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Cellich P, Unger HW, Rogerson SJ, Mola GDL. Impact on pregnancy outcomes of intermittent preventive treatment with sulfadoxine-pyrimethamine in urban and peri-urban Papua New Guinea: a retrospective cohort study. Malar J 2024; 23:201. [PMID: 38970076 PMCID: PMC11225125 DOI: 10.1186/s12936-024-05010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/04/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) reduces malaria-attributable adverse pregnancy outcomes and may also prevent low birth weight (< 2,500 g) through mechanisms independent of malaria. Malaria transmission in Papua New Guinea (PNG) is highly heterogeneous. The impact of IPTp-SP on adverse birth outcomes in settings with little or no malaria transmission, such as PNG's capital city Port Moresby, is unknown. METHODS A retrospective cohort study was conducted amongst HIV-negative women with a singleton pregnancy who delivered at Port Moresby General Hospital between 18 July and 21 August 2022. The impact of IPTp-SP doses on adverse birth outcomes and anaemia was assessed using logistic and linear regression models, as appropriate. RESULTS Of 1,140 eligible women amongst 1,228 consecutive births, 1,110 had a live birth with a documented birth weight. A total of 156 women (13.7%) did not receive any IPTp-SP, 347 women (30.4%) received one, 333 (29.2%) received two, and 304 (26.7%) received the recommended ≥ 3 doses of IPTp-SP. A total of 65 of 1,110 liveborn babies (5.9%) had low birth weight and there were 34 perinatal deaths (3.0%). Anaemia (haemoglobin < 100 g/L) was observed in 30.6% (243/793) of women, and 14 (1.2%) had clinical malaria in pregnancy. Compared to women receiving 0-1 dose of IPTp-SP, women receiving ≥ 2 doses had lower odds of LBW (adjusted odds ratio [aOR] 0.50; 95% confidence interval [CI] 0.26, 0.96), preterm birth (aOR 0.58; 95% CI 0.32, 1.04), perinatal death (aOR 0.49; 95% CI 0.18, 1.38), LBW/perinatal death (aOR 0.55; 95% CI 0.27, 1.12), and anaemia (OR 0.50; 95% CI 0.36, 0.69). Women who received 2 doses versus 0-1 had 45% lower odds of LBW (aOR 0.55, 95% CI 0.27, 1.10), and a 16% further (total 61%) reduction with ≥ 3 doses (aOR 0.39, 95% CI 0.14, 1.05). Birth weights for women who received 2 or ≥ 3 doses versus 0-1 were 81 g (95% CI -3, 166) higher, and 151 g (58, 246) higher, respectively. CONCLUSIONS Provision of IPTp-SP in a low malaria-transmission setting in PNG appears to translate into substantial health benefits, in a dose-response manner, supporting the strengthening IPTp-SP uptake across all transmission settings in PNG.
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Affiliation(s)
- Philip Cellich
- Division of Obstetrics and Gynaecology, School of Medicine and Health Sciences, Port Moresby General Hospital, University of Papua New Guinea, Port Moresby, Papua New Guinea.
- Department of Obstetrics and Gynaecology, Canterbury Hospital, 575 Canterbury Road, Campsie 2194, NSW, Australia.
| | - Holger W Unger
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina 0810, NT, Australia.
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, NT, Australia.
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
- Department of Infectious Diseases, University of Melbourne, The Doherty Institute, Melbourne, VIC, Australia.
| | - Stephen J Rogerson
- Department of Infectious Diseases, University of Melbourne, The Doherty Institute, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, The Doherty Institute, Melbourne, VIC, Australia
| | - Glen D L Mola
- Division of Obstetrics and Gynaecology, School of Medicine and Health Sciences, Port Moresby General Hospital, University of Papua New Guinea, Port Moresby, Papua New Guinea
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
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Yermakovich D, André M, Brucato N, Kariwiga J, Leavesley M, Pankratov V, Mondal M, Ricaut FX, Dannemann M. Denisovan admixture facilitated environmental adaptation in Papua New Guinean populations. Proc Natl Acad Sci U S A 2024; 121:e2405889121. [PMID: 38889149 PMCID: PMC11214076 DOI: 10.1073/pnas.2405889121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/16/2024] [Indexed: 06/20/2024] Open
Abstract
Neandertals and Denisovans, having inhabited distinct regions in Eurasia and possibly Oceania for over 200,000 y, experienced ample time to adapt to diverse environmental challenges these regions presented. Among present-day human populations, Papua New Guineans (PNG) stand out as one of the few carrying substantial amounts of both Neandertal and Denisovan DNA, a result of past admixture events with these archaic human groups. This study investigates the distribution of introgressed Denisovan and Neandertal DNA within two distinct PNG populations, residing in the highlands of Mt Wilhelm and the lowlands of Daru Island. These locations exhibit unique environmental features, some of which may parallel the challenges that archaic humans once confronted and adapted to. Our results show that PNG highlanders carry higher levels of Denisovan DNA compared to PNG lowlanders. Among the Denisovan-like haplotypes with higher frequencies in highlander populations, those exhibiting the greatest frequency difference compared to lowlander populations also demonstrate more pronounced differences in population frequencies than frequency-matched nonarchaic variants. Two of the five most highly differentiated of those haplotypes reside in genomic areas linked to brain development genes. Conversely, Denisovan-like haplotypes more frequent in lowlanders overlap with genes associated with immune response processes. Our findings suggest that Denisovan DNA has provided genetic variation associated with brain biology and immune response to PNG genomes, some of which might have facilitated adaptive processes to environmental challenges.
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Affiliation(s)
- Danat Yermakovich
- Center of Genomics, Evolution and Medicine, Institute of Genomics, University of Tartu, Tartu51010, Estonia
| | - Mathilde André
- Center of Genomics, Evolution and Medicine, Institute of Genomics, University of Tartu, Tartu51010, Estonia
| | - Nicolas Brucato
- Centre de Recherche sur la Biodiversité et l'Environnement, Université de Toulouse, Centre National de la Recherche Scientifique, Institut de Recherche pour le Développement, Toulouse Institut National Polytechnique, Université Toulouse 3–Paul Sabatier, cedex 9, Toulouse31062, France
| | - Jason Kariwiga
- Strand of Anthropology, Sociology and Archaeology, School of Humanities and Social Sciences, University of Papua New Guinea, PO Box 320, University 134, National Capital District, Papua New Guinea
- School of Social Science, University of Queensland, St. Lucia, QLD4072, Australia
| | - Matthew Leavesley
- Strand of Anthropology, Sociology and Archaeology, School of Humanities and Social Sciences, University of Papua New Guinea, PO Box 320, University 134, National Capital District, Papua New Guinea
- The Australian Research Council Centre of Excellence for Australian Biodiversity and Heritage & College of Arts, Society and Education, James Cook University, Cairns, QLD4870, Australia
| | - Vasili Pankratov
- Center of Genomics, Evolution and Medicine, Institute of Genomics, University of Tartu, Tartu51010, Estonia
| | - Mayukh Mondal
- Center of Genomics, Evolution and Medicine, Institute of Genomics, University of Tartu, Tartu51010, Estonia
- Institute of Clinical Molecular Biology, Christian-Albrechts-Universität zu Kiel, Kiel24118, Germany
| | - François-Xavier Ricaut
- Centre de Recherche sur la Biodiversité et l'Environnement, Université de Toulouse, Centre National de la Recherche Scientifique, Institut de Recherche pour le Développement, Toulouse Institut National Polytechnique, Université Toulouse 3–Paul Sabatier, cedex 9, Toulouse31062, France
| | - Michael Dannemann
- Center of Genomics, Evolution and Medicine, Institute of Genomics, University of Tartu, Tartu51010, Estonia
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3
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André M, Brucato N, Hudjasov G, Pankratov V, Yermakovich D, Montinaro F, Kreevan R, Kariwiga J, Muke J, Boland A, Deleuze JF, Meyer V, Evans N, Cox MP, Leavesley M, Dannemann M, Org T, Metspalu M, Mondal M, Ricaut FX. Positive selection in the genomes of two Papua New Guinean populations at distinct altitude levels. Nat Commun 2024; 15:3352. [PMID: 38688933 PMCID: PMC11061283 DOI: 10.1038/s41467-024-47735-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
Highlanders and lowlanders of Papua New Guinea have faced distinct environmental stress, such as hypoxia and environment-specific pathogen exposure, respectively. In this study, we explored the top genomics regions and the candidate driver SNPs for selection in these two populations using newly sequenced whole-genomes of 54 highlanders and 74 lowlanders. We identified two candidate SNPs under selection - one in highlanders, associated with red blood cell traits and another in lowlanders, which is associated with white blood cell count - both potentially influencing the heart rate of Papua New Guineans in opposite directions. We also observed four candidate driver SNPs that exhibit linkage disequilibrium with an introgressed haplotype, highlighting the need to explore the possibility of adaptive introgression within these populations. This study reveals that the signatures of positive selection in highlanders and lowlanders of Papua New Guinea align closely with the challenges they face, which are specific to their environments.
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Affiliation(s)
- Mathilde André
- Estonian Biocentre, Institute of Genomics, University of Tartu, Riia 23b, 51010, Tartu, Tartumaa, Estonia
- Centre for Genomics, Evolution & Medicine, Institute of Genomics, University of Tartu, Riia 23b, 51010, Tartu, Tartumaa, Estonia
| | - Nicolas Brucato
- Centre de Recherche sur la Biodiversité et l'Environnement (CRBE), Université de Toulouse, CNRS, IRD, Toulouse INP, Université Toulouse 3 - Paul Sabatier (UT3), Toulouse, France
| | - Georgi Hudjasov
- Centre for Genomics, Evolution & Medicine, Institute of Genomics, University of Tartu, Riia 23b, 51010, Tartu, Tartumaa, Estonia
| | - Vasili Pankratov
- Centre for Genomics, Evolution & Medicine, Institute of Genomics, University of Tartu, Riia 23b, 51010, Tartu, Tartumaa, Estonia
| | - Danat Yermakovich
- Centre for Genomics, Evolution & Medicine, Institute of Genomics, University of Tartu, Riia 23b, 51010, Tartu, Tartumaa, Estonia
| | - Francesco Montinaro
- Estonian Biocentre, Institute of Genomics, University of Tartu, Riia 23b, 51010, Tartu, Tartumaa, Estonia
- Department of Biosciences, Biotechnology and the Environment, University of Bari, Bari, Italy
| | - Rita Kreevan
- Centre for Genomics, Evolution & Medicine, Institute of Genomics, University of Tartu, Riia 23b, 51010, Tartu, Tartumaa, Estonia
| | - Jason Kariwiga
- Strand of Anthropology, Sociology and Archaeology, School of Humanities and Social Sciences, University of Papua New Guinea, University 134, PO Box 320, National Capital District, Papua New Guinea
- School of Social Science, University of Queensland, St Lucia, QLD, Australia
| | - John Muke
- Social Research Institute Ltd, Port Moresby, Papua New Guinea
| | - Anne Boland
- Université Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine (CNRGH), 91057, Evry, France
| | - Jean-François Deleuze
- Université Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine (CNRGH), 91057, Evry, France
| | - Vincent Meyer
- Université Paris-Saclay, CEA, Centre National de Recherche en Génomique Humaine (CNRGH), 91057, Evry, France
| | - Nicholas Evans
- ARC Centre of Excellence for the Dynamics of Language, Coombs Building, Fellows Road, CHL, CAP, Australian National University, Canberra, ACT, Australia
| | - Murray P Cox
- School of Natural Sciences, Massey University, Palmerston North, New Zealand
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - Matthew Leavesley
- Strand of Anthropology, Sociology and Archaeology, School of Humanities and Social Sciences, University of Papua New Guinea, University 134, PO Box 320, National Capital District, Papua New Guinea
- College of Arts, Society and Education, James Cook University, P.O. Box 6811, Cairns, QLD, 4870, Australia
- ARC Centre of Excellence for Australian Biodiversity and Heritage, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Michael Dannemann
- Centre for Genomics, Evolution & Medicine, Institute of Genomics, University of Tartu, Riia 23b, 51010, Tartu, Tartumaa, Estonia
| | - Tõnis Org
- Centre for Genomics, Evolution & Medicine, Institute of Genomics, University of Tartu, Riia 23b, 51010, Tartu, Tartumaa, Estonia
| | - Mait Metspalu
- Estonian Biocentre, Institute of Genomics, University of Tartu, Riia 23b, 51010, Tartu, Tartumaa, Estonia
| | - Mayukh Mondal
- Centre for Genomics, Evolution & Medicine, Institute of Genomics, University of Tartu, Riia 23b, 51010, Tartu, Tartumaa, Estonia.
- Institute of Clinical Molecular Biology, Christian-Albrechts-Universität zu Kiel, 24118, Kiel, Germany.
| | - François-Xavier Ricaut
- Centre de Recherche sur la Biodiversité et l'Environnement (CRBE), Université de Toulouse, CNRS, IRD, Toulouse INP, Université Toulouse 3 - Paul Sabatier (UT3), Toulouse, France.
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Katusele M, Lagur S, Endersby-Harshman N, Demok S, Goi J, Vincent N, Sakur M, Dau A, Kilepak L, Gideon S, Pombreaw C, Makita L, Hoffmann A, Robinson LJ, Laman M, Karl S. Insecticide resistance in malaria and arbovirus vectors in Papua New Guinea, 2017-2022. Parasit Vectors 2022; 15:426. [PMID: 36376932 PMCID: PMC9664807 DOI: 10.1186/s13071-022-05493-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Insecticide resistance (IR) monitoring is essential for evidence-based control of mosquito-borne diseases. While widespread pyrethroid resistance in Anopheles and Aedes species has been described in many countries, data for Papua New Guinea (PNG) are limited. Available data indicate that the local Anopheles populations in PNG remain pyrethroid-susceptible, making regular IR monitoring even more important. In addition, Aedes aegypti pyrethroid resistance has been described in PNG. Here, Anopheles and Aedes IR monitoring data generated from across PNG between 2017 and 2022 are presented. METHODS Mosquito larvae were collected in larval habitat surveys and through ovitraps. Mosquitoes were reared to adults and tested using standard WHO susceptibility bioassays. DNA from a subset of Aedes mosquitoes was sequenced to analyse the voltage-sensitive sodium channel (Vssc) region for any resistance-related mutations. RESULTS Approximately 20,000 adult female mosquitoes from nine PNG provinces were tested. Anopheles punctulatus sensu lato mosquitoes were susceptible to pyrethroids but there were signs of reduced mortality in some areas. Some Anopheles populations were also resistant to DDT. Tests also showed that Aedes. aegypti in PNG are resistant to pyrethroids and DDT and that there was also likelihood of bendiocarb resistance. A range of Vssc resistance mutations were identified. Aedes albopictus were DDT resistant and were likely developing pyrethroid resistance, given a low frequency of Vssc mutations was observed. CONCLUSIONS Aedes aegypti is highly pyrethroid resistant and also shows signs of resistance against carbamates in PNG. Anopheles punctulatus s.l. and Ae. albopictus populations exhibit low levels of resistance against pyrethroids and DDT in some areas. Pyrethroid-only bed nets are currently the only programmatic vector control tool used in PNG. It is important to continue to monitor IR in PNG and develop proactive insecticide resistance management strategies in primary disease vectors to retain pyrethroid susceptibility especially in the malaria vectors for as long as possible.
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Affiliation(s)
- Michelle Katusele
- PNG Institute of Medical Research, Madang, Madang Province Papua New Guinea
| | - Solomon Lagur
- PNG Institute of Medical Research, Madang, Madang Province Papua New Guinea
| | - Nancy Endersby-Harshman
- School of BioSciences, Bio21 Institute, The University of Melbourne, Parkville, Victoria Australia
| | - Samuel Demok
- PNG Institute of Medical Research, Madang, Madang Province Papua New Guinea
| | - Joelyn Goi
- PNG Institute of Medical Research, Madang, Madang Province Papua New Guinea
| | - Naomi Vincent
- PNG Institute of Medical Research, Madang, Madang Province Papua New Guinea
- Burnet Institute of Medical Research, Melbourne, Victoria Australia
- Papua New Guinea National Department of Health, Port Moresby, National Capitol District Papua New Guinea
| | - Muker Sakur
- PNG Institute of Medical Research, Madang, Madang Province Papua New Guinea
| | - Absalom Dau
- PNG Institute of Medical Research, Madang, Madang Province Papua New Guinea
| | - Lemen Kilepak
- PNG Institute of Medical Research, Madang, Madang Province Papua New Guinea
| | - Stephen Gideon
- PNG Institute of Medical Research, Madang, Madang Province Papua New Guinea
- Papua New Guinea National Department of Health, Port Moresby, National Capitol District Papua New Guinea
| | - Christine Pombreaw
- PNG Institute of Medical Research, Madang, Madang Province Papua New Guinea
| | - Leo Makita
- Papua New Guinea National Department of Health, Port Moresby, National Capitol District Papua New Guinea
| | - Ary Hoffmann
- School of BioSciences, Bio21 Institute, The University of Melbourne, Parkville, Victoria Australia
| | - Leanne J. Robinson
- PNG Institute of Medical Research, Madang, Madang Province Papua New Guinea
- Burnet Institute of Medical Research, Melbourne, Victoria Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Moses Laman
- PNG Institute of Medical Research, Madang, Madang Province Papua New Guinea
| | - Stephan Karl
- PNG Institute of Medical Research, Madang, Madang Province Papua New Guinea
- Australian Institute of Tropical Health and Medicine, James Cook University, Smithfield, Queensland Australia
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5
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Cleary E, Hetzel MW, Clements ACA. A review of malaria epidemiology and control in Papua New Guinea 1900 to 2021: Progress made and future directions. FRONTIERS IN EPIDEMIOLOGY 2022; 2:980795. [PMID: 38455277 PMCID: PMC10910954 DOI: 10.3389/fepid.2022.980795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/29/2022] [Indexed: 03/09/2024]
Abstract
The research and control of malaria has a long history in Papua New Guinea, sometimes resulting in substantial changes to the distribution of infection and transmission dynamics in the country. There have been four major periods of malaria control in PNG, with the current control programme having commenced in 2004. Each previous control programme was successful in reducing malaria burden in the country, but multiple factors led to programme failures and eventual breakdown. A comprehensive review of the literature dating from 1900 to 2021 was undertaken to summarize control strategies, epidemiology, vector ecology and environmental drivers of malaria transmission in PNG. Evaluations of historical control programs reveal poor planning and communication, and difficulty in sustaining financial investment once malaria burden had decreased as common themes in the breakdown of previous programs. Success of current and future malaria control programs in PNG is contingent on adequate planning and management of control programs, effective communication and engagement with at-risk populations, and cohesive targeted approaches to sub-national and national control and elimination.
