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Besombes C, Mbrenga F, Gonofio E, Malaka C, Bationo CS, Gaudart J, Curaudeau M, Hassanin A, Gessain A, Duda R, Vernick TG, Fontanet A, Nakouné E, Landier J. Seasonal Patterns of Mpox Index Cases, Africa, 1970-2021. Emerg Infect Dis 2024; 30:1017-1021. [PMID: 38666645 PMCID: PMC11060470 DOI: 10.3201/eid3005.230293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Across 133 confirmed mpox zoonotic index cases reported during 1970-2021 in Africa, cases occurred year-round near the equator, where climate is consistent. However, in tropical regions of the northern hemisphere under a dry/wet season cycle, cases occurred seasonally. Our findings further support the seasonality of mpox zoonotic transmission risk.
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Tréhard H, Musset L, Lazrek Y, Djossou F, Epelboin L, Roux E, Landier J, Gaudart J, Mosnier E. Understanding the impact of mobility on Plasmodium spp. carriage in an Amazon cross-border area with low transmission rate. PLOS Glob Public Health 2024; 4:e0002706. [PMID: 38349936 PMCID: PMC10863871 DOI: 10.1371/journal.pgph.0002706] [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: 08/04/2023] [Accepted: 01/02/2024] [Indexed: 02/15/2024]
Abstract
Despite the large reduction in malaria incidence in the last decade, the last kilometre to elimination is often the hardest, especially in international border areas. This study investigated the impact of mobility on Plasmodium spp. carriage in people living in a cross-border area in Amazonia with a low malaria transmission rate. We implemented a longitudinal ancillary study in the French Guiana town of St. Georges de l'Oyapock, which is located on the border with Brazil. It was based on data from two transversal surveys performed in October 2017 and October 2018. Data were collected on peri-domestic mobility for food-producing activities, and longer-distance mobility in high-risk areas. Participants were screened for Plasmodium spp. carriage using PCR tests, and treated if positive. Vector density around a participant's home was estimated using a previously published model based on remote sensing and meteorological data. The association between Plasmodium spp. carriage and mobility was analysed using a generalized additive mixed model. A total of 1,192 inhabitants, aged between 0 and 92 years old, were included. Median age was 18 years in 2017 (IQR [8;35]). Plasmodium spp. prevalence in the study population was 7% in 2017 (n = 89) and 3% in 2018 (n = 35). Plasmodium spp. carriage was independently associated with i) travel to the adjoining Oiapoque Indigenous Territories in Brazil (OR = 1.76, p = 0.023), ii) the estimated vector density around a participant's home (High versus Low risk OR = 4.11, p<0.001), iii) slash-and-burn farming (OR = 1.96, p = 0.013), and iv) age (p = 0.032). Specific surveillance systems and interventions which take into account different types of mobility are needed in cross-border areas to achieve and maintain malaria elimination (e.g., reactive case detection and treatment in the places visited).
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Affiliation(s)
- Hélène Tréhard
- Aix Marseille Institute of Public Health ISSPAM, UMR1252 SESSTIM, Aix-Marseille University, Inserm, IRD, Marseille, France
| | - Lise Musset
- Laboratoire de parasitologie, World Health Organization Collaborating Center for Surveillance of Antimalarial Drug Resistance, Centre Nationale de Référence du Paludisme, Institut Pasteur de la Guyane, Cayenne, French Guiana
| | - Yassamine Lazrek
- Laboratoire de parasitologie, World Health Organization Collaborating Center for Surveillance of Antimalarial Drug Resistance, Centre Nationale de Référence du Paludisme, Institut Pasteur de la Guyane, Cayenne, French Guiana
| | - Felix Djossou
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, French Guiana
| | - Loïc Epelboin
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, French Guiana
- Centre d’Investigation Clinique Antilles Guyane CIC Inserm 1424, Centre Hospitalier de Cayenne, French Guiana
| | - Emmanuel Roux
- French National Research Institute for Sustainable Development (IRD), ESPACE‐DEV, University of Montpellier, University of French West Indies, University of French Guiana, University of La Reunion, Montpellier, France
- French National Research Institute for Sustainable Development (IRD), Sentinela International Joint Laboratory, University of Brasilia (UnB), Oswaldo Cruz Foundation (Fiocruz), Montpellier, France
| | - Jordi Landier
- Aix Marseille Institute of Public Health ISSPAM, UMR1252 SESSTIM, Aix-Marseille University, Inserm, IRD, Marseille, France
| | - Jean Gaudart
- Aix Marseille University, INSERM, IRD, ISSPAM, SESSTIM, UMR1252, APHM, Hop Timone, BioSTIC, Biostatistic & ICT, Marseille, France
| | - Emilie Mosnier
- Aix Marseille Institute of Public Health ISSPAM, UMR1252 SESSTIM, Aix-Marseille University, Inserm, IRD, Marseille, France
- Grant Management Office, University of Health Sciences, Phnom Penh, Cambodia
- French Agency for Research on AIDS, Viral Hepatitis and Emerging Infectious Diseases (ANRS-MIE), Phnom Penh, Cambodia
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Fogang B, Lellouche L, Ceesay S, Drammeh S, Jaiteh FK, Guery MA, Landier J, Haanappel CP, Froberg J, Conway D, D'Alessandro U, Bousema T, Claessens A. Asymptomatic Plasmodium falciparum carriage at the end of the dry season is associated with subsequent infection and clinical malaria in Eastern Gambia. Malar J 2024; 23:22. [PMID: 38229097 DOI: 10.1186/s12936-024-04836-y] [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: 10/02/2023] [Accepted: 01/03/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Chronic carriage of asymptomatic low-density Plasmodium falciparum parasitaemia in the dry season may support maintenance of acquired immunity that protects against clinical malaria. However, the relationship between chronic low-density infections and subsequent risk of clinical malaria episodes remains unclear. METHODS In a 2-years study (December 2014 to December 2016) in eastern Gambia, nine cross-sectional surveys using molecular parasite detection were performed in the dry and wet season. During the 2016 malaria transmission season, passive case detection identified episodes of clinical malaria. RESULTS Among the 5256 samples collected, 444 (8.4%) were positive for P. falciparum. A multivariate model identified village of residence, male sex, age ≥ 5 years old, anaemia, and fever as independent factors associated with P. falciparum parasite carriage. Infections did not cluster over time within the same households or recurred among neighbouring households. Asymptomatic parasite carriage at the end of dry season was associated with a higher risk of infection (Hazard Ratio, HR = 3.0, p < 0.0001) and clinical malaria (HR = 1.561, p = 0.057) during the following transmission season. Age and village of residence were additional predictors of infection and clinical malaria during the transmission season. CONCLUSION Chronic parasite carriage during the dry season is associated with an increased risk of malaria infection and clinical malaria. It is unclear whether this is due to environmental exposure or to other factors.
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Affiliation(s)
- Balotin Fogang
- LPHI, MIVEGEC, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Lionel Lellouche
- LPHI, MIVEGEC, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Sukai Ceesay
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Sainabou Drammeh
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Fatou K Jaiteh
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Marc-Antoine Guery
- LPHI, MIVEGEC, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Jordi Landier
- IRD, INSERM, SESSTIM, ISSPAM, Aix Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Cynthia P Haanappel
- Department of Medical Microbiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janeri Froberg
- Department of Medical Microbiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David Conway
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Teun Bousema
- Department of Medical Microbiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Antoine Claessens
- LPHI, MIVEGEC, CNRS, INSERM, University of Montpellier, Montpellier, France.
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia.
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Legendre E, Girond F, Herbreteau V, Hoeun S, Rebaudet S, Thu AM, Rae JD, Lehot L, Dieng S, Delmas G, Nosten F, Gaudart J, Landier J. 'Forest malaria' in Myanmar? Tracking transmission landscapes in a diversity of environments. Parasit Vectors 2023; 16:324. [PMID: 37700295 PMCID: PMC10498628 DOI: 10.1186/s13071-023-05915-w] [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: 03/28/2023] [Accepted: 08/05/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND In the Greater Mekong Subregion, case-control studies and national-level analyses have shown an association between malaria transmission and forest activities. The term 'forest malaria' hides the diversity of ecosystems in the GMS, which likely do not share a uniform malaria risk. To reach malaria elimination goals, it is crucial to document accurately (both spatially and temporally) the influence of environmental factors on malaria to improve resource allocation and policy planning within given areas. The aim of this ecological study is to characterize the association between malaria dynamics and detailed ecological environments determined at village level over a period of several years in Kayin State, Myanmar. METHODS We characterized malaria incidence profiles at village scale based on intra- and inter-annual variations in amplitude, seasonality, and trend over 4 years (2016-2020). Environment was described independently of village localization by overlaying a 2-km hexagonal grid over the region. Specifically, hierarchical classification on principal components, using remote sensing data of high spatial resolution, was used to assign a landscape and a climate type to each grid cell. We used conditional inference trees and random forests to study the association between the malaria incidence profile of each village, climate and landscape. Finally, we constructed eco-epidemiological zones to stratify and map malaria risk in the region by summarizing incidence and environment association information. RESULTS We identified a high diversity of landscapes (n = 19) corresponding to a gradient from pristine to highly anthropogenically modified landscapes. Within this diversity of landscapes, only three were associated with malaria-affected profiles. These landscapes were composed of a mosaic of dense and sparse forest fragmented by small agricultural patches. A single climate with moderate rainfall and a temperature range suitable for mosquito presence was also associated with malaria-affected profiles. Based on these environmental associations, we identified three eco-epidemiological zones marked by later persistence of Plasmodium falciparum, high Plasmodium vivax incidence after 2018, or a seasonality pattern in the rainy season. CONCLUSIONS The term forest malaria covers a multitude of contexts of malaria persistence, dynamics and populations at risk. Intervention planning and surveillance could benefit from consideration of the diversity of landscapes to focus on those specifically associated with malaria transmission.
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Affiliation(s)
- Eva Legendre
- Aix Marseille Univ, IRD, INSERM, SESSTIM, ISSPAM, 27 boulevard Jean Moulin, 13005, Marseille, France.
| | - Florian Girond
- Institut de Recherche pour le Développement, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), Phnom Penh, Cambodia
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Vincent Herbreteau
- Institut de Recherche pour le Développement, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), Phnom Penh, Cambodia
| | - Sokeang Hoeun
- Institut de Recherche pour le Développement, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), Phnom Penh, Cambodia
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Stanislas Rebaudet
- Aix Marseille Univ, IRD, INSERM, SESSTIM, ISSPAM, 27 boulevard Jean Moulin, 13005, Marseille, France
- Hôpital Européen Marseille, Marseille, France
| | - Aung Myint Thu
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Mae Sot, Thailand
| | - Jade Dean Rae
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Mae Sot, Thailand
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Oxford, UK
| | - Laurent Lehot
- Aix Marseille Univ, IRD, INSERM, SESSTIM, ISSPAM, 27 boulevard Jean Moulin, 13005, Marseille, France
| | - Sokhna Dieng
- Aix Marseille Univ, IRD, INSERM, SESSTIM, ISSPAM, 27 boulevard Jean Moulin, 13005, Marseille, France
| | - Gilles Delmas
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Oxford, UK
| | - François Nosten
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road campus, Oxford, UK
| | - Jean Gaudart
- Aix Marseille Univ, IRD, INSERM, AP-HM, SESSTIM, La Timone Hospital, BioSTIC, Biostatistics and ICT, Marseille, France
| | - Jordi Landier
- Aix Marseille Univ, IRD, INSERM, SESSTIM, ISSPAM, 27 boulevard Jean Moulin, 13005, Marseille, France
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Mae Sot, Thailand
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Khirikoekkong N, Asarath SA, Munruchaitrakun M, Blay N, Waithira N, Cheah PY, Nosten F, Lubell Y, Landier J, Althaus T. Fever and health-seeking behaviour among migrants living along the Thai-Myanmar border: a mixed-methods study. BMC Infect Dis 2023; 23:501. [PMID: 37525093 PMCID: PMC10388507 DOI: 10.1186/s12879-023-08482-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 07/21/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Fever is a common reason to seek healthcare in Southeast Asia, and the decline of malaria has complexified how is perceived, and what actions are taken towards it. We investigated the concept of fever and the determinants influencing health-seeking behaviours among migrants on the Thai-Myanmar border, where rapid economic development collides with precarious political and socio-economic conditions. METHODS We implemented a mixed-methods study between August to December 2019. Phase I used a qualitative approach, with in-depth interviews and focus group discussions. Phase II used a quantitative approach with a close-ended questionnaire based on Phase I findings. A conditional inference tree (CIT) model first identified geographic and socio-demographic determinants, which were then tested using a logistic regression model. RESULTS Fever corresponded to a high diversity of conceptions, symptoms and believed causes. Self-medication was the commonest behaviour at fever onset. If fever persisted, migrants primarily sought care in humanitarian cost-free clinics (45.5%, 92/202), followed by private clinics (43.1%, 87/202), health posts (36.1%, 73/202), public hospitals (33.7%, 68/202) and primary care units (30, 14.9%). The qualitative analysis identified distance and legal status as key barriers for accessing health care. The quantitative analysis further investigated determinants influencing health-seeking behaviour: living near a town where a cost-free clinic operated was inversely associated with seeking care at health posts (adjusted odds ratio [aOR], 0.40, 95% confidence interval [95% CI] [0.19-0.86]), and public hospital attendance (aOR 0.31, 95% CI [0.14-0.67]). Living further away from the nearest town was associated with health posts attendance (aOR 1.05, 95% CI [1.00-1.10] per 1 km). Having legal status was inversely associated with cost-free clinics attendance (aOR 0.27, 95% CI [0.10-0.71]), and positively associated with private clinic and public hospital attendance (aOR 2.56, 95% CI [1.00-6.54] and 5.15, 95% CI [1.80-14.71], respectively). CONCLUSIONS Fever conception and believed causes are context-specific and should be investigated prior to any intervention. Distance to care and legal status were key determinants influencing health-seeking behaviour. Current economic upheavals are accelerating the unregulated flow of undocumented migrants from Myanmar to Thailand, warranting further inclusiveness and investments in the public health system.
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Affiliation(s)
- Napat Khirikoekkong
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, Thailand
| | - Supa-At Asarath
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Mayreerat Munruchaitrakun
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, Thailand
| | - Naw Blay
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, Thailand
| | - Naomi Waithira
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - François Nosten
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, Thailand
| | - Yoel Lubell
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Jordi Landier
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, Thailand
- Institut de Recherche pour le Développement (IRD), Aix Marseille Univ, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
| | - Thomas Althaus
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Besombes C, Mbrenga F, Malaka C, Gonofio E, Schaeffer L, Konamna X, Selekon B, Namsenei-Dankpea J, Gildas Lemon C, Landier J, von Platen C, Gessain A, Manuguerra JC, Fontanet A, Nakouné E. Investigation of a mpox outbreak in Central African Republic, 2021-2022. One Health 2023; 16:100523. [PMID: 36950196 PMCID: PMC9988319 DOI: 10.1016/j.onehlt.2023.100523] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Human monkeypox virus is spreading globally, and more information is required about its epidemiological and clinical disease characteristics in endemic countries. We report the investigation of an outbreak in November 2021 in Central African Republic (CAR). The primary case, a hunter, fell ill after contact with a non-human primate at the frontier between forest and savannah. The ensuing investigation in a small nearby town concerned two families and four waves of inter-human transmission, with 14 confirmed cases, 11 suspected cases and 17 non-infected contacts, and a secondary attack rate of 59.5% (25/42). Complications were observed in 12 of the 19 (63.2%) confirmed and suspected cases with available clinical follow-up data: eight cases of bronchopneumonia, two of severe dehydration, one corneal ulcer, one abscess, two cutaneous superinfections, and six cutaneous sequelae (cheloid scars, or depigmentation). There was one death, giving a case fatality ratio of 1/25 (4.0%) for confirmed and suspected cases. This outbreak, with the largest number of confirmed cases ever described in CAR, confirms the potential severity of the disease associated with clade I monkeypox viruses, and highlights the need for rapid control over virus circulation to prevent the further national and international spread of infection.
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Affiliation(s)
- C Besombes
- Institut Pasteur, Université Paris Cité, Epidemiology of Emerging Diseases, 75015 Paris, France
- Sorbonne Université, Paris, France
| | - F Mbrenga
- Institut Pasteur, Bangui, République Centrafricaine - Department of Arboviruses, Emerging Viruses and zoonosis, Central African Republic
| | - C Malaka
- Institut Pasteur, Bangui, République Centrafricaine - Department of Arboviruses, Emerging Viruses and zoonosis, Central African Republic
| | - E Gonofio
- Institut Pasteur, Bangui, République Centrafricaine - Department of Arboviruses, Emerging Viruses and zoonosis, Central African Republic
| | - L Schaeffer
- Institut Pasteur, Université Paris Cité, Epidemiology of Emerging Diseases, 75015 Paris, France
| | - X Konamna
- Institut Pasteur, Bangui, République Centrafricaine - Department of Arboviruses, Emerging Viruses and zoonosis, Central African Republic
| | - B Selekon
- Institut Pasteur, Bangui, République Centrafricaine - Department of Arboviruses, Emerging Viruses and zoonosis, Central African Republic
| | - J Namsenei-Dankpea
- Institut Pasteur, Bangui, République Centrafricaine - Department of Arboviruses, Emerging Viruses and zoonosis, Central African Republic
| | - C Gildas Lemon
- Institut Pasteur, Bangui, République Centrafricaine - Department of Arboviruses, Emerging Viruses and zoonosis, Central African Republic
| | - J Landier
- IRD, Aix Marseille Université, INSERM - SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
| | - C von Platen
- Institut Pasteur Paris- Centre de Recherche Translationnelle- CC, France
| | - A Gessain
- Institut Pasteur, Université Paris Cité, Epidemiology of Emerging Diseases, 75015 Paris, France
- Université Paris Cité, CNRS UMR 3569 - Unité Épidémiologie et Physiopathologie des Virus Oncogènes, France
| | - J C Manuguerra
- Environment and Infectious Risk Research Unit, Laboratory for Urgent Response to Biological Threats (ERI-CIBU), France
| | - A Fontanet
- Institut Pasteur, Université Paris Cité, Epidemiology of Emerging Diseases, 75015 Paris, France
- Conservatoire National des Arts et Métiers, PACRI Unit, Paris, France
| | - E Nakouné
- Institut Pasteur, Bangui, République Centrafricaine - Department of Arboviruses, Emerging Viruses and zoonosis, Central African Republic
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Landier J, Bassez L, Bendiane MK, Chaud P, Franke F, Nauleau S, Danjou F, Malfait P, Rebaudet S, Gaudart J. Social deprivation and SARS-CoV-2 testing: a population-based analysis in a highly contrasted southern France region. Front Public Health 2023; 11:1162711. [PMID: 37250096 PMCID: PMC10213643 DOI: 10.3389/fpubh.2023.1162711] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/05/2023] [Indexed: 05/31/2023] Open
Abstract
Background Testing was the cornerstone of the COVID-19 epidemic response in most countries until vaccination became available for the general population. Social inequalities generally affect access to healthcare and health behaviors, and COVID-19 was rapidly shown to impact deprived population more drastically. In support of the regional health agency in Provence-Alpes-Côte d'Azur (PACA) in South-Eastern France, we analyzed the relationship between testing rate and socio-demographic characteristics of the population, to identify gaps in testing coverage and improve targeting of response strategies. Methods We conducted an ecological analysis of SARS-CoV-2/COVID-19 testing rate in the PACA region, based on data aggregated at the finest spatial resolution available in France (IRIS) and by periods defined by public health implemented measures and major epidemiological changes. Using general census data, population density, and specific deprivation indices, we used principal component analysis followed by hierarchical clustering to define profiles describing local socio-demographic characteristics. We analyzed the association between these profiles and testing rates in a generalized additive multilevel model, adjusting for access to healthcare, presence of a retirement home, and the age profile of the population. Results We identified 6 socio-demographic profiles across the 2,306 analyzed IRIS spatial units: privileged, remote, intermediate, downtown, deprived, and very deprived (ordered by increasing social deprivation index). Profiles also ranged from rural (remote) to high density urban areas (downtown, very deprived). From July 2020 to December 2021, we analyzed SARS-CoV-2/COVID-19 testing rate over 10 periods. Testing rates fluctuated strongly but were highest in privileged and downtown areas, and lowest in very deprived ones. The lowest adjusted testing rate ratios (aTRR) between privileged (reference) and other profiles occurred after implementation of a mandatory healthpass for many leisure activities in July 2021. Periods of contextual testing near Christmas displayed the largest aTRR, especially during the last periods of 2021 after the end of free convenience testing for unvaccinated individuals. Conclusion We characterized in-depth local heterogeneity and temporal trends in testing rates and identified areas and circumstances associated with low testing rates, which the regional health agency targeted specifically for the deployment of health mediation activities.
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Affiliation(s)
- Jordi Landier
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
| | - Léa Bassez
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
| | - Pascal Chaud
- Santé Publique France Cellule Régionale Paca-Corse, Marseille, France
| | - Florian Franke
- Santé Publique France Cellule Régionale Paca-Corse, Marseille, France
| | - Steve Nauleau
- Agence Régionale de la Santé Provence Alpes Côte d’Azur, Marseille, France
| | - Fabrice Danjou
- Agence Régionale de la Santé Provence Alpes Côte d’Azur, Marseille, France
| | - Philippe Malfait
- Santé Publique France Cellule Régionale Paca-Corse, Marseille, France
| | - Stanislas Rebaudet
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
- Hôpital Européen Marseille, Marseille, France
| | - Jean Gaudart
- Aix Marseille Univ, APHM, Inserm, IRD, SESSTIM, ISSPAM, Hop Timone, BioSTIC, Marseille, France
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Cissoko M, Landier J, Kouriba B, Sangare AK, Katilé A, Djimde AA, Berthé I, Traore S, Thera I, Hadiata M, Sogodogo E, Coulibaly K, Guindo A, Dembele O, Sanogo S, Doumbia Z, Dara C, Altmann M, Bonnet E, Balique H, Sagaon-Teyssier L, Vidal L, Sagara I, Bendiane MK, Gaudart J. SARS-CoV-2 seroprevalence and living conditions in Bamako (Mali): a cross-sectional multistage household survey after the first epidemic wave, 2020. BMJ Open 2023; 13:e067124. [PMID: 37080622 PMCID: PMC10123860 DOI: 10.1136/bmjopen-2022-067124] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVES In low-income settings with limited access to diagnosis, COVID-19 information is scarce. In September 2020, after the first COVID-19 wave, Mali reported 3086 confirmed cases and 130 deaths. Most reports originated from Bamako, with 1532 cases and 81 deaths (2.42 million inhabitants). This observed prevalence of 0.06% appeared very low. Our objective was to estimate SARS-CoV-2 infection among inhabitants of Bamako, after the first epidemic wave. We assessed demographic, social and living conditions, health behaviours and knowledges associated with SARS-CoV-2 seropositivity. SETTINGS We conducted a cross-sectional multistage household survey during September 2020, in three neighbourhoods of the commune VI (Bamako), where 30% of the cases were reported. PARTICIPANTS We recruited 1526 inhabitants in 3 areas, that is, 306 households, and 1327 serological results (≥1 years), 220 household questionnaires and collected answers for 962 participants (≥12 years). PRIMARY AND SECONDARY OUTCOME MEASURES We measured serological status, detecting SARS-CoV-2 spike protein antibodies in blood sampled. We documented housing conditions and individual health behaviours through questionnaires among participants. We estimated the number of SARS-CoV-2 infections and deaths in the population of Bamako using the age and sex distributions. RESULTS The prevalence of SARS-CoV-2 seropositivity was 16.4% (95% CI 15.1% to 19.1%) after adjusting on the population structure. This suggested that ~400 000 cases and ~2000 deaths could have occurred of which only 0.4% of cases and 5% of deaths were officially reported. Questionnaires analyses suggested strong agreement with washing hands but lower acceptability of movement restrictions (lockdown/curfew), and mask wearing. CONCLUSIONS The first wave of SARS-CoV-2 spread broadly in Bamako. Expected fatalities remained limited largely due to the population age structure and the low prevalence of comorbidities. Improving diagnostic capacities to encourage testing and preventive behaviours, and avoiding the spread of false information remain key pillars, regardless of the developed or developing setting. ETHICS This study was registered in the registry of the ethics committee of the Faculty of Medicine and Odonto-Stomatology and the Faculty of Pharmacy, Bamako, Mali, under the number: 2020/162/CA/FMOS/FAPH.
