Complete the investigation and disposal of malar...
The health institution or CDC dealing with the epidemic situation shall complete the investigation and disposal of the malaria epidemic focus within 7 days after the case report. The epidemic focus refers to the natural village, residential area or construction site where the malaria case occurs.
3.1 Epidemic focus investigation
3.1.1 Epidemiological data investigation
3.1.1.1 Basic information: The geographical location, topography, annual average temperature, annual rainfall, number of households, population, historical prevalence and malaria incidence of the epidemic focus are collected.
3.1.1.2 Historical epidemic situation of the epidemic focus: data of local malaria parasite species and vector species.
3.1.1.3 Epidemic situation of epidemic focus in recent 4 years: data of vector investigation, surveillance and classification of malaria cases in epidemic focus in recent 4 years. Fill in the Basic Investigation Record Form of Malaria Epidemic Focus (Table 5-4).
3.1.2 Investigation of the source of infection
3.1.2.1 Epidemic focus es where it needs to investigate the source of infection
By means of door-to-door visit, blood samples are collected from patients’ families and surrounding people, as well as those with a history of fever for microscopic examination and RDT detection of malaria parasites. Meanwhile, understand the use of anti-mosquito facilities among residents. If two or more malaria cases or carriers are found, it can be expanded to collect blood from all residents in the epidemic focus for microscopic examination and RDT detection of malaria parasite.
3.1.2.2 Investigation method
The samples are tested by microscopic examination, RDT or PCR. In addition, the positive cases of microscopic examination or RDT test are reported, treatment standardized and epidemiological case investigated. In addition, the Record Form of Infection Source Investigation in Epidemic Focus shall be filled in (Table 5-5).
3.1.3 Imported case peer investigation
The malaria epidemic situation disposal institute in the place where the case is located shall investigate the imported cases from abroad and the returnees within 7 days of the case report. If the survey finds that malaria-related symptoms such as fever are found in the same group of returnees, it is necessary to test for laboratory malaria parasite by microscopic examination or nucleic acid test for all returnees of the same group. What’s more, fill in the questionnaire for those returning from abroad (Table 5-6). The positive cases are reported, standardized treatment and epidemiological investigation are carried out according to the confirmed cases. If the peers are non-local personnel, notify the local malaria epidemic disposal institute to deal with the situation as required.
3.1.4 Vectors survey
3.1.4.1 Epidemic focuses that needs to be investigated.
According to the history of malaria vector surveillance in the place where the cases are located, those without vectors and breeding conditions may not be investigated, while the rest of the cases need to be investigated.
3.1.4.2 Adult mosquito investigation methods
The mosquito trapping lamp method can be used to investigate the adult mosquito vector population. If necessary, the human-net method or artificial capture method can be used according to the ecological habits of Anopheles mosquitoes (see Chapter 4 Malaria Vector Surveillance). Mosquito trapping lamp method and human-net method are used to investigate the patients’ homes indoors and outdoors or near the possible breeding grounds. The investigation should be carried out for at least 3 consecutive nights. However, if the data show that the local Anopheles mosquito bite peak is mainly in the middle of the night, the human-net method can also be used for half-night mosquito trapping. The species of captured Anopheles mosquitoes are preliminarily identified by morphological methods; the specimens of Anopheles mosquitoes which are difficult to identify or suspected can be identified by molecular biological methods.
3.1.4.3 Investigation of larval breeding ground
The spoon catching method can be used to select the breeding grounds of vector larvae for investigation (see Chapter 4 Malaria Vector Surveillance for details).
3.1.5 Schematic map of epidemic focus
The key contents of the epidemic focus map include the main geographical features related to malaria transmission, the distribution of the diseased family and neighboring houses, the location and distance of the main vector breeding places around the disease’s home, the distance between the patient’s home and the nearest medical institution, the case distribution of the epidemic focus in the past 5 years. In addition, the scope of epidemic focus investigation (source of infection and vector investigation) and disposal, etc.
