[Epidemiological analysis of the deaths of malaria in China, 2005-2014]

To explore the epidemiological features of deaths of malaria from 2005 to 2014, so as to provide the evidence for subsequently more effective strategic planning of malaria elimination in China.

The data of individual malaria cases (including probable and confirmed cases, population data, geographic distribution, diagnosis and reporting information) were obtained from the National Notifiable Infectious Disease Reporting Information System from 2005 to 2014 and the epidemiological investigation information (including the clinical systems and the imported and indigenous cases) was extracted from Parasite Disease Prevention and Control Information System from 2011 to 2014. All of the data didn't include Hongkong, Macao, Taiwan and foreign cases. The population characteristics, clinical systems, geographic distribution, diagnosis and reporting and sources of infections of deaths were analyzed.

From 2005 to 2014, a total of 228 deaths of malaria were reported, with 203 (89.0%) of P. falciparum malaria, 13 (5.7%) of P. vivax malaria, 1 (0.5%) of P. malariae malaria and 11(4.8%) other cases. The fatality rate of malaria increased since 2010. Among the deaths, 48 (81.4% ) had serious complications, which included cerebral lesion, coma, severe renal and hepatic injuries and hemolysis and so on. In 2005-2010, the geographical distribution of malaria deaths was mainly in Yunnan (78 deaths, 56.1%), Sichuan (13 deaths, 9.4%), Henan (7 deaths, 5.0%), Shandong (6 deaths, 4.3%) and Zhejiang (5 deaths, 3.6%) province. However, since the initiation of malaria elimination program in 2010, the areas with malaria deaths have changed, which mainly distributed in Henan (10 deaths, 11.2%), Sichuan (9 deaths, 10.1%), Shandong (8 deaths, 9.0%), Jiangsu (7 deaths, 7.9%) and Hunan province (7 deaths, 7.9%). Besides there were nine deaths (10.0%) reported in non-endemic areas of malaria (Beijing, Inner Mongolia, Jilin, and Ningxia) in 2011-2014. The median time from illness onset to diagnosis for deaths was 5.5 (P25-P75: 3.0-8.5) d, which was longer than 3.0 (2.0-6.0)d for survivors. Moreover, for deaths, the median P50 (P25-P75)(6.0, 4.0-9.0 d) from illness onset to diagnosis in 2011-2014 was longer than that in 2005-2010 (5.0, 3.0-9.0 d). Among imported deaths, 77 deaths (90.6%) originated from Africa and 8 deaths (9.4%) from Southeast Asia.

Although the reported deaths of malaria were stable in 2005-2014, the geographical distribution of malaria deaths changed significantly and the time from illness onset to the diagnosis was longer since 2010. Special attention should be paid to the diagnosis and treatment of imported cases to reduce the fatality at the malaria elimination stage.