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Affiliation(s)
- Mady Cissoko
- SESSTIM UMR1252, Aix Marseille Univ, IRD, INSERM, ISSPAM, Marseille, France
- Malaria Research and Training Centre Ogobara Doumbo (MRTC-OD), Université des Sciences, des Techniques et des Technologies de Bamako, FMOS-FAPH, Mali-NIAID-ICER, Bamako, Mali
| | - Jordi Landier
- SESSTIM UMR1252, Aix Marseille Univ, IRD, INSERM, ISSPAM, Marseille, France
| | - Bourema Kouriba
- Centre d'Infectiologie Clinique Charles Mérieux, Bamako, Mali
| | | | - Abdoulaye Katilé
- SESSTIM UMR1252, Aix Marseille Univ, IRD, INSERM, ISSPAM, Marseille, France
- Malaria Research and Training Centre Ogobara Doumbo (MRTC-OD), Université des Sciences, des Techniques et des Technologies de Bamako, FMOS-FAPH, Mali-NIAID-ICER, Bamako, Mali
| | - Abdoulaye A Djimde
- Malaria Research and Training Centre Ogobara Doumbo (MRTC-OD), Université des Sciences, des Techniques et des Technologies de Bamako, FMOS-FAPH, Mali-NIAID-ICER, Bamako, Mali
| | - Ibrahima Berthé
- Malaria Research and Training Centre Ogobara Doumbo (MRTC-OD), Université des Sciences, des Techniques et des Technologies de Bamako, FMOS-FAPH, Mali-NIAID-ICER, Bamako, Mali
- Direction générale de la santé et de l'hygiène publique du ministère de la santé et du développement social, Bamako, Mali
| | - Siriman Traore
- Malaria Research and Training Centre Ogobara Doumbo (MRTC-OD), Université des Sciences, des Techniques et des Technologies de Bamako, FMOS-FAPH, Mali-NIAID-ICER, Bamako, Mali
| | - Ismaila Thera
- Malaria Research and Training Centre Ogobara Doumbo (MRTC-OD), Université des Sciences, des Techniques et des Technologies de Bamako, FMOS-FAPH, Mali-NIAID-ICER, Bamako, Mali
| | - Maiga Hadiata
- Centre d'Infectiologie Clinique Charles Mérieux, Bamako, Mali
| | | | - Karyn Coulibaly
- Centre d'Infectiologie Clinique Charles Mérieux, Bamako, Mali
| | - Abdoulaye Guindo
- Direction générale de la santé et de l'hygiène publique du ministère de la santé et du développement social, Bamako, Mali
| | - Ousmane Dembele
- Direction générale de la santé et de l'hygiène publique du ministère de la santé et du développement social, Bamako, Mali
| | - Souleymane Sanogo
- Direction régionale de Tombouctou et établissement public hospitalier de Tombouctou, Tombouctou, Mali
| | - Zoumana Doumbia
- Direction régionale de Tombouctou et établissement public hospitalier de Tombouctou, Tombouctou, Mali
| | - Charles Dara
- Direction régionale de Tombouctou et établissement public hospitalier de Tombouctou, Tombouctou, Mali
| | | | | | - Hubert Balique
- Direction générale de la santé et de l'hygiène publique du ministère de la santé et du développement social, Bamako, Mali
| | - Luis Sagaon-Teyssier
- SESSTIM UMR1252, Aix Marseille Univ, IRD, INSERM, ISSPAM, Marseille, France
- ARCAD Santé Plus/Centre Intégré de Recherche, de Soins et d'Action Communautaire (CIRSAC), Bamako, Mali
| | - Laurent Vidal
- SESSTIM UMR1252, Aix Marseille Univ, IRD, INSERM, ISSPAM, Marseille, France
| | - Issaka Sagara
- Malaria Research and Training Centre Ogobara Doumbo (MRTC-OD), Université des Sciences, des Techniques et des Technologies de Bamako, FMOS-FAPH, Mali-NIAID-ICER, Bamako, Mali
| | | | - Jean Gaudart
- SESSTIM UMR1252, Aix Marseille Univ, IRD, INSERM, ISSPAM, Marseille, France
- Biostatictics & ICT, AP-HM, Marseille, France
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9
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Legendre E, Lehot L, Dieng S, Rebaudet S, Thu AM, Rae JD, Delmas G, Girond F, Herbreteau V, Nosten F, Landier J, Gaudart J. Malaria Temporal Dynamic Clustering for Surveillance and Intervention Planning. Epidemics 2023; 43:100682. [PMID: 37004429 DOI: 10.1016/j.epidem.2023.100682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/14/2023] [Accepted: 03/26/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Targeting interventions where most needed and effective is crucial for public health. Malaria control and elimination strategies increasingly rely on stratification to guide surveillance, to allocate vector control campaigns, and to prioritize access to community-based early diagnosis and treatment (EDT). We developed an original approach of dynamic clustering to improve local discrimination between heterogeneous malaria transmission settings. METHODS We analysed weekly malaria incidence records obtained from community-based EDT (malaria posts) in Karen/Kayin state, Myanmar. We smoothed longitudinal incidence series over multiple seasons using functional transformation. We regrouped village incidence series into clusters using a dynamic time warping clustering and compared them to the standard, 5-category annual incidence standard stratification. RESULTS We included 1115 villages from 2016 to 2020. We identified eleven P. falciparum and P. vivax incidence clusters which differed by amplitude, trends and seasonality. Specifically the 124 villages classified as "high transmission area" in the standard P. falciparum stratification belonged to the 11 distinct groups when accounting to inter-annual trends and intra-annual variations. Likewise for P. vivax, 399 "high transmission" villages actually corresponded to the 11 distinct dynamics. CONCLUSION Our temporal dynamic clustering methodology is easy to implement and extracts more information than standard malaria stratification. Our method exploits longitudinal surveillance data to distinguish local dynamics, such as increasing inter-annual trends or seasonal differences, providing key information for decision-making. It is relevant to malaria strategies in other settings and to other diseases, especially when many countries deploy health information systems and collect increasing amounts of health outcome data. FUNDING The Bill & Melinda Gates Foundation, The Global Fund against AIDS, Tuberculosis and Malaria (the Regional Artemisinin Initiative) and the Wellcome Trust funded the METF program.
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Affiliation(s)
- Eva Legendre
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France.
| | - Laurent Lehot
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
| | - Sokhna Dieng
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
| | - Stanislas Rebaudet
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France; Hôpital Européen Marseille, Marseille, France
| | - Aung Myint Thu
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Mae Sot, Thailand
| | - Jade D Rae
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Mae Sot, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research building, University of Oxford Old Road campus, Oxford, UK
| | - Gilles Delmas
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Mae Sot, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research building, University of Oxford Old Road campus, Oxford, UK
| | - Florian Girond
- Institut de Recherche pour le Développement, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), Phnom Penh, Cambodia; Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Vincent Herbreteau
- Institut de Recherche pour le Développement, UMR 228 Espace-Dev (IRD, UA, UG, UM, UR), Phnom Penh, Cambodia
| | - François Nosten
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Mae Sot, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research building, University of Oxford Old Road campus, Oxford, UK
| | - Jordi Landier
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France; Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Mae Sot, Thailand
| | - Jean Gaudart
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France; La Timone Hospital, BioSTIC, Biostatistics and ICT, Marseille, France
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10
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Mosnier E, Loubiere S, Monfardini E, Alibert A, Landier J, Ninoves L, Bosetti T, Auquier P, Mosnier M, Wakap SN, Warszawski J, Tinland A. Cumulative incidence of SARS-CoV-2 infection within the homeless population: insights from a city-wide longitudinal study. BMJ Open 2023; 13:e065734. [PMID: 36822808 PMCID: PMC9950589 DOI: 10.1136/bmjopen-2022-065734] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVES The aim of this study was to determine the risk factors associated with SARS-CoV-2 infection in a cohort of homeless people using survival analysis. Seroprevalence in the homeless community was also compared with that of the general population. DESIGN Cohort study. SETTING Data were collected across two testing sessions, 3 months apart, during which each participant was tested for anti-SARS-CoV-2 antibodies and completed a face-to-face survey. PARTICIPANTS All homeless adults sleeping rough, in slums or squats, in emergency shelters or transitional accommodation in Marseille were eligible. PRIMARY OUTCOME MEASURES Occurrence of a seroconversion event defined as a biologically confirmed SARS-CoV-2 infection. Local data from a national seroprevalence survey were used for comparison between homeless people and the general population. RESULTS A total of 1249 people were included. SARS-CoV-2 seroprevalence increased from 6.0% (4.7-7.3) during the first session to 18.9% (16.0-21.7) during the second one, compared with 3.0% (1.9-4.2) and 6.5% (4.5-8.7) in the general population. Factors significantly associated with an increased risk of COVID-19 infection were: having stayed in emergency shelters (1.93 (1.18-3.15)), being an isolated parent (1.64 (1.07-2.52)) and having contact with more than 5-15 people per day (1.84 (1.27-2.67)). By contrast, smoking (0.46 (0.32-0.65)), having financial resources (0.70 (0.51-0.97)) and psychiatric or addictive comorbidities (0.52 (0.32-0.85)) were associated with a lower risk. CONCLUSION We confirm that homeless people have higher infection rates than the general population, with increased risk in emergency shelters. There is growing evidence that, in addition to usual preventive measures, public policies should pay attention to adapt the type of accommodation and overall approach of precariousness. TRIAL REGISTRATION NUMBER NCT04408131.
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Affiliation(s)
- Emilie Mosnier
- Department of Psychiatry, Assistance Publique - Hôpitaux de Marseille, Marseille, France
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Sandrine Loubiere
- Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Assistance Publique - Hôpitaux de Marseille, Marseille, France
- Aix-Marseille University, School of medicine - La Timone Medical Campus, UR3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Elisabetta Monfardini
- Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Agathe Alibert
- Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Assistance Publique - Hôpitaux de Marseille, Marseille, France
- Research Group on Epidemiology of Zoonoses and Public Health (GREZOSP), Faculty of Veterinary Medicine, Université de Montréal, 3200 rue Sicotte, Saint-Hyacinthe, QC, Canada
| | - Jordi Landier
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Laeticia Ninoves
- Unité des Virus Émergents (UVE: Aix-Marseille Univ-IRD 190-Inserm 1207), Marseille, France
| | - Thomas Bosetti
- Médecins du Monde - Doctors of the World, Marseille, France
| | - Pascal Auquier
- Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Assistance Publique - Hôpitaux de Marseille, Marseille, France
- Aix-Marseille University, School of medicine - La Timone Medical Campus, UR3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Marine Mosnier
- Médecins du Monde - Doctors of the World, Marseille, France
| | | | | | - Aurelie Tinland
- Department of Psychiatry, Assistance Publique - Hôpitaux de Marseille, Marseille, France
- Aix-Marseille University, School of medicine - La Timone Medical Campus, UR3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, France
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11
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Althaus T, Landier J, Zhu F, Raps H, Dejoux O, Costantini A, Lavagna C, Rampal P, Mattiuzzo G, Xu S, Wang LF, Voiglio E. The impact of SARS-CoV-2 vaccination and infection on neutralising antibodies: a nation-wide cross-sectional analysis. J Infect Dis 2023; 227:1255-1265. [PMID: 36780397 DOI: 10.1093/infdis/jiad030] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/27/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Neutralising antibodies (nAbs) play a critical role in the protection against severe COVID-19. In the era of vaccine boosters and repeated SARS-CoV-2 outbreaks, identifying individuals at risk represents a public health priority. METHODS Relying on the Monaco COVID Public Health Programme, we evaluated nAbs from July 2021-June 2022 in 8,080 SARS-CoV-2 vaccinated and/or infected children and adults, at their inclusion visit. We stratified by infection status and investigated variables associated with nAbs using a generalised additive model. RESULTS Infected and vaccinated participants had high and consistent nAbs (>800 IU/mL), which remained stable over time since injection, regardless of the number of vaccine doses, body mass index, sex, or age. By contrast, uninfected participants showed larger variability (two doses [V2] median 157.6; interquartile range [IQR] 43.3-439.1 IU/mL) versus three doses [V3] median 882.5; [829.5-914.8] IU/mL). In the multivariate model, nAbs decreased by 20% per month after V2 (adjusted ratio 0.80; 95%CI [0.79-0.82]), but remained stable after V3 (adjusted ratio 0.98; 95%CI [0.92-1.05]). CONCLUSIONS Hybrid immunity provided stable, high and consistent nAbs over time. The benefit of boosters was marked to restore decaying nAbs in uninfected participants. NAbs could identify individuals at risk of severe COVID-19 and provide more targeted vaccine boosters' campaigns.
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Affiliation(s)
- Thomas Althaus
- Direction de l'Action Sanitaire, Monaco.,Monaco Scientific Centre, Monaco
| | - Jordi Landier
- IRD, Aix Marseille Univ, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, France
| | - Feng Zhu
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | | | | | | | - Christian Lavagna
- Monaco Scientific Centre, Monaco.,Centre Hospitalier Princesse Grace, Monaco
| | | | - Giada Mattiuzzo
- Vaccines (Research and Development), Medicines, and Healthcare Products Regulatory Agency, United Kingdom
| | | | - Lin-Fa Wang
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore.,SingHealth Duke-NUS Global Health Institute, Singapore
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12
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Besombes C, Mbrenga F, Schaeffer L, Malaka C, Gonofio E, Landier J, Vickos U, Konamna X, Selekon B, Dankpea JN, Von Platen C, Houndjahoue FG, Ouaïmon DS, Hassanin A, Berthet N, Manuguerra JC, Gessain A, Fontanet A, Nakouné-Yandoko E. National Monkeypox Surveillance, Central African Republic, 2001-2021. Emerg Infect Dis 2022; 28:2435-2445. [PMID: 36328951 PMCID: PMC9707566 DOI: 10.3201/eid2812.220897] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Indexed: 10/17/2023] Open
Abstract
We analyzed monkeypox disease surveillance in Central African Republic (CAR) during 2001-2021. Surveillance data show 95 suspected outbreaks, 40 of which were confirmed as monkeypox, comprising 99 confirmed and 61 suspected monkeypox cases. After 2018, CAR's annual rate of confirmed outbreaks increased, and 65% of outbreaks occurred in 2 forested regions bordering the Democratic Republic of the Congo. The median patient age for confirmed cases was 15.5 years. The overall case-fatality ratio was 7.5% (12/160) for confirmed and suspected cases, 9.6% (8/83) for children <16 years of age. Decreasing cross-protective immunity from smallpox vaccination and recent ecologic alterations likely contribute to increased monkeypox outbreaks in Central Africa. High fatality rates associated with monkeypox virus clade I also are a local and international concern. Ongoing investigations of zoonotic sources and environmental changes that increase human exposure could inform practices to prevent monkeypox expansion into local communities and beyond endemic areas.
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Affiliation(s)
- Camille Besombes
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Festus Mbrenga
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Laura Schaeffer
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Christian Malaka
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Ella Gonofio
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Jordi Landier
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Ulrich Vickos
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Xavier Konamna
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Benjamin Selekon
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Joella Namsenei Dankpea
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Cassandre Von Platen
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Franck Gislain Houndjahoue
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Daniel Sylver Ouaïmon
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Alexandre Hassanin
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Nicolas Berthet
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Jean-Claude Manuguerra
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Antoine Gessain
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
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Katile A, Sagara I, Cissoko M, Bationo CS, Dolo M, Thera I, Traore S, Kone M, Dembele P, Bocoum D, Sidibe I, Simaga I, Sissoko MS, Landier J, Gaudart J. Spatio-Temporal Variability of Malaria Incidence in the Health District of Kati, Mali, 2015-2019. Int J Environ Res Public Health 2022; 19:14361. [PMID: 36361240 PMCID: PMC9656757 DOI: 10.3390/ijerph192114361] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Despite the implementation of control strategies at the national scale, the malaria burden remains high in Mali, with more than 2.8 million cases reported in 2019. In this context, a new approach is needed, which accounts for the spatio-temporal variability of malaria transmission at the local scale. This study aimed to describe the spatio-temporal variability of malaria incidence and the associated meteorological and environmental factors in the health district of Kati, Mali. METHODS Daily malaria cases were collected from the consultation records of the 35 health areas of Kati's health district, for the period 2015-2019. Data on rainfall, relative humidity, temperature, wind speed, the normalized difference vegetation index, air pressure, and land use-land cover were extracted from open-access remote sensing sources, while data on the Niger River's height and flow were obtained from the National Department of Hydraulics. To reduce the dimension and account for collinearity, strongly correlated meteorological and environmental variables were combined into synthetic indicators (SI), using a principal component analysis. A generalized additive model was built to determine the lag and the relationship between the main SIs and malaria incidence. The transmission periods were determined using a change-point analysis. High-risk clusters (hotspots) were detected using the SatScan method and were ranked according to risk level, using a classification and regression tree analysis. RESULTS The peak of the malaria incidence generally occurred in October. Peak incidence decreased from 60 cases per 1000 person-weeks in 2015, to 27 cases per 1000 person-weeks in 2019. The relationship between the first SI (river flow and height, relative humidity, and rainfall) and malaria incidence was positive and almost linear. A non-linear relationship was found between the second SI (air pressure and temperature) and malaria incidence. Two transmission periods were determined per year: a low transmission period from January to July-corresponding to a persisting transmission during the dry season-and a high transmission period from July to December. The spatial distribution of malaria hotspots varied according to the transmission period. DISCUSSION Our study confirmed the important variability of malaria incidence and found malaria transmission to be associated with several meteorological and environmental factors in the Kati district. The persistence of malaria during the dry season and the spatio-temporal variability of malaria hotspots reinforce the need for innovative and targeted strategies.
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Affiliation(s)
- Abdoulaye Katile
- INSERM, IRD, SESSTIM, ISSPAM, UMR1252, Faculty of Medicine, Aix Marseille University, 13005 Marseille, France
- Malaria Research and Training Center (MRTC), FMOS-FAPH, Mali-NIAID-ICER, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako BP 423, Mali
| | - Issaka Sagara
- INSERM, IRD, SESSTIM, ISSPAM, UMR1252, Faculty of Medicine, Aix Marseille University, 13005 Marseille, France
- Malaria Research and Training Center (MRTC), FMOS-FAPH, Mali-NIAID-ICER, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako BP 423, Mali
| | - Mady Cissoko
- INSERM, IRD, SESSTIM, ISSPAM, UMR1252, Faculty of Medicine, Aix Marseille University, 13005 Marseille, France
- Malaria Research and Training Center (MRTC), FMOS-FAPH, Mali-NIAID-ICER, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako BP 423, Mali
| | - Cedric Stephane Bationo
- INSERM, IRD, SESSTIM, ISSPAM, UMR1252, Faculty of Medicine, Aix Marseille University, 13005 Marseille, France
| | - Mathias Dolo
- Malaria Research and Training Center (MRTC), FMOS-FAPH, Mali-NIAID-ICER, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako BP 423, Mali
| | - Ismaila Thera
- Malaria Research and Training Center (MRTC), FMOS-FAPH, Mali-NIAID-ICER, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako BP 423, Mali
| | - Siriman Traore
- Malaria Research and Training Center (MRTC), FMOS-FAPH, Mali-NIAID-ICER, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako BP 423, Mali
| | - Mamady Kone
- Malaria Research and Training Center (MRTC), FMOS-FAPH, Mali-NIAID-ICER, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako BP 423, Mali
| | - Pascal Dembele
- Programme National de Lutte Contre le Paludisme, Bamako BP 233, Mali
| | - Djoouro Bocoum
- Direction Nationale de L’Hydraulique, Bamako BP 66, Mali
| | | | - Ismael Simaga
- Centre de Santé de Référence du District Sanitaire de Kati, Région de Koulikoro, Kati BP 594, Mali
| | - Mahamadou Soumana Sissoko
- Malaria Research and Training Center (MRTC), FMOS-FAPH, Mali-NIAID-ICER, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako BP 423, Mali
| | - Jordi Landier
- INSERM, IRD, SESSTIM, ISSPAM, UMR1252, Faculty of Medicine, Aix Marseille University, 13005 Marseille, France
| | - Jean Gaudart
- Malaria Research and Training Center (MRTC), FMOS-FAPH, Mali-NIAID-ICER, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako BP 423, Mali
- APHM, INSERM, IRD, SESSTIM, ISSPAM, UMR1252, Hop Timone, BioSTIC, Biostatistic & ICT, Faculty of Medicine, Aix Marseille University, 13005 Marseille, France
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14
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Cissoko M, Sagara I, Landier J, Guindo A, Sanogo V, Coulibaly OY, Dembélé P, Dieng S, Bationo CS, Diarra I, Magassa MH, Berthé I, Katilé A, Traoré D, Dessay N, Gaudart J. Sub-national tailoring of seasonal malaria chemoprevention in Mali based on malaria surveillance and rainfall data. Parasit Vectors 2022; 15:278. [PMID: 35927679 PMCID: PMC9351140 DOI: 10.1186/s13071-022-05379-4] [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: 01/06/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background In malaria endemic countries, seasonal malaria chemoprevention (SMC) interventions are performed during the high malaria transmission in accordance with epidemiological surveillance data. In this study we propose a predictive approach for tailoring the timing and number of cycles of SMC in all health districts of Mali based on sub-national epidemiological surveillance and rainfall data. Our primary objective was to select the best of two approaches for predicting the onset of the high transmission season at the operational scale. Our secondary objective was to evaluate the number of malaria cases, hospitalisations and deaths in children under 5 years of age that would be prevented annually and the additional cost that would be incurred using the best approach. Methods For each of the 75 health districts of Mali over the study period (2014–2019), we determined (1) the onset of the rainy season period based on weekly rainfall data; (ii) the onset and duration of the high transmission season using change point analysis of weekly incidence data; and (iii) the lag between the onset of the rainy season and the onset of the high transmission. Two approaches for predicting the onset of the high transmission season in 2019 were evaluated. Results In the study period (2014–2019), the onset of the rainy season ranged from week (W) 17 (W17; April) to W34 (August). The onset of the high transmission season ranged from W25 (June) to W40 (September). The lag between these two events ranged from 5 to 12 weeks. The duration of the high transmission season ranged from 3 to 6 months. The best of the two approaches predicted the onset of the high transmission season in 2019 to be in June in two districts, in July in 46 districts, in August in 21 districts and in September in six districts. Using our proposed approach would prevent 43,819 cases, 1943 hospitalisations and 70 deaths in children under 5 years of age annually for a minimal additional cost. Our analysis shows that the number of cycles of SMC should be changed in 36 health districts. Conclusion Adapting the timing of SMC interventions using our proposed approach could improve the prevention of malaria cases and decrease hospitalisations and deaths. Future studies should be conducted to validate this approach. Graphical Abstract ![]()
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Affiliation(s)
- Mady Cissoko
- Malaria Research and Training Centre Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université Des Sciences, Des Techniques Et Des Technologies de Bamako, 1805, Bamako, Mali. .,INSERM, IRD, ISSPAM, UM1252, Aix-Marseille University, 13005, Marseille, France. .,Direction Régionale de la Santé de Tombouctou, 59, Tombouctou, Mali.
