1,3,7 New Strategy for Malaria surveillance in elimination phases in China. Prof. Gao Qi

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1 1,3,7 New Strategy for Malaria surveillance in elimination phases in China Prof. Gao Qi

2 Differences in control, elimination and post elimination phases Control Elimination Post Goal Reduce morbidity & mortality No local infected case Prevention Reintroduction Target High endemic areas/population case & foci Imported case Intervention Population based MDA, ITN & IRS Case & Foci based intervention Surveillance & response Indicator Coverage Timeline Health ability

3 Surveillance in control, elimination and post elimination phases Control Elimination Post A part of program Important part of program Keep facility & ability To find high risk area & population To find each case & foci To find each imported case Routing surveillance + active survey Routing surveillance + re-active survey Join with infectious dis surveillance

4 1. Objective To find each case and focus timely To block transmission in foci on time 2. Strategy Timely based new 1,3,7 strategy

5 The new 1,3,7 strategy 1 Case Detection & Notification Hospital Diagnosis Report Treatment 1 Day (24 hrs) 3 Case Investigation & Classification County CDC Lab Confirmed Case Classification 3 Days 7 Focus Investigation & response County CDC Focus investigation Epidemiological Entomological Focus Response RACD Vector Control Health Education 7 Days

6 3. Case Detection & Notification (1)Malaria case diagnosis & reported Lab test for all of suspected cases Hospital with lab facility, microscopy & RDT for all of suspected malaria cases Hospital without lab facility, collecting blood samples before give anti-malarial and then send it for lab diagnosis

7 WHO China Control Suspected case: Patient illness suspected as malaria Presumed malaria: Suspected case &without lab test but treated as malaria Confirmed malaria: Suspected case & positive by microscopy or RDT Same Same Same Suspected case Elimination Using as control phase Clinical case: Suspected cases & negative by microscopy or RDT in clinic Confirmed malaria: Suspected case & positive by microscopy or RDT or PCR

8 All of clinical & confirmed cases reported by hospital ( where case found) within 1day Clinical cases: With history in endemic & typically symptom, but negative by microscopy & RDT Confirmed cases: With symptoms & positive by microscopy, RDT or PCR

9 (2)Case confirm & investigation All of reported case re-confirm by county CDC (case reported ) within 3 days Microscopic: Double check with microscopy for all of reported cases by county CDC PCR /LAMP PCR/LAMP confirmed by county CDC or provincial CDC

10 Case investigation for all of confirmed case by same county CDC within 3 days Indigenous: Mosquito transmission within country Introduced: Evidence linking to a imported case (F1) Imported: Traced to evidence infected outside Relapse: Due to liver stage parasites re-arisen Induced: Not due to mosquito transmission If not clear, considered as Indigenous case

11 (3)Case follow up ( New) Carried out by county CDC (case residence ) after full dosage treatment finished Drugs and dosage Treatment result

12 (3)Foci investigation & classification By county CDC (case residence) within 7 days Foci with indigenous case Foci with introduced case Foci with transmission ability (vector & transmission season) & with imported case come back over 14 days

13 Reactive case survey in foci Foci with indigenous & introduced case Collected blood samples from all of villagers within focus and test by PCR Foci with imported case (come back over 14 days) Collected blood samples from case s family members & neighbor and test by PCR ( If new case found, collected blood from all of villages in focus & test)

14 Vector survey in foci Foci without vector data Vector species ( Lamps) & density survey ( Human biting rate) Foci with vector data Vector density survey & breeding place survey

15 WHO Endemic: Transmission is occurring and is not effectively controlled Residual active: Transmission occurring with transmission within the past 2 years China Foci with transmission: Village with indigenous or introduced case New active: Transmission occurring with no local transmission New potential: imported, induced or relapsing cases occurring during transmission season with no transmission in past 2 years or more Residual non-active: No local transmission but with a history of local transmission within the past 2 years Cleared-up: No local transmission during the past 2 years with a history of malaria and suitable for transmission. Foci with potential transmission Village with imported cases & vector within transmission season Foci without transmission Village without vector or not in transmission season

16 (4) Foci response Foci with transmission ( Blocking transmission) Vector control, Target MDA & health educations Foci with potential transmission ( Prevention) Vector control & health educations Foci without transmission Health educations

17 (5) Active survey for imported cases Carried out by county CDC (cases reporting) The person come back with imported cases in the county without vector or out of transmission season The person come back with imported cases within 14 days in the county with transmission ability

18 Investigation History of infection outside Health education & information Laboratory testing: (Microscopy or PCR) The persons with history of infection outside All of people come back with imported case ( If necessary)

19 (6) Sentinel hospital active Survey Selected sentinel hospital Type I county: All of township & county hospitals Type II county: 1 county hospital (second level) & 3-5 township hospitals Type III county: 1 county ( or third lever ) hospital

20 Microscopy & RDT testing rate Township hospital: 10% of annual clinical fever cases Second level hospital: 5% of annual clinical fever cases Third lever hospital: 1% of annual clinical fever cases

21 (7) Pilot test for anti-malarial sensitivity Selection of pilot In border area of Yunnan province and the province with more imported cases Method WHO standard in vivo & in vitro test as well as gene test P. f for ACT & Artesunate P. v for Chloroquine

22 (8) Pilot test for insecticide sensitivity Selection of pilot Areas with An. d, An. m & An. a Area with An. s & high density Method Every 2 yeas WHO standard bio-test & Gene test Insecticide selected according to vector control & agriculture

23 Data collection & analysis 1. County CDC Collecting Original surveillance data & analysis 2. Provincial CDC Analyzing surveillance data and feed back Preparing provincial annual surveillance report 3. China CDC reviewing surveillance data Preparing national annual surveillance report

24 Quality control 1. Laboratory quality control by national & provincial reference lab Blood samples re-confirmed Technical training & support at different level Regularly monitoring & evaluating for laboratory quality control

25 Quality control 2. Quality control for field activities (1) County CDC Selected staff responsible for surveillance Re-check all of positive & 10% negative slides (2) Provincial CDC Quality control for field activities in each county Re-check all of positive & 10% negative slides checked by county lab PCR for samples from confirmed/clinical cases

26 Quality control (3) China CDC Quality control for field activities in each province Re-check 10% positive & 5% negative slides checked by provincial lab 3. Quality control for data collection & analysis Selected staff responsible for data collection & analysis Signature by responsible staff for each record.

27 Indicators in control phase form WHO 1. Annual blood examination rate 2. Malaria Incidence rate 3. % of cases due to P. falciparum 4. % of inpatient deaths due to malaria 5. %of suspected cases receiving diagnostic test 6. Number of inpatient malaria cases/ /year 7. Number of inpatient malaria deaths/ / year 8. %of inpatients with discharge diagnosis of malaria

28 Indicators in elimination phase 1. Number of conformed cases per year 2. Number of local infected cases (Indigenous & Introduced )per year 3. Number of foci with transmission per year 4. Number of inpatient deaths due to malaria 5. Percentage of suspected malaria cases receiving a diagnostic test

29 Thanks

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