1
|
Kumar A, Singh PP, Tyagi S, Hari Kishan Raju K, Sahu SS, Rahi M. Vivax malaria: a possible stumbling block for malaria elimination in India. Front Public Health 2024; 11:1228217. [PMID: 38259757 PMCID: PMC10801037 DOI: 10.3389/fpubh.2023.1228217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Plasmodium vivax is geographically the most widely dispersed human malaria parasite species. It has shown resilience and a great deal of adaptability. Genomic studies suggest that P. vivax originated from Asia or Africa and moved to the rest of the world. Although P. vivax is evolutionarily an older species than Plasmodium falciparum, its biology, transmission, pathology, and control still require better elucidation. P. vivax poses problems for malaria elimination because of the ability of a single primary infection to produce multiple relapses over months and years. P. vivax malaria elimination program needs early diagnosis, and prompt and complete radical treatment, which is challenging, to simultaneously exterminate the circulating parasites and dormant hypnozoites lodged in the hepatocytes of the host liver. As prompt surveillance and effective treatments are rolled out, preventing primaquine toxicity in the patients having glucose-6-phosphate dehydrogenase (G6PD) deficiency should be a priority for the vivax elimination program. This review sheds light on the burden of P. vivax, changing epidemiological patterns, the hurdles in elimination efforts, and the essential tools needed not just in India but globally. These tools encompass innovative treatments for eliminating dormant parasites, coping with evolving drug resistance, and the development of potential vaccines against the parasite.
Collapse
Affiliation(s)
- Ashwani Kumar
- ICMR - Vector Control Research Centre, Puducherry, India
| | | | - Suchi Tyagi
- ICMR - Vector Control Research Centre, Puducherry, India
| | | | | | - Manju Rahi
- ICMR - Vector Control Research Centre, Puducherry, India
- Indian Council of Medical Research, Hqrs New Delhi, India
| |
Collapse
|
2
|
Walker CR, Hickson RI, Chang E, Ngor P, Sovannaroth S, Simpson JA, Price DJ, McCaw JM, Price RN, Flegg JA, Devine A. A model for malaria treatment evaluation in the presence of multiple species. Epidemics 2023; 44:100687. [PMID: 37348379 PMCID: PMC7614843 DOI: 10.1016/j.epidem.2023.100687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 03/12/2023] [Accepted: 05/12/2023] [Indexed: 06/24/2023] Open
Abstract
Plasmodium falciparum and P. vivax are the two most common causes of malaria. While the majority of deaths and severe morbidity are due to P. falciparum, P. vivax poses a greater challenge to eliminating malaria outside of Africa due to its ability to form latent liver stage parasites (hypnozoites), which can cause relapsing episodes within an individual patient. In areas where P. falciparum and P. vivax are co-endemic, individuals can carry parasites of both species simultaneously. These mixed infections complicate dynamics in several ways: treatment of mixed infections will simultaneously affect both species, P. falciparum can mask the detection of P. vivax, and it has been hypothesised that clearing P. falciparum may trigger a relapse of dormant P. vivax. When mixed infections are treated for only blood-stage parasites, patients are at risk of relapse infections due to P. vivax hypnozoites. We present a stochastic mathematical model that captures interactions between P. falciparum and P. vivax, and incorporates both standard schizonticidal treatment (which targets blood-stage parasites) and radical cure treatment (which additionally targets liver-stage parasites). We apply this model via a hypothetical simulation study to assess the implications of different treatment coverages of radical cure for mixed and P. vivax infections and a "unified radical cure" treatment strategy where P. falciparum, P. vivax, and mixed infections all receive radical cure after screening glucose-6-phosphate dehydrogenase (G6PD) normal. In addition, we investigated the impact of mass drug administration (MDA) of blood-stage treatment. We find that a unified radical cure strategy leads to a substantially lower incidence of malaria cases and deaths overall. MDA with schizonticidal treatment was found to decrease P. falciparum with little effect on P. vivax. We perform a univariate sensitivity analysis to highlight important model parameters.
Collapse
Affiliation(s)
- C R Walker
- School of Mathematics and Statistics, University of Melbourne, Australia.
| | - R I Hickson
- School of Mathematics and Statistics, University of Melbourne, Australia; Australian Institute of Tropical Health and Medicine, and College of Public Health, Medical & Veterinary Sciences, James Cook University, Australia; Health and Biosecurity, CSIRO, Australia
| | - E Chang
- School of Mathematics and Statistics, University of Melbourne, Australia
| | - P Ngor
- Cambodian National Center for Parasitology, Entomology and Malaria Control, Cambodia; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Thailand
| | - S Sovannaroth
- Cambodian National Center for Parasitology, Entomology and Malaria Control, Cambodia
| | - J A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - D J Price
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Australia; Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Australia
| | - J M McCaw
- School of Mathematics and Statistics, University of Melbourne, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - R N Price
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Thailand; Division of Global and Tropical Health, Menzies School of Health Research and Charles Darwin University, Australia; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, UK
| | - J A Flegg
- School of Mathematics and Statistics, University of Melbourne, Australia
| | - A Devine
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Australia; Division of Global and Tropical Health, Menzies School of Health Research and Charles Darwin University, Australia
| |
Collapse
|
3
|
Andrade AO, Santos NAC, Bastos AS, Pontual JDC, Araújo JE, Silva AMV, Martinez LN, Lima AA, Aguiar ACC, G. Teles CB, Medeiros JF, Pereira DB, Vinetz JM, Gazzinelli RT, Araújo MS. Transmission-blocking activity of antimalarials for Plasmodium vivax malaria in Anopheles darlingi. PLoS Negl Trop Dis 2023; 17:e0011425. [PMID: 37327209 PMCID: PMC10310017 DOI: 10.1371/journal.pntd.0011425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/29/2023] [Accepted: 05/30/2023] [Indexed: 06/18/2023] Open
Abstract
Malaria is caused by parasite of the genus Plasmodium and is still one of the most important infectious diseases in the world. Several biological characteristics of Plasmodium vivax contribute to the resilience of this species, including early gametocyte production, both of which lead to efficient malaria transmission to mosquitoes. This study evaluated the impact of currently used drugs on the transmission of P. vivax. Participants received one of the following treatments for malaria: i) chloroquine [10 mg/kg on day 1 and 7.5 mg/kg on day 2 and 3] co-administered with Primaquine [0.5 mg/kg/day for 7 days]; ii) Chloroquine [10 mg/kg on day 1 and 7.5 mg/kg on day 2 and 3] co-administered with one-dose of Tafenoquine [300 mg on day 1]; and iii) Artesunate and Mefloquine [100 mg and 200 mg on day 1, 2 and 3] co-administered with Primaquine [0.5 mg/kg/day for 14 days]. Patient blood was collected before treatment and 4 h, 24 h, 48 h and 72 h after treatment. The blood was used to perform a direct membrane feeding assay (DMFA) using Anopheles darlingi mosquitoes. The results showed 100% inhibition of the mosquito infection after 4 h using ASMQ+PQ, after 24 h for the combination of CQ+PQ and 48 h using CQ+TQ. The density of gametocytes declined over time in all treatment groups, although the decline was more rapid in the ASMQ+PQ group. In conclusion, it was possible to demonstrate the transmission-blocking efficacy of the malaria vivax treatment and that ASMQ+PQ acts faster than the two other treatments.