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Affiliation(s)
- Eimear Cleary
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Manuel W. Hetzel
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Archie C. A. Clements
- Curtin University, Perth, WA, Australia
- Telethon Kids Institute, Perth, WA, Australia
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Holzschuh A, Gruenberg M, Hofmann NE, Wampfler R, Kiniboro B, Robinson LJ, Mueller I, Felger I, White MT. Co-infection of the four major Plasmodium species: Effects on densities and gametocyte carriage. PLoS Negl Trop Dis 2022; 16:e0010760. [PMID: 36099312 PMCID: PMC9506632 DOI: 10.1371/journal.pntd.0010760] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/23/2022] [Accepted: 08/22/2022] [Indexed: 11/19/2022] Open
Abstract
Background Co-infection of the four major species of human malaria parasite Plasmodium falciparum (Pf), P. vivax (Pv), P. malariae (Pm), and P. ovale sp. (Po) is regularly observed, but there is limited understanding of between-species interactions. In particular, little is known about the effects of multiple Plasmodium species co-infections on gametocyte production. Methods We developed molecular assays for detecting asexual and gametocyte stages of Pf, Pv, Pm, and Po. This is the first description of molecular diagnostics for Pm and Po gametocytes. These assays were implemented in a unique epidemiological setting in Papua New Guinea with sympatric transmission of all four Plasmodium species permitting a comprehensive investigation of species interactions. Findings The observed frequency of Pf-Pv co-infection for asexual parasites (14.7%) was higher than expected from individual prevalence rates (23.8%Pf x 47.4%Pv = 11.3%). The observed frequency of co-infection with Pf and Pv gametocytes (4.6%) was higher than expected from individual prevalence rates (13.1%Pf x 28.2%Pv = 3.7%). The excess risk of co-infection was 1.38 (95% confidence interval (CI): 1.09, 1.67) for all parasites and 1.37 (95% CI: 0.95, 1.79) for gametocytes. This excess co-infection risk was partially attributable to malaria infections clustering in some villages. Pf-Pv-Pm triple infections were four times more frequent than expected by chance alone, which could not be fully explained by infections clustering in highly exposed individuals. The effect of co-infection on parasite density was analyzed by systematic comparison of all pairwise interactions. This revealed a significant 6.57-fold increase of Pm density when co-infected with Pf. Pm gametocytemia also increased with Pf co-infection. Conclusions Heterogeneity in exposure to mosquitoes is a key epidemiological driver of Plasmodium co-infection. Among the four co-circulating parasites, Pm benefitted most from co-infection with other species. Beyond this, no general prevailing pattern of suppression or facilitation was identified in pairwise analysis of gametocytemia and parasitemia of the four species. Trial registration This trial is registered with ClinicalTrials.gov, Trial ID: NCT02143934. The majority of malaria research focuses on the Plasmodium falciparum and P. vivax parasite species, due to their large public health burden. The epidemiology of P. malariae and P. ovale parasites has been comparatively neglected, due to a lack of research tools, most notably diagnostics. We present new molecular diagnostic assays for detecting P. malariae and P. ovale gametocytes, the sexual stage of the malaria parasite transmitted to mosquitoes. These assays were applied to samples collected in Papua New Guinea, a rare region with high transmission of the four major malaria parasite species. Patterns of co-infections were characterized accounting for interactions between pairs and triples of parasites. Heterogeneity in exposure to mosquito bites was identified as a key driver of patterns of co-infection. The effect of co-infection on parasite density was analyzed by systematic comparison of all pairwise interactions. The most significant within-host interaction of parasites was the large increase in P. malariae parasite density due to co-infection with P. falciparum. This finding was replicated for P. malariae gametocytes (but did not attain statistical significance due to low sample numbers) suggesting that co-infection provides a key transmission advantage to P. malariae.
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Affiliation(s)
- Aurel Holzschuh
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Maria Gruenberg
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Natalie E. Hofmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Rahel Wampfler
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Benson Kiniboro
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang and Maprik, Papua New Guinea
| | - Leanne J. Robinson
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang and Maprik, Papua New Guinea
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Ingrid Felger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail: (IF); (MTW)
| | - Michael T. White
- Institut Pasteur, Université de Paris Cité, G5 Épidémiologie et Analyse des Maladies Infectieuses, Département de Santé Globale, Paris, France
- * E-mail: (IF); (MTW)
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7
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Zhang X, Wei H, Zhang Y, Zhao Y, Wang L, Hu Y, Nguitragool W, Sattabongkot J, Adams J, Cui L, Cao Y, Wang Q. Genetic diversity of Plasmodium vivax reticulocyte binding protein 2b in global parasite populations. Parasit Vectors 2022; 15:205. [PMID: 35698238 PMCID: PMC9191549 DOI: 10.1186/s13071-022-05296-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/23/2022] [Indexed: 11/19/2022] Open
Abstract
Background Plasmodium vivax reticulocyte binding protein 2b (PvRBP2b) plays a critical role in parasite invasion of reticulocytes by binding the transferrin receptor 1. PvRBP2b is a vaccine candidate based on the negative correlation between antibody titers against PvRBP2b recombinant proteins and parasitemia and risk of vivax malaria. The aim of this study was to analyze the genetic diversity of the PvRBP2b gene in the global P. vivax populations. Methods Near full-length PvRBP2b nucleotide sequences (190–8349 bp) were obtained from 88 P. vivax isolates collected from the China–Myanmar border (n = 44) and Thailand (n = 44). An additional 224 PvRBP2b sequences were retrieved from genome sequences from parasite populations worldwide. The genetic diversity, neutral selection, haplotype distribution and genetic differentiation of PvRBP2b were examined. Results The genetic diversity of PvRBP2b was distributed unevenly, with peak diversity found in the reticulocyte binding region in the N-terminus. Neutrality analysis suggested that this region is subjected to balancing selection or population bottlenecks. Several amino acid variants were found in all or nearly all P. vivax endemic regions. However, the critical residues responsible for reticulocyte binding were highly conserved. There was substantial population differentiation according to the geographical separation. The distribution of haplotypes in the reticulocyte binding region varied among regions; even the two major haplotypes Hap_6 and Hap_8 were found in only five populations. Conclusions Our data show considerable genetic variations of PvRBPb in global parasite populations. The geographic divergence may pose a challenge to PvRBP2b-based vaccine development. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-022-05296-6.
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Affiliation(s)
- Xuexing Zhang
- Department of Immunology, College of Basic Medical Science, China Medical University, Shenyang, 110122, Liaoning, China
| | - Haichao Wei
- Department of Immunology, College of Basic Medical Science, China Medical University, Shenyang, 110122, Liaoning, China.,Department of Blood Transfusion Medicine, General Hospital of Northern Theater Command, Shenyang, 110015, Liaoning, China
| | - Yangminghui Zhang
- Department of Immunology, College of Basic Medical Science, China Medical University, Shenyang, 110122, Liaoning, China
| | - Yan Zhao
- Department of Immunology, College of Basic Medical Science, China Medical University, Shenyang, 110122, Liaoning, China
| | - Lin Wang
- Department of Immunology, College of Basic Medical Science, China Medical University, Shenyang, 110122, Liaoning, China.,Department of Blood Transfusion, Yantaishan Hospital, Yantai, 264000, Shandong, China
| | - Yubing Hu
- Department of Immunology, College of Basic Medical Science, China Medical University, Shenyang, 110122, Liaoning, China.,Central Laboratory, The First Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Wang Nguitragool
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jetsumon Sattabongkot
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - John Adams
- College of Public Health, Global Health Infectious Disease Research (GHIDR) Program, Tampa, FL, USA
| | - Liwang Cui
- College of Public Health, Global Health Infectious Disease Research (GHIDR) Program, Tampa, FL, USA.,Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 3720 Spectrum Boulevard, Suite 304, Tampa, FL, 33612, USA
| | - Yaming Cao
- Department of Immunology, College of Basic Medical Science, China Medical University, Shenyang, 110122, Liaoning, China.
| | - Qinghui Wang
- Department of Immunology, College of Basic Medical Science, China Medical University, Shenyang, 110122, Liaoning, China.
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8
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Keven JB, Katusele M, Vinit R, Rodríguez-Rodríguez D, Hetzel MW, Robinson LJ, Laman M, Karl S, Walker ED. Vector composition, abundance, biting patterns and malaria transmission intensity in Madang, Papua New Guinea: assessment after 7 years of an LLIN-based malaria control programme. Malar J 2022; 21:7. [PMID: 34983530 PMCID: PMC8729043 DOI: 10.1186/s12936-021-04030-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background A malaria control programme based on distribution of long-lasting insecticidal bed nets (LLINs) and artemisinin combination therapy began in Papua New Guinea in 2009. After implementation of the programme, substantial reductions in vector abundance and malaria transmission intensity occurred. The research reported here investigated whether these reductions remained after seven years of sustained effort. Methods All-night (18:00 to 06:00) mosquito collections were conducted using human landing catches and barrier screen methods in four villages of Madang Province between September 2016 and March 2017. Anopheles species identification and sporozoite infection with Plasmodium vivax and Plasmodium falciparum were determined with molecular methods. Vector composition was expressed as the relative proportion of different species in villages, and vector abundance was quantified as the number of mosquitoes per barrier screen-night and per person-night. Transmission intensity was quantified as the number of sporozoite-infective vector bites per person-night. Results Five Anopheles species were present, but vector composition varied greatly among villages. Anopheles koliensis, a strongly anthropophilic species was the most prevalent in Bulal, Matukar and Wasab villages, constituting 63.7–73.8% of all Anopheles, but in Megiar Anopheles farauti was the most prevalent species (97.6%). Vector abundance varied among villages (ranging from 2.8 to 72.3 Anopheles per screen-night and 2.2–31.1 Anopheles per person-night), and spatially within villages. Malaria transmission intensity varied among the villages, with values ranging from 0.03 to 0.5 infective Anopheles bites per person-night. Most (54.1–75.1%) of the Anopheles bites occurred outdoors, with a substantial proportion (25.5–50.8%) occurring before 22:00. Conclusion The estimates of vector abundance and transmission intensity in the current study were comparable to or higher than estimates in the same villages in 2010–2012, indicating impeded programme effectiveness. Outdoor and early biting behaviours of vectors are some of the likely explanatory factors. Heterogeneity in vector composition, abundance and distribution among and within villages challenge malaria control programmes and must be considered when planning them. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-04030-4.
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Affiliation(s)
- John B Keven
- Department of Entomology, Michigan State University, East Lansing, MI, USA. .,Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI, USA. .,Papua New Guinea Institute of Medical Research, Vector-Borne Diseases Unit, Madang, Papua New Guinea.
| | - Michelle Katusele
- Papua New Guinea Institute of Medical Research, Vector-Borne Diseases Unit, Madang, Papua New Guinea
| | - Rebecca Vinit
- Papua New Guinea Institute of Medical Research, Vector-Borne Diseases Unit, Madang, Papua New Guinea
| | | | - Manuel W Hetzel
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Leanne J Robinson
- Papua New Guinea Institute of Medical Research, Vector-Borne Diseases Unit, Madang, Papua New Guinea.,Burnet Institute, Melbourne, VIC, Australia.,Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Moses Laman
- Papua New Guinea Institute of Medical Research, Vector-Borne Diseases Unit, Madang, Papua New Guinea
| | - Stephan Karl
- Papua New Guinea Institute of Medical Research, Vector-Borne Diseases Unit, Madang, Papua New Guinea.,Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
| | - Edward D Walker
- Department of Entomology, Michigan State University, East Lansing, MI, USA.,Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI, USA
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9
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Seidahmed O, Jamea S, Kurumop S, Timbi D, Makita L, Ahmed M, Freeman T, Pomat W, Hetzel MW. Stratification of malaria incidence in Papua New Guinea (2011-2019): Contribution towards a sub-national control policy. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000747. [PMID: 36962582 PMCID: PMC10022348 DOI: 10.1371/journal.pgph.0000747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 10/20/2022] [Indexed: 11/22/2022]
Abstract
Malaria risk in Papua New Guinea (PNG) is highly heterogeneous, between and within geographical regions, which is operationally challenging for control. To enhance targeting of malaria interventions in PNG, we investigated risk factors and stratified malaria incidence at the level of health facility catchment areas. Catchment areas and populations of 808 health facilities were delineated using a travel-time accessibility approach and linked to reported malaria cases (2011-2019). Zonal statistics tools were used to calculate average altitude and air temperature in catchment areas before they were spatially joined with incidence rates. In addition, empirical Bayesian kriging (EBK) was employed to interpolate incidence risk strata across PNG. Malaria annual incidence rates are, on average, 186.3 per 1000 population in catchment areas up to 600 m, dropped to 98.8 at (800-1400) m, and to 24.1 cases above 1400 m altitude. In areas above the two altitudinal thresholds 600m and 1400m, the average annual temperature drops below 22°C and 17°C, respectively. EBK models show very low- to low-risk strata (<100 cases per 1000) in the Highlands, National Capital District and Bougainville. In contrast, patches of high-risk (>200 per 1000) strata are modelled mainly in Momase and Islands Regions. Besides, strata with moderate risk (100-200) predominate throughout the coastal areas. While 35.7% of the PNG population (estimated 3.33 million in 2019) lives in places at high or moderate risk of malaria, 52.2% (estimated 4.88 million) resides in very low-risk areas. In five provinces, relatively large proportions of populations (> 50%) inhabit high-risk areas: New Ireland, East and West New Britain, Sandaun and Milne Bay. Incidence maps show a contrast in malaria risk between coastal and inland areas influenced by altitude. However, the risk is highly variable in low-lying areas. Malaria interventions should be guided by sub-national risk levels in PNG.
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Affiliation(s)
- Osama Seidahmed
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
- University of Basel, Basel, Switzerland
| | - Sharon Jamea
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Serah Kurumop
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Diana Timbi
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Leo Makita
- National Department of Health, Port Moresby, Papua New Guinea
| | - Munir Ahmed
- Rotarians Against Malaria, Port Moresby, Papua New Guinea
| | - Tim Freeman
- Rotarians Against Malaria, Port Moresby, Papua New Guinea
| | - William Pomat
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Manuel W Hetzel
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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10
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Meier L, Casagrande G, Abdulla S, Masanja H. A brief history of selected malaria vaccine and medical interventions pursued by the Swiss Tropical and Public Health Institute and partners, 1943-2021. Acta Trop 2022; 225:106115. [PMID: 34464588 DOI: 10.1016/j.actatropica.2021.106115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/29/2021] [Accepted: 08/12/2021] [Indexed: 11/01/2022]
Abstract
In order to be successful in global health today, all the long-established European tropical research institutes had to undergo a transition which can be described as "hunter-gatherer" and descriptive approaches during colonial and postcolonial times to a deeper understanding of infection biology and finally to public health interventions from which populations at large can benefit. During the 1980s and 1990s, the Swiss Tropical Institute (today: Swiss Tropical and Public Health Institute, Swiss TPH) based in Basel too has changed its focus from individual medicine to a public health context. This article does not present new scientific data but takes a historical perspective. Its aim is to highlight the above-mentioned transformation by focusing on selected malaria research-cum-action interventions during the crucial period of the 1990s, which were tailored to the social-ecological settings where the disease was endemic. In order for this transformation to be successful, we intend to emphasise the importance of (i) having a fundamental understanding of local transmission; (ii) building and nurturing relationships with partner institutions; and (iii) developing a coherent research portfolio as key elements for researching and applying evidence in malaria control and elimination as part of national malaria control programmes.
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11
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Timinao L, Vinit R, Katusele M, Koleala T, Nate E, Czeher C, Burkot TR, Schofield L, Felger I, Mueller I, Laman M, Robinson LJ, Karl S. Infectivity of Symptomatic Malaria Patients to Anopheles farauti Colony Mosquitoes in Papua New Guinea. Front Cell Infect Microbiol 2021; 11:771233. [PMID: 35004348 PMCID: PMC8729879 DOI: 10.3389/fcimb.2021.771233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/29/2021] [Indexed: 11/23/2022] Open
Abstract
Plasmodium transmission from humans to mosquitoes is an understudied bottleneck in the transmission of malaria. Direct membrane feeding assays (DMFA) allow detailed malaria transmission studies from humans to mosquitoes. Especially for Plasmodium vivax, which cannot be cultured long-term under laboratory conditions, implementation of DMFAs requires proximity to P. vivax endemic areas. In this study, we investigated the infectivity of symptomatic Plasmodium infections to Anopheles farauti colony mosquitoes in Papua New Guinea (PNG). A total of 182 DMFAs were performed with venous blood collected from rapid diagnostic test (RDT) positive symptomatic malaria patients and subsequently analysed by light microscopy and quantitative real time polymerase chain reaction (qPCR). DMFAs resulted in mosquito infections in 20.9% (38/182) of cases. By light microscopy and qPCR, 10 - 11% of P. falciparum and 32 - 44% of P. vivax positive individuals infected An. farauti. Fifty-eight percent of P. vivax and 15% of P. falciparum gametocytaemic infections infected An farauti.