| | - Issaka Sagara
- Malaria Research and Training Centre Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université Des Sciences, Des Techniques Et Des Technologies de Bamako, 1805, Bamako, Mali.,INSERM, IRD, ISSPAM, UM1252, Aix-Marseille University, 13005, Marseille, France
| | - Jordi Landier
- INSERM, IRD, ISSPAM, UM1252, Aix-Marseille University, 13005, Marseille, France
| | - Abdoulaye Guindo
- Malaria Research and Training Centre Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université Des Sciences, Des Techniques Et Des Technologies de Bamako, 1805, Bamako, Mali.,INSERM, IRD, ISSPAM, UM1252, Aix-Marseille University, 13005, Marseille, France
| | - Vincent Sanogo
- Programme National de Lutte contre le Paludisme (PNLP Mali), 233, Bamako, Mali
| | - Oumou Yacouba Coulibaly
- Direction Générale de la Santé et Hygiène Publique, Sous-Direction Lutte Contre la Maladie (DGSHP-SDLM), 233, Bamako, Mali
| | - Pascal Dembélé
- Programme National de Lutte contre le Paludisme (PNLP Mali), 233, Bamako, Mali
| | - Sokhna Dieng
- INSERM, IRD, ISSPAM, UM1252, Aix-Marseille University, 13005, Marseille, France
| | | | - Issa Diarra
- Malaria Research and Training Centre Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université Des Sciences, Des Techniques Et Des Technologies de Bamako, 1805, Bamako, Mali
| | - Mahamadou H Magassa
- Programme National de Lutte contre le Paludisme (PNLP Mali), 233, Bamako, Mali
| | - Ibrahima Berthé
- Malaria Research and Training Centre Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université Des Sciences, Des Techniques Et Des Technologies de Bamako, 1805, Bamako, Mali
| | - Abdoulaye Katilé
- Malaria Research and Training Centre Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université Des Sciences, Des Techniques Et Des Technologies de Bamako, 1805, Bamako, Mali.,INSERM, IRD, ISSPAM, UM1252, Aix-Marseille University, 13005, Marseille, France
| | - Diahara Traoré
- Programme National de Lutte contre le Paludisme (PNLP Mali), 233, Bamako, Mali
| | - Nadine Dessay
- ESPACE-DEV, UMR228, IRD/UM/UR/UG/UA, Institut de Recherche Pour le Développement (IRD) France, 34093, Montpellier, France
| | - Jean Gaudart
- Malaria Research and Training Centre Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université Des Sciences, Des Techniques Et Des Technologies de Bamako, 1805, Bamako, Mali.,APHM, INSERM, SESSTIM, ISSPAM, Hop Timone, BioSTIC, Biostatistic & ICT, Aix-Marseille University, 13005, Marseille, France
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15
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Rae JD, Nosten S, Kajeechiwa L, Wiladphaingern J, Parker DM, Landier J, Thu AM, Dah H, Be A, Cho WC, Paw K, Paw ES, Shee PB, Poe C, Nu C, Nyaw B, Simpson JA, Devine A, Maude RJ, Moo KL, Min MC, Thwin MM, Tun SW, Nosten FH. Surveillance to achieve malaria elimination in eastern Myanmar: a 7-year observational study. Malar J 2022; 21:175. [PMID: 35672747 PMCID: PMC9171744 DOI: 10.1186/s12936-022-04175-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/05/2022] [Indexed: 12/02/2022] Open
Abstract
Background The collection and utilization of surveillance data is essential in monitoring progress towards achieving malaria elimination, in the timely response to increases in malaria case numbers and in the assessment of programme functioning. This paper describes the surveillance activities used by the malaria elimination task force (METF) programme which operates in eastern Myanmar, and provides an analysis of data collected from weekly surveillance, case investigations, and monitoring and evaluation of programme performance. Methods This retrospective analysis was conducted using data collected from a network of 1250 malaria posts operational between 2014 and 2021. To investigate changes in data completeness, malaria post performance, malaria case numbers, and the demographic details of malaria cases, summary statistics were used to compare data collected over space and time. Results In the first 3 years of the METF programme, improvements in data transmission routes resulted in a 18.9% reduction in late reporting, allowing for near real-time analysis of data collected at the malaria posts. In 2020, travel restrictions were in place across Karen State in response to COVID-19, and from February 2021 the military coup in Myanmar resulted in widescale population displacement. However, over that period there has been no decline in malaria post attendance, and the majority of consultations continue to occur within 48 h of fever onset. Case investigations found that 43.8% of cases travelled away from their resident village in the 3 weeks prior to diagnosis and 36.3% reported never using a bed net whilst sleeping in their resident village, which increased to 72.2% when sleeping away from their resident village. Malaria post assessments performed in 82.3% of the METF malaria posts found malaria posts generally performed to a high standard. Conclusions Surveillance data collected by the METF programme demonstrate that despite significant changes in the context in which the programme operates, malaria posts have remained accessible and continue to provide early diagnosis and treatment contributing to an 89.3% decrease in Plasmodium falciparum incidence between 2014 and 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04175-w.
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16
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Landier J, Bassez L, Chaud P, Franke F, Nauleau S, Bendiane M, Danjou F, Malfait P, Rebaudet S, Gaudart J. Défavorisation sociale et facteurs associés au dépistage du SARS-CoV-2 à l'échelle locale dans une région du Sud de la France entre Juillet 2020 et Janvier 2022. MÉDECINE ET MALADIES INFECTIEUSES FORMATION 2022. [PMCID: PMC9152498 DOI: 10.1016/j.mmifmc.2022.03.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Introduction Les inégalités sociales sont fortement associées aux inégalités de santé, que ce soit pour les maladies chroniques ou infectieuses. Le SARS-CoV-2 ne fait pas exception, l'étude nationale EpiCov ayant montré dès juin 2020 un risque de COVID-19 croissant avec la défavorisation sociale. Le dépistage demeure un des piliers du contrôle de cette pandémie, tant à l'échelle individuelle pour l'isolement des cas et de leurs contacts à risque, que populationnelle pour identifier et cibler certaines mesures d'accompagnement. L'accès au dépistage ne saurait être considéré comme uniforme, tant l'accès au soin apparaît déficitaire dans certains territoires (zones urbaines défavorisées, rurales). Par ailleurs, le manque de prise en compte des inégalités sociales dans les mesures de suivi des cas a été souligné. Notre objectif était de prendre en compte le sous-diagnostic du SARS-CoV-2 lié à la défavorisation sociale afin d'améliorer le ciblage des actions de santé publique à l'échelle régionale. Matériels et méthodes Le nombre de tests (RT-PCR et antigéniques) et de cas de COVID-19 positifs enregistrés dans la base SI-DEP ont été agrégées à l'échelle spatiale des IRIS (subdivision géographique d'environ 2000 habitants) et temporelle selon des périodes correspondant aux grandes mesures de contrôle de l'épidémie (pré-, pendant, post-confinement, passe sanitaire…). Les taux de dépistage, d'incidence de COVID-19 et de positivité des tests ont été définis par IRIS et par période. Nous avons caractérisé le profil socio-démographique de chaque IRIS à partir de données de population et d'accès au soin (source INSEE et DREES), et de l'European Deprivation Index (EDI), indicateur spécifique de défavorisation sociale. Enfin, nous avons analysé le ratio de taux de dépistage (RTD) selon le profil socio-démographique après ajustement sur l'accès au soin, au moyen d'un modèle additif généralisé hiérarchique prenant en compte l'autocorrélation spatiale entre les IRIS voisins. Résultats Nous avons distingué 10 périodes entre Juillet 2020 et Janvier 2022, et identifié six profils d'IRIS : un profil rural, un rural/péri-urbain, et quatre profils urbains correspondant respectivement à des IRIS aisés, denses de centre-ville, défavorisées, et denses très défavorisées. Le taux de dépistage des IRIS urbains très défavorisés était systématiquement inférieur au taux de dépistage des IRIS urbains/péri-urbains aisés (RTD entre 0.85 (IC95 %=0.80-0.91) et 0.64 (0.59-0.69)). Les pics d'incidence de COVID-19 ont été atteints plus tardivement dans les IRIS très défavorisées que dans les IRIS aisés lors de périodes de confinement (novembre 2020) ou de périodes de vaccination massive (juillet 2021). Conclusion Cette étude a permis d'identifier une liste limitée d'IRIS caractérisés par un sous-dépistage et un retard d'efficacité des mesures sanitaires de freinage de la COVID-19. Ils ont ainsi pu être priorisés dans les interventions mises en place par les acteurs régionaux et locaux de la réponse à la pandémie. Aucun lien d'intérêt
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Affiliation(s)
- J. Landier
- IRD, INSERM, Aix Marseille Univ, UMR SESSTIM, ISSPAM, Marseille, France
| | - L. Bassez
- IRD, INSERM, Aix Marseille Univ, UMR SESSTIM, ISSPAM, Marseille, France
| | - P. Chaud
- Santé Publique France, Marseille, France
| | - F. Franke
- Santé Publique France, Marseille, France
| | - S. Nauleau
- Agence Régionale pour la Santé Provence Alpes Côtes d'Azur, Marseille, France
| | - M. Bendiane
- IRD, INSERM, Aix Marseille Univ, UMR SESSTIM, ISSPAM, Marseille, France
| | - F. Danjou
- Agence Régionale pour la Santé Provence Alpes Côtes d'Azur, Marseille, France
| | - P. Malfait
- Santé Publique France, Marseille, France
| | - S. Rebaudet
- IRD, INSERM, Aix Marseille Univ, UMR SESSTIM, ISSPAM, Marseille, France
| | - J. Gaudart
- IRD, INSERM, Aix Marseille Univ, UMR SESSTIM, ISSPAM, Marseille, France
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17
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Allibert A, Tinland A, Landier J, Loubière S, Gaudart J, Mosnier M, Farnarier C, Auquier P, Mosnier E. Residential Mobility of a Cohort of Homeless People in Times of Crisis: COVID-19 Pandemic in a European Metropolis. Int J Environ Res Public Health 2022; 19:ijerph19053129. [PMID: 35270823 PMCID: PMC8910199 DOI: 10.3390/ijerph19053129] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/08/2022] [Accepted: 02/18/2022] [Indexed: 11/16/2022]
Abstract
Most vulnerable individuals are particularly affected by the COVID-19 pandemic. This study takes place in a large city in France. The aim of this study is to describe the mobility of the homeless population at the beginning of the health crisis and to analyze its impact in terms of COVID-19 prevalence. From June to August 2020 and September to December 2020, 1272 homeless people were invited to be tested for SARS-CoV-2 antibodies and virus and complete questionnaires. Our data show that homeless populations are sociologically different depending on where they live. We show that people that were living on the street were most likely to be relocated to emergency shelters than other inhabitants. Some neighborhoods are points of attraction for homeless people in the city while others emptied during the health crisis, which had consequences for virus circulation. People with a greater number of different dwellings reported became more infected. This first study of the mobility and epidemiology of homeless people in the time of the pandemic provides unique information about mobility mapping, sociological factors of this mobility, mobility at different scales, and epidemiological consequences. We suggest that homeless policies need to be radically transformed since the actual model exposes people to infection in emergency.
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Affiliation(s)
- Agathe Allibert
- Department of Psychiatry, Assistance Publique—Hôpitaux de Marseille, 13385 Marseille, France; (A.A.); (A.T.)
- Epidemiology of Zoonoses and Public Health Research Unit (GREZOSP), Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada
| | - Aurélie Tinland
- Department of Psychiatry, Assistance Publique—Hôpitaux de Marseille, 13385 Marseille, France; (A.A.); (A.T.)
- EA 3279: CEReSS—Health Service Research and Quality of Life Center, School of Medicine—La Timone Medical Campus, Aix-Marseille University, 13005 Marseille, France; (S.L.); (P.A.)
| | - Jordi Landier
- Aix Marseille Univ, IRD, INSERM, SESSTIM, ISSPAM, AP-HM, La Timone Hospital, BioSTIC, Biostatistic & ICT, 13005 Marseille, France; (J.L.); (J.G.)
| | - Sandrine Loubière
- EA 3279: CEReSS—Health Service Research and Quality of Life Center, School of Medicine—La Timone Medical Campus, Aix-Marseille University, 13005 Marseille, France; (S.L.); (P.A.)
- Support Unit for Clinical Research and Economic Evaluation, Assistance Publique Hôpitaux de Marseille, 13385 Marseille, France
| | - Jean Gaudart
- Aix Marseille Univ, IRD, INSERM, SESSTIM, ISSPAM, AP-HM, La Timone Hospital, BioSTIC, Biostatistic & ICT, 13005 Marseille, France; (J.L.); (J.G.)
| | - Marine Mosnier
- Médecins du Monde—Doctors of the World, 13003 Marseille, France;
| | - Cyril Farnarier
- Laboratoire de Sciences Sociales Appliquées/Projet ASSAb, 13001 Marseille, France;
| | - Pascal Auquier
- EA 3279: CEReSS—Health Service Research and Quality of Life Center, School of Medicine—La Timone Medical Campus, Aix-Marseille University, 13005 Marseille, France; (S.L.); (P.A.)
- Support Unit for Clinical Research and Economic Evaluation, Assistance Publique Hôpitaux de Marseille, 13385 Marseille, France
| | - Emilie Mosnier
- Department of Psychiatry, Assistance Publique—Hôpitaux de Marseille, 13385 Marseille, France; (A.A.); (A.T.)
- Aix Marseille Univ, IRD, INSERM, SESSTIM, ISSPAM, AP-HM, La Timone Hospital, BioSTIC, Biostatistic & ICT, 13005 Marseille, France; (J.L.); (J.G.)
- Correspondence: ; Tel.: +33-6-51-53-24-62
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18
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Thielemans L, Peerawaranun P, Mukaka M, Paw MK, Wiladphaingern J, Landier J, Bancone G, Proux S, Elsinga H, Trip-Hoving M, Hanboonkunupakarn B, Htoo TL, Wah TS, Beau C, Nosten F, McGready R, Carrara VI. High levels of pathological jaundice in the first 24 hours and neonatal hyperbilirubinaemia in an epidemiological cohort study on the Thailand-Myanmar border. PLoS One 2021; 16:e0258127. [PMID: 34618852 PMCID: PMC8496801 DOI: 10.1371/journal.pone.0258127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/08/2021] [Accepted: 09/20/2021] [Indexed: 11/18/2022] Open
Abstract
Population risks for neonatal hyperbilirubinaemia (NH) vary. Knowledge of local risks permits interventions that may reduce the proportion becoming severe. Between January 2015 and May 2016, in a resource-limited setting on the Thailand-Myanmar border, neonates from 28 weeks' gestation were enrolled into a prospective birth cohort. Each neonate had total serum bilirubin measurements: scheduled (24, 48, 72 and 144 hours of life) and clinically indicated; and weekly follow up until 1 month of age. Risk factors for developing NH were evaluated using Cox proportional hazard mixed model. Of 1710 neonates, 22% (376) developed NH (83% preterm, 19% term). All neonates born <35 weeks, four in five born 35-37 weeks, and three in twenty born ≥38 weeks had NH, giving an overall incidence of 249 per 1000 livebirths [95%CI 225, 403]. Mortality from acute bilirubin encephalopathy was 10% (2/20) amongst the 5.3% (20/376) who reached the severe NH threshold. One-quarter (26.3%) of NH occurred within 24 hours. NH onset varied with gestational age: at a median [IQR] 24 hours [24, 30] for neonates born 37 weeks or prematurely vs 59 hours [48, 84] for neonates born ≥38 weeks. Risk factors for NH in the first week of life independent of gestational age were: neonatal G6PD deficiency, birth bruising, Sgaw Karen ethnicity, primigravidae, pre-eclampsia, and prolonged rupture of membranes. The genetic impact of G6PD deficiency on NH was partially interpreted by using the florescent spot test and further genotyping work is in progress. The risk of NH in Sgaw Karen refugees may be overlooked internationally as they are most likely regarded as Burmese in countries of resettlement. Given high levels of pathological jaundice in the first 24 hours and overall high NH burden, guidelines changes were implemented including preventive PT for all neonates <35 weeks and for those 35-37 weeks with risk factors.
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Affiliation(s)
- Laurence Thielemans
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Neonatology-Pediatrics, Université Libre de Bruxelles, Brussels, Belgium
| | - Pimnara Peerawaranun
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mavuto Mukaka
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Moo Kho Paw
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Jacher Wiladphaingern
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Jordi Landier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- IRD, INSERM, SESSTIM, Aix Marseille University, Marseille, France
| | - Germana Bancone
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stephane Proux
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Henrike Elsinga
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Margreet Trip-Hoving
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Borimas Hanboonkunupakarn
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Tha Ler Htoo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Thaw Shee Wah
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Candy Beau
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Verena I. Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
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19
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Rae JD, Landier J, Simpson JA, Proux S, Devine A, Maude RJ, Thu AM, Wiladphaingern J, Kajeechiwa L, Thwin MM, Tun SW, Nosten FH. Longitudinal trends in malaria testing rates in the face of elimination in eastern Myanmar: a 7-year observational study. BMC Public Health 2021; 21:1725. [PMID: 34551751 PMCID: PMC8459519 DOI: 10.1186/s12889-021-11749-x] [Citation(s) in RCA: 4] [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: 03/26/2021] [Accepted: 09/07/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Providing at-risk communities with uninterrupted access to early diagnosis and treatment is a key component in reducing malaria transmission and achieving elimination. As programmes approach malaria elimination targets it is critical that each case is tested and treated early, which may present a challenge when the burden of malaria is reduced. In this paper we investigate whether malaria testing rates decline over time and assess the impacts of integrating malaria and non-malaria services on testing rates in the malaria elimination task force (METF) programme in the Kayin state of Myanmar. METHODS A retrospective analysis was conducted using weekly collected data on testing rates from a network of more than 1200 malaria posts during the period from 2014 to 2020. To determine whether monthly testing rates changed over the years of programme operations, and whether integrating malaria and non-malaria services impacted these testing rates, we fitted negative binomial mixed-effects regression models to aggregate monthly data, accounting for malaria seasonal variation. RESULTS In the first year of malaria post operation, testing rates declined, correlating with a decline in attendance by people from outside the malaria post catchment area, but then remained fairly constant (the Rate Ratio (RR) for 2nd versus 1st year open ranged from 0.68 to 0.84 across the four townships included in the analysis, the RR for 3rd to 6th year versus 1st year open were similar, ranging from 0.59-0.78). The implementation of a training programme, which was intended to expand the role of the malaria post workers, had minimal impact on testing rates up to 24 months after training was delivered (RR for integrated versus malaria-only services ranged from 1.00 to 1.07 across METF townships). CONCLUSION Despite the decline in malaria incidence from 2014 to 2020, there has been no decline in the malaria testing rate in the METF programme after the establishment of the complete malaria post network in 2016. While the integration of malaria posts with other health services provides benefits to the population, our evaluation questions the necessity of integrated services in maintaining malaria testing rates in areas approaching elimination of malaria.
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Affiliation(s)
- Jade D Rae
- Shoklo Malaria Research Unit (SMRU), Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand. .,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Jordi Landier
- IRD (Institut de Recherche pour le Developpement), Aix Marseille Univ, INSERM, SESSTIM, Marseille, France
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Stéphane Proux
- Shoklo Malaria Research Unit (SMRU), Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Angela Devine
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Richard J Maude
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Harvard TH Chan School of Public Health, Harvard University, Boston, USA.,The Open University, Milton Keynes, UK
| | - Aung Myint Thu
- Shoklo Malaria Research Unit (SMRU), Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Jacher Wiladphaingern
- Shoklo Malaria Research Unit (SMRU), Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Ladda Kajeechiwa
- Shoklo Malaria Research Unit (SMRU), Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - May Myo Thwin
- Shoklo Malaria Research Unit (SMRU), Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Saw Win Tun
- Shoklo Malaria Research Unit (SMRU), Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - François H Nosten
- Shoklo Malaria Research Unit (SMRU), Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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20
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Taylor WR, Hoglund RM, Peerawaranun P, Nguyen TN, Hien TT, Tarantola A, von Seidlein L, Tripura R, Peto TJ, Dondorp AM, Landier J, H Nosten F, Smithuis F, Phommasone K, Mayxay M, Kheang ST, Say C, Neeraj K, Rithea L, Dysoley L, Kheng S, Muth S, Roca-Feltrer A, Debackere M, Fairhurst RM, Song N, Buchy P, Menard D, White NJ, Tarning J, Mukaka M. Development of weight and age-based dosing of daily primaquine for radical cure of vivax malaria. Malar J 2021; 20:366. [PMID: 34503519 PMCID: PMC8427859 DOI: 10.1186/s12936-021-03886-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/30/2021] [Accepted: 08/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In many endemic areas, Plasmodium vivax malaria is predominantly a disease of young adults and children. International recommendations for radical cure recommend fixed target doses of 0.25 or 0.5 mg/kg/day of primaquine for 14 days in glucose-6-phosphate dehydrogenase normal patients of all ages. However, for many anti-malarial drugs, including primaquine, there is evidence that children have lower exposures than adults for the same weight-adjusted dose. The aim of the study was to develop 14-day weight-based and age-based primaquine regimens against high-frequency relapsing tropical P. vivax. METHODS The recommended adult target dose of 0.5 mg/kg/day (30 mg in a 60 kg patient) is highly efficacious against tropical P. vivax and was assumed to produce optimal drug exposure. Primaquine doses were calculated using allometric scaling to derive a weight-based primaquine regimen over a weight range from 5 to 100 kg. Growth curves were constructed from an anthropometric database of 53,467 individuals from the Greater Mekong Subregion (GMS) to define weight-for-age relationships. The median age associated with each weight was used to derive an age-based dosing regimen from the weight-based regimen. RESULTS The proposed weight-based regimen has 5 dosing bands: (i) 5-7 kg, 5 mg, resulting in 0.71-1.0 mg/kg/day; (ii) 8-16 kg, 7.5 mg, 0.47-0.94 mg/kg/day; (iii) 17-40 kg, 15 mg, 0.38-0.88 mg/kg/day; (iv) 41-80 kg, 30 mg, 0.37-0.73 mg/kg/day; and (v) 81-100 kg, 45 mg, 0.45-0.56 mg/kg/day. The corresponding age-based regimen had 4 dosing bands: 6-11 months, 5 mg, 0.43-1.0 mg/kg/day; (ii) 1-5 years, 7.5 mg, 0.35-1.25 mg/kg/day; (iii) 6-14 years, 15 mg, 0.30-1.36 mg/kg/day; and (iv) ≥ 15 years, 30 mg, 0.35-1.07 mg/kg/day. CONCLUSION The proposed weight-based regimen showed less variability around the primaquine dose within each dosing band compared to the age-based regimen and is preferred. Increased dose accuracy could be achieved by additional dosing bands for both regimens. The age-based regimen might not be applicable to regions outside the GMS, which must be based on local anthropometric data. Pharmacokinetic data in small children are needed urgently to inform the proposed regimens.