Collapse
Affiliation(s)
- Alice O. Andrade
- Plataforma de Produção e Infecção de Vetores da Malária (PIVEM), Laboratório de Entomologia, Fiocruz Rondônia, Porto Velho, Rondônia, Brazil
| | - Najara A. C. Santos
- Plataforma de Produção e Infecção de Vetores da Malária (PIVEM), Laboratório de Entomologia, Fiocruz Rondônia, Porto Velho, Rondônia, Brazil
- Programa de Pós-Graduação em Biologia Experimental, Fundação Universidade Federal de Rondônia, FIOCRUZ Rondônia, Porto Velho, Rondônia, Brazil
| | - Alessandra S. Bastos
- Plataforma de Produção e Infecção de Vetores da Malária (PIVEM), Laboratório de Entomologia, Fiocruz Rondônia, Porto Velho, Rondônia, Brazil
| | - José D. C. Pontual
- Plataforma de Produção e Infecção de Vetores da Malária (PIVEM), Laboratório de Entomologia, Fiocruz Rondônia, Porto Velho, Rondônia, Brazil
| | - Jéssica E. Araújo
- Plataforma de Produção e Infecção de Vetores da Malária (PIVEM), Laboratório de Entomologia, Fiocruz Rondônia, Porto Velho, Rondônia, Brazil
- Programa de Pós-Graduação em Biologia Experimental, Fundação Universidade Federal de Rondônia, FIOCRUZ Rondônia, Porto Velho, Rondônia, Brazil
| | - Alexia M. V. Silva
- Ambulatório de Malária, Centro de Pesquisa em Medicina Tropical, Porto Velho, Rondônia, Brazil
| | - Leandro N. Martinez
- Programa de Pós-Graduação em Biologia Experimental, Fundação Universidade Federal de Rondônia, FIOCRUZ Rondônia, Porto Velho, Rondônia, Brazil
- Plataforma de Bioensaios de Malária e Leishmaniose da Fiocruz (PBML), Fiocruz Rondônia, Porto Velho, Rondônia, Brazil
| | - Alzemar A. Lima
- Ambulatório de Malária, Centro de Pesquisa em Medicina Tropical, Porto Velho, Rondônia, Brazil
| | | | - Carolina B. G. Teles
- Programa de Pós-Graduação em Biologia Experimental, Fundação Universidade Federal de Rondônia, FIOCRUZ Rondônia, Porto Velho, Rondônia, Brazil
- Plataforma de Bioensaios de Malária e Leishmaniose da Fiocruz (PBML), Fiocruz Rondônia, Porto Velho, Rondônia, Brazil
| | - Jansen F. Medeiros
- Plataforma de Produção e Infecção de Vetores da Malária (PIVEM), Laboratório de Entomologia, Fiocruz Rondônia, Porto Velho, Rondônia, Brazil
- Programa de Pós-Graduação em Biologia Experimental, Fundação Universidade Federal de Rondônia, FIOCRUZ Rondônia, Porto Velho, Rondônia, Brazil
| | - Dhelio B. Pereira
- Ambulatório de Malária, Centro de Pesquisa em Medicina Tropical, Porto Velho, Rondônia, Brazil
| | - Joseph M. Vinetz
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Ricardo T. Gazzinelli
- Laboratório de Imunopatologia, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Maisa S. Araújo
- Plataforma de Produção e Infecção de Vetores da Malária (PIVEM), Laboratório de Entomologia, Fiocruz Rondônia, Porto Velho, Rondônia, Brazil
| |
Collapse
|
4
|
Kaur N, Korkor C, Mobin SM, Chibale K, Singh K. Fluorene-Chloroquine Hybrids: Synthesis, in vitro Antiplasmodial Activity, and Inhibition of Heme Detoxification Machinery of Plasmodium falciparum. ChemMedChem 2022; 17:e202200414. [PMID: 36017666 DOI: 10.1002/cmdc.202200414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/22/2022] [Indexed: 11/10/2022]
Abstract
Fluorene-chloroquine hybrids have been identified as a new promising class of antiplasmodial agents. The most active compound 9d exhibited good in vitro antiplasmodial activity against a chloroquine-sensitive NF54 strain of the human malaria parasite Plasmodium falciparum with an IC50 value of 139 nM. UV-visible absorption, FTIR spectral and 1H NMR titration data corroborated the binding of 9d to monomeric and µ-oxodimeric heme as well as inhibition of β-hematin formation, which collectively supported the inhibition of heme detoxification machinery in P. falciparum. In silico docking studies revealed the binding interactions of the hybrids in the active site of the wild type as well as quadruple mutant of Pf-DHFR-TS dihydrofolate enzyme. Further, the ADMET parameters were predicted and were in good agreement with the expected values, suggesting the drug likeness of the synthesized hybrid molecules.Introduction.
Collapse
Affiliation(s)
- Navpreet Kaur
- IIT Indore Discipline of Chemistry: Indian Institute of Technology Indore Discipline of Chemistry, Chemistry, INDIA
| | - Constance Korkor
- University of Cape Town Institute of Infectious Disease and Molecular Medicine, Chemistry, INDIA
| | - Shaikh M Mobin
- IIT Indore: Indian Institute of Technology Indore, Chemistry, INDIA
| | - Kelly Chibale
- University of Cape Town Institute of Infectious Disease and Molecular Medicine, Chemistry, INDIA
| | - Kamaljit Singh
- Guru Nanak Dev University, Department of Chemistry, Centre for Advanced Studies-II, Guru Nanak Dev University, Amritsar-143005, 143005, Amritsar, INDIA
| |
Collapse
|
5
|
Poespoprodjo JR, Burdam FH, Candrawati F, Ley B, Meagher N, Kenangalem E, Indrawanti R, Trianty L, Thriemer K, Price DJ, Simpson JA, Price RN. Supervised versus unsupervised primaquine radical cure for the treatment of falciparum and vivax malaria in Papua, Indonesia: a cluster-randomised, controlled, open-label superiority trial. THE LANCET. INFECTIOUS DISEASES 2022; 22:367-376. [PMID: 34710363 PMCID: PMC8866132 DOI: 10.1016/s1473-3099(21)00358-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/30/2021] [Accepted: 06/07/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND There is a high risk of Plasmodium vivax recurrence in patients treated for Plasmodium falciparum malaria in co-endemic areas. Primaquine radical cure has the potential to reduce P vivax recurrences in patients presenting with P falciparum as well as P vivax malaria but is undermined by poor adherence to the currently recommended 14-day regimen. We aimed to assess the efficacy and safety of supervised versus unsupervised primaquine radical cure in patients presenting with uncomplicated malaria. METHODS We did a cluster-randomised, controlled, open-label superiority trial in Papua, Indonesia. 21 clusters of village health posts, matched by annual parasite index, were randomly assigned (1:1) to treat patients (age >12 months and body weight >5 kg) presenting with confirmed uncomplicated P falciparum or P vivax malaria with oral dihydroartemisinin-piperaquine plus either a supervised or unsupervised 14-day course of oral primaquine (0·5 mg/kg per day). Patients in the supervised group were supervised taking their primaquine dose on alternate days. Patients were followed-up for 6 months and those who presented again with malaria were retreated with the same drug regimen. Masking was not possible due to the nature of the study. The primary outcome was the incidence risk of P vivax malaria over 6 months, assessed in the modified intention-to-treat population (all patients who were assigned to a treatment group, excluding patients who were lost to follow-up after their first visit). This trial is now complete, and is registered with ClinicalTrials.gov, NCT02787070. FINDINGS Between Sept 14, 2016, and July 31, 2018, 436 patients were screened for eligibility and 419 were enrolled; 223 (53%) patients in 11 clusters were assigned to supervised primaquine treatment and 196 (47%) in ten clusters to unsupervised primaquine treatment. 161 (72%) of 223 patients in the supervised group and 151 (77%) of 196 in the unsupervised group completed 6 months of follow-up. At 6 months, the incidence risk of P vivax recurrence in the supervised group was 29·7% (95% CI 16·4-49·9) versus 55·8% (32·3-81·8) in the unsupervised group (hazard ratio 0·23 [95% CI 0·07-0·76]; p=0·016). The incidence rate for P vivax recurrence was 539 (95% CI 390-747) infections per 1000 person-years in the supervised group versus 859 (673-1096) in the unsupervised group (incidence rate ratio 0·63 [95% CI 0·42-0·94]; p=0·025). The corresponding rates in the 224 patients who presented with P falciparum malaria were 346 (95% CI 213-563) and 660 (446-977; incidence rate ratio 0·52 [95% CI 0·28-0·98]; p=0·043). Seven serious adverse events were reported (three in the supervised group, four in the unsupervised group), none of which were deemed treatment-related, and there were no deaths. INTERPRETATION In this area of moderate malaria transmission, supervision of primaquine radical cure treatment reduced the risk of P vivax recurrence. This finding was apparent for patients presenting with either P falciparum or P vivax malaria. Further studies are warranted to investigate the safety and efficacy of radical cure for patients presenting with uncomplicated falciparum malaria in other co-endemic areas. FUNDING The Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Foreign Affairs and Trade of the Australian Government. TRANSLATION For the Indonesian translation of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Jeanne Rini Poespoprodjo
- Centre for Child Health and Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia; Mimika District Hospital and District Health Authority, Timika, Papua, Indonesia.
