[Malaria situation in the People's Republic of China in 2003]

Total 40,681 malaria cases and 129,147 suspected cases with 52 deaths were reported by the case reporting system in 910 counties of 21 Provinces/Municipality/Autonomous Region (P/M/A) in 2003, and the annual incidence was 0.39/10000, an increase of 15.3% than that of the last year, which is the third year that malaria incidence consecutively increased since 2001. Based on a baseline survey in the project funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the estimated number of malaria cases was about 740,000 in 2003, 18 times more than reported. Among the 910 counties with reported malaria cases, 29 counties with an incidence more than 10/10000 distributed in Yunnan (17 counties), Hainan (9), Anhui (1), Hubei (1) and Henan (1). There were 69 counties in which the malaria incidence was between 1/10000 and 10/10000. The number of Plasmodium falciparum malaria cases was 4727, accounting for 11.6% of the total cases, of which 13.1% (621) were imported cases reported in 107 counties/cities of 16 P/M/A. Indigenous falciparum malaria was found in 78 counties/cities of Yunnan and Hainan Provinces, of which 64 counties/cities were in Yunnan, increased by 22, 14 counties/cities were in Hainan, decreased by 2 compared to that of 2002. Yunnan and Hainan are stil the relatively high transmission areas. Yunnan has ranked No. 1 in the country in terms of the number of cases while Hainan ranked No. 1 by malaria incidence in recent years. 21,788 malaria cases were reported from the two provinces in 2003, accounting for 53.6% of the total reported cases in the country. There were 15 431 cases with 43 deaths reported from Yunnan, the incidence was 4.24/10000, with an increase of 26.3% than that in the last year. Among the reported cases, 3529 were falciparum malaria, increased by 22.9% in comparison to 2002. The number of reported cases in Hainan was 6357, with an incidence of 7.94/10000, 19.6% increase than the last year. In central China, the re-emergence of malaria was considerable in provinces along the Huai River, especially in Anhui Province. It should be stressed that the proportion of malaria cases was increasing in Anopheles sinensis transmitted areas where malaria was almost under control in the 1990s. The number of malaria cases in Anhui has been the second largest in the country since 2001. 8025 malaria cases and 18533 suspected cases were reported from Anhui in 2003, accounting for 19.7% of the total cases in the country, with an incidence of 1.53/10000 increased by 59.4% than that in 2002. Hubei Province reported 5 334 malaria cases with an incidence of 1.2/10000, increased by 33.3%. The number of reported cases in Henan and Jiangsu Provinces was 2 448 and 638 and the incidence decreased by 24.1% and 12.7% respectively. Focal outbreaks occurred in 222 villages of 9 counties in Anhui, Hubei and Jiangsu, where Anopheles sinensis is the principal transmission vector. Malaria cases reported from the above 4 provinces accounted for over 40% of the national figure. Cases reported from other P/M/A in the South and East China occupied about 6% of the total with certain degree of decrease, several hundreds from each of Guizhou, Guangxi, Sichuan, Guangdong, Fujian, Chongqing, Zhejiang, Shanghai and Hunan, more than 50% of which were imported cases. Less than 100 cases were reported from each of Shandong, Jiangxi, Liaoning, Shaanxi, Shanxi and Gansu Provinces in 2003. In summary, malaria is still an important problem of public health in China, especially in the southern and central parts where the incidence has been increasing since 2001. Yunnan and Hainan still faced critical situation of malaria endemics with a spread of Plasmodium falciparum, especially in the 25 border counties in Yunnan. In the central part of the country including Anhui, Hubei, Henan and Jiangsu, where Anopheles sinensis was the principal vector, the malaria prevalence was highly unstable with frequent focal outbreaks in areas along the Huai River, which revealed new challenges to the malaria control program in China. Meanwhile, opportunities also exist with the support of the GFATM and the government, the latter paid much closer attention recently to issues in relation to public health.