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Objective To compare the cost-effectiveness of conventional antimalarial therapy with that of three artemisinin combination treatment regimens in children from Papua New Guinea aged 6 to 60 months. Methods An incremental cost-effectiveness analysis was performed using data from 656 children with Plasmodium falciparum and/or P. vivaxmalaria who participated in a large intervention trial in two clinics in northern Papua New Guinea. The children were randomized to one of the following groups: (i) conventional treatment with chloroquine plus sulfadoxine plus pyrimethamine (CQ+S+P); (ii) artesunate plus S plus P; (iii) dihydroartemisinin plus piperaquine (DHA+PQ); and (iv) artemether plus lumefantrine (A+L). For treatment outcomes, World Health Organization definitions were used. The cost of transport between home and the clinic plus direct health- care costs served as a basis for determining each regimen's incremental cost per incremental treatment success relative to CQ+S+P by day 42 and its cost per life year saved. Findings A+L proved to be the most effective regimen against R falciparum malaria and was highly cost-effective at 6.97 United States dollars (USS) per treatment success (about USS 58 per life year saved). DHA+PQ was the most effective regimen against P. vivax malaria and was more cost-effective than CQ+S+R Conclusion A+L and DHA+PQ are highly cost-effective regimens for the treatment of paediatric P. falciparum and R vivax malaria, respectively, in parts of Papua New Guinea. Future research will be required to determine if these findings hold true for other territories in Asia and Oceania with similar malaria epidemiology. Objectif Comparer le rapport cout -efficacite de la therapie antipaludeenne conventionnelle avec le rapport respectif de trois regimes de traitement associe a base d'artemisinine chez des enfants de Papouasie-NouvelleGuinee ages de 6 a 60 mois. Methodes Une analyse differentielle de cout-efficacite a ete realisee l'aide des donnees de 656 enfants souffrant de Plasmodium falciparum et/ ou de paludisme a P. vivax ayant participe a un vaste essai d'intervention sur le littoral nord-occidental de la Papouasie-Nouvelle-Guinee. Les enfants, qui ont ete presentes dans deux cliniques, ont fait I'objet d'une randomisation vers I'un des regimes therapeutiques suivants : (i) traitement conventionnel avec chloroquine et sulfadoxine-pyrimethamine; (ii) artesunate plus sulfadoxine-pyrimethamine; (iii) dihydroartemisininepiperaquine (DHA+PQ); et (iv) artemether-lumefantrine (A+L). Les resultats des traitements ont ete etablis conformement aux definitions standard de l'Organisation mondiale de la Sante. Le cout du transport entre le domicile et la clinique, ainsi que les frais directs lies aux soins de sante dispenses, ont ete calcules comme base determinante du cout differentiel de chaque regime par traitement reussi au jour 42, et son cout par annee de vie sauvee. Resultats A+L s'est revele comme le regime le plus efficace du point de vue clinique dans le traitement du paludisme a P. falciparum et representait un excellent rapport cout-efficacite a 6,97 dollars par traitement reussi (environ 58 dollars par annee de vie sauvee). DHA+PQ representait l'association de traitement la plus efficace dans la lutte contre le paludisme a P. vivax, et etait d'un meilleur rapport cout-efficacite que le traitement conventionnel contre le paludisme. Conclusion A+L et DHA+PQ sont des regimes tres rentables pour traiter, respectivement, le paludisme pediatrique a P. falciparum et a P vivax, dans les regions de la Papouasie-Nouvelle-Guinee. Des recherches futures seront necessaires arin de determiner si ces resultats se confirment dans d'autres territoires d'Asie et d'Oceanie presentant une epidemiologie de paludisme similaire. Objetivo Comparar la rentabilidad del tratamiento antipaludico convencional respecto a la de los tres tratamientos combinados con artemisinina en ninos de entre 6 y 60 meses de Papua Nueva Guinea. Metodos Se realizo un analisis incremental de la rentabilidad con los datos procedentes de 656 ninos con malaria por Plasmodium falciparum y/o por R vivax que participaron en un ensayo intervencionista a gran escala en la costa Norte de Papua Nueva Guinea. A los ninos que acudieron a dos consultorios, se les asigno aleatoriamente uno de los siguientes tratamientos: (a) tratamiento tradicional con cloroquina, sulfadoxina y pirimetamina; (b) artesunato, sulfadoxina y pirimetamina; (c) dihidroartemisinina y piperaquina (DHA+PQ); y (d) artemeter y lumefantrina (A+L). Se definieron los resultados terapeuticos siguiendo las definiciones normalizadas de la Organizacion Mundial de la Salud. Como base para la determinacion de los costes incrementales por cada logro terapeutico alcanzado a los 42 dias y su coste por ano de vida salvado, se calculo el coste del transporte entre el hogar y el centro de salud, junto con los gastos directos ocasionados por la asistencia sanitaria proporcionada. Resultados Desde el punto de vista clinico, el tratamiento mas eficaz contra la malaria por R falciparum fue el A+L, con una rentabilidad muy elevada de 6,97 dolares norteamericanos (USS) por logro terapeutico (unos 58 USS por ano de vida salvado). La combinacion terapeutica mas eficaz contra la malaria producida por R vivaxfue la DHA+PQ y resulto ser mas rentable que el tratamiento antipaludico habitual. Conclusion En algunas zonas de Papua Nueva Guinea, les tratamientos A+L y DHA+PQ resultan muy rentables en el tratamiento pediatrico contra la malaria por R falciparum y R vivax, respectivamente. Es preciso que se investigue mas en profundidad para determinar si estos resultados tambien son validos para otras regiones de Asia y Oceania que presenten una epidemiologia de malaria similar., Introduction Recent estimates show that Plasmodium falciparum causes 225 to 500 million cases of malaria and nearly one million malaria-related deaths worldwide each year. (1-3) Of these deaths, 96% take [...]

