title: Malaria control and prevention towards elimination: data from an eleven-year surveillance in Shandong Province, China.
abstract: Shandong Province experienced a declining malaria trend of local-acquired transmission, but the increasing imported malaria remains a challenge. Therefore, understanding the epidemiological characteristics of malaria and the control and elimination strategy and interventions is needed for better planning to achieve the overall elimination goal in Shandong Province.
  
  
  
  A retrospective study was conducted and all individual cases from a web-based reporting system were reviewed and analysed to explore malaria-endemic characteristics in Shandong from 2005 to 2015. Annual malaria incidence reported in 2005-2015 were geo-coded and matched to the county-level. Spatial cluster analysis was performed to evaluate any identified spatial disease clusters for statistical significance. The space-time cluster was detected with high rates through the retrospective space-time analysis scanning using the discrete Poisson model.
  
  
  
  The overall malaria incidence decreased to a low level during 2005-2015. In total, 1564 confirmed malaria cases were reported, 27.1% of which (n = 424) were indigenous cases. Most of the indigenous case (n = 339, 80.0%) occurred from June to October. However, the number and scale of imported cases have been increased but no significant difference was observed during months. Shandong is endemic for both Plasmodium vivax (n = 730) and Plasmodium falciparum (n = 674). The disease is mainly distributed in Southern (n = 710) and Eastern region (n = 424) of Shandong, such as Jinning (n = 214 [13.7%]), Weihai (n = 151 [9.7%]), and Yantai (n = 107 [6.8%]). Furthermore, the spatial cluster analysis of malaria cases from 2005 to 2015 indicated that the diseased was not randomly distributed. For indigenous cases, a total of 15 and 2 high-risk counties were determined from 2005 to 2009 (control phase) and from 2010 to 2015 (elimination phase), respectively. For imported cases, a total of 26 and 29 high-risk counties were determined from 2005 to 2009 (control phase) and from 2010 to 2015 (elimination phase), respectively. The method of spatial scan statistics identified different 13 significant spatial clusters between 2005 and 2015. The space-time clustering analysis determined that the most likely cluster included 14 and 19 counties for indigenous and imported, respectively.
  
  
  
  In order to cope with the requirements of malaria elimination phase, the surveillance system should be strengthened particularity on the frequent migration regions as well as the effective multisectoral cooperation and coordination mechanisms. Specific response packages should be tailored among different types of cities and capacity building should also be improved mainly focus on the emergence response and case management. Fund guarantees for scientific research should be maintained both during the elimination and post-elimination phase to consolidate the achievements of malaria elimination.
authors.affiliation: Shandong Institute of Parasitic Diseases, Shandong Academy of Medical Sciences, No. 11 Taibai Zhong Road, Jining, 272033, Shandong, China.
authors.forename: Xiangli
authors.initials: X
authors.lastname: Kong
authors.affiliation: Shandong Institute of Parasitic Diseases, Shandong Academy of Medical Sciences, No. 11 Taibai Zhong Road, Jining, 272033, Shandong, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Liu
authors.affiliation: National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory of Parasite and Vector Biology, Ministry of Health, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, No. 207 Ruijin Er Road, Shanghai, 200025, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Tu
authors.affiliation: Shandong Institute of Parasitic Diseases, Shandong Academy of Medical Sciences, No. 11 Taibai Zhong Road, Jining, 272033, Shandong, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Jining No. 1 People's Hospital, No. 6 Jiankang Road, Jining, 272011, Shandong, China.
authors.forename: Jianbing
authors.initials: J
authors.lastname: Niu
authors.affiliation: Shandong Institute of Parasitic Diseases, Shandong Academy of Medical Sciences, No. 11 Taibai Zhong Road, Jining, 272033, Shandong, China.
authors.forename: Yongbin
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Shandong Institute of Parasitic Diseases, Shandong Academy of Medical Sciences, No. 11 Taibai Zhong Road, Jining, 272033, Shandong, China.
authors.forename: Changlei
authors.initials: C
authors.lastname: Zhao
authors.affiliation: Shandong Institute of Parasitic Diseases, Shandong Academy of Medical Sciences, No. 11 Taibai Zhong Road, Jining, 272033, Shandong, China.
authors.forename: Jingxuan
authors.initials: J
authors.lastname: Kou
authors.affiliation: National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory of Parasite and Vector Biology, Ministry of Health, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, No. 207 Ruijin Er Road, Shanghai, 200025, China. fjphilip1983@hotmail.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Feng
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D060740:Disease Eradication; D005260:Female; D006801:Humans; D015994:Incidence; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012621:Seasons; D062211:Spatio-Temporal Analysis