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Affiliation(s)
- Lincoln Timinao
- Vector-borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
- Australian Institute of Tropical Health and Medicine, James Cook University, Smithfield, QLD, Australia
| | - Rebecca Vinit
- Vector-borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Michelle Katusele
- Vector-borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Tamarah Koleala
- Vector-borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Elma Nate
- Vector-borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Cyrille Czeher
- Vector-borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Thomas R. Burkot
- Australian Institute of Tropical Health and Medicine, James Cook University, Smithfield, QLD, Australia
| | - Louis Schofield
- Australian Institute of Tropical Health and Medicine, James Cook University, Smithfield, QLD, Australia
| | - Ingrid Felger
- Molecular Diagnostics Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Department Biozentrum, University of Basel, Basel, Switzerland
| | - Ivo Mueller
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
- Malaria Parasites and Hosts Unit, Department of Parasites & Insect Vectors, Institut Pasteur, Paris, France
| | - Moses Laman
- Vector-borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Leanne J. Robinson
- Vector-borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
- Vector-Borne Diseases and Tropical Public Health Division, Burnet Institute, Melbourne, VIC, Australia
| | - Stephan Karl
- Vector-borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
- Australian Institute of Tropical Health and Medicine, James Cook University, Smithfield, QLD, Australia
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12
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Yoshida N, Yamauchi M, Morikawa R, Hombhanje F, Mita T. Increase in the proportion of Plasmodium falciparum with kelch13 C580Y mutation and decline in pfcrt and pfmdr1 mutant alleles in Papua New Guinea. Malar J 2021; 20:410. [PMID: 34666779 PMCID: PMC8524940 DOI: 10.1186/s12936-021-03933-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background The C580Y mutation in the Plasmodium falciparum kelch13 gene is the most commonly observed variant in artemisinin-resistant isolates in the Greater Mekong Subregion (GMS). Until 2017, it had not been identified outside the GMS, except for Guyana/Amazonia. In 2017, three parasites carrying the C580Y mutation were identified in Papua New Guinea (PNG). As the C580Y allele rapidly spread in the GMS, there is concern that this mutant is now spreading in PNG. Methods In 2020, a cross-sectional survey was conducted at two clinics in Wewak, PNG. Symptomatic patients infected with P. falciparum were treated with artemether plus lumefantrine following a national treatment policy. Blood samples were obtained before treatment, and polymorphisms in kelch13, pfcrt, and pfmdr1 were determined. Parasite positivity was examined on day 3. The results were compared with those of previous studies conducted in 2002, 2003, and 2016–2018. Results A total of 94 patients were included in this analysis. The proportion of C580Y was significantly increased (2.2% in 2017, 5.7% in 2018, and 6.4% in 2020; p = 4.2 × 10–3). A significant upward trend was observed in the wild-type proportion for pfcrt (1.9% in 2016 to 46.7% in 2020; p = 8.9 × 10–16) and pfmdr1 (59.5% in 2016 to 91.4% in 2020; p = 2.3 × 10–6). Among 27 patients successfully followed on day 3, including three with C580Y infections, none showed positive parasitaemia. Conclusions Under the conditions of significant increases in pfcrt K76 and pfmdr1 N86 alleles in PNG, the increase in kelch13 C580Y mutants may be a warning indicator of the emergence of parasites resistant to the currently used first-line treatment regimen of artemether plus lumefantrine. Therefore, nationwide surveillance of molecular markers for drug resistance and assessment of its therapeutic effects are important. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03933-6.
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Affiliation(s)
- Naoko Yoshida
- Department of Tropical Medicine and Parasitology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Masato Yamauchi
- Department of Tropical Medicine and Parasitology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Ryosuke Morikawa
- Department of Tropical Medicine and Parasitology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Francis Hombhanje
- Centre for Health Research & Diagnostics, Divine Word University, P.O. Box 483, Madang, Papua New Guinea
| | - Toshihiro Mita
- Department of Tropical Medicine and Parasitology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
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13
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Orbán Á, Longley RJ, Sripoorote P, Maneechai N, Nguitragool W, Butykai Á, Mueller I, Sattabongkot J, Karl S, Kézsmárki I. Sensitive detection of Plasmodium vivax malaria by the rotating-crystal magneto-optical method in Thailand. Sci Rep 2021; 11:18547. [PMID: 34535695 PMCID: PMC8448879 DOI: 10.1038/s41598-021-97532-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022] Open
Abstract
The rotating-crystal magneto-optical detection (RMOD) method has been developed for the rapid and quantitative diagnosis of malaria and tested systematically on various malaria infection models. Very recently, an extended field trial in a high-transmission region of Papua New Guinea demonstrated its great potential for detecting malaria infections, in particular Plasmodium vivax. In the present small-scale field test, carried out in a low-transmission area of Thailand, RMOD confirmed malaria in all samples found to be infected with Plasmodium vivax by microscopy, our reference method. Moreover, the magneto-optical signal for this sample set was typically 1–3 orders of magnitude higher than the cut-off value of RMOD determined on uninfected samples. Based on the serial dilution of the original patient samples, we expect that the method can detect Plasmodium vivax malaria in blood samples with parasite densities as low as \documentclass[12pt]{minimal}
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\begin{document}$$\sim$$\end{document}∼5–10 parasites per microliter, a limit around the pyrogenic threshold of the infection. In addition, by investigating the correlation between the magnitude of the magneto-optical signal, the parasite density and the erythrocytic stage distribution, we estimate the relative hemozoin production rates of the ring and the trophozoite stages of in vivo Plasmodium vivax infections.
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Affiliation(s)
- Ágnes Orbán
- Department of Physics, Budapest University of Technology and Economics, Budapest, Hungary.
| | - Rhea J Longley
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Mahidol Vivax Research Unit, Mahidol University, Bangkok, Thailand.,Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Wang Nguitragool
- Department of Molecular Tropical Medicine and Genetics, Mahidol University, Bangkok, Thailand
| | - Ádám Butykai
- Department of Physics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Ivo Mueller
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia.,Unité Malaria: Parasites et Hôtes, Département Parasites et Insectes Vecteurs, Institut Pasteur, Paris, France
| | | | - Stephan Karl
- Vector-borne Diseases Unit, PNG Institute of Medical Research, Madang, Madang Province 511, Papua New Guinea.,Australian Institute of Tropical Health and Medicine, James Cook University, Smithfield, QLD, Australia
| | - István Kézsmárki
- Department of Physics, Budapest University of Technology and Economics, Budapest, Hungary.,Experimental Physics 5, Center for Electronic Correlations and Magnetism, University of Augsburg, Augsburg, Germany
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14
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André M, Brucato N, Plutniak S, Kariwiga J, Muke J, Morez A, Leavesley M, Mondal M, Ricaut FX. Phenotypic differences between highlanders and lowlanders in Papua New Guinea. PLoS One 2021; 16:e0253921. [PMID: 34288918 PMCID: PMC8294550 DOI: 10.1371/journal.pone.0253921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/16/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Altitude is one of the most demanding environmental pressures for human populations. Highlanders from Asia, America and Africa have been shown to exhibit different biological adaptations, but Oceanian populations remain understudied [Woolcock et al., 1972; Cotes et al., 1974; Senn et al., 2010]. We tested the hypothesis that highlanders phenotypically differ from lowlanders in Papua New Guinea, as a result of inhabiting the highest mountains in Oceania for at least 20,000 years. MATERIALS AND METHODS We collected data for 13 different phenotypes related to altitude for 162 Papua New Guineans living at high altitude (Mont Wilhelm, 2,300-2,700 m above sea level (a.s.l.) and low altitude (Daru, <100m a.s.l.). Multilinear regressions were performed to detect differences between highlanders and lowlanders for phenotypic measurements related to body proportions, pulmonary function, and the circulatory system. RESULTS Six phenotypes were significantly different between Papua New Guinean highlanders and lowlanders. Highlanders show shorter height (p-value = 0.001), smaller waist circumference (p-value = 0.002), larger Forced Vital Capacity (FVC) (p-value = 0.008), larger maximal (p-value = 3.20e -4) and minimal chest depth (p-value = 2.37e -5) and higher haemoglobin concentration (p-value = 3.36e -4). DISCUSSION Our study reports specific phenotypes in Papua New Guinean highlanders potentially related to altitude adaptation. Similar to other human groups adapted to high altitude, the evolutionary history of Papua New Guineans appears to have also followed an adaptive biological strategy for altitude.
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Affiliation(s)
- Mathilde André
- Estonian Biocentre, Institute of Genomics, University of Tartu, Tartu, Tartumaa, Estonia
| | - Nicolas Brucato
- Laboratoire Évolution and Diversité Biologique (EDB UMR5174), Université de Toulouse Midi-Pyrénées, CNRS, IRD, UPS, Toulouse, France
| | - Sébastien Plutniak
- Laboratoire Travaux et Recherches Archéologiques sur les Cultures, les Espaces et les Sociétés (TRACES, UMR 5608), Université Toulouse Jean Jaurès, Maison de la Recherche, Toulouse, France
| | - Jason Kariwiga
- Strand of Anthropology, Sociology and Archaeology, School of Humanities & Social Sciences, University of Papua New Guinea, National Capital District, Papua New Guinea
- School of Social Science, University of Queensland, Australia, St Lucia, Australia
| | - John Muke
- Social Research Institute Ltd, Port Moresby, Papua New Guinea
| | - Adeline Morez
- School of Biological and Environmental Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Matthew Leavesley
- Strand of Anthropology, Sociology and Archaeology, School of Humanities & Social Sciences, University of Papua New Guinea, National Capital District, Papua New Guinea
- ARC Centre of Excellence for Australian Biodiversity and Heritage, College of Arts, Society and Education, James Cook University, Cairns, Australia
| | - Mayukh Mondal
- Estonian Biocentre, Institute of Genomics, University of Tartu, Tartu, Tartumaa, Estonia
| | - François-Xavier Ricaut
- Laboratoire Évolution and Diversité Biologique (EDB UMR5174), Université de Toulouse Midi-Pyrénées, CNRS, IRD, UPS, Toulouse, France
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15
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Cleary E, Hetzel MW, Siba PM, Lau CL, Clements ACA. Spatial prediction of malaria prevalence in Papua New Guinea: a comparison of Bayesian decision network and multivariate regression modelling approaches for improved accuracy in prevalence prediction. Malar J 2021; 20:269. [PMID: 34120604 PMCID: PMC8201920 DOI: 10.1186/s12936-021-03804-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Considerable progress towards controlling malaria has been made in Papua New Guinea through the national malaria control programme’s free distribution of long-lasting insecticidal nets, improved diagnosis with rapid diagnostic tests and improved access to artemisinin combination therapy. Predictive prevalence maps can help to inform targeted interventions and monitor changes in malaria epidemiology over time as control efforts continue. This study aims to compare the predictive performance of prevalence maps generated using Bayesian decision network (BDN) models and multilevel logistic regression models (a type of generalized linear model, GLM) in terms of malaria spatial risk prediction accuracy. Methods Multilevel logistic regression models and BDN models were developed using 2010/2011 malaria prevalence survey data collected from 77 randomly selected villages to determine associations of Plasmodium falciparum and Plasmodium vivax prevalence with precipitation, temperature, elevation, slope (terrain aspect), enhanced vegetation index and distance to the coast. Predictive performance of multilevel logistic regression and BDN models were compared by cross-validation methods. Results Prevalence of P. falciparum, based on results obtained from GLMs was significantly associated with precipitation during the 3 driest months of the year, June to August (β = 0.015; 95% CI = 0.01–0.03), whereas P. vivax infection was associated with elevation (β = − 0.26; 95% CI = − 0.38 to − 3.04), precipitation during the 3 driest months of the year (β = 0.01; 95% CI = − 0.01–0.02) and slope (β = 0.12; 95% CI = 0.05–0.19). Compared with GLM model performance, BDNs showed improved accuracy in prediction of the prevalence of P. falciparum (AUC = 0.49 versus 0.75, respectively) and P. vivax (AUC = 0.56 versus 0.74, respectively) on cross-validation. Conclusions BDNs provide a more flexible modelling framework than GLMs and may have a better predictive performance when developing malaria prevalence maps due to the multiple interacting factors that drive malaria prevalence in different geographical areas. When developing malaria prevalence maps, BDNs may be particularly useful in predicting prevalence where spatial variation in climate and environmental drivers of malaria transmission exists, as is the case in Papua New Guinea.
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Affiliation(s)
- Eimear Cleary
- Research School of Population Health, Australian National University, Canberra, Australia.
| | - Manuel W Hetzel
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.,Centre for Health Research and Diagnostics, Divine Word University, Madang, Papua New Guinea
| | - Colleen L Lau
- Research School of Population Health, Australian National University, Canberra, Australia.,School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Bentley, Australia.,Telethon Kids Institute, Nedlands, Australia
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16
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Rodríguez-Rodríguez D, Katusele M, Auwun A, Marem M, Robinson LJ, Laman M, Hetzel MW, Pulford J. Human Behavior, Livelihood, and Malaria Transmission in Two Sites of Papua New Guinea. J Infect Dis 2021; 223:S171-S186. [PMID: 33906224 PMCID: PMC8079136 DOI: 10.1093/infdis/jiaa402] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Malaria transmission is currently resurging in Papua New Guinea (PNG). In addition to intervention coverage, social and cultural factors influence changes in epidemiology of malaria in PNG. This study aimed to better understand the role of human behavior in relation to current malaria control efforts. Methods A mixed-method design was used in 2 sites in PNG. In-depth interviews, focus group discussions, cross-sectional malaria indicator survey, and population census were implemented. Results We identified 7 population groups based on demographics and behavioral patterns with potential relevance to Anopheles exposure. People spend a substantial amount of time outdoors or in semiopen structures. Between 4 pm and 8 am, all types of activities across all groups in both study sites may be exposing individuals to mosquito bites; sleeping under a long-lasting insecticidal net was the exception. The later in the night, the more outdoor presence was concentrated in adult men. Conclusions Our findings highlight the potential of outdoor exposure to hamper malaria control as people spend a remarkable amount of time outdoors without protection from mosquitoes. To prevent ongoing transmission, targeting of groups, places, and activities with complementary interventions should consider setting-specific human behaviors in addition to epidemiological and entomological data.
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Affiliation(s)
- Daniela Rodríguez-Rodríguez
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Michelle Katusele
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Alma Auwun
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Magdalene Marem
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Leanne J Robinson
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Moses Laman
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Manuel W Hetzel
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Justin Pulford
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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17
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Magneto-optical diagnosis of symptomatic malaria in Papua New Guinea. Nat Commun 2021; 12:969. [PMID: 33579923 PMCID: PMC7881035 DOI: 10.1038/s41467-021-21110-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 01/07/2021] [Indexed: 11/20/2022] Open
Abstract
Improved methods for malaria diagnosis are urgently needed. Here, we evaluate a novel method named rotating-crystal magneto-optical detection (RMOD) in 956 suspected malaria patients in Papua New Guinea. RMOD tests can be conducted within minutes and at low cost. We systematically evaluate the capability of RMOD to detect infections by directly comparing it with expert light microscopy, rapid diagnostic tests and polymerase chain reaction on capillary blood samples. We show that compared to light microscopy, RMOD exhibits 82% sensitivity and 84% specificity to detect any malaria infection and 87% sensitivity and 88% specificity to detect Plasmodium vivax. This indicates that RMOD could be useful in P. vivax dominated elimination settings. Parasite density correlates well with the quantitative magneto-optical signal. Importantly, residual hemozoin present in malaria-negative patients is also detectable by RMOD, indicating its ability to detect previous infections. This could be exploited to reveal transmission hotspots in low-transmission settings. Here Arndt et al. establish rotating-crystal magneto-optical detection (RMOD) as a near-point-of-care diagnostic tool for malaria detection and report a sensitivity and specificity of 82% and 84%, respectively, as validated by analyzing a clinical population in a high transmission setting in Papua New Guinea.
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18
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Jia P, Dai S, Rohli KE, Rohli RV, Ma Y, Yu C, Pan X, Zhou W. Natural environment and childhood obesity: A systematic review. Obes Rev 2021; 22 Suppl 1:e13097. [PMID: 32869468 PMCID: PMC7988590 DOI: 10.1111/obr.13097] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 01/17/2023]
Abstract
The associations between built and food environments and childhood obesity have been studied extensively. However, the association between the natural environment and childhood obesity has received too little scholarly attention. This study reviewed the literature published before 1 January 2019, which described associations between a full range of natural environmental factors (e.g., rainfall, temperature, sunlight, natural disasters, flood and drought) and weight-related behaviours and childhood obesity. Five cross-sectional studies and one longitudinal study were identified. Measures of natural environmental factors varied across six included studies, falling into five broad categories: weather conditions, altitude, natural disaster risk, air quality and day length. It was found that temperature was a significant weather indicator in most included studies and was associated with a reduction of daily physical activity. Children living in high-altitude areas were more likely to be shorter and heavier than their counterparts in low-altitude areas. Findings of this study will contribute to helping multiple stakeholders, including policy makers and urban planners, and formulate health policies and interventions to mitigate the detrimental impact of the natural environment on childhood obesity. More longitudinal studies should be designed to confirm these effects and explore the potential health effects of more natural environmental factors.
