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Viana Dos Santos MB, Braga de Oliveira A, Veras Mourão RH. Brazilian plants with antimalarial activity: A review of the period from 2011 to 2022. J Ethnopharmacol 2024; 322:117595. [PMID: 38122914 DOI: 10.1016/j.jep.2023.117595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/16/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Malaria continues to be a serious global public health problem in subtropical and tropical countries of the world. The main drugs used in the treatment of human malaria, quinine and artemisinin, are isolates of medicinal plants, making the use of plants a widespread practice in countries where malaria is endemic. Over the years, due to the increased resistance of the parasite to chloroquine and artemisinin in certain regions, new strategies for combating malaria have been employed, including research with medicinal plants. AIM This review focuses on the scientific production regarding medicinal plants from Brazil whose antimalarial activity was evaluated during the period from 2011 to 2022. 2. METHODOLOGY For this review, four electronic databases were selected for research: Pubmed, ScienceDirect, Scielo and Periódicos CAPES. Searches were made for full texts published in the form of scientific articles written in Portuguese or English and in a digital format. In addition, prospects for new treatments as well as future research that encourages the search for natural products and antimalarial derivatives are also presented. RESULTS A total of 61 publications were encountered, which cited 36 botanical families and 92 species using different Plasmodium strains in in vitro and in vivo assays. The botanical families with the most expressive number of species found were Rubiaceae, Apocynaceae, Fabaceae and Asteraceae (14, 14, 9 and 6 species, respectively), and the most frequently cited species were of the genera Psychotria L. (8) and Aspidosperma Mart. (12), which belong to the families Rubiaceae and Apocynaceae. Altogether, 75 compounds were identified or isolated from 28 different species, 31 of which are alkaloids. In addition, the extracts of the analyzed species, including the isolated compounds, showed a significant reduction of parasitemia in P. falciparum and P. berghei, especially in the clones W2 CQ-R (in vitro) and ANKA (in vivo), respectively. The Brazilian regions with the highest number of species analyzed were those of the north, especially the states of Pará and Amazonas, and the southeast, especially the state of Minas Gerais. CONCLUSION Although many plant species with antimalarial potential have been identified in Brazil, studies of new antimalarial molecules are slow and have not evolved to the production of a phytotherapeutic medicine. Given this, investigations of plants of traditional use and biotechnological approaches are necessary for the discovery of natural antimalarial products that contribute to the treatment of the disease in the country and in other endemic regions.
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Affiliation(s)
- Maria Beatriz Viana Dos Santos
- Laboratório de Bioprospecção e Biologia Experimental - LabBBEx, Universidade Federal do Oeste do Pará, Rua Vera Paz, s/n, Salé, 68035-110, Santarém, PA, Brazil; Programa de Pós-Graduação Doutorado em Rede de Biodiversidade e Biotecnologia - BIONORTE/Polo Pará. Universidade Federal do Pará, Rua Augusto Corrêa, 01, Guamá, 66075-110, Belém, PA, Brazil.
| | - Alaíde Braga de Oliveira
- Laboratório de Bioprospecção e Biologia Experimental - LabBBEx, Universidade Federal do Oeste do Pará, Rua Vera Paz, s/n, Salé, 68035-110, Santarém, PA, Brazil; Programa de Pós-Graduação Doutorado em Rede de Biodiversidade e Biotecnologia - BIONORTE/Polo Pará. Universidade Federal do Pará, Rua Augusto Corrêa, 01, Guamá, 66075-110, Belém, PA, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas - PPGCF, Faculdade de Farmácia, Departamento de Produtos Farmacêuticos, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, 31270-901, Belo Horizonte, MG, Brazil.
| | - Rosa Helena Veras Mourão
- Laboratório de Bioprospecção e Biologia Experimental - LabBBEx, Universidade Federal do Oeste do Pará, Rua Vera Paz, s/n, Salé, 68035-110, Santarém, PA, Brazil; Programa de Pós-Graduação Doutorado em Rede de Biodiversidade e Biotecnologia - BIONORTE/Polo Pará. Universidade Federal do Pará, Rua Augusto Corrêa, 01, Guamá, 66075-110, Belém, PA, Brazil
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Brito M, Rufatto R, Murta F, Sampaio V, Balieiro P, Baía-Silva D, Castro V, Alves B, Alencar A, Duparc S, Grewal Daumerie P, Borghini-Fuhrer I, Jambert E, Peterka C, Edilson Lima F, Carvalho Maia L, Lucena Cruz C, Maciele B, Vasconcelos M, Machado M, Augusto Figueira E, Alcirley Balieiro A, Menezes A, Ataídes R, Batista Pereira D, Lacerda M. Operational feasibility of Plasmodium vivax radical cure with tafenoquine or primaquine following point-of-care, quantitative glucose-6-phosphate dehydrogenase testing in the Brazilian Amazon: a real-life retrospective analysis. Lancet Glob Health 2024; 12:e467-e477. [PMID: 38365417 PMCID: PMC10882209 DOI: 10.1016/s2214-109x(23)00542-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND To achieve malaria elimination, Brazil must implement Plasmodium vivax radical cure. We aimed to investigate the operational feasibility of point-of-care, quantitative, glucose-6-phosphate dehydrogenase (G6PD) testing followed by chloroquine plus tafenoquine or primaquine. METHODS This non-interventional, observational study was done at 43 health facilities in Manaus (Amazonas State) and Porto Velho (Rondônia State), Brazil, implementing a new P vivax treatment algorithm incorporating point-of-care quantitative G6PD testing to identify G6PD status and single-dose tafenoquine (G6PD normal, aged ≥16 years, and not pregnant or breastfeeding) or primaquine (intermediate or normal G6PD, aged ≥6 months, not pregnant, or breastfeeding >1 month). Following training of health-care providers, we collated routine patient records from the malaria epidemiological surveillance system (SIVEP-Malaria) retrospectively for all consenting patients aged at least 6 months with parasitologically confirmed P vivax malaria mono-infection or P vivax plus P falciparum mixed infection, presenting between Sept 9, 2021, and Aug 31, 2022. The primary endpoint was the proportion of patients aged at least 16 years with P vivax mono-infection treated or not treated appropriately with tafenoquine in accordance with their G6PD status. The trial is registered with ClinicalTrials.gov, NCT05096702, and is completed. FINDINGS Of 6075 patients enrolled, 6026 (99·2%) had P vivax mono-infection, 2685 (44·6%) of whom were administered tafenoquine. G6PD status was identified in 2685 (100%) of 2685 patients treated with tafenoquine. The proportion of patients aged at least 16 years with P vivax mono-infection who were treated or not treated appropriately with tafenoquine in accordance with their G6PD status was 99·7% (95% CI 99·4-99·8; 4664/4680). INTERPRETATION Quantitative G6PD testing before tafenoquine administration was operationally feasible, with high adherence to the treatment algorithm, supporting deployment throughout the Brazilian health system. FUNDING Brazilian Ministry of Health, Municipal and State Health Secretariats; Fiocruz; Medicines for Malaria Venture; Bill & Melinda Gates Foundation; Newcrest Mining; and the UK Government. TRANSLATION For the Portuguese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Marcelo Brito
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Rosilene Rufatto
- Centro de Pesquisa em Medicina Tropical de Rondônia, Porto Velho, Brazil
| | - Felipe Murta
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Vanderson Sampaio
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Patrícia Balieiro
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Djane Baía-Silva
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil; Universidade do Estado do Amazonas, Manaus, Brazil; Instituto Leônidas & Maria Deane, Fiocruz, Manaus, Brazil; Universidade Nilton Lins, Manaus, Brazil
| | | | - Brenda Alves
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Aline Alencar
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | | | | | | | | | | | | | | | | | - Bruna Maciele
- Centro de Pesquisa em Medicina Tropical de Rondônia, Porto Velho, Brazil
| | | | | | | | | | | | | | | | - Marcus Lacerda
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil; Instituto Leônidas & Maria Deane, Fiocruz, Manaus, Brazil; University of Texas Medical Branch, Galveston, TX, USA.
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Costa E, Rocha D, Lopes JIF, Andrade E, Cardoso P, Ribeiro M, Fontana-Maurell M, Vicentino ARR, Calazans AR, Arruda MB, Mesquita CDA, Ferreira AGP, Amorim Filho L, Alvarez P. Detection of Plasmodium spp. in asymptomatic blood donors by the new Brazilian NAT PLUS HIV/HBV/HCV/Malaria Bio-Manguinhos kit. Transfusion 2024; 64:501-509. [PMID: 38258881 DOI: 10.1111/trf.17726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Transfusion-transmitted malaria (TTM) is a public health problem in endemic and nonendemic areas. The Brazilian Ministry of Health (MH) requested the development of a nucleic acid amplification test (NAT) for the detection of Plasmodium spp. in public blood centers to increase blood safety. STUDY DESIGN AND METHODS The new Brazilian NAT kit named NAT PLUS HIV/HBV/HCV/Malaria Bio-Manguinhos was first implemented in HEMORIO, a public blood center in the city of Rio de Janeiro. Since October 1, 2022, this blood center has been testing all its blood donations for malaria in a pool of six plasma samples to detect Plasmodium spp. by real-time polymerase chain reaction (PCR). RESULTS Since the implementation of the NAT PLUS platform until February 2023, HEMORIO has successfully received and tested 200,277 donations. The platform detected two asymptomatic donors in the city of Rio de Janeiro, which is a nonendemic region for malaria. Our analyses suggested a malaria from the Amazon region caused by Plasmodium vivax, in the first case, while an autochthonous transmission case by Plasmodium malariae was identified in the rural area of Rio de Janeiro state. DISCUSSION The NAT PLUS platform detects Plasmodium spp. in plasma samples with sensitivity capable of detecting subpatent infections. This is the first time worldwide that a group developed and implemented molecular diagnosis for Plasmodium spp. to be used by public blood centers to avoid TTM.
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Affiliation(s)
- Elaine Costa
- Laboratório de Tecnologia Diagnóstica (LATED), Instituto de Tecnologia de Imunobiológicos (Bio-Manguinhos), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brasil
| | - Daniele Rocha
- Laboratório de Tecnologia Diagnóstica (LATED), Instituto de Tecnologia de Imunobiológicos (Bio-Manguinhos), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brasil
| | | | - Elisabete Andrade
- Laboratório de Tecnologia Diagnóstica (LATED), Instituto de Tecnologia de Imunobiológicos (Bio-Manguinhos), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brasil
| | - Pedro Cardoso
- Laboratório de Tecnologia Diagnóstica (LATED), Instituto de Tecnologia de Imunobiológicos (Bio-Manguinhos), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brasil
| | - Marisa Ribeiro
- Laboratório de Tecnologia Diagnóstica (LATED), Instituto de Tecnologia de Imunobiológicos (Bio-Manguinhos), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brasil
| | - Marcela Fontana-Maurell
- Laboratório de Tecnologia Diagnóstica (LATED), Instituto de Tecnologia de Imunobiológicos (Bio-Manguinhos), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brasil
- Departamento de Genética, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Amanda Roberta Revoredo Vicentino
- Laboratório de Imunologia Molecular e Celular, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Alexandre Rodrigues Calazans
- Laboratório de Tecnologia Diagnóstica (LATED), Instituto de Tecnologia de Imunobiológicos (Bio-Manguinhos), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brasil
| | - Monica Barcellos Arruda
- Laboratório de Tecnologia Diagnóstica (LATED), Instituto de Tecnologia de Imunobiológicos (Bio-Manguinhos), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brasil
| | | | - Antonio Gomes Pinto Ferreira
- Laboratório de Tecnologia Diagnóstica (LATED), Instituto de Tecnologia de Imunobiológicos (Bio-Manguinhos), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brasil
| | | | - Patrícia Alvarez
- Laboratório de Tecnologia Diagnóstica (LATED), Instituto de Tecnologia de Imunobiológicos (Bio-Manguinhos), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brasil
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Garcia KKS, Soremekun S, Abrahão AA, Marchesini PB, Drakeley C, Ramalho WM, Siqueira AM. Is Brazil reaching malaria elimination? A time series analysis of malaria cases from 2011 to 2023. PLOS Glob Public Health 2024; 4:e0002845. [PMID: 38295141 PMCID: PMC10830034 DOI: 10.1371/journal.pgph.0002845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/14/2024] [Indexed: 02/02/2024]
Abstract
In Brazil, 99% of malaria cases occur in the Amazon region, mainly caused by Plasmodium vivax (~83%) and Plasmodium falciparum (Pf) species. Aligned with the Sustainable Development Goals, Brazil aims to eliminate autochthonous malaria by 2035. This study aims to analyse epidemiological patterns of malaria in Brazil to discuss if Brazil is on track to meet malaria control targets. A time-series study was conducted analysing autochthonous malaria new infections notifications in the Brazilian Amazon region from 2011 until June 2023. Descriptive analyses were conducted, along with joinpoint regression and forecast models to verify trend and future behaviour. A total of 2,067,030 malaria cases were reported in the period. Trend analysis indicated a decreasing trend in all malaria infections since late 2017 (monthly reduction = 0.81%, p-value <0.05), while Pf infections have increased progressively since 2015 (monthly increase = 0.46%, p-value <0.05). Forecast models predict over 124,000 malaria cases in 2023 and over 96,000 cases in 2024. Predictions for Pf infections are around 23,900 cases in 2023 and 22,300 in 2024. Cases in indigenous population villages are predicted to reach 48,000 cases in 2023 and over 51,000 in 2024. In gold mining areas it is expected over 21,000 cases in 2023 and over 20.000 in 2024. Malaria elimination in Brazil has advanced over the last decade, but its speed has slowed. The country exhibits noteworthy advancements in the reduction of overall malaria cases. It is imperative, however, to proactively target specific issues such as the incidence raise among indigenous populations and in gold mining areas. Pf infections remain a persistent challenge to control in the country and may require novel measures for containment. Current government supporting actions towards combating illegal goldmining activities and protecting indigenous populations may help malaria control indicators for the following years.
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Affiliation(s)
| | - Seyi Soremekun
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - André M. Siqueira
- Evandro Chagas National Institute of Infectious Diseases, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
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Alves ACDJ, Feio dos Santos AC, Peres JMV, Nascimento JMDS, Barbosa DRL, Figueiredo JV, Viana GMR, Póvoa MM. Morphological atypia and molecular profile of Plasmodium vivax: Findings from an outbreak in the Brazilian Amazon. Parasite 2023; 30:38. [PMID: 37772844 PMCID: PMC10540677 DOI: 10.1051/parasite/2023039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023] Open
Abstract
This study aimed to perform morphological and molecular analyses of parasites isolated from the blood of malaria-infected individuals during an outbreak in the Microregion of Cametá, State of Pará, Brazilian Amazon. A total of 260 positive samples were identified by microscopy as Plasmodium vivax; however, in three samples, forms considered unusual for the species were found and defined as morphological atypia of P. vivax. Single P. vivax infection was confirmed by qPCR in all samples. Among 256 genotyped samples, the VK247 genotype alone was identified in 255 samples, and the VK210 genotype was found in only one. The study showed that this malaria outbreak was caused by the etiological agent P. vivax, and for the first time, morphological atypia was described in isolates circulating in Brazil. Likewise, for the first time, the VK247 genotype was detected predominantly in single infections in an area of the State of Pará, which may suggest a greater circulation of the genotype in the region.
