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Malla P, Wang Z, Brashear A, Yang Z, Lo E, Baird K, Wang C, Cui L. Effectiveness of an Unsupervised Primaquine Regimen for Preventing Plasmodium vivax Malaria Relapses in Northeast Myanmar: A Single-Arm Nonrandomized Observational Study. J Infect Dis 2024; 229:1557-1564. [PMID: 38041857 PMCID: PMC11095535 DOI: 10.1093/infdis/jiad552] [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: 05/21/2023] [Revised: 11/16/2023] [Accepted: 11/29/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Plasmodium vivax presents a significant challenge for malaria elimination in the Greater Mekong Subregion. We evaluated the effectiveness of primaquine for reducing relapses of vivax malaria. METHODS Patients with uncomplicated P vivax malaria from eastern Myanmar received chloroquine (25-mg base/kg given in 3 days) plus unsupervised PQ (0.25 mg/kg/d for 14 days) without screening for glucose-6-phosphate dehydrogenase deficiency and were followed for a year. RESULTS A total of 556 patients were enrolled to receive the chloroquine/primaquine treatment from February 2012 to August 2013. During the follow-up, 38 recurrences were detected, presenting a cumulative recurrence rate of 9.1% (95% CI, 4.1%-14.1%). Genotyping at the pvmsp1 and pvmsp3α loci by amplicon deep sequencing and model prediction indicated that 13 of the 27 recurrences with genotyping data were likely due to relapses. Notably, all confirmed relapses occurred within the first 6 months. CONCLUSIONS The unsupervised standard dose of primaquine was highly effective as a radical cure for P vivax malaria in eastern Myanmar. The high presumed effectiveness might have benefited from the health messages delivered during the enrollment and follow-up activities. Six-month follow-ups in the Greater Mekong Subregion are sufficient for detecting most relapses.
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Affiliation(s)
- Pallavi Malla
- Department of Internal Medicine, Morsani College of Medicine
- Center for Global Health and Infectious Diseases Research, College of Public Health, University of South Florida, Tampa
| | - Zenglei Wang
- MHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Beijing Union Medical College
| | - Awtum Brashear
- Department of Internal Medicine, Morsani College of Medicine
| | - Zhaoqing Yang
- Department of Pathogen Biology and Immunology, Kunming Medical University, China
| | - Eugenia Lo
- Department of Microbiology and Immunology, College of Medicine, Drexel University
| | - Kevin Baird
- Eijkman-Oxford Clinical Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Chengqi Wang
- Center for Global Health and Infectious Diseases Research, College of Public Health, University of South Florida, Tampa
| | - Liwang Cui
- Department of Internal Medicine, Morsani College of Medicine
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Pottenger AE, Roy D, Srinivasan S, Chavas TEJ, Vlaskin V, Ho DK, Livingston VC, Maktabi M, Lin H, Zhang J, Pybus B, Kudyba K, Roth A, Senter P, Tyson G, Huber HE, Wesche D, Rochford R, Burke PA, Stayton PS. Liver-targeted polymeric prodrugs delivered subcutaneously improve tafenoquine therapeutic window for malaria radical cure. SCIENCE ADVANCES 2024; 10:eadk4492. [PMID: 38640243 PMCID: PMC11029812 DOI: 10.1126/sciadv.adk4492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/19/2024] [Indexed: 04/21/2024]
Abstract
Approximately 3.3 billion people live with the threat of Plasmodium vivax malaria. Infection can result in liver-localized hypnozoites, which when reactivated cause relapsing malaria. This work demonstrates that an enzyme-cleavable polymeric prodrug of tafenoquine addresses key requirements for a mass administration, eradication campaign: excellent subcutaneous bioavailability, complete parasite control after a single dose, improved therapeutic window compared to the parent oral drug, and low cost of goods sold (COGS) at less than $1.50 per dose. Liver targeting and subcutaneous dosing resulted in improved liver:plasma exposure profiles, with increased efficacy and reduced glucose 6-phosphate dehydrogenase-dependent hemotoxicity in validated preclinical models. A COGS and manufacturability analysis demonstrated global scalability, affordability, and the ability to redesign this fully synthetic polymeric prodrug specifically to increase global equity and access. Together, this polymer prodrug platform is a candidate for evaluation in human patients and shows potential for P. vivax eradication campaigns.
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Affiliation(s)
- Ayumi E. Pottenger
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Debashish Roy
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Selvi Srinivasan
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Thomas E. J. Chavas
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Vladmir Vlaskin
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Duy-Khiet Ho
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | | | - Mahdi Maktabi
- Department of Immunology and Microbiology, University of Colorado Anschutz School of Medicine, Aurora, CO 80045, USA
| | - Hsiuling Lin
- Department of Drug Discovery, Experimental Therapeutics Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Jing Zhang
- Department of Drug Discovery, Experimental Therapeutics Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Brandon Pybus
- Department of Drug Discovery, Experimental Therapeutics Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Karl Kudyba
- Department of Drug Discovery, Experimental Therapeutics Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Alison Roth
- Department of Drug Discovery, Experimental Therapeutics Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | | | - George Tyson
- George Tyson Consulting, Los Altos Hills, CA 94022, USA
- Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Hans E. Huber
- BioTD Strategies LLC, 213 Abbey Ln., Lansdale, PA 19446, USA
| | | | - Rosemary Rochford
- Department of Immunology and Microbiology, University of Colorado Anschutz School of Medicine, Aurora, CO 80045, USA
| | - Paul A. Burke
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
- Burke Bioventures LLC, 1 Broadway 14th Floor, Cambridge, MA 02142, USA
| | - Patrick S. Stayton
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
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3
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Labadie-Bracho MY, Adhin MR. Advocating for PCR-RFLP as molecular tool within malaria programs in low endemic areas and low resource settings. PLoS Negl Trop Dis 2023; 17:e0011747. [PMID: 37939114 PMCID: PMC10659184 DOI: 10.1371/journal.pntd.0011747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 11/20/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023] Open
Abstract
The road to malaria elimination for low- and middle-income countries is paved with obstacles, including the complexity and high costs of advanced molecular methods for genomic analysis. The usefulness of PCR-RFLP as less complex and affordable molecular surveillance tool in low-endemic malaria regions was assessed in a cross-sectional study conducted in Suriname, currently striving for malaria elimination, but plagued by recent P. vivax outbreaks. Molecular analysis of two highly polymorphic genes Pvmsp-1 F2 and Pvmsp-3α was performed for 49 samples, collected during October 2019 through September 2021 from four different regions with varying malaria transmission risks. RFLP-profiling revealed that outbreak samples from three indigenous villages, almost exclusively, harbored a single clonal type, matching the "Palumeu" lineage previously described in 2019, despite multiple relapses and drug pressure exerted by mass drug administration events, suggesting a limited P. vivax hypnozoite reservoir in Suriname. In contrast, isolates originating from Sophie, a mining area in neighboring French Guiana displayed a highly heterogeneous parasite population consistent with its endemic malaria status, demonstrating the differentiating capacity and thus the usefulness of PCR-RFLP for P. vivax genetic diversity studies. Outbreak reconstruction emphasized the impact of undetected human movement and relapses on reintroduction and resurgence of P. vivax malaria and PCR-RFLP monitoring of circulating parasites guided the roll-out of targeted interventions. PCR-RFLP seems a suitable molecular alternative in low-endemic areas with restricted resources for outbreak analysis, for monitoring the spread or containment of circulating strains and for identification of imported cases or potential foci.
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Affiliation(s)
| | - Malti R. Adhin
- Anton de Kom Universiteit van Suriname, Faculty of Medical Sciences, Department of Biochemistry, Kernkampweg, Paramaribo, Suriname
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4
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Mehdipour P, Rajasekhar M, Dini S, Zaloumis S, Abreha T, Adam I, Awab GR, Baird JK, Brasil LW, Chu CS, Cui L, Daher A, do Socorro M Gomes M, Gonzalez-Ceron L, Hwang J, Karunajeewa H, Lacerda MVG, Ladeia-Andrade S, Leslie T, Ley B, Lidia K, Llanos-Cuentas A, Longley RJ, Monteiro WM, Pereira DB, Rijal KR, Saravu K, Sutanto I, Taylor WRJ, Thanh PV, Thriemer K, Vieira JLF, White NJ, Zuluaga-Idarraga LM, Guerin PJ, Price RN, Simpson JA, Commons RJ. Effect of adherence to primaquine on the risk of Plasmodium vivax recurrence: a WorldWide Antimalarial Resistance Network systematic review and individual patient data meta-analysis. Malar J 2023; 22:306. [PMID: 37817240 PMCID: PMC10563365 DOI: 10.1186/s12936-023-04725-w] [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: 08/24/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Imperfect adherence is a major barrier to effective primaquine radical cure of Plasmodium vivax. This study investigated the effect of reduced adherence on the risk of P. vivax recurrence. METHODS Efficacy studies of patients with uncomplicated P. vivax malaria, including a treatment arm with daily primaquine, published between January 1999 and March 2020 were identified. Individual patient data from eligible studies were pooled using standardized methodology. Adherence to primaquine was inferred from i) the percentage of supervised doses and ii) the total mg/kg dose received compared to the target total mg/kg dose per protocol. The effect of adherence to primaquine on the incidence of P. vivax recurrence between days 7 and 90 was investigated by Cox regression analysis. RESULTS Of 82 eligible studies, 32 were available including 6917 patients from 18 countries. For adherence assessed by percentage of supervised primaquine, 2790 patients (40.3%) had poor adherence (≤ 50%) and 4127 (59.7%) had complete adherence. The risk of recurrence by day 90 was 14.0% [95% confidence interval: 12.1-16.1] in patients with poor adherence compared to 5.8% [5.0-6.7] following full adherence; p = 0.014. After controlling for age, sex, baseline parasitaemia, and total primaquine dose per protocol, the rate of the first recurrence was higher following poor adherence compared to patients with full adherence (adjusted hazard ratio (AHR) = 2.3 [1.8-2.9]). When adherence was quantified by total mg/kg dose received among 3706 patients, 347 (9.4%) had poor adherence, 88 (2.4%) had moderate adherence, and 3271 (88.2%) had complete adherence to treatment. The risks of recurrence by day 90 were 8.2% [4.3-15.2] in patients with poor adherence and 4.9% [4.1-5.8] in patients with full adherence; p < 0.001. CONCLUSION Reduced adherence, including less supervision, increases the risk of vivax recurrence.
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Affiliation(s)
- Parinaz Mehdipour
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Megha Rajasekhar
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Saber Dini
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Sophie Zaloumis
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Tesfay Abreha
- ICAP, Columbia University Mailman School of Public Health, Addis Ababa, Ethiopia
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | - Ghulam Rahim Awab
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nangarhar Medical Faculty, Nangarhar University, Jalalabad, Afghanistan
| | - J Kevin Baird
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Larissa W Brasil
- Diretoria de Ensino E Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
- Programa de Pós‑Graduação em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, AM, Brazil
| | - Cindy S Chu
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Liwang Cui
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - André Daher
- Fiocruz Clinical Research Platform, Vice-Presidency of Research and Biological Collections, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Margarete do Socorro M Gomes
- Superintendência de Vigilância Em Saúde Do Estado Do Amapá - SVS/AP, Macapá, Amapá, Brazil
- Federal University of aMAPA, Universidade Federal Do Amapá - UNIFAP), Macapá, Amapá, Brazil
| | - Lilia Gonzalez-Ceron
- Regional Centre for Public Health Research, National Institute for Public Health, Tapachula, Chiapas, Mexico
| | - Jimee Hwang
- U.S. President's Malaria Initiative, Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
- Global Health Group, University of California San Francisco, San Francisco, USA
| | - Harin Karunajeewa
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St. Albans, VIC, Australia
| | - Marcus V G Lacerda
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Instituto Leônidas & Maria Deane, Fiocruz, Manaus, Brazil
- University of Texas Medical Branch, Galveston, USA
| | - Simone Ladeia-Andrade
- Laboratory of Parasitic Diseases, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Lisbon, Portugal
| | - Toby Leslie
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- HealthNet-TPO, Kabul, Afghanistan
| | - Benedikt Ley
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Kartini Lidia
- Department of Pharmacology and Therapy, Faculty of Medicine and Veterinary Medicine, Universitas Nusa Cendana, Kupang, Indonesia
| | - Alejandro Llanos-Cuentas
- Unit of Leishmaniasis and Malaria, Instituto de Medicina Tropical "Alexander Von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rhea J Longley
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | | | - Dhelio B Pereira
- Centro de Pesquisa Em Medicina Tropical de Rondonia (CEPEM), Porto Velho, Brazil
- Fundação Universidade Federal de Rondonia (UNIR), Porto Velho, Brazil
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kavitha Saravu
- Department of Infectious Diseases, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Madhava Nagar, Manipal, Karnataka, India
- Manipal Centre for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Madhava Nagar, Manipal, Karnataka, India
| | - Inge Sutanto
- Department of Parasitology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Walter R J Taylor
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Pham Vinh Thanh
- National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | - Kamala Thriemer
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - José Luiz F Vieira
- Federal University of Pará, Universidade Federal Do Pará - UFPA), Belém, Pará, Brazil
| | - Nicholas J White
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Lina M Zuluaga-Idarraga
- Grupo Malaria, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
- Facultad Nacional de Salud Publica, Universidad de Antioquia, Medellín, Colombia
| | - Philippe J Guerin
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK
- Infectious Diseases Data Observatory (IDDO), Oxford, UK
| | - Ric N Price
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
- WorldWide Antimalarial Resistance Network (WWARN), Asia-Pacific Regional Centre, Darwin, NT, Australia
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- WorldWide Antimalarial Resistance Network (WWARN), Asia-Pacific Regional Centre, Darwin, NT, Australia
| | - Robert J Commons
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia.
- WorldWide Antimalarial Resistance Network (WWARN), Asia-Pacific Regional Centre, Darwin, NT, Australia.
- General and Subspecialty Medicine, Grampians Health - Ballarat, Ballarat, Australia.
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Win KM, Aung PL, Ring Z, Linn NYY, Kyaw MP, Nguitragool W, Cui L, Sattabongkot J, Lawpoolsri S. Interventions for promoting patients' adherence to 14-day primaquine treatment in a highly malaria-endemic township in Myanmar: a qualitative study among key stakeholders. Malar J 2023; 22:302. [PMID: 37814267 PMCID: PMC10563334 DOI: 10.1186/s12936-023-04743-8] [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: 08/31/2023] [Accepted: 10/04/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Plasmodium vivax malaria is considered a major threat to malaria eradication. The radical cure for P. vivax malaria normally requires a 14-day administration of primaquine (PQ) to clear hypnozoites. However, maintaining adherence to PQ treatment is a significant challenge, particularly in malaria-endemic rural areas. Hence, this study aimed to formulate interventions for promoting patients' commitment to PQ treatment in a highly malaria-endemic township in Myanmar. METHODS A qualitative study was conducted in Waingmaw Township in northern Myanmar, where P. vivax malaria is highly endemic. Key stakeholders including public health officers and community members participated in focus group discussions (FGDs) and in-depth interviews (IDIs) in September 2022. Data were collected using validated guidelines, translated into English, and visualized through thematic analysis. RESULTS Responsible individuals from different levels of the Myanmar National Malaria Control Programme participated in the IDIs. Most of them reported being aware of the markedly increasing trend of P. vivax and the possibility of relapse cases, especially among migrants who are lost to follow-up. Workload was a key concern surrounding intervention implementation. The respondents discussed possible interventions, such as implementing directly observed treatment (DOT) by family members, piloting a shorter PQ regimen, expanding the community's malaria volunteer network, and strengthening health education activities using local languages to promote reasonable drug adherence. FGDs among community members revealed that although people were knowledgeable about malaria symptoms, places to seek treatment, and the use of bed nets to prevent mosquito bites, most of them still preferred to be treated by quack doctors and rarely used insecticide-treated nets at worksites. Many often stopped taking the prescribed drugs once the symptoms disappeared. Nevertheless, some respondents requested more bed nets to be distributed and health promotion activities to be conducted. CONCLUSION In rural areas where human resources are limited, interventions such as implementing family member DOT or shortening PQ regimens should be introduced to enhance the radical cure for the P. vivax infection. Disseminating information about the importance of taking the entire treatment course and emphasizing the burden of relapse is also essential.
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Affiliation(s)
- Kyawt Mon Win
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Public Health, Ministry of Health, Naypyitaw, Myanmar
| | - Pyae Linn Aung
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Zau Ring
- State Public Health Department, Kachin State, Ministry of Health, Myitkyina, Myanmar
| | - Nay Yi Yi Linn
- Department of Public Health, Ministry of Health, Naypyitaw, Myanmar
| | | | - Wang Nguitragool
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Liwang Cui
- Division of Infectious Diseases and International Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jetsumon Sattabongkot
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Saranath Lawpoolsri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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6
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Win KM, Aung PL, Ring Z, Linn NYY, Kyaw MP, Nguitragool W, Cui L, Sattabongkot J, Lawpoolsri S. Interventions for promoting patients' adherence to 14-day primaquine treatment in a highly malaria-endemic township in Myanmar: A qualitative study among key stakeholders. RESEARCH SQUARE 2023:rs.3.rs-3312278. [PMID: 37720045 PMCID: PMC10503836 DOI: 10.21203/rs.3.rs-3312278/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Background Plasmodium vivax malaria is considered a major threat to malaria eradication. The radical cure for P. vivax malaria normally requires a 14-day administration of primaquine (PQ) to clear hypnozoites. However, maintaining adherence to PQ treatment is a significant challenge, particularly in malaria-endemic rural areas. Hence, this study aimed to formulate interventions for promoting patients' commitment to PQ treatment in a highly malaria-endemic township in Myanmar. Methods A qualitative study was conducted in Waingmaw Township in northern Myanmar, where P. vivax malaria is highly endemic. Key stakeholders including public health officers and community members participated in focus group discussions (FGDs) and in-depth interviews (IDIs) in September 2022. Data were collected using validated guidelines, translated into English, and visualized through thematic analysis. Results Responsible individuals from different levels of the Myanmar National Malaria Control Program participated in the IDIs. Most of them reported being aware of the markedly increasing trend of P. vivax and the possibility of relapse cases, especially among migrants who are lost to follow-up. Workload was a key concern surrounding intervention implementation. The respondents discussed possible interventions, such as implementing directly observed treatment (DOT) by family members, piloting a shorter PQ regimen, expanding the community's malaria volunteer network, and strengthening health education activities using local languages to promote reasonable drug adherence. FGDs among community members revealed that although people were knowledgeable about malaria symptoms, places to seek treatment, and the use of bed nets to prevent mosquito bites, most of them still preferred to be treated by quack doctors and rarely used insecticide-treated nets at worksites. Many often stopped taking the prescribed drugs once the symptoms disappeared. Nevertheless, some respondents requested more bed nets to be distributed and health promotion activities to be conducted. Conclusion In rural areas where human resources are limited, interventions such as implementing family member DOT or shortening PQ regimens should be introduced to enhance the radical cure for the P. vivax infection. Disseminating information about the importance of taking the entire treatment course and emphasizing the burden of relapse is also essential.
