Malaria epidemiology in central Myanmar: identification of a multi-species asymptomatic reservoir of infection

Malaria Journal

Research

Inke ND Lubis¹  Colin J. Sutherland¹  David L. Heymann²  Rosanna Ghinai³  Teddy Tun Win Hla⁴  Therese Hesketh⁴  Jackie Cook⁵  Tom Hall⁵  Chris Drakeley⁵  Nigel Field⁶  Isaac Ghinai⁶  Hein Myat Thu Htet⁶  Ye Naung⁷  Tint Swe Latt⁷  Mya Mya Lwin⁷ 

[1] Department of Immunology & Infection, London School of Hygiene and Tropical Medicine, London, UK;Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK;Haematology, Severn Deanery, Bristol, UK;Institute for Global Health, University College London, London, UK;Malaria Centre, London School of Hygiene and Tropical Medicine, London, UK;Research Department of Infection and Population Health, University College London, WC1E 6JB, London, UK;University of Medicine (2), Yangon, Myanmar;

关键词: Malaria;    Myanmar;    Prevalence;    Serology;    Transmission;    Artemisinin;    Resistance;    Risk factors;    Elimination;   

DOI  :  10.1186/s12936-016-1651-5

 received in 2016-08-20, accepted in 2016-12-15,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe spread of artemisinin-resistant Plasmodium falciparum is a global health concern. Myanmar stands at the frontier of artemisinin-resistant P. falciparum. Myanmar also has the highest reported malaria burden in Southeast Asia; it is integral in the World Health Organization’s plan to eliminate malaria in Southeast Asia, yet few epidemiological data exist for the general population in Myanmar.MethodsThis cross-sectional, probability household survey was conducted in Phyu township, Bago Region (central Myanmar), during the wet season of 2013. Interviewers collected clinical and behavioural data, recorded tympanic temperature and obtained dried blood spots for malaria PCR and serology. Plasmodium falciparum positive samples were tested for genetic mutations in the K13 region that may confer artemisinin resistance. Estimated type-specific malaria PCR prevalence and seroprevalence were calculated, with regression analysis to identify risk factors for seropositivity to P. falciparum. Data were weighted to account for unequal selection probabilities.Results1638 participants were sampled (500 households). Weighted PCR prevalence was low (n = 41, 2.5%) and most cases were afebrile (93%). Plasmodium falciparum was the most common species (n = 19. 1.1%) and five (26%) P. falciparum samples harboured K13 mutations. Plasmodium knowlesi was detected in 1.0% (n = 16) and Plasmodium vivax was detected in 0.4% (n = 7). Seroprevalence was 9.4% for P. falciparum and 3.1% for P. vivax. Seroconversion to P. falciparum was 0.003/year in the whole population, but 16-fold higher in men over 23 years old (LR test p = 0.016).DiscussionThis is the first population-based seroprevalence study from central Myanmar. Low overall prevalence was discovered. However, these data suggest endemic transmission continues, probably associated with behavioural risk factors amongst working-age men. Genetic mutations associated with P. falciparum artemisinin resistance, the presence of P. knowlesi and discrete demographic risk groups present opportunities and challenges for malaria control. Responses targeted to working-age men, capable of detecting sub-clinical infections, and considering all species will facilitate malaria elimination in this setting.

【 授权许可】

CC BY   
© The Author(s) 2017