澳大利亚儿童研究所Peter W Gething研究小组提出，2000年至2022年恶性疟原虫和间日疟原虫疟疾全球患病率、发病率和死亡率的时空建模研究。相关论文于2025年3月5日发表在《柳叶刀》杂志上。

背景:疟疾仍然是全球疾病和死亡的主要原因，撒哈拉以南非洲国家承受着不成比例的负担。疟疾流行率、发病率和死亡率的全球高分辨率地图对于跟踪防治该疾病的空间异质性进展并为战略性疟疾控制工作提供信息至关重要。该课题组展示了自2019年以来的第一张最新地图，涵盖了2000年至2022年。这些地图附有行政一级的，并包括与COVID-19大流行相关的疟疾负担影响估计。

方法:课题组研究人员最初使用地理统计建模框架对高负担非洲国家2-10岁儿童恶性疟原虫疟疾感染流行情况进行了建模。该模型是在一个大型的社区感染流行时空观测数据库上进行训练的；环境和人为协变量；并模拟了驱虫蚊帐、室内残留喷洒和抗疟疾药物有效治疗的干预覆盖率。该研究团队开发了一个额外的模型，以纳入COVID-19大流行对疟疾病例管理造成的干扰。由此产生的2000年至2022年感染流行率的高分辨率地图随后被转化为病例发病率和疟疾死亡率的估计值。对于其他疟疾流行国家和间日疟原虫的估计，研究组使用常规监测数据来模拟行政层面的年度病例发病率。然后，研究人员将这些估计值转换为感染流行率和疟疾死亡率，并将行政级别的结果按空间分类，以生成高分辨率地图。最后，该研究团队将模拟的产出结合起来，生成了适合于评估从次国家到全球范围不断变化的疟疾负担的全球地图和汇总表。

发现:研究小组发现撒哈拉以南非洲地区的疟疾感染流行率和病例发病率持续稳定，自2015年以来没有明显的逐年改善。由于疟疾负担集中在撒哈拉以南非洲，以及该地区相对于其他流行地区的人口快速增长，研究小组估计2022年将有2.34亿例（95%不确定区间为17.8 - 2.99亿）例恶性疟原虫疟疾临床病例，这是自2004年以来最多的。尽管有这些发现:2015年之后，撒哈拉以南非洲地区以及全球疟疾死亡人数继续下降，但受covid -19影响的2020 - 2022年除外。同样，尽管全球进展停滞，但非洲以外地区在减少恶性疟原虫和间日疟原虫发病率方面继续取得进展。然而，巴基斯坦在2022年发生严重洪灾后爆发的大规模疟疾疫情逆转了这一改善趋势，并在很大程度上导致全球共有1240万（1070 - 1480）万间日疟临床病例。在非洲，该研究团队发现在人口更密集的地区，感染流行的高原期出现得更早，而人口更稀少的地区则继续保持适度改善的轨迹。

研究结果表明，自21世纪初以来，在疟疾控制方面的空前投资避免了巨大的疟疾负担。然而，非洲的病例发病率已经趋于平缓，而且由于面临风险的人口迅速增加，非洲以及全球的恶性疟原虫病例数量现在与投资激增之前的水平相当。2015年之后，非洲以外地区在防治疟疾发病率方面继续取得进展，但2022年间日疟病例的再次出现凸显了在气候冲击面前防治疟疾进展的脆弱性。与covid -19相关的破坏导致疟疾病例和死亡人数增加，但影响没有人们担心的那么严重，部分原因是流行国家在大流行期间继续优先考虑疟疾控制。然而，仍然迫切需要改进工具和战略，以重新获得防治这一疾病的势头。

附：英文原文

Title: Mapping the global prevalence, incidence, and mortality of Plasmodium falciparum and Plasmodium vivax malaria, 2000–22: a spatial and temporal modelling study

