1. Large-scale Artemisinin-Piperaquine Mass Drug Administration With or Without Primaquine Dramatically Reduces Malaria in a Highly Endemic Region of Africa.
- Author
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Deng C, Huang B, Wang Q, Wu W, Zheng S, Zhang H, Li D, Feng D, Li G, Xue L, Yang T, Tuo F, Mohadji F, Su XZ, Xu Q, Wu Z, Lin L, Zhou J, Yan H, Bacar A, Said Abdallah K, Kéké RA, Msa Mliva A, Mohamed M, Wang X, Huang S, Oithik F, Li XB, Lu F, Fay MP, Liu XH, Wellems TE, and Song J
- Subjects
- Adolescent, Adult, Child, Child, Preschool, Comoros epidemiology, DNA, Protozoan genetics, Drug Therapy, Combination, Endemic Diseases prevention & control, Female, Humans, Infant, Malaria, Falciparum epidemiology, Malaria, Falciparum mortality, Male, Mass Drug Administration, Parasitemia drug therapy, Parasitemia epidemiology, Plasmodium falciparum, Polymorphism, Genetic, Treatment Outcome, Young Adult, Antimalarials therapeutic use, Artemisinins therapeutic use, Malaria, Falciparum prevention & control, Primaquine therapeutic use, Quinolines therapeutic use
- Abstract
Background: Mass drug administration (MDA), with or without low-dose primaquine (PMQLD), is being considered for malaria elimination programs. The potential of PMQLD to block malaria transmission by mosquitoes must be balanced against liabilities of its use., Methods: Artemisinin-piperaquine (AP), with or without PMQLD, was administered in 3 monthly rounds across Anjouan Island, Union of Comoros. Plasmodium falciparum malaria rates, mortality, parasitemias, adverse events, and PfK13 Kelch-propeller gene polymorphisms were evaluated., Results: Coverage of 85 to 93% of the Anjouan population was achieved with AP plus PMQLD (AP+PMQLD) in 2 districts (population 97164) and with AP alone in 5 districts (224471). Between the months of April-September in both 2012 and 2013, average monthly malaria hospital rates per 100000 people fell from 310.8 to 2.06 in the AP+PMQLD population (ratio 2.06/310.8 = 0.66%; 95% CI: 0.02%, 3.62%; P = .00007) and from 412.1 to 2.60 in the AP population (ratio 0.63%; 95% CI: 0.11%, 1.93%; P < .00001). Effectiveness of AP+PMQLD was 0.9908 (95% CI: 0.9053, 0.9991), while effectiveness of AP alone was 0.9913 (95% CI: 0.9657, 0.9978). Both regimens were well tolerated, without severe adverse events. Analysis of 52 malaria samples after MDA showed no evidence for selection of PfK13 Kelch-propeller mutations., Conclusions: Steep reductions of malaria cases were achieved by 3 monthly rounds of either AP+PMQLD or AP alone, suggesting potential for highly successful MDA without PMQLD in epidemiological settings such as those on Anjouan. A major challenge is to sustain and expand the public health benefits of malaria reductions by MDA.
- Published
- 2018
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