Ready for malaria elimination: zero indigenous case reported in the People's Republic of China

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primaquine 23839 [[36]]. For instance, China has experience with mass drug administration (MDA) of pyrimethamine and primaquine . In the period from 1970s to 1980s, MDA was widely performed on a large scale involving millions of
pyrimethamine 23821 control programme [[36]]. For instance, China has experience with mass drug administration (MDA) of pyrimethamine and primaquine. In the period from 1970s to 1980s, MDA was widely performed on a large scale involving
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AIDS 29311 summarized and fedback to the NHC and all CDC levels.Sustained financial supportThe Global Fund to Fight AIDS , Tuberculosis and Malaria (GFATM) was one of the largest funder for malaria control and elimination
malaria 32 Title: Malaria JournalReady for malaria elimination: zero indigenous case reported in the People’s Republic of ChinaJun FengLi ZhangFang HuangJian-Hai
malaria 529 burden has sharply declined and epidemic areas have shrunk after the implementation of an integrated malaria control and elimination strategy, especially since 2000. In this review, the lessons were distilled
malaria 663 strategy, especially since 2000. In this review, the lessons were distilled from the Chinese national malaria elimination programme and further efforts to mitigate the challenges of malaria resurgence are being
malaria 743 the Chinese national malaria elimination programme and further efforts to mitigate the challenges of malaria resurgence are being discussed.MethodsA retrospective evaluation was performed to assess the changes
malaria 855 resurgence are being discussed.MethodsA retrospective evaluation was performed to assess the changes in malaria epidemic patterns from 1950 to 2017 at national level. The malaria data before 2004 were collected from
malaria 922 performed to assess the changes in malaria epidemic patterns from 1950 to 2017 at national level. The malaria data before 2004 were collected from paper-based annual reports. After 2004, each of the different cases
malaria 1434 examined to complete the missing data from IDIRMS.ResultsFrom 1950 to 2017, the occurrence of indigenous malaria has been steeply reduced, and malaria-epidemic regions have substantially shrunk, especially after the
malaria 1472 IDIRMS.ResultsFrom 1950 to 2017, the occurrence of indigenous malaria has been steeply reduced, and malaria -epidemic regions have substantially shrunk, especially after the launch of the national malaria elimination
malaria 1568 and malaria-epidemic regions have substantially shrunk, especially after the launch of the national malaria elimination programme. There were approximately 30 million malaria cases annually before 1949 with a
malaria 1635 after the launch of the national malaria elimination programme. There were approximately 30 million malaria cases annually before 1949 with a mortality rate of 1%. A total of 5999 indigenous cases were documented
malaria 2875 border areas, through regional cooperation. The findings from this review can probably help improving malaria surveillance systems in China, but also in other elimination countries.Electronic supplementary materialThe
malaria 3205 authorized users.BackgroundToday, the world still faces great challenges in fighting the scourge of malaria . According to the 2017 World Health Organization (WHO) World Malaria Report, after a period of unprecedented
malaria 3340 World Health Organization (WHO) World Malaria Report, after a period of unprecedented global success in malaria control, progress has stalled [[1]]. In 2016, 91 countries reported a total of 216 million cases of
malaria 3448 control, progress has stalled [[1]]. In 2016, 91 countries reported a total of 216 million cases of malaria , an increase of 5 million cases over the previous year, while the number of malaria deaths reached 445,000
malaria 3532 million cases of malaria, an increase of 5 million cases over the previous year, while the number of malaria deaths reached 445,000 [[1]]. Malaria transmission occurred mainly in areas where resources are limited,
malaria 3774 weak and cannot provide adequate diagnosis and treatment.In the past, China suffered seriously from malaria epidemics [[2]]. Malaria has been documented in traditional Chinese medicine books, and the presence
malaria 3886 epidemics [[2]]. Malaria has been documented in traditional Chinese medicine books, and the presence of malaria goes back approximately 4000 years in China’s history. Malaria expanded broadly, especially in rural
malaria 4157 decades [[3]]. From the foundation of the People’s Republic of China in 1949 to reaching the goal of malaria free in 2020, the transmission of the disease can be primarily grouped into five phases: (i) transmission
malaria 4591 (v) the elimination phase (2010–2020). Prior to 1949, there were approximately 30 million cases of malaria reported in China annually, and the mortality rate was about 1% [[5]]. Nevertheless, after the implementation
malaria 4739 mortality rate was about 1% [[5]]. Nevertheless, after the implementation of an integrated strategy for malaria control, including interventions, as well as socio-economic and environmental development, such as urbanization,
malaria 4961 alterations in the natural surroundings which affected the transmission pattern including changes of malaria vector distribution, the occurrence of indigenous malaria cases has been steeply reduced, and epidemic
malaria 5019 transmission pattern including changes of malaria vector distribution, the occurrence of indigenous malaria cases has been steeply reduced, and epidemic regions have drastically shrunk (Fig. 1) [[6]]. Thus,
malaria 5315 Malaria Elimination Action Plan (2010–2020) (NMEAP), with the objective of eliminating indigenous malaria in non-border regions before the end of 2015 and eliminating the disease nationwide before the end of
malaria 5456 end of 2015 and eliminating the disease nationwide before the end of 2020 [[7]].Fig. 1Incidence of malaria in China, 1950–2017. The different control and elimination phases are shown in different colours.
