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

<p><strong>Background:</strong>&nbsp;Mass administrations of antimalarial drugs (MDA) have reduced the incidence and prevalence of&nbsp;<em>P</em>.&nbsp;<em>falciparum</em>&nbsp;infections in a trial in the Greater Mekong Subregion. Here we a...

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Автори: Phommasone, K, Van Leth, F, Peto, TJ, Landier, J, Nguyen, T-N, 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
Формат: Journal article
Мова:English
Опубліковано: Public Library of Science 2020
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Резюме:<p><strong>Background:</strong>&nbsp;Mass administrations of antimalarial drugs (MDA) have reduced the incidence and prevalence of&nbsp;<em>P</em>.&nbsp;<em>falciparum</em>&nbsp;infections in a trial in the Greater Mekong Subregion. Here we assess the impact of the MDA on&nbsp;<em>P</em>.&nbsp;<em>vivax</em>&nbsp;infections.</p> <p><strong>Methods:</strong>&nbsp;Between May 2013 and July 2017, four villages in each Myanmar, Vietnam, Cambodia and Lao PDR were selected based on high prevalence of&nbsp;<em>P</em>.&nbsp;<em>falciparum</em>&nbsp;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&nbsp;<em>P</em>.&nbsp;<em>vivax</em>&nbsp;infection through a mixed-effect logistic regression.</p> <p><strong>Results:</strong>&nbsp;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&nbsp;<em>P</em>.&nbsp;<em>vivax</em>&nbsp;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&nbsp;<em>P</em>.<em>vivax</em>&nbsp;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).</p> <p><strong>Conclusion:</strong>&nbsp;MDA with schizontocidal drugs had a lasting effect on&nbsp;<em>P</em>.&nbsp;<em>falciparum</em>&nbsp;infections but only a transient effect on the prevalence of&nbsp;<em>P</em>.&nbsp;<em>vivax</em>&nbsp;infections. Radical cure with an 8-aminoquinoline will be needed for the rapid elimination of vivax malaria.</p>