Back on track to malaria elimination| Editor's Selection for the April issue of The Lancet - Regional Health (Western Pacific).

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The Lancet Regional Health - Western Pacific is an open access journal owned by The Lancet as part of the Lancet global initiative to promote equal access to quality health care around the world. The ultimate goal of this journal is to improve health outcomes for people in the Western Pacific and will work to promote improvements in clinical practice and health policy progress and development in the Western Pacific. Ultimately, it is expected that the quality of health in the region and the countries concerned will be improved. The Lancet has launched a compilation of selected papers on The Lancet - Regional Health (Western Pacific) to share with readers. The Lancet - Regional Health (Western Pacific) has been | by the Web of Science Included in Science Citation Index Expanded (SCIE).

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Selected papers

1

Back on the track of malaria elimination – experience and innovation

Over the past few decades, much has been done globally to control and eliminate malaria. However, progress towards malaria elimination has stalled since 2015 and has been further exacerbated by the global COVID-19 pandemic. The theme of this year's World Malaria Day is "Using Innovation to Reduce the Burden of Malaria Disease and Save Lives". It reminds us to learn from countries that have experienced setbacks and to learn from innovations from countries that have maintained steady progress. We have made some remarkable achievements with the clear goal of eliminating malaria globally, but we still need to get back on track and move towards a malaria-free future.

2

Allocation of vaccines and antivirals for emerging strains of the coronavirus in East Asia and the Western Pacific: a model study

For emerging variants of concern (VOCs), we aimed to assess the impact of various distribution strategies for COVID-19 vaccines and antivirals, so that end-of-pandemic strategies can be adapted to risk and preference in the East Asia and Western Pacific (EAP) region to improve their efficiency and effectiveness.

The study estimated the efficacy of the vaccine based on the titer distribution of the 50% plaque reduction neutralization test (PRNT50), assuming that the initial dose of PRNT50 was reduced by 2-10 times due to weakened antibodies and the appearance of VOCs, and supplemental vaccination was able to increase the TITer of PRNT50 by 3-9 times. We then used existing models of COVID-19 transmission to assess the results of vaccine allocation strategies for symptomatic patients in Japan, Hong Kong, and Vietnam using and without antiviral drugs.

Increasing initial vaccination coverage is the most important factor in reducing the total number of COVID-19 hospitalizations and the peak number of hospitalizations, especially in the case of lower vaccination coverage or vaccination rates in older adults. Providing antiviral drugs to 50% of symptomatic infected people can only further reduce the total number of hospitalizations and the peak number of hospitalizations by 10-13%. The effect of supplementary vaccination is highly dependent on the immune evasion potential of VOCs and the weakening of antibodies, while the dependence on the enhanced effect of the supplementary vaccine itself is small.

In response to the emergence of new VOCs such as Omilon in the EAP region, we should prioritize increasing coverage of initial vaccination when designing our distribution strategies for COVID-19 vaccines and antiviral drugs. When developing a strategy to end the pandemic in response to the situation in the EAP region, cross-vaccine supplementation with any available vaccine may be considered.

3

Herpes-related hospitalization following COVID-19 inactivated vaccine (CoronaVac) and mRNA vaccine (BNT162b2): self-controlled and nested case-control studies

Stimulation of immunity through vaccination may have side effects. There is currently no conclusive evidence of a relationship between shingles-related hospitalization and COVID-19 vaccination. The objective of this study was to assess the effects of covid-19 inactivated vaccine (CoronaVac) and mRNA vaccine (BNT162b, Baintec/Fosun vaccine) on the risk of herpes zoster-related hospitalization.

Data from the self-controlled case series (SCCS) came from the Electronic Health Records of the Hospital Authority in Hong Kong, China and the COVID-19 Vaccination Archives of the Department of Health. We conducted SCCS analysis of patients hospitalized for their first initial diagnosis of shingles from 23 February to 31 July 2021 and conducted a confirmatory analysis using a nested case-control study approach. 10 control groups were randomly assigned to each patient with shingles based on sex, age, Charlson comorbidity index, and date of admission. Evaluate potential overfill rates of shingles after vaccination based on conditional Poisson regression and logistic regression models.

From 23 February to 31 July 2021, within 28 days of coronaVac and BNT162b vaccinations, 16 and 27 patients, respectively, were initially diagnosed with shingles in hospitals for the first time. The incidence of herpes zoster is 7.9% (95% confidence interval [CI]: 5.2-11.5) for every 1 million doses of CoronaVac vaccine and 7.1% (95CI: 4.1-11.5) for every 1 million doses of BNT162b vaccine vaccinated. In the SCCS analysis, the risk of developing herpes zoster within 14 days of coronaVac vaccination was significantly increased compared with the baseline phase (corrected incidence [aIRR] = 2.67, 95% CI: 1.08 to 6.59), but there was no significant difference after 14 days. Within 14 days of the first and second BNT162b vaccinations, the risk of shingles increased significantly (0-13 days after initial vaccination: [aIRR] = 2.67, 95% CI: 1.61–17.03; 14-27 days after first vaccination: aIRR=5.82, 95% CI: 1.62–20.91; 0-13 days after second vaccination: aIRR=5.14, 95% CI: 1.29–20.47). Based on these relative ratios, we estimate that for every 1 million doses of CoronaVac and BNT162b vaccines, there are approximately 5 and 7 cases hospitalized for shingles, respectively. Nested case analysis found similar results.

