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Nelwan EJ, Shakinah S, Pasaribu A. Association of G6PD status and haemolytic anaemia in patients receiving anti-malarial agents: a systematic review and meta-analysis. Malar J 2023; 22:77. [PMID: 36872344 PMCID: PMC9985861 DOI: 10.1186/s12936-023-04493-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 02/13/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Some anti-malarial drugs often cause haemolytic anaemia in glucose-6-phosphate-dehydrogenase deficiency (G6PDd) patients. This study aims to analyse the association of G6PDd and anaemia in malaria patients receiving anti-malarial drugs. METHODS A literature search was performed in major database portals. All studies searched using keywords with Medical Subject Headings (MeSH) were included, without date or language restriction. Pooled mean difference of haemoglobin and risk ratio of anaemia were analysed using RevMan. RESULTS Sixteen studies comprising 3474 malaria patients that included 398 (11.5%) with G6PDd were found. Mean difference of haemoglobin in G6PDd/G6PD normal (G6PDn) patients was - 0.16 g/dL (95% CI - 0.48, 0.15; I2 5%, p = 0.39), regardless of the type of malaria and dose of drugs. In particular with primaquine (PQ), mean difference of haemoglobin in G6PDd/G6PDn patients with dose < 0.5 mg/kg/day was - 0.04 (95% CI - 0.35, 0.27; I2 0%, p = 0.69). The risk ratio of developing anaemia in G6PDd patients was 1.02 (95% CI 0.75, 1.38; I2 0%, p = 0.79). CONCLUSION Single or daily standard doses of PQ (0.25 mg/kg/day) and weekly PQ (0.75 mg/kg/week) did not increase the risk of anaemia in G6PDd patients.
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Affiliation(s)
- Erni J Nelwan
- Division of Tropical and Infectious Disease, Internal Medicine Department, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia. .,Division of Tropical and Infectious Disease, Internal Medicine Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
| | - Sharifah Shakinah
- Division of Tropical and Infectious Disease, Internal Medicine Department, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Division of Tropical and Infectious Disease, Internal Medicine Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Adeline Pasaribu
- Division of Tropical and Infectious Disease, Internal Medicine Department, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Division of Tropical and Infectious Disease, Internal Medicine Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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2
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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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3
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Sugiarto SR, Baird JK, Singh B, Elyazar I, Davis TME. The history and current epidemiology of malaria in Kalimantan, Indonesia. Malar J 2022; 21:327. [DOI: 10.1186/s12936-022-04366-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/05/2022] [Indexed: 11/15/2022] Open
Abstract
AbstractKalimantan is a part of Indonesia, which occupies the southern three-quarters of the island of Borneo, sharing a border with the Malaysian states of Sabah and Sarawak. Although most areas of Kalimantan have low and stable transmission of Plasmodium falciparum and Plasmodium vivax, there are relatively high case numbers in the province of East Kalimantan. Two aspects of malaria endemicity in Kalimantan differentiate it from the rest of Indonesia, namely recent deforestation and potential exposure to the zoonotic malaria caused by Plasmodium knowlesi that occurs in relatively large numbers in adjacent Malaysian Borneo. In the present review, the history of malaria and its current epidemiology in Kalimantan are examined, including control and eradication efforts over the past two centuries, mosquito vector prevalence, anti-malarial use and parasite resistance, and the available data from case reports of knowlesi malaria and the presence of conditions which would support transmission of this zoonotic infection.