To the Editor: The imperfect diagnosis of malaria is a major impediment to the efforts to control and eliminate the disease (1). The recent report by Peng et al. (2) [...]

A more sensitive surveillance tool is needed to identify Plasmodium vivax infections for treatment and to accelerate malaria elimination efforts. To address this challenge, our laboratory has developed an eight-antigen panel that detects total IgG as serological markers of P. vivax exposure within the prior 9 months. The value of these markers has been established for use in areas with low transmission. In moderate-high transmission areas, there is evidence that total IgG is more long-lived than in areas with low transmission, resulting in poorer performance of these markers in these settings. Antibodies that are shorter-lived may be better markers of recent infection for use in moderate-high transmission areas. Using a multiplex assay, the antibody temporal kinetics of total IgG, IgG1, IgG3, and IgM against 29 P. vivax antigens were measured over 36 weeks following asymptomatic P. vivax infection in Papua New Guinean children (n = 31), from an area with moderate-high transmission intensity. IgG3 declined faster to background than total IgG, IgG1, and IgM. Based on these kinetics, IgG3 performance was then assessed for classifying recent exposure in a cohort of Peruvian individuals (n = 590; age 3-85 years) from an area of moderate transmission intensity. Using antibody responses against individual antigens, the highest performance of IgG3 in classifying recent P. vivax infections in the prior 9 months was to one of the Pv-fam-a proteins assessed (PVX_125728) (AUC = 0.764). Surprisingly, total IgG was overall a better marker of recent P. vivax infection, with the highest individual classification performance to RBP2b1986-2653 (PVX_094255) (AUC = 0.838). To understand the acquisition of IgG3 in this Peruvian cohort, relevant epidemiological factors were explored using a regression model. IgG3 levels were positively associated with increasing age, living in an area with (relatively) higher transmission intensity, and having three or more PCRdetected blood-stage P. vivax infections within the prior 13 months. Overall, we found that IgG3 did not have high accuracy for detecting recent exposure to P. vivax in the Peruvian cohort, with our data suggesting that this is due to the high levels of prior exposure required to acquire high IgG3 antibody levels. [ABSTRACT FROM AUTHOR]

A research conducted to find the pharmacokinetics, efficiency and safety of rectally administered artesunate, artemisinin, dihydroartemisinin and artemether for the treatmet of malaria is presented.

Cryptosporidiosis is a major global health problem and a primary cause of diarrhea, particularly in young children in low- and middle-income countries (LMICs). The zoonotic Cryptosporidium parvum and anthroponotic Cryptosporidium hominis cause most human infections. Here, we present a comprehensive whole-genome study of C. hominis , comprising 114 isolates from 16 countries within five continents. We detect two lineages with distinct biology and demography, which diverged circa 500 years ago. We consider these lineages two subspecies and propose the names C. hominis hominis and C. hominis aquapotentis (gp60 subtype IbA10G2). In our study, C. h. hominis is almost exclusively represented by isolates from LMICs in Africa and Asia and appears to have undergone recent population contraction. In contrast, C. h. aquapotentis was found in high-income countries, mainly in Europe, North America, and Oceania, and appears to be expanding. Notably, C. h. aquapotentis is associated with high rates of direct human-to-human transmission, which may explain its success in countries with well-developed environmental sanitation infrastructure. Intriguingly, we detected genomic regions of introgression following secondary contact between the subspecies. This resulted in high diversity and divergence in genomic islands of putative virulence genes, including muc5 (CHUDEA2_430) and a hypothetical protein (CHUDEA6_5270). This diversity is maintained by balancing selection, suggesting a co-evolutionary arms race with the host. Finally, we find that recent gene flow from C. h. aquapotentis to C. h. hominis , likely associated with increased human migration, maybe driving the evolution of more virulent C. hominis variants. [ABSTRACT FROM AUTHOR]