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Affiliation(s)
- Amanda Caroline de Jesus Alves
- Graduate Program in Biology of Infectious and Parasitic Agents, Federal University of Pará Rua Augusto Corrêa, 01 Belém Pará Brazil
- Laboratory of Malaria Entomology, Parasitology Section, Evandro Chagas Institute Rodovia BR 316, Km 7 Ananindeua Pará Brazil
| | - Ana Cecília Feio dos Santos
- Graduate Program in Biology of Infectious and Parasitic Agents, Federal University of Pará Rua Augusto Corrêa, 01 Belém Pará Brazil
- Laboratory of Malaria Entomology, Parasitology Section, Evandro Chagas Institute Rodovia BR 316, Km 7 Ananindeua Pará Brazil
| | - José Mário Veloso Peres
- Laboratory of Basic Research in Malaria, Parasitology Section, Evandro Chagas Institute Rodovia BR 316, Km 7 Ananindeua Pará Brazil
| | - José Maria de Souza Nascimento
- Laboratory of Basic Research in Malaria, Parasitology Section, Evandro Chagas Institute Rodovia BR 316, Km 7 Ananindeua Pará Brazil
| | - Danielle Regina Lima Barbosa
- Laboratory of Malaria Entomology, Parasitology Section, Evandro Chagas Institute Rodovia BR 316, Km 7 Ananindeua Pará Brazil
| | - Juliana Vasconcelos Figueiredo
- Multiprofessional Residency Program in Animal Reproduction, Federal Rural University of the Amazon Avenida Presidente Tancredo Neves, 2501 Belém Pará Brazil
| | - Giselle Maria Rachid Viana
- Graduate Program in Biology of Infectious and Parasitic Agents, Federal University of Pará Rua Augusto Corrêa, 01 Belém Pará Brazil
- Laboratory of Basic Research in Malaria, Parasitology Section, Evandro Chagas Institute Rodovia BR 316, Km 7 Ananindeua Pará Brazil
| | - Marinete Marins Póvoa
- Graduate Program in Biology of Infectious and Parasitic Agents, Federal University of Pará Rua Augusto Corrêa, 01 Belém Pará Brazil
- Laboratory of Malaria Entomology, Parasitology Section, Evandro Chagas Institute Rodovia BR 316, Km 7 Ananindeua Pará Brazil
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Nekkab N, Obadia T, Monteiro WM, Lacerda MV, White M, Mueller I. Accelerating towards P. vivax elimination with a novel serological test-and-treat strategy: a modelling case study in Brazil. Lancet Reg Health Am 2023; 22:100511. [PMID: 37250687 PMCID: PMC10209700 DOI: 10.1016/j.lana.2023.100511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/05/2023] [Accepted: 05/04/2023] [Indexed: 05/31/2023]
Abstract
Background Plasmodium vivax malaria is challenging to control and eliminate. Treatment with radical cure drugs fails to target the hidden asymptomatic and hypnozoite reservoirs in populations. PvSeroTAT, a novel serological test-and-treat intervention using a serological diagnostic to screen hypnozoite carriers for radical cure eligibility and treatment, could accelerate P. vivax elimination. Methods Using a previously developed mathematical model of P. vivax transmission adapted to the Brazilian context as a case study for implementation, we evaluate the public health impact of various deployment strategies of PvSeroTAT as a mass campaign. We compare relative reductions in prevalence, cases averted, glucose-6-phosphate dehydrogenase (G6PD) tests, and treatment doses of PvSeroTAT campaigns to strengthened case management alone or mass drug administration (MDA) campaigns across different settings. Findings Deploying a single round of PvSeroTAT with 80% coverage to treat cases with a high efficacy radical cure regimen with primaquine is predicted to reduce point population prevalence by 22.5% [95% UI: 20.2%-24.8%] in a peri-urban setting with high transmission and by 25.2% [95% UI: 9.6%-42.2%] in an occupational setting with moderate transmission. In the latter example, while a single PvSeroTAT achieves 9.2% less impact on prevalence and averts 300 less cases per 100,000 than a single MDA (25.2% [95% UI: 9.6%-42.2%] point prevalence reduction versus 34.4% [95% UI: 24.9%-44%]), PvSeroTAT requires 4.6 times less radical cure treatments and G6PD tests. Layering strengthened case management and deploying four rounds of PvSeroTAT six months apart is predicted to reduce point prevalence by a mean of 74.1% [95% UI: 61.3%-86.3%] or more in low transmission settings with less than 10 cases per 1000 population. Interpretation Modelling predicts that mass campaigns with PvSeroTAT are predicted to reduce P. vivax parasite prevalence across a range of transmission settings and require fewer resources than MDA. In combination with strengthened case management, mass campaigns of serological test-and-treat interventions can accelerate towards P. vivax elimination. Funding This project was funded in part by the Bill and Melinda Gates Foundation and the National Health and Medical Research Council.
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Affiliation(s)
- Narimane Nekkab
- Institut Pasteur, Université Paris Cité, G5 Épidémiologie et Analyse des Maladies Infectieuses, Paris, France
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Thomas Obadia
- Institut Pasteur, Université Paris Cité, G5 Épidémiologie et Analyse des Maladies Infectieuses, Paris, France
- Institut Pasteur, Université Paris Cité, Bioinformatics and Biostatistics Hub, Paris, France
| | - Wuelton M. Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Marcus V.G. Lacerda
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
| | - Michael White
- Institut Pasteur, Université Paris Cité, G5 Épidémiologie et Analyse des Maladies Infectieuses, Paris, France
| | - Ivo Mueller
- Population Health & Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
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Monteiro W, Karl S, Kuehn A, Almeida A, White M, Vitor-Silva S, Melo G, Brito-Sousa JD, Baia-da-Silva DC, Silva-Neto AV, Sampaio V, Bassat Q, Felger I, Mueller I, Lacerda M. Prevalence and force of Plasmodium vivax blood-stage infection and associated clinical malaria burden in the Brazilian Amazon. Mem Inst Oswaldo Cruz 2022; 117:e210330. [PMID: 35766676 PMCID: PMC9239689 DOI: 10.1590/0074-02760210330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 05/16/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Understanding the epidemiology of malaria through the molecular force of the blood-stage infection of Plasmodium vivax (molFOB) may provide a detailed assessment of malaria transmission. OBJECTIVES In this study, we investigated risk factors and spatial-temporal patterns of incidence of Plasmodium infection and clinical malaria episodes in three peri-urban communities of Manaus, Western Brazilian Amazon. METHODS Monthly samples were collected in a cohort of 1,274 individuals between April 2013 and March 2014. DNA samples were subject to Plasmodium species. molFOB was calculated by counting the number of genotypes observed on each visit, which had not been present in the preceding two visits and adjusting these counts by the respective times-at-risk. FINDINGS Respectively, 77.8% and 97.2% of the population remained free of P. vivax and P. falciparum infection. Expected heterozygosity for P. vivax was 0.69 for MSP1_F3 and 0.86 for MS2. Multiplicity of infection in P. vivax was close to the value of 1. The season was associated with P. vivax positivity [adjusted hazard ratio (aHR) 2.6 (1.9-5.7)] and clinical disease [aHR 10.6 (2.4-47.2)]. P. falciparum infection was associated with previous malarial episodes [HR 9.7 (4.5-20.9)]. Subjects who reported possession of a bed net [incidence rate ratio (IRR) 1.6 (1.2-2.2)] or previous malaria episodes [IRR 3.0 (2.0-4.5)] were found to have significantly higher P. vivax molFOB. MAIN CONCLUSIONS Overall, P. vivax infection prevailed in the area and infections were mostly observed as monoclonal. Previous malaria episodes were associated with significantly higher P. vivax molFOB.
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Laporta GZ, Grillet ME, Rodovalho SR, Massad E, Sallum MAM. Reaching the malaria elimination goal in Brazil: a spatial analysis and time-series study. Infect Dis Poverty 2022; 11:39. [PMID: 35382896 PMCID: PMC8981179 DOI: 10.1186/s40249-022-00945-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Since 2015, the Global Technical Strategy (GTS) for Malaria 2016–2030 has been adopted by the World Health Organization (WHO) as a comprehensive framework to accelerate progress for malaria elimination in endemic countries. This strategy sets the target of reducing global malaria incidence and mortality rates by 90% in 2030. Here it is sought to evaluate Brazil’s achievements towards reaching the WHO GTS milestone in 2030. Considering the total number of new malaria cases in 2015, the main research question is: will Brazil reach the malaria elimination goal in 2030? Methods Analytical strategies were undertaken using the SIVEP-malaria official databases of the Brazilian Malaria Control Programme for the Brazilian Amazon region from 2009 to 2020. Spatial and time-series analyses were applied for identifying municipalities that support the highest numbers of malaria cases over the years. Forecast analysis was used for predicting the estimated number of new cases in Brazil in 2025–2050. Results Brazil has significantly reduced the number of new malaria cases in 2020 in comparison with 2015 in the states of Acre (− 56%), Amapá (− 75%), and Amazonas (− 21%); however, they increased in the states of Pará (156%), Rondônia (74%), and Roraima (362%). Forecast of the predicted number of new malaria cases in 2030 is 74,764 (95% CI: 41,116–141,160) in the Brazilian Amazon. Conclusions It is likely that Brazil will reduce the number of new malaria cases in the Brazilian Amazon in 2030 in relation to that in 2015. Herein forecast shows a reduction by 46% (74,754 in 2030 forecast/137,982 in 2015), but this reduction is yet far from the proposed reduction under the WHO GTS 2030 milestone (90%). Stable and unbeatable transmission in the Juruá River Valley, Manaus, and Lábrea still support endemic malaria in the Brazilian Amazon. Today’s cross-border malaria is impacting the state of Roraima unprecedently. If this situation is maintained, the malaria elimination goal (zero cases) may not be reached before 2050. An enhanced political commitment is vital to ensure optimal public health intervention designs in the post-2030 milestones for malaria elimination. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40249-022-00945-5.
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Affiliation(s)
- Gabriel Zorello Laporta
- Graduate Research and Innovation Program, Centro Universitario FMABC, Santo André, SP, Brazil.
| | - Maria Eugenia Grillet
- Laboratory of Parasite and Vector Biology, Institute of Zoology and Tropical Ecology, School of Sciences, Central University of Venezuela, Caracas, Venezuela
| | - Sheila Rodrigues Rodovalho
- Technical Unit of Transmissible Diseases and Current Health Assessment, Pan American Health Organization (PAHO/WHO), Brasília, DF, Brazil
| | - Eduardo Massad
- School of Applied Mathematics, Getulio Vargas Foundation, Rio de Janeiro, RJ, Brazil
| | - Maria Anice Mureb Sallum
- Epidemiology Department, School of Public Health, University of São Paulo, São Paulo, SP, Brazil.
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9
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Abdallah R, Louzada J, Carlson C, Ljolje D, Udhayakumar V, Oliveira-Ferreira J, Lucchi NW. Cross-border malaria in the triple border region between Brazil, Venezuela and Guyana. Sci Rep 2022; 12:1200. [PMID: 35075191 DOI: 10.1038/s41598-022-05205-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/09/2021] [Indexed: 11/08/2022] Open
Abstract
The state of Roraima, in Brazil, has recently seen an increase in the number of reported Plasmodium falciparum infections believed to be imported from neighboring countries. The objective of this study was to determine the prevalence of Plasmodium species among patients attending malaria health posts in Roraima and quantify the infections attributable to imported malaria. This cross-sectional case study was carried out between March 2016 and September 2018. Study participants were recruited as they exited the malaria health post. Information about residence, occupation and travel history was collected using a questionnaire. A dried blood spot was collected and used for malaria diagnosis by PCR. A total of 1222 patients were enrolled. Of the 80% Plasmodium positive samples, 50% were P. falciparum, 34% P. vivax, 8% mixed P. falciparum/P. vivax and 0.2% mixed P. falciparum/P. ovale infections and 8% tested positive for Plasmodium, but the species could not be identified. 80% of the malaria patients likely acquired infections in Venezuela and the remaining 20% acquired in Guyana, Brazil, Suriname and French Guyana. 50% of the study participants reported to be working in a mine. Results from this study support the hypothesis that imported malaria contribute to the bulk of malaria diagnosed in Roraima. These findings are in keeping with previous findings and should be considered when developing malaria control interventions.
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Zobrist S, Brito M, Garbin E, Monteiro WM, Clementino Freitas S, Macedo M, Soares Moura A, Advani N, Kahn M, Pal S, Gerth-Guyette E, Bansil P, Domingo GJ, Pereira D, Lacerda MVG. Evaluation of a point-of-care diagnostic to identify glucose-6-phosphate dehydrogenase deficiency in Brazil. PLoS Negl Trop Dis 2021; 15:e0009649. [PMID: 34383774 PMCID: PMC8384181 DOI: 10.1371/journal.pntd.0009649] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 08/24/2021] [Accepted: 07/12/2021] [Indexed: 01/21/2023] Open
Abstract
Background Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common enzyme deficiency, prevalent in many malaria-endemic countries. G6PD-deficient individuals are susceptible to hemolysis during oxidative stress, which can occur from exposure to certain medications, including 8-aminoquinolines used to treat Plasmodium vivax malaria. Accordingly, access to point-of-care (POC) G6PD testing in Brazil is critical for safe treatment of P. vivax malaria. Methodology/Principal findings This study evaluated the performance of the semi-quantitative, POC STANDARD G6PD Test (SD Biosensor, Republic of Korea). Participants were recruited at clinics and through an enriched sample in Manaus and Porto Velho, Brazil. G6PD and hemoglobin measurements were obtained from capillary samples at the POC using the STANDARD and HemoCue 201+ (HemoCue AB, Sweden) tests. A thick blood slide was prepared for malaria microscopy. At the laboratories, the STANDARD and HemoCue tests were repeated on venous samples and a quantitative spectrophotometric G6PD reference assay was performed (Pointe Scientific, Canton, MI). G6PD was also assessed by fluorescent spot test. In Manaus, a complete blood count was performed. Samples were analyzed from 1,736 participants. In comparison to spectrophotometry, the STANDARD G6PD Test performed equivalently in determining G6PD status in venous and capillary specimens under varied operating temperatures. Using the manufacturer-recommended reference value thresholds, the test’s sensitivity at the <30% threshold on both specimen types was 100% (95% confidence interval [CI] venous 93.6%–100.0%; capillary 93.8%–100.0%). Specificity was 98.6% on venous specimens (95% CI 97.9%–99.1%) and 97.8% on capillary (95% CI 97.0%–98.5%). At the 70% threshold, the test’s sensitivity was 96.9% on venous specimens (95% CI 83.8%–99.9%) and 94.3% on capillary (95% CI 80.8%–99.3%). Specificity was 96.5% (95% CI 95.0%–97.6%) and 92.3% (95% CI 90.3%–94.0%) on venous and capillary specimens, respectively. Conclusion/Significance The STANDARD G6PD Test is a promising tool to aid in POC detection of G6PD deficiency in Brazil. Trial registration This study was registered with ClinicalTrials.gov (identifier: NCT04033640). G6PD deficiency affects an estimated 500 million people worldwide and is prevalent in many malaria-endemic settings. People with G6PD deficiency are at risk of hemolysis when exposed to certain medications, including 8-aminoquinoline drugs used to treat Plasmodium vivax malaria. Increased access to testing for G6PD deficiency at or near the point of care is critical for expanding the safe treatment of P. vivax malaria. In this study, we aimed to evaluate the performance of a point-of-care, semi-quantitative test for G6PD deficiency, the STANDARD G6PD Test, in a malaria-endemic setting in Brazil. The test was evaluated on both capillary and venous blood samples across a broad range of operating temperatures. The findings show that the STANDARD G6PD Test performed equivalently to the reference test in its ability to diagnose G6PD deficiency at the point of care. The STANDARD G6PD Test is a promising tool to aid in detecting G6PD deficiency at the point of care in Brazil.