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Juhairiyah J, Andiarsa D, Indriyati L, Ridha MR, Prasodjo RS, Dhewantara PW. Spatial analysis of malaria in Kotabaru, South Kalimantan, Indonesia: an evaluation to guide elimination strategies. Trans R Soc Trop Med Hyg 2021; 115:500-511. [PMID: 33169161 DOI: 10.1093/trstmh/traa125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/04/2020] [Accepted: 10/19/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Malaria remains a significant public health concern in Indonesia. Knowledge about spatial patterns of the residual malaria hotspots is critical to help design elimination strategies in Kotabaru district, South Kalimantan, Indonesia. METHODS Laboratory-confirmed malaria cases from 2012 to 2016 were analysed to examine the trend in malaria cases. Decomposition analysis was performed to assess seasonality. Annual spatial clustering of the incidence and hotspots were identified by Moran's I and the local indicator for spatial association, respectively. RESULTS The annual parasite incidence of malaria was significantly reduced by 87% from 2012 to 2016. Plasmodium vivax infections were significantly much more prevalent over time, followed by Plasmodium falciparum infections (p<0.001). The monthly seasonality of P. vivax and P. falciparum was distinct. High incidence was spatially clustered identified in the north, west and parts of south Kotabaru. Two persistent and four re-emerging high-risk clusters were identified during the period. Despite the significant reduction in the incidence of malaria, the residual high-risk villages remained clustered in the northern part of Kotabaru. CONCLUSIONS A spatially explicit decision support system is needed to support surveillance and control programs in the identified high-risk areas to succeed in the elimination goal of 2030.
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Affiliation(s)
- Juhairiyah Juhairiyah
- Tanah Bumbu Unit for Health Research and Development, National Institute of Health Research and Development, Jl. Loka Litbang, Komplek Perkantoran Pemerintah Daerah Kabupaten Tanah Bumbu, Tanah Bumbu, South Kalimantan 72171, Indonesia
| | - Dicky Andiarsa
- Tanah Bumbu Unit for Health Research and Development, National Institute of Health Research and Development, Jl. Loka Litbang, Komplek Perkantoran Pemerintah Daerah Kabupaten Tanah Bumbu, Tanah Bumbu, South Kalimantan 72171, Indonesia
| | - Liestiana Indriyati
- Tanah Bumbu Unit for Health Research and Development, National Institute of Health Research and Development, Jl. Loka Litbang, Komplek Perkantoran Pemerintah Daerah Kabupaten Tanah Bumbu, Tanah Bumbu, South Kalimantan 72171, Indonesia
| | - Muhammad Rasyid Ridha
- Tanah Bumbu Unit for Health Research and Development, National Institute of Health Research and Development, Jl. Loka Litbang, Komplek Perkantoran Pemerintah Daerah Kabupaten Tanah Bumbu, Tanah Bumbu, South Kalimantan 72171, Indonesia
| | - Rachmalina Soerachman Prasodjo
- Center for Public Health Research and Development, National Institute of Health Research and Development, Ministry of Health of Indonesia, Jl. Percetakan Negara No. 29, Jakarta 10560, Indonesia
| | - Pandji Wibawa Dhewantara
- Center for Public Health Research and Development, National Institute of Health Research and Development, Ministry of Health of Indonesia, Jl. Percetakan Negara No. 29, Jakarta 10560, Indonesia.,Pangandaran Unit for Health Research and Development, National Institute of Health Research and Development, Ministry of Health of Indonesia, Jl. Raya Pangandaran KM.3 Desa Babakan Kp Kamurang, Pangandaran 46396, West Java, Indonesia
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5
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Wardhani P, Butarbutar TV, Adiatmaja CO, Betaubun AM, Hamidah N, Aryati. Performance comparison of two malaria rapid diagnostic test with real time polymerase chain reaction and gold standard of microscopy detection method. Infect Dis Rep 2020; 12:8731. [PMID: 32874462 PMCID: PMC7447940 DOI: 10.4081/idr.2020.8731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/01/2020] [Indexed: 11/23/2022] Open
Abstract
Background The diagnostic test for malaria is mostly based on Rapid Diagnostic Test (RDT) and detection by microscopy. Polymerase Chain Reaction (PCR) is also a sensitive detection method that can be considered as a diagnostic tool. The outcome of malaria microscopy detection depends on the examiner's ability and experience. Some RDT has been distributed in Indonesia, which needs to be evaluated for their results. Objective This study aimed to compare the performance of RightSign RDT and ScreenPlus RDT for detection of Plasmodium in human blood. We used specific real-time polymerase chain reaction abTESTMMalaria qPCRII) and gold standard of microscopy detection method to measure diagnostic efficiency. Methods Blood specimens were evaluated using RightSign RDT, ScreenPlus RDT, Microscopy detection, and RT-PCR as the protocol described. The differences on specificity (Sp), sensitivity (Sn), positive predictive value (PPV), and negative predictive value (NPV) were analyzed using McNemar and Kruskal Wallis analysis. Results A total of 105 subjects were recruited. Based on microscopy test, RightSign RDT had sensitivity, Specificity, PPV, NPV, 100%, 98%, 98.2%, 100%, respectively. ScreenPlus showed 100% sensitivity, 98% specificity, 98.2% PPV, 100% NPV. The sensitivity of both RDTs became lower (75%) and the specificity higher (100 %) when using real-time PCR. Both RDTs showed a 100% agreement. RTPCR detected higher mix infection when compared to microscopy and RDTs. Conclusion RightSign and ScreenPlus RDT have excellent performance when using microscopy detection as a gold standard. Real-time PCR method can be considered as a confirmation tool for malaria diagnosis.