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Affiliation(s)
- Peng Jia
- Department of Land Surveying and Geo‐InformaticsThe Hong Kong Polytechnic UniversityHong KongChina
- Faculty of Geo‐information Science and Earth ObservationUniversity of TwenteEnschedeThe Netherlands
- International Institute of Spatial Lifecourse Epidemiology (ISLE)Hong KongChina
| | - Shaoqing Dai
- Faculty of Geo‐information Science and Earth ObservationUniversity of TwenteEnschedeThe Netherlands
- International Institute of Spatial Lifecourse Epidemiology (ISLE)Hong KongChina
| | | | - Robert V. Rohli
- Department of Oceanography and Coastal Sciences, College of the Coast and EnvironmentLouisiana State UniversityBaton RougeLouisianaUSA
| | - Yanan Ma
- School of Public HealthChina Medical UniversityShenyangChina
- Institute of Health SciencesChina Medical UniversityShenyangChina
| | - Chao Yu
- International Institute of Spatial Lifecourse Epidemiology (ISLE)Hong KongChina
- State Key Laboratory of Remote Sensing Science, Aerospace Information Research InstituteChinese Academy of SciencesBeijingChina
| | - Xiongfeng Pan
- International Institute of Spatial Lifecourse Epidemiology (ISLE)Hong KongChina
- Xiangya School of Public HealthCentral South UniversityChangshaChina
| | - Weiqi Zhou
- State Key Laboratory of Urban and Regional Ecology, Research Center for Eco‐Environmental SciencesChinese Academy of SciencesBeijingChina
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19
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Kattenberg JH, Razook Z, Keo R, Koepfli C, Jennison C, Lautu-Gumal D, Fola AA, Ome-Kaius M, Barnadas C, Siba P, Felger I, Kazura J, Mueller I, Robinson LJ, Barry AE. Monitoring Plasmodium falciparum and Plasmodium vivax using microsatellite markers indicates limited changes in population structure after substantial transmission decline in Papua New Guinea. Mol Ecol 2020; 29:4525-4541. [PMID: 32985031 PMCID: PMC10008436 DOI: 10.1111/mec.15654] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 07/27/2020] [Indexed: 02/01/2023]
Abstract
Monitoring the genetic structure of pathogen populations may be an economical and sensitive approach to quantify the impact of control on transmission dynamics, highlighting the need for a better understanding of changes in population genetic parameters as transmission declines. Here we describe the first population genetic analysis of two major human malaria parasites, Plasmodium falciparum (Pf) and Plasmodium vivax (Pv), following nationwide distribution of long-lasting insecticide-treated nets (LLINs) in Papua New Guinea (PNG). Parasite isolates from pre- (2005-2006) and post-LLIN (2010-2014) were genotyped using microsatellite markers. Despite parasite prevalence declining substantially (East Sepik Province: Pf = 54.9%-8.5%, Pv = 35.7%-5.6%, Madang Province: Pf = 38.0%-9.0%, Pv: 31.8%-19.7%), genetically diverse and intermixing parasite populations remained. Pf diversity declined modestly post-LLIN relative to pre-LLIN (East Sepik: Rs = 7.1-6.4, HE = 0.77-0.71; Madang: Rs = 8.2-6.1, HE = 0.79-0.71). Unexpectedly, population structure present in pre-LLIN populations was lost post-LLIN, suggesting that more frequent human movement between provinces may have contributed to higher gene flow. Pv prevalence initially declined but increased again in one province, yet diversity remained high throughout the study period (East Sepik: Rs = 11.4-9.3, HE = 0.83-0.80; Madang: Rs = 12.2-14.5, HE = 0.85-0.88). Although genetic differentiation values increased between provinces over time, no significant population structure was observed at any time point. For both species, a decline in multiple infections and increasing clonal transmission and significant multilocus linkage disequilibrium post-LLIN were positive indicators of impact on the parasite population using microsatellite markers. These parameters may be useful adjuncts to traditional epidemiological tools in the early stages of transmission reduction.
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Affiliation(s)
- Johanna Helena Kattenberg
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Yagaum, Papua New Guinea
| | - Zahra Razook
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Raksmei Keo
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Cristian Koepfli
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Charlie Jennison
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Dulcie Lautu-Gumal
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Yagaum, Papua New Guinea.,Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Abebe A Fola
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Maria Ome-Kaius
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Yagaum, Papua New Guinea.,Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Céline Barnadas
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Yagaum, Papua New Guinea.,Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Peter Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Ingrid Felger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - James Kazura
- Centre for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
| | - Ivo Mueller
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia.,Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
| | - Leanne J Robinson
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Yagaum, Papua New Guinea.,Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia.,Disease Elimination, Burnet Institute, Melbourne, VIC, Australia
| | - Alyssa E Barry
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
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20
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Jajosky RP, Jajosky AN, Jajosky PG. Therapeutically-rational exchange (T-REX) of Gerbich-negative red blood cells can be evaluated in Papua New Guinea as "a rescue adjunct" for patients with Plasmodium falciparum malaria. Ther Apher Dial 2020; 25:242-247. [PMID: 32567190 DOI: 10.1111/1744-9987.13551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/13/2020] [Accepted: 06/19/2020] [Indexed: 12/01/2022]
Abstract
"Conventional exchange transfusion"-that delivers nondescript "standard issue" units of red blood cells (RBCs)-is used worldwide to rescue dying Plasmodium falciparum (Pf) malaria patients. Recently, exchanging special malaria-resistant RBCs (T-REX) has been recommended to prevent random delivery of malaria-susceptible RBCs that promote Pf infection. Fortunately, Papua New Guinea (PNG) is well positioned to help optimize exchange as "a rescue adjunct" because (a) Gerbich-negative (GN) RBCs that resist Pf invasion are prevalent in PNG; (b) with international support, PNG has conducted outstanding malaria research; (c) PNG's scientists feel studies of GN RBCs can advance malaria therapeutics; and (d) with blood-bank support, evaluating exchange of GN RBCs is feasible in PNG. An exchange-transfusion study of GN RBCs might attract international sponsorship given the threat of expanding drug-resistance as well as growing recognition that advancing transfusion medicine and expanding blood donation could especially help Pf-infected children-immediately.
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Affiliation(s)
- Ryan Philip Jajosky
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA.,Biconcavity Inc., Lilburn, Georgia, USA
| | - Audrey N Jajosky
- Department of Pathology, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Philip G Jajosky
- Biconcavity Inc., Lilburn, Georgia, USA.,Retired USPHS Officer, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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21
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Kelwaip RA, Fose S, Siddiqui MS, Molumi CP, Apaio LM, Conway DI, Johnson NW, Thomas SJ, Lambert DW, Hunter KD. Oral cancer in Papua New Guinea: looking back and looking forward. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:292-297. [PMID: 32665206 DOI: 10.1016/j.oooo.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/05/2020] [Accepted: 06/01/2020] [Indexed: 12/24/2022]
Abstract
Oral diseases, including cancers, affect 3.5 billion people globally and remain largely untreated in low- to middle-income countries because of lack of resources. In Papua New Guinea (PNG), oral cancer has, for many decades, been identified as the most common cancer in men, but as the GLOBOCAN 2018 data are estimates extrapolated from surrounding countries, the real prevalence of this disease is not known. The PNG National Health Plan (2011-2020) highlights the need to improve health care, but oral health is not identified as a priority. Alcohol, tobacco, and areca nut/betel quid, which are the social and commercial determinants of oral cancer, are common risk factors, and there are robust data linking these risk factors to oral cancer in PNG. Our recent Global Challenges Research Fund Workshop on Oral Cancer, held in Port Moresby, PNG, brought together a number of researchers in oral cancer epidemiology and translational science with clinicians from PNG to assess the current situation and plan ways to move forward. In this article, we will review the literature on oral cancer in PNG, and make suggestions as to how, collaboratively, we can address the issues identified, ultimately, for the benefit of the people of PNG.
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Affiliation(s)
| | - Seth Fose
- National Department of Health, Port Moresby, Papua New Guinea; Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | | | | | | | - David I Conway
- Glasgow Dental School, University of Glasgow, Glasgow, UK
| | - Newell W Johnson
- Menzies Health Institute Queensland & School of Dentistry and Oral Health, Griffith University, Australia and Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Steve J Thomas
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Daniel W Lambert
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Keith D Hunter
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
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22
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Kattenberg JH, Gumal DL, Ome-Kaius M, Kiniboro B, Philip M, Jally S, Kasian B, Sambale N, Siba PM, Karl S, Barry AE, Felger I, Kazura JW, Mueller I, Robinson LJ. The epidemiology of Plasmodium falciparum and Plasmodium vivax in East Sepik Province, Papua New Guinea, pre- and post-implementation of national malaria control efforts. Malar J 2020; 19:198. [PMID: 32503607 PMCID: PMC7275396 DOI: 10.1186/s12936-020-03265-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/20/2020] [Indexed: 02/07/2023] Open
Abstract
Background In the past decade, national malaria control efforts in Papua New Guinea (PNG) have received renewed support, facilitating nationwide distribution of free long-lasting insecticidal nets (LLINs), as well as improvements in access to parasite-confirmed diagnosis and effective artemisinin-combination therapy in 2011–2012. Methods To study the effects of these intensified control efforts on the epidemiology and transmission of Plasmodium falciparum and Plasmodium vivax infections and investigate risk factors at the individual and household level, two cross-sectional surveys were conducted in the East Sepik Province of PNG; one in 2005, before the scale-up of national campaigns and one in late 2012-early 2013, after 2 rounds of LLIN distribution (2008 and 2011–2012). Differences between studies were investigated using Chi square (χ2), Fischer’s exact tests and Student’s t-test. Multivariable logistic regression models were built to investigate factors associated with infection at the individual and household level. Results The prevalence of P. falciparum and P. vivax in surveyed communities decreased from 55% (2005) to 9% (2013) and 36% to 6%, respectively. The mean multiplicity of infection (MOI) decreased from 1.8 to 1.6 for P. falciparum (p = 0.08) and from 2.2 to 1.4 for P. vivax (p < 0.001). Alongside these reductions, a shift towards a more uniform distribution of infections and illness across age groups was observed but there was greater heterogeneity across the study area and within the study villages. Microscopy positive infections and clinical cases in the household were associated with high rate infection households (> 50% of household members with Plasmodium infection). Conclusion After the scale-up of malaria control interventions in PNG between 2008 and 2012, there was a substantial reduction in P. falciparum and P. vivax infection rates in the studies villages in East Sepik Province. Understanding the extent of local heterogeneity in malaria transmission and the driving factors is critical to identify and implement targeted control strategies to ensure the ongoing success of malaria control in PNG and inform the development of tools required to achieve elimination. In household-based interventions, diagnostics with a sensitivity similar to (expert) microscopy could be used to identify and target high rate households.
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Affiliation(s)
- Johanna H Kattenberg
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, MP, Papua New Guinea.,Division of Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC, 3052, Australia.,Department of Biomedical Sciences, Institute of Tropical Medicine, Malariology Unit, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Dulcie L Gumal
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, MP, Papua New Guinea.,Disease Elimination Program, Vector-borne Diseases and Tropical Public Health Group, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Maria Ome-Kaius
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, MP, Papua New Guinea.,Division of Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC, 3052, Australia
| | - Benson Kiniboro
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, MP, Papua New Guinea
| | - Matthew Philip
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, MP, Papua New Guinea
| | - Shadrach Jally
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, MP, Papua New Guinea
| | - Bernadine Kasian
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, MP, Papua New Guinea
| | - Naomi Sambale
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, MP, Papua New Guinea
| | - Peter M Siba
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, MP, Papua New Guinea
| | - Stephan Karl
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, MP, Papua New Guinea.,Division of Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC, 3052, Australia
| | - Alyssa E Barry
- Division of Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia.,School of Medicine, Deakin University, Geelong and Burnet Institute, Melbourne, VIC, Australia
| | - Ingrid Felger
- Medical Parasitology and Infection Biology, Swiss Tropical & Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland
| | - James W Kazura
- Center for Global Health and Diseases, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106, USA
| | - Ivo Mueller
- Division of Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia.,Department of Parasites and Insect Vectors, Malaria Parasites and Hosts Unit, Pasteur Institute, 25-28 rue du Docteur-Roux, 75724, Paris Cedex 15, France
| | - Leanne J Robinson
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, MP, Papua New Guinea. .,Division of Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC, 3052, Australia. .,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia. .,Disease Elimination Program, Vector-borne Diseases and Tropical Public Health Group, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.
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23
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Recombinase Polymerase Amplification and Lateral Flow Assay for Ultrasensitive Detection of Low-Density Plasmodium falciparum Infection from Controlled Human Malaria Infection Studies and Naturally Acquired Infections. J Clin Microbiol 2020; 58:JCM.01879-19. [PMID: 32102854 DOI: 10.1128/jcm.01879-19] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 02/06/2020] [Indexed: 11/20/2022] Open
Abstract
Microscopy and rapid diagnostic tests (RDTs) are the main diagnostic tools for malaria but fail to detect low-density parasitemias that are important for maintaining malaria transmission. To complement existing diagnostic methods, an isothermal reverse transcription-recombinase polymerase amplification and lateral flow assay (RT-RPA) was developed. We compared the performance with that of ultrasensitive reverse transcription-quantitative PCR (uRT-qPCR) using nucleic acid extracts from blood samples (n = 114) obtained after standardized controlled human malaria infection (CHMI) with Plasmodium falciparum sporozoites. As a preliminary investigation, we also sampled asymptomatic individuals (n = 28) in an area of malaria endemicity (Lambaréné, Gabon) to validate RT-RPA and assess its performance with unprocessed blood samples (dbRT-RPA). In 114 samples analyzed from CHMI trials, the positive percent agreement to uRT-qPCR was 90% (95% confidence interval [CI], 80 to 96). The negative percent agreement was 100% (95% CI, 92 to 100). The lower limit of detection was 64 parasites/ml. In Gabon, RT-RPA was 100% accurate with asymptomatic volunteers (n = 28), while simplified dbRT-RPA showed 89% accuracy. In a subgroup analysis, RT-RPA detected 9/10 RT-qPCR-positive samples, while loop-mediated isothermal amplification (LAMP) detected 2/10. RT-RPA is a reliable diagnostic test for asymptomatic low-density infections. It is particularly useful in settings where uRT-qPCR is difficult to implement.
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24
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Ome-Kaius M, Kattenberg JH, Zaloumis S, Siba M, Kiniboro B, Jally S, Razook Z, Mantila D, Sui D, Ginny J, Rosanas-Urgell A, Karl S, Obadia T, Barry A, Rogerson SJ, Laman M, Tisch D, Felger I, Kazura JW, Mueller I, Robinson LJ. Differential impact of malaria control interventions on P. falciparum and P. vivax infections in young Papua New Guinean children. BMC Med 2019; 17:220. [PMID: 31813381 PMCID: PMC6900859 DOI: 10.1186/s12916-019-1456-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 10/29/2019] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION As malaria transmission declines, understanding the differential impact of intensified control on Plasmodium falciparum relative to Plasmodium vivax and identifying key drivers of ongoing transmission is essential to guide future interventions. METHODS Three longitudinal child cohorts were conducted in Papua New Guinea before (2006/2007), during (2008) and after scale-up of control interventions (2013). In each cohort, children aged 1-5 years were actively monitored for infection and illness. Incidence of malaria episodes, molecular force of blood-stage infections (molFOB) and population-averaged prevalence of infections were compared across the cohorts to investigate the impact of intensified control in young children and the key risk factors for malaria infection and illness in 2013. RESULTS Between 2006 and 2008, P. falciparum infection prevalence, molFOB, and clinical malaria episodes reduced by 47%, 59% and 69%, respectively, and a further 49%, 29% and 75% from 2008 to 2013 (prevalence 41.6% to 22.1% to 11.2%; molFOB: 3.4 to 1.4 to 1.0 clones/child/year; clinical episodes incidence rate (IR) 2.6 to 0.8 to IR 0.2 episodes/child/year). P. vivax clinical episodes declined at rates comparable to P. falciparum between 2006, 2008 and 2013 (IR 2.5 to 1.1 to 0.2), while P. vivax molFOB (2006, 9.8; 2008, 12.1) and prevalence (2006, 59.6%; 2008, 65.0%) remained high in 2008. However, in 2013, P. vivax molFOB (1.2) and prevalence (19.7%) had also substantially declined. In 2013, 89% of P. falciparum and 93% of P. vivax infections were asymptomatic, 62% and 47%, respectively, were sub-microscopic. Area of residence was the major determinant of malaria infection and illness. CONCLUSION Intensified vector control and routine case management had a differential impact on rates of P. falciparum and P. vivax infections but not clinical malaria episodes in young children. This suggests comparable reductions in new mosquito-derived infections but a delayed impact on P. vivax relapsing infections due to a previously acquired reservoir of hypnozoites. This demonstrates the need to strengthen implementation of P. vivax radical cure to maximise impact of control in co-endemic areas. The high heterogeneity of malaria in 2013 highlights the importance of surveillance and targeted interventions to accelerate towards elimination.
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Affiliation(s)
- Maria Ome-Kaius
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.,Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Johanna Helena Kattenberg
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.,Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.,Institute of Tropical Medicine, Antwerp, Belgium
| | - Sophie Zaloumis
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Matthew Siba
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Benson Kiniboro
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Shadrach Jally
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Zahra Razook
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Daisy Mantila
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Desmond Sui
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Jason Ginny
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | | | - Stephan Karl
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.,Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | | | - Alyssa Barry
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Stephen J Rogerson
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Moses Laman
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | | | - Ingrid Felger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, Australia.,Institut Pasteur, Paris, France
| | - Leanne J Robinson
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea. .,Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia. .,Department of Medical Biology, University of Melbourne, Melbourne, Australia. .,Burnet Institute, Melbourne, Australia.
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25
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Rodriguez-Rodriguez D, Maraga S, Lorry L, Robinson LJ, Siba PM, Mueller I, Pulford J, Ross A, Hetzel MW. Repeated mosquito net distributions, improved treatment, and trends in malaria cases in sentinel health facilities in Papua New Guinea. Malar J 2019; 18:364. [PMID: 31718659 PMCID: PMC6852945 DOI: 10.1186/s12936-019-2993-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 11/04/2019] [Indexed: 11/16/2022] Open
Abstract
Background Long-lasting insecticidal nets (LLIN), improved diagnosis and artemisinin-based combination therapy (ACT) have reduced malaria prevalence in Papua New Guinea since 2008. Yet, national incidence trends are inconclusive due to confounding effects of the scale-up of rapid diagnostic tests, and inconsistencies in routine reporting. Methods Malaria trends and their association with LLIN and ACT roll-out between 2010 and 2014 in seven sentinel health facilities were analysed. The analysis included 35,329 fever patients. Intervention effects were estimated using regression models. Results Malaria incidence initially ranged from 20 to 115/1000 population; subsequent trends varied by site. Overall, LLIN distributions had a cumulative effect, reducing the number of malaria cases with each round (incidence rate ratio ranging from 0.12 to 0.53 in five sites). No significant reduction was associated with ACT introduction. Plasmodium falciparum remained the dominant parasite in all sentinel health facilities. Resurgence occurred in one site in which a shift to early and outdoor biting of anophelines had previously been documented. Conclusions LLINs, but not ACT, were associated with reductions of malaria cases in a range of settings, but sustainability of the gains appear to depend on local factors. Malaria programmes covering diverse transmission settings such as Papua New Guinea must consider local heterogeneity when choosing interventions and ensure continuous monitoring of trends.