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Affiliation(s)
- Walter Robert Taylor
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/60 Rajvithi Road, Bangkok, 10400, Thailand.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Richard M Hoglund
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/60 Rajvithi Road, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Pimnara Peerawaranun
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/60 Rajvithi Road, Bangkok, 10400, Thailand
| | - Thuy Nhien Nguyen
- Oxford University Clinical Research Unit, Wellcome Trust Major Oversea Programme, Ho Chi Minh City, Vietnam
| | - Tran Tinh Hien
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit, Wellcome Trust Major Oversea Programme, Ho Chi Minh City, Vietnam
| | - Arnaud Tarantola
- Institut Pasteur du Cambodge, 5 Monivong Boulevard, Phnom Penh, 12201, Cambodia
| | - Lorenz von Seidlein
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/60 Rajvithi Road, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rupam Tripura
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/60 Rajvithi Road, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Global Health, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Thomas J Peto
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/60 Rajvithi Road, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/60 Rajvithi Road, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jordi Landier
- Shoklo Malaria Research Unit, Mae Sot, Thailand
- Aix-Marseille Université, IRD, INSERM, SESSTIM, Marseille, France
| | - Francois H Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Shoklo Malaria Research Unit, Mae Sot, Thailand
| | | | - Koukeo Phommasone
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao PDR
- Amsterdam Institute for Global Health & Development, Amsterdam, The Netherlands
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao PDR
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao PDR
| | - Soy Ty Kheang
- Center for Health and Social Development (HSD), National Institute for Public Health (NIPH) and University Research Co., LLC (URC), Chey Chumneas, Daun Penh, Phnom Penh, Cambodia
- AQUITY Global Inc, 987 Avenel Farm Dr, Potomac, MD, 20854, USA
| | - Chy Say
- Center for Health and Social Development (HSD), National Institute for Public Health (NIPH) and University Research Co., LLC (URC), Chey Chumneas, Daun Penh, Phnom Penh, Cambodia
| | - Kak Neeraj
- University Research Co., LLC Washington DC, 7200 Wisconsin Ave, Bethesda, MD, 20814, USA
| | - Leang Rithea
- National Center for Parasitology, Entomology and Malaria Control, Khan Sen Sok, Phnom Penh, Cambodia
| | - Lek Dysoley
- National Center for Parasitology, Entomology and Malaria Control, Khan Sen Sok, Phnom Penh, Cambodia
- Institute of Public Health, Phnom Penh, Cambodia
| | - Sim Kheng
- National Center for Parasitology, Entomology and Malaria Control, Khan Sen Sok, Phnom Penh, Cambodia
| | - Sinoun Muth
- National Center for Parasitology, Entomology and Malaria Control, Khan Sen Sok, Phnom Penh, Cambodia
| | | | - Mark Debackere
- MSF Belgium Cambodia Malaria Program, Khan Chamkarmon, Phnom Penh, Cambodia
| | - Rick M Fairhurst
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, 20852, USA
| | - Ngak Song
- FHI 360 Cambodia Office, Keng Kang III Khan Chamkamon, Phnom Penh, Cambodia
| | - Philippe Buchy
- Institut Pasteur du Cambodge, 5 Monivong Boulevard, Phnom Penh, 12201, Cambodia
- GSK Vaccines, 23 Rochester Park, Singapore, Singapore
| | - Didier Menard
- Institut Pasteur du Cambodge, 5 Monivong Boulevard, Phnom Penh, 12201, Cambodia
- Unité Génétique du Paludisme Et Résistance, Département Parasites Et Insectes Vecteurs, Institut Pasteur, Paris, France
| | - Nicholas J White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/60 Rajvithi Road, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Joel Tarning
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/60 Rajvithi Road, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/60 Rajvithi Road, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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21
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Jacob CG, Thuy-Nhien N, Mayxay M, Maude RJ, Quang HH, Hongvanthong B, Vanisaveth V, Ngo Duc T, Rekol H, van der Pluijm R, von Seidlein L, Fairhurst R, Nosten F, Hossain MA, Park N, Goodwin S, Ringwald P, Chindavongsa K, Newton P, Ashley E, Phalivong S, Maude R, Leang R, Huch C, Dong LT, Nguyen KT, Nhat TM, Hien TT, Nguyen H, Zdrojewski N, Canavati S, Sayeed AA, Uddin D, Buckee C, Fanello CI, Onyamboko M, Peto T, Tripura R, Amaratunga C, Myint Thu A, Delmas G, Landier J, Parker DM, Chau NH, Lek D, Suon S, Callery J, Jittamala P, Hanboonkunupakarn B, Pukrittayakamee S, Phyo AP, Smithuis F, Lin K, Thant M, Hlaing TM, Satpathi P, Satpathi S, Behera PK, Tripura A, Baidya S, Valecha N, Anvikar AR, Ul Islam A, Faiz A, Kunasol C, Drury E, Kekre M, Ali M, Love K, Rajatileka S, Jeffreys AE, Rowlands K, Hubbart CS, Dhorda M, Vongpromek R, Kotanan N, Wongnak P, Almagro Garcia J, Pearson RD, Ariani CV, Chookajorn T, Malangone C, Nguyen T, Stalker J, Jeffery B, Keatley J, Johnson KJ, Muddyman D, Chan XHS, Sillitoe J, Amato R, Simpson V, Gonçalves S, Rockett K, Day NP, Dondorp AM, Kwiatkowski DP, Miotto O. Genetic surveillance in the Greater Mekong subregion and South Asia to support malaria control and elimination. eLife 2021; 10:e62997. [PMID: 34372970 PMCID: PMC8354633 DOI: 10.7554/elife.62997] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 09/10/2020] [Accepted: 06/30/2021] [Indexed: 02/04/2023] Open
Abstract
Background National Malaria Control Programmes (NMCPs) currently make limited use of parasite genetic data. We have developed GenRe-Mekong, a platform for genetic surveillance of malaria in the Greater Mekong Subregion (GMS) that enables NMCPs to implement large-scale surveillance projects by integrating simple sample collection procedures in routine public health procedures. Methods Samples from symptomatic patients are processed by SpotMalaria, a high-throughput system that produces a comprehensive set of genotypes comprising several drug resistance markers, species markers and a genomic barcode. GenRe-Mekong delivers Genetic Report Cards, a compendium of genotypes and phenotype predictions used to map prevalence of resistance to multiple drugs. Results GenRe-Mekong has worked with NMCPs and research projects in eight countries, processing 9623 samples from clinical cases. Monitoring resistance markers has been valuable for tracking the rapid spread of parasites resistant to the dihydroartemisinin-piperaquine combination therapy. In Vietnam and Laos, GenRe-Mekong data have provided novel knowledge about the spread of these resistant strains into previously unaffected provinces, informing decision-making by NMCPs. Conclusions GenRe-Mekong provides detailed knowledge about drug resistance at a local level, and facilitates data sharing at a regional level, enabling cross-border resistance monitoring and providing the public health community with valuable insights. The project provides a rich open data resource to benefit the entire malaria community. Funding The GenRe-Mekong project is funded by the Bill and Melinda Gates Foundation (OPP11188166, OPP1204268). Genotyping and sequencing were funded by the Wellcome Trust (098051, 206194, 203141, 090770, 204911, 106698/B/14/Z) and Medical Research Council (G0600718). A proportion of samples were collected with the support of the UK Department for International Development (201900, M006212), and Intramural Research Program of the National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
| | | | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Research Unit (LOMWRU), Microbiology Laboratory, Mahosot HospitalVientianeLao People's Democratic Republic
- Institute of Research and Education Development (IRED), University of Health Sciences, Ministry of HealthVientianeLao People's Democratic Republic
- Centre for Tropical Medicine and Global Health, University of OxfordOxfordUnited Kingdom
| | - Richard J Maude
- Centre for Tropical Medicine and Global Health, University of OxfordOxfordUnited Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkokThailand
- Harvard TH Chan School of Public Health, Harvard UniversityBostonUnited States
| | - Huynh Hong Quang
- Institute of Malariology, Parasitology and Entomology (IMPE-QN)Quy NhonViet Nam
| | - Bouasy Hongvanthong
- Centre of Malariology, Parasitology, and EntomologyVientianeLao People's Democratic Republic
| | - Viengxay Vanisaveth
- Centre of Malariology, Parasitology, and EntomologyVientianeLao People's Democratic Republic
| | - Thang Ngo Duc
- National Institute of Malariology, Parasitology and Entomology (NIMPE)HanoiViet Nam
| | - Huy Rekol
- National Center for Parasitology, Entomology, and Malaria ControlPhnom PenhCambodia
| | - Rob van der Pluijm
- Centre for Tropical Medicine and Global Health, University of OxfordOxfordUnited Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkokThailand
| | - Lorenz von Seidlein
- Centre for Tropical Medicine and Global Health, University of OxfordOxfordUnited Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkokThailand
| | - Rick Fairhurst
- National Institute of Allergy and Infectious Diseases, National Institutes of HealthRockvilleUnited States
| | - François Nosten
- Centre for Tropical Medicine and Global Health, University of OxfordOxfordUnited Kingdom
- Shoklo Malaria Research UnitMae SotThailand
| | | | - Naomi Park
- Wellcome Sanger InstituteHinxtonUnited Kingdom
| | | | | | | | - Paul Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Research Unit (LOMWRU), Microbiology Laboratory, Mahosot HospitalVientianeLao People's Democratic Republic
- Centre for Tropical Medicine and Global Health, University of OxfordOxfordUnited Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkokThailand
| | - Elizabeth Ashley
- Lao-Oxford-Mahosot Hospital-Wellcome Research Unit (LOMWRU), Microbiology Laboratory, Mahosot HospitalVientianeLao People's Democratic Republic
- Centre for Tropical Medicine and Global Health, University of OxfordOxfordUnited Kingdom
| | - Sonexay Phalivong
- Lao-Oxford-Mahosot Hospital-Wellcome Research Unit (LOMWRU), Microbiology Laboratory, Mahosot HospitalVientianeLao People's Democratic Republic
| | - Rapeephan Maude
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkokThailand
- Faculty of Medicine, Ramathibodi Hospital, Mahidol UniversityBangkokThailand
| | - Rithea Leang
- National Center for Parasitology, Entomology, and Malaria ControlPhnom PenhCambodia
| | - Cheah Huch
- National Center for Parasitology, Entomology, and Malaria ControlPhnom PenhCambodia
| | - Le Thanh Dong
- Institute of Malariology, Parasitology and Entomology (IMPEHCM)Ho Chi Minh CityViet Nam
| | - Kim-Tuyen Nguyen
- Oxford University Clinical Research UnitHo Chi Minh CityViet Nam
| | - Tran Minh Nhat
- Oxford University Clinical Research UnitHo Chi Minh CityViet Nam
| | - Tran Tinh Hien
- Oxford University Clinical Research UnitHo Chi Minh CityViet Nam
| | | | | | | | | | - Didar Uddin
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkokThailand
| | - Caroline Buckee
- Harvard TH Chan School of Public Health, Harvard UniversityBostonUnited States
| | - Caterina I Fanello
- Centre for Tropical Medicine and Global Health, University of OxfordOxfordUnited Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkokThailand
| | - Marie Onyamboko
- Kinshasa School of Public Health, University of KinshasaKinshasaDemocratic Republic of the Congo
| | - Thomas Peto
- Centre for Tropical Medicine and Global Health, University of OxfordOxfordUnited Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkokThailand
| | - Rupam Tripura
- Centre for Tropical Medicine and Global Health, University of OxfordOxfordUnited Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkokThailand
| | - Chanaki Amaratunga
- National Institute of Allergy and Infectious Diseases, National Institutes of HealthRockvilleUnited States
| | - Aung Myint Thu
- Centre for Tropical Medicine and Global Health, University of OxfordOxfordUnited Kingdom
- Shoklo Malaria Research UnitMae SotThailand
| | - Gilles Delmas
- Centre for Tropical Medicine and Global Health, University of OxfordOxfordUnited Kingdom
- Shoklo Malaria Research UnitMae SotThailand
| | - Jordi Landier
- Shoklo Malaria Research UnitMae SotThailand
- Aix-Marseille Université, INSERM, IRD, SESSTIM, Aix Marseille Institute of Public Health, ISSPAMMarseilleFrance
| | - Daniel M Parker
- Shoklo Malaria Research UnitMae SotThailand
- Susan and Henry Samueli College of Health Sciences, University of California, IrvineIrvineUnited States
| | | | - Dysoley Lek
- National Center for Parasitology, Entomology, and Malaria ControlPhnom PenhCambodia
| | - Seila Suon
- National Center for Parasitology, Entomology, and Malaria ControlPhnom PenhCambodia
| | - James Callery
- Centre for Tropical Medicine and Global Health, University of OxfordOxfordUnited Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkokThailand
| | | | | | - Sasithon Pukrittayakamee
- Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
- The Royal Society of ThailandBangkokThailand
| | - Aung Pyae Phyo
- Centre for Tropical Medicine and Global Health, University of OxfordOxfordUnited Kingdom
- Myanmar-Oxford Clinical Research UnitYangonMyanmar
| | - Frank Smithuis
- Centre for Tropical Medicine and Global Health, University of OxfordOxfordUnited Kingdom
- Myanmar-Oxford Clinical Research UnitYangonMyanmar
| | - Khin Lin
- Department of Medical ResearchPyin Oo LwinMyanmar
| | - Myo Thant
- Defence Services Medical Research CentreYangonMyanmar
| | | | | | | | | | | | | | - Neena Valecha
- National Institute of Malaria Research, Indian Council of Medical ResearchNew DelhiIndia
| | - Anupkumar R Anvikar
- National Institute of Malaria Research, Indian Council of Medical ResearchNew DelhiIndia
| | | | - Abul Faiz
- Malaria Research Group and Dev Care FoundationDhakaBangladesh
| | - Chanon Kunasol
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkokThailand
| | | | - Mihir Kekre
- Wellcome Sanger InstituteHinxtonUnited Kingdom
| | - Mozam Ali
- Wellcome Sanger InstituteHinxtonUnited Kingdom
| | - Katie Love
- Wellcome Sanger InstituteHinxtonUnited Kingdom
| | | | - Anna E Jeffreys
- Wellcome Trust Centre for Human Genetics, University of OxfordOxfordUnited Kingdom
| | - Kate Rowlands
- Wellcome Trust Centre for Human Genetics, University of OxfordOxfordUnited Kingdom
| | - Christina S Hubbart
- Wellcome Trust Centre for Human Genetics, University of OxfordOxfordUnited Kingdom
| | - Mehul Dhorda
- Centre for Tropical Medicine and Global Health, University of OxfordOxfordUnited Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkokThailand
- Worldwide Antimalarial Resistance Network (WWARN), Asia Regional CentreBangkokThailand
| | - Ranitha Vongpromek
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkokThailand
- Worldwide Antimalarial Resistance Network (WWARN), Asia Regional CentreBangkokThailand
| | - Namfon Kotanan
- Faculty of Tropical Medicine, Mahidol UniversityBangkokThailand
| | - Phrutsamon Wongnak
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkokThailand
| | - Jacob Almagro Garcia
- MRC Centre for Genomics and Global Health, Big Data Institute, Oxford UniversityOxfordUnited Kingdom
| | - Richard D Pearson
- Wellcome Sanger InstituteHinxtonUnited Kingdom
- MRC Centre for Genomics and Global Health, Big Data Institute, Oxford UniversityOxfordUnited Kingdom
| | | | | | | | - T Nguyen
- Wellcome Sanger InstituteHinxtonUnited Kingdom
| | - Jim Stalker
- Wellcome Sanger InstituteHinxtonUnited Kingdom
| | - Ben Jeffery
- MRC Centre for Genomics and Global Health, Big Data Institute, Oxford UniversityOxfordUnited Kingdom
| | | | - Kimberly J Johnson
- Wellcome Sanger InstituteHinxtonUnited Kingdom
- MRC Centre for Genomics and Global Health, Big Data Institute, Oxford UniversityOxfordUnited Kingdom
| | | | - Xin Hui S Chan
- Centre for Tropical Medicine and Global Health, University of OxfordOxfordUnited Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkokThailand
| | | | | | - Victoria Simpson
- Wellcome Sanger InstituteHinxtonUnited Kingdom
- MRC Centre for Genomics and Global Health, Big Data Institute, Oxford UniversityOxfordUnited Kingdom
| | | | - Kirk Rockett
- Wellcome Sanger InstituteHinxtonUnited Kingdom
- Wellcome Trust Centre for Human Genetics, University of OxfordOxfordUnited Kingdom
| | - Nicholas P Day
- Centre for Tropical Medicine and Global Health, University of OxfordOxfordUnited Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkokThailand
| | - Arjen M Dondorp
- Centre for Tropical Medicine and Global Health, University of OxfordOxfordUnited Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkokThailand
| | - Dominic P Kwiatkowski
- Wellcome Sanger InstituteHinxtonUnited Kingdom
- MRC Centre for Genomics and Global Health, Big Data Institute, Oxford UniversityOxfordUnited Kingdom
| | - Olivo Miotto
- Wellcome Sanger InstituteHinxtonUnited Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol UniversityBangkokThailand
- MRC Centre for Genomics and Global Health, Big Data Institute, Oxford UniversityOxfordUnited Kingdom
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Landier J, Paireau J, Rebaudet S, Legendre E, Lehot L, Fontanet A, Cauchemez S, Gaudart J. Cold and dry winter conditions are associated with greater SARS-CoV-2 transmission at regional level in western countries during the first epidemic wave. Sci Rep 2021; 11:12756. [PMID: 34140557 PMCID: PMC8211690 DOI: 10.1038/s41598-021-91798-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 02/04/2021] [Accepted: 06/01/2021] [Indexed: 12/23/2022] Open
Abstract
Higher transmissibility of SARS-CoV-2 in cold and dry weather conditions has been hypothesized since the onset of the COVID-19 pandemic but the level of epidemiological evidence remains low. During the first wave of the pandemic, Spain, Italy, France, Portugal, Canada and USA presented an early spread, a heavy COVID-19 burden, and low initial public health response until lockdowns. In a context when testing was limited, we calculated the basic reproduction number (R0) in 63 regions from the growth in regional death counts. After adjusting for population density, early spread of the epidemic, and age structure, temperature and humidity were negatively associated with SARS-CoV-2 transmissibility. A reduction of mean absolute humidity by 1 g/m3 was associated with a 0.15-unit increase of R0. Below 10 °C, a temperature reduction of 1 °C was associated with a 0.16-unit increase of R0. Our results confirm a dependency of SARS-CoV-2 transmissibility to weather conditions in the absence of control measures during the first wave. The transition from summer to winter, corresponding to drop in temperature associated with an overall decrease in absolute humidity, likely contributed to the intensification of the second wave in north-west hemisphere countries. Non-pharmaceutical interventions must be adjusted to account for increased transmissibility in winter conditions.
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Affiliation(s)
- Jordi Landier
- IRD, Aix Marseille Univ, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France.
| | - Juliette Paireau
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR2000, CNRS, Paris, France.,Santé publique France, French National Public Health Agency, Saint Maurice, France
| | - Stanislas Rebaudet
- IRD, Aix Marseille Univ, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France.,Hôpital Européen Marseille, Marseille, France
| | - Eva Legendre
- IRD, Aix Marseille Univ, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
| | - Laurent Lehot
- IRD, Aix Marseille Univ, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
| | - Arnaud Fontanet
- Emerging Infectious Diseases Unit, Institut Pasteur, Paris, France.,PACRI Unit, Conservatoire National des Arts et Métiers, Paris, France
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR2000, CNRS, Paris, France
| | - Jean Gaudart
- Aix Marseille Univ, APHM, INSERM, IRD, SESSTIM, ISSPAM, Hop Timone, BioSTIC, Marseille, France
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Legendre E, Landier J, Lehot L, Dieng S, Thu A, Drae J, Delmas G, Girond F, Herbreteau V, Nosten F, Gaudart J. Classification de dynamiques temporelles de paludisme à l’échelle du village dans le cadre d’un programme d’élimination du paludisme. Rev Epidemiol Sante Publique 2021. [DOI: 10.1016/j.respe.2021.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Gaudart J, Landier J, Huiart L, Legendre E, Lehot L, Bendiane MK, Chiche L, Petitjean A, Mosnier E, Kirakoya-Samadoulougou F, Demongeot J, Piarroux R, Rebaudet S. Factors associated with the spatial heterogeneity of the first wave of COVID-19 in France: a nationwide geo-epidemiological study. Lancet Public Health 2021; 6:e222-e231. [PMID: 33556327 PMCID: PMC7864788 DOI: 10.1016/s2468-2667(21)00006-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [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: 10/04/2020] [Revised: 12/18/2020] [Accepted: 01/05/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The objective of this study was to better understand the factors associated with the heterogeneity of in-hospital COVID-19 morbidity and mortality across France, one of the countries most affected by COVID-19 in the early months of the pandemic. METHODS This geo-epidemiological analysis was based on data publicly available on government and administration websites for the 96 administrative departments of metropolitan France between March 19 and May 11, 2020, including Public Health France, the Regional Health Agencies, the French national statistics institute, and the Ministry of Health. Using hierarchical ascendant classification on principal component analysis of multidimensional variables, and multivariate analyses with generalised additive models, we assessed the associations between several factors (spatiotemporal spread of the epidemic between Feb 7 and March 17, 2020, the national lockdown, demographic population structure, baseline intensive care capacities, baseline population health and health-care services, new chloroquine and hydroxychloroquine dispensations, economic indicators, degree of urbanisation, and climate profile) and in-hospital COVID-19 incidence, mortality, and case fatality rates. Incidence rate was defined as the cumulative number of in-hospital COVID-19 cases per 100 000 inhabitants, mortality rate as the cumulative number of in-hospital COVID-19 deaths per 100 000, and case fatality rate as the cumulative number of in-hospital COVID-19 deaths per cumulative number of in-hospital COVID-19 cases. FINDINGS From March 19 to May 11, 2020, hospitals in metropolitan France notified a total of 100 988 COVID-19 cases, including 16 597 people who were admitted to intensive care and 17 062 deaths. There was an overall cumulative in-hospital incidence rate of 155·6 cases per 100 000 inhabitants (range 19·4-489·5), in-hospital mortality rate of 26·3 deaths per 100 000 (1·1-119·2), and in-hospital case fatality rate of 16·9% (4·8-26·2). We found clear spatial heterogeneity of in-hospital COVID-19 incidence and mortality rates, following the spread of the epidemic. After multivariate adjustment, the delay between the first COVID-19-associated death and the onset of the national lockdown was positively associated with in-hospital incidence (adjusted standardised incidence ratio 1·02, 95% CI 1·01-1·04), mortality (adjusted standardised mortality ratio 1·04, 1·02-1·06), and case fatality rates (adjusted standardised fatality ratio 1·01, 1·01-1·02). Mortality and case fatality rates were higher in departments with older populations (adjusted standardised ratio for populations with a high proportion older than aged >85 years 2·17 [95% CI 1·20-3·90] for mortality and 1·43 [1·08-1·88] for case fatality rate). Mortality rate was also associated with incidence rate (1·0004, 1·0002-1·001), but mortality and case fatality rates did not appear to be associated with baseline intensive care capacities. We found no association between climate and in-hospital COVID-19 incidence, or between economic indicators and in-hospital COVID-19 incidence or mortality rates. INTERPRETATION This ecological study highlights the impact of the epidemic spread, national lockdown, and reactive adaptation of intensive care capacities on the spatial distribution of COVID-19 morbidity and mortality. It provides information for future geo-epidemiological analyses and has implications for preparedness and response policies to current and future epidemic waves in France and elsewhere. FUNDING None.