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Affiliation(s)
- Stephanie Zobrist
- Diagnostics, PATH, Seattle, Washington, United States of America
- * E-mail:
| | - Marcelo Brito
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado (FMT/HVD), Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Eduardo Garbin
- Centro de Pesquisa Em Medicina Tropical (CEPEM), Porto Velho, Rondônia, Brazil
| | - Wuelton M. Monteiro
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado (FMT/HVD), Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | | | - Marcela Macedo
- Centro de Pesquisa Em Medicina Tropical (CEPEM), Porto Velho, Rondônia, Brazil
| | - Aline Soares Moura
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado (FMT/HVD), Manaus, Amazonas, Brazil
| | - Nicole Advani
- Diagnostics, PATH, Seattle, Washington, United States of America
| | - Maria Kahn
- Diagnostics, PATH, Seattle, Washington, United States of America
| | - Sampa Pal
- Diagnostics, PATH, Seattle, Washington, United States of America
| | | | - Pooja Bansil
- Diagnostics, PATH, Seattle, Washington, United States of America
| | | | - Dhelio Pereira
- Centro de Pesquisa Em Medicina Tropical (CEPEM), Porto Velho, Rondônia, Brazil
- Universidade Federal de Rondônia (UNIR), Porto Velho, Rondônia, Brazil
| | - Marcus VG Lacerda
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado (FMT/HVD), Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Instituto Leônidas & Maria Deane (ILMD), Fiocruz, Manaus, Amazonas, Brazil
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11
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Antinori S, Bonazzetti C, Giacomelli A, Corbellino M, Galli M, Parravicini C, Ridolfo AL. Non-human primate and human malaria: past, present and future. J Travel Med 2021; 28:6162451. [PMID: 33693917 DOI: 10.1093/jtm/taab036] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Studies of the malaria parasites infecting various non-human primates (NHPs) have increased our understanding of the origin, biology and pathogenesis of human Plasmodium parasites.This review considers the major discoveries concerning NHP malaria parasites, highlights their relationships with human malaria and considers the impact that this may have on attempts to eradicate the disease. RESULTS The first description of NHP malaria parasites dates back to the early 20th century. Subsequently, experimental and fortuitous findings indicating that some NHP malaria parasites can be transmitted to humans have raised concerns about the possible impact of a zoonotic malaria reservoir on efforts to control human malaria.Advances in molecular techniques over the last 15 years have contributed greatly to our knowledge of the existence and geographical distribution of numerous Plasmodium species infecting NHPs, and extended our understanding of their close phylogenetic relationships with human malaria parasites. The clinical application of such techniques has also made it possible to document ongoing spillovers of NHP malaria parasites (Plasmodium knowlesi, P. cynomolgi, P. simium, P. brasilianum) in humans living in or near the forests of Asia and South America, thus confirming that zoonotic malaria can undermine efforts to eradicate human malaria. CONCLUSIONS Increasing molecular research supports the prophetic intuition of the pioneers of modern malariology who saw zoonotic malaria as a potential obstacle to the full success of malaria eradication programmes. It is, therefore, important to continue surveillance and research based on one-health approaches in order to improve our understanding of the complex interactions between NHPs, mosquito vectors and humans during a period of ongoing changes in the climate and the use of land, monitor the evolution of zoonotic malaria, identify the populations most at risk and implement appropriate preventive strategies.
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Affiliation(s)
- Spinello Antinori
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Italy.,III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Cecilia Bonazzetti
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Italy.,III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Andrea Giacomelli
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Italy.,III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Massimo Galli
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Italy.,III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Carlo Parravicini
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Italy
| | - Anna Lisa Ridolfo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
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12
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Balieiro AAS, Siqueira AM, Melo GC, Monteiro WM, Sampaio VS, Mueller I, Lacerda MVG, Villela DAM. Short-Time Recurrences of Plasmodium vivax Malaria as a Public Health Proxy for Chloroquine-Resistance Surveillance: A Spatio-Temporal Study in the Brazilian Amazon. Int J Environ Res Public Health 2021; 18:ijerph18105061. [PMID: 34064738 PMCID: PMC8150757 DOI: 10.3390/ijerph18105061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/25/2021] [Accepted: 04/30/2021] [Indexed: 12/17/2022]
Abstract
In Brazil, malaria caused by Plasmodium vivax presents control challenges due to several reasons, among them the increasing possibility of failure of P. vivax treatment due to chloroquine-resistance (CQR). Despite limited reports of CQR, more extensive studies on the actual magnitude of resistance are still needed. Short-time recurrences of malaria cases were analyzed in different transmission scenarios over three years (2005, 2010, and 2015), selected according to malaria incidence. Multilevel models (binomial) were used to evaluate association of short-time recurrences with variables such as age. The zero-inflated Poisson scan model (scanZIP) was used to detect spatial clusters of recurrences up to 28 days. Recurrences compose less than 5% of overall infection, being more frequent in the age group under four years. Recurrences slightly increased incidence. No fixed clusters were detected throughout the period, although there are clustering sites, spatially varying over the years. This is the most extensive analysis of short-time recurrences worldwide which addresses the occurrence of P. vivax CQR. As an important step forward in malaria elimination, policymakers should focus their efforts on young children, with an eventual shift in the first line of malaria treatment to P. vivax.
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Affiliation(s)
- Antonio A. S. Balieiro
- Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz (ILMD/Fiocruz), Amazonas 69057-070, Brazil; (A.A.S.B.); (M.V.G.L.)
- Programa de Pós-Graduação em Biologia Parasitaria—Instituto Oswaldo Cruz (IOC/Fiocruz), Rio de Janeiro 21040-900, Brazil
| | - Andre M. Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/Fiocruz), Rio de Janeiro 21040-360, Brazil;
| | - Gisely C. Melo
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Amazonas 69040-000, Brazil; (G.C.M.); (W.M.M.); (V.S.S.)
- Programa de Pós Graduação em Medicina Tropical—Universidade do Estado do Amazonas (UEA), Amazonas 69040-000, Brazil
| | - Wuelton M. Monteiro
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Amazonas 69040-000, Brazil; (G.C.M.); (W.M.M.); (V.S.S.)
- Programa de Pós Graduação em Medicina Tropical—Universidade do Estado do Amazonas (UEA), Amazonas 69040-000, Brazil
| | - Vanderson S. Sampaio
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Amazonas 69040-000, Brazil; (G.C.M.); (W.M.M.); (V.S.S.)
- Programa de Pós Graduação em Medicina Tropical—Universidade do Estado do Amazonas (UEA), Amazonas 69040-000, Brazil
- Fundação de Vigilância em Saúde (FVS), Amazonas 69093-018, Brazil
| | - Ivo Mueller
- Walter & Elisa Hall Institute, Melbourne 3052, Australia;
- Pasteur Institute, 75015 Paris, France
| | - Marcus V. G. Lacerda
- Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz (ILMD/Fiocruz), Amazonas 69057-070, Brazil; (A.A.S.B.); (M.V.G.L.)
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Amazonas 69040-000, Brazil; (G.C.M.); (W.M.M.); (V.S.S.)
- Programa de Pós Graduação em Medicina Tropical—Universidade do Estado do Amazonas (UEA), Amazonas 69040-000, Brazil
| | - Daniel A. M. Villela
- Programa de Pós-Graduação em Biologia Parasitaria—Instituto Oswaldo Cruz (IOC/Fiocruz), Rio de Janeiro 21040-900, Brazil
- Programa de Computação Científica, Fundação Oswaldo Cruz (PROCC/Fiocruz), Rio de Janeiro 21040-360, Brazil
- Correspondence:
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13
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Nekkab N, Lana R, Lacerda M, Obadia T, Siqueira A, Monteiro W, Villela D, Mueller I, White M. Estimated impact of tafenoquine for Plasmodium vivax control and elimination in Brazil: A modelling study. PLoS Med 2021; 18:e1003535. [PMID: 33891582 PMCID: PMC8064585 DOI: 10.1371/journal.pmed.1003535] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite recent intensification of control measures, Plasmodium vivax poses a major challenge for malaria elimination efforts. Liver-stage hypnozoite parasites that cause relapsing infections can be cleared with primaquine; however, poor treatment adherence undermines drug effectiveness. Tafenoquine, a new single-dose treatment, offers an alternative option for preventing relapses and reducing transmission. In 2018, over 237,000 cases of malaria were reported to the Brazilian health system, of which 91.5% were due to P. vivax. METHODS AND FINDINGS We evaluated the impact of introducing tafenoquine into case management practices on population-level transmission dynamics using a mathematical model of P. vivax transmission. The model was calibrated to reflect the transmission dynamics of P. vivax endemic settings in Brazil in 2018, informed by nationwide malaria case reporting data. Parameters for treatment pathways with chloroquine, primaquine, and tafenoquine with glucose-6-phosphate dehydrogenase deficiency (G6PDd) testing were informed by clinical trial data and the literature. We assumed 71.3% efficacy for primaquine and tafenoquine, a 66.7% adherence rate to the 7-day primaquine regimen, a mean 5.5% G6PDd prevalence, and 8.1% low metaboliser prevalence. The introduction of tafenoquine is predicted to improve effective hypnozoite clearance among P. vivax cases and reduce population-level transmission over time, with heterogeneous levels of impact across different transmission settings. According to the model, while achieving elimination in only few settings in Brazil, tafenoquine rollout in 2021 is estimated to improve the mean effective radical cure rate from 42% (95% uncertainty interval [UI] 41%-44%) to 62% (95% UI 54%-68%) among clinical cases, leading to a predicted 38% (95% UI 7%-99%) reduction in transmission and over 214,000 cumulative averted cases between 2021 and 2025. Higher impact is predicted in settings with low transmission, low pre-existing primaquine adherence, and a high proportion of cases in working-aged males. High-transmission settings with a high proportion of cases in children would benefit from a safe high-efficacy tafenoquine dose for children. Our methodological limitations include not accounting for the role of imported cases from outside the transmission setting, relying on reported clinical cases as a measurement of community-level transmission, and implementing treatment efficacy as a binary condition. CONCLUSIONS In our modelling study, we predicted that, provided there is concurrent rollout of G6PDd diagnostics, tafenoquine has the potential to reduce P. vivax transmission by improving effective radical cure through increased adherence and increased protection from new infections. While tafenoquine alone may not be sufficient for P. vivax elimination, its introduction will improve case management, prevent a substantial number of cases, and bring countries closer to achieving malaria elimination goals.
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Affiliation(s)
- Narimane Nekkab
- Malaria: Parasites and Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
| | - Raquel Lana
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Marcus Lacerda
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
| | - Thomas Obadia
- Malaria: Parasites and Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
| | - André Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Wuelton Monteiro
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Daniel Villela
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ivo Mueller
- Malaria: Parasites and Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
- Population Health & Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael White
- Malaria: Parasites and Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
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Lana R, Nekkab N, Siqueira AM, Peterka C, Marchesini P, Lacerda M, Mueller I, White M, Villela D. The top 1%: quantifying the unequal distribution of malaria in Brazil. Malar J 2021; 20:87. [PMID: 33579298 PMCID: PMC7880522 DOI: 10.1186/s12936-021-03614-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/29/2021] [Indexed: 12/22/2022] Open
Abstract
Background As malaria endemic countries strive towards elimination, intensified spatial heterogeneities of local transmission could undermine the effectiveness of traditional intervention policy. Methods The dynamic nature of large-scale and long-term malaria heterogeneity across Brazilian Amazon basin were explored by (1) exploratory analysis of Brazil’s rich clinical malaria reporting database from 2004 to 2018, and (2) adapting Gini coefficient to study the distribution of malaria cases in the region. Results As transmission declined, heterogeneity increased with cases clustering into smaller subpopulations across the territory. In 2004, the 1% of health units with the greatest number of cases accounted for 46% of all reported Plasmodium vivax cases, whereas in 2018 52% of P. vivax cases occurred in the top 1% of health units. Plasmodium falciparum had lower levels of transmission than P. vivax, and also had greater levels of heterogeneity with 75% of cases occurring in the top 1% of health units. Age and gender stratification of cases revealed peri-domestic and occupational exposure settings that remained relatively stable. Conclusion The pathway to decreasing incidence is characterized by higher proportions of cases in males, in adults, due to importation, and caused by P. vivax. Characterization of spatio-temporal heterogeneity and risk groups can aid stratification for improved malaria control towards elimination with increased heterogeneity potentially allowing for more efficient and cost-effective targeting. Although distinct epidemiological phenomena were clearly observed as malaria transmission declines, the authors argue that there is no canonical path to malaria elimination and a more targeted and dynamic surveillance will be needed if Brazil decides to adopt the elimination target.
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Affiliation(s)
- Raquel Lana
- Scientific Computing Programme, Fundação Oswaldo Cruz, Rio de Janeiro, 21040-360, Brazil
| | - Narimane Nekkab
- Malaria: Parasites and Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
| | - Andre M Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, 21040-360, Brazil
| | - Cassio Peterka
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Programa de Pós-Graduação Em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, AM, Brasil.,Programa Nacional de Controle da Malária, Ministério da Saúde, Brasília, DF, Brasil
| | - Paola Marchesini
- Department of Transmissible Diseases Surveillance, Ministry of Health, Brasília, Brazil
| | - Marcus Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.,Programa de Pós-Graduação Em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, AM, Brasil.,Instituto de Pesquisas Leônidas and Maria Deane, Fundação Oswaldo Cruz, Manaus, AM, Brasil
| | - Ivo Mueller
- Malaria: Parasites and Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France.,Division of Population Health and Immunity, Walter and Eliza Hall Institute, Melbourne, Australia
| | - Michael White
- Malaria: Parasites and Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France.
| | - Daniel Villela
- Scientific Computing Programme, Fundação Oswaldo Cruz, Rio de Janeiro, 21040-360, Brazil.
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Corrêa R, de Oliveira Santos I, Braz-de-Melo HA, de Sant’Ana LP, das Neves Almeida R, Pasquarelli-do-Nascimento G, Prado PS, Kobinger GP, Maurice CF, Magalhães KG. Gut microbiota modulation induced by Zika virus infection in immunocompetent mice. Sci Rep 2021; 11:1421. [PMID: 33446825 PMCID: PMC7809017 DOI: 10.1038/s41598-020-80893-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 12/29/2020] [Indexed: 01/29/2023] Open
Abstract
Gut microbiota composition can modulate neuroendocrine function, inflammation, and cellular and immunological responses against different pathogens, including viruses. Zika virus (ZIKV) can infect adult immunocompetent individuals and trigger brain damage and antiviral responses. However, it is not known whether ZIKV infection could impact the gut microbiome from adult immunocompetent mice. Here, we investigated modifications induced by ZIKV infection in the gut microbiome of immunocompetent C57BL/6J mice. Adult C57BL/6J mice were infected with ZIKV and the gut microbiota composition was analyzed by next-generation sequencing of the V4 hypervariable region present in the bacterial 16S rDNA gene. Our data showed that ZIKV infection triggered a significant decrease in the bacteria belonging to Actinobacteria and Firmicutes phyla, and increased Deferribacteres and Spirochaetes phyla components compared to uninfected mice. Interestingly, ZIKV infection triggered a significant increase in the abundance of bacteria from the Spirochaetaceae family in the gut microbiota. Lastly, we demonstrated that modulation of microbiota induced by ZIKV infection may lead to intestinal epithelium damage and intense leukocyte recruitment to the intestinal mucosa. Taken together, our data demonstrate that ZIKV infection can impact the gut microbiota composition and colon tissue homeostasis in adult immunocompetent mice.
