ABSTRACT

Sri Lanka reported the last case of indigenous malaria in October 2012, and received malaria-free certification from WHO in September 2016. Malaria cases have since, shifted from indigenous to imported, and the country remains receptive and vulnerable to malaria. A case-based epidemiological study was conducted on all imported malaria cases reported in the country in 2015 and 2016 with the aim of profiling imported malaria to improve the effectiveness of the surveillance and case management system for malaria. Data were obtained from case reports of the Anti Malaria Campaign, hospital records and laboratory registers. Over the 2 years, 77 imported malaria infections were diagnosed in 54 Sri Lankans and 23 foreign nationals. A majority of the infections were reported among males (93%) in the age group of 21–50 years (85.8%), and all were recent travelers overseas. Most patients were detected by passive case detection, but 10% of cases were detected by Active Case Detection. Only 25% of patients were diagnosed within 3 days of the onset of symptoms. In 32% of patients, the diagnosis was delayed by more than 10 days after the onset of symptoms. Plasmodium falciparum infections manifested significantly earlier after arrival in Sri Lanka than did P.vivax infections. The majority of patients (74%) were diagnosed in the Western Province, which was not endemic for malaria. A third of patients were diagnosed in the private sector. The shift in the epidemiology of malaria infection from before to after elimination has implications for preventing the reestablishment of malaria.

摘要

斯里兰卡于 2012 年 10 月报告了最后一例本土疟疾病例，并于 2016 年 9 月获得了世卫组织的无疟疾认证。此后，疟疾病例从本土转向输入，该国仍然容易感染疟疾。对 2015 年和 2016 年在该国报告的所有输入性疟疾病例进行了基于病例的流行病学研究，目的是对输入性疟疾进行分析，以提高疟疾监测和病例管理系统的有效性。数据来自抗疟疾运动的病例报告、医院记录和实验室登记册。2 年内，54 名斯里兰卡人和 23 名外国人被诊断出 77 例输入性疟疾感染。据报道，大多数感染发生在 21-50 岁年龄组 (85.8%) 的男性中 (93%)，他们都是最近出国的旅行者。大多数患者是通过被动病例检测发现的，但有 10% 的病例是通过主动病例检测发现的。只有 25% 的患者在症状出现后 3 天内得到诊断。在 32% 的患者中，诊断在症状出现后延迟了 10 天以上。恶性疟原虫感染在抵达斯里兰卡后明显早于间日疟原虫感染。大多数患者（74%）在没有疟疾流行的西部省份被诊断出来。三分之一的患者是在私营部门确诊的。疟疾感染的流行病学从消除之前到消除之后的转变对预防疟疾的重新流行具有重要意义。