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Affiliation(s)
- Daniela Rodriguez-Rodriguez
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Seri Maraga
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Lina Lorry
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Leanne J Robinson
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea.,Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.,Institut Pasteur, Paris, France
| | | | - Amanda Ross
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Manuel W Hetzel
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
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26
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Keven JB, Katusele M, Vinit R, Koimbu G, Vincent N, Thomsen EK, Karl S, Reimer LJ, Walker ED. Species abundance, composition, and nocturnal activity of female Anopheles (Diptera: Culicidae) in malaria-endemic villages of Papua New Guinea: assessment with barrier screen sampling. Malar J 2019; 18:96. [PMID: 30909928 PMCID: PMC6434780 DOI: 10.1186/s12936-019-2742-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/21/2019] [Indexed: 11/18/2022] Open
Abstract
Background Community composition of Anopheles mosquitoes, and their host-seeking and peridomestic behaviour, are important factors affecting malaria transmission. In this study, barrier screen sampling was used to investigate species composition, abundance, and nocturnal activity of Anopheles populations in villages of Papua New Guinea. Methods Mosquitoes were sampled from 6 pm to 6 am in five villages from 2012 to 2016. The barrier screens were positioned between the village houses and the perimeter of villages where cultivated and wild vegetation (“the bush”) grew thickly. Female Anopheles that rested on either village or bush side of the barrier screens, as they commuted into and out of the villages, were captured. Similarity in species composition among villages was assessed. Mosquitoes captured on village and bush sides of the barrier screens were sorted by feeding status and by hour of collection, and their numbers were compared using negative binomial generalized linear models. Results Females of seven Anopheles species were present in the sample. Species richness ranged from four to six species per village, but relative abundance was highly uneven within and between villages, and community composition was similar for two pairs of villages and highly dissimilar in a fifth. For most Anopheles populations, more unfed than blood-fed mosquitoes were collected from the barrier screens. More blood-fed mosquitoes were found on the side of the barrier screens facing the village and relatively more unfed ones on the bush side, suggesting commuting behaviour of unfed host-seeking females into the villages from nearby bush and commuting of blood-fed females away from villages towards the bush. For most populations, the majority of host-seeking mosquitoes arrived in the village before midnight when people were active and unprotected from the mosquitoes by bed nets. Conclusion The uneven distribution of Anopheles species among villages, with each site dominated by different species, even among nearby villages, emphasizes the importance of vector heterogeneity in local malaria transmission and control. Yet, for most species, nocturnal activity patterns of village entry and host seeking predominantly occurred before midnight indicating common behaviours across species and populations relative to human risk of exposure to Anopheles bites. Electronic supplementary material The online version of this article (10.1186/s12936-019-2742-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- John B Keven
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea. .,Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI, USA.
| | - Michelle Katusele
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Rebecca Vinit
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Gussy Koimbu
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Naomi Vincent
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | | | - Stephan Karl
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.,Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, Melbourne University, Parkville, VIC, Australia
| | - Lisa J Reimer
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Edward D Walker
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI, USA
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27
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Colborn KL, Mueller I, Speed TP. Joint Modeling of Mixed Plasmodium Species Infections Using a Bivariate Poisson Lognormal Model. Am J Trop Med Hyg 2018; 98:71-76. [PMID: 29182143 DOI: 10.4269/ajtmh.17-0523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Infectious diseases often present as coinfections that may affect each other in positive or negative ways. Understanding the relationship between two coinfecting pathogens is thus important to understand the risk of infection and burden of disease caused by each pathogen. Although coinfections with Plasmodium falciparum and Plasmodium vivax are very common outside Africa, it is yet unclear whether infections by the two parasite species are positively associated or if infection by one parasite suppresses the other. In this study, we use bivariate Poisson lognormal models (BPLM) to estimate covariate-adjusted associations between the incidence of infections (as measured by the force of blood-stage infections, molFOI) and clinical episodes caused by both P. falciparum and P. vivax in a cohort of Papua New Guinean children. A BPLM permits estimation of either positive or negative correlation, unlike most other multivariate Poisson models. Our results demonstrated a moderately positive association between P. falciparum and P. vivax infection rates, arguing against the hypothesis that P. vivax infections protect against P. falciparum infections. Our findings also suggest that the BPLM is only useful for counts with suitably large means and overdispersion.
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Affiliation(s)
- Kathryn L Colborn
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado
| | - Ivo Mueller
- Walter and Eliza Hall Institute, Melbourne, Australia
| | - Terence P Speed
- Department of Statistics, University of California, Berkeley, Berkeley, California.,Department of Mathematics and Statistics, University of Melbourne, Melbourne, Australia.,Walter and Eliza Hall Institute, Melbourne, Australia
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28
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Pulford J, Saweri OPM, Jeffery C, Siba PM, Mueller I, Hetzel MW. Does test-based prescription of evidence-based treatment for malaria improve treatment seeking and satisfaction? Findings of repeated cross-sectional surveys in Papua New Guinea. BMJ Glob Health 2018; 3:e000915. [PMID: 30498587 PMCID: PMC6254749 DOI: 10.1136/bmjgh-2018-000915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 10/01/2018] [Accepted: 10/06/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction The presumptive treatment of febrile illness with antimalarial medication is becoming less common in low-income and middle-income countries as access to reliable diagnostic tests improves. We explore whether the shift towards test-based antimalarial prescription, and the introduction of highly efficacious artemisinin combination therapies (ACTs), reduces critical delays in seeking treatment for febrile illness or increases patient satisfaction. Methods We conducted countrywide repeat, cross-sectional surveys in 118 randomly selected primary healthcare services in Papua New Guinea. The clinical case management of 1765 consecutively presenting febrile patients was observed and exit interviews were completed at discharge. This was done prior to implementation of test-based ACT prescription (2011) and at 12 (2012) and 60 months (2016) postimplementation. We conducted multiple logistic regressions. Treatment response time was dichotomised as <24 hours from symptom onset vs 24+ hours. Satisfaction was dichotomised as a ‘high’ vs ‘low’ rating based on participant response to a visual, 7-point Likert-type scale. Results 62% (322/517) of febrile patients reported seeking treatment within 24 hours of symptom onset in 2011 compared with 53% (230/434) in 2012 and 42% (339/814) in 2016. Adjusted ORs for reporting a treatment response time <24 hours in the postimplementation surveys were 0.77 (95% CI 0.48 to 1.26) and 0.45 (95% CI 0.31 to 0.65), respectively when compared with the preimplementation period. 53% (230/533) of febrile patients reported ‘high’ satisfaction with the service received in 2011 compared with 32% (143/449) in 2012 and 35% (278/803) in 2016. Adjusted ORs for reporting high satisfaction in the postimplementation surveys were 0.52 (95% CI 0.32 to 0.85) and 0.65 (95% CI 0.39 to 1.10), respectively when compared with the preimplementation period. Conclusion Nationwide implementation of test-based ACT prescription in Papua New Guinea has increased the likelihood of critical treatment seeking delays and decreased patient satisfaction with the service received.
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Affiliation(s)
- Justin Pulford
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Olga P M Saweri
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Caroline Jeffery
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,Institut Pasteur, Paris, France
| | - Manuel W Hetzel
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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29
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Sekihara M, Tachibana SI, Yamauchi M, Yatsushiro S, Tiwara S, Fukuda N, Ikeda M, Mori T, Hirai M, Hombhanje F, Mita T. Lack of significant recovery of chloroquine sensitivity in Plasmodium falciparum parasites following discontinuance of chloroquine use in Papua New Guinea. Malar J 2018; 17:434. [PMID: 30477515 PMCID: PMC6260888 DOI: 10.1186/s12936-018-2585-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 11/21/2018] [Indexed: 11/20/2022] Open
Abstract
Background Chloroquine treatment for Plasmodium falciparum has been discontinued in almost all endemic regions due to the spread of resistant isolates. Reversal of chloroquine susceptibility after chloroquine discontinuation has been reported in dozens of endemic regions. However, this phenomenon has been mostly observed in Africa and is not well documented in other malaria endemic regions. To investigate this, an ex vivo study on susceptibility to chloroquine and lumefantrine was conducted during 2016–2018 in Wewak, Papua New Guinea where chloroquine had been removed from the official malaria treatment regimen in 2010. Genotyping of pfcrt and pfmdr1 was also performed. Results In total, 368 patients were enrolled in this study. Average IC50 values for chloroquine were 106.6, 80.5, and 87.6 nM in 2016, 2017, and 2018, respectively. These values were not significantly changed from those obtained in 2002/2003 (108 nM). The majority of parasites harboured a pfcrt K76T the mutation responsible for chloroquine resistance. However, a significant upward trend was observed in the frequency of the K76 (wild) allele from 2.3% in 2016 to 11.7% in 2018 (P = 0.008; Cochran–Armitage trend test). Conclusions Eight years of chloroquine withdrawal has not induced a significant recovery of susceptibility in Papua New Guinea. However, an increasing tendency of parasites harbouring chloroquine-susceptible K76 suggests a possibility of resurgence of chloroquine susceptibility in the future. Electronic supplementary material The online version of this article (10.1186/s12936-018-2585-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Makoto Sekihara
- Department of Tropical Medicine and Parasitology, Juntendo University, Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shin-Ichiro Tachibana
- Department of Tropical Medicine and Parasitology, Juntendo University, Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Masato Yamauchi
- Department of Tropical Medicine and Parasitology, Juntendo University, Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shoki Yatsushiro
- Health Technology Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Takamatsu, Japan
| | - Steven Tiwara
- Wewak General Hospital, Wewak, East Sepik Province, Papua New Guinea
| | - Naoyuki Fukuda
- Department of Tropical Medicine and Parasitology, Juntendo University, Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Mie Ikeda
- Department of Tropical Medicine and Parasitology, Juntendo University, Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Toshiyuki Mori
- Department of Tropical Medicine and Parasitology, Juntendo University, Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Makoto Hirai
- Department of Tropical Medicine and Parasitology, Juntendo University, Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Francis Hombhanje
- Centre for Health Research & Diagnostics, Divine Word University, P.O. Box 483, Madang, Papua New Guinea
| | - Toshihiro Mita
- Department of Tropical Medicine and Parasitology, Juntendo University, Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
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30
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White MT, Walker P, Karl S, Hetzel MW, Freeman T, Waltmann A, Laman M, Robinson LJ, Ghani A, Mueller I. Mathematical modelling of the impact of expanding levels of malaria control interventions on Plasmodium vivax. Nat Commun 2018; 9:3300. [PMID: 30120250 PMCID: PMC6097992 DOI: 10.1038/s41467-018-05860-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 07/23/2018] [Indexed: 01/07/2023] Open
Abstract
Plasmodium vivax poses unique challenges for malaria control and elimination, notably the potential for relapses to maintain transmission in the face of drug-based treatment and vector control strategies. We developed an individual-based mathematical model of P. vivax transmission calibrated to epidemiological data from Papua New Guinea (PNG). In many settings in PNG, increasing bed net coverage is predicted to reduce transmission to less than 0.1% prevalence by light microscopy, however there is substantial risk of rebounds in transmission if interventions are removed prematurely. In several high transmission settings, model simulations predict that combinations of existing interventions are not sufficient to interrupt P. vivax transmission. This analysis highlights the potential options for the future of P. vivax control: maintaining existing public health gains by keeping transmission suppressed through indefinite distribution of interventions; or continued development of strategies based on existing and new interventions to push for further reduction and towards elimination.
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Affiliation(s)
- Michael T White
- Malaria: Parasites and Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, 25-28 Rue du Dr Roux, 75015, Paris, France.
| | - Patrick Walker
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, Norfolk Place, W2 1PG, UK
| | - Stephan Karl
- Vector-borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang 511, Papua New Guinea
- Division of Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, 3052, Australia
- Department of Medical Biology, Melbourne University, Melbourne, VIC, 3052, Australia
| | - Manuel W Hetzel
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland
- University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Tim Freeman
- Rotarians Against Malaria, Port Moresby 121, Papua New Guinea
| | - Andreea Waltmann
- Division of Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, 3052, Australia
- Department of Medical Biology, Melbourne University, Melbourne, VIC, 3052, Australia
| | - Moses Laman
- Vector-borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang 511, Papua New Guinea
| | - Leanne J Robinson
- Vector-borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang 511, Papua New Guinea
- Division of Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, 3052, Australia
- Department of Medical Biology, Melbourne University, Melbourne, VIC, 3052, Australia
- Burnet Institute, Melbourne, VIC, 3004, Australia
| | - Azra Ghani
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, Norfolk Place, W2 1PG, UK
| | - Ivo Mueller
- Malaria: Parasites and Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, 25-28 Rue du Dr Roux, 75015, Paris, France
- Division of Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, 3052, Australia
- Department of Medical Biology, Melbourne University, Melbourne, VIC, 3052, Australia
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31
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Pulford J, Kurumop S, Mueller I, Siba PM, Hetzel MW. The impact of the scale-up of malaria rapid diagnostic tests on the routine clinical diagnosis procedures for febrile illness: a series of repeated cross-sectional studies in Papua New Guinea. Malar J 2018; 17:202. [PMID: 29769128 PMCID: PMC5956836 DOI: 10.1186/s12936-018-2351-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper examines the impact of the scale-up of malaria rapid diagnostic tests (RDT) on routine clinical diagnosis procedures for febrile illness in primary healthcare settings in Papua New Guinea. METHODS Repeat, cross-sectional surveys in randomly selected primary healthcare services were conducted. Surveys included passive observation of consecutive febrile case management cases and were completed immediately prior to RDT scale-up (2011) and at 12- (2012) and 60-months (2016) post scale-up. The frequency with which specified diagnostic questions and procedures were observed to occur, with corresponding 95% CIs, was calculated for febrile patients prescribed anti-malarials pre- and post-RDT scale-up and between febrile patients who tested either negative or positive for malaria infection by RDT (post scale-up only). RESULTS A total of 1809 observations from 120 health facilities were completed across the three survey periods of which 915 (51%) were prescribed an anti-malarial. The mean number of diagnostic questions and procedures asked or performed, leading to anti-malarial prescription, remained consistent pre- and post-RDT scale-up (range 7.4-7.7). However, alterations in diagnostic content were evident with the RDT replacing body temperature as the primary diagnostic procedure performed (observed in 5.3 and 84.4% of cases, respectively, in 2011 vs. 77.9 and 58.2% of cases in 2016). Verbal questioning, especially experience of fever, cough and duration of symptoms, remained the most common feature of a diagnostic examination leading to anti-malarial prescription irrespective of RDT use (observed in 96.1, 86.8 and 84.8% of cases, respectively, in 2011 vs. 97.5, 76.6 and 85.7% of cases in 2016). Diagnostic content did not vary substantially by RDT result. CONCLUSIONS Rapid diagnostic tests scale-up has led to a reduction in body temperature measurement. Investigations are very limited when malaria infection is ruled out as a cause of febrile illness by RDT.
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Affiliation(s)
- Justin Pulford
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. .,Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Serah Kurumop
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.,Barcelona Centre for International Health Research, Barcelona, Spain
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Manuel W Hetzel
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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32
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Mita T, Hombhanje F, Takahashi N, Sekihara M, Yamauchi M, Tsukahara T, Kaneko A, Endo H, Ohashi J. Rapid selection of sulphadoxine-resistant Plasmodium falciparum and its effect on within-population genetic diversity in Papua New Guinea. Sci Rep 2018; 8:5565. [PMID: 29615786 PMCID: PMC5882878 DOI: 10.1038/s41598-018-23811-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/21/2018] [Indexed: 11/18/2022] Open
Abstract
The ability of the human malarial parasite Plasmodium falciparum to adapt to environmental changes depends considerably on its ability to maintain within-population genetic variation. Strong selection, consequent to widespread antimalarial drug usage, occasionally elicits a rapid expansion of drug-resistant isolates, which can act as founders. To investigate whether this phenomenon induces a loss of within-population genetic variation, we performed a population genetic analysis on 302 P. falciparum cases detected during two cross-sectional surveys in 2002/2003, just after the official introduction of sulphadoxine/pyrimethamine as a first-line treatment, and again in 2010/2011, in highly endemic areas in Papua New Guinea. We found that a single-origin sulphadoxine-resistant parasite isolate rapidly increased from 0% in 2002/2003 to 54% in 2010 and 84% in 2011. However, a considerable number of pairs exhibited random associations among 10 neutral microsatellite markers located in various chromosomes, suggesting that outcrossing effectively reduced non-random associations, albeit at a low average multiplicity of infection (1.35–1.52). Within-population genetic diversity was maintained throughout the study period. This indicates that the parasites maintained within-population variation, even after a clonal expansion of drug-resistant parasites. Outcrossing played a role in the preservation of within-population genetic diversity despite low levels of multiplicity of infection.
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Affiliation(s)
- Toshihiro Mita
- Department of Tropical Medicine and Parasitology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo, 113-8421, Japan.
| | - Francis Hombhanje
- Centre for Health Research & Diagnostics, Divine Word University, Nabasa Road, P.O. Box 483, Madang, Papua New Guinea
| | - Nobuyuki Takahashi
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Makoto Sekihara
- Department of Tropical Medicine and Parasitology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo, 113-8421, Japan
| | - Masato Yamauchi
- Department of Tropical Medicine and Parasitology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo, 113-8421, Japan
| | - Takahiro Tsukahara
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Akira Kaneko
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Department of Parasitology, Osaka City University Graduate School of Medicine, Asahi-cho 1-4-3, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroyoshi Endo
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Jun Ohashi
- Department of Biological Sciences, Graduate School of Science, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Urlacher SS, Liebert MA, Konečná M. Global variation in diurnal cortisol rhythms: evidence from Garisakang forager-horticulturalists of lowland Papua New Guinea. Stress 2018; 21:101-109. [PMID: 29237322 DOI: 10.1080/10253890.2017.1414798] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The hypothalamic-pituitary-adrenal (HPA) axis represents an important and evolutionarily ancient biological pathway linking physical and psychological stressors with human health. Despite considerable research exploring the physiological stress response among developed populations, few studies have examined HPA activity in non-industrialized contexts, restricting understanding of variation in human stress reactivity across global socio-ecological diversity. The present study addresses this shortcoming by investigating diurnal cortisol rhythms among Garisakang forager-horticulturalists of remote, lowland Papua New Guinea. Using a large sample of repeated salivary cortisol measurements from 169 participants (age 4-70 years), multilevel growth curve models were constructed to assess Garisakang waking cortisol concentrations and diurnal cortisol slopes. As predicted, results demonstrate identifiable but substantially diminished diurnal cortisol rhythms relative to those of industrialized populations. Sample-wide, Garisakang cortisol concentrations are highest upon waking (mean = 4.86 nmol/L) and decrease throughout the day at a mean rate of only -0.18 nmol/L/h or -6.20%/h. Age and sex significantly predict evaluated cortisol parameters in ways not consistently reported among industrialized populations, suggesting that Garisakang diurnal cortisol rhythms are defined by distinct ontogenetic trajectories across the lifespan. These findings highlight cross-cultural diversity in HPA activity and have important implications for understanding basic mechanisms of the physiological stress response in contexts of chronic physical stressors such as limited nutrition, heavy burden of infectious disease, and high levels of physical activity.
