Eliminate malaria How can Guangxi win the "war" with mosquitoes?

Reporter Wu Yueming reported from Guangzhou

"When the trees sprout in the spring, the disease control people go to the grassroots level to carry out prevention and control, and when the autumn returns, the leaves on the trees have fallen." An old disease controller in Guangxi talked to a reporter from China Business Daily about the story of malaria prevention and control in the past, "At that time, we were investigating the situation of malaria in the field, and we went for more than half a year. Folk have laughed at this, there are women who do not marry epidemic prevention langs, and keep empty houses all year round. ”

Guangxi is one of the four high-incidence areas with the most serious malaria epidemic in China, and in the past 70 years, countless disease controllers have followed on the road to fight malaria.

In 2019, Guangxi passed the national final assessment of malaria elimination, marking that Guangxi has reached the standard of malaria elimination.

Long time. After 70 years of hard work, on June 30, 2021, China was certified malaria-free by the World Health Organization (WHO).

Avatar "Catcher of Mosquitoes"

Malaria is an insect-borne infectious disease caused by an Anopheles mosquito bites or transfusion into the blood of people with plasmodium malaria.

Historically, my country has been one of the most malaria-infested countries. The malaria epidemics in Guangdong, Guangxi, Yunnan and Guizhou are the most severe.

It is worth noting that in the 1960s and 1970s, the Chinese government launched a large-scale antimalarial campaign. In the absence of effective antimalarial drugs, the Chinese government has effectively controlled the pathogen and transmission vector of malaria through the establishment of professional prevention and control institutions, collective treatment and large-scale residual spraying of mosquito repellents, which has greatly reduced the incidence and incidence of malaria infection.

In the era when everyone talks about malaria discoloration, many disease control people endure mosquito bites, roll up their pants legs and trek on the most dangerous line of malaria, building a defense line against malaria.

Malaria was once one of the most common and perennial infectious diseases in Longsheng County, Guilin, Guangxi. "Longsheng two rivers, do not swing scabies", "rice yellow, sick bed", these folk songs describe the harm of malaria to the people of Longsheng.

"We need to dissect a lot of mosquitoes in the lab, and even need to inject mosquitoes to make them immune to malaria parasites." Ye Ming (pseudonym) was involved in the antimalarial campaign at that time as a disease control expert in Guangxi. In addition to the research on mosquito resistance, the diagnosis of malaria parasites, and the monitoring of immunology, Ye Ming also has a very important work content is on-site research.

"In the past, when the autumn harvest came, there were people swinging everywhere." When Ye Ming inspected The Township of Douli in Longsheng County, Guangxi Province, he found that the rice fields in the village were yellow and brilliant, but no one harvested them. The local buildings mainly belong to the wooden structure of cohabitation, and the upper level is inhabited by people and the lower level is a characteristic house of livestock. Mosquitoes and flies are rampant.

"Does anyone in your village have a chill or fever?" Because this feature is more obvious at the time of malaria outbreak, Ye Ming often uses this as a clue when he goes deep into the frontline with other disease control personnel to visit every household in the village to inquire about the situation. Once a villager is found to have such signs, the disease control personnel will collect blood for them to test, and then determine the source of infection, whether group medication and mosquito control operations are carried out in this area.

In fact, not all mosquitoes transmit malaria. After Ye Ming and others arrived in the high-incidence area of malaria, they immediately became "mosquito catchers" and investigated the population, habits, activity rules, distribution density of different seasons and years of the vector on the spot, etc. Only in this way can we scientifically formulate an anti-mosquito plan and block the transmission of the vector.

There is a trilogy in the prevention and treatment of infectious diseases, that is, controlling the source of infection, eliminating the vector and protecting healthy people.

"To complete malaria control in a region and meet the criteria for malaria elimination, it takes a long time front. Because the prevention and control of malaria is not limited to a village, it is necessary to link up with other villages, counties and cities to carry out mass and systematic prevention and control. A disease controller told reporters, "In this way, the incidence of malaria in areas with high incidence is slowly reduced." ”

Contain imported malaria

In 2013, when local malaria cases in Guangxi disappeared, a "gold rush" led to a significant increase in imported cases of malaria in Guangxi.

At that time, tens of thousands of people in Shanglin County, Nanning, Guangxi, went to Africa to pan for gold, and many Shanglin people's migrant land spread from ghana to Cameroon, Sierra Leone and other countries.

Li Jun, deputy director of the Institute of Parasitic Disease Prevention and Control of the Guangxi Center for Disease Control and Prevention, told reporters, "At this stage, the imported cases in Guangxi have increased rapidly and significantly. The cumulative number of cases in Guangxi rose from 66 in 2010 to 112 in 2011 and 220 in 2012. Until 2013, guangxi saw an explosive increase in imported malaria, with 1,251 cases reported that year and 1,052 in Shanglin County. This meant that at that time, more than 80% of the cases in Guangxi were concentrated in Shanglin County. ”

Li Jun added, "Guangxi is mainly based on migrant workers going abroad, mainly to Go to Africa to pan for gold, in an unorganized state. This also makes it more difficult to control malaria. ”

A disease control person who inspected Shanglin County lamented, "At that time, no county or city would suddenly have so many cases." However, Guangxi withstood this test, which is not easy. ”

How to fight the hard war on imported malaria in Shanglin County became a major challenge at that time. The difficulty lies in the uncontrollable nature of imported cases.