3.1.6 Classification of epidemic focus
3.1.6.1 Classification of malaria foci in China
A. Epidemic focuses where malaria has spread: natural villages (settlements) where there are local infections or imported secondary cases.
B. Epidemic focuses with the possibility of transmission: natural villages (settlements) where there are imported cases and conditions for transmission.
C. Epidemic focuses where there is no possibility of transmission: natural villages (settlements) where there are imported cases but there is no malaria vector or there is a malaria vector but not in the transmission season.
3.1.6.2 WHO’s classification of malaria foci
A. Active epidemic spots: there are epidemic spots with continuous transmission. In addition, local cases appear in the epidemic spots in the same year.
B. Residual inactive spots: there have been local cases in the last 1-3 years.
C. Cleared epidemic spots: epidemic spots with no local cases for more than 3 years.
3.2 Epidemic foci disposal
3.2.1 Epidemic spots that have transmission.
3.2.1.1 Treatment measures for personnel in epidemic foci
A. Standardize the treatment of patients in epidemic foci, expand the treatment of key personnel. Besides, remove possible sources of infection (see Chapter 3 Treatment and Management of Malaria Cases for details).
B. For the epidemic foci where Plasmodium vivax or Plasmodium ovale transmission has occurred, anti-recurrence treatment should be given to the cases before the next transmission season (see Chapter 3 Treatment and Management of Malaria Cases for details).
3.2.1.2 Epidemic focus vector control measures
In the whole epidemic focus, the measures of indoor residual spray of insecticides (see Chapter F. Vector Control techniques and personal Protection) are taken to eliminate infectious adult Anopheles mosquitoes so as to reduce the density of malaria vectors, block possible transmission. After that, fill in the Record Table of Residual Spray in the epidemic foci disposal room (Table 5-7).
3.2.1.3 Health education for people in epidemic foci
Combined with the investigation and disposal of epidemic foci, health education shall be carried out for residents in epidemic spots in a variety of ways, focusing on improving selfprotection and timely medical treatment awareness, avoiding sleeping in the streets, as well as advocating the use of mosquito nets, screen doors and windows and other anti-mosquito facilities.
3.2.2 Possible epidemic foci for transmission
3.2.2.1 Epidemic focus vector control measures
IRS measures should be taken to eliminate adult Anopheles mosquitoes that may be contagious in the focus area (with the case’s family as the center, radius ≥ 500m). The specific method is the same as above.
3.2.2.2 Health education for people in epidemic foci: the same as that in epidemic foci that have transmission.
3.2.3 Epidemic foci where there is no possibility of transmission
Only combined with the case epidemiological investigation, health education shall be carried out to improve the residents’ awareness of mosquito prevention and medical treatment.
Table 5-1 Blood Test Record Table of Plasmodiu.
Table 5-2 Microscopic Examination of Plasmodium Parasite Source institute of blood slices: .
Form 5-3 Malaria Epidemiology Case Questionnair.
Serial number.
1.Case basic situation
1.1 patient name:
1.2 ID number:
1.3 Telephone number:
1.4 Age:
1.5 Gender: A. male B. female
1.6 Place of household registration:
1.7 Current address (please specify the name of administrative village/neighborhood committee, natural village/resident group): Province_________ , City__________ , County (City, District) Township_____________________________
1.8 Current address GPS coordinates:
2. The incidence, diagnosis and report
2.1 Main clinical manifestations (optional): A. Fever B. Chills C. Sweating.
D. Headache E. Diarrhea F. Others (please describe_______________.
2.2 Are there any complications: A. Yes B. No, if not, please jump to Item 2.4
2.3 Major complications: A. Brain damage B. ARDS C. Shock D. Hemolysis E. Severe renal damage F. Pulmonary edema G. Severe anemia H. Acidosis I. Liver damage J. Gastrointestinal damage K. Others (please describe_______________).