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7
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Rahi M, Sirohi PR, Sharma A. Supervised administration of primaquine may enhance adherence to radical cure for P. vivax malaria in India. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 13:100199. [PMID: 37383547 PMCID: PMC10305963 DOI: 10.1016/j.lansea.2023.100199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/21/2023] [Accepted: 03/31/2023] [Indexed: 06/30/2023]
Abstract
The Plasmodium vivax lifecycle encompasses a dormant liver-stage known as 'hypnozoite' which serves as silent reservoirs of malaria, reactivation of which results in recurring episodes of relapse with varying periodicity. This contributes to continuous transmission of malaria unamenable to control methods. The prevention of relapse requires a "radical cure" by a hypnozoitcidal drug. Primaquine (PQ) has been the recommended radical cure for this malaria. However, adherence to 14 days PQ treatment remains poor. India accounts for majority of P. vivax burden globally. However, PQ administration is not supervised in the current national programme. Supervised administration of drugs ensures compliance and improves drug regime success rate. Trials across different countries have established the effectiveness of directly observed therapy (DOT) for prevention of relapses. As India aims to eliminate malaria by 2030, it is prudent to consider DOT to ensure complete treatment of the malaria affected populations. Therefore, we recommend that the Indian malaria control programme may consider DOT of primaquine for treatment of vivax malaria. The supervised administration would entail additional direct and indirect costs but will ensure complete treatment and hence minimize the probability of relapses. This will help the country in achieving the goal of malaria elimination.
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Affiliation(s)
- Manju Rahi
- Indian Council of Medical Research, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | | | - Amit Sharma
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
- International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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8
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Rahmalia A, Poespoprodjo JR, Landuwulang CUR, Ronse M, Kenangalem E, Burdam FH, Thriemer K, Devine A, Price RN, Peeters Grietens K, Ley B, Gryseels C. Adherence to 14-day radical cure for Plasmodium vivax malaria in Papua, Indonesia: a mixed-methods study. Malar J 2023; 22:162. [PMID: 37210520 PMCID: PMC10199529 DOI: 10.1186/s12936-023-04578-3] [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: 06/15/2022] [Accepted: 04/25/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Reducing the risk of recurrent Plasmodium vivax malaria is critical for malaria control and elimination. Primaquine (PQ) is the only widely available drug against P. vivax dormant liver stages, but is recommended as a 14-day regimen, which can undermine adherence to a complete course of treatment. METHODS This is a mixed-methods study to assess socio-cultural factors influencing adherence to a 14-day PQ regimen in a 3-arm, treatment effectiveness trial in Papua, Indonesia. The qualitative strand, consisting of interviews and participant observation was triangulated with a quantitative strand in which trial participants were surveyed using a questionnaire. RESULTS Trial participants differentiated between two types of malaria: tersiana and tropika, equivalent to P. vivax and Plasmodium falciparum infection, respectively. The perceived severity of both types was similar with 44.0% (267/607) perceiving tersiana vs. 45.1% (274/607) perceiving tropika as more severe. There was no perceived differentiation whether malaria episodes were due to a new infection or relapse; and 71.3% (433/607) acknowledged the possibility of recurrence. Participants were familiar with malaria symptoms and delaying health facility visit by 1-2 days was perceived to increase the likelihood of a positive test. Prior to health facility visits, symptoms were treated with leftover drugs kept at home (40.4%; 245/607) or bought over the counter (17.0%; 103/607). Malaria was considered to be cured with 'blue drugs' (referring to dihydroartemisinin-piperaquine). Conversely, 'brown drugs,' referring to PQ, were not considered malaria medication and instead were perceived as supplements. Adherence to malaria treatment was 71.2% (131/184), in the supervised arm, 56.9% (91/160) in the unsupervised arm and 62.4% (164/263) in the control arm; p = 0.019. Adherence was 47.5% (47/99) among highland Papuans, 51.7% (76/147) among lowland Papuans, and 72.9% (263/361) among non-Papuans; p < 0.001. CONCLUSION Adherence to malaria treatment was a socio-culturally embedded process during which patients (re-)evaluated the characteristics of the medicines in relation to the course of the illness, their past experiences with illness, and the perceived benefits of the treatment. Structural barriers that hinder the process of patient adherence are crucial to consider in the development and rollout of effective malaria treatment policies.
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Affiliation(s)
- Annisa Rahmalia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia.
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
- Institute of Tropical Medicine, Antwerp, Belgium.
| | - Jeanne Rini Poespoprodjo
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia
- Mimika District Hospital, Timika, Indonesia
- Paediatric Research Office, Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Chandra U R Landuwulang
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia
| | - Maya Ronse
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Enny Kenangalem
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia
- Mimika Regency Health Authority, Timika, Papua, Indonesia
| | - Faustina H Burdam
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia
- Mimika Regency Health Authority, Timika, Papua, Indonesia
| | - Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Angela Devine
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Ric N Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Koen Peeters Grietens
- Institute of Tropical Medicine, Antwerp, Belgium
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
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9
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Drysdale M, Tan L, Martin A, Fuhrer IB, Duparc S, Sharma H. Plasmodium vivax in Children: Hidden Burden and Conspicuous Challenges, a Narrative Review. Infect Dis Ther 2023; 12:33-51. [PMID: 36378465 PMCID: PMC9868225 DOI: 10.1007/s40121-022-00713-w] [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: 06/29/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
There has been progress towards decreasing malaria prevalence globally; however, Plasmodium vivax has been less responsive to elimination efforts compared with Plasmodium falciparum. P. vivax malaria remains a serious public health concern in regions where it is the dominant species (South and South-East Asia, the Eastern Mediterranean region, and South America) and is increasingly recognized for its contribution to overall morbidity and mortality worldwide. The incidence of P. vivax decreases with increasing age owing to rapidly acquired clinical immunity and there is a disproportionate burden of P. vivax in infants and children, who remain highly vulnerable to severe disease, recurrence, and anemia with associated developmental impacts. Diagnosis is sometimes difficult owing to the sensitivity of diagnostic tests to detect low levels of parasitemia. Additionally, the propensity of P. vivax to relapse following reactivation of dormant hypnozoites in the liver contributes to disease recurrence in infants and children, and potentiates morbidity and transmission. The 8-aminoquinolines, primaquine and tafenoquine, provide radical cure (relapse prevention). However, the risk of hemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency necessitates testing prior to administration of 8-aminoquinolines, which has limited their uptake. Additional challenges include lack of availability of pediatric dose formulations and problems with adherence to primaquine owing to the length of treatment recommended. A paucity of data and studies specific to pediatric P. vivax malaria impacts the ability to deliver targeted interventions. It is imperative that P. vivax in infants and children be the focus of future research, control initiatives, and anti-malarial drug development.
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Affiliation(s)
| | - Lionel Tan
- GSK, 980 Great West Road, Brentford, TW8 9GS Middlesex UK
| | - Ana Martin
- GSK, 980 Great West Road, Brentford, TW8 9GS Middlesex UK
| | | | | | - Hema Sharma
- GSK, 980 Great West Road, Brentford, TW8 9GS Middlesex UK
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10
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Kheang ST, Ridley R, Ngeth E, Ir P, Ngor P, Sovannaroth S, Lek D, Phon S, Kak N, Yeung S. G6PD testing and radical cure for Plasmodium vivax in Cambodia: A mixed methods implementation study. PLoS One 2022; 17:e0275822. [PMID: 36264996 PMCID: PMC9584508 DOI: 10.1371/journal.pone.0275822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/25/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Cambodia aims to eliminate malaria by 2025, however tackling Plasmodium vivax (P.v) presents multiple challenges. The prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency has prevented the deployment of 8-aminoquinolones for “radical cure”, due to the risk of severe haemolysis. Patients with P. vivax have therefore continued to experience recurrent relapses leading to cumulative health and socioeconomic burden. The recent advent of point of care testing for G6PD deficiency has made radical cure a possibility, however at the time of the study lack of operational experience and guidance meant that they had not been introduced. This study therefore aimed to design, implement and evaluate a new care pathway for the radical cure of P.vivax. Methods This implementation study took place in Pursat province, Western Cambodia. The interventions were co-developed with key stakeholders at the national, district, and local level, through a continuous process of consultations as well as formal meetings. Mixed methods were used to evaluate the feasibility of the intervention including its uptake (G6PD testing rate and the initiation of primaquine treatment according to G6PD status); adherence (self-reported); and acceptability, using quantitative analysis of primary and secondary data as well as focus group discussions and key informant interviews. Results The co-development process resulted in the design of a new care pathway with supporting interventions, and a phased approach to their implementation. Patients diagnosed with P.v infection by Village Malaria Workers (VMWs) were referred to local health centres for point-of-care G6PD testing and initiation of radical cure treatment with 14-day or 8-week primaquine regimens depending on G6PD status. VMWs carried out follow-up in the community on days 3, 7 and 14. Supporting interventions included training, community sensitisation, and the development of a smartphone and tablet application to aid referral, follow-up and surveillance. The testing rate was low initially but increased rapidly over time, reflecting the deliberately cautious phased approach to implementation. In total 626 adults received G6PD testing, for a total of 675 episodes. Of these 555 occurred in patients with normal G6PD activity and nearly all (549/555, 98.8%) were initiated on PQ14. Of the 120 with deficient/intermediate G6PD activity 61 (50.8%) were initiated on PQ8W. Self-reported adherence was high (100% and 95.1% respectively). No severe adverse events were reported. The pathway was found to be highly acceptable by both staff and patients. The supporting interventions and gradual introduction were critical to success. Challenges included travel to remote areas and mobility of P.v patients. Conclusion The new care pathway with supporting interventions was highly feasible with high levels of uptake, adherence and acceptability in this setting where high prevalence of G6PD deficiency is high and there is a well-established network of VMWs. Scaling up of the P.v radical cure programme is currently underway in Cambodia and a decline in reduction in the burden of malaria is being seen, bringing Cambodia a step closer to elimination.
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Affiliation(s)
- Soy Ty Kheang
- The Center for Health and Social Development (HSD), Phnom Penh, Cambodia
- National Institute of Public Health (NIPH), Phnom Penh, Cambodia
| | - Rosemarie Ridley
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Eng Ngeth
- The Center for Health and Social Development (HSD), Phnom Penh, Cambodia
| | - Por Ir
- The Center for Health and Social Development (HSD), Phnom Penh, Cambodia
- National Institute of Public Health (NIPH), Phnom Penh, Cambodia
| | - Pengby Ngor
- National Malaria Control Program, The National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh, Cambodia
| | - Siv Sovannaroth
- National Malaria Control Program, The National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh, Cambodia
| | - Dysoley Lek
- National Malaria Control Program, The National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh, Cambodia
| | - Somaly Phon
- The Center for Health and Social Development (HSD), Phnom Penh, Cambodia
| | - Neeraj Kak
- The Center for Health and Social Development (HSD), Phnom Penh, Cambodia
| | - Shunmay Yeung
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
- * E-mail:
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11
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Aung YN, Tun STT, Vanisaveth V, Chindavongsa K, Kanya L. Cost-effectiveness analysis of G6PD diagnostic test for Plasmodium vivax radical cure in Lao PDR: An economic modelling study. PLoS One 2022; 17:e0267193. [PMID: 35468145 PMCID: PMC9037946 DOI: 10.1371/journal.pone.0267193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 04/04/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Plasmodium vivax (Pv) infections were 68% of the total malaria burden in Laos in 2019. The parasite causes frequent relapses, which can be prevented by primaquine (PMQ). Testing for glucose-6-phosphate-dehydrogenase (G6PD) deficiency is recommended before giving PMQ to avoid haemolysis. Because of the risk of haemolysis in G6PD intermediate deficiencies among females, Laos uses the PMQ 14-days regimen only in G6PD normal females. Among G6PD point-of-care tests, qualitative tests cannot differentiate between G6PD normal and intermediate females. Quantitative tests are required to differentiate between G6PD normal and intermediate deficiencies. However, the quantitative test lacks the cost-effectiveness evidence necessary for decision-making for large-scale adoption. This study examined the cost-effectiveness of quantitative G6PD test, with either supervised PMQ treatment or unsupervised PMQ treatment, against the usual unsupervised PMQ 8-weeks strategy. Supervised PMQ 8-weeks strategy without G6PD testing was also compared against the unsupervised PMQ 8-weeks strategy since the former had recently been adopted in malaria high burden villages that had village malaria volunteers. A budget impact analysis was conducted to understand the incremental cost and effect needed for a nationwide scale-up of the chosen strategy.
Methods
A decision tree model compared the cost-effectiveness of implementing four strategies at one health facility with an average of 14 Pv cases in one year. The strategies were unsupervised PMQ strategy, supervised PMQ strategy, G6PD test with unsupervised PMQ strategy, and G6PD test with supervised PMQ strategy. Disability Adjusted Life Years (DALYs) was the effect measure. Costs were calculated from a payer perspective, and sensitivity analyses were conducted. One Gross Domestic Product (GDP) per capita of Laos was set as the cost-effectiveness threshold. Budget impact analysis was conducted using the health facility wise Pv data in Laos in 2020.
Findings
Supervised PMQ strategy was extendedly dominated by G6PD test strategies. When compared against the unsupervised PMQ strategy, both G6PD test strategies were more costly but more effective. Their Incremental Cost-Effectiveness Ratios (ICER) were 96.72US$ for the G6PD test with unsupervised PMQ strategy and 184.86US$ for the G6PD test with supervised PMQ strategy. Both ICERs were lower than one GDP per capita in Laos. Following the sensitivity analysis, low adherence for PMQ 14 days made both G6PD test strategies less cost-effective. The lower the Pv case number reported in a health facility, the higher the ICER was. In the budget impact analysis, the expected budget need was only half a million US$ when the G6PD test rollout was discriminately done depending on the Pv case number reported at the health facilities. Indiscriminate roll out of G6PD test to all health facilities was most expensive with least effect impact.
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Affiliation(s)
- Yu Nandar Aung
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- * E-mail:
| | - Sai Thein Than Tun
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Viengxay Vanisaveth
- Center for Malaria, Parasitology and Entomology, Ministry of Health, Vientiane, Lao PDR
| | | | - Lucy Kanya
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
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12
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Hypnozoite dynamics for Plasmodium vivax malaria: the epidemiological effects of radical cure. J Theor Biol 2022; 537:111014. [PMID: 35016895 DOI: 10.1016/j.jtbi.2022.111014] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 11/30/2021] [Accepted: 01/03/2022] [Indexed: 01/27/2023]
Abstract
Malaria is a mosquito-borne disease with a devastating global impact. Plasmodium vivax is a major cause of human malaria beyond sub-Saharan Africa. Relapsing infections, driven by a reservoir of liver-stage parasites known as hypnozoites, present unique challenges for the control of P. vivax malaria. Following indeterminate dormancy periods, hypnozoites may activate to trigger relapses. Clearance of the hypnozoite reservoir through drug treatment (radical cure) has been proposed as a potential tool for the elimination of P. vivax malaria. Here, we introduce a stochastic, within-host model to jointly characterise hypnozoite and infection dynamics for an individual in a general transmission setting, allowing for radical cure. We begin by extending an existing activation-clearance model for a single hypnozoite, adapted to both short- and long-latency strains, to include drug treatment. We then embed this activation-clearance model in an epidemiological framework accounting for repeated mosquito inoculation and the administration of radical cure. By constructing an open network of infinite server queues, we derive analytic expressions for several quantities of epidemiological significance, including the size of the hypnozoite reservoir; the relapse rate; the relative contribution of relapses to the infection burden; the distribution of multiple infections; the cumulative number of recurrences over time, and the time to first recurrence following drug treatment. We derive from first principles the functional dependence between within-host and transmission parameters and patterns of blood- and liver-stage infection, whilst allowing for treatment under a mass drug administration regime. To yield population-level insights, our analytic within-host distributions can be embedded in multiscale models. Our work thus contributes to the epidemiological understanding of the effects of radical cure on P. vivax malaria.