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Affiliation(s)
- Rafael Corrêa
- grid.7632.00000 0001 2238 5157Laboratory of Immunology and Inflammation, Department of Cell Biology, University of Brasilia, Brasília, DF Brazil
| | - Igor de Oliveira Santos
- grid.7632.00000 0001 2238 5157Laboratory of Immunology and Inflammation, Department of Cell Biology, University of Brasilia, Brasília, DF Brazil
| | - Heloísa Antoniella Braz-de-Melo
- grid.7632.00000 0001 2238 5157Laboratory of Immunology and Inflammation, Department of Cell Biology, University of Brasilia, Brasília, DF Brazil
| | - Lívia Pimentel de Sant’Ana
- grid.7632.00000 0001 2238 5157Laboratory of Immunology and Inflammation, Department of Cell Biology, University of Brasilia, Brasília, DF Brazil
| | - Raquel das Neves Almeida
- grid.7632.00000 0001 2238 5157Laboratory of Immunology and Inflammation, Department of Cell Biology, University of Brasilia, Brasília, DF Brazil
| | - Gabriel Pasquarelli-do-Nascimento
- grid.7632.00000 0001 2238 5157Laboratory of Immunology and Inflammation, Department of Cell Biology, University of Brasilia, Brasília, DF Brazil
| | | | - Gary P. Kobinger
- grid.23856.3a0000 0004 1936 8390Département de Microbiologie-Infectiologie et d’Immunologie, Université Laval, Quebec, Canada ,grid.23856.3a0000 0004 1936 8390Centre de Recherche en Infectiologie du CHU de Québec-Université Laval, Quebec, Canada
| | - Corinne F. Maurice
- grid.14709.3b0000 0004 1936 8649Department of Microbiology and Immunology, McGill University, Montreal, Canada
| | - Kelly Grace Magalhães
- grid.7632.00000 0001 2238 5157Laboratory of Immunology and Inflammation, Department of Cell Biology, University of Brasilia, Brasília, DF Brazil
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Del-Tejo PL, Cubas-Vega N, Caraballo-Guerra C, da Silva BM, da Silva Valente J, Sampaio VS, Baia-da-Silva DC, Castro DB, Martinez-Espinosa FE, Siqueira AM, Lacerda MVG, Monteiro WM, Val F. Should we care about Plasmodium vivax and HIV co-infection? A systematic review and a cases series from the Brazilian Amazon. Malar J 2021; 20:13. [PMID: 33407474 PMCID: PMC7788992 DOI: 10.1186/s12936-020-03518-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria and HIV are two important public health issues. However, evidence on HIV-Plasmodium vivax co-infection (HIV/PvCo) is scarce, with most of the available information related to Plasmodium falciparum on the African continent. It is unclear whether HIV can change the clinical course of vivax malaria and increase the risk of complications. In this study, a systematic review of HIV/PvCo studies was performed, and recent cases from the Brazilian Amazon were included. METHODS Medical records from a tertiary care centre in the Western Brazilian Amazon (2009-2018) were reviewed to identify HIV/PvCo hospitalized patients. Demographic, clinical and laboratory characteristics and outcomes are reported. Also, a systematic review of published studies on HIV/PvCo was conducted. Metadata, number of HIV/PvCo cases, demographic, clinical, and outcome data were extracted. RESULTS A total of 1,048 vivax malaria patients were hospitalized in the 10-year period; 21 (2.0%) were HIV/PvCo cases, of which 9 (42.9%) had AIDS-defining illnesses. This was the first malaria episode in 11 (52.4%) patients. Seven (33.3%) patients were unaware of their HIV status and were diagnosed on hospitalization. Severe malaria was diagnosed in 5 (23.8%) patients. One patient died. The systematic review search provided 17 articles (12 cross-sectional or longitudinal studies and 5 case report studies). A higher prevalence of studies involved cases in African and Asian countries (35.3 and 29.4%, respectively), and the prevalence of reported co-infections ranged from 0.1 to 60%. CONCLUSION Reports of HIV/PvCo are scarce in the literature, with only a few studies describing clinical and laboratory outcomes. Systematic screening for both co-infections is not routinely performed, and therefore the real prevalence of HIV/PvCo is unknown. This study showed a low prevalence of HIV/PvCo despite the high prevalence of malaria and HIV locally. Even though relatively small, this is the largest case series to describe HIV/PvCo.
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Affiliation(s)
- Paola López Del-Tejo
- Programa de Pós-Graduação Em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Nadia Cubas-Vega
- Programa de Pós-Graduação Em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Cecilia Caraballo-Guerra
- Programa de Pós-Graduação Em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Bernardo Maia da Silva
- Programa de Pós-Graduação Em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Jefferson da Silva Valente
- Programa de Pós-Graduação Em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Vanderson Souza Sampaio
- Programa de Pós-Graduação Em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal Do Amazonas, Manaus, Brazil
| | - Djane Clarys Baia-da-Silva
- Programa de Pós-Graduação Em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | - Flor Ernestina Martinez-Espinosa
- Programa de Pós-Graduação Em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto Leônidas and Maria Deane, FIOCRUZ, Manaus, Brazil
| | | | - Marcus Vinícius Guimarães Lacerda
- Programa de Pós-Graduação Em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto Leônidas and Maria Deane, FIOCRUZ, Manaus, Brazil
| | - Wuelton Marcelo Monteiro
- Programa de Pós-Graduação Em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Fernando Val
- Programa de Pós-Graduação Em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal Do Amazonas, Manaus, Brazil.
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Meireles BM, de Souza Sampaio V, Monteiro WM, Gonçalves MJF. Factors associated with malaria in indigenous populations: A retrospective study from 2007 to 2016. PLoS One 2020; 15:e0240741. [PMID: 33085704 PMCID: PMC7577477 DOI: 10.1371/journal.pone.0240741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 10/01/2020] [Indexed: 12/04/2022] Open
Abstract
Background In Brazil malaria is most frequent in the Amazon region, mainly in the Amazonas state, where it is found the most proportion of indigenous people of the whole country. It is remarkable publications about malaria in the Amazon, although information on malaria in indigenous populations is still poorly explored. Objective Identify factors associated with malaria in indigenous populations. Methods Cross-sectional study of positive cases of malaria in the state of Amazonas, Brazil, from 2007 to 2016. Secondary data were obtained from the Epidemiological Surveillance Information System for Malaria and from the Mortality Information System, both from Brazil. To tackle with race missing data, cases with no race fulfilled were classified according to the probable location where infection occurred. This way, was imputed indigenous race for those which the probable infection location was indigenous village (aldeia). Variables tested with race were: sex, age, schooling, microscope surveillance slide type, parasitic infection species, parasitemia level, and timeliness of treatment. Multivariate logistic regression was used. Results A total of 1,055,852 cases of malaria were notified in the state of Amazonas. Among the factors that associate malaria and indigenous peoples, the most significant were sex, children and high levels of parasitemia. The magnitude of Plasmodium vivax infection is higher than Plasmodium falciparum, although this parasite was more frequent in indigenous than other races. In regards to mortality, 109 deaths were registered, most of them related to P. vivax. Conclusion The findings underscore the importance of look at indigenous people differently of other races. The associated factors highlight a profile of cases severity, because of highest parasitemia, many cases of P. falciparum although high frequency of P. vivax, and children. Furthermore, the mortality in indigenous, specially in older people is worrying
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Affiliation(s)
- Bruna Martins Meireles
- Escola de Enfermagem de Manaus, Universidade Federal do Amazonas, Manaus, Amazonas, Brazil
| | - Vanderson de Souza Sampaio
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Vigilância em Saúde do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Maria Jacirema Ferreira Gonçalves
- Escola de Enfermagem de Manaus, Universidade Federal do Amazonas, Manaus, Amazonas, Brazil
- Instituto Leônidas & Maria Deane/Fiocruz, Manaus, Brazil
- * E-mail:
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Bezerra JMT, Barbosa DS, Martins-Melo FR, Werneck GL, Braga ÉM, Tauil PL, Carneiro M. Changes in malaria patterns in Brazil over 28 years (1990-2017): results from the Global Burden of Disease Study 2017. Popul Health Metr 2020; 18:5. [PMID: 32993671 PMCID: PMC7526087 DOI: 10.1186/s12963-020-00211-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/22/2020] [Indexed: 12/27/2022] Open
Abstract
Background This study presents the malaria burden in Brazil from 1990 to 2017 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), by analyzing disease burden indicators in federated units of the Legal Amazon and Extra-Amazon regions, as well as describing malaria cases according to Plasmodium species occurring in the country. Methods We used estimates from the GBD 2017 to report years of life lost due to premature death (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) for malaria in Brazil, grouped by gender, age group, and Brazilian federated unit, from 1990 to 2017. Results are presented as absolute numbers and age-standardized rates (per 100,000 inhabitants) with 95% uncertainty intervals (UI). Results At the national level, the age-standardized DALYs rate due to malaria decreased by 92.0%, from 42.5 DALYs per 100,000 inhabitants (95% UI 16.6–56.9) in 1990 to 3.4 DALYs per 100,000 inhabitants (95% UI 2.7–4.7) in 2017. The YLLs were the main component of the total DALYs rate for malaria in 1990 (67.3%), and the YLDs were the main component of the metric in 2017 (61.8%). In 2017, the highest sex–age DALYs rate was found among females in the “< 1-year-old” age group, with a 6.4 DALYs per 100,000 inhabitants (95% UI 1.8–14.7) and among males in the age group of “20 to 24 years old”, with a 4.7 DALYs per 100,000 inhabitants (95% UI 3.3–9.9). Within the Brazilian Amazon region, the three federated units with the highest age-standardized DALYs rates in 2017 were Acre [28.4 (95% UI 14.2–39.1)], Roraima [28.3 (95% UI 13.5–40.2)], and Rondônia [24.7 (95% UI 11.4–34.8)]. Concerning the parasite species that caused malaria, 73.5% of the total of cases registered in the period had Plasmodium vivax as the etiological agent. Conclusions The results of the GBD 2017 show that despite the considerable reduction in the DALYs rates between 1990 and 2017, malaria remains a relevant and preventable disease, which in recent years has generated more years of life lost due to disability than deaths. The states endemic for malaria in the Amazon region require constant evaluation of preventive and control measures. The present study will contribute to the direction of current health policies aimed at reducing the burden of malaria in Brazil, as knowing the geographical and temporal distribution of the risk of death and disability of this disease can facilitate the planning, implementation, and improvement of control strategies aimed at eliminating the disease.
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Affiliation(s)
- Juliana Maria Trindade Bezerra
- Laboratory of Epidemiology of Infectious and Parasitic Diseases, Department of Parasitology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - David Soeiro Barbosa
- Laboratory of Epidemiology of Infectious and Parasitic Diseases, Department of Parasitology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Francisco Rogerlândio Martins-Melo
- Federal Institute of Education, Science, and Technology of Ceará, Rua Francisco da Rocha Martins, S/N, Pabussu, Caucaia, Ceará, 61609-090, Brazil.,Department of Epidemiology, Social Medicine Institute, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524, Maracanã, Rio de Janeiro, 20550-013, Brazil
| | - Guilherme Loureiro Werneck
- Institute for Public Health Studies, Universidade Federal do Rio de Janeiro, Avenida Horácio Macedo, S/N, Ilha do Fundão - Cidade Universitária, Rio de Janeiro, 21941-598, Brazil
| | - Érika Martins Braga
- Laboratory of Malaria, Department of Parasitology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Pedro Luiz Tauil
- School of Medicine, Postgraduate Program in Tropical Medicine, Universidade de Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, Distrito Federal, 70910-900, Brazil
| | - Mariângela Carneiro
- Laboratory of Epidemiology of Infectious and Parasitic Diseases, Department of Parasitology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil. .,Post-Graduation Program in Health Sciences, Infectology and Tropical Medicine, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil.
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Costa EMF, Amador ECC, Silva ES, Alvarenga CO, Pereira PE, Póvoa MM, Cunha MG. Malaria transmission and individual variability of the naturally acquired IgG antibody against the Plasmodium vivax blood-stage antigen in an endemic area in Brazil. Acta Trop 2020; 209:105537. [PMID: 32454033 DOI: 10.1016/j.actatropica.2020.105537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 11/20/2022]
Abstract
Plasmodium vivax remains an important cause of malaria in South America and Asia, and analyses of the antibody immune response are being used to identify biomarker of parasite exposure. The IgG antibody naturally acquired predominantly occurs against targets on blood-stage parasites, including C-terminal of the merozoite surface protein 1 (MSP1-19). Epidemiological and immunological evidence has been showed that antibodies to malaria parasite antigens are lost in the absence of ongoing exposure. We describe the IgG antibody response in individuals living in an unstable malaria transmission area in Pará state, Amazon region, Brazil, where an epidemic of P. vivax malaria was recorded and monitored over time. As indicated by epidemiological data, the number of P. vivax-caused malaria cases decreased by approximately 90% after three years and the prevalence of IgG positive to PvMSP1-19 decreased significantly over time, in 2010 (93.4%), 2012 (78.3%), and 2013 (85.1%). Acquisition and decay of the IgG antibody against P. vivax MSP1-19 showed variability among individuals living in areas with recent circulating parasites, where the malaria epidemic was being monitored until transmission had been completely controlled. We also found that previous malaria episodes were associated with an increased in the IgG positivity . Our results showed epidemiological, spatial, temporal and individual variability. The understanding on dynamics of antibodies may have implications for the design of serosurveillance tools for monitoring parasite circulation, especially in a context with spatial and temporal changes in P. vivax malaria transmission.
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Affiliation(s)
- Edna Maria F Costa
- Universidade Federal do Pará, Instituto de Ciências Biológicas, CEP: 66075-110, Belém, Pará, Brazil
| | | | - Eliane S Silva
- Fundação Centro de Hemoterapia e Hematologia do Pará, CEP: 660033-000, Belém, Pará, Brazil
| | - Cassiana O Alvarenga
- Universidade Federal do Pará, Instituto de Ciências Biológicas, CEP: 66075-110, Belém, Pará, Brazil
| | - Pedro Elias Pereira
- Fundação Centro de Hemoterapia e Hematologia do Pará, CEP: 660033-000, Belém, Pará, Brazil
| | - Marinete M Póvoa
- Instituto Evandro Chagas, CEP: 66087-082, Ananindeua, Pará, Brazil
| | - Maristela G Cunha
- Universidade Federal do Pará, Instituto de Ciências Biológicas, CEP: 66075-110, Belém, Pará, Brazil.
