Rolling Back a Malaria Epidemic in South Africa 英文参考文献.docVIP

Open access, freely available online Perspectives Rolling Back a Malaria Epidemic in South Africa Patrick E. Duffy*,Theonest K. Mutabingwa A mid the dire statistics showing a deadly resurgence of malaria, a notable success has been scored in South Africa. In KwaZulu–Natal province, malaria cases increased from about 600 in 1991–1992 to more than 30,000 by 1999–2000 [1]. Then, after household spraying with DDT was implemented, and the new antimalarial combination artemether-lumefantrine (AL) was widely deployed (Figure 1), cases declined by more than 99% over the next three years. A paper in PLoS Medicine by Barnes et al. [2] examines the implementation and ef?cacy of AL during the KwaZulu–Natal crisis. They conclude that vector control and widespread use of artemisinin-based combination therapy (ACT) such as AL may confer similar bene?ts in other African countries. Could the adoption of these policies salvage the Roll Back Malaria Initiative that was formed in 1999 to halve malaria deaths by 2010 [3], but which was recently lamented as “dysfunctional” for its inaction in the face of rising malaria morbidity and mortality rates [4]? DOI: 10.1371/journal.pmed.0020368.g001 Figure 1. Mosquito Control and ACT Are Both Likely Contributors to the Reduction of Malaria in KwaZulu–Natal (Photo: Karen Barnes and Atis Muelenbachs) children treated with a chloroquine and sulfadoxine-pyrimethamine (SP) combination to infect mosquitoes. These reports have led many to expect that ACTs will dramatically improve case management, and reduce malaria transmission in Africa. enough to seek treatment, and act as a reservoir for continued transmission. Additionally, African children often present with high-density parasitemia, making it more likely that parasites will be temporarily suppressed but then recrudesce after artemisinin therapy [8,9]. KwaZulu–Natal—A Special Case? Caution is warranted, however. Artemisinins to the Rescue KwaZulu–Natal is mo