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13
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Woon SA, Manning L, Moore BR. Antimalarials for children with Plasmodium vivax infection: Current status, challenges, and research priorities. Parasitol Int 2021; 87:102512. [PMID: 34785369 DOI: 10.1016/j.parint.2021.102512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/01/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
The aim of this narrative review is to summarise efficacy and pharmacokinetic data for Plasmodium vivax in children. The burden of P. vivax malaria in children continues to remain a significant public health issue, and the need for improved treatment regimens for this vulnerable population is critical. Relapse after re-activation of dormant liver-stage hypnozoites poses additional challenges for treatment, elimination, and control strategies for P. vivax. Whilst it is recognised that paediatric pharmacology may be significantly influenced by anatomical and physiological changes of childhood, dosing regimens often continue to be extrapolated from adult data, highlighting the need for antimalarial dosing in children to be evaluated in early phase clinical trials. This will ensure that globally recommended treatment regimens do not result in suboptimal dosing in children. Furthermore, the development of affordable paediatric formulations to enhance treatment acceptability and widespread G6PD testing to facilitate use of anti-hypnozoite treatment such as primaquine and tafenoquine, should be further prioritised. As the world prepares for malaria elimination, a renewed focus on P. vivax malaria provides an ideal opportunity to harness momentum and ensure that all populations, including children have access to safe, efficacious, and correctly dosed antimalarial therapies.
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Affiliation(s)
- Sze-Ann Woon
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Laurens Manning
- Medical School, University of Western Australia, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Brioni R Moore
- Medical School, University of Western Australia, Perth, Western Australia, Australia; Curtin Medical School, Curtin University, Perth, Western Australia, Australia; Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia.
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14
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Abstract
India observed a significant reduction in malaria cases in the previous year, reaffirming our trust and efficiency of the existing tools to achieve malaria elimination. On 25 April, 2019, countries around the world marked World Malaria Day under the theme “Zero malaria starts with me”. This provides an opportunity to rejoice the success and re-evaluate ongoing challenges in the fight against this preventable and treatable parasitic disease. We highlight the potential gaps in the malaria elimination program, and underscore potential solutions and strategies to implement, improve and intensify the success of the national goal of malaria elimination by 2030.
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15
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Ruwanpura VSH, Nowak S, Gerth‐Guyette E, Theodora M, Dysoley L, Haile M, Peeters Grietens K, Price RN, Lynch CA, Thriemer K. Further evidence needed to change policy for the safe and effective radical cure of vivax malaria: Insights from the 2019 annual APMEN Vivax Working Group meeting. ASIA & THE PACIFIC POLICY STUDIES 2021; 8:208-242. [PMID: 34820128 PMCID: PMC8596681 DOI: 10.1002/app5.314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 06/19/2020] [Accepted: 06/30/2020] [Indexed: 06/01/2023]
Abstract
New diagnostics and treatment options for the radical cure of Plasmodium vivax malaria are now available. At the 2019 annual meeting of the Vivax Working Group of the Asia Pacific Malaria Elimination Network, participants took part in a roundtable discussion to identify further evidence required to introduce these new tools into policy and practice. Key gaps identified were accuracy and reliability of glucose-6-phosphate-dehydrogenase deficiency tests, health system capacity, and feasibility and cost effectiveness of novel treatment strategies in routine clinical practice. As expected, there were differences in the priorities between country partners and researcher partners. To achieve the 2030 target for the regional elimination of malaria, evidence to address these issues should be generated as a matter of priority. Review of global guidelines alongside locally generated data will help to ensure the timely revision and optimisation of national treatment guidelines that will be vital to meet regional elimination goals.
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Affiliation(s)
| | | | | | | | - Lek Dysoley
- National Centre for Parasitology, Entomology and Malaria ControlCambodia
- School of Public HealthNational Institute of Public HealthCambodia
| | - Mebratom Haile
- National Malaria Control and Elimination Program, Disease Prevention and Control DirectorateFederal Ministry of HealthEthiopia
| | - Koen Peeters Grietens
- Institute of Tropical MedicineAntwerpBelgium
- School of Tropical Medicine and Global HealthNagasaki UniversityNagasakiJapan
| | - Ric Norman Price
- Global and Tropical Health DivisionMenzies School of Health Research and Charles Darwin UniversityDarwinAustralia
- Mahidol‐Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical MedicineUniversity of OxfordOxfordUK
| | - Caroline Anita Lynch
- Medicines for Malaria VentureGenevaSwitzerland
- Faculty of Epidemiology and Population HealthLondon School of Tropical Medicine and HygieneLondonUK
| | - Kamala Thriemer
- Global and Tropical Health DivisionMenzies School of Health Research and Charles Darwin UniversityDarwinAustralia
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16
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Abstract
In this review for the Vivax malaria collection, Kamala Thriemer and colleagues explore efforts to eliminate P. vivax malaria.
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Affiliation(s)
- Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Lorenz von Seidlein
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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17
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Popovici J, Tebben K, Witkowski B, Serre D. Primaquine for Plasmodium vivax radical cure: What we do not know and why it matters. Int J Parasitol Drugs Drug Resist 2021; 15:36-42. [PMID: 33529838 PMCID: PMC7851417 DOI: 10.1016/j.ijpddr.2020.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022]
Abstract
Plasmodium vivax radical cure requires the administration of a blood schizonticide for killing blood-stage parasites and the addition of a drug able to kill hypnozoites, the dormant parasite stages residing in the liver of infected patients. All drugs used clinically for killing hypnozoites are 8-aminoquinolines and among them, primaquine has been at the forefront of P. vivax case management for decades. We discuss here the possible factors that could lead to the emergence and selection of P. vivax primaquine resistant parasites and emphasize on how a better understanding of the mechanisms underlying primaquine treatment and hypnozoite biology is needed to prevent this catastrophic scenario from happening.
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Affiliation(s)
- Jean Popovici
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia; Malaria Translational Research Unit, Institut Pasteur, Paris & Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
| | - Kieran Tebben
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, USA
| | - Benoit Witkowski
- Malaria Molecular Epidemiology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia; Malaria Translational Research Unit, Institut Pasteur, Paris & Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - David Serre
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, USA
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18
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Abstract
Supplemental Digital Content is available in the text. Plasmodium vivax has the largest geographic range of human malaria species and is challenging to manage and eradicate due to its ability to establish a dormant liver stage, the hypnozoite, which can reactivate leading to relapse. Until recently, the only treatment approved to kill hypnozoites was the 8-aminoquinoline, primaquine, requiring daily treatment for 14 days. Tafenoquine, an 8-aminoquinoline single-dose treatment with activity against P. vivax hypnozoites, has recently been approved by the US Food and Drug Administration and Australian Therapeutic Goods Administration for the radical cure of P. vivax malaria in patients 16 years and older. We conducted an exploratory pharmacogenetic analysis (GSK Study 208099) to assess the role of host genome-wide variation on tafenoquine efficacy in patients with P. vivax malaria using data from three GSK clinical trials, GATHER and DETECTIVE Part 1 and Part 2. Recurrence-free efficacy at 6 and 4 months and time to recurrence up to 6 months postdosing were analyzed in 438 P. vivax malaria patients treated with tafenoquine. Among the approximately 10.6 million host genetic variants analyzed, two signals reached genome-wide significance (P value ≤ 5 × 10−8). rs62103056, and variants in a chromosome 12 intergenic region, were associated with recurrence-free efficacy at 6 and 4 months, respectively. Neither of the signals has an obvious biological rationale and would need replication in an independent population. This is the first genome-wide association study to evaluate genetic influence on response to tafenoquine in P. vivax malaria.
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Labadie-Bracho MY, Adhin MR. Reconstruction of Plasmodium vivax outbreaks in a low malaria endemic setting utilizing conventional restriction fragment length polymorphism. INTERNATIONAL JOURNAL OF MOLECULAR EPIDEMIOLOGY AND GENETICS 2021; 12:9-15. [PMID: 33859783 PMCID: PMC8044709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/31/2020] [Indexed: 06/12/2023]
Abstract
Suriname is on track to eliminate local malaria transmission. P. vivax malaria reemerged in March and September 2019 in the Amerindian village Palumeu, free of malaria for two years and concurrently, a case was reported in another village Alalaparoe. The outbreaks were contained through targeted interventions including Mass Drug Administration (MDA). Molecular outbreak analysis was performed on 23 dried blood spots (DBS) using combined polymerase chain reaction/restriction fragment length polymorphism (PCR-RFLP) with Pvmsp-1 F2 and Pvmsp-3α as polymorphic marker genes. Independent controls substantiated the discriminating capacities of the utilized PCR-RFLP method. All isolates from the first and second Palumeu outbreak shared a distinctive haplotype presuming single clonal lineage. An imported case probably triggered the first outbreak, while a delayed episode, prompted by withdrawal of drug pressure at the end of the prophylactic MDA, was suggested as source of the second outbreak. A diverging variant was demonstrated in Alalaparoe, implicating an infection from a different source. PCR-RFLP proved to be a useful molecular tool for P. vivax outbreak management in low endemic malaria settings.
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Affiliation(s)
| | - Malti R Adhin
- Anton de Kom Universiteit van Suriname, Faculty of Medical Sciences, Department of BiochemistryKernkampweg 5, Paramaribo, Suriname
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20
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Milligan R, Daher A, Villanueva G, Bergman H, Graves PM. Primaquine alternative dosing schedules for preventing malaria relapse in people with Plasmodium vivax. Cochrane Database Syst Rev 2020; 8:CD012656. [PMID: 32816320 DOI: 10.1002/14651858.cd012656.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Plasmodium vivax liver stages (hypnozoites) may cause relapses, prolonging morbidity, and impeding malaria control and elimination. The World Health Organization (WHO) recommends three schedules for primaquine: 0.25 mg/kg/day (standard), or 0.5 mg/kg/day (high standard) for 14 days, or 0.75 mg/kg once weekly for eight weeks, all of which can be difficult to complete. Since primaquine can cause haemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, clinicians may be reluctant to prescribe primaquine without G6PD testing, and recommendations when G6PD status is unknown must be based on an assessment of the risks and benefits of prescribing primaquine. Alternative safe and efficacious regimens are needed. OBJECTIVES To assess the efficacy and safety of alternative primaquine regimens for radical cure of P vivax malaria compared to the standard or high-standard 14-day courses. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (PubMed); Embase (Ovid); LILACS (BIREME); WHO International Clinical Trials Registry Platform and ClinicalTrials.gov up to 2 September 2019, and checked the reference lists of all identified studies. SELECTION CRITERIA Randomized controlled trials (RCTs) of adults and children with P vivax malaria using either chloroquine or artemisinin-based combination therapy plus primaquine at a total adult dose of at least 210 mg, compared with the WHO-recommended regimens of 0.25 or 0.5 mg/kg/day for 14 days. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and quality, and extracted data. We calculated risk ratios (RRs) with 95% confidence intervals (CIs) for dichotomous data. We grouped efficacy data according to length of follow-up, partner drug, and trial location. We analysed safety data where included. MAIN RESULTS 0.5 mg/kg/day for seven days versus standard 0.25 mg/kg/day for 14 days There may be little or no difference in P vivax recurrences at six to seven months when using the same total dose (210 mg adult dose) over seven days compared to 14 days (RR 0.96, 95% CI 0.66 to 1.39; 4 RCTs, 1211 participants; low-certainty evidence). No serious adverse events were reported. We do not know if there is any difference in the number of adverse events resulting in discontinuation of primaquine (RR 1.04, 95% CI 0.15 to 7.38; 5 RCTs, 1427 participants) or in the frequency of anaemia (RR 3.00, 95% CI 0.12 to 72.91, 1 RCT, 240 participants) between the shorter and longer regimens (very low-certainty evidence). Three trials excluded people with G6PD deficiency; two did not provide this information. Pregnant and lactating women were either excluded or no details were provided. High-standard 0.5 mg/kg/day for 14 days versus standard 0.25 mg/kg/day for 14 days There may be little or no difference in P vivax recurrences at six months with 0.5 mg/kg/day primaquine for 14 days compared to 0.25 mg/kg/day for 14 days (RR 0.84 (95% CI 0.49 to 1.43; 2 RCTs, 677 participants, low-certainty evidence). No serious adverse events were reported. We do not know whether there is a difference in adverse events resulting in discontinuation of treatment with the high-standard dosage (RR 4.19, 95% CI 0.90 to 19.60; 1 RCT, 778 participants, very low-certainty evidence). People with G6PD deficiency and pregnant or lactating women were excluded. 0.75 mg/kg/week for eight weeks versus high-standard 0.5 mg/kg/day for 14 days We do not know whether weekly primaquine increases or decreases recurrences of P vivax compared to high-standard 0.5 mg/kg/day for 14 days, at 11 months' follow-up (RR 3.18, 95% CI 0.37 to 27.60; 1 RCT, 122 participants; very low-certainty evidence). No serious adverse events and no episodes of anaemia were reported. G6PD-deficient patients were not randomized but included in the weekly primaquine group (only one patient detected). 1 mg/kg/day for seven days versus high standard 0.5 mg/kg/day for 14 days There is probably little or no difference in P vivax recurrences at 12 months between 1.0 mg/kg/day primaquine for seven days and the high-standard 0.5 mg/kg/day for 14 days (RR 1.03, 95% CI 0.82 to 1.30; 2 RCTs, 2526 participants; moderate-certainty evidence). There may be moderate to large increase in serious adverse events in the 1.0 mg/kg/day primaquine for seven days compared with the high-standard 0.5 mg/kg/day for 14 days, during 42 days follow-up (RR 12.03, 95% CI 1.57 to 92.30; 1 RCT, 1872 participants, low-certainty evidence). We do not know if there is a difference between 1.0 mg/kg/day primaquine for seven days and high-standard 0.5 mg/kg/day for 14 days in adverse events that resulted in discontinuation of treatment (RR 2.50, 95% CI 0.49 to 12.87; 1 RCT, 2526 participants, very low-certainty evidence), nor if there is difference in frequency of anaemia by 42 days (RR 0.93, 95% CI 0.62 to 1.41; 2 RCTs, 2440 participants, very low-certainty evidence). People with G6PD deficiency were excluded. Other regimens Two RCTs evaluated other rarely-used doses of primaquine, one of which had very high loss to follow-up. Adverse events were not reported. People with G6PD deficiency and pregnant or lactating women were excluded. AUTHORS' CONCLUSIONS Trials available to date do not detect a difference in recurrence between the following regimens: 1) 0.5 mg/kg/day for seven days versus standard 0.25 mg/kg/day for 14 days; 2) high-standard 0.5 mg/kg/day for 14 days versus standard 0.25 mg/kg/day for 14 days; 3) 0.75 mg/kg/week for eight weeks versus high-standard 0.5 mg/kg/day for 14 days; 4) 1 mg/kg/day for seven days versus high-standard 0.5 mg/kg/day for 14 days. There were no differences detected in adverse events for Comparisons 1, 2 or 3, but there may be more serious adverse events with the high seven-day course in Comparison 4. The shorter regimen of 0.5 mg/kg/day for seven days versus standard 0.25 mg/kg/day for 14 days may suit G6PD-normal patients. Further research will help increase the certainty of the findings and applicability in different settings.
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Affiliation(s)
- Rachael Milligan
- Cochrane Infectious Diseases Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - André Daher
- Vice-Presidency of Research and Biological Collections, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | - Patricia M Graves
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia
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Martin Ramírez A, Lombardia González C, Soler Maniega T, Gutierrez Liarte Á, Domingo García D, Lanza Suárez M, Bernal Fernández MJ, Rubio JM. Several Plasmodium vivax relapses after correct primaquine treatment in a patient with impaired cytochrome P450 2D6 function. Malar J 2020; 19:259. [PMID: 32680522 PMCID: PMC7368755 DOI: 10.1186/s12936-020-03326-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/07/2020] [Indexed: 12/16/2022] Open
Abstract
Background Plasmodium vivax malaria is characterized by the presence of dormant liver-stage parasites, called hypnozoites, which can cause malaria relapses after an initial attack. Primaquine, which targets liver hypnozoites, must be used in combination with a schizonticidal agent to get the radical cure. However, relapses can sometimes occur in spite of correct treatment, due to different factors such as a diminished metabolization of primaquine. Case presentation In January 2019, a 21 years old woman with residence in Madrid, returning from a trip to Venezuela with clinical symptoms compatible with malaria infection, was diagnosed with vivax malaria. Chloroquine for 3 days plus primaquine for 14 days was the elected treatment. Two months later and after a second trip to Venezuela, the patient presented a second P. vivax infection, which was treated as the previous one. A third P. vivax malaria episode was diagnosed 2 months later, after returning from a trip to Morocco, receiving chloroquine for 3 days but increasing to 28 days the primaquine regimen, and with no more relapses after 6 months of follow up. The genotyping of P. vivax in the three malaria episodes revealed that the same strain was present in the different relapses. Upon confirmation of correct adherence to the treatment, non-description of resistance in the infection area and the highly unlikely re-infection on subsequent trips or stays in Spain, a possible metabolic failure was considered. CYP2D6 encodes the human cytochrome P450 isoenzyme 2D6 (CYP2D6), responsible for primaquine activation. The patient was found to have a CYP2D6*4/*1 genotype, which turns out in an intermediate metabolizer phenotype, which has been related to P. vivax relapses. Conclusions The impairment in CYP2D6 enzyme could be the most likely cause of P. vivax relapses in this patient. This highlights the importance of considering the analysis of CYP2D6 gene polymorphisms in cases of P. vivax relapses after a correct treatment and, especially, it should be considered in any study of dosage and duration of primaquine treatment.
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Affiliation(s)
- Alexandra Martin Ramírez
- Malaria and Parasitic Diseases Laboratory, National Microbiology Center, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Tamara Soler Maniega
- Microbiology and Parasitology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Diego Domingo García
- Microbiology and Parasitology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Marta Lanza Suárez
- Malaria and Parasitic Diseases Laboratory, National Microbiology Center, Instituto de Salud Carlos III, Madrid, Spain
| | - María Josefa Bernal Fernández
- Malaria and Parasitic Diseases Laboratory, National Microbiology Center, Instituto de Salud Carlos III, Madrid, Spain
| | - José Miguel Rubio
- Malaria and Parasitic Diseases Laboratory, National Microbiology Center, Instituto de Salud Carlos III, Madrid, Spain.