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Almeida ACG, Puça MCB, Figueiredo EFG, Barbosa LR, Salazar YEAR, Silva EL, Brito MAM, Siqueira AM, Vieira JLF, Lacerda MVG, Monteiro WM, Melo GC. Influence of CYP2C8, CYP3A4, and CYP3A5 Host Genotypes on Early Recurrence of Plasmodium vivax. Antimicrob Agents Chemother 2020; 64:e02125-19. [PMID: 32366712 DOI: 10.1128/AAC.02125-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 04/25/2020] [Indexed: 11/20/2022] Open
Abstract
Cytochrome P450 (CYP) enzymes are involved in the biotransformation of chloroquine (CQ), but the role of the different profiles of metabolism of this drug in relation to Plasmodium vivax recurrences has not been properly investigated. To investigate the influence of the CYP genotypes associated with CQ metabolism on the rates of P. vivax early recurrences, a case-control study was carried out. The cases included patients presenting with an early recurrence (CQ-recurrent individuals), defined as a recurrence during the first 28 days after initial infection and plasma concentrations of CQ plus desethylchloroquine (DCQ; the major CQ metabolite) higher than 100 ng/ml. A control group with no parasite recurrence over the follow-up (the CQ-responsive group) was also included. CQ and DCQ plasma levels were measured on day 28. CQ-metabolizing CYP (CYP2C8, CYP3A4, and CYP3A5) genotypes were determined by real-time PCR. An ex vivo study was conducted to verify the efficacy of CQ and DCQ against P. vivax isolates. The frequency of alleles associated with normal and slow metabolism was similar between the cases and the controls for the CYP2C8 (odds ratio [OR] = 1.45, 95% confidence interval [CI] = 0.51 to 4.14, P = 0.570), CYP3A4 (OR = 2.38, 95% CI = 0.92 to 6.19, P = 0.105), and CYP3A5 (OR = 4.17, 95% CI = 0.79 to 22.04, P = 1.038) genes. DCQ levels were higher than CQ levels, regardless of the genotype. Regarding the DCQ/CQ ratio, there was no difference between groups or between those patients who had a normal genotype and those patients who had a mutant genotype. DCQ and CQ showed similar efficacy ex vivo CYP genotypes had no influence on early recurrence rates. The similar efficacy of CQ and DCQ ex vivo could explain the absence of therapeutic failure, despite the presence of alleles associated with slow metabolism.
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Melo J, Padilha M, Barbosa R, Alonso W, Vittor A, Laporta G. Evaluation of the malaria elimination policy in Brazil: a systematic review and epidemiological analysis study. Trop Biomed 2020; 37:513-535. [PMID: 33235398 PMCID: PMC7682744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
After a centenary fight against malaria, Brazil has seen an opportunity for change with the proposal of the malaria elimination policy set by the Brazilian government, in line with malaria elimination policies in other Latin American countries. Brazilian malaria experts regard eliminating malaria by 2030 to be within reach. Herein we evaluated the likelihood that malaria elimination can be accomplished in Brazil through systematic review of the literature on malaria elimination in Brazil and epidemiological analysis. Fifty-two articles referring to malaria eradication/elimination in Brazil were analyzed to identify challenges and technological breakthroughs for controlling malaria. Monthly deaths (1979-2016) and monthly severe malaria cases (1998-2018) were analyzed according to age groups, geographic region and parasite species. As a result, we observed that the declining malaria burden was mostly attributable to a decline in Plasmodium falciparum-malaria. At the same time, the proportional increase of Plasmodium vivax-malaria in comparison with P. falciparum-malaria was notable. This niche replacement mechanism was discussed in the reviewed literature. In addition, the challenges to P. vivax-malaria elimination outnumbered the available technological breakthroughs. Although accumulated and basic information exists on mosquito vector biology, the lack of specific knowledge about mosquito vector taxonomy and ecology may hamper current attempts at stopping malaria in the country. An impressive reduction in malaria hospitalizations and mortality was seen in Brazil in the past 3 decades. Eliminating malaria deaths in children less than 5 years and P. falciparum severe cases may be achievable goals under the current malaria policy until 2030. However, eliminating P. vivax malaria transmission and morbidity seems unattainable with the available tools. Therefore, complete malaria elimination in Brazil in the near future is unlikely.
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Affiliation(s)
- J.O. Melo
- Setor de Pos-graduaçao, Pesquisa e Inovação, Centro Universitârio Saûde ABC, Fundação do ABC, Santo André, SP, Brazil
| | - M.A.O. Padilha
- Setor de Pos-graduaçao, Pesquisa e Inovação, Centro Universitârio Saûde ABC, Fundação do ABC, Santo André, SP, Brazil
| | - R.T.A. Barbosa
- Setor de Pos-graduaçao, Pesquisa e Inovação, Centro Universitârio Saûde ABC, Fundação do ABC, Santo André, SP, Brazil
| | | | - A.Y. Vittor
- Department of Medicine and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
- Division of Infectious Diseases and Global Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - G.Z. Laporta
- Setor de Pos-graduaçao, Pesquisa e Inovação, Centro Universitârio Saûde ABC, Fundação do ABC, Santo André, SP, Brazil
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Douine M, Lambert Y, Musset L, Hiwat H, Blume LR, Marchesini P, Moresco GG, Cox H, Sanchez JF, Villegas L, de Santi VP, Sanna A, Vreden S, Suarez-mutis M. Malaria in Gold Miners in the Guianas and the Amazon: Current Knowledge and Challenges. Curr Trop Med Rep 2020; 7:37-47. [DOI: 10.1007/s40475-020-00202-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Purpose of Review
Following Paraguay and Argentina, several countries from the Amazon region aim to eliminate malaria. To achieve this, all key affected and vulnerable populations by malaria, including people working on gold mining sites, must be considered. What is the situation of malaria in these particular settings and what are the challenges? This literature review aims to compile knowledge to answer these questions.
Recent Findings
The contexts in which gold miners operate are very heterogeneous: size and localization of mines, links with crime, administrative status of the mines and of the miners, mobility of the workers or national regulations. The number of malaria cases has been correlated with deforestation (Brazil, Colombia), gold production (Colombia), gold prices (Guyana), or location of the mining region (Peru, Colombia, Venezuela, Guyana). The burden of malaria in gold mines differs between territories: significant in Guyana, French Guiana, or Venezuela; lower in Brazil. Although Plasmodiumvivax causes 75% of malaria cases in the Americas, P. falciparum is predominant in several gold mining regions, especially in the Guiana Shield. Because of the remoteness from health facilities, self-medication with under-the-counter antimalarials is frequent. This constitutes a significant risk for the emergence of new P. falciparum parasites resistant to antimalarial drugs.
Summary
Because of the workers’ mobility, addressing malaria transmission in gold mines is essential, not only for miners, but also to prevent the (re-)emergence of malaria. Strategies among these populations should be tailored to the context because of the heterogeneity of situations in different territories. The transnational environment favoring malaria transmission also requires transborder and regional cooperation, where innovative solutions should be considered and evaluated.
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Robortella DR, Calvet AA, Amaral LC, Fantin RF, Guimarães LFF, França Dias MH, de Brito CFA, de Sousa TN, Herzog MM, Oliveira-Ferreira J, Carvalho LH. Prospective assessment of malaria infection in a semi-isolated Amazonian indigenous Yanomami community: Transmission heterogeneity and predominance of submicroscopic infection. PLoS One 2020; 15:e0230643. [PMID: 32191777 PMCID: PMC7081991 DOI: 10.1371/journal.pone.0230643] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/04/2020] [Indexed: 12/17/2022] Open
Abstract
In the Amazon basin, indigenous forest-dwelling communities typically suffer from a high burden of infectious diseases, including malaria. Difficulties in accessing these isolated ethnic groups, such as the semi-nomadic Yanomami, make official malaria data largely underestimated. In the current study, we longitudinally surveyed microscopic and submicroscopic malaria infection in four Yanomami villages of the Marari community in the northern-most region of the Brazilian Amazon. Malaria parasite species-specific PCR-based detection of ribosomal and non-ribosomal targets showed that approximately 75% to 80% of all malaria infections were submicroscopic, with the ratio of submicroscopic to microscopic infection remaining stable over the 4-month follow-up period. Although the prevalence of malaria infection fluctuated over time, microscopically-detectable parasitemia was only found in children and adolescents, presumably reflecting their higher susceptibility to malaria infection. As well as temporal variation, the prevalence of malaria infection differed significantly between villages (from 1% to 19%), demonstrating a marked heterogeneity at micro-scales. Over the study period, Plasmodium vivax was the most commonly detected malaria parasite species, followed by P. malariae, and much less frequently P. falciparum. Consecutive blood samples from 859 out of the 981 studied Yanomami showed that malaria parasites were detected in only 8% of the previously malaria-positive individuals, with most of them young children (median age 3 yrs). Overall, our results show that molecular tools are more sensitive for the identification of malaria infection among the Yanomami, which is characterized by heterogeneous transmission, a predominance of low-density infections, circulation of multiple malaria parasite species, and a higher susceptibility in young children. Our findings are important for the design and implementation of the new strategic interventions that will be required for the elimination of malaria from isolated indigenous populations in Latin America.
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Affiliation(s)
- Daniela Rocha Robortella
- Departamento de Parasitologia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Instituto René Rachou (FIOCRUZ-MINAS), Belo Horizonte, Brazil
| | | | | | | | | | | | | | | | - Mariza Maia Herzog
- Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (IOC/FIOCRUZ), Rio De Janeiro, Brazil
| | - Joseli Oliveira-Ferreira
- Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (IOC/FIOCRUZ), Rio De Janeiro, Brazil
- * E-mail: (LHC); (JOF)
| | - Luzia Helena Carvalho
- Departamento de Parasitologia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Instituto René Rachou (FIOCRUZ-MINAS), Belo Horizonte, Brazil
- * E-mail: (LHC); (JOF)
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Monteiro WM, Barbosa MDGV, Guerra JADO, de Melo GC, Barbosa LRA, Machado KVA, de Abreu RL, de Lacerda MVG. Driving forces for strengthening the surveillance of Chagas disease in the Brazilian Amazon by "training the eyes" of malaria microscopists. Rev Soc Bras Med Trop 2020; 53:e20190423. [PMID: 32187340 PMCID: PMC7094040 DOI: 10.1590/0037-8682-0423-2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/17/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Wuelton Marcelo Monteiro
- Gerência de malária da Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil
| | - Maria das Graças Vale Barbosa
- Gerência de malária da Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil
| | - Jorge Augusto de Oliveira Guerra
- Gerência de malária da Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil
| | - Gisely Cardoso de Melo
- Gerência de malária da Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil
| | - Layla Rowena Albuquerque Barbosa
- Gerência de malária da Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil
| | - Kim Vinicius Amaral Machado
- Gerência de malária da Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil
| | - Rebeca Linhares de Abreu
- Gerência de malária da Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil
| | - Marcus Vinicius Guimarães de Lacerda
- Gerência de malária da Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brasil
- Fundação Oswaldo Cruz, Instituto de Pesquisas Leônidas e Maria Deane, Manaus, AM, Brasil
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Murta FLG, Mendes MO, Sampaio VS, Junior ASB, Díaz-Bermúdez XP, Monteiro WM, Lacerda MVG. Misperceptions of patients and health workers regarding malaria elimination in the Brazilian Amazon: a qualitative study. Malar J 2019; 18:223. [PMID: 31272509 PMCID: PMC6611038 DOI: 10.1186/s12936-019-2854-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brazil has considerably reduced the number of cases of malaria in recent years and aims to eradicate the disease completely, however, vivax malaria continues to be a major challenge for the health system. In this context, the key to building a successful elimination programme may lie in the knowledge and the perceptions of the health agents, the patients affected by the disease and the personnel responsible for malaria diagnosis, treatment and control at the local level. METHODS A qualitative study was undertaken in Manaus, capital of the state of Amazonas, Western Brazilian Amazon, using a sample of 33 patients who were being treated for malaria and 22 health agents who were working in malaria diagnosis, treatment and control at the local level. A semi-structured interview with a further thematic analysis was performed. RESULTS There are still many myths regarding malaria transmission and treatment that may hinder the sensitization of the population of this region in relation to the use of current control tools and elimination strategies, such as mass drug administration (MDA). Most health professionals reported that the abandonment of treatment for malaria by the patient is related to poor social conditions, the high incidence of alcoholism and the low level of schooling of the affected population. One negative perception, observed in both groups with regard to the use of insecticide-treated nets, is that they may cause skin irritations and allergies. Most patients and health professionals have described malaria as an impossible disease to eliminate because it is intrinsically associated with forest landscapes, and according to them, elimination would only be possible if there were a vaccine against malaria. CONCLUSION In the Amazon, cultural perceptions about the etiology of this disease can influence the behaviour and practices that social groups adopt in relation to the different forms of living in a malaria-endemic context. Negative perceptions about malaria elimination can act as a barrier when trying to reach proper coverage for control strategies such as mosquito nets and MDA.
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Affiliation(s)
- Felipe Leão Gomes Murta
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil. .,Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil.
| | | | - Vanderson Souza Sampaio
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | | | - Ximena Pamela Díaz-Bermúdez
- Departamento de Saúde Coletiva da Faculdade de Ciências da Saúde., Universidade de Brasília (UnB), Brasília, DF, Brazil
| | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Marcus Vinícius Guimarães Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil.,Fundação Oswaldo Cruz, Instituto Leônidas e Maria Deane (FIOCRUZ-Amazonas), Manaus, Brazil
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Albuquerque HG, Peiter PC, Toledo LM, Sabroza PC, Pereira RDS, Caldas JP, Angelo JR, Dias CG, Suárez-Mutis MC. Imported malaria in Rio de Janeiro state between 2007 and 2015: an epidemiologic approach. Mem Inst Oswaldo Cruz 2019; 114:e190064. [PMID: 31215589 PMCID: PMC6565357 DOI: 10.1590/0074-02760190064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/28/2019] [Indexed: 11/30/2022] Open
Abstract
Imported malaria is a malaria infection diagnosed outside the area where it was acquired and is induced by human migration and mobility. This retrospective study was performed based on secondary data from 2007 to 2015. In total, 736 cases of imported malaria (79.7% of 923 cases) were recorded in Rio de Janeiro state. Of the imported cases, 55.3% came from abroad, while 44.7% came from other regions of Brazil. Most cases of imported malaria in Brazil (85.5%) originated in Amazônia Legal, and Burundi (Africa) accounted for 59% of the cases from abroad. Analyses of the determinants of imported malaria in Rio de Janeiro state must be continued to understand the relationship between the origin and destination of cases.