2.4 The date of sickness: Month Day Year
2.5 Fever: A. persistent fever B. the next day fever C. interval irregular fever
2.6 Degree of illness: A. mild (outpatient treatment) B. severe (hospitalization) C. critical (with dangerous symptoms such as coma_______________)
2.7 place of onset (please specify the name of administrative village/neighborhood committee, natural village/resident group): Province______________, City______________, County_______________ (City, District) Township (if abroad, fill in the name of the country or region: _______________)
2.8 Results of microscopic examination:
A. did not do B. negative C. Plasmodium vivax D. Plasmodium falciparum
E. Plasmodium malariae F. Plasmodium ovale G. mixed infection H. others
2.9 RDT test results (please indicate RDT manufacturer:________________ product batch number: ______________ )
A. Did not do B. Negative C. Positive D. Plasmodium falciparum E. Others
2.10 Institutes to carry out laboratory examination:_______________________________
This institute belongs to: A. Individual doctors B. Village clinics C. Township health centers D. County-level medical institutions E. County-level disease control institutions F. Prefectural-and-municipal-level medical institutions G. Prefectural-and-municipal-level disease control institutions H. Provincial-level medical institutions I. Provincial-level disease control institutions J. Others
2.11 First-time medical institute.
The institute belongs to: A. Individual doctors B. Village clinics C. Township health centers D. County-level medical institutions E. County-level disease control institutions F. Prefectural-and-municipal-level medical institutions G. Prefectural-and-municipal-level disease control institutions H. Provincial-level medical institutions I. Provincial-level disease control institutions J. Others
2.12 First visit time: Month Day Year
2.13 Diagnosis results of first visit: A. Malaria B. Other diseases
2.14 Diagnosis date:
Diagnosis institute:
This institute belongs to: A. individual doctor B. village clinic C. township health center D. county-level medical institution E. county-level disease control institution F. prefecture city level disease control institution G. prefecture city level disease control institution H. provincial-level disease control institution I. provincial-level disease control institution J. others
2.15 Case diagnosis classification: A. suspected case B. clinically diagnosed case C. confirmed case D. carrier
2.16 Case report time:
2.17 reporting unit: this unit belongs to: A. individual doctors B. village clinics C. township health centers D. county-level medical institutions E. county-level disease control institutions F. Prefectural-and-municipal-level medical institutions G. prefecturelevel disease control institutions H. provincial-level medical institutions I. provinciallevel disease control institutions J. others
2.18 The ways of case discovery are as follows: A. Patients seeking medical treatment (routine fever blood test, patient self-report, etc.) B. Active case detection (epidemic spot infection source screening, case clue investigation/peer screening, etc.)
2.19 Laboratory review (please indicate the name of the laboratory: _______________)
2.19.1 Results of microscopic examination: A. Negative B. Plasmodium vivax C. Plasmodium falciparum D. Plasmodium malariae E. Plasmodium ovale F. Mixed infection (please indicate other species) G. Others
2.19.2 Results of PCR reexamination (please indicate laboratory name:) A. Negative B. Plasmodium vivax C. Plasmodium falciparum D. Plasmodium malariae E. Plasmodium ovale F. Mixed infection (please indicate parasite species: _______________) G. Others
3. The situation of this treatment
3.1 G6PD test results: A. Untested B. Tested (A. Deficiency B. Not lacking)
3.2 Name of the antimalarial drug taken.
A. chloroquine plus primaquine B. artemisinin compound C. artemisinin injection form D. Other (please indicate drug name: _______________) E. Do not know
3.3 Whether hospitalization: A. Yes B. No
3.4. Frequency of drug access: A. Daily drug B. One time drug C. Other ways
3.5 Institutions access to drug: A. Individual doctors B. Village clinics C. Township hospitals D. County-level medical institutions E. County-level disease control institutions F. Prefectural-and-municipal-level medical institutions G. Prefecture-level disease control institutions H. Provincial-level medical institutions I. Provincial-level disease control institutions J. Other
3.6 First medication time: Month Day Year
3.7 Last medication time: Month Day Year
3.8 Medication days:
3.9 Whether formal treatment: A. Yes B. No
3.10 Treatment unit:(https://www.daowen.com)
This unit belongs to: A. individual doctor B. Village clinic C. Township health center D. County-level medical institution E. County-level disease control institution F. Prefectural-and-municipal-level medical institution G. Prefectural-and-municipal-level disease control institution H. Provincial-level medical institution I. Provincial-level disease control institution J. Other
