Abstract
BACKGROUND: The Hubei Province in China reported its last indigenous malaria case in September 2012, but imported malaria cases, particularly those related to Plasmodium vivax and Plasmodium falciparum, threaten Hubei's malaria-free status. This study investigated the epidemiological changes in P. vivax and P. falciparum malaria in this province to provide scientific evidence for preventing malaria resurgence. METHODS: The prevalence, demographic characteristics, seasonal features, and geographical distribution of malaria were assessed using surveillance data and were compared across three stages: control stage (2005-2009) and elimination stages I (2010-2014) and II (2015-2019). RESULTS: In 2005-2019, 8483 malaria cases were reported, including 5599 indigenous P. vivax cases, 275 imported P. vivax cases, 866 imported P. falciparum cases, and 1743 other cases. Imported P. falciparum cases accounted for 0.07% of all cases reported in 2005, but increased to 78.81% in 2019. Most imported P. vivax and P. falciparum malaria occurred among males, aged 21-60 years, during elimination stages I and II. The number of regions affected by imported P. falciparum and P. vivax increased markedly in Hubei from the control stage to elimination stage II. Overall, 1125 imported P. vivax and P. falciparum cases were detected from 47 other nations. Eight imported cases were detected from other provinces in China. From the control stage to elimination stage II, the number of cases of malaria imported from African countries increased, and that of cases imported from Southeast Asian countries decreased. CONCLUSIONS: Although Hubei has achieved malaria elimination, it faces challenges in maintaining this status. Hence, imported malaria surveillance need to be strengthened to reduce the risk of malaria re-introduction.