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      Communicating and Monitoring Surveillance and Response Activities for Malaria Elimination: China's “1-3-7” Strategy


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          Qi Gao and colleagues describe China's 1-3-7 strategy for eliminating malaria: reporting of malaria cases within one day, their confirmation and investigation within three days, and the appropriate public health response to prevent further transmission within seven days.

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          The changing epidemiology of malaria elimination: new strategies for new challenges.

          Malaria-eliminating countries achieved remarkable success in reducing their malaria burdens between 2000 and 2010. As a result, the epidemiology of malaria in these settings has become more complex. Malaria is increasingly imported, caused by Plasmodium vivax in settings outside sub-Saharan Africa, and clustered in small geographical areas or clustered demographically into subpopulations, which are often predominantly adult men, with shared social, behavioural, and geographical risk characteristics. The shift in the populations most at risk of malaria raises important questions for malaria-eliminating countries, since traditional control interventions are likely to be less effective. Approaches to elimination need to be aligned with these changes through the development and adoption of novel strategies and methods. Knowledge of the changing epidemiological trends of malaria in the eliminating countries will ensure improved targeting of interventions to continue to shrink the malaria map. Copyright © 2013 Elsevier Ltd. All rights reserved.
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            Operational strategies to achieve and maintain malaria elimination

            Summary Present elimination strategies are based on recommendations derived during the Global Malaria Eradication Program of the 1960s. However, many countries considering elimination nowadays have high intrinsic transmission potential and, without the support of a regional campaign, have to deal with the constant threat of imported cases of the disease, emphasising the need to revisit the strategies on which contemporary elimination programmes are based. To eliminate malaria, programmes need to concentrate on identification and elimination of foci of infections through both passive and active methods of case detection. This approach needs appropriate treatment of both clinical cases and asymptomatic infections, combined with targeted vector control. Draining of infectious pools entirely will not be sufficient since they could be replenished by imported malaria. Elimination will thus additionally need identification and treatment of incoming infections before they lead to transmission, or, more realistically, embarking on regional initiatives to dry up importation at its source.
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              A method of active case detection to target reservoirs of asymptomatic malaria and gametocyte carriers in a rural area in Southern Province, Zambia

              Background Asymptomatic reservoirs of malaria parasites are common yet are difficult to detect, posing a problem for malaria control. If control programmes focus on mosquito control and treatment of symptomatic individuals only, malaria can quickly resurge if interventions are scaled back. Foci of parasite populations must be identified and treated. Therefore, an active case detection system that facilitates detection of asymptomatic parasitaemia and gametocyte carriers was developed and tested in the Macha region in southern Zambia. Methods Each week, nurses at participating rural health centres (RHC) communicated the number of rapid diagnostic test (RDT) positive malaria cases to a central research team. During the dry season when malaria transmission was lowest, the research team followed up each positive case reported by the RHC by a visit to the homestead. The coordinates of the location were obtained by GPS and all consenting residents completed a questionnaire and were screened for malaria using thick blood film, RDT, nested-PCR, and RT-PCR for asexual and sexual stage parasites. Persons who tested positive by RDT were treated with artemether/lumefantrine (Coartem®). Data were compared with a community-based study of randomly selected households to assess the prevalence of asymptomatic parasitaemia in the same localities in September 2009. Results In total, 186 and 141 participants residing in 23 case and 24 control homesteads, respectively, were screened. In the case homesteads for which a control population was available (10 of the 23), household members of clinically diagnosed cases had a 8.0% prevalence of malaria using PCR compared to 0.7% PCR positive individuals in the control group (p = 0.006). The case and control groups had a gametocyte prevalence of 2.3% and 0%, respectively but the difference was not significant (p = 0.145). Conclusions This pilot project showed that active case detection is feasible and can identify reservoirs of asymptomatic infection. A larger sample size, data over multiple low transmission seasons, and in areas with different transmission dynamics are needed to further validate this approach.

                Author and article information

                Role: Academic Editor
                PLoS Med
                PLoS Med
                PLoS Medicine
                Public Library of Science (San Francisco, USA )
                May 2014
                13 May 2014
                : 11
                : 5
                [1 ]Jiangsu Institute of Parasitic Diseases, Wuxi, China
                [2 ]Key Laboratory of Parasitic Disease Control and Prevention, Ministry of Health, Wuxi, China
                [3 ]Jiangsu Provincial Key Laboratory of Parasite Molecular Biology, Wuxi, China
                [4 ]Global Health Group, University of California, San Francisco, San Francisco, California, United States of America
                [5 ]National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China
                PLOS Medicine, United Kingdom
                Author notes

                The authors have declared that no competing interests exist.

                Conceived and designed the experiments: JC SZ LT QG. Analyzed the data: JC SZ HZ YL LT QG. Wrote the first draft of the manuscript: JC HJWS CC RDG QG. Contributed to the writing of the manuscript: JC HJWS CC SZ HZ YL LT RDG RGAF QG. ICMJE criteria for authorship read and met: JC HJWS CC SZ HZ YL LT RDG RGAF QG. Agree with manuscript results and conclusions: JC HJWS CC SZ HZ YL LT RDG RGAF QG. Evaluated the program: JC HJWS CC SZ HZ YL LT RDG RGAF QG.


                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Pages: 6
                This work was supported by the Jiangsu Province's Medical High Tech Platform (ZX201108), the Jiangsu Province's Construction Project (BM2009902), the Asia Pacific Malaria Elimination Network (APMEN), and the Program for National S & T Major Program (No. 2012ZX10004-220) to JC, HZ, YL, and QG. HJWS and RDG are supported by a grant from the Bill & Melinda Gates Foundation [#OPP1013170]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Health in Action
                Medicine and Health Sciences
                Infectious Diseases
                Infectious Disease Control
                Parasitic Diseases
                Public and Occupational Health
                Global Health
                Tropical Diseases



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