| | - Faustina Helena Burdam
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia; Mimika District Hospital and District Health Authority, Timika, Papua, Indonesia
| | - Freis Candrawati
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Benedikt Ley
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Niamh Meagher
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, VIC, Australia; Victorian Infectious Diseases Reference Laboratory Epidemiology Unit at the Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, VIC, Australia
| | - Enny Kenangalem
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia; Mimika District Hospital and District Health Authority, Timika, Papua, Indonesia
| | - Ratni Indrawanti
- Centre for Child Health and Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Leily Trianty
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Kamala Thriemer
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - David J Price
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, VIC, Australia; Victorian Infectious Diseases Reference Laboratory Epidemiology Unit at the Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, VIC, Australia
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, VIC, Australia
| | - Ric N Price
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| |
Collapse
|
6
|
Devine A, Battle KE, Meagher N, Howes RE, Dini S, Gething PW, Simpson JA, Price RN, Lubell Y. Global economic costs due to vivax malaria and the potential impact of its radical cure: A modelling study. PLoS Med 2021; 18:e1003614. [PMID: 34061843 PMCID: PMC8168905 DOI: 10.1371/journal.pmed.1003614] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/07/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In 2017, an estimated 14 million cases of Plasmodium vivax malaria were reported from Asia, Central and South America, and the Horn of Africa. The clinical burden of vivax malaria is largely driven by its ability to form dormant liver stages (hypnozoites) that can reactivate to cause recurrent episodes of malaria. Elimination of both the blood and liver stages of the parasites ("radical cure") is required to achieve a sustained clinical response and prevent ongoing transmission of the parasite. Novel treatment options and point-of-care diagnostics are now available to ensure that radical cure can be administered safely and effectively. We quantified the global economic cost of vivax malaria and estimated the potential cost benefit of a policy of radical cure after testing patients for glucose-6-phosphate dehydrogenase (G6PD) deficiency. METHODS AND FINDINGS Estimates of the healthcare provider and household costs due to vivax malaria were collated and combined with national case estimates for 44 endemic countries in 2017. These provider and household costs were compared with those that would be incurred under 2 scenarios for radical cure following G6PD screening: (1) complete adherence following daily supervised primaquine therapy and (2) unsupervised treatment with an assumed 40% effectiveness. A probabilistic sensitivity analysis generated credible intervals (CrIs) for the estimates. Globally, the annual cost of vivax malaria was US$359 million (95% CrI: US$222 to 563 million), attributable to 14.2 million cases of vivax malaria in 2017. From a societal perspective, adopting a policy of G6PD deficiency screening and supervision of primaquine to all eligible patients would prevent 6.1 million cases and reduce the global cost of vivax malaria to US$266 million (95% CrI: US$161 to 415 million), although healthcare provider costs would increase by US$39 million. If perfect adherence could be achieved with a single visit, then the global cost would fall further to US$225 million, equivalent to $135 million in cost savings from the baseline global costs. A policy of unsupervised primaquine reduced the cost to US$342 million (95% CrI: US$209 to 532 million) while preventing 2.1 million cases. Limitations of the study include partial availability of country-level cost data and parameter uncertainty for the proportion of patients prescribed primaquine, patient adherence to a full course of primaquine, and effectiveness of primaquine when unsupervised. CONCLUSIONS Our modelling study highlights a substantial global economic burden of vivax malaria that could be reduced through investment in safe and effective radical cure achieved by routine screening for G6PD deficiency and supervision of treatment. Novel, low-cost interventions for improving adherence to primaquine to ensure effective radical cure and widespread access to screening for G6PD deficiency will be critical to achieving the timely global elimination of P. vivax.
Collapse
Affiliation(s)
- Angela Devine
- Division of Global and Tropical Health, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Katherine E. Battle
- Institute for Disease Modeling, Seattle, Washington, United States of America
| | - Niamh Meagher
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Reference Laboratory Epidemiology Unit, Royal Melbourne Hospital, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Rosalind E. Howes
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
- Oxford Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Saber Dini
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter W. Gething
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- Curtin University, Bentley, Western Australia, Australia
| | - Julie A. Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Ric N. Price
- Division of Global and Tropical Health, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Yoel Lubell
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| |
Collapse
|
7
|
Commons RJ, Simpson JA, Watson J, White NJ, Price RN. Estimating the Proportion of Plasmodium vivax Recurrences Caused by Relapse: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2020; 103:1094-1099. [PMID: 32524950 PMCID: PMC7470578 DOI: 10.4269/ajtmh.20-0186] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Plasmodium vivax and Plasmodium ovale form dormant liver hypnozoites that can reactivate weeks to months following initial infection. Malaria recurrences caused by relapses are an important cause of morbidity and source of transmission. To estimate the proportions of P. vivax malaria recurrences caused by relapses in different geographical locations, we systematically reviewed clinical efficacy studies of uncomplicated P. vivax malaria, in which patients were randomized to treatment with or without radical cure primaquine regimens and were followed up for 1 year. The minimum proportion of recurrences caused by relapses was estimated for each study site by assuming primaquine prevented all relapses and did not augment blood-stage efficacy. Of the 261 studies identified, six were eligible enrolling 4,092 patients from 14 treatment arm comparisons across seven countries. Of the 2,735 patients treated with primaquine, 24.3% received low dose (2.5 to < 5.0 mg/kg total) and 75.7% received high-dose primaquine (≥ 5.0 mg/kg total). The overall pooled incidence rate ratio of P. vivax relapses for patients treated with primaquine versus no primaquine was 0.15 (95% CI: 0.10-0.21; I 2 = 83.3%), equating to a minimum of 79% of recurrences attributable to relapse. Country-specific incidence rate ratios ranged from 0.05 (95% CI: 0.01-0.34; one estimate) in Pakistan to 0.34 in Nepal (95% CI: 0.12-0.83; one estimate) and Afghanistan (95% CI: 0.22-0.51; three estimates). Relapses account for a very high proportion of recurrent infections following schizontocidal treatment of acute P. vivax malaria across diverse geographic locations. This emphasizes the importance of implementing hypnozoitocidal treatment.
Collapse
Affiliation(s)
- Robert J. Commons
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia;,Internal Medical Services, Ballarat Health Services, Ballarat, Australia;,Address correspondence to Robert J. Commons, Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, P.O. Box 41096, Casuarina 0811, Australia. E-mail:
| | - Julie A. Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - James Watson
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Nicholas J. White
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Ric N. Price
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia;,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
8
|
Plasmodium vivax in the Era of the Shrinking P. falciparum Map. Trends Parasitol 2020; 36:560-570. [PMID: 32407682 PMCID: PMC7297627 DOI: 10.1016/j.pt.2020.03.009] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 01/13/2023]
Abstract
Plasmodium vivax is an important cause of malaria, associated with a significant public health burden. Whilst enhanced malaria-control activities have successfully reduced the incidence of Plasmodium falciparum malaria in many areas, there has been a consistent increase in the proportion of malaria due to P. vivax in regions where both parasites coexist. This article reviews the epidemiology and biology of P. vivax, how the parasite differs from P. falciparum, and the key features that render it more difficult to control and eliminate. Since transmission of the parasite is driven largely by relapses from dormant liver stages, its timely elimination will require widespread access to safe and effective radical cure.
Collapse
|
9
|
Umunnakwe FA, Idowu ET, Ajibaye O, Etoketim B, Akindele S, Shokunbi AO, Otubanjo OA, Awandare GA, Amambua-Ngwa A, Oyebola KM. High cases of submicroscopic Plasmodium falciparum infections in a suburban population of Lagos, Nigeria. Malar J 2019; 18:433. [PMID: 31856852 PMCID: PMC6924037 DOI: 10.1186/s12936-019-3073-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Asymptomatic malaria parasites are significant sources of infections for onward malaria transmission. Conventional tools for malaria diagnosis such as microscopy and rapid diagnostic test kits (RDT) have relatively low sensitivity, hence the need for alternative tools for active screening of such low-density infections. METHODS This study tested var acidic terminal sequence-based (varATS) quantitative polymerase chain reaction (qPCR) for screening asymptomatic Plasmodium falciparum infections among dwellers of a sub-urban community in Lagos, Nigeria. Clinically healthy participants were screened for malaria using microscopy, RDT and varATS qPCR techniques. Participants were stratified into three age groups: 1-5, 6-14 and > 14 years old. RESULTS Of the 316 participants screened for asymptomatic malaria infection, 78 (24.68%) were positive by microscopy, 99 (31.33%) were positive by RDT and 112 (35.44%) by varATS qPCR. Participants aged 6-14 years had the highest prevalence of asymptomatic malaria, with geometric means of ~ 116 parasites/µL and ~ 6689 parasites/µL as detected by microscopy and varATS, respectively. CONCLUSION This study has revealed high prevalence of asymptomatic malaria in the study population, with varATS detecting additional sub-microscopic infections. The highest concentration of asymptomatic malaria was observed among school-age children between 6 and 14 years old. A large-scale screening to identify other potential hotspots of asymptomatic parasites in the country is recommended.