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Affiliation(s)
- Samuel S Urlacher
- a Department of Anthropology , City University of New York - Hunter College , New York , NY , USA
- b New Guinea Binatang Research Center , Madang , Papua New Guinea
| | - Melissa A Liebert
- c Department of Anthropology , Northern Arizona University , Flagstaff , AZ , USA
| | - Martina Konečná
- b New Guinea Binatang Research Center , Madang , Papua New Guinea
- d Department of Zoology, Faculty of Science , University of South Bohemia , Ceske Budejovice, Czech Republic
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34
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Lufele E, Umbers A, Ordi J, Ome-Kaius M, Wangnapi R, Unger H, Tarongka N, Siba P, Mueller I, Robinson L, Rogerson S. Risk factors and pregnancy outcomes associated with placental malaria in a prospective cohort of Papua New Guinean women. Malar J 2017; 16:427. [PMID: 29065884 PMCID: PMC5655867 DOI: 10.1186/s12936-017-2077-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/19/2017] [Indexed: 12/19/2022] Open
Abstract
Background Plasmodium falciparum in pregnancy results in substantial poor health outcomes for both mother and child, particularly in young, primigravid mothers who are at greatest risk of placental malaria (PM) infection. Complications of PM include maternal anaemia, low birth weight and preterm delivery, which contribute to maternal and infant morbidity and mortality in coastal Papua New Guinea (PNG). Methods Placental biopsies were examined from 1451 pregnant women who were enrolled in a malaria prevention study at 14–26 weeks gestation. Clinical and demographic information were collected at first antenatal clinic visits and women were followed until delivery. Placental biopsies were collected and examined for PM using histology. The presence of infected erythrocytes and/or the malaria pigment in monocytes or fibrin was used to determine the type of placental infection. Results Of 1451 placentas examined, PM infection was detected in 269 (18.5%), of which 54 (3.7%) were acute, 55 (3.8%) chronic, and 160 (11.0%) were past infections. Risk factors for PM included residing in rural areas (adjusted odds ratio (AOR) 3.65, 95% CI 1.76–7.51; p ≤ 0.001), being primigravid (AOR 2.45, 95% CI 1.26–4.77; p = 0.008) and having symptomatic malaria during pregnancy (AOR 2.05, 95% CI 1.16–3.62; p = 0.013). After adjustment for covariates, compared to uninfected women, acute infections (AOR 1.97, 95% CI 0.98–3.95; p = 0.056) were associated with low birth weight babies, whereas chronic infections were associated with preterm delivery (AOR 3.92, 95% CI 1.64–9.38; p = 0.002) and anaemia (AOR 2.22, 95% CI 1.02–4.84; p = 0.045). Conclusions Among pregnant PNG women receiving at least one dose of intermittent preventive treatment in pregnancy and using insecticide-treated bed nets, active PM infections were associated with adverse outcomes. Improved malaria prevention is required to optimize pregnancy outcomes.
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Affiliation(s)
- Elvin Lufele
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Alexandra Umbers
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.,Department of Medicine and Radiology, Peter Doherty Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Jaume Ordi
- Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Maria Ome-Kaius
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Regina Wangnapi
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Holger Unger
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.,Department of Medicine and Radiology, Peter Doherty Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Nandao Tarongka
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Peter Siba
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Ivo Mueller
- Population Health and Immunity Division, Walter and Eliza Hall Institute, Melbourne, VIC, Australia.,Institute Pasteur, Paris, France
| | - Leanne Robinson
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.,Population Health and Immunity Division, Walter and Eliza Hall Institute, Melbourne, VIC, Australia.,Burnet Institute, Melbourne, VIC, Australia
| | - Stephen Rogerson
- Department of Medicine and Radiology, Peter Doherty Institute, University of Melbourne, Melbourne, VIC, Australia.
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35
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Lombardo P, Vaucher P, Rarau P, Mueller I, Favrat B, Senn N. Hemoglobin Levels and the Risk of Malaria in Papua New Guinean Infants: A Nested Cohort Study. Am J Trop Med Hyg 2017; 97:1770-1776. [PMID: 29016324 DOI: 10.4269/ajtmh.17-0093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Studies are available that assess the risk of malaria in accordance to the body's iron store and the systematic iron supplementation of preschool children. However, only a few studies evaluated the temporal association between hemoglobin and malaria and their results are opposing. A total of 1,650 3-month-old Papua New Guinean infants were enrolled in this study and followed-up for 12 months. The risk of malaria was assessed in all children every 3 months and with each episode of fever. The incidence of clinical malaria between 3 and 15 months of age was 249 cases per 1,000 infants per year. After adjustment for potential confounding factors, a decrease of 1 g/dL of hemoglobin was associated with a nonsignificant increase of 11% for risk of malaria infection (hazard ratio, 1.11, 95% confidence interval; CI, 0.99-1.25, P = 0.076). Only children with severe anemia (hemoglobin < 8.0 g/dL) at baseline were at higher risk of malaria infection (hazard ratio, 1.72, 95% CI, 1.08-2.76, P = 0.023) during the follow-up year compared with the control group (Hemoglobin > 10.0 g/dL). This association was not statistically significant if only clinical malaria episodes were taken into account (hazard ratio, 1.42, 95% CI, 0.77-2.61, P = 0.26). Our study suggests that infants with lower hemoglobin levels are not protected against malaria infection. Further research that examines the risk of malaria in relation to both hemoglobin and iron store levels would be important to better understand this complex interaction.
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Affiliation(s)
- Patrick Lombardo
- Institute of Family Medicine, University of Lausanne, Lausanne, Switzerland
| | - Paul Vaucher
- University Center of Legal Medicine, University Hospital Lausanne (CHUV), Lausanne, Switzerland.,School of Health Sciences Fribourg, University of Applied Sciences Western Switzerland (HES-SO), Fribourg, Switzerland
| | - Patricia Rarau
- Papua New Guinea Institute of Medical Research, Vector Borne Diseases Unit, Madang, Papua New Guinea
| | - Ivo Mueller
- Division of Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Bernard Favrat
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Nicolas Senn
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.,Institute of Family Medicine, University of Lausanne, Lausanne, Switzerland
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36
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Hetzel MW, Pulford J, Ura Y, Jamea-Maiasa S, Tandrapah A, Tarongka N, Lorry L, Robinson LJ, Lilley K, Makita L, Siba PM, Mueller I. Insecticide-treated nets and malaria prevalence, Papua New Guinea, 2008-2014. Bull World Health Organ 2017; 95:695-705B. [PMID: 29147042 PMCID: PMC5689189 DOI: 10.2471/blt.16.189902] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 12/21/2022] Open
Abstract
Objective To investigate changes in malaria prevalence in Papua New Guinea after the distribution of long-lasting Insecticide-treated nets, starting in 2004, and the introduction of artemisinin-based combination therapy in 2011. Methods Two malaria surveys were conducted in 2010–2011 and 2013–2014. They included 77 and 92 randomly selected villages, respectively. In each village, all members of 30 randomly selected households gave blood samples and were assessed for malaria infection by light microscopy. In addition, data were obtained from a malaria survey performed in 2008–2009. Results The prevalence of malaria below 1600 m in altitude decreased from 11.1% (95% confidence interval, CI: 8.5–14.3) in 2008–2009 to 5.1% (95% CI 3.6–7.4) in 2010–2011 and 0.9% (95% CI 0.6–1.5) in 2013–2014. Prevalence decreased with altitude. Plasmodium falciparum was more common than P. vivax overall, but not everywhere, and initially the prevalence of P. vivax infection decreased more slowly than P. falciparum infection. Malaria infections were clustered in households. In contrast to findings in 2008–2009, no significant association between net use and prevalence was found in the later two surveys. The prevalence of both fever and splenomegaly also decreased but their association with malaria infection became stronger. Conclusion Large-scale insecticide-treated net distribution was associated with an unprecedented decline in malaria prevalence throughout Papua New Guinea, including epidemic-prone highland areas. The decline was accompanied by broader health benefits, such as decreased morbidity. Better clinical management of nonmalarial fever and research into residual malaria transmission are required.
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Affiliation(s)
- Manuel W Hetzel
- Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel, 4002, Switzerland
| | - Justin Pulford
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Yangta Ura
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Sharon Jamea-Maiasa
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Anthony Tandrapah
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Nandao Tarongka
- Deceased, formerly, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Lina Lorry
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Leanne J Robinson
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Ken Lilley
- Australian Army Malaria Institute, Enoggera, Australia
| | - Leo Makita
- National Department of Health, Waigani, Papua New Guinea
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Ivo Mueller
- Division of Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
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37
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Hofmann NE, Karl S, Wampfler R, Kiniboro B, Teliki A, Iga J, Waltmann A, Betuela I, Felger I, Robinson LJ, Mueller I. The complex relationship of exposure to new Plasmodium infections and incidence of clinical malaria in Papua New Guinea. eLife 2017; 6:23708. [PMID: 28862132 PMCID: PMC5606846 DOI: 10.7554/elife.23708] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 08/18/2017] [Indexed: 01/20/2023] Open
Abstract
The molecular force of blood-stage infection (molFOB) is a quantitative surrogate metric for malaria transmission at population level and for exposure at individual level. Relationships between molFOB, parasite prevalence and clinical incidence were assessed in a treatment-to-reinfection cohort, where P.vivax (Pv) hypnozoites were eliminated in half the children by primaquine (PQ). Discounting relapses, children acquired equal numbers of new P. falciparum (Pf) and Pv blood-stage infections/year (Pf-molFOB = 0–18, Pv-molFOB = 0–23) resulting in comparable spatial and temporal patterns in incidence and prevalence of infections. Including relapses, Pv-molFOB increased >3 fold (relative to PQ-treated children) showing greater heterogeneity at individual (Pv-molFOB = 0–36) and village levels. Pf- and Pv-molFOB were strongly associated with clinical episode risk. Yearly Pf clinical incidence rate (IR = 0.28) was higher than for Pv (IR = 0.12) despite lower Pf-molFOB. These relationships between molFOB, clinical incidence and parasite prevalence reveal a comparable decline in Pf and Pv transmission that is normally hidden by the high burden of Pv relapses. Clinical trial registration: ClinicalTrials.gov NCT02143934 Malaria is caused by five different species of parasites that are transmitted to humans by bites from parasite-carrying mosquitos. Once in human blood, the parasites rapidly multiply. People who live in countries where malaria is common may become infected and never show any symptoms because their immune systems are able to keep parasite numbers low. Repeated infections, or infection with more than one species of malaria parasite also are common. Some species of malaria, including Plasmodium vivax, can hibernate in the liver for weeks or months after the infection and only become active later. Asymptomatic infections, multi-parasite infections, and reactivating parasites make it hard to measure how often new malaria infections occur. One way scientists can determine if a new infection has occurred is by genotyping the parasites in a person’s blood. Genotyping involves looking for small differences in the parasite DNA. For example, a study in Papua New Guinea, where P. vivax is very common, showed that reactivations of hibernating parasites were more common than new infections. Now, Hofmann et al. use the same study in Papua New Guinea to compare the frequency and consequences of new infections with P. vivax and another malaria parasite, Plasmodium falciparum. In the study, 466 children from 6 villages were followed for 8 months with tests every 2 to 4 weeks to genotype the parasites in their blood. Some of the children were treated with antimalarial drugs to help wipe out any existing parasites including hibernating ones. While P. vivax was about twice as common in blood samples—likely due to reactivation—genotyping showed that new infections with the two parasites occur at equal rates and often at the same times and locations. Hofmann et al. also showed that some villages and some children had much higher rates of infection than others. This difference could not fully be explained by use of bednets or other preventive measures. Children were more likely to become ill from P. falciparum than P. vivax even though P. vivax was more common. But children with more frequent infections with P. falciparum seemed better able to manage the parasites and were less likely to develop symptoms that those with infrequent infections. The experiments show that genotyping may help scientists better track new malaria infections and develop better strategies to prevent or treat malaria.
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Affiliation(s)
- Natalie E Hofmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Stephan Karl
- Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Rahel Wampfler
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Benson Kiniboro
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Albina Teliki
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Jonah Iga
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Andreea Waltmann
- Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.,University of Melbourne, Melbourne, Australia
| | - Inoni Betuela
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Ingrid Felger
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Leanne J Robinson
- Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.,University of Melbourne, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.,University of Melbourne, Melbourne, Australia.,ISGlobal, Barcelona Centre for International Health Research, Hospital Clínic-University of Barcelona, Barcelona, Spain.,Institut Pasteur, Paris, France
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38
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Fola AA, Harrison GLA, Hazairin MH, Barnadas C, Hetzel MW, Iga J, Siba PM, Mueller I, Barry AE. Higher Complexity of Infection and Genetic Diversity of Plasmodium vivax Than Plasmodium falciparum Across All Malaria Transmission Zones of Papua New Guinea. Am J Trop Med Hyg 2017; 96:630-641. [PMID: 28070005 DOI: 10.4269/ajtmh.16-0716] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Plasmodium falciparum and Plasmodium vivax have varying transmission dynamics that are informed by molecular epidemiology. This study aimed to determine the complexity of infection and genetic diversity of P. vivax and P. falciparum throughout Papua New Guinea (PNG) to evaluate transmission dynamics across the country. In 2008-2009, a nationwide malaria indicator survey collected 8,936 samples from all 16 endemic provinces of PNG. Of these, 892 positive P. vivax samples were genotyped at PvMS16 and PvmspF3, and 758 positive P. falciparum samples were genotyped at Pfmsp2. The data were analyzed for multiplicity of infection (MOI) and genetic diversity. Overall, P. vivax had higher polyclonality (71%) and mean MOI (2.32) than P. falciparum (20%, 1.39). These measures were significantly associated with prevalence for P. falciparum but not for P. vivax. The genetic diversity of P. vivax (PvMS16: expected heterozygosity = 0.95, 0.85-0.98; PvMsp1F3: 0.78, 0.66-0.89) was higher and less variable than that of P. falciparum (Pfmsp2: 0.89, 0.65-0.97). Significant associations of MOI with allelic richness (rho = 0.69, P = 0.009) and expected heterozygosity (rho = 0.87, P < 0.001) were observed for P. falciparum. Conversely, genetic diversity was not correlated with polyclonality nor mean MOI for P. vivax. The results demonstrate higher complexity of infection and genetic diversity of P. vivax across the country. Although P. falciparum shows a strong association of these parameters with prevalence, a lack of association was observed for P. vivax and is consistent with higher potential for outcrossing of this species.
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Affiliation(s)
- Abebe A Fola
- Department of Medical Biology, University of Melbourne, Parkville, Australia.,Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - G L Abby Harrison
- Department of Medical Biology, University of Melbourne, Parkville, Australia.,Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Mita Hapsari Hazairin
- Department of Epidemiology and Preventative Medicine, Monash University, Clayton, Australia.,Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Céline Barnadas
- Statens Serum Institut, Copenhagen, Denmark.,European Public Health Microbiology (EUPHEM) Training Programme, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Manuel W Hetzel
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Jonah Iga
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Ivo Mueller
- Institut Pasteur, Paris, France.,Department of Medical Biology, University of Melbourne, Parkville, Australia.,Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Alyssa E Barry
- Department of Medical Biology, University of Melbourne, Parkville, Australia.,Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
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39
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Keven JB, Reimer L, Katusele M, Koimbu G, Vinit R, Vincent N, Thomsen E, Foran DR, Zimmerman PA, Walker ED. Plasticity of host selection by malaria vectors of Papua New Guinea. Parasit Vectors 2017; 10:95. [PMID: 28222769 PMCID: PMC5320767 DOI: 10.1186/s13071-017-2038-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/15/2017] [Indexed: 11/20/2022] Open
Abstract
Background Host selection is an important determinant of vectorial capacity because malaria transmission increases when mosquitoes feed more on humans than non-humans. Host selection also affects the outcome of long-lasting insecticidal nets (LLIN). Despite the recent nationwide implementation of LLIN-based malaria control program in Papua New Guinea (PNG), little is known about the host selection of the local Anopheles vectors. This study investigated the host selection of Anopheles vectors in PNG. Methods Blood-engorged mosquitoes were sampled using the barrier screen method and blood meals analyzed for vertebrate host source with PCR-amplification of the mitochondrial cytochrome b gene. Abundance of common hosts was estimated in surveys. The test of homogeneity of proportions and the Manly resource selection ratio were used to determine if hosts were selected in proportion to their abundance. Results Two thousand four hundred and forty blood fed Anopheles females of seven species were sampled from five villages in Madang, PNG. Of 2,142 samples tested, 2,061 (96.2%) yielded a definitive host source; all were human, pig, or dog. Hosts were not selected in proportion to their abundance, but rather were under-selected or over-selected by the mosquitoes. Four species, Anopheles farauti (sensu stricto) (s.s.), Anopheles punctulatus (s.s.), Anopheles farauti no. 4 and Anopheles longirostris, over-selected humans in villages with low LLIN usage, but over-selected pigs in villages with high LLIN usage. Anopheles koliensis consistently over-selected humans despite high LLIN usage, and Anopheles bancroftii over-selected pigs. Conclusions The plasticity of host selection of an Anopheles species depends on its opportunistic, anthropophilic or zoophilic behavior, and on the extent of host availability and LLIN usage where the mosquitoes forage for hosts. The high anthropophily of An. koliensis increases the likelihood of contacting the LLIN inside houses. This allows its population size to be reduced to levels insufficient to support transmission. In contrast, by feeding on alternative hosts the likelihood of the opportunistic species to contact LLIN is lower, making them difficult to control. By maintaining high population size, the proportion that feed on humans outdoors can sustain residual transmission despite high LLIN usage in the village. Electronic supplementary material The online version of this article (doi:10.1186/s13071-017-2038-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- John B Keven
- Papua New Guinea Institute of Medical Research, Vector Borne Diseases Unit, Madang, 511, Madang, Papua New Guinea. .,Department of Microbiology and Molecular Genetics, Michigan State University, 48824, East Lansing, MI, USA.