malaria 5987 the right-hand columnThere is strong evidence that the country has reached crucial milestones towards malaria elimination over the last 8 years [[8]]. Firstly, from 2010, the transmission of malaria, which was
malaria 6077 milestones towards malaria elimination over the last 8 years [[8]]. Firstly, from 2010, the transmission of malaria , which was primarily reported in 75 counties from 7 provinces, including Hainan and Yunnan, declined
malaria 6251 including Hainan and Yunnan, declined quickly in the first 4 years (Fig. 2) [[9]], while since 2014, malaria foci were mainly concentrated on the counties along the China–Myanmar border and in the Motuo County
malaria 6440 and in the Motuo County of the Tibetan Autonomous Region [[10]]. Secondly, a total of 5999 indigenous malaria cases were documented from 2010 to 2016, however those indigenous cases were steeply reduced by 99.9%
malaria 6645 99.9% over the 6 years (2010, n = 4262; 2016, n = 3) [[11]–[17]]. Thirdly, the species of malaria parasites that were transmitted has altered, e.g. no indigenous Plasmodium malariae and Plasmodium ovale
malaria 6728 Thirdly, the species of malaria parasites that were transmitted has altered, e.g. no indigenous Plasmodium malaria e and Plasmodium ovale were documented over the last few years, and the final indigenous case of Plasmodium
malaria 7092 in 2010, but there was zero indigenous case reported nationwide in 2017 [[18]] (Fig. 2). Fifthly, malaria elimination efforts have paid attention on the border areas since 2016, which was documented in the
malaria 7575 border areas, such as establishment of ‘three border defensive lines’ to prevent re-establishment of malaria transmission due to imported cases in Yunnan border areas, and the malaria elimination programme and
malaria 7650 prevent re-establishment of malaria transmission due to imported cases in Yunnan border areas, and the malaria elimination programme and reference laboratory were established in remote areas of Tibet in 2016 to
malaria 7954 professionals from the Guangdong Provincial Centre for Disease Control and Prevention.Fig. 2Indigenous malaria cases in China, 2010–2017. The red zones represent the areas where indigenous cases occur (the county
malaria 8245 Strategy for Malaria 2016–2030 (GTS) [[20]]. One of the key target of the GTS is the elimination of malaria in at least 35 countries by 2030, and to keep that timeline in sight, the strategy established milestones
malaria 8396 keep that timeline in sight, the strategy established milestones along the way, including eliminating malaria by 2020 in at least 10 countries that had the disease in 2015. The GTS recognizes progression towards
malaria 8506 2020 in at least 10 countries that had the disease in 2015. The GTS recognizes progression towards malaria -free status is a continuous process, and not a set of independent stages. Therefore, this review summarizes
malaria 8663 set of independent stages. Therefore, this review summarizes lessons learnt from the Chinese national malaria elimination programme and proposes further efforts to mitigate the challenges that still exist during
malaria 8821 to mitigate the challenges that still exist during the elimination phase, based on the analysis of malaria incidence patterns since 1950 and changes of the case-based malaria reporting data since 2010. The outcomes
malaria 8889 phase, based on the analysis of malaria incidence patterns since 1950 and changes of the case-based malaria reporting data since 2010. The outcomes are likely to demonstrate that malaria elimination is a country-led