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Affiliation(s)
- Jean Gaudart
- Aix Marseille University, National Institute of Health and Medical Research (INSERM), Institute of Research for Development (IRD), Economic and Social Sciences for Health and Medical Information Processing (SESSTIM), UMR1252, Marseille, France; Public Assistance Marseille Hospitals (APHM), Biostatistics and Information and Communication Technologies Service (BioSTIC), Marseille, France.
| | - Jordi Landier
- Aix Marseille University, National Institute of Health and Medical Research (INSERM), Institute of Research for Development (IRD), Economic and Social Sciences for Health and Medical Information Processing (SESSTIM), UMR1252, Marseille, France
| | | | - Eva Legendre
- Aix Marseille University, National Institute of Health and Medical Research (INSERM), Institute of Research for Development (IRD), Economic and Social Sciences for Health and Medical Information Processing (SESSTIM), UMR1252, Marseille, France
| | - Laurent Lehot
- Aix Marseille University, National Institute of Health and Medical Research (INSERM), Institute of Research for Development (IRD), Economic and Social Sciences for Health and Medical Information Processing (SESSTIM), UMR1252, Marseille, France
| | - Marc Karim Bendiane
- Aix Marseille University, National Institute of Health and Medical Research (INSERM), Institute of Research for Development (IRD), Economic and Social Sciences for Health and Medical Information Processing (SESSTIM), UMR1252, Marseille, France
| | - Laurent Chiche
- Internal Medicine and Clinical Research Unit, European Hospital Marseille, Marseille, France
| | - Aliette Petitjean
- Aix Marseille University, National Institute of Health and Medical Research (INSERM), Institute of Research for Development (IRD), Economic and Social Sciences for Health and Medical Information Processing (SESSTIM), UMR1252, Marseille, France
| | - Emilie Mosnier
- Aix Marseille University, National Institute of Health and Medical Research (INSERM), Institute of Research for Development (IRD), Economic and Social Sciences for Health and Medical Information Processing (SESSTIM), UMR1252, Marseille, France
| | - Fati Kirakoya-Samadoulougou
- Research Centre for Epidemiology, Biostatistics, and Research Clinic, School of Public Health, Free University of Brussels, Brussels, Belgium
| | | | - Renaud Piarroux
- Sorbonne University, INSERM, Pierre-Louis Institute of Epidemiology and Public Health (IPLESP), AP-HP, Laboratory of Parasitology and Mycologie, Pitié-Salpêtrière Hospital, Paris, France
| | - Stanislas Rebaudet
- European Hospital Marseille, Aix-Marseille University, INSERM, IRD, SESSTIM, IPLESP, Marseille, France
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Menu E, Landier J, Prudent E, Ranque S, L’Ollivier C. Evaluation of 11 DNA Automated Extraction Protocols for the Detection of the 5 Mains Candida Species from Artificially Spiked Blood. J Fungi (Basel) 2021; 7:jof7030228. [PMID: 33808911 PMCID: PMC8003619 DOI: 10.3390/jof7030228] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 01/08/2023] Open
Abstract
The molecular detection of Candida plays an important role in the diagnosis of candidaemia, a major cause of morbidity and mortality. The sensitivity of this diagnosis is partly related to the efficiency of yeast DNA extraction. In this monocentric study, we investigated the suitability of 11 recent automated procedures for the extraction of low and high amounts of Candida DNA from spiked blood. The efficacy of the DNA extraction procedures to detect Candida spp. in blood samples ranged from 31.4% to 80.6%. The NucliSENSTM easyMAGTM procedure was the most efficient, for each species and each inoculum. It significantly outperformed the other procedures at the lower Candida inocula mimicking the clinical setting. This study highlighted a heterogeneity in DNA extraction efficacy between the five main Candida species (Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis and Candida krusei). Up to five automated procedures were appropriate for C. krusei DNA extraction, whereas only one method yielded an appropriate detection of low amount of C. tropicalis. In the era of the syndromic approach to bloodstream infection diagnosis, this evaluation of 11 automated DNA extraction methods for the PCR diagnosis of candidaemia, puts the choice of an appropriate method in routine diagnosis within the reach of laboratories.
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Affiliation(s)
- Estelle Menu
- Institut de Recherche pour le Développement, Aix Marseille Université, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME: Vecteurs—Infections Tropicales et Méditerranéennes, 13385 Marseille, France; (S.R.); (C.L.)
- IHU Méditerranée Infection, 13385 Marseille, France;
- Correspondence:
| | - Jordi Landier
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Institut de Recherche pour le Développement, Institut National de Santé et de Recherche Médicale, Aix Marseille Université, 13385 Marseille, France;
| | - Elsa Prudent
- IHU Méditerranée Infection, 13385 Marseille, France;
| | - Stéphane Ranque
- Institut de Recherche pour le Développement, Aix Marseille Université, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME: Vecteurs—Infections Tropicales et Méditerranéennes, 13385 Marseille, France; (S.R.); (C.L.)
- IHU Méditerranée Infection, 13385 Marseille, France;
| | - Coralie L’Ollivier
- Institut de Recherche pour le Développement, Aix Marseille Université, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME: Vecteurs—Infections Tropicales et Méditerranéennes, 13385 Marseille, France; (S.R.); (C.L.)
- IHU Méditerranée Infection, 13385 Marseille, France;
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Mosnier E, Djossou F, Priam R, Carbunar A, Demar M, Landier J, Roux E, Gaudart J, Lazrek Y, Musset L. Profil épidémiologique des infections à Plasmodium vivax dans une région endémique en Guyane, étude de cohorte, 2007–2018. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Stresman G, Sepúlveda N, Fornace K, Grignard L, Mwesigwa J, Achan J, Miller J, Bridges DJ, Eisele TP, Mosha J, Lorenzo PJ, Macalinao ML, Espino FE, Tadesse F, Stevenson JC, Quispe AM, Siqueira A, Lacerda M, Yeung S, Sovannaroth S, Pothin E, Gallay J, Hamre KE, Young A, Lemoine JF, Chang MA, Phommasone K, Mayxay M, Landier J, Parker DM, Von Seidlein L, Nosten F, Delmas G, Dondorp A, Cameron E, Battle K, Bousema T, Gething P, D'Alessandro U, Drakeley C. Association between the proportion of Plasmodium falciparum and Plasmodium vivax infections detected by passive surveillance and the magnitude of the asymptomatic reservoir in the community: a pooled analysis of paired health facility and community data. Lancet Infect Dis 2020; 20:953-963. [PMID: 32277908 PMCID: PMC7391005 DOI: 10.1016/s1473-3099(20)30059-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/23/2020] [Accepted: 01/28/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Passively collected malaria case data are the foundation for public health decision making. However, because of population-level immunity, infections might not always be sufficiently symptomatic to prompt individuals to seek care. Understanding the proportion of all Plasmodium spp infections expected to be detected by the health system becomes particularly paramount in elimination settings. The aim of this study was to determine the association between the proportion of infections detected and transmission intensity for Plasmodium falciparum and Plasmodium vivax in several global endemic settings. METHODS The proportion of infections detected in routine malaria data, P(Detect), was derived from paired household cross-sectional survey and routinely collected malaria data within health facilities. P(Detect) was estimated using a Bayesian model in 431 clusters spanning the Americas, Africa, and Asia. The association between P(Detect) and malaria prevalence was assessed using log-linear regression models. Changes in P(Detect) over time were evaluated using data from 13 timepoints over 2 years from The Gambia. FINDINGS The median estimated P(Detect) across all clusters was 12·5% (IQR 5·3-25·0) for P falciparum and 10·1% (5·0-18·3) for P vivax and decreased as the estimated log-PCR community prevalence increased (adjusted odds ratio [OR] for P falciparum 0·63, 95% CI 0·57-0·69; adjusted OR for P vivax 0·52, 0·47-0·57). Factors associated with increasing P(Detect) included smaller catchment population size, high transmission season, improved care-seeking behaviour by infected individuals, and recent increases (within the previous year) in transmission intensity. INTERPRETATION The proportion of all infections detected within health systems increases once transmission intensity is sufficiently low. The likely explanation for P falciparum is that reduced exposure to infection leads to lower levels of protective immunity in the population, increasing the likelihood that infected individuals will become symptomatic and seek care. These factors might also be true for P vivax but a better understanding of the transmission biology is needed to attribute likely reasons for the observed trend. In low transmission and pre-elimination settings, enhancing access to care and improvements in care-seeking behaviour of infected individuals will lead to an increased proportion of infections detected in the community and might contribute to accelerating the interruption of transmission. FUNDING Wellcome Trust.
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Affiliation(s)
- Gillian Stresman
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Nuno Sepúlveda
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK; Centre of Statistics and Its Applications, University of Lisbon, Lisbon, Portugal
| | - Kimberly Fornace
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Lynn Grignard
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Julia Mwesigwa
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia; Department of Global Health, University of Antwerp, Antwerp, Belgium
| | - Jane Achan
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - John Miller
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Elimination Centre, Ministry of Health, Chainama Grounds Lusaka, Zambia
| | - Daniel J Bridges
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Elimination Centre, Ministry of Health, Chainama Grounds Lusaka, Zambia
| | - Thomas P Eisele
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Jacklin Mosha
- National Institute for Medical Research, Mwanza Medical Research Centre, Mwanza, Tanzania
| | - Pauline Joy Lorenzo
- Department of Parasitology, Research Institute for Tropical Medicine, Research Drive, Alabang, Muntinlupa, Metro Manila, Philippines
| | - Maria Lourdes Macalinao
- Department of Parasitology, Research Institute for Tropical Medicine, Research Drive, Alabang, Muntinlupa, Metro Manila, Philippines
| | - Fe Esperanza Espino
- Department of Parasitology, Research Institute for Tropical Medicine, Research Drive, Alabang, Muntinlupa, Metro Manila, Philippines
| | - Fitsum Tadesse
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jennifer C Stevenson
- Macha Research Trust, Choma District, Zambia; Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - André Siqueira
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil; Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil; Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Marcus Lacerda
- Fundacao de Medicine Tropical Dr. Heitor Viera Dourado, Manaus, Brazil; Institutos Nacionais de Ciencia e Technologia (INCT), Instituto Elimina, Manaus, Brazil
| | - Shunmay Yeung
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Siv Sovannaroth
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Emilie Pothin
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland; Clinton Health Access Initiative, Boston, MA, USA
| | - Joanna Gallay
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Karen E Hamre
- Centers for Disease Control and Prevention, Center for Global Health, Division of Parasitic Diseases and Malaria, Malaria Branch, Atlanta, GA, USA; CDC Foundation, Atlanta, GA, USA
| | - Alyssa Young
- Clinton Health Access Initiative, Port-au-Prince, Haiti
| | - Jean Frantz Lemoine
- Programme National de Contrôle de la Malaria, Ministère de la Santé Publique et de la Population (MSPP), Port-au-Prince, Haiti
| | - Michelle A Chang
- Centers for Disease Control and Prevention, Center for Global Health, Division of Parasitic Diseases and Malaria, Malaria Branch, Atlanta, GA, USA
| | - Koukeo Phommasone
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Institute of Research and Education Development, University of Health Sciences, Vientiane, Laos
| | - Jordi Landier
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Marseille, France
| | - Daniel M Parker
- Department of Population Health and Disease Prevention and Department of Epidemiology, University of California, Irvine, CA, USA
| | - Lorenz Von Seidlein
- Oxford Tropical Medicine Research Unit, Mahidol University Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Francois Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Shoklo Malaria Research Unit, Mae Sot, Thailand
| | - Gilles Delmas
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Shoklo Malaria Research Unit, Mae Sot, Thailand
| | - Arjen Dondorp
- Oxford Tropical Medicine Research Unit, Mahidol University Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ewan Cameron
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA, Australia; Curtin University, Bentley, WA, Australia
| | | | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Peter Gething
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA, Australia; Curtin University, Bentley, WA, Australia
| | - Umberto D'Alessandro
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK; Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
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28
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Dieng S, Ba EH, Cissé B, Sallah K, Guindo A, Ouedraogo B, Piarroux M, Rebaudet S, Piarroux R, Landier J, Sokhna C, Gaudart J. Spatio-temporal variation of malaria hotspots in Central Senegal, 2008-2012. BMC Infect Dis 2020; 20:424. [PMID: 32552759 PMCID: PMC7301493 DOI: 10.1186/s12879-020-05145-w] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 06/10/2020] [Indexed: 12/01/2022] Open
Abstract
Background In malaria endemic areas, identifying spatio-temporal hotspots is becoming an important element of innovative control strategies targeting transmission bottlenecks. The aim of this work was to describe the spatio-temporal variation of malaria hotspots in central Senegal and to identify the meteorological, environmental, and preventive factors that influence this variation. Methods This study analysed the weekly incidence of malaria cases recorded from 2008 to 2012 in 575 villages of central Senegal (total population approximately 500,000) as part of a trial of seasonal malaria chemoprevention (SMC). Data on weekly rainfall and annual vegetation types were obtained for each village through remote sensing. The time series of weekly malaria incidence for the entire study area was divided into periods of high and low transmission using change-point analysis. Malaria hotspots were detected during each transmission period with the SaTScan method. The effects of rainfall, vegetation type, and SMC intervention on the spatio-temporal variation of malaria hotspots were assessed using a General Additive Mixed Model. Results The malaria incidence for the entire area varied between 0 and 115.34 cases/100,000 person weeks during the study period. During high transmission periods, the cumulative malaria incidence rate varied between 7.53 and 38.1 cases/100,000 person-weeks, and the number of hotspot villages varied between 62 and 147. During low transmission periods, the cumulative malaria incidence rate varied between 0.83 and 2.73 cases/100,000 person-weeks, and the number of hotspot villages varied between 10 and 43. Villages with SMC were less likely to be hotspots (OR = 0.48, IC95%: 0.33–0.68). The association between rainfall and hotspot status was non-linear and depended on both vegetation type and amount of rainfall. The association between village location in the study area and hotspot status was also shown. Conclusion In our study, malaria hotspots varied over space and time according to a combination of meteorological, environmental, and preventive factors. By taking into consideration the environmental and meteorological characteristics common to all hotspots, monitoring of these factors could lead targeted public health interventions at the local level. Moreover, spatial hotspots and foci of malaria persisting during LTPs need to be further addressed. Trial registration The data used in this work were obtained from a clinical trial registered on July 10, 2008 at www.clinicaltrials.gov under NCT00712374.
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Affiliation(s)
- Sokhna Dieng
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Marseille, France. .,Ecole des Hautes Etudes en Santé Publique, Rennes, France.
| | - El Hadj Ba
- UMR VITROME, Campus International IRD-UCAD de l'IRD, Dakar, Sénégal
| | - Badara Cissé
- Institut de Recherche en Santé, de Surveillance Épidémiologique et de Formation (IRESSEF) Diamniadio, Dakar, Sénégal
| | - Kankoe Sallah
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Marseille, France.,AP-HP, Hôpital Bichat, Unité de Recherche Clinique PNVS, Paris, France
| | - Abdoulaye Guindo
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Marseille, France.,Research and Training Center - Ogobara K Doumbo, FMOS-FAPH, Mali-NIAID-ICER, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Boukary Ouedraogo
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Marseille, France.,Direction des Systèmes d'Information en santé, Ministère de la santé, Ouagadougou, Burkina Faso
| | - Martine Piarroux
- French Armed Forces Center for Epidemiology and Public Health (CESPA), Marseille, France
| | - Stanislas Rebaudet
- APHM, Assistance Publique - Hôpitaux de Marseille, Marseille, France.,Hôpital Européen, Marseille, France
| | - Renaud Piarroux
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jordi Landier
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Marseille, France
| | - Cheikh Sokhna
- UMR VITROME, Campus International IRD-UCAD de l'IRD, Dakar, Sénégal
| | - Jean Gaudart
- Aix Marseille Univ, APHM, INSERM, IRD, SESSTIM, Hop Timone, BioSTIC, Biostatistic & ICT, Marseille, France
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29
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Cissoko M, Sagara I, Sankaré MH, Dieng S, Guindo A, Doumbia Z, Allasseini B, Traore D, Fomba S, Bendiane MK, Landier J, Dessay N, Gaudart J. Geo-Epidemiology of Malaria at the Health Area Level, Dire Health District, Mali, 2013-2017. Int J Environ Res Public Health 2020; 17:E3982. [PMID: 32512740 PMCID: PMC7312793 DOI: 10.3390/ijerph17113982] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 12/28/2022]
Abstract
Background: According to the World Health Organization, there were more than 228 million cases of malaria globally in 2018, with 93% of cases occurring in Africa; in Mali, a 13% increase in the number of cases was observed between 2015 and 2018; this study aimed to evaluate the impact of meteorological and environmental factors on the geo-epidemiology of malaria in the health district of Dire, Mali. Methods: Meteorological and environmental variables were synthesized using principal component analysis and multiple correspondence analysis, the relationship between malaria incidence and synthetic indicators was determined using a multivariate general additive model; hotspots were detected by SaTScan. Results: Malaria incidence showed high inter and intra-annual variability; the period of high transmission lasted from September to February; health areas characterized by proximity to the river, propensity for flooding and high agricultural yield were the most at risk, with an incidence rate ratio of 2.21 with confidence intervals (95% CI: 1.85-2.58); malaria incidence in Dire declined from 120 to 20 cases per 10,000 person-weeks between 2013 and 2017. Conclusion: The identification of areas and periods of high transmission can help improve malaria control strategies.
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Affiliation(s)
- Mady Cissoko
- Malaria Research and Training Center—Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako 1805, Mali; (I.S.); (A.G.); (J.G.)
- Aix Marseille Université (AMU), Institut national de la santé et de la recherche médicale (INSERM), Institut de Recherche pour le Développement (IRD), 13005 Marseille, France; (S.D.); (M.K.B.); (J.L.)
- Direction Régionale de la Santé de Tombouctou, Tombouctou 59, Mali; (M.H.S.); (Z.D.); (B.A.)
| | - Issaka Sagara
- Malaria Research and Training Center—Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako 1805, Mali; (I.S.); (A.G.); (J.G.)
- Aix Marseille Université (AMU), Institut national de la santé et de la recherche médicale (INSERM), Institut de Recherche pour le Développement (IRD), 13005 Marseille, France; (S.D.); (M.K.B.); (J.L.)
| | - Moussa H. Sankaré
- Direction Régionale de la Santé de Tombouctou, Tombouctou 59, Mali; (M.H.S.); (Z.D.); (B.A.)
| | - Sokhna Dieng
- Aix Marseille Université (AMU), Institut national de la santé et de la recherche médicale (INSERM), Institut de Recherche pour le Développement (IRD), 13005 Marseille, France; (S.D.); (M.K.B.); (J.L.)
| | - Abdoulaye Guindo
- Malaria Research and Training Center—Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako 1805, Mali; (I.S.); (A.G.); (J.G.)
- Mère et Enfant face aux Infections Tropicales (MERIT), IRD, Université Paris 5, 75006 Paris, France
| | - Zoumana Doumbia
- Direction Régionale de la Santé de Tombouctou, Tombouctou 59, Mali; (M.H.S.); (Z.D.); (B.A.)
| | - Balam Allasseini
- Direction Régionale de la Santé de Tombouctou, Tombouctou 59, Mali; (M.H.S.); (Z.D.); (B.A.)
| | - Diahara Traore
- Programme National de la Lutte contre le Paludisme (PNLP Mali), Bamako 233, Mali; (D.T.); (S.F.)
| | - Seydou Fomba
- Programme National de la Lutte contre le Paludisme (PNLP Mali), Bamako 233, Mali; (D.T.); (S.F.)
| | - Marc Karim Bendiane
- Aix Marseille Université (AMU), Institut national de la santé et de la recherche médicale (INSERM), Institut de Recherche pour le Développement (IRD), 13005 Marseille, France; (S.D.); (M.K.B.); (J.L.)
| | - Jordi Landier
- Aix Marseille Université (AMU), Institut national de la santé et de la recherche médicale (INSERM), Institut de Recherche pour le Développement (IRD), 13005 Marseille, France; (S.D.); (M.K.B.); (J.L.)
| | - Nadine Dessay
- ESPACE-DEV, UMR228 IRD/UM/UR/UG/UA, Institut de Recherche pour le Développement (IRD), 34093 Montpellier, France;
| | - Jean Gaudart
- Malaria Research and Training Center—Ogobara K. Doumbo (MRTC-OKD), FMOS-FAPH, Mali-NIAID-ICER, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako 1805, Mali; (I.S.); (A.G.); (J.G.)
