Safety and effectiveness of mass drug administration to accelerate elimination of artemisinin-resistant falciparum malaria: A pilot trial in four villages of Eastern Myanmar

Wellcome Open Research

article

Victor Chaumeau¹  Jacher Wiladphaingern¹  Mallika Imwong⁴  Olivo Miotto⁴  Krittaya Patumrat⁵  Jureeporn Duanguppama⁵  Dominique Cerqueira⁴  Benoit Malleret⁸  Jordi Landier¹  Ladda Kajeechiwa¹  May Myo Thwin¹  Daniel M. Parker¹  Laurent Rénia⁹  Suphak Nosten¹  Lorenz von Seidlein⁴  Clare Ling¹  Stéphane Proux¹  Vincent Corbel²  Julie A. Simpson^1,10  Arjen M. Dondorp⁴  Nicholas J. White⁴  François H. Nosten¹ 

[1] Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University;Maladies Infectieuses et Vecteurs Ecologie, Génétique, Evolution et Contrôle ,(IRD 224-CNRS 4280 UM1-UM2), Institut de Recherche pour le Développement;Centre Hospitalier Régional Universitaire de Montpellier;Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University;Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University;Centre for Genomics and Global Health, Wellcome Trust Centre for Human Genetics, University of Oxford;Wellcome Trust Sanger Institute;Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University of Singapore;Singapore Immunology Network ,(SIgN), Agency for Science & Technology;Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne;Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford

关键词: Plasmodium falciparum;    Plasmodium vivax;    Mass Drug Administration;    Asymptomatic carriage;    submicroscopic infection;    artemisinin-resistance;    transmission;   

DOI  :  10.12688/wellcomeopenres.12240.1

学科分类：内科医学

来源: Wellcome

【 摘 要 】

Background: Artemisinin and partner drug-resistant falciparum malaria is expanding over the Greater Mekong Sub-region (GMS). Eliminating falciparum malaria in the GMS while drugs still retain enough efficacy could prevent global spread of antimalarial resistance. Eliminating malaria rapidly requires targeting the reservoir of asymptomatic parasite carriers. This pilot trial aimed to evaluate the acceptability, safety, feasibility and effectiveness of mass-drug administration (MDA) in reducing malaria in four villages in Eastern Myanmar.Methods: Villages with ≥30% malaria prevalence were selected. Long-lasting insecticidal bednets (LLINs) and access to malaria early diagnosis and treatment (EDT) were provided. Two villages received MDA immediately and two were followed for nine months pre-MDA. MDA consisted of a 3-day supervised course of  dihydroartemisinin-piperaquine and single low-dose primaquine administered monthly for three months. Adverse events (AE) were monitored by interviews and consultations. Malaria prevalence was assessed by ultrasensitive PCR quarterly for 24 months. Symptomatic malaria incidence,entomological indices, and antimalarial resistance markers were monitored.Results: MDA was well tolerated. There were no serious AE and mild to moderate AE were reported in 5.6%(212/3931) interviews. In the smaller villages, participation to three MDA courses was 61% and 57%, compared to 28% and 29% in the larger villages. Baseline prevalence was higher in intervention than in control villages (18.7% (95%CI=16.1-21.6) versus 6.8%(5.2-8.7), p<0.0001) whereas three months after starting MDA, prevalence was lower in intervention villages (0.4%(0.04-1.3) versus 2.7%(1.7-4.1), p=0.0014). After nine months the difference was no longer significant (2.0%(1.0-3.5) versus 0.9%(0.04-1.8), p=0.10). M0-M9 symptomatic falciparum incidence was similar between intervention and control. Before/after MDA comparisons showed that asymptomaticP. falciparum carriage and anopheline vector positivity decreased significantly whereas prevalence of the artemisinin-resistance molecular marker remained stable.Conclusions: This MDA was safe and feasible, and, could accelerate elimination ofP. falciparum in addition to EDT and LLINswhen community participation was sufficient.

【 授权许可】

CC BY