malaria 8968 changes of the case-based malaria reporting data since 2010. The outcomes are likely to demonstrate that malaria elimination is a country-led and country-owned endeavour which can probably help improve malaria surveillance
malaria 9065 that malaria elimination is a country-led and country-owned endeavour which can probably help improve malaria surveillance systems not only in China, but also in other elimination countries.MethodsData collectionA
malaria 9239 elimination countries.MethodsData collectionA retrospective analysis was performed to assess the changes in malaria epidemic patterns from 1 January, 1950 to 31 December, 2017 at national level. The data before 2005
malaria 9958 reacting to any communicable disease. The IDIRMS mandated that each of the confirmed and suspected malaria cases in China’s hospital system be documented with the local Centre for Disease Control and Prevention
malaria 11467 response activities based on the results of the investigation. Reactive case detection, targeted anti- malaria l administration, indoor residual spray, and information, education, and communication activities can
malaria 11869 IDIRMS and the NIMSM are private. Malaria Department in NIPD was responsible for handling the national malaria data for these two systems, and has permission to access them. The data could be obtained once the staff
malaria 12843 investigation, and foci responses, were retrieved from the NMISM database. Finally, each of the documented malaria cases was geo-coded and paired to the county-level layers of polygon and point with ArcGIS 10.1 software
malaria 13040 ArcGIS 10.1 software (Environmental Systems Research Institute, Inc, Redlands, CA, USA).ResultsTrends of malaria incidence in ChinaChina is the most populous country in the world with a population of around 1.4 billion.
malaria 13444 challenge for the public health system and after sustainable efforts, the occurrence of indigenous malaria has been steeply reduced, and malaria-epidemic regions have been substantially shrunk between 1950 and
malaria 13482 system and after sustainable efforts, the occurrence of indigenous malaria has been steeply reduced, and malaria -epidemic regions have been substantially shrunk between 1950 and 2017. There were approximately 30 million
malaria 13597 malaria-epidemic regions have been substantially shrunk between 1950 and 2017. There were approximately 30 million malaria cases yearly nationwide prior to 1949, and the incidence peak occurred in 1970 (2961/100,000). Plasmodium
malaria 13823 the major species for relatively long time. From 2004 to 2017, it accounted for 70.1% of all reported malaria cases and had a peak in 2006, particularly in Huang-Huai Plain of central China such as Anhui and Henan
malaria 13966 particularly in Huang-Huai Plain of central China such as Anhui and Henan provinces, where the number of malaria cases in those two provinces accounted for 62.5% of the total cases in the country for that year [[10]–[16],
malaria 14751 intervention measures, and the disease burden was sharply reduced by 99.9% compared to 2010 when the national malaria elimination programme initiated. Indigenous cases were mainly documented in 2 regions since 2014, and
malaria 15167 [15.5%]), Hubei (n = 459 [7.7%]), and Guizhou (n = 458 [7.6%]).Patterns of imported caseOut of 2675 malaria cases reported in 2017, 99.9% of them were imported cases with only 0.1% (n = 3) induced cases from
malaria 15554 falciparum (n = 1719 [64.3%]), P. vivax (n = 496 [18.6%]), P. ovale (n = 350 [13.1%]), P. malaria e (n = 65 [2.4%]), and P. knowlesi (n = 1), as well as mixed infections (n = 35 [1.3%]).