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22
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Single dose tafenoquine for preventing relapse in people with plasmodium vivax malaria-an updated meta-analysis. Travel Med Infect Dis 2020; 36:101576. [PMID: 32036012 DOI: 10.1016/j.tmaid.2020.101576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 01/31/2020] [Accepted: 02/05/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Plasmodium vivax is a frequent cause of recurring malaria in endemic areas as in its latent stage it resides in liver, and is responsible for relapse. Treatment with 8 aminoquinoline Primaquine is given for 14 days, however studies have shown dismal results with adherence to therapy. A new long acting 8 aminoquinoline, Tafenoquine was introduced that showed efficacy and safety almost similar to Primaquine in a single dose regimen, hence giving hopes for improved compliance and help in eradicating malaria. METHODS We searched for randomized controlled trials (RCTs) that compared the efficacy of Tafenoquine with Primaquine or placebo. Our primary outcome was the recurrence of Plasmodium vivax parasitemia at 6 months and our safety outcomes included total number of adverse events as well as serious adverse events. We performed pooled data analysis by the random effects model and I2 was used to assess heterogeneity. RESULTS 4 RCTs were included. Our pooled analysis showed that the number of episodes of recurrence at 6 months between Tafenoquine and Primaquine (RR = 1.08, 95% CI = 0.74-1.59), and between Tafenoquine and placebo (RR = 0.17, 95%CI = 0.03-1.11) was statistically insignificant. Comparison of serious adverse events did not show any significant risk associated with the use of Tafenoquine as compared to Primaquine when analyzed till day 29, which was the time period considered to show most probable drug associated events. CONCLUSION Tafenoquine as a single dose is an effective alternative to Primaquine for prevention of recurrence of P vivax malaria, with a reasonable safety profile.
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23
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Brummaier T, Gilder ME, Gornsawun G, Chu CS, Bancone G, Pimanpanarak M, Chotivanich K, Nosten F, McGready R. Vivax malaria in pregnancy and lactation: a long way to health equity. Malar J 2020; 19:40. [PMID: 31969155 PMCID: PMC6977346 DOI: 10.1186/s12936-020-3123-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 01/13/2020] [Indexed: 12/30/2022] Open
Abstract
Background The Sustainable Development Goals (SDG) call for increased gender equity and reduction in malaria-related mortality and morbidity. Plasmodium vivax infections in pregnancy are associated with maternal anaemia and increased adverse perinatal outcomes. Providing radical cure for women with 8-aminoquinolines (e.g., primaquine) is hindered by gender-specific complexities. Case presentation A symptomatic episode of vivax malaria at 18 weeks of gestation in a primigravid woman was associated with maternal anaemia, a recurrent asymptomatic P. vivax episode, severe intra-uterine growth restriction with no other identifiable cause and induction to reduce the risk of stillbirth. At 5 months postpartum a qualitative glucose-6-phosphate dehydrogenase (G6PD) point-of-care test was normal and radical cure with primaquine was prescribed to the mother. A 33% fractional decrease in haematocrit on day 7 of primaquine led to further testing which showed intermediate phenotypic G6PD activity; the G6PD genotype could not be identified. Her infant daughter was well throughout maternal treatment and found to be heterozygous for Mahidol variant. Conclusion Adverse effects of vivax malaria in pregnancy, ineligibility of radical cure for pregnant and postpartum women, and difficulties in diagnosing intermediate levels of G6PD activity multiplied morbidity in this woman. Steps towards meeting the SDG include prevention of malaria in pregnancy, reducing unnecessary exclusion of women from radical cure, and accessible quantitative G6PD screening in P. vivax-endemic settings.
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Affiliation(s)
- Tobias Brummaier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, P.O. Box 46, 68/31 Bann Tung Road, Mae Sot, 63110, Thailand. .,Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, UK.
| | - Mary Ellen Gilder
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, P.O. Box 46, 68/31 Bann Tung Road, Mae Sot, 63110, Thailand
| | - Gornpan Gornsawun
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, P.O. Box 46, 68/31 Bann Tung Road, Mae Sot, 63110, Thailand
| | - Cindy S Chu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, P.O. Box 46, 68/31 Bann Tung Road, Mae Sot, 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, UK
| | - Germana Bancone
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, P.O. Box 46, 68/31 Bann Tung Road, Mae Sot, 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, UK
| | - Mupawjay Pimanpanarak
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, P.O. Box 46, 68/31 Bann Tung Road, Mae Sot, 63110, Thailand
| | - Kesinee Chotivanich
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - François Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, P.O. Box 46, 68/31 Bann Tung Road, Mae Sot, 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, UK
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, P.O. Box 46, 68/31 Bann Tung Road, Mae Sot, 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, UK
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24
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Phommasone K, van Leth F, Imwong M, Henriques G, Pongvongsa T, Adhikari B, Peto TJ, Promnarate C, Dhorda M, Sirithiranont P, Mukaka M, Peerawaranun P, Day NPJ, Cobelens F, Dondorp AM, Newton PN, White NJ, von Seidlein L, Mayxay M. The use of ultrasensitive quantitative-PCR to assess the impact of primaquine on asymptomatic relapse of Plasmodium vivax infections: a randomized, controlled trial in Lao PDR. Malar J 2020; 19:4. [PMID: 31900172 PMCID: PMC6942400 DOI: 10.1186/s12936-019-3091-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/25/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Trials to assess the efficacy of the radical cure of Plasmodium vivax malaria with 8-aminoquinolines require that most post-treatment relapses are identified, but there is no consensus on the optimal duration of follow-up in either symptomatic or asymptomatic vivax malaria. The efficacy of a 14-day course of primaquine on the cumulative incidence of recurrent asymptomatic P. vivax infections detected by ultrasensitive quantitative PCR (uPCR) as a primary endpoint was assessed. METHODS A randomized, placebo-controlled, single-blind trial was conducted in four villages of the Lao PDR during 2016-2018 nested in a larger project evaluating mass drug administrations (MDA) with dihydroartemisinin-piperaquine (DP) and a single low-dose primaquine to clear Plasmodium falciparum infections. In the nested sub-study, eligible participants with mono- or mixed P. vivax infections detected by uPCR were randomized to receive either 14 days of primaquine (0.5 mg/kg/day) or placebo during the last round of MDA (round 3) through directly observed therapy. Participants were checked monthly for 12 months for parasitaemia using uPCR. The primary outcome was cumulative incidence of participants with at least one recurrent episode of P. vivax infection. RESULTS 20 G6PD-normal participants were randomized in each arm. 5 (29%) of 20 participants in the placebo arm experienced asymptomatic, recurrent P. vivax infections, resulting in a cumulative incidence at month 12 of 29%. None of the 20 participants in the intervention arm had recurrent infections (p = 0.047 Fisher's exact test). Participants with recurrent P. vivax infections were found to be parasitaemic for between one and five sequential monthly tests. The median time to recurrence of P. vivax parasitaemia was 178 days (range 62-243 days). CONCLUSIONS A 14-day course of primaquine in addition to a DP-MDA was safe, well-tolerated, and prevented recurrent asymptomatic P. vivax infections. Long follow-up for up to 12 months is required to capture all recurrences following the treatment of asymptomatic vivax infection. To eliminate all malarias in settings where P. vivax is endemic, a full-course of an 8-aminoquinolines should be added to MDA to eliminate all malarias. Trial registration This study was registered with ClinicalTrials.gov under NCT02802813 on 16th June 2016. https://clinicaltrials.gov/ct2/show/NCT02802813.
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Affiliation(s)
- Koukeo Phommasone
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Department of Global Health, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health & Development, Amsterdam, The Netherlands
| | - Frank van Leth
- Department of Global Health, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health & Development, Amsterdam, The Netherlands
| | - Mallika Imwong
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Gisela Henriques
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
| | - Tiengkham Pongvongsa
- Savannakhet Provincial Health Department, Savannakhet, Savannakhet Province, Lao PDR
| | - Bipin Adhikari
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Thomas J Peto
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Mehul Dhorda
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- WWARN Asia Regional Centre, Mahidol University, Bangkok, Thailand
| | | | - Mavuto Mukaka
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Nicholas P J Day
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Frank Cobelens
- Department of Global Health, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health & Development, Amsterdam, The Netherlands
| | - Arjen M Dondorp
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Paul N Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nicholas J White
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lorenz von Seidlein
- Mahidol Oxford Research Unit, Mahidol University, Bangkok, Thailand.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao PDR
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25
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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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26
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Milligan R, Daher A, Graves PM. Primaquine at alternative dosing schedules for preventing relapse in people with Plasmodium vivax malaria. Cochrane Database Syst Rev 2019; 7:CD012656. [PMID: 31274189 PMCID: PMC6611223 DOI: 10.1002/14651858.cd012656.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Malaria caused by Plasmodium vivax requires treatment of the blood-stage infection and treatment of the hypnozoites that develop in the liver. This is a challenge to effective case management of P vivax malaria, as well as being a more general substantial impediment to malaria control. The World Health Organization (WHO) recommends a 14-day drug course with primaquine, an 8-aminoquinoline, at 0.25 mg/kg/day in most of the world (standard course), or 0.5 mg/kg/day in East Asia and Oceania (high-standard course). This long treatment course can be difficult to complete, and primaquine can cause dangerous haemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, meaning that physicians may be reluctant to prescribe in areas where G6PD testing is not available. This Cochrane Review evaluated whether more patient-friendly alternative regimens are as efficacious as the standard regimen for radical cure ofP vivax malaria. OBJECTIVES To assess the efficacy and safety of alternative primaquine regimens for radical cure of P vivax malaria compared to the standard or high-standard 14 days of primaquine (0.25 or 0.5 mg/kg/day), as well as comparison of these two WHO-recommended regimens. SEARCH METHODS We searched the Cochrane Infectious Diseases Group (CIDG) Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (PubMed); Embase (Ovid); and LILACS (BIREME) up to 17 December 2018. We also searched the WHO International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov, and checked the reference lists of all studies identified by the above methods. SELECTION CRITERIA Randomized controlled trials (RCTs) of adults and children with P vivax malaria using any regimen of either chloroquine or an artemisinin-based combination therapy (ACT) plus primaquine with either higher daily doses for 14 days, shorter regimens with the same total dose, or using weekly dosing regimens; compared with the usual standard regimens recommended by the WHO (0.25 or 0.5 mg/kg/day for 14 days), or a comparison of these two WHO-recommended regimens. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and quality, and extracted data. We calculated risk ratios (RRs) with 95% confidence intervals (CIs) for dichotomous data. We grouped efficacy data according to length of follow-up. We analysed safety data where this information was included. MAIN RESULTS High-standard 14-day course versus standard 14-day courseTwo RCTs compared the high-standard 14-day regimen with the standard 14-day regimen. People with G6PD deficiency and pregnant or lactating women were excluded. We do not know if there is any difference in P vivax recurrences at 6 months with 0.5 mg/kg/day primaquine therapy for 14 days compared to 0.25 mg/kg/day primaquine therapy for 14 days (with chloroquine: RR 0.82, 95% CI 0.47 to 1.43, 639 participants, very low-certainty evidence; with chloroquine or an ACT: RR 1.11, 95% CI 0.17 to 7.09, 38 participants, very low-certainty evidence). No serious adverse events were reported. We do not know whether there is a difference in adverse events with the higher dosage (very low-certainty evidence).0.5 mg/kg/day primaquine for 7 days versus standard 14-day courseFive RCTs compared 0.5 mg/kg/day primaquine for 7 days with the standard 14-day course. There may be little or no difference in P vivax recurrences at 6 to 7 months when using the same total dose (0.5 mg/kg/day to 210 mg) over 7 days as compared to 14 days (RR 0.96, 95% CI 0.66 to 1.39; 1211 participants; low-certainty evidence). No serious adverse events were reported. There may be little or no difference in the number of adverse events known to occur with primaquine between the primaquine shorter regimen as compared to the longer regimen (RR 1.06, 95% CI 0.64 to 1.76; 1154 participants; low-certainty evidence). We do not know whether there is any difference in the frequency of anaemia or discontinuation of treatment between groups (very low-certainty evidence). Three trials excluded people with G6PD deficiency, and two did not provide this information. Pregnant and lactating women were either excluded or no details were provided regarding their inclusion or exclusion.0.75 mg/kg primaquine/week for 8 weeks versus high-standard course One RCT compared weekly primaquine with the high-standard 14-day course. G6PD-deficient patients were not randomized but were included in the weekly primaquine group. Only one G6PD-deficient participant was detected during the trial. We do not know whether weekly primaquine increases or decreases recurrences of P vivax compared to the 14-day regimen at 11 months' follow-up (RR 3.18, 95% CI 0.37 to 27.6; 122 participants; very low-certainty evidence). No serious adverse events and no episodes of anaemia were reported.Three other RCTs evaluated different alternative regimens and doses of primaquine, but one of these RCTs did not have results available, and two used regimens that have not been widely used and the evidence was of very low certainty. AUTHORS' CONCLUSIONS Although limited data were available, the analysis did not detect a difference in recurrence between the 7-day regimen and the standard 14-day regimen of 0.5 mg/kg/day primaquine, and no serious adverse events were reported in G6PD-normal participants taking 0.5 mg/kg/day of primaquine. This shorter regimen may be useful in G6PD-normal patients if there are treatment adherence concerns. Further large high-quality RCTs are needed, such as the IMPROV trial, with more standardised comparison regimens and longer follow-up to help resolve uncertainties.
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Affiliation(s)
- Rachael Milligan
- Liverpool School of Tropical MedicineCochrane Infectious Diseases GroupPembroke PlaceLiverpoolUKL3 5QA
| | - André Daher
- Oswaldo Cruz Foundation (FIOCRUZ)Vice‐Presidency of Research and Biological CollectionsRio de JaneiroBrazil
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesLiverpoolUK
| | - Patricia M Graves
- James Cook UniversityCollege of Public Health, Medical and Veterinary SciencesPO Box 6811CairnsQueenslandAustralia4870
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Chen N, Dowd S, Gatton ML, Auliff A, Edstein MD, Cheng Q. Cytochrome P450 2D6 profiles and their relationship with outcomes of primaquine anti-relapse therapy in Australian Defence Force personnel deployed to Papua New Guinea and East Timor. Malar J 2019; 18:140. [PMID: 30999967 PMCID: PMC6471761 DOI: 10.1186/s12936-019-2774-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background Primaquine, an 8-aminoquinoline with anti-hypnozoite activity against Plasmodium vivax, is metabolized by human cytochrome P450 2D6 (CYP2D6) to its active metabolite. Human CYP2D6 activities may influence the metabolism of primaquine and the risk of experiencing Plasmodium relapses following primaquine anti-relapse therapies (PART). In this study, the CYP2D6 profile and its relationship with outcomes of PART in Australian Defence Force (ADF) personnel is retrospectively investigated. Methods Genomic DNA was isolated from stored and de-identified serum or blood samples from ADF personnel deployed on peacekeeping duties to Papua New Guinea (PNG) (1999) and East Timor (1999–2000) who received PART before returning to Australia and after experiencing relapses. CYP2D6 allelic type was determined by PCR and Sanger sequencing. CYP2D6 allele frequency, predicted phenotypes and activity scores were compared among personnel who did not experience P. vivax (ADF-NR, n = 48) and those who experience at least one (ADF-R, n = 109) relapse, as well as between those who experienced 1 (n = 79), 2 (n = 21) and 3–5 (n = 9) relapses within the ADF-R group. Results 16 CYP2D6 alleles were observed in 157 ADF personnel. Alleles *1, *4, *2 and *41 were major alleles (> 5%). The CYP2D6 allele frequency profile in the ADF-NR group matched that of a European population. There was an increased proportion of non-functional CYP2D6 alleles in the ADF-R group compared to the European population and ADF-NR group. However, frequencies of predicted CYP2D6 phenotype and activity score were not different between the ADF-R and ADF-NR groups, nor among sub-groups experiencing multiple relapses within the ADF-R group. Conclusions CYP2D6 phenotype or activity score based on the allele classification was not a major contributor to P. vivax relapse in this ADF cohort. Other factors such as adherence and/or parasite tolerance to primaquine are likely contributing factors to P. vivax relapses in this cohort.
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Affiliation(s)
- Nanhua Chen
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, QLD, Australia
| | - Simone Dowd
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, QLD, Australia
| | - Michelle L Gatton
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Alyson Auliff
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, QLD, Australia
| | - Michael D Edstein
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, QLD, Australia
| | - Qin Cheng
- Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, QLD, Australia.
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Lawpoolsri S, Sattabongkot J, Sirichaisinthop J, Cui L, Kiattibutr K, Rachaphaew N, Suk-Uam K, Khamsiriwatchara A, Kaewkungwal J. Epidemiological profiles of recurrent malaria episodes in an endemic area along the Thailand-Myanmar border: a prospective cohort study. Malar J 2019; 18:124. [PMID: 30961583 PMCID: PMC6454765 DOI: 10.1186/s12936-019-2763-5] [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] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 04/02/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In low malaria transmission areas, many people acquire multiple malaria infections within a single season. This study aimed to describe the pattern and epidemiological profile of malaria recurrence in a hypoendemic area of western Thailand and identify factors associated with having multiple malaria episodes. METHODS An open cohort of 7000 residents in seven clusters along the Thai-Myanmar border was followed during a 6.5-year period (2011-mid 2017). Symptomatic and asymptomatic malaria infections were detected by passive case detection (PCD), weekly household visit, and mass blood surveys every 4-6 months. Malaria recurrence was defined as subsequent parasitaemic episodes occurred later than 7 days after receiving anti-malarial treatment. This study focused on analysis of recurrent episodes that occurred within 1 year after treatment. Numbers of malaria cases with single and multiple episodes were compared between clusters. Kaplan-Meier curve was performed to determine the intervals of recurrent episodes by Plasmodium species and age groups. The ordinal logistic model was used to determine factors associated with multiple malaria episodes, and to compare with single episodes, and those with no malaria infection. RESULTS The cumulative incidence of malaria in the study area was 5.2% over the 6.5 years. Overall, 410 malaria patients were detected. Of these patients, 20% and 16% had multiple malaria episodes during the entire period and within 1 year after initial treatment, respectively. About 80% of repeated malaria episodes were caused by the same Plasmodium species as the primary infections. The median interval and interquartile range (IQR) between the first and second episode was 88 (43-175) days for all parasites, 56 (35-133) days for two Plasmodium falciparum episodes, and 90 (59-204) days for two Plasmodium vivax episodes. The interval between the episodes was increased with age. Factors significantly associated with multiple episodes of malaria infection included male sex, young age, Karen ethnicity, forest-related occupation, and having other malaria infected persons in the same house in the same period. CONCLUSIONS People who have multiple malaria episodes may play an important role in maintaining malaria transmission in the area. Understanding epidemiological profiles of this group is important for planning strategies to achieve the elimination goal.
