROM AUTHOR]