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Affiliation(s)
- Hermano Gomes Albuquerque
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Doenças Parasitárias, Rio de Janeiro, RJ, Brasil.,Fundação Oswaldo Cruz-Fiocruz, Escola Nacional de Saúde Pública Sérgio Arouca, Laboratório de Monitoramento Epidemiológico de Grandes Empreendimentos, Rio de Janeiro, RJ, Brasil
| | - Paulo Cesar Peiter
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Doenças Parasitárias, Rio de Janeiro, RJ, Brasil
| | - Luciano Medeiros Toledo
- Fundação Oswaldo Cruz-Fiocruz, Escola Nacional de Saúde Pública Sérgio Arouca, Laboratório de Monitoramento Epidemiológico de Grandes Empreendimentos, Rio de Janeiro, RJ, Brasil
| | - Paulo Chagastelles Sabroza
- Fundação Oswaldo Cruz-Fiocruz, Escola Nacional de Saúde Pública Sérgio Arouca, Laboratório de Monitoramento Epidemiológico de Grandes Empreendimentos, Rio de Janeiro, RJ, Brasil
| | - Rafael Dos Santos Pereira
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Doenças Parasitárias, Rio de Janeiro, RJ, Brasil
| | - Jefferson Pereira Caldas
- Fundação Oswaldo Cruz-Fiocruz, Escola Nacional de Saúde Pública Sérgio Arouca, Laboratório de Monitoramento Epidemiológico de Grandes Empreendimentos, Rio de Janeiro, RJ, Brasil
| | - Jussara Rafael Angelo
- Fundação Oswaldo Cruz-Fiocruz, Escola Nacional de Saúde Pública Sérgio Arouca, Laboratório de Monitoramento Epidemiológico de Grandes Empreendimentos, Rio de Janeiro, RJ, Brasil
| | | | - Martha Cecília Suárez-Mutis
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Doenças Parasitárias, Rio de Janeiro, RJ, Brasil
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Santana RAG, Oliveira MC, Cabral I, Junior RCAS, de Sousa DRT, Ferreira L, Lacerda MVG, Monteiro WM, Abrantes P, Guerra MDGVB, Silveira H. Anopheles aquasalis transcriptome reveals autophagic responses to Plasmodium vivax midgut invasion. Parasit Vectors 2019; 12:261. [PMID: 31126324 PMCID: PMC6534896 DOI: 10.1186/s13071-019-3506-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/14/2019] [Indexed: 01/23/2023] Open
Abstract
Background Elimination of malaria depends on mastering transmission and understanding the biological basis of Plasmodium infection in the vector. The first mosquito organ to interact with the parasite is the midgut and its transcriptomic characterization during infection can reveal effective antiplasmodial responses able to limit the survival of the parasite. The vector response to Plasmodium vivax is not fully characterized, and its specificities when compared with other malaria parasites can be of fundamental interest for specific control measures. Methods Experimental infections were performed using a membrane-feeding device. Three groups were used: P. vivax-blood-fed, blood-fed on inactivated gametocytes, and unfed mosquitoes. Twenty-four hours after feeding, the mosquitoes were dissected and the midgut collected for transcriptomic analysis using RNAseq. Nine cDNA libraries were generated and sequenced on an Illumina HiSeq2500. Readings were checked for quality control and analysed using the Trinity platform for de novo transcriptome assembly. Transcript quantification was performed and the transcriptome was functionally annotated. Differential expression gene analysis was carried out. The role of the identified mechanisms was further explored using functional approaches. Results Forty-nine genes were identified as being differentially expressed with P. vivax infection: 34 were upregulated and 15 were downregulated. Half of the P. vivax-related differentially expressed genes could be related to autophagy; therefore, the effect of the known inhibitor (wortmannin) and activator (spermidine) was tested on the infection outcome. Autophagic activation significantly reduced the intensity and prevalence of infection. This was associated with transcription alterations of the autophagy regulating genes Beclin, DRAM and Apg8. Conclusions Our data indicate that P. vivax invasion of An. aquasalis midgut epithelium triggers an autophagic response and its activation reduces infection. This suggests a novel mechanism that mosquitoes can use to fight Plasmodium infection. Electronic supplementary material The online version of this article (10.1186/s13071-019-3506-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rosa Amélia Gonçalves Santana
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Maurício Costa Oliveira
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Iria Cabral
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Rubens Celso Andrade Silva Junior
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Débora Raysa Teixeira de Sousa
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Lucas Ferreira
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Marcus Vinícius Guimarães Lacerda
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
| | - Wuelton Marcelo Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Patrícia Abrantes
- Instituto de Higiene e Medicina Tropical, Global Health and Tropical Medicine, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Maria das Graças Vale Barbosa Guerra
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Henrique Silveira
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil. .,Instituto de Higiene e Medicina Tropical, Global Health and Tropical Medicine, Universidade Nova de Lisboa, Lisboa, Portugal.
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Amaral LC, Robortella DR, Guimarães LFF, Limongi JE, Fontes CJF, Pereira DB, de Brito CFA, Kano FS, de Sousa TN, Carvalho LH. Ribosomal and non-ribosomal PCR targets for the detection of low-density and mixed malaria infections. Malar J 2019; 18:154. [PMID: 31039781 PMCID: PMC6492410 DOI: 10.1186/s12936-019-2781-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/13/2019] [Indexed: 01/01/2023] Open
Abstract
Background The unexpected high proportion of submicroscopic malaria infections in areas with low transmission intensity challenges the control and elimination of malaria in the Americas. The current PCR-based assays present limitations as most protocols still rely on amplification of few-copies target gene. Here, the hypothesis was that amplification of different plasmodial targets—ribosomal (18S rRNA) and non-ribosomal multi-copy sequences (Pvr47 for Plasmodium vivax and Pfr364 for Plasmodium falciparum)—could increase the chances of detecting submicroscopic malaria infection. Methods A non-ribosomal real-time PCR assay targeting Pvr47/Pfr364 (NR-qPCR) was established and compared with three additional PCR protocols, two of them based on 18S rRNA gene amplification (Nested-PCR and R-qPCR) and one based on Pvr47/Pfr364 targets (NR-cPCR). The limit of detection of each PCR protocol, at single and artificial mixed P. vivax/P. falciparum infections, was determined by end-point titration curves. Field samples from clinical (n = 110) and subclinical (n = 324) malaria infections were used to evaluate the impact of using multiple molecular targets to detect malaria infections. Results The results demonstrated that an association of ribosomal and non-ribosomal targets did not increase sensitivity to detect submicroscopic malaria infections. Despite of that, artificial mixed-malaria infections demonstrated that the NR-qPCR was the most sensitive protocol to detect low-levels of P. vivax/P. falciparum co-infections. Field studies confirmed that submicroscopic malaria represented a large proportion (up to 77%) of infections among asymptomatic Amazonian residents, with a high proportion of infections (~ 20%) identified only by the NR-qPCR. Conclusions This study presents a new species-specific non-ribosomal PCR assay with potential to identify low-density P. vivax and P. falciparum infections. As the majority of subclinical infections was caused by P. vivax, the commonest form of malaria in the Amazon area, future studies should investigate the potential of Pvr47/Pfr364 to detect mixed-malaria infections in the field. Electronic supplementary material The online version of this article (10.1186/s12936-019-2781-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lara Cotta Amaral
- Instituto René Rachou, Fundação Oswaldo Cruz, FIOCRUZ-MINAS, Belo Horizonte, MG, Brazil
| | - Daniela Rocha Robortella
- Instituto René Rachou, Fundação Oswaldo Cruz, FIOCRUZ-MINAS, Belo Horizonte, MG, Brazil.,Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | | | - Dhelio Batista Pereira
- Centro de Pesquisas em Medicina Tropical de Rondônia (CEPEM), Porto Velho, Rondônia, Brazil
| | | | - Flora Satiko Kano
- Instituto René Rachou, Fundação Oswaldo Cruz, FIOCRUZ-MINAS, Belo Horizonte, MG, Brazil
| | - Taís Nóbrega de Sousa
- Instituto René Rachou, Fundação Oswaldo Cruz, FIOCRUZ-MINAS, Belo Horizonte, MG, Brazil.
| | - Luzia Helena Carvalho
- Instituto René Rachou, Fundação Oswaldo Cruz, FIOCRUZ-MINAS, Belo Horizonte, MG, Brazil. .,Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Abstract
Malaria remains a serious public health problem in Brazil despite a significant drop in the number of cases in the past decade. We conduct a comprehensive analysis of malaria transmission in Brazil to highlight the epidemiologically most relevant components that could help tackle the disease. We consider factors impacting on the malaria burden and transmission dynamics including the geographical occurrence of both autochthonous and imported infections, the distribution and abundance of malaria vectors and records of natural mosquito infections with Plasmodium. Our analysis identifies three discrete malaria transmission systems related to the Amazon rainforest, Atlantic rainforest and Brazilian coast, respectively. The Amazonian system accounts for 99% of all malaria cases in the country. It is largely due to autochthonous P. vivax and P. falciparum transmission by mosquitoes of the Nyssorhynchus subgenus, primarily Anopheles darlingi. Whilst P. vivax transmission is widespread, P. falciparum transmission is restricted to hotspot areas mostly in the States of Amazonas and Acre. This system is the major source of P. vivax exportation to the extra-Amazonian regions that are also affected by importation of P. falciparum from Africa. The Atlantic system comprises autochthonous P. vivax transmission typically by the bromeliad-associated mosquitoes An. cruzii and An. bellator of the Kerteszia subgenus. An. cruzii also transmits simian malaria parasites to humans. The third, widespread but geographically fragmented, system is found along the Brazilian coast and comprises P. vivax transmission mainly by An. aquasalis. We conclude that these geographically and biologically distinct malaria transmission systems require specific strategies for effective disease control.
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Affiliation(s)
- Bianca C Carlos
- a School of Agricultural Sciences, Department of Bioprocesses and Biotechnology, Central Multiuser Laboratory , São Paulo State University (UNESP) , Botucatu , Brazil.,b Institute of Biotechnology , São Paulo State University (UNESP) , Botucatu , Brazil
| | - Luisa D P Rona
- c Department of Life Sciences , Imperial College London , London , UK.,d Department of Cell Biology, Embryology and Genetics , Federal University of Santa Catarina (UFSC) , Florianópolis , Brazil.,e National Council for Scientific and Technological Development (INCT-EM, CNPq) , National Institute of Science and Technology in Molecular Entomology , Rio de Janeiro , Brazil
| | | | - Jayme A Souza-Neto
- a School of Agricultural Sciences, Department of Bioprocesses and Biotechnology, Central Multiuser Laboratory , São Paulo State University (UNESP) , Botucatu , Brazil.,b Institute of Biotechnology , São Paulo State University (UNESP) , Botucatu , Brazil
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Daher A, Silva JCAL, Stevens A, Marchesini P, Fontes CJ, Ter Kuile FO, Lalloo DG. Evaluation of Plasmodium vivax malaria recurrence in Brazil. Malar J 2019; 18:18. [PMID: 30670020 PMCID: PMC6343355 DOI: 10.1186/s12936-019-2644-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/10/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Control of vivax malaria in endemic areas requires management of recurrence. The Brazilian National Malaria Surveillance System (SIVEP-Malária) records every case of malaria in Brazil, but is not designed to differentiate between primary and recurrent infections. The aim of this study was to explore whether the information provided by SIVEP-Malária could be used to identify Plasmodium vivax recurrences, its risk factors and evaluate the effectiveness of short course primaquine (7-9 days: total dose 3-4.2 mg/kg) in preventing relapses. METHODS In this observational retrospective cohort study, data matching of SIVEP-Malária records was undertaken using bloom filters to identify potential recurrences defined as microscopically-confirmed P. vivax episodes from the same individual occurring within a year. Generalized Estimation Equation (GEE) models were used to determine predictors of recurrence. Extended Cox-based conditional Prentice-Williams-Peterson models (PWP) models were used to evaluate time to recurrence. RESULTS Between June 1, 2014 and May 31, 2015, 26,295 episodes fulfilled the criteria of potential recurrence among 154,970 reported malaria episodes. Age ≤ 3 years, being male, literate, not-indigenous and having domestic working activities were identified as risk factors for recurrence. There was no difference in time to recurrence or recurrence frequency between patients treated with 14-day or 7-9 day primaquine regimens (HR = 1.02, 0.96-1.09) and RR = 0.97 (0.90-1.04), respectively. The use of chloroquine alone was associated with a 1.43 (1.29-1.58, p < 0.0001) increased risk of P. vivax recurrence compared to patients who used chloroquine combined with short-course primaquine, the Brazilian standard of care. This was RR = 2.06 (1.48-2.86, p < 0.0001), RR = 1.90 (1.60-2.25, p = 0.0001) and RR = 1.14 (1.00-1.29, p = 0.05) for recurrences occurring between 3-28, 29-60 and > 60 days, respectively. PWP models showed that the time to recurrence was longer in recipients of both primaquine and artemisinin-based combination therapy (ACT) compared to patients treated with chloroquine alone or with concomitant primaquine, HR = 2.2 (1.62-2.99, p < 0.0001), HR = 1.27 (0.97-1.66, p = 0.08), respectively. CONCLUSION Short course primaquine was as effective as 14-day regimens and associated with a halving of the risk and delay in time to recurrence of P. vivax infections in comparison to chloroquine alone. The study demonstrates the feasibility of using record linkage on routine surveillance data to identify potential P. vivax recurrences, associated risk factors and impact of treatment.
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Affiliation(s)
- André Daher
- Vice-presidency of Research and Biological Collections, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Júlio C A L Silva
- National Institute of Infectious Disease, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Antony Stevens
- Secretariat of Health Surveillance, Ministry of Health, Brasília, Brazil
| | - Paola Marchesini
- Department of Transmissible Diseases Surveillance, Ministry of Health, Brasília, Brazil
| | - C J Fontes
- Faculty of Medicine, Mato Grosso Federal University, Cuiabá, Brazil
| | - F O Ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - David G Lalloo
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Pires CV, Alves JRS, Lima BAS, Paula RB, Costa HL, Torres LM, Sousa TN, Soares IS, Sanchez BAM, Fontes CJF, Ntumngia FB, Adams JH, Kano FS, Carvalho LH. Blood-stage Plasmodium vivax antibody dynamics in a low transmission setting: A nine year follow-up study in the Amazon region. PLoS One 2018; 13:e0207244. [PMID: 30419071 PMCID: PMC6231651 DOI: 10.1371/journal.pone.0207244] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/26/2018] [Indexed: 11/23/2022] Open
Abstract
Plasmodium vivax remains a global health problem and its ability to cause relapses and subpatent infections challenge control and elimination strategies. Even in low malaria transmission settings, such as the Amazon basin, where progress in malaria control has caused a remarkable reduction in case incidence, a recent increase in P. vivax transmission demonstrates the continued vulnerability of P.vivax-exposed populations. As part of a search for complementary approaches to P.vivax surveillance in areas in which adults are the majority of the exposed-population, here we evaluated the potential of serological markers covering a wide range of immunogenicity to estimate malaria transmission trends. For this, antibodies against leading P. vivax blood-stage vaccine candidates were assessed during a 9 year follow-up study among adults exposed to unstable malaria transmission in the Amazon rainforest. Circulating antibody levels against immunogenic P. vivax proteins, such as the Apical Membrane Antigen-1, were a sensitive measure of recent P. vivax exposure, while antibodies against less immunogenic proteins were indicative of naturally-acquired immunity, including the novel engineered Duffy binding protein II immunogen (DEKnull-2). Our results suggest that the robustness of serology to estimate trends in P.vivax malaria transmission will depend on the immunological background of the study population, and that for adult populations exposed to unstable P.vivax malaria transmission, the local heterogeneity of antibody responses should be considered when considering use of serological surveillance.
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Affiliation(s)
- Camilla V. Pires
- Instituto René Rachou/FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Ruth B. Paula
- Instituto René Rachou/FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Helena L. Costa
- Instituto René Rachou/FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | | | - Taís N. Sousa
- Instituto René Rachou/FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Irene S. Soares
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Bruno A. M. Sanchez
- Instituto de Ciências da Saúde, Universidade Federal de Mato Grosso, Campus Sinop, Sinop, Mato Grosso, Brazil
| | - Cor J. F. Fontes
- Hospital Júlio Muller, Universidade Federal de Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Francis B. Ntumngia
- Center for Global Health and Infectious Diseases Research, Department of Global Health, College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - John H. Adams
- Center for Global Health and Infectious Diseases Research, Department of Global Health, College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Flora S. Kano
- Instituto René Rachou/FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
- * E-mail: (LHC); (FSK)
| | - Luzia H. Carvalho
- Instituto René Rachou/FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
- * E-mail: (LHC); (FSK)
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Garrido-Cardenas JA, González-Cerón L, Manzano-Agugliaro F, Mesa-Valle C. Plasmodium genomics: an approach for learning about and ending human malaria. Parasitol Res 2019; 118:1-27. [PMID: 30402656 DOI: 10.1007/s00436-018-6127-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/19/2018] [Indexed: 12/31/2022]
Abstract
Malaria causes high levels of morbidity and mortality in human beings worldwide. According to the World Health Organization (WHO), about half a million people die of this disease each year. Malaria is caused by six species of parasites belonging to the Plasmodium genus: P. falciparum, P. knowlesi, P. vivax, P. malariae, P. ovale curtisi, and P. ovale wallikeri. Currently, malaria is being kept under control with varying levels of elimination success in different countries. The development of new molecular tools as well as the use of next-generation sequencing (NGS) technologies and novel bioinformatic approaches has improved our knowledge of malarial epidemiology, diagnosis, treatment, vaccine development, and surveillance strategies. In this work, the genetics and genomics of human malarias have been analyzed. Since the first P. falciparum genome was sequenced in 2002, various population-level genetic and genomic surveys, together with transcriptomic and proteomic studies, have shown the importance of molecular approaches in supporting malaria elimination.