Collapse
Affiliation(s)
- Florence A Umunnakwe
- Parasitology and Bioinformatics Unit, Department of Zoology, Faculty of Science, University of Lagos, Akoka, Lagos, Nigeria
| | - Emmanuel T Idowu
- Parasitology and Bioinformatics Unit, Department of Zoology, Faculty of Science, University of Lagos, Akoka, Lagos, Nigeria
| | - Olusola Ajibaye
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Blessed Etoketim
- Medical Research Council at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Samuel Akindele
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Aminat O Shokunbi
- Parasitology and Bioinformatics Unit, Department of Zoology, Faculty of Science, University of Lagos, Akoka, Lagos, Nigeria
| | - Olubunmi A Otubanjo
- Parasitology and Bioinformatics Unit, Department of Zoology, Faculty of Science, University of Lagos, Akoka, Lagos, Nigeria
| | - Gordon A Awandare
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Accra, Ghana
| | - Alfred Amambua-Ngwa
- Medical Research Council at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Kolapo M Oyebola
- Parasitology and Bioinformatics Unit, Department of Zoology, Faculty of Science, University of Lagos, Akoka, Lagos, Nigeria. .,Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria. .,Medical Research Council at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia. .,West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Accra, Ghana.
| |
Collapse
|
10
|
The efficacy of dihydroartemisinin-piperaquine and artemether-lumefantrine with and without primaquine on Plasmodium vivax recurrence: A systematic review and individual patient data meta-analysis. PLoS Med 2019; 16:e1002928. [PMID: 31584960 PMCID: PMC6777759 DOI: 10.1371/journal.pmed.1002928] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 09/03/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Artemisinin-based combination therapy (ACT) is recommended for uncomplicated Plasmodium vivax malaria in areas of emerging chloroquine resistance. We undertook a systematic review and individual patient data meta-analysis to compare the efficacies of dihydroartemisinin-piperaquine (DP) and artemether-lumefantrine (AL) with or without primaquine (PQ) on the risk of recurrent P. vivax. METHODS AND FINDINGS Clinical efficacy studies of uncomplicated P. vivax treated with DP or AL and published between January 1, 2000, and January 31, 2018, were identified by conducting a systematic review registered with the International Prospective Register of Systematic Reviews (PROSPERO): CRD42016053310. Investigators of eligible studies were invited to contribute individual patient data that were pooled using standardised methodology. The effect of mg/kg dose of piperaquine/lumefantrine, ACT administered, and PQ on the rate of P. vivax recurrence between days 7 and 42 after starting treatment were investigated by Cox regression analyses according to an a priori analysis plan. Secondary outcomes were the risk of recurrence assessed on days 28 and 63. Nineteen studies enrolling 2,017 patients were included in the analysis. The risk of recurrent P. vivax at day 42 was significantly higher in the 384 patients treated with AL alone (44.0%, 95% confidence interval [CI] 38.7-49.8) compared with the 812 patients treated with DP alone (9.3%, 95% CI 7.1-12.2): adjusted hazard ratio (AHR) 12.63 (95% CI 6.40-24.92), p < 0.001. The rates of recurrence assessed at days 42 and 63 were associated inversely with the dose of piperaquine: AHRs (95% CI) for every 5-mg/kg increase 0.63 (0.48-0.84), p = 0.0013 and 0.83 (0.73-0.94), p = 0.0033, respectively. The dose of lumefantrine was not significantly associated with the rate of recurrence (1.07 for every 5-mg/kg increase, 95% CI 0.99-1.16, p = 0.0869). In a post hoc analysis, in patients with symptomatic recurrence after AL, the mean haemoglobin increased 0.13 g/dL (95% CI 0.01-0.26) for every 5 days that recurrence was delayed, p = 0.0407. Coadministration of PQ reduced substantially the rate of recurrence assessed at day 42 after AL (AHR = 0.20, 95% CI 0.10-0.41, p < 0.001) and at day 63 after DP (AHR = 0.08, 95% CI 0.01-0.70, p = 0.0233). Results were limited by follow-up of patients to 63 days or less and nonrandomised treatment groups. CONCLUSIONS In this study, we observed the risk of P. vivax recurrence at day 42 to be significantly lower following treatment with DP compared with AL, reflecting the longer period of post-treatment prophylaxis; this risk was reduced substantially by coadministration with PQ. We found that delaying P. vivax recurrence was associated with a small but significant improvement in haemoglobin. These results highlight the benefits of PQ radical cure and also the provision of blood-stage antimalarial agents with prolonged post-treatment prophylaxis.
Collapse
|
11
|
Commons RJ, Simpson JA, Thriemer K, Hossain MS, Douglas NM, Humphreys GS, Sibley CH, Guerin PJ, Price RN. Risk of Plasmodium vivax parasitaemia after Plasmodium falciparum infection: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2019; 19:91-101. [PMID: 30587297 PMCID: PMC6300482 DOI: 10.1016/s1473-3099(18)30596-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/11/2018] [Accepted: 09/13/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND A 14-day course of primaquine is used for radical cure of Plasmodium vivax and Plasmodium ovale malaria only. We quantified the risk of P vivax parasitaemia after treatment of Plasmodium falciparum with commonly used antimalarial drugs to assess the potential benefits of radical cure for all patients with uncomplicated malaria in co-endemic regions. METHODS In this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Science, and the Cochrane Database of Systematic Reviews for prospective clinical studies in any language, published between Jan 1, 1960, and Jan 5, 2018, assessing drug efficacy in patients with uncomplicated P falciparum malaria in countries co-endemic for P vivax. Studies were included if the presence or absence of P vivax parasitaemia was recorded after treatment. The primary outcome was the risk of P vivax parasitaemia between day 7 and day 42 after initiation of antimalarial treatment for P falciparum, with the pooled risk calculated by random-effects meta-analysis. We compared the risk of P vivax parasitaemia after treatment with different artemisinin-based combination therapies (ACTs). This study is registered with PROSPERO, number CRD42017064838. FINDINGS 153 of 891 screened studies were included in the analysis, including 31 262 patients from 323 site-specific treatment groups: 130 (85%) studies were from the Asia-Pacific region, 16 (10%) from the Americas, and seven (5%) from Africa. The risk of P vivax parasitaemia by day 42 was 5·6% (95% CI 4·0-7·4; I2=92·0%; 117 estimates). The risk of P vivax parasitaemia was 6·5% (95% CI 4·6-8·6) in regions of short relapse periodicity compared with 1·9% (0·4-4·0) in regions of long periodicity, and was greater after treatment with a more rapidly eliminated ACT: 15·3% (5·1-29·3) for artemether-lumefantrine compared with 4·5% (1·2-9·3) for dihydroartemisinin-piperaquine and 5·2% (2·9-7·9) for artesunate-mefloquine. Recurrent parasitaemia was delayed in patients treated with ACTs containing mefloquine or piperaquine compared with artemether-lumefantrine, but by day 63 the risk of vivax parasitaemia was more than 15% for all ACTs assessed. INTERPRETATION Our findings show a high risk of vivax parasitaemia after treatment of falciparum malaria, particularly in areas with short relapse periodicity and after rapidly eliminated treatment. In co-endemic regions, universal radical cure for all patients with uncomplicated malaria has the potential to substantially reduce recurrent malaria. FUNDING Australian National Health and Medical Research Council, Royal Australasian College of Physicians, Wellcome Trust, and Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Robert J Commons
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia; WorldWide Antimalarial Resistance Network, Oxford, UK.