Author: Daniel J Weiss, Paulina A Dzianach, Adam Saddler, Jailos Lubinda, Annie Browne, Michael McPhail, Susan F Rumisha, Francesca Sanna, Yalemzewod Gelaw, Juniper B Kiss, Sarah Hafsia, Rubini Jayaseelen, Hunter S Baggen, Punam Amratia, Amelia Bertozzi-Villa, Olivia Nesbit, Joanna Whisnant, Katherine E Battle, Michele Nguyen, Kefyalew Addis Alene, Ewan Cameron, Melissa A Penny, Samir Bhatt, David L Smith, Tasmin L Symons, Jonathan F Mosser, Christopher J L Murray, Simon I Hay, Peter W Gething

Issue&Volume: 2025-03-05

Abstract: Background

Malaria remains a leading cause of illness and death globally, with countries in sub-Saharan Africa bearing a disproportionate burden. Global high-resolution maps of malaria prevalence, incidence, and mortality are crucial for tracking spatially heterogeneous progress against the disease and to inform strategic malaria control efforts. We present the latest such maps, the first since 2019, which cover the years 2000–22. The maps are accompanied by administrative-level summaries and include estimated COVID-19 pandemic-related impacts on malaria burden.

Methods

We initially modelled prevalence of Plasmodium falciparum malaria infection in children aged 2–10 years in high-burden African countries using a geostatistical modelling framework. The model was trained on a large database of spatiotemporal observations of community infection prevalence; environmental and anthropogenic covariates; and modelled intervention coverages for insecticide-treated bednets, indoor residual spraying, and effective treatment with an antimalarial drug. We developed an additional model to incorporate disruptions to malaria case management caused by the COVID-19 pandemic. The resulting high-resolution maps of infection prevalence from 2000 to 2022 were subsequently translated to estimates of case incidence and malaria mortality. For other malaria-endemic countries and for Plasmodium vivax estimates, we used routine surveillance data to model annual case incidence at administrative levels. We then converted these estimates to infection prevalence and malaria mortality, and spatially disaggregated administrative-level results to produce high-resolution maps. Lastly, we combined the modelled outputs to produce global maps and summarised tables that are suitable for assessing changing malaria burden from subnational to global scales.

Findings

We found an ongoing plateau in rates of malaria infection prevalence and case incidence within sub-Saharan Africa, with consistent year-on-year improvements not evident since 2015. Due to the concentration of malaria burden in sub-Saharan Africa and the region's rapid population growth relative to other endemic regions, we estimate that 2022 had 234·8 (95% uncertainty interval 179·2–299·0) million clinical cases of P falciparum malaria, the most since 2004. Despite these findings, deaths from malaria continued to decline in sub-Saharan Africa and consequently globally after 2015, except for the COVID-19-impacted years of 2020–22. Similarly, progress in reducing P falciparum and P vivax morbidity outside Africa continued despite stalled progress globally. However, a major malaria outbreak in Pakistan following intense flooding in 2022 resulted in a reversal in this improving trend and contributed heavily to the global total of 12·4 (10·7–14·8) million clinical cases of P vivax malaria. Within Africa, we found that the plateau in infection prevalence occurred earlier in more densely populated areas, whereas more sparsely populated regions have continued a trajectory of modest improvement.

Interpretation

The unprecedented investment in malaria control since the early 2000s has averted an enormous amount of malaria burden. However, case incidence rates in Africa have flattened, and with a rapidly growing population at risk, the number of P falciparum cases in Africa, and thus globally, is now comparable to levels before the surge of investment. Outside Africa progress against malaria morbidity continued after 2015, but a resurgence of P vivax cases in 2022 underscores the fragility of progress against malaria in the face of climatic shocks. COVID-19-related disruptions led to increased malaria cases and deaths, but the impact was less severe than feared, in part because endemic countries continued to prioritise malaria control during the pandemic. Nevertheless, improved tools and strategies remain urgently needed to regain momentum against this disease.

DOI: 10.1016/S0140-6736(25)00038-8

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00038-8/abstract