Establishing and applying an adaptive strategy and approach to eliminating malaria: practice and lessons learnt from China from 2011 to 2020

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.

Polymorphisms of potential drug resistant molecular markers in Plasmodium vivax from China–Myanmar border during 2008‒2017

“…Of the six countries within GMS, malaria transmission levels are drastically various by country. Myanmar suffered the heaviest malaria load in GMS, whereas China reported no autochthonous malaria in 2017 and was certified indigenous malaria-free by the World Health Organization (WHO) in 2021 [ 2 – 4 ]. However, China still faces the challenge of maintaining the control efforts because it shares a long border with Myanmar, involving 18 counties in Yunnan Province.…”

Prompt and precise identification of various sources of infection in response to the prevention of malaria re-establishment in China

“…China has been under tremendous pressure from imported malaria over the years [ 10 ]. Before the COVID-19 pandemic, there were about 3,000 cases every year, mainly from Africa and Southeast Asia [ 10 ].…”

“…China has been under tremendous pressure from imported malaria over the years [ 10 ]. Before the COVID-19 pandemic, there were about 3,000 cases every year, mainly from Africa and Southeast Asia [ 10 ]. Five Plasmodium species were reported, with P. falciparum being the most prevalent, followed by P. vivax , and the proportion of P. ovale has been on the rise for several years [ 10 ].…”

“…Before the COVID-19 pandemic, there were about 3,000 cases every year, mainly from Africa and Southeast Asia [ 10 ]. Five Plasmodium species were reported, with P. falciparum being the most prevalent, followed by P. vivax , and the proportion of P. ovale has been on the rise for several years [ 10 ]. These imported malaria cases were not only large in quantity, but also widely distributed across China [ 11 ].…”

<i>Plasmodium vivax</i> in the Elimination Phase — China, 2013–2020

“…As most areas in central and southern China are susceptible areas where An. sinensis is prevalent, the imported P. vivax malaria may pose a high risk of malaria transmission re-establishment in these malaria-free localities during the transmission season ( 6 ).…”