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. 2023 Nov 20;12(1):101.
doi: 10.1186/s40249-023-01156-2.

Epidemiological characteristics of Plasmodium malariae malaria in China: a malaria that should not be neglected post elimination

Li Zhang  1 , Bo-Yu Yi  1 , Shui-Sen Zhou  1 , Zhi-Gui Xia  1 , Jian-Hai Yin  2
Affiliations

Epidemiological characteristics of Plasmodium malariae malaria in China: a malaria that should not be neglected post elimination

Li Zhang et al. Infect Dis Poverty. .

Abstract

Background: Plasmodium malariae was always neglected compared with P. falciparum and P. vivax. In the present study, we aimed to describe the epidemiology of reported cases infected with P. malariae in the past decade to raise awareness of the potential threat of this malaria parasite in China.

Methods: Individual data of malaria cases infected with P. malariae reported in China in the past decade were collected via the China Information System for Disease Control and Prevention and Parasitic Diseases Information Reporting Management System, to explore their epidemiological characteristics. Pearson Chi-square tests or Fisher's Exact Test was used in the statistical analysis.

Results: From 2013 to 2022, a total of 581 P. malariae cases were reported in China, and mainly concentrated in 20-59 years old group (P < 0.001), and there was no significant trend in the number of cases reported per month. Moreover, four kinds of P. malariae cases were classified, including 567 imported cases from 41 countries in 8 regions and distributed in 27 provinces (autonomous regions, municipalities) in China, six indigenous cases in a small outbreak in Hainan, seven recurrent cases in Guangdong and Shanghai, and one induced case in Shanghai, respectively. In addition, only 379 cases (65.2%) were diagnosed as malaria on the first visit (P < 0.001), and 413 cases (71.1%) were further confirmed as P. malariae cases (P = 0.002). Meanwhile, most cases sought healthcare first in the health facilities at the county and prefectural levels, but only 76.7% (161/210) and 73.7% (146/198) cases were diagnosed as malaria, and the accuracy of confirmed diagnosis as malaria cases infected with P. malariae was only 77.2% (156/202) and 69.9% (167/239) in these health facilities respectively.

Conclusions: Even though malaria cases infected with P. malariae didn't account for a high proportion of reported malaria cases nationwide, the threat posed by widely distributed imported cases, a small number of indigenous cases, recurrent cases and induced case cannot be ignored in China. Therefore, it is necessary to raise awareness and improve the surveillance and response to the non-falciparum species such as P. malariae, and prevent the reestablishment of malaria transmission after elimination.

Keywords: China; Imported case; Induced case; Plasmodium malariae; Recurrence; Reestablishment.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Proportion of malaria cases infected with Plasmodium malariae among the total malaria cases reported nationwide in China, 2013–2022
Fig. 2
Fig. 2
Quarterly distribution of the reported malaria cases infected with Plasmodium malariae reported in China, 2013–2022
Fig. 3
Fig. 3
Distribution of reported cases infected with Plasmodium malariae at various health facilities nationwide in China, 2013–2022. a Case distribution in the first visit; b Case distribution when they were confirmed
Fig. 4
Fig. 4
Distribution of malaria case infected with Plasmodium malariae diagnosed in the first visit and confirmation in various health facilities nationwide in China, 2013–2022. a Distribution of cases diagnosed as malaria cases in the first visit; b Distribution of cases confirmed as malaria cases infected with P. malariae
Fig. 5
Fig. 5
Country origins of the imported malaria cases infected with Plasmodium malariae reported in China, 2013–2022
Fig. 6
Fig. 6
Provincial distribution of the imported malaria cases infected with Plasmodium malariae reported in China, 2013–2022
See this image and copyright information in PMC

References

    1. Makam P, Matsa R. “Big Three” infectious diseases: tuberculosis, malaria and HIV/AIDS. Curr Top Med Chem. 2021;21(31):2779–2799. doi: 10.2174/1568026621666210916170417. - DOI - PubMed
    1. WHO. Malaria. https://www.who.int/news-room/fact-sheets/detail/malaria. Accessed Jun 11, 2023.
    1. Collins WE, Jeffery GM. Plasmodium malariae: parasite and disease. Clin Microbiol Rev. 2007;20(4):579–592. doi: 10.1128/CMR.00027-07. - DOI - PMC - PubMed
    1. World malaria report 2022. Geneva: World Health Organization; 2022.
    1. Hawadak J, Dongang Nana RR, Singh V. Global trend of Plasmodium malariae and Plasmodium ovale spp. malaria infections in the last two decades (2000–2020): a systematic review and meta-analysis. Parasit Vectors. 2021;14:297. doi: 10.1186/s13071-021-04797-0. - DOI - PMC - PubMed