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Kamala Thriemer
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Mohammad S Hossain
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia; WorldWide Antimalarial Resistance Network, Oxford, UK; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Nicholas M Douglas
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Georgina S Humphreys
- WorldWide Antimalarial Resistance Network, Oxford, UK; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Carol H Sibley
- WorldWide Antimalarial Resistance Network, Oxford, UK; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Philippe J Guerin
- WorldWide Antimalarial Resistance Network, Oxford, UK; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Ric N Price
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia; WorldWide Antimalarial Resistance Network, Oxford, UK; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
12
|
Commons RJ, Simpson JA, Thriemer K, Humphreys GS, Abreha T, Alemu SG, Añez A, Anstey NM, Awab GR, Baird JK, Barber BE, Borghini-Fuhrer I, Chu CS, D'Alessandro U, Dahal P, Daher A, de Vries PJ, Erhart A, Gomes MSM, Gonzalez-Ceron L, Grigg MJ, Heidari A, Hwang J, Kager PA, Ketema T, Khan WA, Lacerda MVG, Leslie T, Ley B, Lidia K, Monteiro WM, Nosten F, Pereira DB, Phan GT, Phyo AP, Rowland M, Saravu K, Sibley CH, Siqueira AM, Stepniewska K, Sutanto I, Taylor WRJ, Thwaites G, Tran BQ, Tran HT, Valecha N, Vieira JLF, Wangchuk S, William T, Woodrow CJ, Zuluaga-Idarraga L, Guerin PJ, White NJ, Price RN. The effect of chloroquine dose and primaquine on Plasmodium vivax recurrence: a WorldWide Antimalarial Resistance Network systematic review and individual patient pooled meta-analysis. THE LANCET. INFECTIOUS DISEASES 2018; 18:1025-1034. [PMID: 30033231 PMCID: PMC6105624 DOI: 10.1016/s1473-3099(18)30348-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/30/2018] [Accepted: 05/21/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Chloroquine remains the mainstay of treatment for Plasmodium vivax malaria despite increasing reports of treatment failure. We did a systematic review and meta-analysis to investigate the effect of chloroquine dose and the addition of primaquine on the risk of recurrent vivax malaria across different settings. METHODS A systematic review done in MEDLINE, Web of Science, Embase, and Cochrane Database of Systematic Reviews identified P vivax clinical trials published between Jan 1, 2000, and March 22, 2017. Principal investigators were invited to share individual patient data, which were pooled using standardised methods. Cox regression analyses with random effects for study site were used to investigate the roles of chloroquine dose and primaquine use on rate of recurrence between day 7 and day 42 (primary outcome). The review protocol is registered in PROSPERO, number CRD42016053310. FINDINGS Of 134 identified chloroquine studies, 37 studies (from 17 countries) and 5240 patients were included. 2990 patients were treated with chloroquine alone, of whom 1041 (34·8%) received a dose below the target 25 mg/kg. The risk of recurrence was 32·4% (95% CI 29·8-35·1) by day 42. After controlling for confounders, a 5 mg/kg higher chloroquine dose reduced the rate of recurrence overall (adjusted hazard ratio [AHR] 0·82, 95% CI 0·69-0·97; p=0·021) and in children younger than 5 years (0·59, 0·41-0·86; p=0·0058). Adding primaquine reduced the risk of recurrence to 4·9% (95% CI 3·1-7·7) by day 42, which is lower than with chloroquine alone (AHR 0·10, 0·05-0·17; p<0·0001). INTERPRETATION Chloroquine is commonly under-dosed in the treatment of vivax malaria. Increasing the recommended dose to 30 mg/kg in children younger than 5 years could reduce substantially the risk of early recurrence when primaquine is not given. Radical cure with primaquine was highly effective in preventing early recurrence and may also improve blood schizontocidal efficacy against chloroquine-resistant P vivax. FUNDING Wellcome Trust, Australian National Health and Medical Research Council, and Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Robert J Commons
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia; WorldWide Antimalarial Resistance Network, Clinical module, Darwin, NT, Australia; Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Kamala Thriemer
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Georgina S Humphreys
- WorldWide Antimalarial Resistance Network, Oxford, UK; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Tesfay Abreha
- ICAP, Columbia University Mailman School of Public Health, Addis Ababa, Ethiopia
| | - Sisay G Alemu
- College of Natural Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Arletta Añez
- Departamento de Salud Pública, Universidad de Barcelona, Barcelona, Spain; Organización Panamericana de Salud, Oficina de país Bolivia, La Paz, Bolivia
| | - Nicholas M Anstey
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Ghulam R Awab
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Nangarhar Medical Faculty, Nangarhar University, Jalalabad Afghanistan
| | - J Kevin Baird
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Bridget E Barber
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia; Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | | | - Cindy S Chu
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Umberto D'Alessandro
- Unit of Malariology, Institute of Tropical Medicine, Antwerp, Belgium; Medical Research Council Unit, Fajara, The Gambia
| | - Prabin Dahal
- WorldWide Antimalarial Resistance Network, Oxford, UK; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - André Daher
- Institute of Drug Technology (Farmanguinhos), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; Vice-Presidency of Research and Reference Laboratories, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; Liverpool School of Tropical Medicine, Liverpool, UK
| | - Peter J de Vries
- Department of Internal Medicine, Tergooi Hospital, Hilversum, Netherlands
| | - Annette Erhart
- Unit of Malariology, Institute of Tropical Medicine, Antwerp, Belgium; Medical Research Council Unit, Fajara, The Gambia; Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Margarete S M Gomes
- Superintendência de Vigilância em Saúde do Estado do Amapá -SVS/AP, Macapá, Amapá, Brazil; Federal University of Amapá, Macapá, Amapá, Brazil
| | - Lilia Gonzalez-Ceron
- Regional Centre for Public Health Research, National Institute for Public Health, Tapachula, Chiapas, Mexico
| | - Matthew J Grigg
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia; Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Aliehsan Heidari
- Department of Medical Parasitology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Jimee Hwang
- US President's Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Global Health Group, University of California San Francisco, San Francisco, CA, USA
| | - Piet A Kager
- Centre for Infection and Immunity Amsterdam, Academic Medical Center, Amsterdam, Netherlands
| | - Tsige Ketema
- Department of Biology, Addis Ababa University, Addis Ababa, Ethiopia; Department of Biology, Jimma University, Jimma, Ethiopia
| | - Wasif A Khan
- International Centre for Diarrheal Diseases and Research, Dhaka, Bangladesh
| | - Marcus V G Lacerda
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil; Fundação Oswaldo Cruz, Instituto Leônidas e Maria Deane (FIOCRUZ-Amazonas), Manaus, Brazil
| | - Toby Leslie
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; HealthNet-TPO, Kabul, Afghanistan
| | - Benedikt Ley
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Kartini Lidia
- Department of Pharmacology and Therapy, Faculty of Medicine, Nusa Cendana University, Kupang, Indonesia
| | - Wuelton M Monteiro
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil; Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Francois Nosten
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Dhelio B Pereira
- Centro de Pesquisa em Medicina Tropical de Rondônia, Porto Velho, Rondônia, Brazil; Universidade Federal de Rondônia, Porto Velho, Rondônia, Brazil
| | - Giao T Phan
- Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, Netherlands; Tropical Diseases Clinical Research Center, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Aung P Phyo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Mark Rowland
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Kavitha Saravu
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India; Manipal McGill Center for Infectious Diseases, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Carol H Sibley
- WorldWide Antimalarial Resistance Network, Oxford, UK; Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - André M Siqueira
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil; Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil; Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Inge Sutanto
- Department of Parasitology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Walter R J Taylor
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Guy Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Binh Q Tran
- Tropical Diseases Clinical Research Center, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Hien T Tran
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Sonam Wangchuk
- Public Health Laboratory, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia; Infectious Diseases Unit, Clinical Research Centre, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Charles J Woodrow
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Division of Clinical Sciences, St George's, University of London, London, UK
| | | | - Philippe J Guerin
- WorldWide Antimalarial Resistance Network, Oxford, UK; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Nicholas J White
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ric N Price
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia; WorldWide Antimalarial Resistance Network, Clinical module, Darwin, NT, Australia; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
| |
Collapse
|
13
|
Lover AA, Baird JK, Gosling R, Price RN. Malaria Elimination: Time to Target All Species. Am J Trop Med Hyg 2018; 99:17-23. [PMID: 29761762 PMCID: PMC6035869 DOI: 10.4269/ajtmh.17-0869] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/14/2018] [Indexed: 01/13/2023] Open
Abstract
Important strides have been made within the past decade toward malaria elimination in many regions, and with this progress, the feasibility of eradication is once again under discussion. If the ambitious goal of eradication is to be achieved by 2040, all species of Plasmodium infecting humans will need to be targeted with evidence-based and concerted interventions. In this perspective, the potential barriers to achieving global malaria elimination are discussed with respect to the related diversities in host, parasite, and vector populations. We argue that control strategies need to be reorientated from a sequential attack on each species, dominated by Plasmodium falciparum to one that targets all species in parallel. A set of research themes is proposed to mitigate the potential setbacks on the pathway to a malaria-free world.
Collapse
Affiliation(s)
- Andrew A. Lover
- Malaria Elimination Initiative at the University of California, San Francisco, San Francisco, California
| | - J. Kevin Baird
- Eijkman-Oxford Clinical Research Unit, Eijkman Institute of Molecular Biology, Jakarta, Indonesia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Roly Gosling
- Malaria Elimination Initiative at the University of California, San Francisco, San Francisco, California
| | - Ric N. Price
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| |
Collapse
|
14
|
Ali AS, Thawer NG, Khatib B, Amier HH, Shija J, Msellem M, Al-Mafazy AW, Garimo IA, Mkali H, Ramsan MM, Kafuko JM, Paxton LA, Reithinger R, Ngondi JM. Artemisinin combination therapy mass drug administration in a setting of low malaria endemicity: programmatic coverage and adherence during an observational study in Zanzibar. Malar J 2017; 16:332. [PMID: 28807035 PMCID: PMC5557321 DOI: 10.1186/s12936-017-1982-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/07/2017] [Indexed: 11/30/2022] Open
Abstract
Background Mass drug administration (MDA) appears to be effective in reducing the risk of malaria parasitaemia. This study reports on programmatic coverage and compliance of MDA using artemisinin-based combination therapy (ACT) in four shehias (smallest administration unit) that had been identified as hotspots through Zanzibar’s malaria case notification surveillance system. Methods Mass drug administration was done in four shehias selected on the basis of: being an established malaria hot spot; having had mass screening and treatment (MSaT) 2–6 weeks previously; and exceeding the epidemic alert threshold of 5 cases within a week even after MSaT. Communities were sensitized and MDA was conducted using a house-to-house approach. All household members, except pregnant women and children aged less than 2 months, were provided with ACT medicine. Two weeks after the MDA campaign, a survey was undertaken to investigate completion of ACT doses. Results A total of 8816 [97.1% of eligible; 95% confidence interval (CI) 96.8–97.5] people received ACT. During post MDA surveys, 2009 people were interviewed: 90.2% reported having completed MDA doses; 1.9% started treatment but did not complete dosage; 4.7% did not take treatment; 2.0% were absent during MDA and 1.2% were ineligible (i.e. infants <2 months and pregnant women). Main reasons for failure to complete treatment were experience of side-effects and forgetting to take subsequent doses. Failure to take treatment was mainly due to fear of side-effects, reluctance due to lack of malaria symptoms and caregivers forgetting to give medication to children. Conclusion Mass drug administration for malaria was well accepted by communities at high risk of malaria in Zanzibar, with high participation and completion rates. Further work to investigate the potential of MDA in accelerating Zanzibar’s efforts towards malaria elimination should be pursued.