malaria 15843 P. falciparum plus P. ovale (n = 10), P. vivax plus P. ovale (n = 9), P. falciparum plus P. malaria e (n = 1), P. ovale plus P. malariae (n = 1). Among the imported cases, 9 (0.3%) were clinically
malaria 15882 (n = 10), P. vivax plus P. ovale (n = 9), P. falciparum plus P. malariae (n = 1), P. ovale plus P. malaria e (n = 1). Among the imported cases, 9 (0.3%) were clinically diagnosed in Jilin (n = 4), Heilongjiang
malaria 16215 cases in China stratified by species (a) and origin of those imported cases (b) in 2017. The number of malaria cases using different colours to represent the imported cases distribution in China, as well as the
malaria 16442 cases. Each province in China and the origin country was marked with different colours on the mapThose malaria cases were imported from 53 countries, mainly from African countries (38 countries, n = 2285 [85.5%]),
malaria 16878 central Africa (n = 663 [38.6%]), P. vivax was mainly from Southeast Asia (n = 264 [53.2%]), P. malaria e and P. ovale were mainly from western (n = 178 [42.9%]) and central Africa (n = 172 [41.4%]),
malaria 17520 conducted by 20 blood slides from external quality assessment programme for communicable diseases ( malaria microscopy) in the WHO Western Pacific Region. PCR assessment was carried out using 3 different blood
malaria 17746 staff in a blind test for analysis [[31]].In addition, WHO has held external competency assessment of malaria microscopists in China since 2015, to assess microscopists, especially those at provincial level from
malaria 18144 in the WHO external assessment. Moreover, 2 rounds of the external quality assessment programme for malaria microscopy in NIPD were also organized annually sponsored by the WHO in 2013–2015. To date, 19 CDC
malaria 18725 launched in 1992 [[32]–[34]]; these are typical models for regional cooperation to greatly reduce malaria incidence in these regions. The regional collaboration mechanism strengthens timely information sharing
malaria 19039 and foci response, which in turn facilitates the elimination process.Verification and assessment for malaria eliminationUp to the end of 2017, a total of 2155 endemic counties and 215 prefectures completed the
malaria 19148 eliminationUp to the end of 2017, a total of 2155 endemic counties and 215 prefectures completed the malaria verification, which accounts for 99.5% and 83.3% of all of the endemic counties and prefectures, respectively
malaria 19338 and prefectures, respectively (Fig. 4). In 2015 and 2018, Shanghai and Jiangxi achieved sub-national malaria verification by the NHC [[35]].Fig. 4Sub-national malaria verification progress in China, 2012–2017.
malaria 19397 Shanghai and Jiangxi achieved sub-national malaria verification by the NHC [[35]].Fig. 4Sub-national malaria verification progress in China, 2012–2017. China has conducted sub-national verification of malaria
malaria 19499 malaria verification progress in China, 2012–2017. China has conducted sub-national verification of malaria elimination for all endemic provinces, and endemic provinces carry out county and prefecture malaria
malaria 19600 malaria elimination for all endemic provinces, and endemic provinces carry out county and prefecture malaria elimination verification by themselves. Similarly, a province/prefecture/county could conduct malaria
malaria 19702 malaria elimination verification by themselves. Similarly, a province/prefecture/county could conduct malaria elimination where no indigenous cases were reported in 3 consecutive yearsMonitoring and evaluationIn
malaria 20044 on Severe Malaria. Every quarter, the national elimination expert group carefully reviewed reported malaria cases, mainly on case investigation and foci response. The national experts group on severe malaria
malaria 20144 malaria cases, mainly on case investigation and foci response. The national experts group on severe malaria reviewed each death case attributed to malaria since 2016 and analysed the cause and lessons learned
malaria 20191 foci response. The national experts group on severe malaria reviewed each death case attributed to malaria since 2016 and analysed the cause and lessons learned from those reports.Each year, the NHC organizes
malaria 20322 the cause and lessons learned from those reports.Each year, the NHC organizes panels of experts on malaria elimination to supervise the elimination process for endemic provinces. The provinces are selected because
malaria 21115 Countries that progress towards UHC will make progress towards other health-related targets, such as end of malaria epidemic by sustained surveillance and prompt response for each malaria foci. In spite of the fact
malaria 21187 health-related targets, such as end of malaria epidemic by sustained surveillance and prompt response for each malaria foci. In spite of the fact that China has made large strides in managing malaria over the last several
malaria 21269 response for each malaria foci. In spite of the fact that China has made large strides in managing malaria over the last several decades, zero case of indigenous malaria was reported in the whole county in 2017,
malaria 21332 China has made large strides in managing malaria over the last several decades, zero case of indigenous malaria was reported in the whole county in 2017, which indicated that Chinese NMEAP has entered into a new
malaria 21670 two questions: What are the major lessons from Chinese NMEAP? What are the challenges of sustaining malaria non-transmission status?Lessons learnt from the successive NMEAPThe success of NMEAP since 2010 is mainly