| | - Lisa Reimer
- Liverpool School of Tropical Medicine and Hygiene, Liverpool, UK
| | - Michelle Katusele
- Papua New Guinea Institute of Medical Research, Vector Borne Diseases Unit, Madang, 511, Madang, Papua New Guinea
| | - Gussy Koimbu
- Papua New Guinea Institute of Medical Research, Vector Borne Diseases Unit, Madang, 511, Madang, Papua New Guinea
| | - Rebecca Vinit
- Papua New Guinea Institute of Medical Research, Vector Borne Diseases Unit, Madang, 511, Madang, Papua New Guinea.,Department of Entomology, Michigan State University, 48824, East Lansing, MI, USA
| | - Naomi Vincent
- Papua New Guinea Institute of Medical Research, Vector Borne Diseases Unit, Madang, 511, Madang, Papua New Guinea
| | - Edward Thomsen
- Liverpool School of Tropical Medicine and Hygiene, Liverpool, UK
| | - David R Foran
- School of Criminal Justice and Department of Integrative Biology, Michigan State University, 48824, East Lansing, MI, USA
| | - Peter A Zimmerman
- Center for Global Health and Diseases, Case Western Reserve University, 44106, Cleveland, OH, USA
| | - Edward D Walker
- Department of Microbiology and Molecular Genetics, Michigan State University, 48824, East Lansing, MI, USA.,Department of Entomology, Michigan State University, 48824, East Lansing, MI, USA
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40
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Feterl M, Graves P, Seehofer L, Warner J, Wood P, Miles K, Hutton R. The Epidemiology of Malaria in Kutubu, Southern Highlands Province, Papua New Guinea, before and during a Private Sector Initiative for Malaria Control. Trop Med Infect Dis 2017; 2:E2. [PMID: 30270861 PMCID: PMC6082053 DOI: 10.3390/tropicalmed2010002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/22/2017] [Accepted: 02/06/2017] [Indexed: 11/21/2022] Open
Abstract
Papua New Guinea (PNG) has a significant malaria burden, is resource constrained, and has isolated populations with limited access to health services. Home-based management is a key element of the national program that supports strategies of early detection, diagnosis and treatment. We describe the epidemiology of malaria near Lake Kutubu in the Southern Highlands Province through reported data on suspected and confirmed malaria in patients accessing public health facilities or using a novel, incentivised, social marketing approach for malaria treatment at the village level. Monthly case data reported by nine health facilities and 14 village-based providers, known as Marasin Stoa Kipas (MSK), were extracted from outpatient registers and MSK malaria case forms. Descriptive statistics of diagnostic use, monthly incidence, test positivity rate and species distribution were estimated. Summary statistics of service delivery demonstrate patient access and diagnostic coverage in program areas. From May 2005 to September 2013, 15,726 individuals were tested with either rapid diagnostic test and/or microscopy at health facilities, and 42% had a positive result for malaria (n = 6604); of these 67.1% (n = 4431) were positive for P. falciparum (alone or mixed) and 32.9% were positive for non-P. falciparum species (alone or mixed). From October 2007 to September 2013, 9687 individuals were tested with either RDT and/or microscopy at MSK sites and 44.2% (n = 4283) tested positive for malaria; of these, 65.3% (n = 2796) were positive for P. falciparum, while 34.7% (n = 1487) were positive for non-P. falciparum species. Up to April 2010 there was an intermittent and upward trend in the reported incidence of all species of confirmed malaria, reaching 50 per 1000 population per month for both sites combined, followed by a steady decline to four per 1000 population per month in 2013, with P. vivax the most common infection. This study is the most recent longitudinal overview of malaria in the Southern Highlands since 2003. It outlines patient access to a community-based model of care. The analysis shows changes in health facility versus MSK use, a strongly decreasing trend in incidence of confirmed malaria from 2010 to 2013, and a shift from predominantly P. falciparum to P. vivax infection.
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Affiliation(s)
- Marshall Feterl
- Australian Institute of Tropical Health and Medicine, Division of Tropical Health and Medicine, James Cook University, Townsville 4811, Australia.
- College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Cairns 6811, Australia.
| | - Patricia Graves
- Australian Institute of Tropical Health and Medicine, Division of Tropical Health and Medicine, James Cook University, Townsville 4811, Australia.
- College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Cairns 6811, Australia.
| | - Liesel Seehofer
- Oil Search Foundation, PO Box 842, Port Moresby, Papua New Guinea.
| | - Jeffery Warner
- Australian Institute of Tropical Health and Medicine, Division of Tropical Health and Medicine, James Cook University, Townsville 4811, Australia.
- College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Cairns 6811, Australia.
| | - Peter Wood
- College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Cairns 6811, Australia.
| | - Kevin Miles
- Oil Search Foundation, PO Box 842, Port Moresby, Papua New Guinea.
| | - Ross Hutton
- Oil Search Foundation, PO Box 842, Port Moresby, Papua New Guinea.
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41
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Ome-Kaius M, Karl S, Wangnapi RA, Bolnga JW, Mola G, Walker J, Mueller I, Unger HW, Rogerson SJ. Effects of Plasmodium falciparum infection on umbilical artery resistance and intrafetal blood flow distribution: a Doppler ultrasound study from Papua New Guinea. Malar J 2017; 16:35. [PMID: 28103875 PMCID: PMC5248505 DOI: 10.1186/s12936-017-1689-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 01/10/2017] [Indexed: 11/13/2022] Open
Abstract
Background Doppler velocimetry studies of umbilical artery (UA) and middle cerebral artery (MCA) flow help to determine the presence and severity of fetal growth restriction. Increased UA resistance and reduced MCA pulsatility may indicate increased placental resistance and intrafetal blood flow redistribution. Malaria causes low birth weight and fetal growth restriction, but few studies have assessed its effects on uteroplacental and fetoplacental blood flow. Methods Colour-pulsed Doppler ultrasound was used to assess UA and MCA flow in 396 Papua New Guinean singleton fetuses. Abnormal flow was defined as an UA resistance index above the 90th centile, and/or a MCA pulsatility index and cerebroplacental ratio (ratio of MCA and UA pulsatility index) below the 10th centile of population-specific models fitted to the data. Associations between malaria (peripheral infection prior to and at ultrasound examination, and any gestational infection, i.e., ‘exposure’) and abnormal flow, and between abnormal flow and birth outcomes, were estimated. Results Of 78 malaria infection episodes detected before or at the ultrasound visit, 62 (79.5%) were Plasmodium falciparum (34 sub-microscopic infections), and 16 were Plasmodium vivax. Plasmodium falciparum infection before or at Doppler measurement was associated with increased UA resistance (adjusted odds ratio (aOR) 2.3 95% CI 1.0–5.2, P = 0.047). When assessed by ‘exposure’, P. falciparum infection was significantly associated with increased UA resistance (all infections: 2.4, 1.1–4.9, P = 0.024; sub-microscopic infections 2.6, 1.0–6.6, P = 0.051) and a reduced MCA pulsatility index (all infections: 2.6, 1.2–5.3, P = 0.012; sub-microscopic infections: 2.8, 1.1–7.5, P = 0.035). Sub-microscopic P. falciparum infections were additionally associated with a reduced cerebroplacental ratio (3.64, 1.22–10.88, P = 0.021). There were too few P. vivax infections to draw robust conclusions. An increased UA resistance index was associated with histological evidence of placental malaria (5.1, 2.3–10.9, P < 0.001; sensitivity 0.26, specificity 0.93). A low cerebroplacental Doppler ratio was associated with concurrently measuring small-for-gestational-age, and with low birth weight. Discussion/conclusion Both microscopic and sub-microscopic P. falciparum infections impair fetoplacental and intrafetal flow, at least temporarily. Increased UA resistance has high specificity but low sensitivity for the detection of placental infection. These findings suggest that interventions to protect the fetus should clear and prevent both microscopic and sub-microscopic malarial infections. Trial Registration ClinicalTrials.gov NCT01136850. Registered 06 April 2010 Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1689-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Ome-Kaius
- Papua New Guinea Institute of Medical Research (PNG IMR), Madang, Papua New Guinea
| | - Stephan Karl
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research (WEHI), 1G Royal Parade, Parkville, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | | | - John Walpe Bolnga
- Department of Obstetrics and Gynaecology, Modilon General Hospital, Madang, Papua New Guinea
| | - Glen Mola
- Department of Obstetrics and Gynaecology, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Jane Walker
- Department of Radiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Ivo Mueller
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research (WEHI), 1G Royal Parade, Parkville, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.,Institut Pasteur, 28 Rue de Dr. Roux, 75015, Paris, France
| | - Holger Werner Unger
- Department of Obstetrics and Gynaecology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.,Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Post Office Royal Melbourne Hospital, Parkville, VIC, 3050, Australia
| | - Stephen John Rogerson
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Post Office Royal Melbourne Hospital, Parkville, VIC, 3050, Australia.
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Imai C, Cheong HK, Kim H, Honda Y, Eum JH, Kim CT, Kim JS, Kim Y, Behera SK, Hassan MN, Nealon J, Chung H, Hashizume M. Associations between malaria and local and global climate variability in five regions in Papua New Guinea. Trop Med Health 2016; 44:23. [PMID: 27524928 PMCID: PMC4972963 DOI: 10.1186/s41182-016-0021-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/04/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Malaria is a significant public health issue in Papua New Guinea (PNG) as the burden is among the highest in Asia and the Pacific region. Though PNG's vulnerability to climate change and sensitivity of malaria mosquitoes to weather are well-documented, there are few in-depth epidemiological studies conducted on the potential impacts of climate on malaria incidence in the country. METHODS This study explored what and how local weather and global climate variability impact on malaria incidence in five regions of PNG. Time series methods were applied to evaluate the associations of malaria incidence with weather and climate factors, respectively. Local weather factors including precipitation and temperature and global climate phenomena such as El Niño-Southern Oscillation (ENSO), the ENSO Modoki, the Southern Annular Mode, and the Indian Ocean Dipole were considered in analyses. RESULTS The results showed that malaria incidence was associated with local weather factors in most regions but at the different lag times and in directions. Meanwhile, there were trends in associations with global climate factors by geographical locations of study sites. CONCLUSIONS Overall heterogeneous associations suggest the importance of location-specific approaches in PNG not only for further investigations but also public health interventions in repose to the potential impacts arising from climate change.
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Affiliation(s)
- Chisato Imai
- School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Brisbane, 4064 QLD Australia ; Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523 Japan
| | - Hae-Kwan Cheong
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, 300 Cheoncheon-dong, Jangan-gu, Suwon, Gyeonggi-do 440-746 Republic of Korea
| | - Ho Kim
- Department of Biostatistics, Graduate School of Public Health, Seoul National University, 599 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
| | - Yasushi Honda
- Faculty of Health and Sport Sciences, The University of Tsukuba, Comprehensive Research Building D 709, 1-1-1 Tennoudai, Tsukuba, Japan
| | - Jin-Hee Eum
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, 300 Cheoncheon-dong, Jangan-gu, Suwon, Gyeonggi-do 440-746 Republic of Korea
| | - Clara T Kim
- Department of Biostatistics, Graduate School of Public Health, Seoul National University, 599 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
| | - Jin Seob Kim
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, 300 Cheoncheon-dong, Jangan-gu, Suwon, Gyeonggi-do 440-746 Republic of Korea
| | - Yoonhee Kim
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523 Japan
| | - Swadhin K Behera
- Japan Agency for Marine-Earth Science and Technology (JAMSTEC), Yokohama Institute for Earth Science, 3173-25 Showa-machi, Kanazawa-ku, Yokohama, 236-0001 Japan
| | - Mohd Nasir Hassan
- World Health Organization Western Pacific Regional Office, P.O. Box 2932, 1000 Manila, Philippines
| | - Joshua Nealon
- World Health Organization Western Pacific Regional Office, P.O. Box 2932, 1000 Manila, Philippines
| | - Hyenmi Chung
- World Health Organization Western Pacific Regional Office, P.O. Box 2932, 1000 Manila, Philippines ; National Institute of Environmental Research, Hwangyong-ro 42, Seogu, Incheon Republic of Korea
| | - Masahiro Hashizume
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523 Japan
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Hetzel MW, Reimer LJ, Gideon G, Koimbu G, Barnadas C, Makita L, Siba PM, Mueller I. Changes in malaria burden and transmission in sentinel sites after the roll-out of long-lasting insecticidal nets in Papua New Guinea. Parasit Vectors 2016; 9:340. [PMID: 27301964 PMCID: PMC4908799 DOI: 10.1186/s13071-016-1635-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/08/2016] [Indexed: 12/25/2022] Open
Abstract
Background Papua New Guinea exhibits a complex malaria epidemiology due to diversity in malaria parasites, mosquito vectors, human hosts, and their natural environment. Heterogeneities in transmission and burden of malaria at various scales are likely to affect the success of malaria control interventions, and vice-versa. This manuscript assesses changes in malaria prevalence, incidence and transmission in sentinel sites following the first national distribution of long-lasting insecticidal nets (LLINs). Methods Before and after the distribution of LLINs, data collection in six purposively selected sentinel sites included clinical surveillance in the local health facility, household surveys and entomological surveys. Not all activities were carried out in all sites. Mosquitoes were collected by human landing catches. Diagnosis of malaria infection in humans was done by rapid diagnostic test, light microscopy and PCR for species confirmation. Results Following the roll-out of LLINs, the average monthly malaria incidence rate dropped from 13/1,000 population to 2/1,000 (incidence rate ratio = 0.12; 95 % CI: 0.09–0.17; P < 0.001). The average population prevalence of malaria decreased from 15.7 % pre-LLIN to 4.8 % post-LLIN (adjusted odds ratio = 0.26; 95 % CI: 0.20–0.33; P < 0.001). In general, reductions in incidence and prevalence were more pronounced in infections with P. falciparum than with P. vivax. Additional morbidity indicators (anaemia, splenomegaly, self-reported fever) showed a decreasing trend in most sites. Mean Anopheles man biting rates decreased from 83 bites/person/night pre-LLIN to 31 post-LLIN (P = 0.008). Anopheles species composition differed between sites but everywhere diversity was lower post-LLIN. In two sites, post-LLIN P. vivax infections in anophelines had decreased but P. falciparum infections had increased despite the opposite observation in humans. Conclusions LLIN distribution had distinct effects on P. falciparum and P. vivax. Higher resilience of P. vivax may be attributed to relapses from hypnozoites and other biological characteristics favouring the transmission of P. vivax. The effect on vector species composition varied by location which is likely to impact on the effectiveness of LLINs. In-depth and longer-term epidemiological and entomological investigations are required to understand when and where residual transmission occurs and whether observed changes are sustained. Electronic supplementary material The online version of this article (doi:10.1186/s13071-016-1635-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Manuel W Hetzel
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea. .,Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Lisa J Reimer
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea.,Case Western Reserve University, Cleveland, OH, USA.,Present address: Liverpool School of Tropical Medicine, Liverpool, UK
| | - Gibson Gideon
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Gussy Koimbu
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Céline Barnadas
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea.,Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Vic, Australia.,Department of Medical Biology, University of Melbourne, Parkville, Vic, Australia.,Present address: European Public Health Microbiology (EUPHEM) training programme, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Present address: Statens Serum Institut, Copenhagen, Denmark
| | - Leo Makita
- National Department of Health, Waigani, Papua New Guinea
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Ivo Mueller
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Vic, Australia.,Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
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Kinaston RL, Roberts GL, Buckley HR, Oxenham M. A bioarchaeological analysis of oral and physiological health on the south coast of New Guinea. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2016; 160:414-26. [PMID: 26990104 DOI: 10.1002/ajpa.22978] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 02/19/2016] [Accepted: 02/24/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The south coast of New Guinea has a complex prehistory known for its exchange systems that linked distinct cultural groups living along the coast, inland, and on offshore islands. Here we compare the palaeohealth of two relatively contemporaneous skeletal samples from the south coast of New Guinea (850-200 BP) that were from two ecologically different sites (one inland and one offshore island) and likely represent distinct cultural groups. We aim to elucidate health patterns that may provide information about the specific lifeways and quality of life of each community. MATERIALS AND METHODS Oral conditions (caries, calculus, alveolar lesions, and antemortem tooth loss [AMTL]) were analyzed macroscopically to assess possible intra- and inter-population variation in oral and physiological health. The frequency of linear enamel hypoplasia (LEH) was also used as a nonspecific indicator of stress to assess childhood health at each site. RESULTS The inhabitants from the small offshore island of Motupore, thought to be associated with Austronesian-speaking Motu tribes, displayed different patterns of oral pathological conditions (more carious lesions on the tooth crown and calculus) and LEH (lower frequencies) compared with inland people residing at the site of Nebira. DISCUSSION It is suggested that the causes for the variation in oral and physiological health were likely multifactorial and potentially associated with variables such as the ecological and geographical settings of the sites, cultural differences, infectious disease, differential fertility and, potentially, diet. This research provides previously unknown information about possible culturally-moderated practices that affected health in the past. Am J Phys Anthropol 160:414-426, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Rebecca L Kinaston
- Department of Anatomy, Otago School of Medical Sciences, Dunedin, New Zealand
| | - Georgia L Roberts
- Department of Archaeology and History, La Trobe University, Melbourne, Australia
| | - Hallie R Buckley
- Department of Anatomy, Otago School of Medical Sciences, Dunedin, New Zealand
| | - Marc Oxenham
- School of Archaeology and Anthropology, Australian National University, Canberra, Australia
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Park JW, Cheong HK, Honda Y, Ha M, Kim H, Kolam J, Inape K, Mueller I. Time trend of malaria in relation to climate variability in Papua New Guinea. ENVIRONMENTAL HEALTH AND TOXICOLOGY 2016; 31:e2016003. [PMID: 26987606 PMCID: PMC4825189 DOI: 10.5620/eht.e2016003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/17/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES This study was conducted to describe the regional malaria incidence in relation to the geographic and climatic conditions and describe the effect of altitude on the expansion of malaria over the last decade in Papua New Guinea. METHODS Malaria incidence was estimated in five provinces from 1996 to 2008 using national health surveillance data. Time trend of malaria incidence was compared with rainfall and minimum/maximum temperature. In the Eastern Highland Province, time trend of malaria incidence over the study period was stratified by altitude. Spatio-temporal pattern of malaria was analyzed. RESULTS Nationwide, malaria incidence was stationary. Regionally, the incidence increased markedly in the highland region (292.0/100000/yr, p =0.021), and remained stationary in the other regions. Seasonality of the malaria incidence was related with rainfall. Decreasing incidence of malaria was associated with decreasing rainfall in the southern coastal region, whereas it was not evident in the northern coastal region. In the Eastern Highland Province, malaria incidence increased in areas below 1700 m, with the rate of increase being steeper at higher altitudes. CONCLUSIONS Increasing trend of malaria incidence was prominent in the highland region of Papua New Guinea, while long-term trend was dependent upon baseline level of rainfall in coastal regions.