In 2013, Guangxi CDC innovatively carried out infectious disease monitoring in the epidemic prevention work in Shanglin County, and made great efforts to block the spread of possible diseases.

Li Jun introduced, "Under the technical guidance of the Guangxi Center for Disease Control and Prevention, the village doctors in Shanglin County have to visit every household in the village every month to find out whether there are villagers returning from Africa in time, and if there is a similar situation, they need to go to the CDC or hospital for screening." At the same time, the village doctor also needs to report the above situation to the health administrative department at the next higher level. After receiving the data push, the health administration department will forward it to the CDC. The CDC then follows up and screens the above-mentioned personnel. ”

"This measure is unique to Shanglin County and is difficult to replicate elsewhere. You know, this workload is not persisted a few times, but for several years. It's not easy. Li Jun said, "Through monitoring, this has been effective in timely detection of the source of infection." ”

In addition, in order to let the Shanglin people who returned from Africa not go home first, but go to the CDC for monitoring, the local CDC has thought of many ways.

"At that time, we had a little trick to let the wives take care of their husbands." Disease control experts involved in the frontline told reporters, "We remind everyone that when men go to Africa, they may get two diseases, malaria and AIDS." If your husband comes back, don't let him go home first, but go to the disease control for testing first. "In fact, AIDS and malaria are indeed disease control surveillance projects.

In terms of treatment, Li Jun introduced, "Since 2013, provincial, municipal and county malaria designated diagnosis and treatment hospitals have been established, of which the Fourth People's Hospital of Nanning City and the First Affiliated Hospital of Guangxi Medical University are provincial-level critical care hospitals, and the infectious disease hospitals or the first people's hospitals of various cities and counties are designated hospitals for malaria under their jurisdiction. And from 2011 to 2019, the autonomous region held 30 technical training sessions to maintain the stability of the technical and personnel of the prevention and control team. In order to enhance the service capacity of designated hospitals, since 2016, Guangxi has purchased rapid detection reagents from the provincial level relatively fixedly, and enhanced the service capabilities of designated hospitals. ”

Since then, Guangxi has adopted comprehensive prevention and control measures of "prevention first and adapted to local conditions", and the incidence and mortality of malaria have been declining. Finally, in 2019, Guangxi passed the national final assessment of malaria elimination, marking that Guangxi has met the criteria for malaria elimination.

Tang Linhua, then deputy head of the final assessment team and researcher of the Institute of Parasitic Diseases of the Chinese Center for Disease Control and Prevention, introduced this, "Because of geography, climate and other reasons, Guangxi and Yunnan, Hainan and Guizhou are the four major high malaria areas in China, after 70 years and generations of efforts, Guangxi's elimination of malaria is a very difficult thing and a very important contribution to the whole country." ”

Certified "Malaria Free"

In fact, the prevention and control of malaria is only a major microcosm of China's public health development in the past 70 years.

In addition to malaria, parasitic diseases such as schistosomiasis and filariasis, which are called "plague gods", have also disappeared in China, and the efforts of disease control people have also been remembered by history.

The reporter learned that in the eyes of many disease controllers, the elimination of this series of parasitic diseases is inseparable from the monitoring, early warning and response system for infectious diseases established in China and gradually improved. On this basis, the development path and context of various infectious diseases in China began to be clear.

According to the data, on January 1, 2004, China launched a network direct reporting system (online report) for the surveillance information of statutory infectious diseases, and malaria, as one of the 37 statutory infectious diseases, also needs to be reported online. In 2012, China launched the parasitic disease prevention and control information management system (special report) to carry out special management of malaria, schistosomiasis, etc., and set up a "1-3-7" work specification and related indicator requirements. That is, the malaria case is reported within 1 day after the discovery, the case verification and epidemiological case investigation are completed within 3 days, and the investigation and disposal of the epidemic site is completed within 7 days.

In fact, in addition to providing treatment to patients to locate and stop the spread of malaria, my country has also made remarkable achievements in providing preventive antimalarial drugs.

In 1978, China's new antimalarial drug artemisinin was officially announced. Artesunate, developed by Guilin Pharmaceutical Factory, and artemether, jointly developed by Shanghai Pharmaceutical Institute and Kunming Pharmaceutical Factory, were subsequently approved for production.

A disease controller in Guangxi told reporters that in 1977, Guilin Pharmaceutical Factory and the Guangxi Center for Disease Control and Prevention Institute of Parasitic Disease Control and other four units successfully synthesized artesunate on the basis of artemisinin, invented a new antimalarial drug artesunate, solved the problem of water insoluble of artemisinin, and the efficacy was correspondingly improved. In 2005, artesunate successfully passed the WHO drug pre-certification and was recommended by WHO as the drug of choice for the treatment of severe malaria, saving the lives of tens of millions of patients with severe malaria worldwide.

The reporter learned that the national malaria elimination standards have three aspects, one is that there have been no local infection cases for 3 consecutive years, the second is that there is a perfect, sensitive and systematic malaria monitoring network in the epidemic area, and the third is that there are good programs and measures to prevent import and re-transmission after the elimination of malaria.

In 2020, after four consecutive years of reporting zero local cases, China applied for who official certification for malaria elimination.

On 30 June 2021, WHO announced that China had been awarded a national malaria elimination certification.