Clinical Malaria along the China–Myanmar Border, Yunnan Province, China, January 2011–August 2012

Zhou, Guofa; Sun, Ling; Rongji, Xia; Duan, Yihong; Xu, Jianwei; Yang, Henglin; Wang, Ying; Lee, Ming‐Chieh; Xiang, Zheng; Yan, Guiyun; Cui, Liwang; Yang, Zhaoqing

doi:10.3201/eid2004.130647

Cited by 31 publications

(50 citation statements)

References 6 publications

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“…In addition, P. vivax malaria persists in areas of Yunnan province along the China-Myanmar border (25), and CQ was adopted more than 50 years ago in China as the first-line drug used for treatment of the blood-stage P. vivax infection. Although highlevel resistance of P. vivax to CQ and SP was reported more than a decade ago in the north of Myanmar (26,27), the resistance in the border counties of China remains unknown.…”

Section: Discussionmentioning

confidence: 99%

Amplification of pfmdr1 , pfcrt , pvmdr1 , and K13 Propeller Polymorphisms Associated with Plasmodium falciparum and Plasmodium vivax Isolates from the China-Myanmar Border

Feng

Zhou

Lin

et al. 2015

Antimicrob Agents Chemother

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bMalaria in the China-Myanmar border region is still severe; local transmission of both falciparum and vivax malaria persists, and there is a risk of geographically expanding antimalarial resistance. In this research, the pfmdr1, pfcrt, pvmdr1, and K13-propeller genotypes were determined in 26 Plasmodium falciparum and 64 Plasmodium vivax isolates from Yingjiang county of Yunnan province. The pfmdr1 (11.5%), pfcrt (34.6%), and pvmdr1 (3.1%) mutations were prevalent at the China-Myanmar border. The indigenous samples exhibited prevalences of 14.3%, 28.6%, and 14.3% for pfmdr1 N86Y, pfcrt K76T, and pfcrt M74I, respectively, whereas the samples from Myanmar showed prevalences of 10.5%, 21.1%, and 5.3%, respectively. The most prevalent genotypes of pfmdr1 and pfcrt were Y 86 Y 184 and M 74 N 75 T 76 , respectively. No pvmdr1 mutation occurred in the indigenous samples but was observed in two cases coming from Myanmar. In addition, we are the first to report on 10 patients (38.5%) with five different K13 point mutations. The F446I allele is predominant (19.2%), and its prevalence was 28.6% in the indigenous samples of Yingjiang county and 15.8% in samples from Myanmar. The present data might be helpful for enrichment of the molecular surveillance of antimalarial resistance and useful for developing and updating guidance for the use of antimalarials in this region. Malaria is a serious public health problem in the Greater Mekong Subregion (GMS), which includes Cambodia, Laos, Thailand, Vietnam, Myanmar, and Yunnan province of China (1). Within this region, malaria transmission is particularly intense in international border areas. The malaria prevalence along the China-Myanmar border is particularly high, and malaria outbreaks have occurred frequently (2). In 2010, China initiated the National Malaria Elimination Action Plan, which aims to eliminate local malaria transmission nationwide by 2015 with the exception of the border region in Yunnan province and to completely eliminate malaria from China by 2020 (3). Despite a great reduction in the number of local malaria cases recently, both Plasmodium falciparum and Plasmodium vivax infections persist in the counties at the China-Myanmar border.Effective chemotherapy is essential for malaria control, but the emergence and spread of multidrug-resistant (MDR) P. falciparum strains have led to the adoption of artemisinin-based combination therapies (ACTs) as the first-line treatment for uncomplicated falciparum malaria in the GMS. However, the confirmed emergence of artemisinin resistance in western Cambodia is a major threat for malaria control and elimination (4). Artemisinin resistance has since spread or emerged independently or both in other areas of mainland Southeast Asia (5). Because this area has been the origin of both chloroquine (CQ) and sulfadoxine-pyrimethamine (SP) resistance (6, 7), the consequences of a similar spread of artemisinin resistance will be catastrophic. Therefore, the World Health Organization (WHO) is coordinating a largescale elimination campa...

