{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T16:00:22Z","timestamp":1792425622788,"version":"4.5.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,6,28]],"date-time":"2023-06-28T00:00:00Z","timestamp":1687910400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>This study aimed at exploring the epidemiological pattern of imported malaria in China before malaria elimination in 2021, to provide evidence-based data for preventing malaria re-establishment in China.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Nine-year surveillance data on imported malaria in four provincial-level administrative divisions (PLADs) (Anhui, Chongqing, Guangxi, and Zhejiang) between 2011 and 2019 were thoroughly collected and analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A quite stable trend in imported malaria cases between 2011 and 2019 was observed. In total, 6,064 imported patients were included. <jats:italic>Plasmodium falciparum<\/jats:italic> was the most frequently reported species (4,575, 75.6%). Cases of malaria were most frequently imported from Western Africa (54.4%). We identified an increasing trend in <jats:italic>P. ovale<\/jats:italic> and a persistence of <jats:italic>P. vivax<\/jats:italic> infections among the cases of malaria imported from Western Africa. Most patients (97.5%) were 20\u201350 years old. Among imported malaria infections, the main purposes for traveling abroad were labor export (4,914\/6,064, 81.0%) and business trips (649, 10.7%). Most patients (2,008\/6,064, 33.1%) first visited county-level medical institutions when they sought medical help in China. More patients were diagnosed within 3 days after visiting Centers for Disease Control and Prevention (CDCs) or entry\u2013exit quarantine facilities (EQFs) (1,147\/1609, 71.3%) than after visiting medical institutions (2,182\/3993, 54.6%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Imported malaria still poses a threat to the malaria-free status of China. County-level institutions are the primary targets in China to improve the sensitivity of the surveillance system and prevent the re-establishment of malaria. Health education should focus on exported labors, especially to Western and Central Africa. Increasing trend in <jats:italic>P. ovale<\/jats:italic> and persistence of <jats:italic>P. vivax<\/jats:italic> infections indicated their underestimations in Western Africa. Efficient diagnostic tools and sensitive monitoring systems are required to identify <jats:italic>Plasmodium<\/jats:italic> species in Africa.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1203095","type":"journal-article","created":{"date-parts":[[2023,6,28]],"date-time":"2023-06-28T12:25:58Z","timestamp":1687955158000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Increasing incidence of Plasmodium ovale and persistent reporting of Plasmodium vivax in imported malaria cases: an analysis of 9-year surveillance data in four areas of China"],"prefix":"10.3389","volume":"11","author":[{"given":"Xiaoxiao","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjie","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kangming","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linong","family":"Yao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Auburn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duoquan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Ruan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,6,28]]},"reference":[{"key":"ref1","volume-title":"World malaria report 2021","year":"2021"},{"key":"ref2","volume-title":"Update on the E-2020 initiative of 21 malaria-eliminating countries: report and country briefs","year":"2018"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1016\/j.pt.2017.06.010","article-title":"Anopheles vectors in mainland China while approaching malaria elimination","volume":"33","author":"Zhang","year":"2017","journal-title":"Trends Parasitol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/s40249-020-00661-y","article-title":"Protecting the gains of malaria elimination in China","volume":"9","author":"Feng","year":"2020","journal-title":"Infect Dis Poverty"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e1001642","DOI":"10.1371\/journal.pmed.1001642","article-title":"Communicating and monitoring surveillance and response activities for malaria elimination: China's \u201c1-3-7\u201d strategy","volume":"11","author":"Cao","year":"2014","journal-title":"PLoS Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e871","DOI":"10.1016\/S2468-2667(21)00201-2","article-title":"Achieving malaria elimination in China","volume":"6","author":"Cao","year":"2021","journal-title":"Lancet Public Health"},{"key":"ref7","volume-title":"Malaria elimination: a field manual for low and moderate endemic countries","year":"2007"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"19993","DOI":"10.2807\/ese.16.42.19993-en","article-title":"Autochthonous plasmodium vivax malaria in Greece, 2011","volume":"16","author":"Danis","year":"2011","journal-title":"Euro Surveill"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"O12","DOI":"10.1186\/1475-2875-11-S1-O12","article-title":"Eliminating malaria and preventing its reintroduction: the Mauritius case