malaria 22235 evaluation.Country leadership effortsNational elimination strategyStrong governmental leadership is essential for a malaria control and elimination programme. Between 2005 and 2017, the central government developed a series
malaria 22516 technical plans (Fig. 5). These documents helped staff members to make appropriate decisions when malaria was at epidemic proportions or even if there was an outbreak during control and elimination phase. For
malaria 22642 proportions or even if there was an outbreak during control and elimination phase. For example, since malaria incidence has been at the lowest level in 2009, the former Ministry of Health developed a new stratification
malaria 22762 has been at the lowest level in 2009, the former Ministry of Health developed a new stratification of malaria endemicity at the county level, which stated in NMEAP that each of the counties in China was divided
malaria 22974 into 4 types, with its own strategy and interventions.Fig. 5Documents developed to guide the national malaria control and elimination programme, 2005–2017The central government unified command scheduling, to
malaria 23158 command scheduling, to mobilize social resources to participate in the prevention and treatment of malaria . Local government officials support and prioritize malaria control and elimination when they are given
malaria 23217 participate in the prevention and treatment of malaria. Local government officials support and prioritize malaria control and elimination when they are given specific malaria control and elimination targets. The local
malaria 23278 government officials support and prioritize malaria control and elimination when they are given specific malaria control and elimination targets. The local Bureau of Health has developed its own malaria elimination
malaria 23368 specific malaria control and elimination targets. The local Bureau of Health has developed its own malaria elimination goal and timetable.Community mobilizationThe government mobilized social and financial resources
malaria 23489 goal and timetable.Community mobilizationThe government mobilized social and financial resources for malaria control and elimination. The mobilization of various sectors, including the community and the technical
malaria 23713 institutions and control services to participate and cooperate, is one of the major experience for the malaria control programme [[36]]. For instance, China has experience with mass drug administration (MDA) of
malaria 23988 MDA was widely performed on a large scale involving millions of people in Southern China, to decrease malaria incidence of P. vivax [[37]]. After 2000, focal MDA was adopted on a smaller scale, usually implemented
malaria 24343 clearing)China has experienced a big transition with its surveillance system. Between 1950 and 1985, malaria cases were recorded via county-based monthly reports delivered by post; in 1985–2003, malaria cases
malaria 24439 1985, malaria cases were recorded via county-based monthly reports delivered by post; in 1985–2003, malaria cases were recorded monthly via electronic means, and in 2004, due to the severe acute respiratory syndrome
malaria 24676 real-time information reporting management system, IDIRMS, was established [[38]].After 2010, the national malaria surveillance and response system has been altered so it is in line with the transition from control
malaria 24852 with the transition from control to elimination phase to promptly detect and investigate each of the malaria infections and be sure that the appropriate treatment is administered, in order to prevent re-establishment.
malaria 25423 especially for prioritizing surveillance and response activities based on different risk characteristics of malaria transmission [[39]]. Even so, the 1-3-7 approach could be considered a model for other countries.Table 1Implementation
malaria 26255 detected in the laboratory using microscopy, RDTs or PCRbThe number (proportion) of cases confirmed as malaria by the method of microscopy or PCR in provincial reference laboratoryReference laboratory systemA malaria
malaria 26361 malaria by the method of microscopy or PCR in provincial reference laboratoryReference laboratory systemA malaria diagnostic reference laboratory system covering 24 endemic provinces has been set up in China. Its primary
malaria 26931 determination of Plasmodium species via microscopy and PCR is at medium to high level [[31]]. The national malaria reference laboratory in NIPD, is responsible for investigating all difficult samples from provincial
malaria 27388 preparation, and microscopy of medical professionals and CDC staff from all 31 provinces. In reference to malaria , from 2011 to 2015, more than 600 CDC staff participated in the microscopy examination and malaria control
malaria 27487 malaria, from 2011 to 2015, more than 600 CDC staff participated in the microscopy examination and malaria control and prevention knowledge; this should improve the awareness of malaria management and prevention
malaria 27566 microscopy examination and malaria control and prevention knowledge; this should improve the awareness of malaria management and prevention and increase clinicians’ skill in diagnosing and treating the disease.Country-led
malaria 27810 inter-sectoral collaborationChina has successfully carried out regional cooperation and collaboration for malaria control and elimination for several decades, such as the Middle Five Provinces Malaria Joint Control