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Batista-Dos-Santos SA, Freitas DRC, Raiol M, Cabral GF, Feio AC, Póvoa MM, Cunha MG, Ribeiro-Dos-Santos Â. Strategy to improve malaria surveillance system preventing transfusion-transmitted malaria in blood banks using molecular diagnostic. Malar J 2018; 17:344. [PMID: 30285750 PMCID: PMC6167815 DOI: 10.1186/s12936-018-2486-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Malaria can be transmitted by blood transfusion through donations collected from asymptomatic or parasitic donors. The parasites are released into the bloodstream during its life cycle and will therefore be present in donated blood by infected individuals. All cases of transfusion-transmitted malaria (TTM) notified since 2005 in Brazil were fatal. A good screening tool for Plasmodium spp. detection in blood units must have a high detection threshold, and the prevention of TTM relies entirely on the exclusion of potentially infected donors. However, in Brazilian blood banks, the screening test relies on blood thick smears examination. Methods The molecular diagnostic based on mitochondrial DNA (mtDNA) using real time PCR (mt-qPCR) was improved to detect Plasmodium falciparum, Plasmodium vivax, and standardized for use in Plasmodium malariae. The analytic sensitivity of this mt-qPCR methodology was performed using a sample of P. vivax. Results The mt-qPCR was highly efficient, and the analytic sensitivity for P. vivax was determined (0.000006 parasites/µL). This method was tested to detect P. vivax and P. falciparum in individuals from two malaria-endemic areas in Brazil, Amazon region (Pará and Rondônia states), the samples were collected in 10 reference units of two blood banks (Pará/nine cities and Rondônia/Porto Velho), and parasites mtDNA were detected in 10 of 2224 potential blood donors (0.45%). In all 10 positive samples, only P. vivax was detected. Conclusion Molecular diagnostic using mt-qPCR was effective in revealing infected potential donors with good perspectives to be applied as screening routine of asymptomatic carriers for preventing transfusion-transmitted malaria in blood banks.
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Affiliation(s)
- Sérgio Antônio Batista-Dos-Santos
- Laboratório de Genética Humana e Médica, Universidade Federal do Pará, Belém, Pará, CEP: 66075-110, Brazil.,Fundação Centro de Hemoterapia e Hematologia do Pará, Belém, Pará, CEP: 660033-000, Brazil
| | | | - Milene Raiol
- Laboratório de Genética Humana e Médica, Universidade Federal do Pará, Belém, Pará, CEP: 66075-110, Brazil
| | - Gleyce F Cabral
- Laboratório de Genética Humana e Médica, Universidade Federal do Pará, Belém, Pará, CEP: 66075-110, Brazil
| | - Ana Cecília Feio
- Instituto Evandro Chagas, Ananindeua, Pará, CEP: 66087-082, Brazil
| | - Marinete M Póvoa
- Instituto Evandro Chagas, Ananindeua, Pará, CEP: 66087-082, Brazil
| | - Maristela G Cunha
- Laboratório de Microbiologia e Imunologia, Universidade Federal do Pará, Belém, Pará, CEP: 66075-110, Brazil.
| | - Ândrea Ribeiro-Dos-Santos
- Laboratório de Genética Humana e Médica, Universidade Federal do Pará, Belém, Pará, CEP: 66075-110, Brazil
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Pereira VA, Sánchez-Arcila JC, Vasconcelos MPA, Ferreira AR, de Souza Videira L, Teva A, Perce-da-Silva D, Marques MTQ, de Carvalho LH, Banic DM, Pôrto LCS, Oliveira-Ferreira J. Evaluating seroprevalence to circumsporozoite protein to estimate exposure to three species of Plasmodium in the Brazilian Amazon. Infect Dis Poverty 2018; 7:46. [PMID: 29754588 PMCID: PMC5950184 DOI: 10.1186/s40249-018-0428-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 04/19/2018] [Indexed: 11/20/2022] Open
Abstract
Background Brazil has seen a great decline in malaria and the country is moving towards elimination. However, for eventual elimination, the control program needs efficient tools in order to monitor malaria exposure and transmission. In this study, we aimed to evaluate whether seroprevalence to the circumsporozoite protein (CSP) is a good tool for monitoring the exposure to and/or evaluating the burden and distribution of Plasmodium species in the Brazilian Amazon. Methods Cross-sectional surveys were conducted in a rural area of Porto Velho, Rondônia state. Parasite infection was detected by microscopy and polymerase chain reaction. Antibodies to the sporozoite CSP repeats of Plasmodium vivax, P. falciparum, and P. malariae (PvCS, PfCS, and PmCS) were detected using the enzyme-linked immunosorbent assay technique. Human leukocyte antigen (HLA)-DRB1 and DQB1 genes were typed using Luminex® xMAP® technology. Results The prevalence of immunoglobulin G against P. vivax CSP peptide (62%) was higher than P. falciparum (49%) and P. malariae (46%) CSP peptide. Most of the studied individuals had antibodies to at least one of the three peptides (72%), 34% had antibodies to all three peptides and 28% were non-responders. Although the majority of the population was not infected at the time of the survey, 74.3% of parasite-negative individuals had antibodies to at least one of the CSPs. Importantly, among individuals carrying the haplotypes DRB1*04~DQB1*03, there was a significantly higher frequency of PfCS responders, and DRB1*16~DQB1*03 haplotype for PvCS and PfCS responders. In contrast, HLA-DRB1*01 and HLA-DQB1*05 allelic groups were associated with a lack of antibodies to P. vivax and P. falciparum CSP repeats, and the haplotype DRB1*01~DQB1*05 was also associated with non-responders, including non-responders to P. malariae. Conclusions Our results show that in low transmission settings, naturally acquired antibody responses against the CSP repeats of P. vivax, P. falciparum, and P. malariae in a single cross-sectional study may not represent a valuable marker for monitoring recent malaria exposure, especially in an area with a high prevalence of P. vivax. Furthermore, HLA class II molecules play an important role in antibody response and require further study with a larger sample size. It will be of interest to consider HLA analysis when using serosurveillance to monitor malaria exposure among genetically diverse populations. Electronic supplementary material The online version of this article (10.1186/s40249-018-0428-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Virginia Araujo Pereira
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute/Fiocruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, Brazil
| | - Juan Camilo Sánchez-Arcila
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute/Fiocruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, Brazil
| | | | - Amanda Ribeiro Ferreira
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute/Fiocruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, Brazil
| | - Lorene de Souza Videira
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute/Fiocruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, Brazil
| | - Antonio Teva
- Laboratory of Immunodiagnosis, Departament of Biological Sciences, National School of Public Health/Fiocruz, Rio de Janeiro, Brazil
| | - Daiana Perce-da-Silva
- Laboratory of Clinical Immunology, Oswaldo Cruz Institute/Fiocruz, Rio de Janeiro, Brazil
| | | | - Luzia Helena de Carvalho
- Molecular Biology and Malaria Immunology Research Group, Centro de Pesquisas René Rachou/Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | - Dalma Maria Banic
- Laboratory of Clinical Immunology, Oswaldo Cruz Institute/Fiocruz, Rio de Janeiro, Brazil
| | | | - Joseli Oliveira-Ferreira
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute/Fiocruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, Brazil.
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Siqueira AM, Bassat Q, Rodovalho S, Lacerda MVG. Raising the red flag for malaria elimination and integrated fever surveillance in the Brazilian amazon. Lancet Glob Health 2018; 5:e257-e258. [PMID: 28193387 DOI: 10.1016/s2214-109x(17)30042-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/22/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Andre M Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro 21040-360, Brazil; Programa de Pós-Graduação em Medicina Tropical UEA/FMT-HVD, Manaus, Brazil.
| | - Quique Bassat
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ICREA, Pg. Lluís Companys 23, Barcelona, Spain
| | - Sheila Rodovalho
- Coordenação Geral do Programa de Malária, Ministério da Saúde, Brasilia, Brazil
| | - Marcus V G Lacerda
- Programa de Pós-Graduação em Medicina Tropical UEA/FMT-HVD, Manaus, Brazil; Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil; Instituto Leônidas e Maria Deane, Fiocruz, Manaus, Brazil
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Almeida ACG, Kuehn A, Castro AJM, Vitor-Silva S, Figueiredo EFG, Brasil LW, Brito MAM, Sampaio VS, Bassat Q, Felger I, Tadei WP, Monteiro WM, Mueller I, Lacerda MVG. High proportions of asymptomatic and submicroscopic Plasmodium vivax infections in a peri-urban area of low transmission in the Brazilian Amazon. Parasit Vectors 2018; 11:194. [PMID: 29558985 PMCID: PMC5859403 DOI: 10.1186/s13071-018-2787-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/07/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Population-based studies conducted in Latin America have shown a high proportion of asymptomatic and submicroscopic malarial infections. Considering efforts aiming at regional elimination, it is important to investigate the role of this asymptomatic reservoir in malaria transmission in peri-urban areas. This study aimed to estimate the prevalence of Plasmodium spp. and gametocyte burden on symptomatic and asymptomatic infections in the Brazilian Amazon. RESULTS Two cross-sectional household surveys (CS) were conducted including all inhabitants in a peri-urban area of Manaus, western Amazonas State, Brazil. Malaria parasites were detected by light microscopy (LM) and qPCR. Sexual stages of Plasmodium spp. were detected by LM and RT-qPCR. A total of 4083 participants were enrolled during the two surveys. In CS1, the prevalence of Plasmodium vivax infections was 4.3% (86/2010) by qPCR and 1.6% (32/2010) by LM. Fifty percent (43/86) of P. vivax infected individuals (qPCR) carried P. vivax gametocytes. In CS2, 3.4% (70/2073) of participants had qPCR-detectable P. vivax infections, of which 42.9% (30/70) of infections were gametocyte positive. The P. vivax parasite density was associated with gametocyte carriage (P < 0.001). Sixty-seven percent of P. vivax infected individuals and 53.4% of P. vivax gametocyte carriers were asymptomatic. CONCLUSIONS This study confirms a substantial proportion of asymptomatic and submicroscopic P. vivax infections in the study area. Most asymptomatic individuals carried gametocytes and presented low asexual parasitemia. This reservoir actively contributes to malaria transmission in the Brazilian Amazon, underscoring a need to implement more efficient control and elimination strategies.
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Affiliation(s)
- Anne C G Almeida
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Av. Pedro Teixeira, N.25, Dom Pedro, Manaus, Amazonas, CEP: 69040-000, Brazil. .,Universidade do Estado do Amazonas (UEA), Av. Djalma Batista, N. 3578, Flores, Manaus, Amazonas, CEP: 69005-010, Brazil.
| | - Andrea Kuehn
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Carrer del Rosselló, 132, 08036, Barcelona, Spain
| | - Arthur J M Castro
- Universidade do Estado do Amazonas (UEA), Av. Djalma Batista, N. 3578, Flores, Manaus, Amazonas, CEP: 69005-010, Brazil.,Instituto Nacional de Pesquisas da Amazônia (INPA), Av. André Araújo, N. 2.936, Petrópolis, Manaus, CEP: 69067-375, Brazil
| | - Sheila Vitor-Silva
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Av. Pedro Teixeira, N.25, Dom Pedro, Manaus, Amazonas, CEP: 69040-000, Brazil
| | - Erick F G Figueiredo
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Av. Pedro Teixeira, N.25, Dom Pedro, Manaus, Amazonas, CEP: 69040-000, Brazil
| | - Larissa W Brasil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Av. Pedro Teixeira, N.25, Dom Pedro, Manaus, Amazonas, CEP: 69040-000, Brazil
| | - Marcelo A M Brito
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Av. Pedro Teixeira, N.25, Dom Pedro, Manaus, Amazonas, CEP: 69040-000, Brazil.,Universidade do Estado do Amazonas (UEA), Av. Djalma Batista, N. 3578, Flores, Manaus, Amazonas, CEP: 69005-010, Brazil
| | - Vanderson S Sampaio
- Fundação de Vigilância em Saúde do Amazonas, Sala de Análise de Situação em Saúde, Av. Torquato Tapajós, N. 6132, Colônia Santo Antonio, Manaus, CEP:69093-018, Brazil
| | - Quique Bassat
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Carrer del Rosselló, 132, 08036, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Cambeve, Vila de Manhiça, CP 1929, Maputo, Mozambique.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Passeig Lluís Companys, 23 08010, Barcelona, Spain
| | - Ingrid Felger
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland.,University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Wanderli P Tadei
- Instituto Nacional de Pesquisas da Amazônia (INPA), Av. André Araújo, N. 2.936, Petrópolis, Manaus, CEP: 69067-375, Brazil
| | - Wuelton M Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Av. Pedro Teixeira, N.25, Dom Pedro, Manaus, Amazonas, CEP: 69040-000, Brazil. .,Universidade do Estado do Amazonas (UEA), Av. Djalma Batista, N. 3578, Flores, Manaus, Amazonas, CEP: 69005-010, Brazil.