- Aix Marseille Université, APHM, INSERM, IRD, SESSTIM, Hop Timone, BioSTIC, Biostatistic & ICT, 13005 Marseille, France
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30
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Phommasone K, van Leth F, Peto TJ, Landier J, Nguyen TN, Tripura R, Pongvongsa T, Lwin KM, Kajeechiwa L, Thwin MM, Parker DM, Wiladphaingern J, Nosten S, Proux S, Nguon C, Davoeung C, Rekol H, Adhikari B, Promnarate C, Chotivanich K, Hanboonkunupakarn B, Jittmala P, Cheah PY, Dhorda M, Imwong M, Mukaka M, Peerawaranun P, Pukrittayakamee S, Newton PN, Thwaites GE, Day NPJ, Mayxay M, Hien TT, Nosten FH, Cobelens F, Dondorp AM, White NJ, von Seidlein L. Mass drug administrations with dihydroartemisinin-piperaquine and single low dose primaquine to eliminate Plasmodium falciparum have only a transient impact on Plasmodium vivax: Findings from randomised controlled trials. PLoS One 2020; 15:e0228190. [PMID: 32023293 PMCID: PMC7001954 DOI: 10.1371/journal.pone.0228190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/21/2019] [Accepted: 01/08/2020] [Indexed: 11/30/2022] Open
Abstract
Background Mass administrations of antimalarial drugs (MDA) have reduced the incidence and prevalence of P. falciparum infections in a trial in the Greater Mekong Subregion. Here we assess the impact of the MDA on P. vivax infections. Methods Between May 2013 and July 2017, four villages in each Myanmar, Vietnam, Cambodia and Lao PDR were selected based on high prevalence of P. falciparum infections. Eight of the 16 villages were randomly assigned to receive MDA consisting of three-monthly rounds of three-day courses of dihydroartemisinin-piperaquine and, except in Cambodia, a single low-dose of primaquine. Cross-sectional surveys were conducted at quarterly intervals to detect Plasmodium infections using ultrasensitive qPCR. The difference in the cumulative incidence between the groups was assessed through a discrete time survival approach, the difference in prevalence through a difference-in-difference analysis, and the difference in the number of participants with a recurrence of P. vivax infection through a mixed-effect logistic regression. Results 3,790 (86%) residents in the intervention villages participated in at least one MDA round, of whom 2,520 (57%) participated in three rounds. The prevalence of P. vivax infections fell from 9.31% to 0.89% at month 3 but rebounded by six months to 5.81%. There was no evidence that the intervention reduced the cumulative incidence of P.vivax infections (95% confidence interval [CI] Odds ratio (OR): 0.29 to 1.36). Similarly, there was no evidence of MDA related reduction in the number of participants with at least one recurrent infection (OR: 0.34; 95% CI: 0.08 to 1.42). Conclusion MDA with schizontocidal drugs had a lasting effect on P. falciparum infections but only a transient effect on the prevalence of P. vivax infections. Radical cure with an 8-aminoquinoline will be needed for the rapid elimination of vivax malaria.
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Affiliation(s)
- Koukeo Phommasone
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
- Department of Global Health, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, Netherlands
- Amsterdam Institute for Global Health & Development, Amsterdam, Netherlands
| | - Frank van Leth
- Department of Global Health, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, Netherlands
- Amsterdam Institute for Global Health & Development, Amsterdam, Netherlands
| | - Thomas J. Peto
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
| | - Jordi Landier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Institut de Recherche pour le Développement (IRD), Institut national de la santé et de la recherche médical (INSERM), Aix-Marseille Université · SESSTIM, Marseille, France
| | - Thuy-Nhien Nguyen
- Oxford University Clinical Research Unit, Wellcome Trust Major Oversea Programme, Ho Chi Minh City, Vietnam
| | - Rupam Tripura
- Department of Global Health, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, Netherlands
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
| | - Tiengkham Pongvongsa
- Savannakhet Provincial Health Department, Savannakhet Province, Lao People’s Demographic Republic
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Khin Maung Lwin
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Ladda Kajeechiwa
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - May Myo Thwin
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Daniel M. Parker
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Department of Population Health and Disease Prevention, University of California, Irvine, California, United States of America
| | - Jacher Wiladphaingern
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Suphak Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Stephane Proux
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Chea Nguon
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | | | - Huy Rekol
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Bipin Adhikari
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
| | - Cholrawee Promnarate
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Worldwide Antimalarial Resistance Network (WWARN) Asia Regional Centre, Mahidol University, Bangkok, Thailand
| | - Kesinee Chotivanich
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Borimas Hanboonkunupakarn
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Podjanee Jittmala
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
| | - Mehul Dhorda
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Worldwide Antimalarial Resistance Network (WWARN) Asia Regional Centre, Mahidol University, Bangkok, Thailand
| | - Mallika Imwong
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
| | - Pimnara Peerawaranun
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sasithon Pukrittayakamee
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- The Royal Society of Thailand, Dusit, Bangkok, Thailand
| | - Paul N. Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
| | - Guy E. Thwaites
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
- Oxford University Clinical Research Unit, Wellcome Trust Major Oversea Programme, Ho Chi Minh City, Vietnam
| | - Nicholas P. J. Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao People’s Demographic Republic
| | - Tran Tinh Hien
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
- Oxford University Clinical Research Unit, Wellcome Trust Major Oversea Programme, Ho Chi Minh City, Vietnam
| | - Francois H. Nosten
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Frank Cobelens
- Department of Global Health, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, Netherlands
- Amsterdam Institute for Global Health & Development, Amsterdam, Netherlands
| | - Arjen M. Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
| | - Nicholas J. White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
| | - Lorenz von Seidlein
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, England, United Kingdom
- * E-mail:
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Wouda EMN, Thielemans L, Darakamon MC, Nge AA, Say W, Khing S, Hanboonkunupakarn B, Ngerseng T, Landier J, van Rheenen PF, Turner C, Nosten F, McGready R, Carrara VI. Extreme neonatal hyperbilirubinaemia in refugee and migrant populations: retrospective cohort. BMJ Paediatr Open 2020; 4:e000641. [PMID: 32537522 PMCID: PMC7264833 DOI: 10.1136/bmjpo-2020-000641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/14/2020] [Accepted: 04/27/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To describe neonatal survival and long-term neurological outcome in neonatal hyperbilirubinaemia (NH) with extreme serum bilirubin (SBR) values. DESIGN Retrospective chart review, a one-off neurodevelopmental evaluation. SETTING Special care baby unit in a refugee camp and clinics for migrant populations at the Thailand-Myanmar border with phototherapy facilities but limited access to exchange transfusion (ET). PATIENTS Neonates ≥28 weeks of gestational age with extreme SBR values and/or acute neurological symptoms, neurodevelopment evaluation conducted at 23-97 months of age. MAIN OUTCOME MEASURES Neonatal mortality rate, prevalence of acute bilirubin encephalopathy (ABE) signs, prevalence of delayed development scores based on the Griffiths Mental Development Scale (GMDS). RESULTS From 2009 to 2014, 1946 neonates were diagnosed with jaundice; 129 (6.6%) had extreme SBR values during NH (extreme NH). In this group, the median peak SBR was 430 (IQR 371-487) µmol/L and the prevalence of ABE was 28.2%. Extreme NH-related mortality was 10.9% (14/129). Median percentile GMDS general score of 37 survivors of extreme NH was poor: 11 (2-42). 'Performance', 'practical reasoning' and 'hearing and language' domains were most affected. Four (10.8%) extreme NH survivors had normal development scores (≥50th centile). Two (5.4%) developed the most severe form of kernicterus spectrum disorders. CONCLUSION In this limited-resource setting, poor neonatal survival and neurodevelopmental outcomes, after extreme NH, were high. Early identification and adequate treatment of NH where ET is not readily available are key to minimising the risk of extreme SBR values or neurological symptoms.
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Affiliation(s)
- Eva Maria Nadine Wouda
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,University Medical Center, University of Groningen, Groningen, Netherlands
| | - Laurence Thielemans
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Neonatology-Pediatrics Department, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Mue Chae Darakamon
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Aye Aye Nge
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Wah Say
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Sanda Khing
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Borimas Hanboonkunupakarn
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Thatsanun Ngerseng
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Jordi Landier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,IRD-INSERM-SESSTIM, Aix-Marseille Université, Marseille, France
| | | | - Claudia Turner
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.,Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Verena Ilona Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
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32
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Peerawaranun P, Landier J, Nosten FH, Nguyen TN, Hien TT, Tripura R, Peto TJ, Phommasone K, Mayxay M, Day NPJ, Dondorp A, White N, von Seidlein L, Mukaka M. Intracluster correlation coefficients in the Greater Mekong Subregion for sample size calculations of cluster randomized malaria trials. Malar J 2019; 18:428. [PMID: 31852499 PMCID: PMC6921387 DOI: 10.1186/s12936-019-3062-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 06/19/2019] [Accepted: 12/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sample size calculations for cluster randomized trials are a recognized methodological challenge for malaria research in pre-elimination settings. Positively correlated responses from the participants in the same cluster are a key feature in the estimated sample size required for a cluster randomized trial. The degree of correlation is measured by the intracluster correlation coefficient (ICC) where a higher coefficient suggests a closer correlation hence less heterogeneity within clusters but more heterogeneity between clusters. METHODS Data on uPCR-detected Plasmodium falciparum and Plasmodium vivax infections from a recent cluster randomized trial which aimed at interrupting malaria transmission through mass drug administrations were used to calculate the ICCs for prevalence and incidence of Plasmodium infections. The trial was conducted in four countries in the Greater Mekong Subregion, Laos, Myanmar, Vietnam and Cambodia. Exact and simulation approaches were used to estimate ICC values for both the prevalence and the incidence of parasitaemia. In addition, the latent variable approach to estimate ICCs for the prevalence was utilized. RESULTS The ICCs for prevalence ranged between 0.001 and 0.082 for all countries. The ICC from the combined 16 villages in the Greater Mekong Subregion were 0.26 and 0.21 for P. falciparum and P. vivax respectively. The ICCs for incidence of parasitaemia ranged between 0.002 and 0.075 for Myanmar, Cambodia and Vietnam. There were very high ICCs for incidence in the range of 0.701 to 0.806 in Laos during follow-up. CONCLUSION ICC estimates can help researchers when designing malaria cluster randomized trials. A high variability in ICCs and hence sample size requirements between study sites was observed. Realistic sample size estimates for cluster randomized malaria trials in the Greater Mekong Subregion have to assume high between cluster heterogeneity and ICCs. This work focused on uPCR-detected infections; there remains a need to develop more ICC references for trials designed around prevalence and incidence of clinical outcomes. Adequately powered trials are critical to estimate the benefit of interventions to malaria in a reliable and reproducible fashion. TRIAL REGISTRATION ClinicalTrials.govNCT01872702. Registered 7 June 2013. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT01872702.
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Affiliation(s)
- Pimnara Peerawaranun
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 60th Anniversary Chalermprakiat Building, 3rd Floor, 420/6 Ratchawithi Rd, Ratchathewi District, Bangkok, 10400, Thailand
| | - Jordi Landier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Aix-Marseille University, IRD, INSERM, SESSTIM, Marseille, France
| | - Francois H Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Thuy-Nhien Nguyen
- Oxford University Clinical Research Unit, Wellcome Trust Major Oversea Programme, Ho Chi Minh City, Vietnam
| | - Tran Tinh Hien
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Oxford University Clinical Research Unit, Wellcome Trust Major Oversea Programme, Ho Chi Minh City, Vietnam
| | - Rupam Tripura
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 60th Anniversary Chalermprakiat Building, 3rd Floor, 420/6 Ratchawithi Rd, Ratchathewi District, Bangkok, 10400, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Department of Global Health, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - Thomas J Peto
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 60th Anniversary Chalermprakiat Building, 3rd Floor, 420/6 Ratchawithi Rd, Ratchathewi District, Bangkok, 10400, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Koukeo Phommasone
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.,Amsterdam Institute for Global Health & Development, Amsterdam, Netherlands
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.,Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao PDR
| | - Nicholas P J Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 60th Anniversary Chalermprakiat Building, 3rd Floor, 420/6 Ratchawithi Rd, Ratchathewi District, Bangkok, 10400, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Arjen Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 60th Anniversary Chalermprakiat Building, 3rd Floor, 420/6 Ratchawithi Rd, Ratchathewi District, Bangkok, 10400, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nick White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 60th Anniversary Chalermprakiat Building, 3rd Floor, 420/6 Ratchawithi Rd, Ratchathewi District, Bangkok, 10400, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lorenz von Seidlein
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 60th Anniversary Chalermprakiat Building, 3rd Floor, 420/6 Ratchawithi Rd, Ratchathewi District, Bangkok, 10400, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 60th Anniversary Chalermprakiat Building, 3rd Floor, 420/6 Ratchawithi Rd, Ratchathewi District, Bangkok, 10400, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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Parker DM, Tun STT, White LJ, Kajeechiwa L, Thwin MM, Landier J, Chaumeau V, Corbel V, Dondorp AM, von Seidlein L, White NJ, Maude RJ, Nosten F. Potential herd protection against Plasmodium falciparum infections conferred by mass antimalarial drug administrations. eLife 2019; 8:e41023. [PMID: 30990166 PMCID: PMC6467567 DOI: 10.7554/elife.41023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 08/11/2018] [Accepted: 03/25/2019] [Indexed: 11/13/2022] Open
Abstract
The global malaria burden has decreased over the last decade and many nations are attempting elimination. Asymptomatic malaria infections are not normally diagnosed or treated, posing a major hurdle for elimination efforts. One solution to this problem is mass drug administration (MDA), with success depending on adequate population participation. Here, we present a detailed spatial and temporal analysis of malaria episodes and asymptomatic infections in four villages undergoing MDA in Myanmar. In this study, individuals from neighborhoods with low MDA adherence had 2.85 times the odds of having a malaria episode post-MDA in comparison to those from high adherence neighborhoods, regardless of individual participation, suggesting a herd effect. High mosquito biting rates, living in a house with someone else with malaria, or having an asymptomatic malaria infection were also predictors of clinical episodes. Spatial clustering of non-adherence to MDA, even in villages with high overall participation, may frustrate elimination efforts.
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Affiliation(s)
- Daniel M Parker
- Department of Population Health and Disease PreventionUniversity of CaliforniaIrvineUnited States
| | - Sai Thein Than Tun
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityNakhon PathomThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of MedicineUniversity of OxfordOxfordUnited kingdom
| | - Lisa J White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityNakhon PathomThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of MedicineUniversity of OxfordOxfordUnited kingdom
| | - Ladda Kajeechiwa
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityNakhon PathomThailand
| | - May Myo Thwin
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityNakhon PathomThailand
| | - Jordi Landier
- Institut de Recherche pour le DéveloppementUniversity of MontpellierMontpellierFrance
| | - Victor Chaumeau
- Centre for Tropical Medicine and Global Health, Nuffield Department of MedicineUniversity of OxfordOxfordUnited kingdom
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityNakhon PathomThailand
- Centre Hospitalier Universitaire de MontpellierMontpellierFrance
- Maladies Infectieuses et Vecteurs, Ecologie, Génétique, Evolution et Contrôle IRD 224-CNRS 5290UM1-UM2, Institut de Recherche pour le Développement (IRD)University of MontpellierMontpellierFrance
| | - Vincent Corbel
- Maladies Infectieuses et Vecteurs, Ecologie, Génétique, Evolution et Contrôle IRD 224-CNRS 5290UM1-UM2, Institut de Recherche pour le Développement (IRD)University of MontpellierMontpellierFrance
| | - Arjen M Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityNakhon PathomThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of MedicineUniversity of OxfordOxfordUnited kingdom
| | - Lorenz von Seidlein
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityNakhon PathomThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of MedicineUniversity of OxfordOxfordUnited kingdom
| | - Nicholas J White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityNakhon PathomThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of MedicineUniversity of OxfordOxfordUnited kingdom
| | - Richard J Maude
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityNakhon PathomThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of MedicineUniversity of OxfordOxfordUnited kingdom
- Harvard TH Chan School of Public HealthHarvard UniversityHarvardUnited States
| | - François Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of MedicineUniversity of OxfordOxfordUnited kingdom
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityNakhon PathomThailand
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Chaumeau V, Kajeechiwa L, Fustec B, Landier J, Naw Nyo S, Nay Hsel S, Phatharakokordbun P, Kittiphanakun P, Nosten S, Thwin MM, Win Tun S, Wiladphaingern J, Cottrell G, Parker DM, Minh MC, Kwansomboon N, Metaane S, Montazeau C, Kunjanwong K, Sawasdichai S, Andolina C, Ling C, Haohankhunnatham W, Christiensen P, Wanyatip S, Konghahong K, Cerqueira D, Imwong M, Dondorp AM, Chareonviriyaphap T, White NJ, Nosten FH, Corbel V. Contribution of Asymptomatic Plasmodium Infections to the Transmission of Malaria in Kayin State, Myanmar. J Infect Dis 2019; 219:1499-1509. [PMID: 30500927 PMCID: PMC6467188 DOI: 10.1093/infdis/jiy686] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [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: 09/19/2018] [Accepted: 11/27/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The objective of mass antimalarial drug administration (MDA) is to eliminate malaria rapidly by eliminating the asymptomatic malaria parasite reservoirs and interrupting transmission. In the Greater Mekong Subregion, where artemisinin-resistant Plasmodium falciparum is now widespread, MDA has been proposed as an elimination accelerator, but the contribution of asymptomatic infections to malaria transmission has been questioned. The impact of MDA on entomological indices has not been characterized previously. METHODS MDA was conducted in 4 villages in Kayin State (Myanmar). Malaria mosquito vectors were captured 3 months before, during, and 3 months after MDA, and their Plasmodium infections were detected by polymerase chain reaction (PCR) analysis. The relationship between the entomological inoculation rate, the malaria prevalence in humans determined by ultrasensitive PCR, and MDA was characterized by generalized estimating equation regression. RESULTS Asymptomatic P. falciparum and Plasmodium vivax infections were cleared by MDA. The P. vivax entomological inoculation rate was reduced by 12.5-fold (95% confidence interval [CI], 1.6-100-fold), but the reservoir of asymptomatic P. vivax infections was reconstituted within 3 months, presumably because of relapses. This was coincident with a 5.3-fold (95% CI, 4.8-6.0-fold) increase in the vector infection rate. CONCLUSION Asymptomatic infections are a major source of malaria transmission in Southeast Asia.
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Affiliation(s)
- Victor Chaumeau
- Centre hospitalier universitaire de Montpellier, Montpellier
- UMR 224 “Maladies Infectieuses et Vecteurs, Ecologie, Génétique, Evolution et Contrôle,” Institut de Recherche pour le Développement, Montpellier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Ladda Kajeechiwa
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Bénédicte Fustec
- UMR 224 “Maladies Infectieuses et Vecteurs, Ecologie, Génétique, Evolution et Contrôle,” Institut de Recherche pour le Développement, Montpellier
| | - Jordi Landier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
- Institut de Recherches pour le Développement, Aix Marseille Univ, INSERM, SESSTIM, Marseille
| | - Saw Naw Nyo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Saw Nay Hsel
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Phabele Phatharakokordbun
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Prapan Kittiphanakun
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Suphak Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - May Myo Thwin
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Saw Win Tun
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Jacher Wiladphaingern
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Gilles Cottrell
- UMR 216 “Mère et enfant face aux infections tropicales,” Institut de Recherche pour le Développement, Université Paris Descartes, Paris, France
| | - Daniel M Parker
- Department of Population Health and Disease Prevention, University of California, Irvine
| | - Myo Chit Minh
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Nittpha Kwansomboon
- Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok, Thailand
| | - Selma Metaane
- UMR 224 “Maladies Infectieuses et Vecteurs, Ecologie, Génétique, Evolution et Contrôle,” Institut de Recherche pour le Développement, Montpellier
| | - Céline Montazeau
- UMR 224 “Maladies Infectieuses et Vecteurs, Ecologie, Génétique, Evolution et Contrôle,” Institut de Recherche pour le Développement, Montpellier
| | - Kitti Kunjanwong
- Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok, Thailand
| | - Sunisa Sawasdichai
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Chiara Andolina
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Clare Ling
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Warat Haohankhunnatham
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Peter Christiensen
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Sunaree Wanyatip
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Kamonchanok Konghahong
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Dominique Cerqueira
- Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok, Thailand
| | - Mallika Imwong
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University
| | - Arjen M Dondorp
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University
| | | | - Nicholas J White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University
| | - François H Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Vincent Corbel
- UMR 224 “Maladies Infectieuses et Vecteurs, Ecologie, Génétique, Evolution et Contrôle,” Institut de Recherche pour le Développement, Montpellier
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von Seidlein L, Peto TJ, Landier J, Nguyen TN, Tripura R, Phommasone K, Pongvongsa T, Lwin KM, Keereecharoen L, Kajeechiwa L, Thwin MM, Parker DM, Wiladphaingern J, Nosten S, Proux S, Corbel V, Tuong-Vy N, Phuc-Nhi TL, Son DH, Huong-Thu PN, Tuyen NTK, Tien NT, Dong LT, Hue DV, Quang HH, Nguon C, Davoeung C, Rekol H, Adhikari B, Henriques G, Phongmany P, Suangkanarat P, Jeeyapant A, Vihokhern B, van der Pluijm RW, Lubell Y, White LJ, Aguas R, Promnarate C, Sirithiranont P, Malleret B, Rénia L, Onsjö C, Chan XH, Chalk J, Miotto O, Patumrat K, Chotivanich K, Hanboonkunupakarn B, Jittmala P, Kaehler N, Cheah PY, Pell C, Dhorda M, Imwong M, Snounou G, Mukaka M, Peerawaranun P, Lee SJ, Simpson JA, Pukrittayakamee S, Singhasivanon P, Grobusch MP, Cobelens F, Smithuis F, Newton PN, Thwaites GE, Day NPJ, Mayxay M, Hien TT, Nosten FH, Dondorp AM, White NJ. The impact of targeted malaria elimination with mass drug administrations on falciparum malaria in Southeast Asia: A cluster randomised trial. PLoS Med 2019; 16:e1002745. [PMID: 30768615 PMCID: PMC6377128 DOI: 10.1371/journal.pmed.1002745] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/15/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The emergence and spread of multidrug-resistant Plasmodium falciparum in the Greater Mekong Subregion (GMS) threatens global malaria elimination efforts. Mass drug administration (MDA), the presumptive antimalarial treatment of an entire population to clear the subclinical parasite reservoir, is a strategy to accelerate malaria elimination. We report a cluster randomised trial to assess the effectiveness of dihydroartemisinin-piperaquine (DP) MDA in reducing falciparum malaria incidence and prevalence in 16 remote village populations in Myanmar, Vietnam, Cambodia, and the Lao People's Democratic Republic, where artemisinin resistance is prevalent. METHODS AND FINDINGS After establishing vector control and community-based case management and following intensive community engagement, we used restricted randomisation within village pairs to select 8 villages to receive early DP MDA and 8 villages as controls for 12 months, after which the control villages received deferred DP MDA. The MDA comprised 3 monthly rounds of 3 daily doses of DP and, except in Cambodia, a single low dose of primaquine. We conducted exhaustive cross-sectional surveys of the entire population of each village at quarterly intervals using ultrasensitive quantitative PCR to detect Plasmodium infections. The study was conducted between May 2013 and July 2017. The investigators randomised 16 villages that had a total of 8,445 residents at the start of the study. Of these 8,445 residents, 4,135 (49%) residents living in 8 villages, plus an additional 288 newcomers to the villages, were randomised to receive early MDA; 3,790 out of the 4,423 (86%) participated in at least 1 MDA round, and 2,520 out of the 4,423 (57%) participated in all 3 rounds. The primary outcome, P. falciparum prevalence by month 3 (M3), fell by 92% (from 5.1% [171/3,340] to 0.4% [12/2,828]) in early MDA villages and by 29% (from 7.2% [246/3,405] to 5.1% [155/3,057]) in control villages. Over the following 9 months, the P. falciparum prevalence increased to 3.3% (96/2,881) in early MDA villages and to 6.1% (128/2,101) in control villages (adjusted incidence rate ratio 0.41 [95% CI 0.20 to 0.84]; p = 0.015). Individual protection was proportional to the number of completed MDA rounds. Of 221 participants with subclinical P. falciparum infections who participated in MDA and could be followed up, 207 (94%) cleared their infections, including 9 of 10 with artemisinin- and piperaquine-resistant infections. The DP MDAs were well tolerated; 6 severe adverse events were detected during the follow-up period, but none was attributable to the intervention. CONCLUSIONS Added to community-based basic malaria control measures, 3 monthly rounds of DP MDA reduced the incidence and prevalence of falciparum malaria over a 1-year period in areas affected by artemisinin resistance. P. falciparum infections returned during the follow-up period as the remaining infections spread and malaria was reintroduced from surrounding areas. Limitations of this study include a relatively small sample of villages, heterogeneity between villages, and mobility of villagers that may have limited the impact of the intervention. These results suggest that, if used as part of a comprehensive, well-organised, and well-resourced elimination programme, DP MDA can be a useful additional tool to accelerate malaria elimination. TRIAL REGISTRATION ClinicalTrials.gov NCT01872702.