malaria 29384 supportThe Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) was one of the largest funder for malaria control and elimination in the last decade in China. From 2002 to 2012, China has successfully obtained
malaria 29722 total of US$116 million were released, which was used to assist China in reaching its achievement of malaria elimination goal. With the GFATM support, almost 1.4 million malaria cases were treated, 2.80 million
malaria 29791 in reaching its achievement of malaria elimination goal. With the GFATM support, almost 1.4 million malaria cases were treated, 2.80 million insecticide-treated bed nets (ITNs), and 1.80 million long-lasting
malaria 30309 management and other costs (28%). The expenses of ITNs and LLINs, insecticides, spraying solutions, and anti- malaria l medicines took up limited proportions of the international (4%) and domestic (13%) funding [[42]].Challenges
malaria 30431 took up limited proportions of the international (4%) and domestic (13%) funding [[42]].Challenges for malaria resurgenceEfforts in pursuing a malaria-free world have never waned. In spite of the stalled progress
malaria 30471 international (4%) and domestic (13%) funding [[42]].Challenges for malaria resurgenceEfforts in pursuing a malaria -free world have never waned. In spite of the stalled progress globally, there is an increasing number
malaria 30622 the stalled progress globally, there is an increasing number of countries that are close to achieving malaria elimination: while there were 37 countries with fewer than 10,000 indigenous malaria cases in 2010 this
malaria 30707 close to achieving malaria elimination: while there were 37 countries with fewer than 10,000 indigenous malaria cases in 2010 this number had increased to 44 by 2017 [[1]]. In China, although great successes in malaria
malaria 30814 cases in 2010 this number had increased to 44 by 2017 [[1]]. In China, although great successes in malaria management and elimination have been attained, there are still challenges in the elimination process
malaria 31234 cooperation.Maintenance of non-transmission statusA country can be assessed for WHO certification of malaria elimination following the documentation of zero indigenous case of malaria for a minimum of 3 consecutive
malaria 31309 for WHO certification of malaria elimination following the documentation of zero indigenous case of malaria for a minimum of 3 consecutive years. To keep non-malaria status from 2018–2020, China still has a
malaria 31367 documentation of zero indigenous case of malaria for a minimum of 3 consecutive years. To keep non- malaria status from 2018–2020, China still has a long way to go.Once the sustained importance on elimination
malaria 31503 China still has a long way to go.Once the sustained importance on elimination interventions has waned, malaria could be re-introduced in areas where it has been previously eliminated, because the Anopheles mosquito
malaria 31673 eliminated, because the Anopheles mosquito still exists. For instance, in Liaoning and Hainan, after malaria transmission was interrupted for 4 years, officials reported 2 local P. vivax and 6 local P. malariae
malaria 31775 malaria transmission was interrupted for 4 years, officials reported 2 local P. vivax and 6 local P. malaria e cases, respectively, in 2015 [[6]].Malaria elimination is a big challenge at the border between Yunnan
malaria 31952 challenge at the border between Yunnan and Tibet provinces, as there are many vectors that can transmit malaria in the area. There is a big mobile cross-border population and there is no natural barrier in the area,
malaria 32105 cross-border population and there is no natural barrier in the area, which makes surveillance of all imported malaria cases a huge challenge [[43]–[45]]. Further, inadequate transportation also makes it difficult to
malaria 32407 this problem, the ‘three border defensive lines’ programme was implemented and aims at preventing malaria re-establishment, by establishing 68 malaria and consultation service posts in the second defence line,
malaria 32452 lines’ programme was implemented and aims at preventing malaria re-establishment, by establishing 68 malaria and consultation service posts in the second defence line, by providing RDTs to screen for patients
malaria 32996 sRNA throughout the transmission season [[47]].Given the reason that the possibility of resurgence of malaria still remain particularly for P. vivax, due to the widespread distribution of Anopheles sinensis in
malaria 33341 onward transmission will certainly required. It is still necessary for China to keep vigilance on the malaria resurgence to guide health policy in monitoring and preventing potential risks of malaria resurgence
malaria 33431 vigilance on the malaria resurgence to guide health policy in monitoring and preventing potential risks of malaria resurgence or outbreaks.Surveillance and response to the imported malariaImported cases are another
malaria 33505 preventing potential risks of malaria resurgence or outbreaks.Surveillance and response to the imported malaria Imported cases are another big challenge to face in the elimination phase. In comparison to the steep
malaria 33658 face in the elimination phase. In comparison to the steep reduction of indigenous cases, the imported malaria cases constituted 16.2% of the total cases reported in 2004, but in 2017, this had increased to 99.9%.