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Affiliation(s)
- Saranath Lawpoolsri
- Center of Excellence in Biomedical and Public Health Informatics (BIOPHICS), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Jetsumon Sattabongkot
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jeeraphat Sirichaisinthop
- Bureau of Vector-Borne Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Liwang Cui
- Division of Infectious Diseases and Internal Medicine, Department of Internal Medicine, University of South Florida, Tampa, USA
| | - Kirakorn Kiattibutr
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nattawan Rachaphaew
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kritsana Suk-Uam
- Vector-Borne Disease Control Center 2.3, Ministry of Public Health, Tak, Thailand
| | - Amnat Khamsiriwatchara
- Center of Excellence in Biomedical and Public Health Informatics (BIOPHICS), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jaranit Kaewkungwal
- Center of Excellence in Biomedical and Public Health Informatics (BIOPHICS), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Chu CS, Phyo AP, Turner C, Win HH, Poe NP, Yotyingaphiram W, Thinraow S, Wilairisak P, Raksapraidee R, Carrara VI, Paw MK, Wiladphaingern J, Proux S, Bancone G, Sriprawat K, Lee SJ, Jeeyapant A, Watson J, Tarning J, Imwong M, Nosten F, White NJ. Chloroquine Versus Dihydroartemisinin-Piperaquine With Standard High-dose Primaquine Given Either for 7 Days or 14 Days in Plasmodium vivax Malaria. Clin Infect Dis 2019; 68:1311-1319. [PMID: 30952158 PMCID: PMC6452005 DOI: 10.1093/cid/ciy735] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 08/23/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Primaquine is necessary for the radical cure of Plasmodium vivax malaria, but the optimum duration of treatment and best partner drug are uncertain. A randomized controlled trial was performed to compare the tolerability and radical curative efficacy of 7-day versus 14-day high-dose primaquine regimens (total dose 7mg/kg) with either chloroquine or dihydroartemisinin-piperaquine. METHODS Patients with uncomplicated P. vivax malaria on the Thailand-Myanmar border were randomized to either chloroquine (25mg base/kg) or dihydroartemisinin-piperaquine (dihydroartemisinin 7mg/kg and piperaquine 55mg/kg) plus primaquine, either 0.5 mg/kg/day for 14 days or 1 mg/kg/day for 7 days. Adverse events within 42 days and 1-year recurrence rates were compared and their relationship with day 6 drug concentrations assessed. RESULTS Between February 2012 and July 2014, 680 patients were enrolled. P. vivax recurrences (all after day 35) occurred in 80/654 (12%) patients; there was no difference between treatments. Compared to the 7-day primaquine groups the pooled relative risk of recurrence in the 14-day groups was 1.15 (95% confidence interval 0.7 to 1.8). Hematocrit reductions were clinically insignificant except in G6PD female heterozygotes, 2 of whom had hematocrit reductions to <23% requiring blood transfusion. CONCLUSION Radical cure should be deployed more widely. The radical curative efficacy in vivax malaria of 7-day high-dose primaquine is similar to the standard 14-day high-dose regimen. Chloroquine and dihydroartemisinin-piperaquine are both highly effective treatments of the blood stage infection. Quantitative point of care G6PD testing would ensure safe use of the 7-day high-dose primaquine regimen in G6PD heterozygous females. CLINICAL TRIALS REGISTRATION NCT01640574.
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Affiliation(s)
- Cindy S Chu
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Aung Pyae Phyo
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Claudia Turner
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Htun Htun Win
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Naw Pet Poe
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Widi Yotyingaphiram
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Suradet Thinraow
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Pornpimon Wilairisak
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Rattanaporn Raksapraidee
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Verena I Carrara
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Moo Kho Paw
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Jacher Wiladphaingern
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Stéphane Proux
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Germana Bancone
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Kanlaya Sriprawat
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Sue J Lee
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
- Mahidol–Oxford Tropical Medicine Research Unit
| | | | - James Watson
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
- Mahidol–Oxford Tropical Medicine Research Unit
| | - Joel Tarning
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
- Mahidol–Oxford Tropical Medicine Research Unit
| | - Mallika Imwong
- Mahidol–Oxford Tropical Medicine Research Unit
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - François Nosten
- Shoklo Malaria Research Unit, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Nicholas J White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
- Mahidol–Oxford Tropical Medicine Research Unit
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Yoshii A, Sekihara M, Furusawa T, Hombhanje F, Tsukahara T. Factors associated with children's health facility visits for primaquine treatment in rural Papua New Guinea. Malar J 2019; 18:42. [PMID: 30786891 PMCID: PMC6383275 DOI: 10.1186/s12936-019-2675-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 02/14/2019] [Indexed: 12/20/2022] Open
Abstract
Background To control and eventually eliminate vivax malaria, radical treatment with primaquine (PQ) is essential after completion of blood-stage treatment. Although in many malaria-endemic countries, village health volunteers (VHVs) are engaged in diagnostic treatment of malaria in remote communities, they principally provide blood-stage treatment. In such a situation, access to PQ following blood-stage treatment can be a barrier to complete treatment. However, studies on access to PQ treatment have been scarce and limited in health facility-based settings. This study aimed to identify factors associated with access to PQ treatment in rural Papua New Guinea (PNG) from the community case management perspective. Methods A community-based, cross-sectional survey was conducted to collect sociodemographic information on children under 15 years of age, their households, and their caretakers in East Sepik Province, PNG. Data collection lasted from February to March, 2015. Information on the diagnoses of potential non-falciparum malaria and prescription of PQ in preceding year (January to December 2014) were obtained from child health-record books. Then, multilevel logistic regression model was used to determine the factors associated with formal health facility visits for PQ treatment among children with potential non-falciparum malaria. Results Of 420 episodes diagnosed as potential non-falciparum malaria, 46 (11%) were immediately given PQ. The rest were instructed to visit formal health facilities (HFs) for PQ, and the patients obtained PQ during the second visit to HFs was 44%. Consequently, the overall proportion of PQ prescription was 50%. Logistic regression analysis suggested that among the patients who were instructed to visit HFs for PQ treatment, the initial visit to VHV and higher transportation costs to HF were inversely associated with PQ prescription during the second visit to an HF. Conclusions Few children received PQ treatment during the second visit to HFs following diagnosis of potential non-falciparum malaria. These findings suggest a need to establish a policy to reduce structural and economic barriers and improve rural inhabitant access to PQ treatment. Electronic supplementary material The online version of this article (10.1186/s12936-019-2675-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Akiko Yoshii
- TWMU Career Development Center for Medical Professionals, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.,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 International Affairs and Tropical Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.,Department of Tropical Medicine and Parasitology, Juntendo University School of Medicine, 6th Floor, Bldg. No.9, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takuro Furusawa
- Department of Ecology and Environment, Graduate School of Asian and African Area Studies, Kyoto University, Room#AA431, Research Bldg. No.2, Yoshida-Honmachi, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Francis Hombhanje
- Centre for Health Research and Diagnostics, Divine Word University-Rabaul Campus, Kokopo, Papua New Guinea
| | - Takahiro Tsukahara
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. .,School of Economics, Hosei University Graduate School, 2-15-2 Ichigaya Tamachi, Shinjuku-ku, Tokyo, 162-0843, Japan.
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Lacerda MVG, Llanos-Cuentas A, Krudsood S, Lon C, Saunders DL, Mohammed R, Yilma D, Batista Pereira D, Espino FEJ, Mia RZ, Chuquiyauri R, Val F, Casapía M, Monteiro WM, Brito MAM, Costa MRF, Buathong N, Noedl H, Diro E, Getie S, Wubie KM, Abdissa A, Zeynudin A, Abebe C, Tada MS, Brand F, Beck HP, Angus B, Duparc S, Kleim JP, Kellam LM, Rousell VM, Jones SW, Hardaker E, Mohamed K, Clover DD, Fletcher K, Breton JJ, Ugwuegbulam CO, Green JA, Koh GCKW. Single-Dose Tafenoquine to Prevent Relapse of Plasmodium vivax Malaria. N Engl J Med 2019; 380:215-228. [PMID: 30650322 PMCID: PMC6657226 DOI: 10.1056/nejmoa1710775] [Citation(s) in RCA: 167] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Treatment of Plasmodium vivax malaria requires the clearing of asexual parasites, but relapse can be prevented only if dormant hypnozoites are cleared from the liver (a treatment termed "radical cure"). Tafenoquine is a single-dose 8-aminoquinoline that has recently been registered for the radical cure of P. vivax. METHODS This multicenter, double-blind, double-dummy, parallel group, randomized, placebo-controlled trial was conducted in Ethiopia, Peru, Brazil, Cambodia, Thailand, and the Philippines. We enrolled 522 patients with microscopically confirmed P. vivax infection (>100 to <100,000 parasites per microliter) and normal glucose-6-phosphate dehydrogenase (G6PD) activity (with normal activity defined as ≥70% of the median value determined at each trial site among 36 healthy male volunteers who were otherwise not involved in the trial). All patients received a 3-day course of chloroquine (total dose of 1500 mg). In addition, patients were assigned to receive a single 300-mg dose of tafenoquine on day 1 or 2 (260 patients), placebo (133 patients), or a 15-mg dose of primaquine once daily for 14 days (129 patients). The primary outcome was the Kaplan-Meier estimated percentage of patients who were free from recurrence at 6 months, defined as P. vivax clearance without recurrent parasitemia. RESULTS In the intention-to-treat population, the percentage of patients who were free from recurrence at 6 months was 62.4% in the tafenoquine group (95% confidence interval [CI], 54.9 to 69.0), 27.7% in the placebo group (95% CI, 19.6 to 36.6), and 69.6% in the primaquine group (95% CI, 60.2 to 77.1). The hazard ratio for the risk of recurrence was 0.30 (95% CI, 0.22 to 0.40) with tafenoquine as compared with placebo (P<0.001) and 0.26 (95% CI, 0.18 to 0.39) with primaquine as compared with placebo (P<0.001). Tafenoquine was associated with asymptomatic declines in hemoglobin levels, which resolved without intervention. CONCLUSIONS Single-dose tafenoquine resulted in a significantly lower risk of P. vivax recurrence than placebo in patients with phenotypically normal G6PD activity. (Funded by GlaxoSmithKline and Medicines for Malaria Venture; DETECTIVE ClinicalTrials.gov number, NCT01376167 .).
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Affiliation(s)
- Marcus V G Lacerda
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Alejandro Llanos-Cuentas
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Srivicha Krudsood
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Chanthap Lon
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - David L Saunders
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Rezika Mohammed
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Daniel Yilma
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Dhelio Batista Pereira
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Fe E J Espino
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Reginaldo Z Mia
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Raul Chuquiyauri
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Fernando Val
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Martín Casapía
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Wuelton M Monteiro
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Marcelo A M Brito
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Mônica R F Costa
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Nillawan Buathong
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Harald Noedl
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Ermias Diro
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Sisay Getie
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Kalehiwot M Wubie
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Alemseged Abdissa
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Ahmed Zeynudin
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Cherinet Abebe
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Mauro S Tada
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Françoise Brand
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Hans-Peter Beck
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Brian Angus
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Stephan Duparc
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Jörg-Peter Kleim
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Lynda M Kellam
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Victoria M Rousell
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Siôn W Jones
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Elizabeth Hardaker
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Khadeeja Mohamed
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Donna D Clover
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Kim Fletcher
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - John J Breton
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Cletus O Ugwuegbulam
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Justin A Green
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Gavin C K W Koh
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
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32
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Lover AA, Baird JK, Gosling R, Price RN. Malaria Elimination: Time to Target All Species. Am J Trop Med Hyg 2018; 99:17-23. [PMID: 29761762 PMCID: PMC6035869 DOI: 10.4269/ajtmh.17-0869] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/14/2018] [Indexed: 01/13/2023] Open
Abstract
Important strides have been made within the past decade toward malaria elimination in many regions, and with this progress, the feasibility of eradication is once again under discussion. If the ambitious goal of eradication is to be achieved by 2040, all species of Plasmodium infecting humans will need to be targeted with evidence-based and concerted interventions. In this perspective, the potential barriers to achieving global malaria elimination are discussed with respect to the related diversities in host, parasite, and vector populations. We argue that control strategies need to be reorientated from a sequential attack on each species, dominated by Plasmodium falciparum to one that targets all species in parallel. A set of research themes is proposed to mitigate the potential setbacks on the pathway to a malaria-free world.
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Affiliation(s)
- Andrew A. Lover
- Malaria Elimination Initiative at the University of California, San Francisco, San Francisco, California
| | - J. Kevin Baird
- Eijkman-Oxford Clinical Research Unit, Eijkman Institute of Molecular Biology, Jakarta, Indonesia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Roly Gosling
- Malaria Elimination Initiative at the University of California, San Francisco, San Francisco, California
| | - Ric N. Price
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
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33
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Thriemer K, Bobogare A, Ley B, Gudo CS, Alam MS, Anstey NM, Ashley E, Baird JK, Gryseels C, Jambert E, Lacerda M, Laihad F, Marfurt J, Pasaribu AP, Poespoprodjo JR, Sutanto I, Taylor WR, van den Boogaard C, Battle KE, Dysoley L, Ghimire P, Hawley B, Hwang J, Khan WA, Mudin RNB, Sumiwi ME, Ahmed R, Aktaruzzaman MM, Awasthi KR, Bardaji A, Bell D, Boaz L, Burdam FH, Chandramohan D, Cheng Q, Chindawongsa K, Culpepper J, Das S, Deray R, Desai M, Domingo G, Duoquan W, Duparc S, Floranita R, Gerth-Guyette E, Howes RE, Hugo C, Jagoe G, Sariwati E, Jhora ST, Jinwei W, Karunajeewa H, Kenangalem E, Lal BK, Landuwulang C, Le Perru E, Lee SE, Makita LS, McCarthy J, Mekuria A, Mishra N, Naket E, Nambanya S, Nausien J, Duc TN, Thi TN, Noviyanti R, Pfeffer D, Qi G, Rahmalia A, Rogerson S, Samad I, Sattabongkot J, Satyagraha A, Shanks D, Sharma SN, Sibley CH, Sungkar A, Syafruddin D, Talukdar A, Tarning J, ter Kuile F, Thapa S, Theodora M, Huy TT, Waramin E, Waramori G, Woyessa A, Wongsrichanalai C, Xa NX, Yeom JS, Hermawan L, Devine A, Nowak S, Jaya I, Supargiyono S, Grietens KP, Price RN. Quantifying primaquine effectiveness and improving adherence: a round table discussion of the APMEN Vivax Working Group. Malar J 2018; 17:241. [PMID: 29925430 PMCID: PMC6011582 DOI: 10.1186/s12936-018-2380-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/08/2018] [Indexed: 01/13/2023] Open
Abstract
The goal to eliminate malaria from the Asia-Pacific by 2030 will require the safe and widespread delivery of effective radical cure of malaria. In October 2017, the Asia Pacific Malaria Elimination Network Vivax Working Group met to discuss the impediments to primaquine (PQ) radical cure, how these can be overcome and the methodological difficulties in assessing clinical effectiveness of radical cure. The salient discussions of this meeting which involved 110 representatives from 18 partner countries and 21 institutional partner organizations are reported. Context specific strategies to improve adherence are needed to increase understanding and awareness of PQ within affected communities; these must include education and health promotion programs. Lessons learned from other disease programs highlight that a package of approaches has the greatest potential to change patient and prescriber habits, however optimizing the components of this approach and quantifying their effectiveness is challenging. In a trial setting, the reactivity of participants results in patients altering their behaviour and creates inherent bias. Although bias can be reduced by integrating data collection into the routine health care and surveillance systems, this comes at a cost of decreasing the detection of clinical outcomes. Measuring adherence and the factors that relate to it, also requires an in-depth understanding of the context and the underlying sociocultural logic that supports it. Reaching the elimination goal will require innovative approaches to improve radical cure for vivax malaria, as well as the methods to evaluate its effectiveness.