| | - Ivo Mueller
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Carrer del Rosselló, 132, 08036, Barcelona, Spain.,Walter and Eliza Hall Institute, Parkville, Australia
| | - Marcus V G Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Av. Pedro Teixeira, N.25, Dom Pedro, Manaus, Amazonas, CEP: 69040-000, Brazil.,Universidade do Estado do Amazonas (UEA), Av. Djalma Batista, N. 3578, Flores, Manaus, Amazonas, CEP: 69005-010, Brazil.,Instituto de Pesquisas Leônidas e Maria Deane (ILMD), Manaus, Brazil
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Daher A, Pereira D, Lacerda MVG, Alexandre MAA, Nascimento CT, Alves de Lima E Silva JC, Tada M, Ruffato R, Maia I, Dos Santos TC, Marchesini P, Santelli AC, Lalloo DG. Efficacy and safety of artemisinin-based combination therapy and chloroquine with concomitant primaquine to treat Plasmodium vivax malaria in Brazil: an open label randomized clinical trial. Malar J 2018; 17:45. [PMID: 29361939 PMCID: PMC5782374 DOI: 10.1186/s12936-018-2192-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/16/2018] [Indexed: 02/06/2023] Open
Abstract
Background There is general international agreement that the importance of vivax malaria has been neglected, and there is a need for new treatment approaches in an effort to progress towards control and elimination in Latin America. This open label randomized clinical trial evaluated the efficacy and safety of three treatment regimens using either one of two fixed dose artemisinin-based combinations or chloroquine in combination with a short course of primaquine (7–9 days: total dose 3–4.2 mg/kg) in Brazil. The primary objective was establishing whether cure rates above 90% could be achieved in each arm. Results A total of 264 patients were followed up to day 63. The cure rate of all three treatment arms was greater than 90% at 28 and 42 days. Cure rates were below 90% in all three treatment groups at day 63, although the 95% confidence interval included 90% for all three treatments. Most of the adverse events were mild in all treatment arms. Only one of the three serious adverse events was related to the treatment and significant drops in haemoglobin were rare. Conclusion This study demonstrated the efficacy and safety of all three regimens that were tested with 42-day cure rates that meet World Health Organization criteria. The efficacy and safety of artemisinin-based combination therapy regimens in this population offers the opportunity to treat all species of malaria with the same regimen, simplifying protocols for malaria control programmes and potentially contributing to elimination of both vivax and falciparum malaria. Trial registration RBR-79s56s Electronic supplementary material The online version of this article (10.1186/s12936-018-2192-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- André Daher
- Institute of Drug Technology (Farmanguinhos), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil. .,Vice-presidency of Research and Reference Laboratories, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil. .,Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Dhelio Pereira
- Tropical Medicine Research Center of Rondonia (CEPEM), Porto Velho, Brazil.,Federal University of Rondonia (UNIR), Porto Velho, Brazil
| | - Marcus V G Lacerda
- Research Institute Leônidas & Maria Deane, FIOCRUZ, Manaus, Brazil.,Tropical Medicine Foundation Dr Heitor Vieira Dourado, Manaus, Brazil
| | | | | | | | - Mauro Tada
- Tropical Medicine Research Center of Rondonia (CEPEM), Porto Velho, Brazil
| | - Rosilene Ruffato
- Tropical Medicine Research Center of Rondonia (CEPEM), Porto Velho, Brazil
| | - Ivan Maia
- Vice-presidency of Research and Reference Laboratories, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | | | - Paola Marchesini
- National Malaria Control Programme, Ministry of Health, Brasília, Brazil
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Brasil P, Zalis MG, de Pina-Costa A, Siqueira AM, Júnior CB, Silva S, Areas ALL, Pelajo-Machado M, de Alvarenga DAM, da Silva Santelli ACF, Albuquerque HG, Cravo P, Santos de Abreu FV, Peterka CL, Zanini GM, Suárez Mutis MC, Pissinatti A, Lourenço-de-Oliveira R, de Brito CFA, de Fátima Ferreira-da-Cruz M, Culleton R, Daniel-Ribeiro CT. Outbreak of human malaria caused by Plasmodium simium in the Atlantic Forest in Rio de Janeiro: a molecular epidemiological investigation. Lancet Glob Health 2017; 5:e1038-46. [PMID: 28867401 DOI: 10.1016/S2214-109X(17)30333-9] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/17/2017] [Accepted: 08/08/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Malaria was eliminated from southern and southeastern Brazil over 50 years ago. However, an increasing number of autochthonous episodes attributed to Plasmodium vivax have recently been reported from the Atlantic Forest region of Rio de Janeiro state. As the P vivax-like non-human primate malaria parasite species Plasmodium simium is locally enzootic, we performed a molecular epidemiological investigation to determine whether zoonotic malaria transmission is occurring. METHODS We examined blood samples from patients presenting with signs or symptoms suggestive of malaria as well as from local howler monkeys by microscopy and PCR. Samples were included from individuals if they had a history of travel to or resided in areas within the Rio de Janeiro Atlantic Forest, but not if they had malaria prophylaxis, blood transfusion or tissue or organ transplantation, or had travelled to known malaria endemic areas in the preceding year. Additionally, we developed a molecular assay based on sequencing of the parasite mitochondrial genome to distinguish between P vivax and P simium, and applied this assay to 33 cases from outbreaks that occurred in 2015, and 2016. FINDINGS A total of 49 autochthonous malaria cases were reported in 2015-16. Most patients were male, with a mean age of 44 years (SD 14·6), and 82% lived in urban areas of Rio de Janeiro state and had visited the Atlantic Forest for leisure or work-related activities. 33 cases were used for mitochondrial DNA sequencing. The assay was successfully performed for 28 samples, and all were shown to be P simium, indicative of zoonotic transmission of this species to human beings in this region. Sequencing of the whole mitochondrial genome of three of these cases showed that P simium is most closely related to P vivax parasites from South America. The malaria outbreaks in this region were caused by P simium, previously considered to be a monkey-specific malaria parasite, related to but distinct from P vivax, and which has never conclusively been shown to infect people before. INTERPRETATION This unequivocal demonstration of zoonotic transmission, 50 years after the only previous report of P simium in people, leads to the possibility that this parasite has always infected people in this region, but that it has been consistently misdiagnosed as P vivax because of an absence of molecular typing techniques. Thorough screening of local non-human primates and mosquitoes (Anopheline) is required to evaluate the extent of this newly recognised zoonotic threat to public health and malaria elimination in Brazil. FUNDING Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado de Rio de Janeiro, The Brazilian National Council for Scientific and Technological Development (CNPq), JSPS Grant-in-Aid for scientific research, Secretary for Health Surveillance of the Brazilian Ministry of Health, Global Fund, Fundaçao de amparo à pesquisa do estado de Minas Gerais (Fapemig), and PRONEX Program of the CNPq.
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Costa AG, Ramasawmy R, Ibiapina HNS, Sampaio VS, Xábregas LA, Brasil LW, Tarragô AM, Almeida ACG, Kuehn A, Vitor-Silva S, Melo GC, Siqueira AM, Monteiro WM, Lacerda MVG, Malheiro A. Association of TLR variants with susceptibility to Plasmodium vivax malaria and parasitemia in the Amazon region of Brazil. PLoS One 2017; 12:e0183840. [PMID: 28850598 PMCID: PMC5574562 DOI: 10.1371/journal.pone.0183840] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/11/2017] [Indexed: 01/29/2023] Open
Abstract
Background Plasmodium vivax malaria (Pv-malaria) is still considered a neglected disease despite an alarming number of individuals being infected annually. Malaria pathogenesis occurs with the onset of the vector-parasite-host interaction through the binding of pathogen-associated molecular patterns (PAMPs) and receptors of innate immunity, such as toll-like receptors (TLRs). The triggering of the signaling cascade produces an elevated inflammatory response. Genetic polymorphisms in TLRs are involved in susceptibility or resistance to infection, and the identification of genes involved with Pv-malaria response is important to elucidate the pathogenesis of the disease and may contribute to the formulation of control and elimination tools. Methodology/Principal findings A retrospective case-control study was conducted in an intense transmission area of Pv-malaria in the state of Amazonas, Brazil. Genetic polymorphisms (SNPs) in different TLRs, TIRAP, and CD14 were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis in 325 patients infected with P. vivax and 274 healthy individuals without malaria history in the prior 12 months from the same endemic area. Parasite load was determined by qPCR. Simple and multiple logistic/linear regressions were performed to investigate association between the polymorphisms and the occurrence of Pv-malaria and parasitemia. The C/T (TLR5 R392StopCodon) and T/T (TLR9 -1486C/T) genotypes appear to be risk factors for infection by P. vivax (TLR5: C/C vs. C/T [OR: 2.116, 95% CI: 1.054–4.452, p = 0.031]; TLR9: C/C vs. T/T [OR: 1.919, 95% CI: 1.159–3.177, p = 0.010]; respectively). Fever (COEF = 7599.46, 95% CI = 3063.80–12135.12, p = 0.001) and the C/C genotype of TLR9 -1237C/T (COEF = 17006.63, 95% CI = 3472.83–30540.44, p = 0.014) were independently associated with increased parasitemia in patients with Pv-malaria. Conclusions Variants of TLRs may predispose individuals to infection by P. vivax. The TLR5 R392StopCodon and TLR9 -1486C/T variants are associated with susceptibility to Pv-malaria. Furthermore, the TLR9 variant -1237C/C correlates with high parasitemia.
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Affiliation(s)
- Allyson Guimarães Costa
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, AM, Brazil
- Laboratório de Genômica, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- * E-mail: (AGC)
| | - Rajendranath Ramasawmy
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
- Universidade Nilton Lins (UNINILTONLINS), Manaus, AM, Brasil
| | - Hiochelson Najibe Santos Ibiapina
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, AM, Brazil
| | - Vanderson Souza Sampaio
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, AM, Brazil
| | - Lilyane Amorim Xábregas
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, AM, Brazil
| | - Larissa Wanderley Brasil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, AM, Brazil
| | - Andréa Monteiro Tarragô
- Laboratório de Genômica, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
| | - Anne Cristine Gomes Almeida
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, AM, Brazil
| | - Andrea Kuehn
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, AM, Brazil
- Barcelona Centre for International Health Research (CRESIB), Barcelona Global Health Institute (ISGLOBAL), Barcelona, Spain
| | - Sheila Vitor-Silva
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, AM, Brazil
| | - Gisely Cardoso Melo
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, AM, Brazil
| | - André Machado Siqueira
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Wuelton Marcelo Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, AM, Brazil
| | - Marcus Vinicius Guimarães Lacerda
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, AM, Brazil
- Instituto de Pesquisas Leônidas & Maria Deane, FIOCRUZ-Amazônia, Manaus, AM, Brazil
| | - Adriana Malheiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Laboratório de Genômica, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
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Uppal K, Salinas JL, Monteiro WM, Val F, Cordy RJ, Liu K, Melo GC, Siqueira AM, Magalhaes B, Galinski MR, Lacerda MVG, Jones DP. Plasma metabolomics reveals membrane lipids, aspartate/asparagine and nucleotide metabolism pathway differences associated with chloroquine resistance in Plasmodium vivax malaria. PLoS One 2017; 12:e0182819. [PMID: 28813452 PMCID: PMC5559093 DOI: 10.1371/journal.pone.0182819] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 07/25/2017] [Indexed: 11/18/2022] Open
Abstract
Background Chloroquine (CQ) is the main anti-schizontocidal drug used in the treatment of uncomplicated malaria caused by Plasmodium vivax. Chloroquine resistant P. vivax (PvCR) malaria in the Western Pacific region, Asia and in the Americas indicates a need for biomarkers of resistance to improve therapy and enhance understanding of the mechanisms associated with PvCR. In this study, we compared plasma metabolic profiles of P. vivax malaria patients with PvCR and chloroquine sensitive parasites before treatment to identify potential molecular markers of chloroquine resistance. Methods An untargeted high-resolution metabolomics analysis was performed on plasma samples collected in a malaria clinic in Manaus, Brazil. Male and female patients with Plasmodium vivax were included (n = 46); samples were collected before CQ treatment and followed for 28 days to determine PvCR, defined as the recurrence of parasitemia with detectable plasma concentrations of CQ ≥100 ng/dL. Differentially expressed metabolic features between CQ-Resistant (CQ-R) and CQ-Sensitive (CQ-S) patients were identified using partial least squares discriminant analysis and linear regression after adjusting for covariates and multiple testing correction. Pathway enrichment analysis was performed using Mummichog. Results Linear regression and PLS-DA methods yielded 69 discriminatory features between CQ-R and CQ-S groups, with 10-fold cross-validation classification accuracy of 89.6% using a SVM classifier. Pathway enrichment analysis showed significant enrichment (p<0.05) of glycerophospholipid metabolism, glycosphingolipid metabolism, aspartate and asparagine metabolism, purine and pyrimidine metabolism, and xenobiotics metabolism. Glycerophosphocholines levels were significantly lower in the CQ-R group as compared to CQ-S patients and also to independent control samples. Conclusions The results show differences in lipid, amino acids, and nucleotide metabolism pathways in the plasma of CQ-R versus CQ-S patients prior to antimalarial treatment. Metabolomics phenotyping of P. vivax samples from patients with well-defined clinical CQ-resistance is promising for the development of new tools to understand the biological process and to identify potential biomarkers of PvCR.
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Affiliation(s)
- Karan Uppal
- Clinical Biomarkers Laboratory, Division of Pulmonary Medicine, Department of Medicine, Emory University, Atlanta, Georgia, United States of America
- Malaria Host–Pathogen Interaction Center, Atlanta, Georgia, United States of America
- * E-mail: ;
| | - Jorge L. Salinas
- Malaria Host–Pathogen Interaction Center, Atlanta, Georgia, United States of America
- International Center for Malaria Research, Education and Development, Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, 954 Gatewood Road, Atlanta, Georgia, United States of America
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Wuelton M. Monteiro
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Fernando Val
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Regina J. Cordy
- Malaria Host–Pathogen Interaction Center, Atlanta, Georgia, United States of America
- International Center for Malaria Research, Education and Development, Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, 954 Gatewood Road, Atlanta, Georgia, United States of America
| | - Ken Liu
- Clinical Biomarkers Laboratory, Division of Pulmonary Medicine, Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Gisely C. Melo
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Andre M. Siqueira
- Instituto Nacional de Infectologia Evandro Chagas (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Mary R. Galinski
- Malaria Host–Pathogen Interaction Center, Atlanta, Georgia, United States of America
- International Center for Malaria Research, Education and Development, Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, 954 Gatewood Road, Atlanta, Georgia, United States of America
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Marcus V. G. Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Instituto Leônidas & Maria Deane (FIOCRUZ), Manaus, Amazonas, Brazil
- * E-mail: ;
| | - Dean P. Jones
- Clinical Biomarkers Laboratory, Division of Pulmonary Medicine, Department of Medicine, Emory University, Atlanta, Georgia, United States of America
- Malaria Host–Pathogen Interaction Center, Atlanta, Georgia, United States of America
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Recht J, Siqueira AM, Monteiro WM, Herrera SM, Herrera S, Lacerda MVG. Malaria in Brazil, Colombia, Peru and Venezuela: current challenges in malaria control and elimination. Malar J 2017; 16:273. [PMID: 28676055 PMCID: PMC5496604 DOI: 10.1186/s12936-017-1925-6] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 06/29/2017] [Indexed: 01/24/2023] Open
Abstract
In spite of significant progress towards malaria control and elimination achieved in South America in the 2000s, this mosquito-transmitted tropical disease remains an important public health concern in the region. Most malaria cases in South America come from Amazon rain forest areas in northern countries, where more than half of malaria is caused by Plasmodium vivax, while Plasmodium falciparum malaria incidence has decreased in recent years. This review discusses current malaria data, policies and challenges in four South American Amazon countries: Brazil, Colombia, Peru and the Bolivarian Republic of Venezuela. Challenges to continuing efforts to further decrease malaria incidence in this region include: a significant increase in malaria cases in recent years in Venezuela, evidence of submicroscopic and asymptomatic infections, peri-urban malaria, gold mining-related malaria, malaria in pregnancy, glucose-6-phosphate dehydrogenase (G6PD) deficiency and primaquine use, and possible under-detection of Plasmodium malariae. Some of these challenges underscore the need to implement appropriate tools and procedures in specific regions, such as a field-compatible molecular malaria test, a P. malariae-specific test, malaria diagnosis and appropriate treatment as part of regular antenatal care visits, G6PD test before primaquine administration for P. vivax cases (with weekly primaquine regimen for G6PD deficient individuals), single low dose of primaquine for P. falciparum malaria in Colombia, and national and regional efforts to contain malaria spread in Venezuela urgently needed especially in mining areas. Joint efforts and commitment towards malaria control and elimination should be strategized based on examples of successful regional malaria fighting initiatives, such as PAMAFRO and RAVREDA/AMI.
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Affiliation(s)
| | - André M Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Wuelton M Monteiro
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Sonia M Herrera
- Centro de Investigación Científica Caucaseco, Cali, Colombia
| | | | - Marcus V G Lacerda
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.,Fiocruz/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado/Institute Elimina, Manaus, Brazil
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