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Affiliation(s)
- Puspa Wardhani
- Clinical Pathology Department.,Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Trieva Verawaty Butarbutar
- Clinical Pathology Specialist Study Programme, Clinical Pathology Department.,Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Christophorus Oetama Adiatmaja
- Clinical Pathology Specialist Study Programme, Clinical Pathology Department.,Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Amarensi Milka Betaubun
- Clinical Pathology Subspecialist Study Programme, Clinical Pathology Department, Faculty of Medicine.,Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Nur Hamidah
- Science and Technology Faculty, C Campus, Universitas Airlangga
| | - Aryati
- Clinical Pathology Department.,Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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Sulistyaningrum N, Arlinda D, Hutagalung J, Sunarno S, Oktoberia IS, Handayani S, Ekowatiningsih R, Yusnita EA, Prasetyorini B, Rizki A, Tjitra E, Na-Bangchang K, Chaijaroenkul W. Prevalence of Glucose 6-Phosphate Dehydrogenase Variants in Malaria-Endemic Areas of South Central Timor, Eastern Indonesia. Am J Trop Med Hyg 2020; 103:760-766. [PMID: 32602432 DOI: 10.4269/ajtmh.19-0780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Primaquine is an effective anti-hypnozoite drug for Plasmodium vivax and Plasmodium ovale. However, it can trigger erythrocyte hemolysis in people with glucose 6-phosphate dehydrogenase (G6PD) deficiency. In a previous report from South Central Timor (SCT), Indonesia, we described the prevalence of Vanua Lava, Chatham, and Viangchan variants; in this study, other G6PD variants (Kaiping, Coimbra, Gaohe, Canton, and Mahidol) were subsequently analyzed. For clarity, all of these results are described together. The 381 DNA samples from the previous study during 2013-2014 were analyzed for G6PD variants by using PCR-restriction fragment length polymorphism (RFLP). The prevalence of G6PD deficiency in SCT was 6.3% (24/381 cases), including 4.2% (16/381 cases), 0.5% (2/381 cases), and 1.6% (6/381 cases) for Coimbra, Kaiping, and Vanua Lava variants, respectively. No other variants were found in this population. A significant association was found between ethnicity and the distribution of G6PD Kaiping in female subjects. A positive association was shown between G6PD activity and heterozygous females carrying Coimbra genotype, hemizygous males carrying Vanua Lava, Plasmodium falciparum infection in female subjects, and P. vivax infection in male subjects. Further molecular analysis of heterozygous females, particularly in malaria-endemic areas, is needed for mapping distribution of G6PD deficiency status in Indonesia.