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Affiliation(s)
- Kamala Thriemer
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Darwin, NT 0810 Australia
| | - Albino Bobogare
- Ministry of Health and Medical Services, National Vector-Borne Disease Control Programme, Honiara, Solomon Islands
| | - Benedikt Ley
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Darwin, NT 0810 Australia
| | | | - Mohammad Shafiul Alam
- 0000 0004 0600 7174grid.414142.6International Center for Diarrheal Diseases (ICDDR,B), Dhaka, Bangladesh
| | - Nick M. Anstey
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Darwin, NT 0810 Australia
| | - Elizabeth Ashley
- Myanmar-Oxford Clinical Research Unit, Yangon, Myanmar ,0000 0004 1936 8948grid.4991.5Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - J. Kevin Baird
- 0000 0004 1936 8948grid.4991.5Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK ,0000 0004 1795 0993grid.418754.bEijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Charlotte Gryseels
- 0000 0001 2153 5088grid.11505.30Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Elodie Jambert
- 0000 0004 0432 5267grid.452605.0Medicines for Malaria Venture (MMV), Geneva, Switzerland
| | - Marcus Lacerda
- Instituto Leônidas & Maria Deane (Fiocruz), Manaus, Amazonas Brazil ,0000 0004 0486 0972grid.418153.aFundação de Medicina Tropical Dr, Heitor Vieira Dourado, Manaus, Amazonas Brazil
| | - Ferdinand Laihad
- National Forum on Indonesia RBM/National Forum on Gebrak Malaria, Jakarta, Indonesia
| | - Jutta Marfurt
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Darwin, NT 0810 Australia
| | | | | | - Inge Sutanto
- 0000000120191471grid.9581.5University of Indonesia, Jakarta, Indonesia
| | - Walter R. Taylor
- 0000 0004 1936 8948grid.4991.5Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK ,Mahidol Oxford Clinical Research Unit (MORU), Bangkok, Thailand
| | - Christel van den Boogaard
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Darwin, NT 0810 Australia
| | - Katherine E. Battle
- 0000 0004 1936 8948grid.4991.5Malaria Atlas Project (MAP), Big Data Institute, University of Oxford, Oxford, UK
| | - Lek Dysoley
- grid.452707.3National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia ,grid.436334.5School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Prakash Ghimire
- 0000 0001 2114 6728grid.80817.36Microbiology Department, Tribhuvan University, Kathmandu, Nepal
| | - Bill Hawley
- 0000 0001 2163 0069grid.416738.fEntomology Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, USA
| | - Jimee Hwang
- 0000 0001 2163 0069grid.416738.fPresident’s Malaria Initiative, Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, USA ,0000 0001 2297 6811grid.266102.1Global Health Group, University of California San Francisco, San Francisco, USA
| | - Wasif Ali Khan
- 0000 0004 0600 7174grid.414142.6International Center for Diarrheal Diseases (ICDDR,B), Dhaka, Bangladesh
| | - Rose Nani Binti Mudin
- 0000 0001 0690 5255grid.415759.bDisease Control Division, Ministry of Health, Putrajaya, Malaysia
| | | | - Rukhsana Ahmed
- 0000 0004 1936 9764grid.48004.38Liverpool School of Tropical Medicine, Liverpool, UK
| | - M. M. Aktaruzzaman
- grid.466907.aDirectorate General of Health Services, Ministry of Health & Family Welfare Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | | | - Azucena Bardaji
- 0000 0000 9635 9413grid.410458.cISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - David Bell
- 0000 0004 0406 7608grid.471104.7Intellectual Ventures Global Good Fund, Bellevue, USA
| | - Leonard Boaz
- Ministry of Health and Medical Services, National Vector-Borne Disease Control Programme, Honiara, Solomon Islands
| | | | - Daniel Chandramohan
- 0000 0004 0425 469Xgrid.8991.9The London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Qin Cheng
- Australian Defence Force Malaria and Infectious Disease Institute, Enoggera, Australia
| | | | - Janice Culpepper
- 0000 0000 8990 8592grid.418309.7Bill & Melinda Gates Foundation, Seattle, USA
| | - Santasabuj Das
- 0000 0004 1767 225Xgrid.19096.37Indian Council of Medical Research, New Delhi, India
| | - Raffy Deray
- Department of Health, National Centre for Disease Control & Prevention, Manila, Philippines
| | - Meghna Desai
- 0000 0001 2163 0069grid.416738.fMalaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Wang Duoquan
- 0000 0000 8803 2373grid.198530.6National Institute of Parasitic Diseases, China CDC, Shanghai, China
| | - Stephan Duparc
- 0000 0004 0432 5267grid.452605.0Medicines for Malaria Venture (MMV), Geneva, Switzerland
| | | | | | - Rosalind E. Howes
- 0000 0004 1936 8948grid.4991.5Malaria Atlas Project (MAP), Big Data Institute, University of Oxford, Oxford, UK
| | | | - George Jagoe
- 0000 0004 0432 5267grid.452605.0Medicines for Malaria Venture (MMV), Geneva, Switzerland
| | - Elvieda Sariwati
- 0000 0004 0470 8161grid.415709.eMinistry of Health, National Malaria Control Program, Jakarta, Indonesia
| | - Sanya Tahmina Jhora
- grid.466907.aDirectorate General of Health Services, Ministry of Health & Family Welfare Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Wu Jinwei
- Tengchong Center for Disease Control and Prevention, Tengchong, China
| | - Harin Karunajeewa
- grid.1042.7Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Enny Kenangalem
- Yayasan Pengembangan Kesehatan dan Masyarakat, Papua (YPKMP), Papua, Indonesia
| | - Bibek Kumar Lal
- Epidemiology & Disease Control Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | | | | | - Sang-Eun Lee
- 0000 0004 1763 8617grid.418967.5Division of Vectors and Parasitic Diseases, Korea Centers for Disease Control and Prevention, Seoul, South Korea
| | - Leo Sora Makita
- Ministry of Health, National Malaria Control Programme, Port Mosby, Papua New Guinea
| | - James McCarthy
- 0000 0001 2294 1395grid.1049.cQIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Asrat Mekuria
- 0000 0001 1250 5688grid.7123.7School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Neelima Mishra
- 0000 0004 1767 225Xgrid.19096.37Indian Council of Medical Research, New Delhi, India
| | - Esau Naket
- Ministry of Health, Malaria and Other Vector-Borne Diseases Control Program (MOVBDCP), Port Vila, Vanuatu
| | - Simone Nambanya
- Center of Malariology, Parasitology and Entomology, Communicable Diseases Control, Vientiane, Lao PDR
| | - Johnny Nausien
- Ministry of Health, Malaria and Other Vector-Borne Diseases Control Program (MOVBDCP), Port Vila, Vanuatu
| | - Thang Ngo Duc
- grid.452658.8National Institute of Malariology, Parasitology and Entomology (NIMPE), Hanoi, Vietnam
| | - Thuan Nguyen Thi
- grid.452658.8National Institute of Malariology, Parasitology and Entomology (NIMPE), Hanoi, Vietnam
| | - Rinitis Noviyanti
- 0000 0004 1795 0993grid.418754.bEijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Daniel Pfeffer
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Darwin, NT 0810 Australia ,0000 0004 1936 8948grid.4991.5Malaria Atlas Project (MAP), Big Data Institute, University of Oxford, Oxford, UK
| | - Gao Qi
- grid.452515.2Jiangsu Institute of Parasitic Diseases, Wuxi, China ,WHO Collaborative Centre for Research and Training of Malaria Elimination, Wuxi, China
| | - Annisa Rahmalia
- 0000 0004 1796 1481grid.11553.33Tuberculosis-HIV Research Center Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia ,0000000122931605grid.5590.9Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Stephen Rogerson
- 0000 0001 2179 088Xgrid.1008.9Department of Medicine at the Doherty Institute, University of Melbourne, Melbourne, Australia
| | - Iriani Samad
- 0000 0004 0470 8161grid.415709.eMinistry of Health, National Malaria Control Program, Jakarta, Indonesia
| | - Jetsumon Sattabongkot
- 0000 0004 1937 0490grid.10223.32Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Bangok, Thailand
| | - Ari Satyagraha
- 0000 0004 1795 0993grid.418754.bEijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Dennis Shanks
- Australian Defence Force Malaria and Infectious Disease Institute, Enoggera, Australia
| | - Surender Nath Sharma
- grid.415820.aNational Vector Borne Disease Control Programme Directorate General of Health Services Ministry of Health & Family Welfare, New Delhi, India
| | - Carol Hopkins Sibley
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK ,0000000122986657grid.34477.33University of Washington, Seattle, WA USA
| | - Ali Sungkar
- 0000 0004 0470 8161grid.415709.eFamily Health Directorate, Ministry of Health, Jakarta, Indonesia
| | - Din Syafruddin
- 0000 0004 1795 0993grid.418754.bEijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Arunansu Talukdar
- 0000 0004 1768 2335grid.413204.0Medicine Department, Medical College Kolkata, Kolkata, India
| | - Joel Tarning
- Mahidol Oxford Clinical Research Unit (MORU), Bangkok, Thailand
| | - Feiko ter Kuile
- 0000 0004 1936 9764grid.48004.38Liverpool School of Tropical Medicine, Liverpool, UK ,0000 0001 0155 5938grid.33058.3dKenya Medical Research Institute (KEMRI) Centre for Global Health Research, Kisumu, Kenya
| | | | - Minerva Theodora
- 0000 0004 0470 8161grid.415709.eMinistry of Health, National Malaria Control Program, Jakarta, Indonesia
| | - Tho Tran Huy
- grid.452658.8National Institute of Malariology, Parasitology and Entomology (NIMPE), Hanoi, Vietnam
| | - Edward Waramin
- Family Health Services, Ministry of Health, Port Mosby, Papua New Guinea
| | | | - Adugna Woyessa
- grid.452387.fEthiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | | | - Nguyen Xuan Xa
- grid.452658.8National Institute of Malariology, Parasitology and Entomology (NIMPE), Hanoi, Vietnam
| | - Joon Sup Yeom
- 0000 0004 0470 5454grid.15444.30Yonsei University College of Medicine, Seoul, South Korea
| | - Lukas Hermawan
- 0000 0004 0470 8161grid.415709.eFamily Health Directorate, Ministry of Health, Jakarta, Indonesia
| | - Angela Devine
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Darwin, NT 0810 Australia ,0000 0004 1936 8948grid.4991.5Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK ,Mahidol Oxford Clinical Research Unit (MORU), Bangkok, Thailand
| | - Spike Nowak
- 0000 0000 8940 7771grid.415269.dPATH, Seattle, USA
| | - Indra Jaya
- Program and Information Department, Directorate General of Disease Prevention and Control, Jakarta, Indonesia
| | | | - Koen Peeters Grietens
- 0000 0001 2153 5088grid.11505.30Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Ric N. Price
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Darwin, NT 0810 Australia ,0000 0004 1936 8948grid.4991.5Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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Recht J, Ashley EA, White NJ. Use of primaquine and glucose-6-phosphate dehydrogenase deficiency testing: Divergent policies and practices in malaria endemic countries. PLoS Negl Trop Dis 2018; 12:e0006230. [PMID: 29672516 PMCID: PMC5908060 DOI: 10.1371/journal.pntd.0006230] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Primaquine is the only available antimalarial drug that kills dormant liver stages of Plasmodium vivax and Plasmodium ovale malarias and therefore prevents their relapse (‘radical cure’). It is also the only generally available antimalarial that rapidly sterilises mature P. falciparum gametocytes. Radical cure requires extended courses of primaquine (usually 14 days; total dose 3.5–7 mg/kg), whereas transmissibility reduction in falciparum malaria requires a single dose (formerly 0.75 mg/kg, now a single low dose [SLD] of 0.25 mg/kg is recommended). The main adverse effect of primaquine is dose-dependent haemolysis in glucose 6-phosphate dehydrogenase (G6PD) deficiency, the most common human enzymopathy. X-linked mutations conferring varying degrees of G6PD deficiency are prevalent throughout malaria-endemic regions. Phenotypic screening tests usually detect <30% of normal G6PD activity, identifying nearly all male hemizygotes and female homozygotes and some heterozygotes. Unfortunately, G6PD deficiency screening is usually unavailable at point of care, and, as a consequence, radical cure is greatly underused. Both haemolytic risk (determined by the prevalence and severity of G6PD deficiency polymorphisms) and relapse rates vary, so there has been considerable uncertainty in both policies and practices related to G6PD deficiency testing and use of primaquine for radical cure. Review of available information on the prevalence and severity of G6PD variants together with countries’ policies for the use of primaquine and G6PD deficiency testing confirms a wide range of practices. There remains lack of consensus on the requirement for G6PD deficiency testing before prescribing primaquine radical cure regimens. Despite substantially lower haemolytic risks, implementation of SLD primaquine as a P. falciparum gametocytocide also varies. In Africa, a few countries have recently adopted SLD primaquine, yet many with areas of low seasonal transmission do not use primaquine as an antimalarial at all. Most countries that recommended the higher 0.75 mg/kg single primaquine dose for falciparum malaria (e.g., most countries in the Americas) have not changed their recommendation. Some vivax malaria–endemic countries where G6PD deficiency testing is generally unavailable have adopted the once-weekly radical cure regimen (0.75 mg/kg/week for 8 weeks), known to be safer in less severe G6PD deficiency variants. There is substantial room for improvement in radical cure policies and practices.
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Affiliation(s)
- Judith Recht
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Elizabeth A. Ashley
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nicholas J. White
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
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Hamid MMA, Thriemer K, Elobied ME, Mahgoub NS, Boshara SA, Elsafi HMH, Gumaa SA, Hamid T, Abdelbagi H, Basheir HM, Marfurt J, Chen I, Gosling R, Price RN, Ley B. Low risk of recurrence following artesunate-Sulphadoxine-pyrimethamine plus primaquine for uncomplicated Plasmodium falciparum and Plasmodium vivax infections in the Republic of the Sudan. Malar J 2018; 17:117. [PMID: 29548285 PMCID: PMC5857106 DOI: 10.1186/s12936-018-2266-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/08/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND First-line schizontocidal treatment for uncomplicated malaria in the Republic of the Sudan is artesunate (total dose 12 mg/kg) plus Sulphadoxine/pyrimethamine (25/1.25 mg/kg) (AS/SP). Patients with Plasmodium vivax are also treated with 14 days primaquine (total dose 3.5 mg/kg) (PQ). The aim of this study was to assess the efficacy of the national policy. METHODS Patients above 1 year, with microscopy-confirmed, Plasmodium falciparum and/or P. vivax malaria were treated with AS/SP. Patients with P. falciparum were randomized to no primaquine (Pf-noPQ) or a single 0.25 mg/kg dose of PQ (Pf-PQ1). Patients with P. vivax received 14 days unsupervised 3.5 mg/kg PQ (Pv-PQ14) on day 2 or at the end of follow up (Pv-noPQ). Primary endpoint was the risk of recurrent parasitaemia at day 42. G6PD activity was measured by spectrophotometry and the Accessbio Biosensor™. RESULTS 231 patients with P. falciparum (74.8%), 77 (24.9%) with P. vivax and 1 (0.3%) patient with mixed infection were enrolled. The PCR corrected cumulative risk of recurrent parasitaemia on day 42 was 3.8% (95% CI 1.2-11.2%) in the Pf-noPQ arm compared to 0.9% (95% CI 0.1-6.0%) in the Pf-PQ1 arm; (HR = 0.25 [95% CI 0.03-2.38], p = 0.189). The corresponding risks of recurrence were 13.4% (95% CI 5.2-31.9%) in the Pv-noPQ arm and 5.3% (95% CI 1.3-19.4%) in the Pv-PQ14 arm (HR 0.36 [95% CI 0.1-2.0], p = 0.212). Two (0.9%) patients had G6PD enzyme activity below 10%, 19 (8.9%) patients below 60% of the adjusted male median. Correlation between spectrophotometry and Biosensor™ was low (rs = 0.330, p < 0.001). CONCLUSION AS/SP remains effective for the treatment of P. falciparum and P. vivax. The addition of PQ reduced the risk of recurrent P. falciparum and P. vivax by day 42, although this did not reach statistical significance. The version of the Biosensor™ assessed is not suitable for routine use. Trial registration https://clinicaltrials.gov/ct2/show/NCT02592408.
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Affiliation(s)
- Muzamil Mahdi Abdel Hamid
- 0000 0001 0674 6207grid.9763.bDepartment of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Republic of the Sudan
| | - Kamala Thriemer
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, PO Box 41096, Darwin, NT 0811 Australia
| | - Maha E. Elobied
- 0000 0001 0674 6207grid.9763.bDepartment of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Republic of the Sudan
| | - Nouh S. Mahgoub
- 0000 0001 0674 6207grid.9763.bDepartment of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Republic of the Sudan
| | - Salah A. Boshara
- 0000 0001 0674 6207grid.9763.bDepartment of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Republic of the Sudan
| | - Hassan M. H. Elsafi
- 0000 0001 0674 6207grid.9763.bDepartment of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Republic of the Sudan
| | - Suhaib A. Gumaa
- 0000 0001 0674 6207grid.9763.bDepartment of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Republic of the Sudan
| | - Tassneem Hamid
- 0000 0001 0674 6207grid.9763.bDepartment of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Republic of the Sudan
| | - Hanadi Abdelbagi
- 0000 0001 0674 6207grid.9763.bDepartment of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Republic of the Sudan
| | - Hamid M. Basheir
- 0000 0001 0674 6207grid.9763.bDepartment of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Republic of the Sudan
| | - Jutta Marfurt
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, PO Box 41096, Darwin, NT 0811 Australia
| | - Ingrid Chen
- 0000 0001 2297 6811grid.266102.1Global Health Group, University of California San Francisco, San Francisco, CA USA
| | - Roly Gosling
- 0000 0001 2297 6811grid.266102.1Global Health Group, University of California San Francisco, San Francisco, CA USA
| | - Ric N. Price
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, PO Box 41096, Darwin, NT 0811 Australia ,0000 0004 1936 8948grid.4991.5Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Benedikt Ley
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, PO Box 41096, Darwin, NT 0811 Australia
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Martin TCS, Vinetz JM. Asymptomatic Plasmodium vivax parasitaemia in the low-transmission setting: the role for a population-based transmission-blocking vaccine for malaria elimination. Malar J 2018; 17:89. [PMID: 29466991 PMCID: PMC5822557 DOI: 10.1186/s12936-018-2243-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 02/17/2018] [Indexed: 12/21/2022] Open
Abstract
Plasmodium vivax remains an important cause of morbidity and mortality across the Americas, Horn of Africa, East and South East Asia. Control of transmission has been hampered by emergence of chloroquine resistance and several intrinsic characteristics of infection including asymptomatic carriage, challenges with diagnosis, difficulty eradicating the carrier state and early gametocyte appearance. Complex human-parasite-vector immunological interactions may facilitate onward infection of mosquitoes. Given these challenges, new therapies are being explored including the development of transmission to mosquito blocking vaccines. Herein, the case supporting the need for transmission-blocking vaccines to augment control of P. vivax parasite transmission and explore factors that are limiting eradication efforts is discussed.