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Section: Discussionmentioning

confidence: 99%

Amplification of pfmdr1 , pfcrt , pvmdr1 , and K13 Propeller Polymorphisms Associated with Plasmodium falciparum and Plasmodium vivax Isolates from the China-Myanmar Border

Feng

Zhou

Lin

et al. 2015

Antimicrob Agents Chemother

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“…Intensive intervention during the past two decades has led to a dramatic decrease in global malaria incidence. Countries like China and Thailand have entered the malaria elimination phase (Cui et al, 2012a; Cui et al, 2012b; Zhou et al, 2014a). As malaria transmission further declines, control measures will increasingly rely on accurate knowledge of risk factors as well as the ability to define high-risk areas and populations for targeted interventions (Bousema et al, 2010; Bousema et al, 2012; Marsh, 2010; Moonen et al, 2010; Mosha et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

“…As a consequence of shared borders, low malaria transmission countries such as China (Zhang et al, 2014b) and Thailand will continually face the challenges of managing cross-border malaria introduction (Parker et al, 2015; Wangdi et al, 2015; Zhou et al, 2005; Zhou et al, 2014a). China is entering the malaria elimination phase with a very low malaria incidence rate (< 0.3 cases per 1,000,000p erson year in 2013).…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, timely, detailed mapping of malaria epidemiology in the border regions is essential for identifying malaria transmission hotspots and guiding targeted control efforts. However, malaria epidemiology studies conducted so far in this region mostly focused on malaria in China on large scales (Bi et al, 2013a; Clements et al, 2009; Hui et al, 2009; Li et al, 2013; Lin et al, 2009; Xu et al, 2015; Zhou et al, 2014a). Though these studies depicted the overall trends of malaria situation, better understanding of malaria transmission on a microgeographic level (e.g., villages) would provide unprecedented opportunities for local health department officials to execute targeted control efforts.…”

Section: Introductionmentioning

confidence: 99%

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Seasonal dynamics and microgeographical spatial heterogeneity of malaria along the China–Myanmar border

Zhou

Ruan

et al. 2016

Acta Tropica

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Malaria transmission is heterogeneous in the Greater Mekong Subregion with most of the cases occurring along international borders. Knowledge of transmission hotspots is essential for targeted malaria control and elimination in this region. This study aimed to determine the dynamics of malaria transmission and possible existence of transmission hotspots on a microgeographical scale along the China-Myanmar border. Microscopically confirmed clinical malaria cases were recorded in five border villages through a recently established surveillance system between January 2011 and December 2014. A total of 424 clinical cases with confirmed spatial and temporal information were analyzed, of which 330 (77.8%) were Plasmodium vivax and 88 (20.8%) were Plasmodium falciparum, respectively. The P. vivax and P. falciparum case ratio increased dramatically from 2.2 in 2011 to 4.7 in 2014, demonstrating that P. vivax malaria has become the predominant parasite species. Clinical infections showed a strong bimodal seasonality. There were significant differences in monthly average incidence rates among the study villages with rates in a village in China being 3-8 folds lower than those in nearby villages in Myanmar. Spatial analysis revealed the presence of clinical malaria hotspots in four villages. This information on malaria seasonal dynamics and transmission hotspots should be harnessed for planning targeted control.

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“…The temporary local population includes businessmen, travelers, and migrant workers (including migrants from economically less developed areas to developed areas, residents of border countries visiting relatives, and those carrying out cross-border trade, logging, quarry, and plantation activities). Myanmar may have reintroduced malaria to Yunnan [30]. The main reason for this cross-border contamination is that most young migrant workers live in villages, where poor living conditions and a lack of anti-mosquito facilities are likely to increase exposure to malaria vectors.…”

Section: Discussionmentioning

confidence: 99%

From Control to Elimination: Integrated Impact of Malaria Interventions in the Yunnan Province of China from 1983 to 2013

Li¹,

Yang²,

Zhou³

et al. 2017

Adv Tech Biol Med

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Clinical Malaria along the China–Myanmar Border, Yunnan Province, China, January 2011–August 2012

Cited by 31 publications

References 6 publications

Amplification of pfmdr1 , pfcrt , pvmdr1 , and K13 Propeller Polymorphisms Associated with Plasmodium falciparum and Plasmodium vivax Isolates from the China-Myanmar Border

Amplification of pfmdr1 , pfcrt , pvmdr1 , and K13 Propeller Polymorphisms Associated with Plasmodium falciparum and Plasmodium vivax Isolates from the China-Myanmar Border

Seasonal dynamics and microgeographical spatial heterogeneity of malaria along the China–Myanmar border

From Control to Elimination: Integrated Impact of Malaria Interventions in the Yunnan Province of China from 1983 to 2013

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