Effect of artesunate-mefloquine fixed-dose combination in malaria transmission in amazon basin communities

Malaria Journal

Research

André Daher¹  Isabela Ribeiro²  Paola B Marchesini³  José LB Ladislau⁴  Ana C Santelli⁴  Marize BF Lucena⁵  Izanelda Magalhães⁵  Roseli La Corte dos Santos⁶  Marcos Boulos⁷  Antonio P Leon⁸  Washington Junger⁸ 

[1] Drugs for Neglected Diseases initiative, Rio de Janeiro, Brazil;Instituto de Tecnologia em Fármacos - Farmanguinhos, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil;Instituto de Tecnologia em Fármacos - Farmanguinhos, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil;Pan American Health Organization, Brasília, Brazil;Programa Nacional de Controle da Malária, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brazil;Secretaria Estadual de Saúde, Acre, Brazil;Universidade Federal de Sergipe, Sergipe, Brazil;Universidade de São Paulo, São Paulo, Brazil;Universidade do Estado do Rio de Janeiro – UERJ, Rio de Janeiro, Brazil;

关键词: Malaria;    ACT;    artesunate;    mefloquine;    Fixed-dose combination;    P. falciparum;    Brazil;    Amazon;   

DOI  :  10.1186/1475-2875-11-286

 received in 2012-05-25, accepted in 2012-07-31,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundStudies in South-East Asia have suggested that early diagnosis and treatment with artesunate (AS) and mefloquine (MQ) combination therapy may reduce the transmission of Plasmodium falciparum malaria and the progression of MQ resistance.MethodsThe effectiveness of a fixed-dose combination of AS and MQ (ASMQ) in reducing malaria transmission was tested in isolated communities of the Juruá valley in the Amazon region.Priority municipalities within the Brazilian Legal Amazon area were selected according to pre-specified criteria. Routine national malaria control programmatic procedures were followed. Existing health structures were reinforced and health care workers were trained to treat with ASMQ all confirmed falciparum malaria cases that match inclusion criteria. A local pharmacovigilance structure was implemented. Incidence of malaria and hospitalizations were recorded two years before, during, and after the fixed-dose ASMQ intervention. In total, between July 2006 and December 2008, 23,845 patients received ASMQ. Two statistical modelling approaches were applied to monthly time series of P. falciparum malaria incidence rates, P. falciparum/Plasmodium vivax infection ratio, and malaria hospital admissions rates. All the time series ranged from January 2004 to December 2008, whilst the intervention period span from July 2006 to December 2008.ResultsThe ASMQ intervention had a highly significant impact on the mean level of each time series, adjusted for trend and season, of 0.34 (95%CI 0.20 – 0.58) for the P. falciparum malaria incidence rates, 0.67 (95%CI 0.50 – 0.89) for the P. falciparum/P. vivax infection ratio, and 0.53 (95%CI 0.41 – 0.69) for the hospital admission rates. There was also a significant change in the seasonal (or monthly) pattern of the time series before and after intervention, with the elimination of the malaria seasonal peak in the rainy months of the years following the introduction of ASMQ. No serious adverse events relating to the use of fixed-dose ASMQ were reported.ConclusionsIn the remote region of the Juruá valley, the early detection of malaria by health care workers and treatment with fixed-dose ASMQ was feasible and efficacious, and significantly reduced the incidence and morbidity of P. falciparum malaria.

【 授权许可】

Unknown   
© Santelli et al.; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.