malaria 33911 returned from Ghana to Shanglin County of the Guangxi Zhuang Autonomous Region, about 1000 imported malaria cases found from migrants, significantly lifting the nationwide reported malaria numbers that year [[48],
malaria 33992 about 1000 imported malaria cases found from migrants, significantly lifting the nationwide reported malaria numbers that year [[48], [49]]. To deal with this situation, a risk assessment should be well conducted,
malaria 35453 diagnosis and treatment, as well as foci investigation and response.Verification and assessment for malaria eliminationChina was listed as one of the countries at an elimination stage in the WHO World Malaria
malaria 35858 2018, the NHC will organize national expert panels from related departments to conduct sub-national malaria verification on the endemic provinces.Global cooperation and engagementChina is on track to eliminate
malaria 35968 verification on the endemic provinces.Global cooperation and engagementChina is on track to eliminate malaria and the experience gained could be used by other countries that are on the same path. There is a need
malaria 36121 other countries that are on the same path. There is a need for collaboration to control and eliminate malaria in those countries which have shared imported malaria cases with China [[53]].To reduce the malaria
malaria 36175 need for collaboration to control and eliminate malaria in those countries which have shared imported malaria cases with China [[53]].To reduce the malaria burden on the China–Myanmar border, since 2010, county
malaria 36221 malaria in those countries which have shared imported malaria cases with China [[53]].To reduce the malaria burden on the China–Myanmar border, since 2010, county CDC staff on China side and Myanmar have carried
malaria 36519 sharing, with regard to border-specific mobile population management and surveillance system, to lower the malaria incidence on the China–Myanmar border region. Under bilateral or multilateral cooperative mechanisms,
malaria 37193 and 1st Kachin State Special Region. Health Poverty Action, an integral member of the China–Myanmar malaria management and elimination project, eased the formation of an information exchange platform for observing
malaria 37608 which emerged on the Thai-Cambodian border in the Great Mekong Sub-region, which may be catastrophic to malaria elimination in border countries [[56]–[58]]. Some work previously conducted and reported on drug resistance
malaria 37966 under the framework of the ‘Belt and Road’ initiative [[61]]. For example, the China-UK-Tanzania malaria control application of community-based and integrated strategy, which is a pilot project to improve
malaria 38074 control application of community-based and integrated strategy, which is a pilot project to improve malaria diagnosis, reporting, treatment, and tracking using China’s 1-3-7 model and surveillance systems,
malaria 38236 China’s 1-3-7 model and surveillance systems, will explore the model for effectively reducing local malaria disease burden by applying Chinese knowledge and experience with malaria control integrated with the
malaria 38309 effectively reducing local malaria disease burden by applying Chinese knowledge and experience with malaria control integrated with the WHO-T3 strategy (Test, Treat and Track) in the pilot areas [[62]].ConclusionNo
malaria 38487 the pilot areas [[62]].ConclusionNo indigenous case was reported in China in 2017, and most of the malaria cases (2672 cases) are imported from African and Southeast Asian countries at the same time [[18]].
malaria 38687 [[18]]. Strategies and interventions have been developed and implemented to facilitate the national malaria elimination programme in order to achieve the goal of malaria elimination, with the evidence that no
malaria 38749 implemented to facilitate the national malaria elimination programme in order to achieve the goal of malaria elimination, with the evidence that no indigenous case being reported for at least 3 consecutive years
malaria 38961 in the country. Nevertheless, to deal with the elevated number of imported cases and retain the free- malaria status in whole country, it is necessary to intensify multi-interventions, including governmental leadership,
malaria 39456 post-elimination phases of the national programme. China’s engagement and leadership in regional malaria elimination initiatives has helped to promote the progress of malaria elimination efforts in neighbouring
malaria 39526 engagement and leadership in regional malaria elimination initiatives has helped to promote the progress of malaria elimination efforts in neighbouring countries where there is malaria transmission. China is beginning
malaria 39595 helped to promote the progress of malaria elimination efforts in neighbouring countries where there is malaria transmission. China is beginning to cooperate with Africa countries on malaria control and elimination
malaria 39674 countries where there is malaria transmission. China is beginning to cooperate with Africa countries on malaria control and elimination in order to reduce the number of imported malaria cases further. Building on
malaria 39748 with Africa countries on malaria control and elimination in order to reduce the number of imported malaria cases further. Building on its 2017 milestone of zero indigenous cases, and backed by strong national
malaria 39918 indigenous cases, and backed by strong national commitment, China is on a solid footing towards the goal of malaria elimination by 2020.Additional fileAdditional file 1: Table S1. Origin of the countries for the imported

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