Seven decades towards malaria elimination in Yunnan, China

Abstract

Background Yunnan Province was considered the most difficult place in China for malaria elimination because of its complex malaria epidemiology, heterogeneous ecological features, relatively modest economic development, and long, porous border with three malaria endemic countries: Lao People’s Democratic Republic, Myanmar, and Viet Nam. Methods Academic publications and grey literature relevant to malaria elimination in Yunnan covering the period from 1950 until 2020 inclusive were considered. The following academic indexes were searched: China Science Periodical Database, China National Knowledge Infrastructure Database, and MEDLINE. Grey literature sources were mainly available from the National Institute of Parasitic Diseases (NIPD), the Chinese Center for Diseases Control and Prevention, and the Yunnan Institute of Parasitic Diseases (YIPD). Results A malaria elimination campaign in the 1950–1960s, based mainly on mass administration of antimalarial drugs and large-scale vector control, reduced morbidity and mortality from malaria and interrupted transmission in some areas, although elimination was not achieved. Similar strategies were used to contain outbreaks and a resurgence of disease during the 1970s, when malaria services were discontinued. From the 1980s, malaria incidence declined, despite the challenges of large numbers of mobile and migrant populations and an unstable primary health care system in rural areas following economic transformation. Launch of the national malaria elimination programme in 2010 led to adoption of the ‘1–3-7′ surveillance and response strategy specifying timely detection of and response for every case, supported by the establishment of a real-time web-based disease surveillance system and a new primary health care system in rural areas. Border malaria was addressed in Yunnan by strengthening the surveillance system down to the lowest level, cross-border collaboration with neighbouring countries and non-governmental organizations, and the involvement of other sectors. Conclusions Seven decades of work to eliminate malaria in Yunnan have shown the importance of political commitment, technically sound strategies with high quality implementation, a robust surveillance and response system at all levels, community participation and effective management of border malaria. The experiences and lessons learned from elimination remain important for prevention re-establishment of malaria transmission in the Province.

Evidence for the early emergence of piperaquine-resistant Plasmodium falciparum malaria and modeling strategies to mitigate resistance

“…While PPQ resistance was documented clinically in Cambodia in 2014, reports dating back to the 1980s suggest resistance previously emerged in Yunnan Province, China, when PPQ was used as a monotherapy to treat CQ-resistant malaria [36][37][38]. This region borders Myanmar, Laos and Vietnam and was the most difficult region to control malaria transmission in China [39]. We hypothesized that mutations in PfCRT may explain the early PPQ resistance in Yunnan Province and that investigating PPQ-resistant isoforms from that region could provide important evolutionary clues when compared to the structure and function of the currently circulating isoforms.…”

Asymptomatic malaria infection at the China-Vietnam border: Knowledge and implications for the cross-border migrant population during the COVID-19 pandemic

“…Our study detected 6 asymptomatic infections, accounting for 5.6% of the migrant population from Vietnam, in this study. Unlike the China-Myanmar border, which poses a substantial challenge for malaria elimination in Yunnan Province due to the high prevalence of P. vivax and P. falciparum in northern Myanmar [ 14 , 15 ], the China-Vietnam border seems to be “forgotten” in terms of malaria prevention because of the low incidence of malaria in northern Vietnam. The incidence rates in two border counties on the China-Myanmar border, Jingxi and Longzhou counties, decreased to 4.0 and 4.27 per 100,000 in the late 20th century, respectively, and no indigenous cases occurred during the early 21st century [ 16 , 17 ].…”

Malaria Knowledge and Infection Among Migrant Population in the China-vietnam Border: A Questionnaire-based Survey

“…The ndings in our study have revealed that 6 asymptomatic infections detected, accounting for 5.6% of all migrant population from Vietnam. Unlikely the China-Myanmar border, which may pose great challenge for malaria elimination to Yunnan Province due to the high prevalence of P. vivax and P. falciparum in northern Myanmar [11,12], malaria in the China-Vietnam border seems a "forgotten disease" because of the low incidence in northern Vietnam. Hai Phong, located in the northern Vietnam, the average positive predictive values was 0.10% in 2010-2014 [13].…”