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Affiliation(s)
- Jae-Won Park
- Department of Microbiology, Graduate School of Medicine, Gachon University of Medicine and Science, Incheon, Korea
| | - Hae-Kwan Cheong
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Yasushi Honda
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Mina Ha
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Ho Kim
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, and Institute of Public Health and Environment, Seoul National University, Seoul, Korea
| | - Joel Kolam
- National Department of Health, Port Moresby, Papua New Guinea
| | - Kasis Inape
- National Weather Service, Port Moresby, Papua New Guinea
| | - Ivo Mueller
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
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46
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Reimer LJ, Thomsen EK, Koimbu G, Keven JB, Mueller I, Siba PM, Kazura JW, Hetzel MW, Zimmerman PA. Malaria transmission dynamics surrounding the first nationwide long-lasting insecticidal net distribution in Papua New Guinea. Malar J 2016; 15:25. [PMID: 26753618 PMCID: PMC4709896 DOI: 10.1186/s12936-015-1067-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 12/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The major malaria vectors of Papua New Guinea exhibit heterogeneities in distribution, biting behaviour and malaria infection levels. Long-lasting, insecticide-treated nets (LLINs), distributed as part of the National Malaria Control Programme, are the primary intervention targeting malaria transmission. This study evaluated the impact of LLINs on anopheline density, species composition, feeding behaviour, and malaria transmission. METHODS Mosquitoes were collected by human landing catch in 11 villages from East Sepik Province and Madang Province. Mosquitoes were collected for 3 years (1 year before distribution and 2 years after), and assayed to determine mosquito species and Plasmodium spp. infection prevalence. The influence of weather conditions and the presence of people and animals on biting density was determined. Determinants of biting density and sporozoite prevalence were analysed by generalized estimating equations (GEE). RESULTS Mosquito biting rates and entomological inoculation rates decreased significantly after the distribution. Plasmodium falciparum and P. vivax sporozoite prevalence decreased in year 2, but increased in year 3, suggesting the likelihood of resurgence in transmission if low biting rates are not maintained. An earlier shift in the median biting time of Anopheles punctulatus and An. farauti s.s. was observed. However, this was not accompanied by an increase in the proportion of infective bites occurring before 2200 hours. A change in species composition was observed, which resulted in dominance of An. punctulatus in Dreikikir region, but a decrease in An. punctulatus in the Madang region. When controlling for village and study year, An. farauti s.s., An. koliensis and An. punctulatus were equally likely to carry P. vivax sporozoites. However, An. punctulatus was significantly more likely than An. farauti s.s. (OR 0.14; p = 0.007) or An. koliensis (OR 0.27; p < 0.001) to carry P. falciparum sporozoites. CONCLUSIONS LLINs had a significant impact on malaria transmission, despite exophagic and crepuscular feeding behaviours of dominant vectors. Changes in species composition and feeding behaviour were observed, but their epidemiological significance will depend on their durability over time.
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Affiliation(s)
- Lisa J Reimer
- Case Western Reserve University, Cleveland, OH, USA. .,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. .,Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Edward K Thomsen
- Case Western Reserve University, Cleveland, OH, USA. .,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. .,Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Gussy Koimbu
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - John B Keven
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. .,Michigan State University, East Lansing, MI, USA.
| | - Ivo Mueller
- Walter and Eliza Hall Institute, Parkville, VIC, Australia.
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | | | - Manuel W Hetzel
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. .,Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
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Manning L, Cutts J, Stanisic DI, Laman M, Carmagnac A, Allen S, O'Donnell A, Karunajeewa H, Rosanas-Urgell A, Siba P, Davis TME, Michon P, Schofield L, Rockett K, Kwiatkowski D, Mueller I. A Toll-like receptor-1 variant and its characteristic cellular phenotype is associated with severe malaria in Papua New Guinean children. Genes Immun 2015; 17:52-9. [PMID: 26633000 DOI: 10.1038/gene.2015.50] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 08/18/2015] [Accepted: 08/20/2015] [Indexed: 01/13/2023]
Abstract
Genetic factors are likely to contribute to low severe malaria case fatality rates in Melanesian populations, but association studies can be underpowered and may not provide plausible mechanistic explanations if significant associations are detected. In preparation for a genome-wide association study, 29 candidate single-nucleotide polymorphisms (SNPs) with minor allele frequencies >5% were examined in a case-control study of 504 Papua New Guinean children with severe malaria. In parallel, an immunological substudy was performed on convalescent peripheral blood mononuclear cells (PBMCs) from cases and controls. Following stimulation with a Toll-like receptor (TLR) 1/2 agonist, effector cytokines and chemokines were assayed. The only significant genetic association observed involved a nonsynonymous SNP (TLR1rs4833095) in the TLR1 gene. A recessive (TT) genotype was associated with reduced odds of severe malaria of 0.52 (95% confidence interval (0.29-0.90), P=0.006). Concentrations of pro-inflammatory cytokines interleukin-1β and tumour necrosis factor α were significantly higher in severe malaria cases compared with healthy controls, but lower in children with the protective recessive (TT) genotype. A genetic variant in TLR1 may contribute to the low severe malaria case fatality rates in this region through a reduced pro-inflammatory cellular phenotype.
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Affiliation(s)
- L Manning
- School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Institute, Fiona Stanley Hospital, Bull Creek, Western Australia, Australia
| | - J Cutts
- Infection and Immunity Division, Walter & Eliza Hall Institute, Parkville, Melbourne, Australia.,Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia
| | - D I Stanisic
- Infection and Immunity Division, Walter & Eliza Hall Institute, Parkville, Melbourne, Australia.,Institute for Glycomics, Griffith University, Southport, Queensland, Australia
| | - M Laman
- School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Institute, Fiona Stanley Hospital, Bull Creek, Western Australia, Australia.,Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - A Carmagnac
- Infection and Immunity Division, Walter & Eliza Hall Institute, Parkville, Melbourne, Australia
| | - S Allen
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - A O'Donnell
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - H Karunajeewa
- Infection and Immunity Division, Walter & Eliza Hall Institute, Parkville, Melbourne, Australia
| | - A Rosanas-Urgell
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.,Institute of Tropical Medicine, Antwerp, Belgium
| | - P Siba
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - T M E Davis
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - P Michon
- Infection and Immunity Division, Walter & Eliza Hall Institute, Parkville, Melbourne, Australia.,Faculty of Health Sciences, Divine Word University, Madang, Papua New Guinea
| | - L Schofield
- Infection and Immunity Division, Walter & Eliza Hall Institute, Parkville, Melbourne, Australia
| | - K Rockett
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK and Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - D Kwiatkowski
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK and Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - I Mueller
- Infection and Immunity Division, Walter & Eliza Hall Institute, Parkville, Melbourne, Australia.,Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.,Barcelona Center for International Health Research (CRESIB), Barcelona, Spain
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Hetzel MW, Morris H, Tarongka N, Barnadas C, Pulford J, Makita L, Siba PM, Mueller I. Prevalence of malaria across Papua New Guinea after initial roll-out of insecticide-treated mosquito nets. Trop Med Int Health 2015; 20:1745-55. [PMID: 26427024 DOI: 10.1111/tmi.12616] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To assess the population prevalence of malaria in villages across Papua New Guinea (PNG) following the first roll-out of free long-lasting insecticidal nets (LLIN). METHODS Between October 2008 and August 2009, a household survey was conducted in 49 random villages in districts covered by the LLIN distribution campaign. The survey extended to 19 villages in sentinel sites that had not yet been covered by the campaign. In each village, 30 households were randomly sampled, household heads were interviewed and capillary blood samples were collected from all consenting household members for microscopic diagnosis of malaria. RESULTS Malaria prevalence ranged from 0% to 49.7% with a weighted average of 12.1% (95% CI 9.5, 15.3) in the national sample. More people were infected with Plasmodium falciparum (7.0%; 95% CI 5.4, 9.1) than with P. vivax (3.8%; 95% CI 2.4, 5.7) or P. malariae (0.3%; 95% CI 0.1, 0.6). Parasitaemia was strongly age-dependent with a P. falciparum peak at age 5-9 years and a P. vivax peak at age 1-4 years, yet with differences between geographical regions. Individual LLIN use and high community coverage were associated with reduced odds of infection (OR = 0.64 and 0.07, respectively; both P < 0.001). Splenomegaly in children and anaemia were common morbidities attributable to malaria. CONCLUSIONS Malaria prevalence across PNG is again at levels comparable to the 1970s. The strong association of LLIN use with reduced parasitaemia supports efforts to achieve and maintain high country-wide coverage. P. vivax infections will require special targeted approaches across PNG.
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Affiliation(s)
- Manuel W Hetzel
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Hector Morris
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Nandao Tarongka
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Céline Barnadas
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.,Walter and Eliza Hall Institute of Medical Research, Parkville, Vic., Australia.,Department of Medical Biology, University of Melbourne, Parkville, Vic., Australia
| | - Justin Pulford
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.,School of Public Health, The University of Queensland, Herston, Qld, Australia
| | - Leo Makita
- National Department of Health, Waigani, Papua New Guinea
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Parkville, Vic., Australia.,Department of Medical Biology, University of Melbourne, Parkville, Vic., Australia.,Barcelona Centre for International Health Research, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
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Barnadas C, Timinao L, Javati S, Iga J, Malau E, Koepfli C, Robinson LJ, Senn N, Kiniboro B, Rare L, Reeder JC, Siba PM, Zimmerman PA, Karunajeewa H, Davis TM, Mueller I. Significant geographical differences in prevalence of mutations associated with Plasmodium falciparum and Plasmodium vivax drug resistance in two regions from Papua New Guinea. Malar J 2015; 14:399. [PMID: 26452541 PMCID: PMC4600278 DOI: 10.1186/s12936-015-0879-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/31/2015] [Indexed: 12/22/2022] Open
Abstract
Background Drug resistance remains a major obstacle to malaria treatment and control. It can arise and spread rapidly, and vary substantially even at sub-national level. National malaria programmes require cost-effective and timely ways of characterizing drug-resistance at multiple sites within their countries. Methods An improved multiplexed post-PCR ligase detection reaction—fluorescent microsphere assay (LDR-FMA) was used to simultaneously determine the presence of mutations in chloroquine resistance transporter (crt), multidrug resistance 1 (mdr1), dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) genes in Plasmodium falciparum (n = 727) and Plasmodium vivax (n = 574) isolates collected in 2006 from cross-sectional community population surveys in two geographically distinct regions (Madang and East Sepik) of Papua New Guinea (PNG) where strong regional differences in in vivo aminoquinoline and antifolate therapeutic efficacy had previously been observed. Data were compared to those of a follow-up survey conducted in 2010. Results Despite some very low parasite densities, the assay successfully amplified all P. falciparum and P. vivax loci in 77 and 69 % of samples, respectively. In 2006, prevalences of pfdhfr (59R-108 N) double mutation/wild type pfdhps haplotype, pfcrt SVMNT haplotype (72S-76T double mutation), and 86Y pfmdr1 mutation all exceeded 90 %. For P. vivax, 65 % carried at least two pvdhfr mutations, 97 % the 647P pvdhps mutation and 54 % the 976F pvmdr1 mutation. Prevalence of mutant haplotypes was higher in Madang than East Sepik for pfcrt SVMNT (97.4 vs 83.3 %, p = 0.001), pfdhfr (59R-108 N) (100 vs 90.6 %, p = 0.001), pvdhfr haplotypes (75.8 vs 47.6 %, p = 0.001) and pvmdr1 976F (71.2 vs 26.2 %, p < 0.001). Data from a subsequent Madang survey in 2010 showed that the prevalence of pfdhps mutations increased significantly from <5 % to >30 % (p < 0.001) as did the prevalence of pvdhfr mutant haplotypes (from 75.8 to 97.4 %, p = 0.012). Conclusions This LDR-FMA multiplex platform shows feasibility for low-cost, high-throughput, rapid characterization of a broad range of drug-resistance markers in low parasitaemia infections. Significant geographical differences in mutation prevalence correlate with previous genotyping surveys and in vivo trials and may reflect variable drug pressure and differences in health-care access in these two PNG populations. Electronic supplementary material The online version of this article (doi:10.1186/s12936-015-0879-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Céline Barnadas
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. .,Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia. .,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.
| | - Lincoln Timinao
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Sarah Javati
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Jonah Iga
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Elisheba Malau
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia. .,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.
| | - Cristian Koepfli
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia. .,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.
| | - Leanne J Robinson
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. .,Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia. .,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.
| | - Nicolas Senn
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. .,Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - Benson Kiniboro
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Lawrence Rare
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | | | - Peter M Siba
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Peter A Zimmerman
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, USA.
| | - Harin Karunajeewa
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia. .,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.
| | - Timothy M Davis
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
| | - Ivo Mueller
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia. .,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia. .,Centre de Recerca en Salut Internacional de Barcelona, Barcelona, Spain.
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Koepfli C, Rodrigues PT, Antao T, Orjuela-Sánchez P, Van den Eede P, Gamboa D, van Hong N, Bendezu J, Erhart A, Barnadas C, Ratsimbasoa A, Menard D, Severini C, Menegon M, Nour BYM, Karunaweera N, Mueller I, Ferreira MU, Felger I. Plasmodium vivax Diversity and Population Structure across Four Continents. PLoS Negl Trop Dis 2015; 9:e0003872. [PMID: 26125189 PMCID: PMC4488360 DOI: 10.1371/journal.pntd.0003872] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 06/02/2015] [Indexed: 01/12/2023] Open
Abstract
Plasmodium vivax is the geographically most widespread human malaria parasite. To analyze patterns of microsatellite diversity and population structure across countries of different transmission intensity, genotyping data from 11 microsatellite markers was either generated or compiled from 841 isolates from four continents collected in 1999–2008. Diversity was highest in South-East Asia (mean allelic richness 10.0–12.8), intermediate in the South Pacific (8.1–9.9) Madagascar and Sudan (7.9–8.4), and lowest in South America and Central Asia (5.5–7.2). A reduced panel of only 3 markers was sufficient to identify approx. 90% of all haplotypes in South Pacific, African and SE-Asian populations, but only 60–80% in Latin American populations, suggesting that typing of 2–6 markers, depending on the level of endemicity, is sufficient for epidemiological studies. Clustering analysis showed distinct clusters in Peru and Brazil, but little sub-structuring was observed within Africa, SE-Asia or the South Pacific. Isolates from Uzbekistan were exceptional, as a near-clonal parasite population was observed that was clearly separated from all other populations (FST>0.2). Outside Central Asia FST values were highest (0.11–0.16) between South American and all other populations, and lowest (0.04–0.07) between populations from South-East Asia and the South Pacific. These comparisons between P. vivax populations from four continents indicated that not only transmission intensity, but also geographical isolation affect diversity and population structure. However, the high effective population size results in slow changes of these parameters. This persistency must be taken into account when assessing the impact of control programs on the genetic structure of parasite populations. Plasmodium vivax is the predominant malaria parasite in Latin America, Asia and the South Pacific. Different factors are expected to shape diversity and population structure across continents, e.g. transmission intensity which is much lower in South America as compared to Southeast-Asia and the South Pacific, or geographical isolation of P. vivax populations in the South Pacific. We have compiled data from 841 isolates from South and Central America, Africa, Central Asia, Southeast-Asia and the South Pacific typed with a panel of 11 microsatellite markers. Diversity was highest in Southeast-Asia, where transmission is intermediate-high and migration of infected hosts is high, and lowest in South America and Central Asia where malaria transmission is low and focal. Reducing the panel of microsatellites showed that 2–6 markers are sufficient for genotyping for most drug trials and epidemiological studies, as these markers can identify >90% of all haplotypes. Parasites clustered according to continental origin, with high population differentiation between South American and Central Asian populations and the other populations, and lowest differences between Southeast-Asia and the South Pacific. Current attempts to reduce malaria transmission might change this pattern, but only after transmission is reduced for an extended period of time.
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Affiliation(s)
- Cristian Koepfli
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Walter and Eliza Hall Institute, Parkville, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Priscila T. Rodrigues
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Tiago Antao
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Pamela Orjuela-Sánchez
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Peter Van den Eede
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Dionicia Gamboa
- Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nguyen van Hong
- National Institute of Malariology, Parasitology, and Entomology, Hanoi, Vietnam
| | - Jorge Bendezu
- Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Annette Erhart
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Céline Barnadas
- Walter and Eliza Hall Institute, Parkville, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Arsène Ratsimbasoa
- Immunology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Didier Menard
- Institut Pasteur de Cambodge, Malaria Molecular Epidemiology Unit, Phnom Penh, Cambodia
| | - Carlo Severini
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Michela Menegon
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Bakri Y. M. Nour
- Department of Parasitology, Blue Nile National Institute for Communicable Diseases, University of Gezira, Wad Medani, Sudan
| | - Nadira Karunaweera
- Department of Parasitology, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Ivo Mueller
- Walter and Eliza Hall Institute, Parkville, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
- Barcelona Centre for International Health Research, Barcelona, Spain
| | - Marcelo U. Ferreira
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Ingrid Felger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
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