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Affiliation(s)
- Lorenz von Seidlein
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Thomas J. Peto
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jordi Landier
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Institut de Recherche pour le Développement, Aix–Marseille University, INSERM, SESSTIM, Marseille, France
| | - Thuy-Nhien Nguyen
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programmes, Ho Chi Minh City, Vietnam
| | - Rupam Tripura
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Koukeo Phommasone
- Lao–Oxford–Mahosot Hospital–Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
- Amsterdam Institute for Global Health & Development, Amsterdam, The Netherlands
| | - Tiengkham Pongvongsa
- Savannakhet Provincial Health Department, Savannakhet Province, Lao People’s Democratic Republic
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Khin Maung Lwin
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Lilly Keereecharoen
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Ladda Kajeechiwa
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - May Myo Thwin
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Daniel M. Parker
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Department of Population Health and Disease Prevention, University of California, Irvine, Irvine, California, United States of America
| | - Jacher Wiladphaingern
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Suphak Nosten
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Stephane Proux
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Vincent Corbel
- Maladies Infectieuses et Vecteurs: Écologie, Génétique, Evolution et Contrôle, Institut de Recherche pour le Développement, Université Montpellier, Montpellier, France
| | - Nguyen Tuong-Vy
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programmes, Ho Chi Minh City, Vietnam
| | - Truong Le Phuc-Nhi
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programmes, Ho Chi Minh City, Vietnam
| | - Do Hung Son
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programmes, Ho Chi Minh City, Vietnam
| | - Pham Nguyen Huong-Thu
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programmes, Ho Chi Minh City, Vietnam
| | - Nguyen Thi Kim Tuyen
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programmes, Ho Chi Minh City, Vietnam
| | - Nguyen Thanh Tien
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programmes, Ho Chi Minh City, Vietnam
| | - Le Thanh Dong
- Institute of Malariology, Parasitology, and Entomology, Ho Chi Minh City, Vietnam
| | - Dao Van Hue
- Center for Malariology, Parasitology and Entomology, Ninh Thuan Province, Vietnam
| | - Huynh Hong Quang
- Institute of Malariology, Parasitology, and Entomology, Quy Nhon, Vietnam
| | - Chea Nguon
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | | | - Huy Rekol
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Bipin Adhikari
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Gisela Henriques
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Pathogen Molecular Biology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Panom Phongmany
- Savannakhet Provincial Health Department, Savannakhet Province, Lao People’s Democratic Republic
| | - Preyanan Suangkanarat
- Lao–Oxford–Mahosot Hospital–Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - Atthanee Jeeyapant
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Benchawan Vihokhern
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rob W. van der Pluijm
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Yoel Lubell
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Lisa J. White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ricardo Aguas
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Cholrawee Promnarate
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- WWARN Asia Regional Centre, Mahidol University, Bangkok, Thailand
| | - Pasathorn Sirithiranont
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Benoit Malleret
- Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore
| | - Laurent Rénia
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore
| | - Carl Onsjö
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Faculty of Medicine and Health Sciences, Linköping University, Linköping, Linköping, Sweden
| | - Xin Hui Chan
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jeremy Chalk
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Olivo Miotto
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Krittaya Patumrat
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kesinee Chotivanich
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Borimas Hanboonkunupakarn
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Podjanee Jittmala
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nils Kaehler
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Christopher Pell
- Amsterdam Institute for Global Health & Development, Amsterdam, The Netherlands
| | - Mehul Dhorda
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- WWARN Asia Regional Centre, Mahidol University, Bangkok, Thailand
| | - Mallika Imwong
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Georges Snounou
- CEA–Université Paris Sud 11–INSERM U1184, IDMIT, Direction de la Recherche Fondamentale, Commissariat à l’Énergie Atomique et aux Énergies Alternatives, Fontenay-aux-Roses, France
| | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Pimnara Peerawaranun
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sue J. Lee
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Julie A. Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Sasithon Pukrittayakamee
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Royal Society of Thailand, Bangkok, Thailand
| | - Pratap Singhasivanon
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Martin P. Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank Cobelens
- Amsterdam Institute for Global Health & Development, Amsterdam, The Netherlands
| | | | - Paul N. Newton
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Lao–Oxford–Mahosot Hospital–Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - Guy E. Thwaites
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programmes, Ho Chi Minh City, Vietnam
| | - Nicholas P. J. Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Mayfong Mayxay
- Lao–Oxford–Mahosot Hospital–Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao People’s Democratic Republic
| | - Tran Tinh Hien
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Institut de Recherche pour le Développement, Aix–Marseille University, INSERM, SESSTIM, Marseille, France
| | - Francois H. Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Arjen M. Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nicholas J. White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Abstract
Malaria transmission is highly heterogeneous through time and space, and mapping of this heterogeneity is necessary to better understand local dynamics. New targeted policies are needed as numerous countries have placed malaria elimination on their public health agenda for 2030. In this context, developing national health information systems and collecting information at sufficiently precise scales (at least at the 'week' and 'village' scales), is of strategic importance. In a recent study, Macharia et al. relied on extensive prevalence survey data to develop malaria risk maps for Kenya, including uncertainty assessments specifically designed to support decision-making by the National Malaria Control Program. Targeting local persistent transmission or epidemiologic changes is necessary to maintain efficient control, but also to deploy sustainable elimination strategies against identified transmission bottlenecks such as the reservoir of subpatent infections. Such decision-making tools are paramount to allocate resources based on sound scientific evidence and public health priorities.Please see related article: https://malariajournal.biomedcentral.com/articles/10.1186/s12936-018-2489-9 .
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Affiliation(s)
- Jordi Landier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Stanislas Rebaudet
- APHM, Assistance Publique - Hôpitaux de Marseille, Marseille, France.,Hôpital Européen, Marseille, France
| | - Renaud Piarroux
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean Gaudart
- Aix Marseille Univ, APHM, INSERM, IRD, SESSTIM, Hop Timone, BioSTIC, Biostatistic & ICT, Marseille, France.
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Thielemans L, Trip-Hoving M, Landier J, Turner C, Prins TJ, Wouda EMN, Hanboonkunupakarn B, Po C, Beau C, Mu M, Hannay T, Nosten F, Van Overmeire B, McGready R, Carrara VI. Indirect neonatal hyperbilirubinemia in hospitalized neonates on the Thai-Myanmar border: a review of neonatal medical records from 2009 to 2014. BMC Pediatr 2018; 18:190. [PMID: 29895274 PMCID: PMC5998587 DOI: 10.1186/s12887-018-1165-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 06/04/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Indirect neonatal hyperbilirubinemia (INH) is a common neonatal disorder worldwide which can remain benign if prompt management is available. However there is a higher morbidity and mortality risk in settings with limited access to diagnosis and care. The manuscript describes the characteristics of neonates with INH, the burden of severe INH and identifies factors associated with severity in a resource-constrained setting. METHODS We conducted a retrospective evaluation of anonymized records of neonates hospitalized on the Thai-Myanmar border. INH was defined according to the National Institute for Health and Care Excellence guidelines as 'moderate' if at least one serum bilirubin (SBR) value exceeded the phototherapy threshold and as 'severe' if above the exchange transfusion threshold. RESULTS Out of 2980 records reviewed, 1580 (53%) had INH within the first 14 days of life. INH was moderate in 87% (1368/1580) and severe in 13% (212/1580). From 2009 to 2011, the proportion of severe INH decreased from 37 to 15% and the mortality dropped from 10% (8/82) to 2% (7/449) coinciding with the implementation of standardized guidelines and light-emitting diode (LED) phototherapy. Severe INH was associated with: prematurity (< 32 weeks, Adjusted Odds Ratio (AOR) 3.3; 95% CI 1.6-6.6 and 32 to 37 weeks, AOR 2.2; 95% CI 1.6-3.1), Glucose-6-phosphate dehydrogenase deficiency (G6PD) (AOR 2.3; 95% CI 1.6-3.3), potential ABO incompatibility (AOR 1.5; 95% CI 1.0-2.2) and late presentation (AOR 1.8; 95% CI 1.3-2.6). The risk of developing severe INH and INH-related mortality significantly increased with each additional risk factor. CONCLUSION INH is an important cause of neonatal hospitalization on the Thai-Myanmar border. Risk factors for severity were similar to previous reports from Asia. Implementing standardized guidelines and appropriate treatment was successful in reducing mortality and severity. Accessing to basic neonatal care including SBR testing, LED phototherapy and G6PD screening can contribute to improve neonatal outcomes.
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MESH Headings
- ABO Blood-Group System
- Blood Group Incompatibility/complications
- Glucosephosphate Dehydrogenase Deficiency/complications
- Hospitalization
- Humans
- Hyperbilirubinemia, Neonatal/complications
- Hyperbilirubinemia, Neonatal/epidemiology
- Hyperbilirubinemia, Neonatal/mortality
- Hyperbilirubinemia, Neonatal/therapy
- Infant, Newborn
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/mortality
- Infant, Premature, Diseases/therapy
- Myanmar/epidemiology
- Phototherapy
- Retrospective Studies
- Risk Factors
- Thailand/epidemiology
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Affiliation(s)
- L. Thielemans
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Neonatology-Pediatrics, Cliniques Universitaires de Bruxelles - Hôspital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M. Trip-Hoving
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - J. Landier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - C. Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - T. J. Prins
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - E. M. N. Wouda
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- University of Groningen, Groningen, The Netherlands
| | - B. Hanboonkunupakarn
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Salaya, Thailand
| | - C. Po
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - C. Beau
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - M. Mu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - T. Hannay
- University of Glasgow, Glasgow, Scotland UK
| | - F. Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - B. Van Overmeire
- Neonatology-Pediatrics, Cliniques Universitaires de Bruxelles - Hôspital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - R. McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - V. I. Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
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Landier J, Parker DM, Thu AM, Lwin KM, Delmas G, Nosten FH. Effect of generalised access to early diagnosis and treatment and targeted mass drug administration on Plasmodium falciparum malaria in Eastern Myanmar: an observational study of a regional elimination programme. Lancet 2018; 391:1916-1926. [PMID: 29703425 PMCID: PMC5946089 DOI: 10.1016/s0140-6736(18)30792-x] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [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: 10/25/2017] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Potentially untreatable Plasmodium falciparum malaria threatens the Greater Mekong subregion. A previous series of pilot projects in Myanmar, Laos, Cambodia, and Vietnam suggested that mass drug administration was safe, and when added to provision of early diagnosis and treatment, could reduce the reservoir of P falciparum and interrupts transmission. We examined the effects of a scaled-up programme of this strategy in four townships of eastern Myanmar on the incidence of P falciparum malaria. METHODS The programme was implemented in the four townships of Myawaddy, Kawkareik, Hlaingbwe, and Hpapun in Kayin state, Myanmar. Increased access to early diagnosis and treatment of malaria was provided to all villages through community-based malaria posts equipped with rapid diagnostic tests, and treatment with artemether-lumefantrine plus single low-dose primaquine. Villages were identified as malarial hotspots (operationally defined as >40% malaria, of which 20% was P falciparum) with surveys using ultrasensitive quantitative PCR either randomly or targeted at villages where the incidence of clinical cases of P falciparum malaria remained high (ie, >100 cases per 1000 individuals per year) despite a functioning malaria post. During each survey, a 2 mL sample of venous blood was obtained from randomly selected adults. Hotspots received targeted mass drug administration with dihydroartemisinin-piperaquine plus single-dose primaquine once per month for 3 consecutive months in addition to the malaria posts. The main outcome was the change in village incidence of clinical P falciparum malaria, quantified using a multivariate, generalised, additive multilevel model. Malaria prevalence was measured in the hotspots 12 months after mass drug administration. FINDINGS Between May 1, 2014, and April 30, 2017, 1222 malarial posts were opened, providing early diagnosis and treatment to an estimated 365 000 individuals. Incidence of P falciparum malaria decreased by 60 to 98% in the four townships. 272 prevalence surveys were undertaken and 69 hotspot villages were identified. By April 2017, 50 hotspots were treated with mass drug administration. Hotspot villages had a three times higher incidence of P falciparum at malarial posts than neighbouring villages (adjusted incidence rate ratio [IRR] 2·7, 95% CI 1·8-4·4). Early diagnosis and treatment was associated with a significant decrease in P falciparum incidence in hotspots (IRR 0·82, 95% CI 0·76-0·88 per quarter) and in other villages (0·75, 0·73-0·78 per quarter). Mass drug administration was associated with a five-times decrease in P falciparum incidence within hotspot villages (IRR 0·19, 95% CI 0·13-0·26). By April, 2017, 965 villages (79%) of 1222 corresponding to 104 village tracts were free from P falciparum malaria for at least 6 months. The prevalence of wild-type genotype for K13 molecular markers of artemisinin resistance was stable over the three years (39%; 249/631). INTERPRETATION Providing early diagnosis and effective treatment substantially decreased village-level incidence of artemisinin-resistant P falciparum malaria in hard-to-reach, politically sensitive regions of eastern Myanmar. Targeted mass drug administration significantly reduced malaria incidence in hotspots. If these activities could proceed in all contiguous endemic areas in addition to standard control programmes already implemented, there is a possibility of subnational elimination of P falciparum. FUNDING The Bill & Melinda Gates Foundation, the Regional Artemisinin Initiative (Global Fund against AIDS, Tuberculosis and Malaria), and the Wellcome Trust.
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Affiliation(s)
- Jordi Landier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand; Institut de Recherches pour le Développement, Aix Marseille Univ, INSERM, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.
| | - Daniel M Parker
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand; Department of Population Health and Disease Prevention, University of California, Irvine, CA, USA
| | - Aung Myint Thu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Khin Maung Lwin
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Gilles Delmas
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - François H Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Parker DM, Landier J, Thu AM, Lwin KM, Delmas G, Nosten FH. Scale up of a Plasmodium falciparum elimination program and surveillance system in Kayin State, Myanmar. Wellcome Open Res 2017; 2:98. [PMID: 29384151 PMCID: PMC5701446 DOI: 10.12688/wellcomeopenres.12741.2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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] [Accepted: 12/19/2017] [Indexed: 12/17/2022] Open
Abstract
Background: Myanmar has one of the largest malaria burdens in the Greater Mekong Subregion (GMS). Throughout the GMS,
Plasmodium falciparum parasites are increasingly resistant to artemisinin combination therapies. Given that there are no current alternative treatment therapies, one proposed solution to the threat of untreatable
P. falciparum malaria is to eliminate the parasite from the region. Several small-scale elimination projects have been piloted in the GMS, including along the Myanmar-Thailand border. Following the success of the pilot elimination project along the Myanmar-Thailand border, there was a scale up to a broad area of Eastern Kayin State, Myanmar. Here we describe the establishment of the scale up elimination project in Easter Kayin State. Methods: The scale up relied on geographic reconnaissance and a geographic information system, community engagement, generalized access to community-based early diagnosis and treatment, near real-time epidemiological surveillance, cross sectional malaria prevalence surveys and targeted mass drug administration in villages with high prevalence of
P. falciparum malaria. Molecular markers of drug resistance were also monitored in individuals with symptomatic and asymptomatic infections. Discussion: This protocol illustrates the establishment of an elimination project and operational research in a remote, rural area encompassing several armed groups, multiple political organizations and a near-absent health care infrastructure. The establishment of the project relied on a strong rapport with the target community, on-the-ground knowledge (through geographic surveys and community engagement), rapid decision making and an approach that was flexible enough to quickly adapt to a complex landscape. The elimination project is ongoing, now over three years in operation, and assessment of the impact of this operational research will follow. This project has relevance not only for other malaria elimination projects but also for operational research aimed at eliminating other diseases.
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Affiliation(s)
- Daniel M Parker
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Jordi Landier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Aung Myint Thu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Khin Maung Lwin
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Gilles Delmas
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - François H Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
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40
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Parker DM, Landier J, Thu AM, Lwin KM, Delmas G, Nosten FH. Scale up of a Plasmodium falciparum elimination program and surveillance system in Kayin State, Myanmar. Wellcome Open Res 2017. [PMID: 29384151 DOI: 10.12688/wellcomeopenres.12741.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Myanmar has one of the largest malaria burdens in the Greater Mekong Subregion (GMS). Throughout the GMS, Plasmodium falciparum parasites are increasingly resistant to artemisinin combination therapies. Given that there are no current alternative treatment therapies, one proposed solution to the threat of untreatable P. falciparum malaria is to eliminate the parasite from the region. Several small-scale elimination projects have been piloted in the GMS, including along the Myanmar-Thailand border. Following the success of the pilot elimination project along the Myanmar-Thailand border, there was a scale up to a broad area of Eastern Kayin State, Myanmar. Here we describe the establishment of the scale up elimination project in Easter Kayin State. Methods: The scale up relied on geographic reconnaissance and a geographic information system, community engagement, generalized access to community-based early diagnosis and treatment, near real-time epidemiological surveillance, cross sectional malaria prevalence surveys and targeted mass drug administration in villages with high prevalence of P. falciparum malaria. Molecular markers of drug resistance were also monitored in individuals with symptomatic and asymptomatic infections. Discussion: This protocol illustrates the establishment of an elimination project and operational research in a remote, rural area encompassing several armed groups, multiple political organizations and a near-absent health care infrastructure. The establishment of the project relied on a strong rapport with the target community, on-the-ground knowledge (through geographic surveys and community engagement), rapid decision making and an approach that was flexible enough to quickly adapt to a complex landscape. The elimination project is ongoing, now over three years in operation, and assessment of the impact of this operational research will follow. This project has relevance not only for other malaria elimination projects but also for operational research aimed at eliminating other diseases.
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Affiliation(s)
- Daniel M Parker
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Jordi Landier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Aung Myint Thu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Khin Maung Lwin
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Gilles Delmas
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - François H Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
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Vandelannoote K, Meehan CJ, Eddyani M, Affolabi D, Phanzu DM, Eyangoh S, Jordaens K, Portaels F, Mangas K, Seemann T, Marsollier L, Marion E, Chauty A, Landier J, Fontanet A, Leirs H, Stinear TP, de Jong BC. Multiple Introductions and Recent Spread of the Emerging Human Pathogen Mycobacterium ulcerans across Africa. Genome Biol Evol 2017; 9:414-426. [PMID: 28137745 PMCID: PMC5381664 DOI: 10.1093/gbe/evx003] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 12/21/2022] Open
Abstract
Buruli ulcer (BU) is an insidious neglected tropical disease. Cases are reported around the world but the rural regions of West and Central Africa are most affected. How BU is transmitted and spreads has remained a mystery, even though the causative agent, Mycobacterium ulcerans, has been known for more than 70 years. Here, using the tools of population genomics, we reconstruct the evolutionary history of M. ulcerans by comparing 165 isolates spanning 48 years and representing 11 endemic countries across Africa. The genetic diversity of African M. ulcerans was found to be restricted due to the bacterium's slow substitution rate coupled with its relatively recent origin. We identified two specific M. ulcerans lineages within the African continent, and inferred that M. ulcerans lineage Mu_A1 existed in Africa for several hundreds of years, unlike lineage Mu_A2, which was introduced much more recently, approximately during the 19th century. Additionally, we observed that specific M. ulcerans epidemic Mu_A1 clones were introduced during the same time period in the three hydrological basins that were well covered in our panel. The estimated time span of the introduction events coincides with the Neo-imperialism period, during which time the European colonial powers divided the African continent among themselves. Using this temporal association, and in the absence of a known BU reservoir or-vector on the continent, we postulate that the so-called "Scramble for Africa" played a significant role in the spread of the disease across the continent.
