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Impact of Chemoprophylaxis on Plasmodium vivax and Plasmodium ovale Infection Among Civilian Travelers: A Nested Case-Control Study With a Counterfactual Approach on 862 Patients

Authors :
Le Goff, Maëlle
Kendjo, Eric
Thellier, Marc
Piarroux, Renaud
Boelle, Pierre Yves
Jauréguiberry, Stéphane
BOELLE, Pierre-Yves
Centre National de Référence CERAINO, Service de Rhumatologie (Hôpital de la Cavale Blanche)
Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)
Centre National de Référence du Paludisme [CHU Pitié-Salpétrière] (CNRpalu)
CHU Pitié-Salpêtrière [AP-HP]
Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP)
Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)
AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)
Source :
Clinical Infectious Diseases, Clinical Infectious Diseases, 2022, ⟨10.1093/cid/ciac641⟩
Publication Year :
2022
Publisher :
Oxford University Press (OUP), 2022.

Abstract

Background The impact of chemoprophylaxis targeting Plasmodium falciparum on Plasmodium vivax and Plasmodium ovale, which may remain quiescent as hypnozoites in the liver, is debated. Methods We conducted a nested case-control analysis of the outcomes of P. vivax and P. ovale infections in imported malaria cases in France among civilian travelers from 1 January 2006, to 31 December 2017. Using adjusted logistic regression, we assessed the effect of chemoprophylaxis on the incubation period, time from symptoms to diagnosis, management, blood results, symptoms, and hospitalization duration. We analyzed the effect of blood-stage drugs (doxycycline, mefloquine, chloroquine, chloroquine-proguanil) or atovaquone-proguanil on the incubation period. We used a counterfactual approach to ascertain the causal effect of chemoprophylaxis on postinfection characteristics. Results Among 247 P. vivax– and 615 P. ovale–infected travelers, 30% and 47%, respectively, used chemoprophylaxis, and 7 (3%) and 8 (1%) were severe cases. Chemoprophylaxis users had a greater risk of presenting symptoms >2 months after returning for both species (P. vivax odds ratio [OR], 2.91 [95% confidence interval {CI}, 1.22–6.95], P = .02; P. ovale OR, 2.28 [95% CI, 1.47–3.53], P < .001). Using drugs only acting on the blood stage was associated with delayed symptom onset after 60 days, while using atovaquone-proguanil was not. Conclusions Civilian travelers infected with P. vivax or P. ovale reporting chemoprophylaxis use, especially of blood-stage agents, had a greater risk of delayed onset of illness. The impact of chemoprophylaxis on the outcomes of infection with relapse-causing species calls for new chemoprophylaxis acting against erythrocytic and liver stages.

Details

ISSN :
15376591 and 10584838
Volume :
76
Database :
OpenAIRE
Journal :
Clinical Infectious Diseases
Accession number :
edsair.doi.dedup.....0cfe6403fb98498cff7583f05fde9355