Collapse
Affiliation(s)
- Abdullah S Ali
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | | | - Bakar Khatib
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | - Haji H Amier
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | - Joseph Shija
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | - Mwinyi Msellem
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | | | | | | | | | - Jessica M Kafuko
- President's Malaria Initiative/United States Agency for International Development, Abuja, Nigeria
| | - Lynn A Paxton
- President's Malaria Initiative/Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | | | | |
Collapse
|
15
|
Howes RE, Battle KE, Mendis KN, Smith DL, Cibulskis RE, Baird JK, Hay SI. Global Epidemiology of Plasmodium vivax. Am J Trop Med Hyg 2016; 95:15-34. [PMID: 27402513 PMCID: PMC5198891 DOI: 10.4269/ajtmh.16-0141] [Citation(s) in RCA: 253] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/19/2016] [Indexed: 01/09/2023] Open
Abstract
Plasmodium vivax is the most widespread human malaria, putting 2.5 billion people at risk of infection. Its unique biological and epidemiological characteristics pose challenges to control strategies that have been principally targeted against Plasmodium falciparum Unlike P. falciparum, P. vivax infections have typically low blood-stage parasitemia with gametocytes emerging before illness manifests, and dormant liver stages causing relapses. These traits affect both its geographic distribution and transmission patterns. Asymptomatic infections, high-risk groups, and resulting case burdens are described in this review. Despite relatively low prevalence measurements and parasitemia levels, along with high proportions of asymptomatic cases, this parasite is not benign. Plasmodium vivax can be associated with severe and even fatal illness. Spreading resistance to chloroquine against the acute attack, and the operational inadequacy of primaquine against the multiple attacks of relapse, exacerbates the risk of poor outcomes among the tens of millions suffering from infection each year. Without strategies accounting for these P. vivax-specific characteristics, progress toward elimination of endemic malaria transmission will be substantially impeded.
Collapse
Affiliation(s)
- Rosalind E. Howes
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio
| | - Katherine E. Battle
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Kamini N. Mendis
- Global Malaria Program, World Health Organization, Geneva, Switzerland
| | - David L. Smith
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland
- Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | | | - J. Kevin Baird
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Simon I. Hay
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford, United Kingdom
| |
Collapse
|
16
|
Olliaro PL, Barnwell JW, Barry A, Mendis K, Mueller I, Reeder JC, Shanks GD, Snounou G, Wongsrichanalai C. Implications of Plasmodium vivax Biology for Control, Elimination, and Research. Am J Trop Med Hyg 2016; 95:4-14. [PMID: 27799636 PMCID: PMC5201222 DOI: 10.4269/ajtmh.16-0160] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 09/29/2016] [Indexed: 12/03/2022] Open
Abstract
This paper summarizes our current understanding of the biology of Plasmodium vivax, how it differs from Plasmodium falciparum, and how these differences explain the need for P. vivax-tailored interventions. The article further pinpoints knowledge gaps where investments in research are needed to help identify and develop such specific interventions. The principal obstacles to reduce and eventually eliminate P. vivax reside in 1) its higher vectorial capacity compared with P. falciparum due to its ability to develop at lower temperature and over a shorter sporogonic cycle in the vector, allowing transmission in temperate zones and making it less sensitive to vector control measures that are otherwise effective on P. falciparum; 2) the presence of dormant liver forms (hypnozoites), sustaining multiple relapsing episodes from a single infectious bite that cannot be diagnosed and are not susceptible to any available antimalarial except primaquine, with routine deployment restricted by toxicity; 3) low parasite densities, which are difficult to detect with current diagnostics leading to missed diagnoses and delayed treatments (and protracted transmission), coupled with 4) transmission stages (gametocytes) occurring early in acute infections, before infection is diagnosed.
Collapse
Affiliation(s)
- Piero L Olliaro
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,UNICEF/UNDP/World Bank/WHO Special Programme on Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - John W Barnwell
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alyssa Barry
- Department of Medical Biology, University of Melbourne, Melbourne, Australia.,Division of Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | | | - Ivo Mueller
- Institute of Global Health (ISGLOBAL), Barcelona, Spain.,Division of Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - John C Reeder
- UNICEF/UNDP/World Bank/WHO Special Programme on Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - G Dennis Shanks
- School of Population Health, University of Queensland, Brisbane, Australia
| | - Georges Snounou
- Centre d'Immunologie et de Maladies Infectieuses (CIMI)-Paris, Institut National de la Santé et de la Recherche Médicale (INSERM) U1135-Centre National de la Recherche Scientifique (CNRS) ERL 8255, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UPMC UMRS CR7, Paris, France
| | | |
Collapse
|
17
|
Bassat Q, Velarde M, Mueller I, Lin J, Leslie T, Wongsrichanalai C, Baird JK. Key Knowledge Gaps for Plasmodium vivax Control and Elimination. Am J Trop Med Hyg 2016; 95:62-71. [PMID: 27430544 PMCID: PMC5201224 DOI: 10.4269/ajtmh.16-0180] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/11/2016] [Indexed: 11/18/2022] Open
Abstract
There is inadequate understanding of the biology, pathology, transmission, and control of Plasmodium vivax, the geographically most widespread cause of human malaria. During the last decades, study of this species was neglected, in part due to the erroneous belief that it is intrinsically benign. In addition, many technical challenges in culturing the parasite also hampered understanding its fundamental biology and molecular and cellular responses to chemotherapeutics. Research on vivax malaria needs to be substantially expanded over the next decade to accelerate its elimination and eradication. This article summarizes key knowledge gaps identified by researchers, national malaria control programs, and other stakeholders assembled by the World Health Organization to develop strategies for controlling and eliminating vivax malaria. The priorities presented in this article emerged in these technical discussions, and were adopted by expert consensus of the authors. All involved understood the priority placed upon pragmatism in this research agenda, that is, focus upon tools delivering better prevention, diagnosis, treatment, and surveillance of P. vivax.