4. Past medical history and treatment (if they have ever had malaria, please fill in the following options)
4.1 Last incidence: time of last illness ______________; location of disease/diagnosis _____________.
Diagnosis: A. Plasmodium vivax B. Plasmodium falciparum C. Plasmodium malariae D. Plasmodium ovale E. Mixed infection (please indicate worm species) F. Other
4.2 Last antimalarial treatment drugs: A. chloroquine plus primaquine B. Artemisinin compound C. Artemisinin injection form D. Others (please indicate the full name of the drug _______________) E. Do not know
4.3 Days of the last use of the drug:
4.4 whether receiving the last redical treatment during telogen: A. Yes B. No
5. Investigation on the source of infection
5.1 Whether there is any history of living abroad within one month before the onset: A. Yes B. No
Whether there is any history of living abroad in the past 1 year (Plasmodium falciparum, Plasmodium malariae): A. Yes B. No; if not, please jump to item 5.6.
Whether there is any history of overseas residence in the past 3 years (Plasmodium vivax, Plasmodium ovale): A. Yes B. No. If not, please jump to item 5.6.
5.2 Place of residence abroad: country or region
5.3 Reasons for going out: A. work (type of work: _______________) B. Tourism C. Official D. Business E. Visit relatives and friends F. Others (note:_ ______________ .
5.4 Prevalence of malaria abroad: A. Yes B. No
5.5 Precautionary measures
5.5.1 Whether to take preventive medication before leaving the country: A. Yes B. No; If preventive medication is taken (please indicate the name, dose and course of treatment):________________
5.5.2 Whether to use avoidance agents during overseas stay: A. Yes B. No
5.5.3 Whether mosquito nets are used during overseas stay: A. Yes B. No
5.5.4 Whether to take preventive medicine during overseas residence: A. Yes B. No
5.5.5 Other preventive measures taken during overseas residence: _______________
5.6 Whether there is a history of residence in other endemic areas within 2 weeks before the onset of the disease: A. Yes B. No; if not, please jump to 5.8
5.7 Place of residence in other endemic areas:
Residence time:________________ Day(s)
5.8 Whether there is a history of blood transfusion within 2 weeks before onset: A. Yes B. No
5.9 Whether any family members or visiting relatives and friends have a fever in the past 1 month: A. Yes B. No
5.10 The possible source of this infection is.
A. Locally infected (A. Infection in this county B. Infection in another of the province C. Infection in another province) B. Overseas infection
5.11 Case classification
A. Local primary cases B. Imported cases C. Others (A. Imported secondary cases B. Recurrent cases C. Non-mosquito-borne malaria cases D. Relapse cases)
6. Case follow-up
6.1 whether to take the whole course of medication: A. Yes (if so, please jump to 6.3) B. No
6.2 Reasons for not taking the full course of medication:
6.3 Whether there are adverse drug reactions: A. Yes B. No. If yes, If yes, please indicate the specific adverse drug r eactions: _______________
6.4 Treatment effect: A. Cured B. Not cured (please indicate condition: _______________) C. Death (please indicate date of death: _______________.
6.5 If the patient is hospitalized, his/her total hospitalization days _______________.
6.6 Date of follow-up: ____________
6.7 Followers: __________________
Note:
1. Please tick the numbers or letters of the choice.
2. The serial number of this form is uniformly arranged by the malaria epidemic situation disposal unit and is only used for preservation and access to data.
3. “Last time” in items “4.1, 4.2, 4.3, 4.4” refers to the last case of malaria before this illness.
4. The part of “6. Case Follow-up” is a return survey after the end of the whole course of treatment.
Survey institute: ________________;
Investigators: ___________________;
Date of survey:_________________.
Form 5-4 Questionnaire on Basic Situation of Malaria Epidemic Focus Address of epidemic focus:
Ⅰ Epidemic focus classification .