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Affiliation(s)
- Thomas C S Martin
- Division of Infectious Diseases, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Joseph M Vinetz
- Division of Infectious Diseases, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
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Ley B, Bancone G, von Seidlein L, Thriemer K, Richards JS, Domingo GJ, Price RN. Methods for the field evaluation of quantitative G6PD diagnostics: a review. Malar J 2017; 16:361. [PMID: 28893237 PMCID: PMC5594530 DOI: 10.1186/s12936-017-2017-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/06/2017] [Indexed: 01/12/2023] Open
Abstract
Individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency are at risk of severe haemolysis following the administration of 8-aminoquinoline compounds. Primaquine is the only widely available 8-aminoquinoline for the radical cure of Plasmodium vivax. Tafenoquine is under development with the potential to simplify treatment regimens, but point-of-care (PoC) tests will be needed to provide quantitative measurement of G6PD activity prior to its administration. There is currently a lack of appropriate G6PD PoC tests, but a number of new tests are in development and are likely to enter the market in the coming years. As these are implemented, they will need to be validated in field studies. This article outlines the technical details for the field evaluation of novel quantitative G6PD diagnostics such as sample handling, reference testing and statistical analysis. Field evaluation is based on the comparison of paired samples, including one sample tested by the new assay at point of care and one sample tested by the gold-standard reference method, UV spectrophotometry in an established laboratory. Samples can be collected as capillary or venous blood; the existing literature suggests that potential differences in capillary or venous blood are unlikely to affect results substantially. The collection and storage of samples is critical to ensure preservation of enzyme activity, it is recommended that samples are stored at 4 °C and testing occurs within 4 days of collection. Test results can be visually presented as scatter plot, Bland-Altman plot, and a histogram of the G6PD activity distribution of the study population. Calculating the adjusted male median allows categorizing results according to G6PD activity to calculate standard performance indicators and to perform receiver operating characteristic (ROC) analysis.
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Affiliation(s)
- Benedikt Ley
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Germana Bancone
- 0000 0004 1937 0490grid.10223.32Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand ,0000 0004 1936 8948grid.4991.5Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | - Kamala Thriemer
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Jack S. Richards
- 0000 0001 2224 8486grid.1056.2Malaria Elimination Program, Burnet Institute, Melbourne, VIC Australia ,0000 0001 2179 088Xgrid.1008.9Department of Medicine, University of Melbourne, Parkville, VIC Australia ,Victorian Infectious Diseases Service, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC Australia
| | - Gonzalo J. Domingo
- 0000 0000 8940 7771grid.415269.dDiagnostics Global Program, PATH, Seattle, WA USA
| | - Ric N. Price
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia ,0000 0004 1936 8948grid.4991.5Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Ong KIC, Kosugi H, Thoeun S, Araki H, Thandar MM, Iwagami M, Hongvanthong B, Brey PT, Kano S, Jimba M. Systematic review of the clinical manifestations of glucose-6-phosphate dehydrogenase deficiency in the Greater Mekong Subregion: implications for malaria elimination and beyond. BMJ Glob Health 2017; 2:e000415. [PMID: 29082022 PMCID: PMC5656182 DOI: 10.1136/bmjgh-2017-000415] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/06/2017] [Accepted: 07/09/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION To achieve malaria elimination in the Greater Mekong Subregion (GMS) by 2030, proper case management is necessary. 8-aminoquinolines, such as primaquine, are the only available medicines effective in preventing relapse of the hypnozoite stage of Plasmodium vivax, as well as the onward transmission of Plasmodium falciparum. However, primaquine can cause haemolysis in individuals who have glucose-6-phosphate dehydrogenase deficiency (G6PDd). We conducted a systematic review on the reported clinical manifestations of G6PDd to provide a comprehensive overview of the situation in the GMS. METHODS The protocol for this systematic review was registered on PROSPERO: International prospective register of systematic reviews (CRD42016043146). We searched the PubMed/MEDLINE, CINAHL, and Web of Science databases for published articles describing the clinical manifestations of G6PDd in the GMS. We included articles of all study designs from inception until 31 July 2016, reporting the clinical manifestations of G6PDd. We then performed a narrative synthesis of these articles. RESULTS We included 56 articles in this review, 45 of which were from Thailand. Haemolysis in G6PD-deficient individuals was caused not only by primaquine but also by other medicines and infections. Other clinical manifestations of G6PDd that were found were favism, neonatal jaundice and chronic non-spherocytic haemolytic anaemia. G6PDd also influenced the clinical presentations of genetic disorders and infections, such as thalassemia and typhoid fever. CONCLUSION As G6PDd also affects the clinical presentations of other infections, the benefits of G6PD testing and proper record keeping transcend those of malaria case management. Therefore, healthcare workers at the community level should be made familiar with complications resulting from G6PDd as these complications extend beyond the scope of malaria.
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Affiliation(s)
- Ken Ing Cherng Ong
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,SATREPS Project (JICA/AMED) for Parasitic Diseases, Vientiane Capital, Lao People's Democratic Republic
| | - Hodaka Kosugi
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sophea Thoeun
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hitomi Araki
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,SATREPS Project (JICA/AMED) for Parasitic Diseases, Vientiane Capital, Lao People's Democratic Republic
| | - Moe Moe Thandar
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Moritoshi Iwagami
- SATREPS Project (JICA/AMED) for Parasitic Diseases, Vientiane Capital, Lao People's Democratic Republic.,Institut Pasteur du Laos, Ministry of Health, Vientiane Capital, Lao People's Democratic Republic.,Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Bouasy Hongvanthong
- SATREPS Project (JICA/AMED) for Parasitic Diseases, Vientiane Capital, Lao People's Democratic Republic.,Center of Malariology, Parasitology and Entomology, Ministry of Health, Vientiane Capital, Lao People's Democratic Republic
| | - Paul T Brey
- SATREPS Project (JICA/AMED) for Parasitic Diseases, Vientiane Capital, Lao People's Democratic Republic.,Institut Pasteur du Laos, Ministry of Health, Vientiane Capital, Lao People's Democratic Republic
| | - Shigeyuki Kano
- SATREPS Project (JICA/AMED) for Parasitic Diseases, Vientiane Capital, Lao People's Democratic Republic.,Institut Pasteur du Laos, Ministry of Health, Vientiane Capital, Lao People's Democratic Republic.,Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,SATREPS Project (JICA/AMED) for Parasitic Diseases, Vientiane Capital, Lao People's Democratic Republic
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Ley B, Thriemer K, Jaswal J, Poirot E, Alam MS, Phru CS, Khan WA, Dysoley L, Qi G, Kheong CC, Shamsudin UK, Chen I, Hwang J, Gosling R, Price RN. Barriers to routine G6PD testing prior to treatment with primaquine. Malar J 2017; 16:329. [PMID: 28797255 PMCID: PMC5553859 DOI: 10.1186/s12936-017-1981-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/07/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Primaquine is essential for the radical cure of vivax malaria, however its broad application is hindered by the risk of drug-induced haemolysis in individuals with glucose-6-phosphate-dehydrogenase (G6PD) deficiency. Rapid diagnostic tests capable of diagnosing G6PD deficiency are now available, but these are not used widely. METHODS A series of qualitative interviews were conducted with policy makers and healthcare providers in four vivax-endemic countries. Routine G6PD testing is not part of current policy in Bangladesh, Cambodia or China, but it is in Malaysia. The interviews were analysed with regard to respondents perceptions of vivax malaria, -primaquine based treatment for malaria and the complexities of G6PD deficiency. RESULTS Three barriers to the roll-out of routine G6PD testing were identified in all sites: (a) a perceived low risk of drug-induced haemolysis; (b) the perception that vivax malaria was benign and accordingly treatment with primaquine was not regarded as a priority; and, (c) the additional costs of introducing routine testing. In Malaysia, respondents considered the current test and treat algorithm suitable and the need for an alternative approach was only considered relevant in highly mobile and hard to reach populations. CONCLUSIONS Greater efforts are needed to increase awareness of the benefits of the radical cure of Plasmodium vivax and this should be supported by economic analyses exploring the cost effectiveness of routine G6PD testing.
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Affiliation(s)
- Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0811 Australia
| | - Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0811 Australia
| | - Jessica Jaswal
- 0000 0001 2297 6811grid.266102.1Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, CA USA
| | - Eugenie Poirot
- 0000 0001 2297 6811grid.266102.1Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, CA USA
| | - Mohammad Shafiul Alam
- 0000 0004 0600 7174grid.414142.6Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh, Mohakhali, Dhaka, 1212 Bangladesh
| | - Ching Swe Phru
- 0000 0004 0600 7174grid.414142.6Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh, Mohakhali, Dhaka, 1212 Bangladesh
| | - Wasif Ali Khan
- 0000 0004 0600 7174grid.414142.6Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh, Mohakhali, Dhaka, 1212 Bangladesh
| | - Lek Dysoley
- grid.452707.3Ministry of Health, National Center for Parasitology Entomology and Malaria Control (CNM), Phnom Penh, Cambodia ,grid.436334.5School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Gao Qi
- grid.452515.2National Key Laboratory ON Parasitic Diseases, Jiangsu Institute of Parasitic Diseases, Wuxi, China
| | - Chong Chee Kheong
- 0000 0001 0690 5255grid.415759.bDisease Control Division, Ministry of Health, Kuala Lumpur, Malaysia
| | - Ummi Kalthom Shamsudin
- 0000 0001 0690 5255grid.415759.bDisease Control Division, Ministry of Health, Kuala Lumpur, Malaysia
| | - Ingrid Chen
- 0000 0001 2297 6811grid.266102.1Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, CA USA
| | - Jimee Hwang
- 0000 0001 2297 6811grid.266102.1Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, CA USA ,0000 0001 2163 0069grid.416738.fDivision of Parasitic Diseases and Malaria, US President’s Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Roly Gosling
- 0000 0001 2297 6811grid.266102.1Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, CA USA
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT 0811 Australia ,0000 0004 1936 8948grid.4991.5Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Douglas NM, Poespoprodjo JR, Patriani D, Malloy MJ, Kenangalem E, Sugiarto P, Simpson JA, Soenarto Y, Anstey NM, Price RN. Unsupervised primaquine for the treatment of Plasmodium vivax malaria relapses in southern Papua: A hospital-based cohort study. PLoS Med 2017; 14:e1002379. [PMID: 28850568 PMCID: PMC5574534 DOI: 10.1371/journal.pmed.1002379] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/27/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Primaquine is the only licensed drug for eradicating Plasmodium vivax hypnozoites and, therefore, preventing relapses of vivax malaria. It is a vital component of global malaria elimination efforts. Primaquine is efficacious when supervised in clinical trials, but its effectiveness in real-world settings is unknown. We aimed to determine whether unsupervised primaquine was effective for preventing re-presentation to hospital with vivax malaria in southern Papua, Indonesia. METHODS AND FINDINGS Routinely-collected hospital surveillance data were used to undertake a pragmatic comparison of the risk of re-presentation to hospital with vivax malaria in patients prescribed dihydroartemisinin-piperaquine (DHP) combined with primaquine versus those patients prescribed DHP alone. The omission of primaquine was predominantly due to 3 stock outages. Individual clinical, pharmacy, and laboratory data were merged using individual hospital identification numbers and the date of presentation to hospital. Between April 2004 and December 2013, there were 86,797 documented episodes of vivax malaria, of which 62,492 (72.0%) were included in the analysis. The risk of re-presentation with vivax malaria within 1 year was 33.8% (95% confidence Interval [CI] 33.1%-34.5%) after initial monoinfection with P. vivax and 29.2% (95% CI 28.1%-30.4%) after mixed-species infection. The risk of re-presentation with P. vivax malaria was higher in children 1 to <5 years of age (49.6% [95% CI 48.4%-50.9%]) compared to patients 15 years of age or older (24.2% [95% CI 23.4-24.9%]); Adjusted Hazard Ratio (AHR) = 2.23 (95% CI 2.15-2.31), p < 0.001. Overall, the risk of re-presentation was 37.2% (95% CI 35.6%-38.8%) in patients who were prescribed no primaquine compared to 31.6% (95% CI 30.9%-32.3%) in those prescribed either a low (≥1.5 mg/kg and <5 mg/kg) or high (≥5 mg/kg) dose of primaquine (AHR = 0.90 [95% CI 0.86-0.95, p < 0.001]). Limiting the comparison to high dose versus no primaquine in the period during and 12 months before and after a large stock outage resulted in minimal change in the estimated clinical effectiveness of primaquine (AHR 0.91, 95% CI 0.85-0.97, p = 0.003). Our pragmatic study avoided the clinical influences associated with prospective study involvement but was subject to attrition bias caused by passive follow-up. CONCLUSIONS Unsupervised primaquine for vivax malaria, prescribed according to the current World Health Organization guidelines, was associated with a minimal reduction in the risk of clinical recurrence within 1 year in Papua, Indonesia. New strategies for the effective radical cure of vivax malaria are needed in resource-poor settings.
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Affiliation(s)
- Nicholas M. Douglas
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Division of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand
| | - Jeanne Rini Poespoprodjo
- Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Department of Child Health, Faculty of Medicine, University Gadjah Mada, Yogyakarta, Indonesia
| | - Dewi Patriani
- Department of Child Health, Faculty of Medicine, University Gadjah Mada, Yogyakarta, Indonesia
| | - Michael J. Malloy
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Cytology Service Ltd., Melbourne, Victoria, Australia
| | - Enny Kenangalem
- Timika Malaria Research Program, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Mimika District Hospital, Timika, Papua, Indonesia
| | | | - Julie A. Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Yati Soenarto
- Department of Child Health, Faculty of Medicine, University Gadjah Mada, Yogyakarta, Indonesia
| | - Nicholas M. Anstey
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
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Milligan R, Daher A, Graves PM. Primaquine at alternative dosing schedules for preventing relapse in people withPlasmodium vivaxmalaria. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Rachael Milligan
- Liverpool School of Tropical Medicine; Cochrane Infectious Diseases Group; Pembroke Place Liverpool UK L3 5QA
| | - André Daher
- Oswaldo Cruz Foundation (FIOCRUZ); Research and Reference Laboratories; Rio de Janeiro Brazil
| | - Patricia M Graves
- James Cook University; College of Public Health, Medical and Veterinary Sciences; PO Box 6811 Cairns Queensland Australia 4870
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Abreha T, Hwang J, Thriemer K, Tadesse Y, Girma S, Melaku Z, Assef A, Kassa M, Chatfield MD, Landman KZ, Chenet SM, Lucchi NW, Udhayakumar V, Zhou Z, Shi YP, Kachur SP, Jima D, Kebede A, Solomon H, Mekasha A, Alemayehu BH, Malone JL, Dissanayake G, Teka H, Auburn S, von Seidlein L, Price RN. Comparison of artemether-lumefantrine and chloroquine with and without primaquine for the treatment of Plasmodium vivax infection in Ethiopia: A randomized controlled trial. PLoS Med 2017; 14:e1002299. [PMID: 28510573 PMCID: PMC5433686 DOI: 10.1371/journal.pmed.1002299] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 04/03/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Recent efforts in malaria control have resulted in great gains in reducing the burden of Plasmodium falciparum, but P. vivax has been more refractory. Its ability to form dormant liver stages confounds control and elimination efforts. To compare the efficacy and safety of primaquine regimens for radical cure, we undertook a randomized controlled trial in Ethiopia. METHODS AND FINDINGS Patients with normal glucose-6-phosphate dehydrogenase status with symptomatic P. vivax mono-infection were enrolled and randomly assigned to receive either chloroquine (CQ) or artemether-lumefantrine (AL), alone or in combination with 14 d of semi-supervised primaquine (PQ) (3.5 mg/kg total). A total of 398 patients (n = 104 in the CQ arm, n = 100 in the AL arm, n = 102 in the CQ+PQ arm, and n = 92 in the AL+PQ arm) were followed for 1 y, and recurrent episodes were treated with the same treatment allocated at enrolment. The primary endpoints were the risk of P. vivax recurrence at day 28 and at day 42. The risk of recurrent P. vivax infection at day 28 was 4.0% (95% CI 1.5%-10.4%) after CQ treatment and 0% (95% CI 0%-4.0%) after CQ+PQ. The corresponding risks were 12.0% (95% CI 6.8%-20.6%) following AL alone and 2.3% (95% CI 0.6%-9.0%) following AL+PQ. On day 42, the risk was 18.7% (95% CI 12.2%-28.0%) after CQ, 1.2% (95% CI 0.2%-8.0%) after CQ+PQ, 29.9% (95% CI 21.6%-40.5%) after AL, and 5.9% (95% CI 2.4%-13.5%) after AL+PQ (overall p < 0.001). In those not prescribed PQ, the risk of recurrence by day 42 appeared greater following AL treatment than CQ treatment (HR = 1.8 [95% CI 1.0-3.2]; p = 0.059). At the end of follow-up, the incidence rate of P. vivax was 2.2 episodes/person-year for patients treated with CQ compared to 0.4 for patients treated with CQ+PQ (rate ratio: 5.1 [95% CI 2.9-9.1]; p < 0.001) and 2.3 episodes/person-year for AL compared to 0.5 for AL+PQ (rate ratio: 6.4 [95% CI 3.6-11.3]; p < 0.001). There was no difference in the occurrence of adverse events between treatment arms. The main limitations of the study were the early termination of the trial and the omission of haemoglobin measurement after day 42, resulting in an inability to estimate the cumulative risk of anaemia. CONCLUSIONS Despite evidence of CQ-resistant P. vivax, the risk of recurrence in this study was greater following treatment with AL unless it was combined with a supervised course of PQ. PQ combined with either CQ or AL was well tolerated and reduced recurrence of vivax malaria by 5-fold at 1 y. TRIAL REGISTRATION ClinicalTrials.gov NCT01680406.
