Predicting the risk of malaria importation into Jiangsu Province, China: a modeling study

Kaixuan Liu; Yuanyuan Cao; Enyu Xu; Zeyin Chong; Liying Chai; Yi Wang; Yuhui Xu; Yin Wang; Jun Zhang; Olaf Müller; Jun Cao; Guoding Zhu; Guangyu Lu

doi:10.1186/s12992-024-01090-4

Predicting the risk of malaria importation into Jiangsu Province, China: a modeling study

Global Health. 2024 Nov 26;20(1):84. doi: 10.1186/s12992-024-01090-4.

Authors

Kaixuan Liu^#¹, Yuanyuan Cao^#², Enyu Xu¹, Zeyin Chong¹, Liying Chai¹, Yi Wang², Yuhui Xu³, Yin Wang³, Jun Zhang³, Olaf Müller⁴, Jun Cao^{2

5}, Guoding Zhu^{6

7}, Guangyu Lu^{8

9}

Affiliations

¹ Institute of Public Health, Medical School of Yangzhou University, Yangzhou University, Yangzhou, Hanjiang District, 225007, China.
² National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory On Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China.
³ Yangzhou Center for Disease Control and Prevention, Yangzhou, China.
⁴ Institute of Global Health, Medical School, Ruprecht-Karls-University, Heidelberg, Germany.
⁵ Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.
⁶ National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory On Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China. jipdzhu@hotmail.com.
⁷ Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China. jipdzhu@hotmail.com.
⁸ Institute of Public Health, Medical School of Yangzhou University, Yangzhou University, Yangzhou, Hanjiang District, 225007, China. guangyu.lu@yzu.edu.cn.
⁹ Jiangsu Key Laboratory of Zoonosis, Yangzhou, China. guangyu.lu@yzu.edu.cn.

^# Contributed equally.

PMID: 39593092
DOI: 10.1186/s12992-024-01090-4

Abstract

Background: The World Health Organization certified China malaria-free in 2021. Consequently, preventing the risk of malaria re-introduction caused by imported malaria has now become a major challenge. This study aims to characterize the dynamics and predict the risk of malaria importation in Jiangsu Province, where the number of imported malaria cases ranks among the highest in China.

Methods: The annual number of cases with imported malaria in Jiangsu Province, the annual number of travelers from sub-Saharan Africa (SSA) to Jiangsu Province (both Chinese and international travelers), and the annual number of Chinese migrant workers from Jiangsu Province who stayed abroad between 2013 and 2020 were assessed. The spatio-temporal dynamics of malaria importation was characterized with ArcGIS 10.8. A negative binomial model was applied to model malaria importation to Jiangsu Province, China.

Results: A total of 2,221 of imported malaria cases were reported from January 1, 2013, until December 31, 2020. Imported malaria cases into China were mainly from SSA (98%) and P. falciparum (78%), the most common species. A seasonal pattern was observed, with the most cases occurring from December to February. The negative binomial model, which incorporates the number of Chinese migrant workers from Jiangsu Province who stayed abroad as an independent variable, demonstrated better performance (AIC: 96.495, BIC: 94.230) compared to the model based solely on travelers from SSA to Jiangsu Province. The model indicated an estimated 139% increase in imported cases for a 10% increase in Chinese migrant workers from Jiangsu Province who stayed abroad.

Conclusion: In conclusion, our study underscores the importance of incorporating data on Chinese migrant workers who have stayed abroad when predicting malaria importation risks. By integrating both international travel patterns and migrant worker data, our findings offer a more robust framework for assessing and managing malaria risk in Jiangsu Province. This approach provides valuable insights for public health officials, enabling more effective resource allocation and targeted interventions to prevent the re-introduction of malaria and improve overall disease management.

Keywords: Imported malaria; Malaria elimination; Migrant workers; Prevention of malaria reintroduction; Travel medicine.