Collapse
Affiliation(s)
- Quique Bassat
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Mar Velarde
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Ivo Mueller
- Population Health and Immunology Division, Walter and Eliza Hall Institute, Victoria, Australia
| | - Jessica Lin
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
| | - Toby Leslie
- Health Protection and Research Organisation, Kabul, Afghanistan.,London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - J Kevin Baird
- Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom.,Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| |
Collapse
|
18
|
Challenges in Antimalarial Drug Treatment for Vivax Malaria Control. Trends Mol Med 2015; 21:776-788. [DOI: 10.1016/j.molmed.2015.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 10/19/2015] [Accepted: 10/20/2015] [Indexed: 01/01/2023]
|
19
|
Prevention of Malaria Resurgence in Greece through the Association of Mass Drug Administration (MDA) to Immigrants from Malaria-Endemic Regions and Standard Control Measures. PLoS Negl Trop Dis 2015; 9:e0004215. [PMID: 26583650 PMCID: PMC4652894 DOI: 10.1371/journal.pntd.0004215] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/14/2015] [Indexed: 01/27/2023] Open
Abstract
Greece was declared malaria-free in 1974 after a long antimalarial fight. In 2011–2012, an outbreak of P. vivax malaria was reported in Evrotas, an agricultural area in Southern Greece, where a large number of immigrants from endemic countries live and work. A total of 46 locally acquired and 38 imported malaria cases were detected. Despite a significant decrease of the number of malaria cases in 2012, a mass drug administration (MDA) program was considered as an additional measure to prevent reestablishment of the disease in the area. During 2013 and 2014, a combination of 3-day chloroquine and 14-day primaquine treatment was administered under direct observation to immigrants living in the epicenter of the 2011 outbreak in Evrotas. Adverse events were managed and recorded on a daily basis. The control measures implemented since 2011 continued during the period of 2013–2014 as a part of a national integrated malaria control program that included active case detection (ACD), vector control measures and community education. The MDA program was started prior to the transmission periods (from May to December). One thousand ninety four (1094) immigrants successfully completed the treatment, corresponding to 87.3% coverage of the target population. A total of 688 adverse events were recorded in 397 (36.2%, 95% C.I.: 33.4–39.1) persons, the vast majority minor, predominantly dizziness and headache for chloroquine (284 events) and abdominal pain (85 events) for primaquine. A single case of primaquine-induced hemolysis was recorded in a person whose initial G6PD test proved incorrect. No malaria cases were recorded in Evrotas, Laconia, in 2013 and 2014, though three locally acquired malaria cases were recorded in other regions of Greece in 2013. Preventive antimalarial MDA to a high-risk population in a low transmission setting appears to have synergized with the usual antimalarial activities to achieve malaria elimination. This study suggests that judicious use of MDA can be a useful addition to the antimalarial armamentarium in areas threatened with the reintroduction of the disease. Greece was declared malaria-free in the year 1974 after a long antimalarial fight. In 2011–2012, a number of malaria cases reported in Evrotas, Laconia, in Southern Greece, where a large number of immigrants from malaria-endemic countries live and work. A total of 84 malaria cases, both in immigrants (38 cases) and in Greeks (46 cases), were detected. A number of malaria control measures were deployed in the area since 2011. Despite a decrease of the number of malaria cases in 2012, elimination could not be achieved, and thus antimalarial MDA was considered as an additional measure to prevent the reestablishment of the disease. During 2013 and 2014, a combination of two drugs was administered under direct observation to all immigrants in the epicenter of the 2011 Evrotas outbreak. The antimalarial MDA program was started on July-August and was successfully completed by 1094 immigrants (87.3% coverage). No serious adverse events were recorded except one case of primaquine-induced hemolysis due to false G6PD test result. In 2013 and 2014, no malaria cases were recorded in Evrotas, Laconia. This study suggests that careful use of supervised antimalarial MDA is a useful addition to the antimalarial control measures in areas threatened with the reintroduction of the disease.
Collapse
|
20
|
Val FF, Sampaio VS, Cassera MB, Andrade RT, Tauil PL, Monteiro WM, Lacerda MVG. Plasmodium vivax malaria elimination: should innovative ideas from the past be revisited? Mem Inst Oswaldo Cruz 2015; 109:522-4. [PMID: 25184997 PMCID: PMC4156444 DOI: 10.1590/0074-0276140240] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 07/25/2014] [Indexed: 01/13/2023] Open
Abstract
In the 1950s, the strategy of adding chloroquine to food salt as a prophylaxis
against malaria was considered to be a successful tool. However, with the development
of Plasmodium resistance in the Brazilian Amazon, this control
strategy was abandoned. More than 50 years later, asexual stage resistance can be
avoided by screening for antimalarial drugs that have a selective action against
gametocytes, thus old prophylactic measures can be revisited. The efficacy of the old
methods should be tested as complementary tools for the elimination of malaria.
Collapse
Affiliation(s)
| | | | - Maria Belén Cassera
- Department of Biochemistry, Virginia Tech Center for Drug Discovery, Virginia Tech, Blacksburg, VA, USA
| | | | - Pedro Luiz Tauil
- Faculdade de Medicina, Universidade de Brasília, Brasília, DF, Brasil
| | | | | |
Collapse
|
21
|
Monteiro WM, Val FFA, Siqueira AM, Franca GP, Sampaio VS, Melo GC, Almeida ACG, Brito MAM, Peixoto HM, Fuller D, Bassat Q, Romero GAS, Maria Regina F O, Marcus Vinícius G L. G6PD deficiency in Latin America: systematic review on prevalence and variants. Mem Inst Oswaldo Cruz 2014; 109:553-68. [PMID: 25141282 PMCID: PMC4156449 DOI: 10.1590/0074-0276140123] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/02/2014] [Indexed: 01/14/2023] Open
Abstract
Plasmodium vivax radical cure requires the use of primaquine (PQ), a drug that induces haemolysis in glucose-6-phosphate dehydrogenase deficient (G6PDd) individuals, which further hampers malaria control efforts. The aim of this work was to study the G6PDd prevalence and variants in Latin America (LA) and the Caribbean region. A systematic search of the published literature was undertaken in August 2013. Bibliographies of manuscripts were also searched and additional references were identified. Low prevalence rates of G6PDd were documented in Argentina, Bolivia, Mexico, Peru and Uruguay, but studies from Curaçao, Ecuador, Jamaica, Saint Lucia, Suriname and Trinidad, as well as some surveys carried out in areas of Brazil, Colombia and Cuba, have shown a high prevalence (> 10%) of G6PDd. The G6PD A-202A mutation was the variant most broadly distributed across LA and was identified in 81.1% of the deficient individuals surveyed. G6PDd is a frequent phenomenon in LA, although certain Amerindian populations may not be affected, suggesting that PQ could be safely used in these specific populations. Population-wide use of PQ as part of malaria elimination strategies in LA cannot be supported unless a rapid, accurate and field-deployable G6PDd diagnostic test is made available.
Collapse
Affiliation(s)
- Wuelton M Monteiro
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
| | - Fernando FA Val
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
| | - André M Siqueira
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
| | - Gabriel P Franca
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
| | - Vanderson S Sampaio
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
| | - Gisely C Melo
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
| | - Anne CG Almeida
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
| | - Marcelo AM Brito
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
| | - Henry M Peixoto
- Faculdade de Medicina, Universidade de Brasília, Brasília, DF,
Brasil
| | - Douglas Fuller
- Department of Geography and Regional Studies, University of Miami, Coral
Gables, FL, USA
| | - Quique Bassat
- Barcelona Centre for International Health Research, Hospital Clinic,
University of Barcelona, Barcelona, Spain
| | - Gustavo AS Romero
- Faculdade de Medicina, Universidade de Brasília, Brasília, DF,
Brasil
- Instituto Nacional de Ciência e Tecnologia para Avaliação de Tecnologias
em Saúde, Porto Alegre, RS, Brasil
| | - Oliveira Maria Regina F
- Faculdade de Medicina, Universidade de Brasília, Brasília, DF,
Brasil
- Instituto Nacional de Ciência e Tecnologia para Avaliação de Tecnologias
em Saúde, Porto Alegre, RS, Brasil
| | - Lacerda Marcus Vinícius G
- Gerência de Malária, Fundação de Medicina Tropical Dr Heitor Vieira
Dourado, Manaus, AM, Brasil
- Escola Superior de Ciências da Saúde, Universidade do Estado do
Amazonas, Manaus, AM, Brasil
| |
Collapse
|
22
|
Prevalence of mutations in the antifolates resistance-associated genes (dhfr and dhps) in Plasmodium vivax parasites from Eastern and Central Sudan. INFECTION GENETICS AND EVOLUTION 2014; 26:153-9. [PMID: 24861816 DOI: 10.1016/j.meegid.2014.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/10/2014] [Accepted: 05/14/2014] [Indexed: 01/17/2023]
Abstract
Plasmodium vivax is the most geographically widespread species, and its burden has been increasingly documented in Eastern and Central Sudan. P. vivax becomes the crucial challenge during elimination programs; thus an effective treatment is necessary to prevent the development and the spread of resistant parasites. Therefore, the main objective of the present study was to provide data on the prevalence of molecular markers in two genes (pvdhfr and pvdhps) associated with SP resistance after nine years of AS+SP deployment among P. vivax parasites from Eastern and Central Sudan using PCR-RFLP. During 2012-2013, a number of 66 blood spots were obtained on filter paper. The samples were collected before treatment from febrile patients who were microscopically positive for P. vivax, from three states in Eastern and Central Sudan (Gezira, Gedarif, and Kassala). Mutations were detected in three codons of pvdhfr (I13L, S58R, and S117N) and none in pvdhps. The majority of P. vivax parasites had double mutations (58R/117N, 58%) in dhfr gene, while all parasites were wild type in dhps gene. In addition, limited distinct haplotypes (n=4) were detected. In conclusion, the prevalence of mutations associated with SP resistance is low in Eastern and Central Sudan. Such information is necessary for guiding malaria control measures in the frame of Roll Back Malaria strategies for the elimination of malaria in the world.