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Affiliation(s)
- Tesfay Abreha
- ICAP, Columbia University Mailman School of Public Health, Addis Ababa, Ethiopia
| | - Jimee Hwang
- US President’s Malaria Initiative, Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Global Health Group, University of California San Francisco, San Francisco, California, United States of America
| | - Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- * E-mail:
| | - Yehualashet Tadesse
- ICAP, Columbia University Mailman School of Public Health, Addis Ababa, Ethiopia
| | - Samuel Girma
- ICAP, Columbia University Mailman School of Public Health, Addis Ababa, Ethiopia
| | - Zenebe Melaku
- ICAP, Columbia University Mailman School of Public Health, Addis Ababa, Ethiopia
| | - Ashenafi Assef
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Moges Kassa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Mark D. Chatfield
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Keren Z. Landman
- Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Stella M. Chenet
- Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Naomi W. Lucchi
- Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Venkatachalam Udhayakumar
- Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Zhiyong Zhou
- Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ya Ping Shi
- Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - S. Patrick Kachur
- Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Daddi Jima
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Amha Kebede
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Addis Mekasha
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | | | - Joseph L. Malone
- US President’s Malaria Initiative, Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Gunewardena Dissanayake
- US President’s Malaria Initiative, US Agency for International Development, Addis Ababa, Ethiopia
| | - Hiwot Teka
- US President’s Malaria Initiative, US Agency for International Development, Addis Ababa, Ethiopia
| | - Sarah Auburn
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Lorenz von Seidlein
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Challenges for achieving safe and effective radical cure of Plasmodium vivax: a round table discussion of the APMEN Vivax Working Group. Malar J 2017; 16:141. [PMID: 28381261 PMCID: PMC5382417 DOI: 10.1186/s12936-017-1784-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 03/18/2017] [Indexed: 01/12/2023] Open
Abstract
The delivery of safe and effective radical cure for Plasmodium vivax is one of the greatest challenges for achieving malaria elimination from the Asia-Pacific by 2030. During the annual meeting of the Asia Pacific Malaria Elimination Network Vivax Working Group in October 2016, a round table discussion was held to discuss the programmatic issues hindering the widespread use of primaquine (PQ) radical cure. Participants included 73 representatives from 16 partner countries and 33 institutional partners and other research institutes. In this meeting report, the key discussion points are presented and grouped into five themes: (i) current barriers for glucose-6-phosphate deficiency (G6PD) testing prior to PQ radical cure, (ii) necessary properties of G6PD tests for wide scale deployment, (iii) the promotion of G6PD testing, (iv) improving adherence to PQ regimens and (v) the challenges for future tafenoquine (TQ) roll out. Robust point of care (PoC) G6PD tests are needed, which are suitable and cost-effective for clinical settings with limited infrastructure. An affordable and competitive test price is needed, accompanied by sustainable funding for the product with appropriate training of healthcare staff, and robust quality control and assurance processes. In the absence of quantitative PoC G6PD tests, G6PD status can be gauged with qualitative diagnostics, however none of the available tests is currently sensitive enough to guide TQ treatment. TQ introduction will require overcoming additional challenges including the management of severely and intermediately G6PD deficient individuals. Robust strategies are needed to ensure that effective treatment practices can be deployed widely, and these should ensure that the caveats are outweighed by the benefits of radical cure for both the patients and the community. Widespread access to quality controlled G6PD testing will be critical.
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44
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Cohen R, Cardona JS, Navarro ES, Padilla N, Reyes L, Villar RJP, Masuoka P, Bernart C, Peruski LF, Bryan JP. Outbreak Investigation of Plasmodium vivax Malaria in a Region of Guatemala Targeted for Malaria Elimination. Am J Trop Med Hyg 2017; 96:819-825. [PMID: 28138056 DOI: 10.4269/ajtmh.15-0698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AbstractThe Department of Santa Rosa, Guatemala, is targeted for malaria elimination. However, compared with 2011, a 13-fold increase in cases was reported in 2012. To describe the epidemiology of malaria in Santa Rosa in the setting of the apparent outbreak, demographic and microscopic data from 2008 to 2013 were analyzed. In April 2012, a new surveillance strategy, funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, was introduced involving more active case detection, centralized microscopy, increased community engagement, and expanded vector control. Interviews with vector control personnel and site visits were conducted in June 2013. From 2008 to 2013, 337 cases of malaria were reported. The increase in cases occurred largely after the new surveillance strategy was implemented. Most (137/165; 83%) 2012 cases came from one town near a lake. Plasmodium vivax was the malaria species detected in all cases. Cases were detected where malaria was not previously reported. Monthly rainfall or/and temperature did not correlate with cases. Interviews with public health personnel suggested that the new funding, staffing, and strategy were responsible for improved quality of malaria detection and control and thus the increase in reported cases. Improvements in surveillance, case detection, and funding appear responsible for the temporary increase in cases, which thus may paradoxically indicate progress toward elimination.
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Affiliation(s)
- Robert Cohen
- U.S. Army Public Health Command, Edgewood, Maryland
| | - Joel Sarceño Cardona
- Area de Salud, Department of Santa Rosa, Ministerio de Salud, Cuilapa, Guatemala
| | | | | | - Lisette Reyes
- Area de Salud, Department of Santa Rosa, Ministerio de Salud, Cuilapa, Guatemala
| | | | - Penny Masuoka
- Henry M. Jackson Foundation, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | | | - Leonard F Peruski
- Division of Global Health Protection, Center for Disease Control and Prevention, Atlanta, Georgia.,Central American Regional Office, Centers for Disease Control and Prevention, Guatemala City, Guatemala
| | - Joe P Bryan
- Division of Global Health Protection, Center for Disease Control and Prevention, Atlanta, Georgia.,Central American Regional Office, Centers for Disease Control and Prevention, Guatemala City, Guatemala
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Baird JK, Valecha N, Duparc S, White NJ, Price RN. Diagnosis and Treatment of Plasmodium vivax Malaria. Am J Trop Med Hyg 2016; 95:35-51. [PMID: 27708191 PMCID: PMC5198890 DOI: 10.4269/ajtmh.16-0171] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/19/2016] [Indexed: 11/07/2022] Open
Abstract
The diagnosis and treatment of Plasmodium vivax malaria differs from that of Plasmodium falciparum malaria in fundamentally important ways. This article reviews the guiding principles, practices, and evidence underpinning the diagnosis and treatment of P. vivax malaria.
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Affiliation(s)
- J Kevin Baird
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Neena Valecha
- National Institute for Malaria Research, New Delhi, India
| | | | - Nicholas J White
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ric N Price
- Division of Global and Tropical Health, Menzies School of Health Research-Charles Darwin University, Darwin, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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46
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Longley RJ, Sripoorote P, Chobson P, Saeseu T, Sukasem C, Phuanukoonnon S, Nguitragool W, Mueller I, Sattabongkot J. High Efficacy of Primaquine Treatment for Plasmodium vivax in Western Thailand. Am J Trop Med Hyg 2016; 95:1086-1089. [PMID: 27601524 DOI: 10.4269/ajtmh.16-0410] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/25/2016] [Indexed: 11/07/2022] Open
Abstract
Primaquine is the only licensed antimalarial drug that is capable of clearing dormant Plasmodium vivax liver stage parasites. To date, there is no clear evidence of resistance of the liver stage parasite against this drug, because of the difficulty in ascertaining the cause of recurrent infection. We followed 52 Thai P. vivax patients for 9 months after directly observed treatment of 15 mg primaquine daily for 14 days. Blood samples taken at 2-4 weekly intervals were assessed by microscopy and polymerase chain reaction (PCR) for the presence of parasites. Only four of 52 (7.7%) volunteers had recurrent P. vivax infections, all at least 8 weeks after treatment. This demonstrates that primaquine retains a high efficacy in this population. Although a risk of new infections could not be ruled out, parasite genotyping at two polymorphic markers suggested a high probability of late relapsing infections in these volunteers. Continued monitoring of primaquine efficacy in this region is advisable.
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Affiliation(s)
- Rhea J Longley
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Piyarat Sripoorote
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Pornpimol Chobson
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Teerawat Saeseu
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Chonlaphat Sukasem
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suparat Phuanukoonnon
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Wang Nguitragool
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, Australia.,ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jetsumon Sattabongkot
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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Abstract
Introduction: Relapses are important contributors to illness and morbidity in Plasmodium vivax and P. ovale infections. Relapse prevention (radical cure) with primaquine is required for optimal management, control and ultimately elimination of Plasmodium vivax malaria. A review was conducted with publications in English, French, Portuguese and Spanish using the search terms ‘P. vivax’ and ‘relapse’. Areas covered: Hypnozoites causing relapses may be activated weeks or months after initial infection. Incidence and temporal patterns of relapse varies geographically. Relapses derive from parasites either genetically similar or different from the primary infection indicating that some derive from previous infections. Malaria illness itself may activate relapse. Primaquine is the only widely available treatment for radical cure. However, it is often not given because of uncertainty over the risks of primaquine induced haemolysis when G6PD deficiency testing is unavailable. Recommended dosing of primaquine for radical cure in East Asia and Oceania is 0.5 mg base/kg/day and elsewhere is 0.25 mg base/kg/day. Alternative treatments are under investigation. Expert commentary: Geographic heterogeneity in relapse patterns and chloroquine susceptibility of P. vivax, and G6PD deficiency epidemiology mean that radical treatment should be given much more than it is today. G6PD testing should be made widely available so primaquine can be given more safely.
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Affiliation(s)
- Cindy S Chu
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Mae Sot , Thailand.,b Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Bangkok , Thailand
| | - Nicholas J White
- b Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Bangkok , Thailand.,c Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine , University of Oxford , Oxford , UK
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48
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Therapeutic failure of primaquine and need for new medicines in radical cure of Plasmodium vivax. Acta Trop 2016; 160:35-8. [PMID: 27109040 DOI: 10.1016/j.actatropica.2016.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/18/2016] [Accepted: 04/20/2016] [Indexed: 11/23/2022]
Abstract
Primaquine has been the drug of choice for the prevention of Plasmodium vivax relapse for more than 60 years. Primaquine tolerant strain of P. vivax was identified in 1944. Significant mortality and disease burden of P. vivax calls for the need of new drugs. Primaquine resistance is a complex issue, as the mechanism of resistance is not clear. Direct evidence of resistance to primaquine by hypnozoites has not yet been shown. There are some reports detailing risk of primaquine resistance in specific regions, but the overall distribution of primaquine resistance in P. vivax-infected people is largely unknown. Confounding factors contribute to treatment failures; such as inadequate doses, inappropriate dosing intervals, risk of reinfection, combinations with blood schizontocidals, and compliance. Therefore, primaquine resistance needs to be addressed along with additional important confounding factors. Tafenoquine is the most studied drug in replacing primaquine for the radical cure of P. vivax malaria. It has comparable efficacy with primaquine. The potential advantage of tafenoquine is better compliance with a single dose regimen. Rational use of primaquine can secure its effectiveness, but it is essential in the future to have better or similar alternatives to treat P. vivax.
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Saravu K, Kumar R, Ashok H, Kundapura P, Kamath V, Kamath A, Mukhopadhyay C. Therapeutic Assessment of Chloroquine-Primaquine Combined Regimen in Adult Cohort of Plasmodium vivax Malaria from Primary Care Centres in Southwestern India. PLoS One 2016; 11:e0157666. [PMID: 27315280 PMCID: PMC4912090 DOI: 10.1371/journal.pone.0157666] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 06/02/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several reports of chloroquine treatment failure and resistance in Plasmodium vivax malaria from Southeast Asian countries have been published. Present study was undertaken to assess the efficacy of chloroquine-primaquine (CQ-PQ) combined regimen for the treatment of P. vivax malaria patients who were catered by the selected primary health centres (PHCs) of Udupi taluk, Udupi district, Karnataka, India. METHOD Five PHCs were selected within Udupi taluk based on probability proportional to size. In-vivo therapeutic efficacy assessment of CQ (1500 mg over three days) plus PQ (210 mg over 14 days) regimen was carried out in accordance with the World Health Organization's protocol of 28 days follow-up among microscopically diagnosed monoinfection P. vivax cohort. RESULTS In total, 161 participants were recruited in the study of which, 155 (96.3%) participants completed till day 28 follow-up, fully complied with the treatment regimen and showed adequate clinical and parasitological response. Loss to follow up was noted with 5 (3.1%) participants and non-compliance with treatment regimen occurred with one participant (0.6%). Glucose-6-phosphate dehydrogenase deficiency (G6PDd, <30% of normal mean activity) was noted among 5 (3.1%) participants and one of them did develop PQ induced dark-brown urination which subsided after PQ discontinuation. G6PDd patients were treated with PQ 45 mg/week for eight weeks while PQ was discontinued in one case with G6PD 1.4 U/g Hb due to complaint of reddish-brown coloured urine by 48 hours of PQ initiation. Nested polymerase chain reaction test revealed 45 (28%) cases as mixed (vivax and falciparum) malaria. CONCLUSIONS The CQ-PQ combined regimen remains outstandingly effective to treat uncomplicated P. vivax malaria in Udupi taluk and thus it should continue as first line regimen. For all P. vivax cases, G6PD screening before PQ administration must be mandatory and made available in all PHCs.
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Affiliation(s)
- Kavitha Saravu
- Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, Karnataka, India
- * E-mail:
| | - Rishikesh Kumar
- Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, Karnataka, India
| | | | | | - Veena Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, India
| | - Asha Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, India
| | - Chiranjay Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, India
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Wangchuk S, Drukpa T, Penjor K, Peldon T, Dorjey Y, Dorji K, Chhetri V, Trimarsanto H, To S, Murphy A, von Seidlein L, Price RN, Thriemer K, Auburn S. Where chloroquine still works: the genetic make-up and susceptibility of Plasmodium vivax to chloroquine plus primaquine in Bhutan. Malar J 2016; 15:277. [PMID: 27176722 PMCID: PMC4866075 DOI: 10.1186/s12936-016-1320-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/30/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Bhutan has made substantial progress in reducing malaria incidence. The national guidelines recommend chloroquine (CQ) and primaquine (PQ) for radical cure of uncomplicated Plasmodium vivax, but the local efficacy has not been assessed. The impact of cases imported from India on the genetic make-up of the local vivax populations is currently unknown. METHODS Patients over 4 years of age with uncomplicated P. vivax mono-infection were enrolled into a clinical efficacy study and molecular survey. Study participants received a standard dose of CQ (25 mg/kg over 3 days) followed by weekly review until day 28. On day 28 a 14-day regimen of PQ (0.25 mg/kg/day) was commenced under direct observation. After day 42, patients were followed up monthly for a year. The primary and secondary endpoints were risk of treatment failure at day 28 and at 1 year. Parasite genotyping was undertaken at nine tandem repeat markers, and standard population genetic metrics were applied to examine population diversity and structure in infections thought to be acquired inside or outside of Bhutan. RESULTS A total of 24 patients were enrolled in the clinical study between April 2013 and October 2015. Eight patients (33.3 %) were lost to follow-up in the first 6 months and another eight patients lost between 6 and 12 months. No (0/24) treatment failures occurred by day 28 and no (0/8) parasitaemia was detected following PQ treatment. Some 95.8 % (23/24) of patients were aparasitaemic by day 2. There were no haemolytic or serious events. Genotyping was undertaken on parasites from 12 autochthonous cases and 16 suspected imported cases. Diversity was high (H E 0.87 and 0.90) in both populations. There was no notable differentiation between the autochthonous and imported populations. CONCLUSIONS CQ and PQ remains effective for radical cure of P. vivax in Bhutan. The genetic analyses indicate that imported infections are sustaining the local vivax population, with concomitant risk of introducing drug-resistant strains.
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Affiliation(s)
- Sonam Wangchuk
- Public Health Laboratory, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - Tobgyel Drukpa
- Vector Borne Disease Control Programme in Gelephu, Communicable Disease Division, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - Kinley Penjor
- Sarpang District Hospital, Ministry of Health, Sarpang District, Bhutan
| | - Tashi Peldon
- Gelephu Regional Referral Hospital, Ministry of Health, Gelephu, Bhutan
| | - Yeshey Dorjey
- Yebilaptsa Hospital, Ministry of Health, Zhemgang District, Bhutan
| | - Kunzang Dorji
- Public Health Laboratory, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - Vishal Chhetri
- Gelephu Regional Referral Hospital, Ministry of Health, Gelephu, Bhutan
| | - Hidayat Trimarsanto
- Eijkman Institute for Molecular Biology, Jl. Diponegoro 69, Jakarta Pusat, 10430, Indonesia.,The Ministry of Research and Technology (RISTEK), Jakarta, Indonesia.,Agency for Assessment and Application of Technology, Jl. MH Thamrin 8, Jakarta, 10340, Indonesia
| | - Sheren To
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, 0810, Australia
| | - Amanda Murphy
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, 0810, Australia.,Faculty of Medicine and Biomedical Sciences, School of Population Health, The University of Queensland, Brisbane, Australia
| | - Lorenz von Seidlein
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford Old Road Campus, Oxford, UK
| | - Ric N Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, 0810, Australia.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford Old Road Campus, Oxford, UK
| | - Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, 0810, Australia.
| | - Sarah Auburn
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, 0810, Australia.
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