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Affiliation(s)
- Koen Vandelannoote
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Evolutionary Ecology Group University of Antwerp, Antwerp, Belgium
| | - Conor J Meehan
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Miriam Eddyani
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Sara Eyangoh
- Service de Mycobactériologie, Centre Pasteur du Cameroun, Yaoundé, Cameroun
| | - Kurt Jordaens
- Evolutionary Ecology Group University of Antwerp, Antwerp, Belgium.,Invertebrates Section, Royal Museum for Central Africa, Tervuren, Belgium
| | - Françoise Portaels
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kirstie Mangas
- Department of Microbiology and Immunology, University of Melbourne, Victoria, Australia
| | - Torsten Seemann
- Victorian Life Sciences Computation Initiative University of Melbourne, Victoria, Australia
| | | | - Estelle Marion
- CRCNA Inserm U892 CNRS 6299, CHU & Université d'Angers, Angers, France
| | | | - Jordi Landier
- Service de Mycobactériologie, Centre Pasteur du Cameroun, Yaoundé, Cameroun.,Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France
| | - Arnaud Fontanet
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France
| | - Herwig Leirs
- Evolutionary Ecology Group University of Antwerp, Antwerp, Belgium
| | - Timothy P Stinear
- Department of Microbiology and Immunology, University of Melbourne, Victoria, Australia
| | - Bouke C de Jong
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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42
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Landier J, Kajeechiwa L, Thwin MM, Parker DM, Chaumeau V, Wiladphaingern J, Imwong M, Miotto O, Patumrat K, Duanguppama J, Cerqueira D, Malleret B, Rénia L, Nosten S, von Seidlein L, Ling C, Proux S, Corbel V, Simpson JA, Dondorp AM, White NJ, Nosten FH. Safety and effectiveness of mass drug administration to accelerate elimination of artemisinin-resistant falciparum malaria: A pilot trial in four villages of Eastern Myanmar. Wellcome Open Res 2017; 2:81. [PMID: 29062913 PMCID: PMC5635445 DOI: 10.12688/wellcomeopenres.12240.1] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [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] [Accepted: 08/21/2017] [Indexed: 01/26/2023] Open
Abstract
Background: Artemisinin and partner drug-resistant falciparum malaria is expanding over the Greater Mekong Sub-region (GMS). Eliminating falciparum malaria in the GMS while drugs still retain enough efficacy could prevent global spread of antimalarial resistance. Eliminating malaria rapidly requires targeting the reservoir of asymptomatic parasite carriers. This pilot trial aimed to evaluate the acceptability, safety, feasibility and effectiveness of mass-drug administration (MDA) in reducing malaria in four villages in Eastern Myanmar. Methods: Villages with ≥30% malaria prevalence were selected. Long-lasting insecticidal bednets (LLINs) and access to malaria early diagnosis and treatment (EDT) were provided. Two villages received MDA immediately and two were followed for nine months pre-MDA. MDA consisted of a 3-day supervised course of dihydroartemisinin-piperaquine and single low-dose primaquine administered monthly for three months. Adverse events (AE) were monitored by interviews and consultations. Malaria prevalence was assessed by ultrasensitive PCR quarterly for 24 months. Symptomatic malaria incidence,entomological indices, and antimalarial resistance markers were monitored. Results: MDA was well tolerated. There were no serious AE and mild to moderate AE were reported in 5.6%(212/3931) interviews. In the smaller villages, participation to three MDA courses was 61% and 57%, compared to 28% and 29% in the larger villages. Baseline prevalence was higher in intervention than in control villages (18.7% (95%CI=16.1-21.6) versus 6.8%(5.2-8.7), p<0.0001) whereas three months after starting MDA, prevalence was lower in intervention villages (0.4%(0.04-1.3) versus 2.7%(1.7-4.1), p=0.0014). After nine months the difference was no longer significant (2.0%(1.0-3.5) versus 0.9%(0.04-1.8), p=0.10). M0-M9 symptomatic falciparum incidence was similar between intervention and control. Before/after MDA comparisons showed that asymptomatic
P. falciparum carriage and anopheline vector positivity decreased significantly whereas prevalence of the artemisinin-resistance molecular marker remained stable. Conclusions: This MDA was safe and feasible, and, could accelerate elimination of
P. falciparum in addition to EDT and LLINs
when community participation was sufficient.
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Affiliation(s)
- Jordi Landier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Ladda Kajeechiwa
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - May Myo Thwin
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Daniel M Parker
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Victor Chaumeau
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Maladies Infectieuses et Vecteurs Ecologie, Génétique, Evolution et Contrôle (IRD 224-CNRS 4280 UM1-UM2), Institut de Recherche pour le Développement, Montpellier, France.,Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France
| | - Jacher Wiladphaingern
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Mallika Imwong
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Olivo Miotto
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Genomics and Global Health, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK.,Wellcome Trust Sanger Institute, Cambridge, CB10 1SA, UK
| | - Krittaya Patumrat
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jureeporn Duanguppama
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Dominique Cerqueira
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Benoit Malleret
- Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119077, Singapore.,Singapore Immunology Network (SIgN), Agency for Science & Technology, Singapore, 138632, Singapore
| | - Laurent Rénia
- Singapore Immunology Network (SIgN), Agency for Science & Technology, Singapore, 138632, Singapore
| | - Suphak Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Lorenz von Seidlein
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Clare Ling
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Stéphane Proux
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Vincent Corbel
- Maladies Infectieuses et Vecteurs Ecologie, Génétique, Evolution et Contrôle (IRD 224-CNRS 4280 UM1-UM2), Institut de Recherche pour le Développement, Montpellier, France
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3053, Australia
| | - Arjen M Dondorp
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
| | - Nicholas J White
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
| | - François H Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
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Thu AM, Phyo AP, Landier J, Parker DM, Nosten FH. Combating multidrug-resistant Plasmodium falciparum malaria. FEBS J 2017; 284:2569-2578. [PMID: 28580606 PMCID: PMC5575457 DOI: 10.1111/febs.14127] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [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: 11/30/2016] [Revised: 05/09/2017] [Accepted: 06/01/2017] [Indexed: 01/05/2023]
Abstract
Over the past 50 years, Plasmodium falciparum has developed resistance against all antimalarial drugs used against it: chloroquine, sulphadoxine-pyrimethamine, quinine, piperaquine and mefloquine. More recently, resistance to the artemisinin derivatives and the resulting failure of artemisinin-based combination therapy (ACT) are threatening all major gains made in malaria control. Each time resistance has developed progressively, with delayed clearance of parasites first emerging only in a few regions, increasing in prevalence and geographic range, and then ultimately resulting in the complete failure of that antimalarial. Drawing from this repeated historical chain of events, this article presents context-specific approaches for combating drug-resistant P. falciparum malaria. The approaches begin with a context of drug-sensitive parasites and focus on the prevention of the emergence of drug resistance. Next, the approaches address a scenario in which resistance has emerged and is increasing in prevalence and geographic extent, with interventions focused on disrupting transmission through vector control, early diagnosis and treatment, and the use of new combination therapies. Elimination is also presented as an approach for addressing the imminent failure of all available antimalarials. The final drug resistance context presented is one in which all available antimalarials have failed; leaving only personal protection and the use of new antimalarials (or new combinations of antimalarials) as a viable strategy for dealing with complete resistance. All effective strategies and contexts require a multipronged, holistic approach.
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Affiliation(s)
- Aung Myint Thu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Aung Pyae Phyo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK
| | - Jordi Landier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Daniel M Parker
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - François H Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK
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Parker DM, Landier J, von Seidlein L, Dondorp A, White L, Hanboonkunupakarn B, Maude RJ, Nosten FH. Limitations of malaria reactive case detection in an area of low and unstable transmission on the Myanmar-Thailand border. Malar J 2016; 15:571. [PMID: 27887652 PMCID: PMC5124267 DOI: 10.1186/s12936-016-1631-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 09/05/2016] [Accepted: 11/21/2016] [Indexed: 11/10/2022] Open
Abstract
Background Reactive case detection is an approach that has been proposed as a tool for malaria elimination in low-transmission settings. It is an intuitively justified approach based on the concept of space–time clustering of malaria cases. When an index malaria clinical case is detected, it triggers reactive screening and treatment in the index house and neighbouring houses. However, the efficacy of this approach at varying screening radii and malaria prevalence remains ill defined. Methods Data were obtained from a detailed demographic and geographic surveillance study in four villages on the Myanmar–Thailand border. Clinical cases were recorded at village malaria clinics and were linked back to patients’ residencies. These data were used to simulate the efficacy of reactive case detection for clinical cases using rapid diagnostic tests (RDT). Simulations took clinical cases in a given month and tabulated the number of cases that would have been detected in the following month at varying screening radii around the index houses. Simulations were run independently for both falciparum and vivax malaria. Each simulation of a reactive case detection effort was run in comparison with a strategy using random selection of houses for screening. Results In approximately half of the screenings for falciparum and 10% for vivax it would have been impossible to detect any malaria cases regardless of the screening strategy because the screening would have occurred during times when there were no cases. When geographically linked cases were present in the simulation, reactive case detection would have only been successful at detecting most malaria cases using larger screening radii (150-m radius and above). At this screening radius and above, reactive case detection does not perform better than random screening of an equal number of houses in the village. Screening within very small radii detects only a very small proportion of cases, but despite this low performance is better than random screening with the same sample size. Conclusions The results of these simulations indicate that reactive case detection for clinical cases using RDTs has limited ability in halting transmission in regions of low and unstable transmission. This is linked to high spatial heterogeneity of cases, acquisition of malaria infections outside the village, as well missing asymptomatic infections. When cases are few and sporadic, reactive case detection would result in major time and budgetary losses. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1631-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel M Parker
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, Thailand.
| | - Jordi Landier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, Thailand
| | - Lorenz von Seidlein
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Arjen Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Lisa White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | - Richard J Maude
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, Thailand.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, USA
| | - François H Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, Thailand.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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Landier J, Parker DM, Thu AM, Carrara VI, Lwin KM, Bonnington CA, Pukrittayakamee S, Delmas G, Nosten FH. The role of early detection and treatment in malaria elimination. Malar J 2016; 15:363. [PMID: 27421656 PMCID: PMC4946177 DOI: 10.1186/s12936-016-1399-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [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: 03/17/2016] [Accepted: 06/17/2016] [Indexed: 12/30/2022] Open
Abstract
Falciparum malaria persists in hard-to-reach areas or demographic groups that are missed by conventional healthcare systems but could be reached by trained community members in a malaria post (MP). The main focus of a MP is to provide uninterrupted and rapid access to rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT) too all inhabitants of a village. RDTs allow trained community members to perform malaria diagnosis accurately and prescribe appropriate treatment, reducing as much as possible any delay between the onset of fever and treatment. Early treatment with ACT and with a low-dose of primaquine prevents further transmission from human to mosquito. A functioning MP represents an essential component of any malaria elimination strategy. Implementing large-scale, high-coverage, community-based early diagnosis and treatment through MPs requires few technological innovations but relies on a very well structured organization able to train, supervise and supply MPs, to monitor activity and to perform strict malaria surveillance.
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Affiliation(s)
- Jordi Landier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
| | - Daniel M Parker
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Aung Myint Thu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Verena I Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Khin Maung Lwin
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Craig A Bonnington
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | | | - Gilles Delmas
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - François H Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Landier J, Constantin de Magny G, Garchitorena A, Guégan JF, Gaudart J, Marsollier L, Le Gall P, Giles-Vernick T, Eyangoh S, Fontanet A, Texier G. Seasonal Patterns of Buruli Ulcer Incidence, Central Africa, 2002-2012. Emerg Infect Dis 2016. [PMID: 26196525 PMCID: PMC4517715 DOI: 10.3201/eid2108.141336] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To determine when risk for Buruli ulcer is highest, we examined seasonal patterns in a highly disease-endemic area of Cameroon during 2002–2012. Cases peaked in March, suggesting that risk is highest during the high rainy season. During and after this season, populations should increase protective behaviors, and case detection efforts should be intensified.
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Andolina C, Landier J, Carrara V, Chu CS, Franetich JF, Roth A, Rénia L, Roucher C, White NJ, Snounou G, Nosten F. The suitability of laboratory-bred Anopheles cracens for the production of Plasmodium vivax sporozoites. Malar J 2015; 14:312. [PMID: 26259952 PMCID: PMC4531391 DOI: 10.1186/s12936-015-0830-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 05/12/2015] [Accepted: 08/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A stenogamous colony of Anopheles cracens (A. dirus B) established 20 years ago in a Thai insectary proved susceptible to Plasmodium vivax. However, routine sporozoite production by feeding on field-collected blood samples has not been described. The setting-up of an A. cracens colony in an insectary on the Thai-Myanmar border and the process of using P. vivax field samples for the production of infectious sporozoites are described. METHODS The colony was started in 2012 from egg batches that were sent from the Department of Parasitology, Faculty of Medicine, University of Chiang Mai, to the Shoklo Malaria Research Unit (SMRU), on wet filter paper in sealed Petri dishes. From May 2013 to December 2014, P. vivax-infected blood samples collected from patients seeking care at SMRU clinics were used for membrane feeding assays and sporozoite production. RESULTS Mosquitoes were fed on blood samples from 55 patients, and for 38 (69 %) this led to the production sporozoites. The average number of sporozoites obtained per mosquito was 26,112 (range 328-79,310). Gametocytaemia was not correlated with mosquito infectiousness (p = 0.82), or with the number of the sporozoites produced (Spearman's ρ = -0.016, p = 0.905). Infectiousness did not vary with the date of collection or the age of the patient. Mosquito survival was not correlated with sporozoite load (Spearman's ρ = 0.179, p = 0.282). CONCLUSION Consistent and routine P. vivax sporozoites production confirms that A. cracens is highly susceptible to P. vivax infection. Laboratory-bred colonies of this vector are suitable for experimental transmission protocols and thus constitute a valuable resource.
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Affiliation(s)
- Chiara Andolina
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
| | - Jordi Landier
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
| | - Verena Carrara
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
| | - Cindy S Chu
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
| | - Jean-François Franetich
- Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 Bd de l'Hôpital, 75013, Paris, France.
- Institut National de la Santé et de la Recherche Médicale, U1135, CIMI-PARIS, 91 Bd de l'Hôpital, 75013, Paris, France.
- Centre National de la Recherche Scientifique, ERL 8255, CIMI-PARIS, 91 Bd de l'Hôpital, 75013, Paris, France.
| | - Alison Roth
- Department of Global Health, College of Public Health, University of South Florida, Tampa, FL, USA.
| | - Laurent Rénia
- Singapore Immunology Network (SIgN), Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore.
| | - Clémentine Roucher
- Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 Bd de l'Hôpital, 75013, Paris, France.
- Institut National de la Santé et de la Recherche Médicale, U1135, CIMI-PARIS, 91 Bd de l'Hôpital, 75013, Paris, France.
- Centre National de la Recherche Scientifique, ERL 8255, CIMI-PARIS, 91 Bd de l'Hôpital, 75013, Paris, France.
| | - Nick J White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Georges Snounou
- Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 Bd de l'Hôpital, 75013, Paris, France.
- Institut National de la Santé et de la Recherche Médicale, U1135, CIMI-PARIS, 91 Bd de l'Hôpital, 75013, Paris, France.
- Centre National de la Recherche Scientifique, ERL 8255, CIMI-PARIS, 91 Bd de l'Hôpital, 75013, Paris, France.
| | - François Nosten
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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Carolan K, Garchitorena A, García-Peña GE, Morris A, Landier J, Fontanet A, Le Gall P, Texier G, Marsollier L, Gozlan RE, Eyangoh S, Lo Seen D, Guégan JF. Topography and land cover of watersheds predicts the distribution of the environmental pathogen Mycobacterium ulcerans in aquatic insects. PLoS Negl Trop Dis 2014; 8:e3298. [PMID: 25375173 PMCID: PMC4222759 DOI: 10.1371/journal.pntd.0003298] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 08/01/2014] [Accepted: 09/25/2014] [Indexed: 11/25/2022] Open
Abstract
Background An understanding of the factors driving the distribution of pathogens is useful in preventing disease. Often we achieve this understanding at a local microhabitat scale; however the larger scale processes are often neglected. This can result in misleading inferences about the distribution of the pathogen, inhibiting our ability to manage the disease. One such disease is Buruli ulcer, an emerging neglected tropical disease afflicting many thousands in Africa, caused by the environmental pathogen Mycobacterium ulcerans. Herein, we aim to describe the larger scale landscape process describing the distribution of M. ulcerans. Methodology Following extensive sampling of the community of aquatic macroinvertebrates in Cameroon, we select the 5 dominant insect Orders, and conduct an ecological niche model to describe how the distribution of M. ulcerans positive insects changes according to land cover and topography. We then explore the generalizability of the results by testing them against an independent dataset collected in a second endemic region, French Guiana. Principal Findings We find that the distribution of the bacterium in Cameroon is accurately described by the land cover and topography of the watershed, that there are notable seasonal differences in distribution, and that the Cameroon model does not predict the distribution of M. ulcerans in French Guiana. Conclusions/Significance Future studies of M. ulcerans would benefit from consideration of local structure of the local stream network in future sampling, and further work is needed on the reasons for notable differences in the distribution of this species from one region to another. This work represents a first step in the identification of large-scale environmental drivers of this species, for the purposes of disease risk mapping. Many pathogens persist in the environment, and an understanding of where they are can assist in disease control, allowing us to identify areas of risk to local human populations. Herein, we use general linear models to describe the distribution of a particular environmental pathogen, Mycobacterium ulcerans, describing the landscape conditions correlated with the presence of this pathogen in local biota, and mapping the distribution of these habitats in a region of Cameroon, Africa. Our findings identify the importance of the watershed as a factor determining the distribution of the bacterium, where landscape conditions upstream of the sample site can influence the abundance of the bacterium in downstream sites. We find that the bacterium has notable seasonal changes in its distribution, between the wet and dry seasons, which may have implications for human health. We also discuss sensitivity of these models to extrapolation, finding that they work well in the African region and underperforming when extrapolated to another region in South America.
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Affiliation(s)
- Kevin Carolan
- Unité mixte de recherche (UMR) Maladies Infectieuses et Vecteurs: Écologie, Génétique, Evolution, et Contrôle (MIVEGEC) IRD-CNRS-Universities of Montpellier I and II, Centre IRD de Montpellier, Montpellier, France
- UMR Territoires, Environnement, Télédétection et Information Spatiale (TETIS) CIRAD, Montpellier, France
- Unité d'Epidémiologie de Maladies Emergentes, Institut Pasteur, Paris, France
- * E-mail:
| | - Andres Garchitorena
- Unité mixte de recherche (UMR) Maladies Infectieuses et Vecteurs: Écologie, Génétique, Evolution, et Contrôle (MIVEGEC) IRD-CNRS-Universities of Montpellier I and II, Centre IRD de Montpellier, Montpellier, France
- Ecole des Hautes Etudes en Santé Publique, Rennes, France
| | - Gabriel E. García-Peña
- Unité mixte de recherche (UMR) Maladies Infectieuses et Vecteurs: Écologie, Génétique, Evolution, et Contrôle (MIVEGEC) IRD-CNRS-Universities of Montpellier I and II, Centre IRD de Montpellier, Montpellier, France
- Centre de Synthèse et d'Analyse sur la Biodiversité -CESAB. Bâtiment Henri Poincaré, Domaine du Petit Arbois. Aix-en-Provence, France
| | - Aaron Morris
- Unité mixte de recherche (UMR) Maladies Infectieuses et Vecteurs: Écologie, Génétique, Evolution, et Contrôle (MIVEGEC) IRD-CNRS-Universities of Montpellier I and II, Centre IRD de Montpellier, Montpellier, France
- Bournemouth University, School of Applied Sciences, Dorset, United Kingdom
| | - Jordi Landier
- Unité d'Epidémiologie de Maladies Emergentes, Institut Pasteur, Paris, France
- Service d'épidémiologie et de santé publique, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaoundé, Cameroun
| | - Arnaud Fontanet
- Unité d'Epidémiologie de Maladies Emergentes, Institut Pasteur, Paris, France
- Chaire Santé et Développement, Conservatoire National des Arts et Métiers, Paris, France
| | - Philippe Le Gall
- Institut de Recherche pour le Développement (IRD), UR 072, Laboratoire Evolution, Génomes et Spéciation, UPR 9034, Centre National de la Recherche Scientifique (CNRS), Gif sur Yvette, France et Université Paris-Sud 11, Orsay, France
| | - Gaëtan Texier
- Service d'épidémiologie et de santé publique, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaoundé, Cameroun
- UMR 912 - SESSTIM - INSERM/IRD/Aix-Marseille Université Faculté de Médecine - 27, Marseille, France
| | - Laurent Marsollier
- ATOMycA, Inserm Avenir Team, CRCNA, Inserm U892, 6299 CNRS and LUNAM, Angers, France
| | - Rodolphe E. Gozlan
- Unité mixte de recherche (UMR) Maladies Infectieuses et Vecteurs: Écologie, Génétique, Evolution, et Contrôle (MIVEGEC) IRD-CNRS-Universities of Montpellier I and II, Centre IRD de Montpellier, Montpellier, France
- Bournemouth University, School of Applied Sciences, Dorset, United Kingdom
- UMR 207 BOREA IRD-MNHN-Université Pierre et Marie Curie, Muséum National d'Histoire Naturelle, Paris, France
| | - Sara Eyangoh
- Service de Mycobactériologie, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaoundé, Cameroun
| | - Danny Lo Seen
- UMR Territoires, Environnement, Télédétection et Information Spatiale (TETIS) CIRAD, Montpellier, France
| | - Jean-Francois Guégan
- Unité mixte de recherche (UMR) Maladies Infectieuses et Vecteurs: Écologie, Génétique, Evolution, et Contrôle (MIVEGEC) IRD-CNRS-Universities of Montpellier I and II, Centre IRD de Montpellier, Montpellier, France
- Ecole des Hautes Etudes en Santé Publique, Rennes, France
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Carolan K, Ebong SMA, Garchitorena A, Landier J, Sanhueza D, Texier G, Marsollier L, Gall PL, Guégan JF, Lo Seen D. Ecological niche modelling of Hemipteran insects in Cameroon; the paradox of a vector-borne transmission for Mycobacterium ulcerans, the causative agent of Buruli ulcer. Int J Health Geogr 2014; 13:44. [PMID: 25344052 PMCID: PMC4213541 DOI: 10.1186/1476-072x-13-44] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 08/02/2014] [Accepted: 10/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The mode of transmission of the emerging neglected disease Buruli ulcer is unknown. Several potential transmission pathways have been proposed, such as amoebae, or transmission through food webs. Several lines of evidence have suggested that biting aquatic insects, Naucoridae and Belostomatidae, may act as vectors, however this proposal remains controversial. MATERIALS AND METHODS Herein, based on sampling in Cameroon, we construct an ecological niche model of these insects to describe their spatial distribution. We predict their distribution across West Africa, describe important environmental drivers of their abundance, and examine the correlation between their abundance and Buruli ulcer prevalence in the context of the Bradford-Hill guidelines. RESULTS We find a significant positive correlation between the abundance of the insects and the prevalence of Buruli ulcer. This correlation changes in space and time, it is significant in one Camerounese study region in (Akonolinga) and not other (Bankim). We discuss notable environmental differences between these regions. CONCLUSION We interpret the presence of, and change in, this correlation as evidence (though not proof) that these insects may be locally important in the environmental persistence, or transmission, of Mycobacterium. ulcerans. This is consistent with the idea of M. ulcerans as a pathogen transmitted by multiple modes of infection, the importance of any one pathway changing from region to region, depending on the local environmental conditions.
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Affiliation(s)
- Kevin Carolan
- Unité mixte de recherche (UMR) Maladies Infectieuses et Vecteurs : Écologie, Génétique, Evolution, et Contrôle (MIVEGEC) IRD-CNRS-Universities of Montpellier I and II, Centre IRD de Montpellier, BP 64501, 34394 Montpellier Cedex 5, France.
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Affiliation(s)
- Jordi Landier
- Institut Pasteur, Unité de Recherche et d'expertise en Epidémiologie des Maladies Emergentes, Paris, France; Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaoundé, Cameroon.
| | - Arnaud Fontanet
- Institut Pasteur, Unité de Recherche et d'expertise en Epidémiologie des Maladies Emergentes, Paris, France; Chaire Santé et Développement, Conservatoire National des Arts et Métiers, Paris, France
| | - Gaëtan Texier
- Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaoundé, Cameroon; Aix-Marseille Université, UMR912 SESSTIM (INSERM-IRD- AMU), Marseille 13005, France
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