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Malaria elimination in China, evolution and challenges with respect to cross border transmission

Abstract : Malaria has occurred in 80% of the counties in China in the past. After several decades of effort, malaria prevalence decreased drastically and China is currently approaching elimination throughout the country. Information on malaria vectors is still found not well documented, which could hinder the development of appropriate surveillance strategies and WHO certification. The major risk to malaria elimination is the re-introduction of the disease from imported malaria cases. There are an increasing number of imported malaria cases caused by Chinese citizens returning from malaria-affected countries recently. The information about their characters, drivers and route of introduction in different areas will provide evidence-based data to policy makers where and when to carry out the interventions. This will in turn allow them to develop efficient guidelines for risk-assessment of malaria re-introduction and for allocating appropriate resources. As a country with over 1.3 billion population and a territory covering different climatic zones, lessons learnt from malaria elimination in China that could serve as references to other countries. According to the Belt and Road initiatives, China will participate more globally to governance related activities. Partners and stakeholders within Global malaria elimination campaign are interested to the future opportunity and potential fields that would involve Chinese expertise. 1.A summary analysis was conducted on the nationwide distribution of malaria vectors, their bionomic characteristics, control measures and related studies. The distribution in China of the principal malaria vectors was found reduced, in particular for Anopheles lesteri and Anopheles dirus s.l., including the two main malaria vector species, An. dirus and An. baimaii, which nearly disappeared after several years of malaria control effort. Anopheles sinensis, which was previously reported to be less efficient in malaria transmission, is becoming the predominant species in Southwestern China. The field sampling results indicated the existence of high efficient malaria vectors, e.g. An. minimus and An. harrisoni at the China-Myanmar border. In addition, elevated human-biting rates, high adult and larval densities, and parous rates were found in both An. sinensis and An. harrisoni, which reveal a very high receptivity and risk of malaria re-introduction along the China–Myanmar border. 2.The comparative analysis of imported malaria cases reported from former non-endemic areas and former endemic areas in China showed that all former non-endemic areas are now reporting imported malaria cases. 3. A summary analysis on malaria elimination progress since 2010, was carried out with specific focus on mapping the residual malaria foci and the distribution of malaria cases in China. The incidence of locally acquired malaria has declined sharply along with the concomitant decrease of malaria-endemic areas from 762 counties reporting malaria in 2010 to just two counties adjacent to border areas (Yunnan Province: China-Myanmar and Tibet, China-India) in 2016. In 2017, China achieved zero indigenous malaria case report for the first time. In conclusion, China is on the track to achieve malaria elimination by 2020. The risk of re-introduction caused by the emergence of imported malaria cases and the occurrence of highly efficient malaria vectors present in the country is still the target of malaria surveillance. To maintain malaria elimination, intensified international collaboration with specific focus on cross-border areas and mobile/migrant population is called to take actions. The pilot studies on how to introduce the lessons learned from malaria elimination in China and the Chinese expertise are on the list to take action in future, which would harmonize the China aid to malaria elimination in the target countries.
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Shaosen Zhang. Malaria elimination in China, evolution and challenges with respect to cross border transmission. Human health and pathology. Université Montpellier, 2019. English. ⟨NNT : 2019MONTT027⟩. ⟨tel-02464817⟩

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