We found that after coronaVac and BNT162b vaccinations, the risk of herpes zoster-related hospitalization increased. However, the absolute risk of developing such side effects after both inoculations is very low. In COVID-19-endemic areas, vaccination will provide far more protection than its side effects.

4

Trends and associated factors in the places of death of patients with cardiovascular disease in China, 2008-2020: a population-based study

Cardiovascular disease is the leading cause of death in China. Studying the distribution characteristics of deaths sites of cardiovascular diseases is of great significance for evaluating the utilization of medical services at the end of life. Studies on the distribution of places of death from cardiovascular disease are limited, and we know very little about the factors associated with cardiovascular disease deaths in hospitals.

Based on data from the National Mortality Surveillance System (NMSS) in China, the distribution of deaths from cardiovascular disease between 2008 and 2020 was analyzed. Multi-level logistic regression analysis was used to explore the factors associated with hospital cardiovascular disease death, and the degree to which the spatial variability of hospital cardiovascular disease death can be explained by these related factors was quantified.

From 2008 to 2020, china NMSS collected a total of 7,101,871 cardiovascular disease deaths, of which home was the first place of death (77.13%), followed by hospitals (18.49%). Shanghai (59.40%) has the highest proportion of cardiovascular disease deaths in hospitals. Age, gender, ethnicity, marital status, education, occupation, and potential cause of death are all significant factors influencing death from cardiovascular disease in hospitals. Individual-level factors can explain 33.88% of the provincial-level spatial variability.

The home is the main place of death from cardiovascular disease in China, among which women, young, Han, married, retired, living in urban areas, high socio-economic level, and dying from chronic cardiovascular disease have a higher probability of dying in hospital. Providing accessible and accessible health care is a top priority in improving the quality of end-of-life care for cardiovascular disease deaths. The significant variability at the provincial level and subpopulation also suggests that the allocation of health care resources needs to be balanced, and ethnic minorities also need more choices of places of death.

5

Diagnostic accuracy of the main types of stroke in adults in China: a clinically determined study of 40,000 stroke cases

In China, brain imaging technology has been widely used in adult cases of suspected stroke, which has promoted the clinical determination of stroke types. Therefore, we conducted a clinically determinative study to assess the accuracy of reporting and diagnosis of the main types of stroke.

The China Prospective Study of Chronic Diseases (China Kadoorie Biobank) recruited more than 512,000 adults (average age 52 years, 59% female) from 10 urban and rural areas in China between 2004 and 2008 and recorded 45,859 new stroke patients during an 11-year follow-up period. About 85% of cases have access to their medical records and use laptops to record their clinical information so that professional physicians act as adjudicators to make decisions based on the diagnostic criteria for stroke developed by the World Health Organization (WHO). Analysis was based on different stroke types (ischaemic stroke, IS, intracerebral haemorrhage, ICH] and subarachnoid haemorrhage [subarachnoid haemorrhage, SAH]), year of diagnosis, region, and hospital type to assess the positive predictive values for reported stroke cases and judged stroke cases predictive value, PPV）。

Of the 38,823 patients with medical records, the previous ICD-10-based stroke PPV was 91%. Of the 29,952 cases judged, the PPV diagnosed for stroke was 81% with a decision result as the gold standard, of which ICH (n = 3391; PPV=98%), SAH(364; PPV = 98%) of PPV than IS of PPV (20,473; 79%) is higher. 5504 confirmed IS cases were rejected at the time of determination, of which 3763 (68%) were lacunar infarction (LACI). Among confirmed IS cases, the proportion of resting LACI rose from 7.1% in 2004-2008 to 18.2% in 2016-2017. If resting LACI is classified as IS according to the diagnostic criteria for stroke in the latest International Classification of Diseases (ICD-11) (i.e., combining imaging and clinical criteria, rather than clinical criteria alone), the PPV of IS will increase to 93%.

Based on the overall high accuracy of reporting and diagnosis of stroke types in adults in China, the implementation of the latest IS diagnostic criteria has an important impact on the current clinical practice and research of stroke in Chinese populations.

6

Use rate of intravenous thrombolysis and endovascular therapy for acute ischemic stroke in China, 2019-2020

In recent years, China has undertaken a series of initiatives to promote the use of intravenous thrombolysis (IVT) and endovascular therapy (EVT) in patients with acute ischaemic stroke (AIS). The aim of this study was to report on the latest use of IVT and EVT in China between 2019 and 2020 and to assess the application of IVT and EVT according to the hospital grade.

Based on the Chinese Cerebrovascular Disease Big Data Platform for Stroke of China (BOSC), cross-sectional data of patients treated with IVT/EVT was obtained. The number of discharged patients with AIS as the primary diagnosis is obtained from the medical record homepage of each hospital. IvT and EVT usage and related information are analyzed according to the hospital grade.

During this period, 938 tertiary hospitals and 786 secondary hospitals from 31 provinces continuously entered data into the BOSC. Among AIS patients, the overall use rate of IVT treatment was 5.64%, and the overall use rate of EVT was 1.45%. IvT use in secondary hospitals was higher than in tertiary hospitals (6.39% vs.5.39%, P

In China, the rate of IVT and EVT received by AIS patients has increased significantly, but there is still a big gap compared with developed countries. Differences in IVT and EVT use between hospitals of different grades suggest the importance of establishing a region-specific stroke treatment network. END

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*Chinese translation is for reference only, and all content is subject to the original English text.