1. The epidemic focus of transmission has appeared: .
A. new epidemic focus .
B. residual epidemic focus .
C. persistent epidemic focus .
2. There is the possibility of transmission .
3. There is no possible epidemic focus of transmission Judgment basis:
Ⅱ General situation
1. Main crops:
A. Rice B. Dry grain C. Cotton D. Mixed
2. Cultivated land area:
paddy field:
3. Total number of large livestock (including cattle, pigs, horses, donkeys, mules, etc.):
4. Name of insecticides commonly used in agriculture:
Ⅲ Natural environment.
5. The epidemic foci belong to:
A. Cities B. Rural areas
6. Altitude:
7. Main topography:
A. Plains B. Mountainous areas C. Water networks D. Hills
E. Basins F. River valleys G. Other
8. Epidemic focus area:
9. Whether epidemic foci are border counties (cities, districts):
A. Yes B. No.
If yes, please briefly describe the boundary situation and the type of environment:
Ⅳ Health service situation
10. The number of medical institutions in the county (city, district) of the epidemic focus: _______________ the total number of medical personnel _______________; the number of prevention and protection (disease control) personnel_______________ ; the number of people who have participated in malaria control training _______________.
11. The number of health service institutions in villages and towns (streets) of the epidemic focus; the number of medical personnel _______________: among them, the number of prevention and protection personnel _______________; the number of people who have participated in malaria control training _______________:
Ⅴ Key meteorological data
12. Annual average temperature: _______________℃;
Annual rainfall (mm): _______________;
May-October average relative humidity (%): _______________ .
Ⅵ Characteristics of population in epidemic focus
13. Population of epidemic focus: ______________ .
Floating population of epidemic focus: _______________ .
(Note: Briefly describe the susceptibility of people in epidemic focus, such as floating population characteristics, population mobility characteristics and human-mosquito exposure risk, etc.)
Ⅶ Historical materials
14. The number of reported cases of malaria in the past 4 years; including Plasmodium vivax; Plasmodium falciparum; Plasmodium ovale; Plasmodium malariae; mixed infection; and others. The number of local cases; the number of imported cases.
15. The main local malaria vectors are: _____________________________________________________________________________
16. The results of the last vector survey conducted by the county to which the epidemic focus belongs: ______________________________________________________________________________________________________________________________
Ⅷ The basic description of the case indicated by the epidemic focus:
Note.
1.Epidemic foci that have transmission: refer to the natural villages (residential areas) where there are local infections or imported secondary cases. The epidemic foci that have transmission include new epidemic spots, residual epidemic foci and persistent epidemic spots. Among them, new epidemic spot refer to natural villages where there is no local infection or imported secondary cases in the past 2 years or no local infection or imported secondary cases in history (residential group). Residual epidemic foci refer to natural villages where local infection or imported secondary cases have occurred in the past 2 years (residential group). Persistent epidemic foci refer to natural villages where transmission persists and there is no effective control (residential group).
2.Epidemic foci with the possibility of transmission: refer to the natural villages (residential areas) where there are imported cases and conditions for transmission.
3.Epidemic foci with no possibility of transmission: refer to natural villages (settlements) where there are imported cases but there is no malaria vector or there is a malaria vector but it is not in the transmission season.
Formfilling explanation:
1. In the cpidemic foci of confirmel local primary cases and imperted secondary cases, as well as imperted cases, recurrent cases and non-mosquito-borne malaria cases in counties with transmission conditiens (there is a malaria vector, and it is in the malaria epidemic season), tit needs to complete the full contents of this questionnaire.
2. In the epidemic foci of imported cases, recurrent cases and non-mosquito-borne malaria cases in counties with no conditions for transmission, it only needs to complete the part of “1. epidemic focus classification”.
Survey institute: ________________ .
Date of survey: _________________
Investigators: ___________________
Table 5-5 Investigation Record Form of Infection Source in Malaria Epidemic Focus
Table 5-6 Questionnaire for Peers Retuming from Overseas
Table 5-7 Record Table of Residual Spraying in Malaria Epidemic Focus Disposal Room