Collapse
|
23
|
Hsiang MS, Hwang J, Tao AR, Liu Y, Bennett A, Shanks GD, Cao J, Kachur SP, Feachem RGA, Gosling RD, Gao Q. Mass drug administration for the control and elimination of Plasmodium vivax malaria: an ecological study from Jiangsu province, China. Malar J 2013; 12:383. [PMID: 24175930 PMCID: PMC3842644 DOI: 10.1186/1475-2875-12-383] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 10/24/2013] [Indexed: 12/05/2022] Open
Abstract
Background Recent progress in malaria control has caused renewed interest in mass drug administration (MDA) as a potential elimination strategy but the evidence base is limited. China has extensive experience with MDA, but it is not well documented. Methods An ecological study was conducted to describe the use of MDA for the control and elimination of Plasmodium vivax in Jiangsu Province and explore the association between MDA and malaria incidence. Two periods were focused on: 1973 to 1983 when malaria burden was high and MDA administered to highly endemic counties province-wide, and 2000 to 2009, when malaria burden was low and a focal approach was used in two counties. All available data about the strategies implemented, MDA coverage, co-interventions, incidence, and adverse events were collected and described. Joinpoint analysis was used to describe trends in incidence and the relationship between MDA coverage and incidence was explored in negative binomial regression models. Results From 1973 to 1983, MDA with pyrimethamine and primaquine was used on a large scale, with up to 30 million people in target counties covered in a peak year (50% of the total population). Joinpoint analyses identified declines in annual incidence, -56.7% (95% CI -75.5 to -23.7%) from 1973–1976 and -12.4% (95% CI -24.7 to 2.0%) from 1976–1983. Population average negative binomial models identified a relationship between higher total population MDA coverage and lower monthly incidence from 1973–1976, IRR 0.98 (95% CI 0.97 to 1.00), while co-interventions, rainfall and GDP were not associated. From 2000–2009, incidence in two counties declined (annual change -43.7 to -14.0%) during a time when focal MDA using chloroquine and primaquine was targeted to villages and/or individuals residing near passively detected index cases (median 0.04% of total population). Although safety data were not collected systematically, there were rare reports of serious but non-fatal events. Conclusions In Jiangsu Province, China, large-scale MDA was implemented and associated with declines in high P. vivax malaria transmission; a more recent focal approach may have contributed to interruption of transmission. MDA should be considered a potential key strategy for malaria control and elimination.
Collapse
Affiliation(s)
- Michelle S Hsiang
- Global Health Group, University of California San Francisco (UCSF), San Francisco, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Douglas NM, Simpson JA, Phyo AP, Siswantoro H, Hasugian AR, Kenangalem E, Poespoprodjo JR, Singhasivanon P, Anstey NM, White NJ, Tjitra E, Nosten F, Price RN. Gametocyte dynamics and the role of drugs in reducing the transmission potential of Plasmodium vivax. J Infect Dis 2013; 208:801-12. [PMID: 23766527 PMCID: PMC3733516 DOI: 10.1093/infdis/jit261] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Designing interventions that will reduce transmission of vivax malaria requires knowledge of Plasmodium vivax gametocyte dynamics. METHODS We analyzed data from a randomized controlled trial in northwestern Thailand and 2 trials in Papua, Indonesia, to identify and compare risk factors for vivax gametocytemia at enrollment and following treatment. RESULTS A total of 492 patients with P. vivax infections from Thailand and 476 patients (162 with concurrent falciparum parasitemia) from Indonesia were evaluable. Also, 84.3% (415/492) and 66.6% (209/314) of patients with monoinfection were gametocytemic at enrollment, respectively. The ratio of gametocytemia to asexual parasitemia did not differ between acute and recurrent infections (P = .48 in Thailand, P = .08 in Indonesia). High asexual parasitemia was associated with an increased risk of gametocytemia during follow-up in both locations. In Thailand, the cumulative incidence of gametocytemia between day 7 and day 42 following dihydroartemisinin + piperaquine (DHA + PIP) was 6.92% vs 29.1% following chloroquine (P < .001). In Indonesia, the incidence of gametocytemia was 33.6% following artesunate + amodiaquine (AS + AQ), 7.42% following artemether + lumefantrine, and 6.80% following DHA + PIP (P < .001 for DHA + PIP vs AS + AQ). CONCLUSIONS P. vivax gametocyte carriage mirrors asexual-stage infection. Prevention of relapses, particularly in those with high asexual parasitemia, is likely the most important strategy for interrupting P. vivax transmission.
Collapse
Affiliation(s)
- Nicholas M Douglas
- Global Health Division, Menzies School of Health Research, Charles Darwin University, Darwin 0811, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Ubben D, Poll EM. MMV in partnership: the Eurartesim® experience. Malar J 2013; 12:211. [PMID: 23782869 PMCID: PMC3691732 DOI: 10.1186/1475-2875-12-211] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 06/11/2013] [Indexed: 12/23/2022] Open
Abstract
Background This case study describes how a public-private partnership between Medicines for Malaria Venture (MMV) and Sigma-Tau Industrie Farmaceutiche Riunite SpA achieved international regulatory approval for use of the fixed-dose artemisinin-based combination therapy dihydroartemisinin-piperaquine (Eurartesim®) for the treatment of malaria, enabling more widespread access to the medicine in malaria-endemic countries. Case description The combination of dihydroartemisinin and piperaquine demonstrated success in clinical trials for the treatment of malaria in Asia and Africa in the 2000s. However, as it had not been developed to international regulatory standards it was out of the reach of the majority of patients in disease-endemic countries, particularly those reliant on public healthcare systems supported by international donor funding. To overcome this, as of 2004 MMV worked in partnership with Sigma-Tau, Holleykin, Oxford University, the Institute of Tropical Medicine Antwerp, and the National Institute of Malaria Research India to develop the dihydroartemisinin-piperaquine combination to international standards. In 2011, the European Commission granted full marketing authorization to Sigma-Tau for Eurartesim. Discussion and evaluation The partnership between MMV, Sigma-Tau, and numerous other academic and industrial partners across the world, led to the successful development to EMA regulatory standards of a high-quality and highly efficacious anti-malarial treatment that otherwise would not have been possible. The dossier has also been submitted to the WHO for prequalification, and a safety statement to guide correct use of Eurartesim has been produced. In July 2012, the first delivery to a disease-endemic country was made to Cambodia, where the medicine is being used to treat patients and help counter the emergence of artemisinin resistance in the area. A paediatric dispersible formulation of Eurartesim is being developed, with the objective to submit the dossier to the EMA by the end of 2014. Conclusions The development of Eurartesim to international regulatory standards exemplifies the strengths of the product development partnership model in utilising the individual skills and expertise of partners with differing objectives to achieve a common goal. Successful uptake of Eurartesim by public health systems in malaria-endemic countries poses new challenges, which may require additional partnerships as we move forward.
Collapse
Affiliation(s)
- David Ubben
- Medicines for Malaria Venture, 20 Rte de Pré-Bois, PO Box 1826, Geneva 1215, Switzerland
| | | |
Collapse
|
26
|
Wells S, Diap G, Kiechel JR. The story of artesunate-mefloquine (ASMQ), innovative partnerships in drug development: case study. Malar J 2013; 12:68. [PMID: 23433060 PMCID: PMC3640935 DOI: 10.1186/1475-2875-12-68] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 01/17/2013] [Indexed: 11/21/2022] Open
Abstract
Background The Drugs for Neglected Diseases initiative (DNDi) is a not-for profit organization committed to providing affordable medicines and access to treatments in resource-poor settings. Traditionally drug development has happened “in house” within pharmaceutical companies, with research and development costs ultimately recuperated through drug sales. The development of drugs for the treatment of neglected tropical diseases requires a completely different model that goes beyond the scope of market-driven research and development. Artesunate and mefloquine are well-established drugs for the treatment of uncomplicated malaria, with a strong safety record based on many years of field-based studies and use. The administration of such artemisinin-based combination therapy in a fixed-dose combination is expected to improve patient compliance and to reduce the risk of emerging drug resistance. Case description DNDi developed an innovative approach to drug development, reliant on strong collaborations with a wide range of partners from the commercial world, academia, government institutions and NGOs, each of which had a specific role to play in the development of a fixed dose combination of artesunate and mefloquine. Discussion and evaluation DNDi undertook the development of a fixed-dose combination of artesunate with mefloquine. Partnerships were formed across five continents, addressing formulation, control and production through to clinical trials and product registration, resulting in a safe and efficacious fixed dose combination treatment which is now available to treat patients in resource-poor settings. The south-south technology transfer of production from Farmanguinhos/Fiocruz in Brazil to Cipla Ltd in India was the first of its kind. Of additional benefit was the increased capacity within the knowledge base and infrastructure in developing countries. Conclusions This collaborative approach to drug development involving international partnerships and independent funding mechanisms is a powerful new way to develop drugs for tropical diseases.
Collapse
Affiliation(s)
- Susan Wells
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | | | | |
Collapse
|