Establishing and applying an adaptive strategy and approach to eliminating malaria: practice and lessons learnt from China from 2011 to 2020

On 30 June 2021, China was certified malaria-free by the World Health Organization. In this study, the evolution, performance, outcomes, and impact of China’s adaptive strategy and approach for malaria elimination from 2011 to 2020 were analysed using 10-year data. The strategy and approach focused on timely detection and rapid responses to individual cases and foci. Indigenous cases declined from 1,308 in 2011 to 36 in 2015, and the last one was reported from Yunnan Province in April 2016, although thousands of imported cases still occur annually. The “1–3–7” approach was implemented successfully between 2013 and 2020, with 100% of cases reported within 24 h, 94.5% of cases investigated within three days of case reporting, and 93.4% of foci responses performed within seven days. Additionally, 81.6% of patients attended the first healthcare visit within 1–3 days of onset and 58.4% were diagnosed as malaria within three days of onset, in 2017–2020. The adaptive strategy and approach, along with their universal implementation, are most critical in malaria elimination. In addition to strengthening surveillance on drug resistance and vectors and border malaria collaboration, a further adapted three-step strategy and the corresponding “3–3–7” model are recommended to address the risks of re-transmission and death by imported cases after elimination. China’s successful practice and lessons learnt through long-term efforts provide a reference for countries moving towards elimination.

2021年6月30日，世界卫生组织（World Health Organization）正式认证中国消除疟疾。本研究基于2011至2020年的十年监测数据，分析了中国2011-2020年疟疾消除适应性策略与实施路径的演变历程、执行成效、最终结果及社会影响。该策略与路径聚焦于对散发病例及疫点的及时发现与快速响应。本土病例数从2011年的1308例降至2015年的36例，最后一例本土病例于2016年4月在云南省报告，尽管每年仍有数千例输入性病例出现。'1-3-7'工作模式于2013至2020年间成功推行：所有病例均在24小时内完成上报，94.5%的病例在上报后3日内完成流行病学调查，93.4%的疫点处置工作在7日内完成。2017-2020年的数据显示，81.6%的患者在发病后1-3日内首次就诊，58.4%的患者在发病后3日内获得疟疾确诊。适应性策略与路径及其全面推广落地，是疟疾消除工作的核心关键。除强化耐药性监测、媒介生物监测以及跨境疟疾防控协作外，本研究还建议进一步优化形成三步式策略及对应的'3-3-7'工作模式，以应对消除后输入性病例引发的再传播与死亡风险。中国通过长期实践积累的成功经验与总结成果，可为其他致力于疟疾消除的国家提供参考借鉴。