Malaria Imported from Ghana by Returning Gold Miners, China, 2013

Abstract

During May-August 2013, a malaria outbreak comprising 874 persons in Shanglin County, China, was detected among 4,052 persons returning from overseas. Ghana was the predominant destination country, and 92.3% of malarial infections occurred in gold miners. Preventive measures should be enhanced for persons in high-risk occupations traveling to malaria-endemic countries.

Plasmodium falciparum malaria importation from Africa to China and its mortality: an analysis of driving factors

“…the strongest linkage was between Ghana and Guangxi province) in this analysis reflects the variability of connections and driving factors that exist. The presence of four distinct communities relates to patterns in investments and volume of workers moving between specific provinces in China and specific countries in SSA1920. The strong origin-destination importation pair between Ghana and Guangxi Province in China is likely caused by the large number of migrant workers from Shanglin county in Guangxi to Ghana, with >10,000 inhabitants travelling abroad to conduct gold mining work in Ghana since 2006.…”

“…The strong origin-destination importation pair between Ghana and Guangxi Province in China is likely caused by the large number of migrant workers from Shanglin county in Guangxi to Ghana, with >10,000 inhabitants travelling abroad to conduct gold mining work in Ghana since 2006. Moreover, Ghana began to strictly regulate the gold mining industry in late April 2013, which forced many gold miners to return to China within a short period, and more than 800  P. falciparum cases were found through screening in Shanglin during May–August 201319.…”

“…Recent ODA investments (in particular natural resource extraction projects) by Chinese companies14, mainly state-owned enterprises, has led to growth in the number of migrant Chinese labourers in SSA, and those engaged in outdoor activities are at particularly high risk for malaria infection121319. The findings in this analysis also echo a previous retrospective study in Jiangsu Province of China covering the period of 2001–2011, which found that the increase of imported malaria cases was associated with the growth of investment and the increasing number of Chinese labourers to Africa from Jiangsu20.…”

“…Since the initiation of National Malaria Elimination Action Plan (2010–2020) in May 2010, which aims to eliminate malaria by 2020, autochthonous malaria cases have numbered in the hundreds annually, and the spatial distribution of locally acquired P. falciparum malaria in China has been significantly narrowed to Yunnan and Hainan provinces1718. However, imported P. falciparum malaria is on the rise, with a higher case-fatality rate reported than that for countries in north America and Europe7111213, leading to a threat to the health of travellers and challenges to the Chinese healthcare system, as well as increasing the potential for re-introduction and onward transmission in malaria-free receptive areas1213181920.…”

“…For example, identifying which regions tend to import cases from certain parts of Africa more than others means that local health facilities can be aware of risks and make more rapid diagnoses to save lives, undertake proactive interventions, such as prophylaxis to high risk travellers, and tailoring public health awareness campaigns2223. The majority of imported P. falciparum malaria cases in China have been reported in those with a history of labour-related travel to Africa12131920, and thus, identifying potential high risk groups of travellers and the factors driving these risks facilitates both the tailoring of interventions2425 and an understanding of how these risks might impact future importation rates, supporting strategy design.…”