study","volume":"11","author":"Aboobakar","year":"2012","journal-title":"Malar J"},{"key":"ref10","first-page":"138","article-title":"Re-emergence of malaria in Armenia and vector control interventions","volume":"2","author":"Avetisyan","year":"2004","journal-title":"J Health Sci Manage Public Health"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1186\/s12936-019-2843-6","article-title":"The first introduced malaria case reported from Sri Lanka after elimination: implications for preventing the re-introduction of malaria in recently eliminated countries","volume":"18","author":"Karunasena","year":"2019","journal-title":"Malar J"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1186\/s12936-020-03527-8","article-title":"Prevention of re-establishment of malaria: historical perspective and future prospects","volume":"19","author":"Nasir","year":"2020","journal-title":"Malar J"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"864","DOI":"10.3201\/2105.141712","article-title":"Malaria imported from Ghana by returning gold miners, China, 2013","volume":"21","author":"Li","year":"2015","journal-title":"Emerg Infect Dis"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1186\/1475-2875-11-328","article-title":"Management of imported malaria in Europe","volume":"11","author":"Askling","year":"2012","journal-title":"Malar J"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1111\/j.1708-8305.2011.00512.x","article-title":"Knowledge, attitudes, and practices on malaria prevention among Chinese international travelers","volume":"18","author":"Zhang","year":"2011","journal-title":"J Travel Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1093\/jtm\/taz067","article-title":"Malaria prevention in the older traveller: a systematic review","volume":"26","author":"Del Prete","year":"2019","journal-title":"J Travel Med"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1186\/s12936-016-1188-7","article-title":"Epidemiologic features of overseas imported malaria in the People's Republic of China","volume":"15","author":"Li","year":"2016","journal-title":"Malar J"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"7568","DOI":"10.1038\/s41598-020-64593-1","article-title":"Epidemiological characteristics of imported malaria in Shandong Province, China, from 2012 to 2017","volume":"10","author":"Yu","year":"2020","journal-title":"Sci Rep"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1186\/1475-2875-12-452","article-title":"Plasmodium vivax malaria incidence over time and its association with temperature and rainfall in four counties of Yunnan Province, China","volume":"12","author":"Wardrop","year":"2013","journal-title":"Malar J"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1186\/1475-2875-8-180","article-title":"Space-time variation of malaria incidence in Yunnan province, China","volume":"8","author":"Clements","year":"2009","journal-title":"Malar J"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.idc.2018.10.002","article-title":"Malaria: What's new in the Management of Malaria?","volume":"33","author":"Plewes","year":"2019","journal-title":"Infect Dis Clin N Am"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"852","DOI":"10.3201\/eid2804.212269","article-title":"In vitro confirmation of Artemisinin resistance in plasmodium falciparum from patient isolates, southern Rwanda, 2019","volume":"28","author":"van Loon","year":"2022","journal-title":"Emerg Infect Dis"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.1056\/NEJMoa2101746","article-title":"Evidence of Artemisinin-resistant malaria in Africa","volume":"385","author":"Balikagala","year":"2021","journal-title":"N Engl J Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e0007140","DOI":"10.1371\/journal.pntd.0007140","article-title":"Growing evidence of plasmodium vivax across malaria-endemic Africa","volume":"13","author":"Twohig","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1186\/s12936-017-1722-2","article-title":"Molecular evidence of plasmodium vivax infection in Duffy negative symptomatic individuals from Dschang, West Cameroon","volume":"16","author":"Russo","year":"2017","journal-title":"Malar J"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1186\/s12936-022-04339-8","article-title":"A systematic review of asymptomatic plasmodium knowlesi infection: an emerging challenge involving an emerging infectious disease","volume":"21","author":"Naserrudin","year":"2022","journal-title":"Malar J"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1093\/infdis\/jiv475","article-title":"Asymptomatic and submicroscopic carriage of plasmodium knowlesi malaria in household and community members of clinical cases in Sabah, Malaysia","volume":"213","author":"Fornace","year":"2016","journal-title":"J Infect Dis"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1203095\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,28]],"date-time":"2023-06-28T12:26:04Z","timestamp":1687955164000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1203095\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,28]]},"references-count":27,"alternative-id":["10.3389\/fpubh.2023.1203095"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2023.1203095","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,28]]},"article-number":"1203095"}}