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Affiliation(s)
- Novi Sulistyaningrum
- National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia.,Chulabhorn International College of Medicine (CICM), Thammasat University (Rangsit Campus), Patum Thani, Thailand
| | - Dona Arlinda
- National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia.,Chulabhorn International College of Medicine (CICM), Thammasat University (Rangsit Campus), Patum Thani, Thailand
| | - Jontari Hutagalung
- National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
| | - Sunarno Sunarno
- National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
| | - Intan Sari Oktoberia
- National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
| | - Sarwo Handayani
- National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
| | - Riyanti Ekowatiningsih
- National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
| | - Endah Ariyanti Yusnita
- National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
| | - Budi Prasetyorini
- National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
| | - Aulia Rizki
- National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
| | | | - Kesara Na-Bangchang
- Chulabhorn International College of Medicine (CICM), Thammasat University (Rangsit Campus), Patum Thani, Thailand
| | - Wanna Chaijaroenkul
- Chulabhorn International College of Medicine (CICM), Thammasat University (Rangsit Campus), Patum Thani, Thailand
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Lee J, Ryu JS. Current Status of Parasite Infections in Indonesia: A Literature Review. THE KOREAN JOURNAL OF PARASITOLOGY 2019; 57:329-339. [PMID: 31533400 PMCID: PMC6753303 DOI: 10.3347/kjp.2019.57.4.329] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 12/26/2022]
Abstract
Indonesia and South Korea have become inseparable in various respects since the 2 countries established diplomatic relation in 1973. Indonesia is a tropical region that stretches across the equator, comprised of 5 main islands (Java, Kalimantan, Sumatra, Sulawesi, and Papua) and 4 archipelagoes (Riau, Bangka Belitung, Nusa Tenggara, and Maluku). As most population of Eastern Indonesia (Sulawesi, Papua and Nusa Tenggara & Maluku) live in poor areas, it is expected that there will be many parasites. Nevertheless, little is known about the status of parasites in Indonesia. This study examines the prevalences of malaria and lymphatic filaria, which are prevalent in Indonesia, as well as those of soil-transmitted-helminths (STH). As a result, the Plasmodium falciparum and P. vivax case loads are almost equal. The current prevalence of P. vivax is uniformly low (<5%) in all age groups and annual parasite incidence (API) showed decreasing tendency as 0.84 per 1,000 population in 2016. However, more than 65 million people still live in malaria epidemic regions. Lymphatic filariasis remains an important public health problem and 236 cities were classified as endemic areas in 514 cities/districts in 2017. It is difficult to ascertain the current prevalence rate of STH in Indonesia, although West Sumba and Southwest Sumba in East Nusa Tenggara reported prevalence rate of more than 20%. The study also considers the (sero) prevalences of other parasites identified in Indonesia. This report should be useful not only to parasitologists but also to travelers and people with business in Indonesia.
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Affiliation(s)
- Juyoung Lee
- Department of Malay-Indonesian Interpretation and Translation, Hankuk University of Foreign Studies, Yongin 17035, Korea
| | - Jae-Sook Ryu
- Department of Environmental Biology and Medical Parasitology, Hanyang University College of Medicine, Seoul 04763, Korea
- Department of Biomedical Science, Graduate School of Biomedical Science & Engineering, Seoul 04763, Korea
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Wongsrichanalai C, Kurdova-Mintcheva R, Palmer K. Current Malaria Situation in Asia-Oceania. METHODS IN MOLECULAR BIOLOGY (CLIFTON, N.J.) 2019; 2013:45-56. [PMID: 31267492 DOI: 10.1007/978-1-4939-9550-9_3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Asia-Oceania is a diverse region that comprises roughly 65% of the global population at risk for malaria. In 2016 WHO estimated the number of malaria cases across the Asia-Oceania to be 17 million, which is only a small part (8%) of the total global malaria burden, and the number of cases is shrinking rapidly. Most countries have brought their cases down to the point where elimination is in sight. Plasmodium vivax (P. vivax) is becoming the dominant malaria species in many of those countries, where malaria occurs in hot spots of transmission frequently along international borders. The challenge is now to concentrate on those areas. This chapter reviews the situation in various areas of the Region and focuses on a number of important issues, including the prevalence of P. vivax and drug-resistant malaria.
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Affiliation(s)
| | | | - Kevin Palmer
- Department of Tropical Medicine and Pharmacology, John A. Burns School of Medicine, Honolulu, HI, USA
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Rijal KR, Adhikari B, Ghimire P, Banjara MR, Hanboonkunupakarn B, Imwong M, Chotivanich K, Ceintury KP, Lal BK, Das Thakur G, Day NPJ, White NJ, Pukrittayakamee S. Epidemiology of Plasmodium vivax Malaria Infection in Nepal. Am J Trop Med Hyg 2018; 99:680-687. [PMID: 30014810 PMCID: PMC6169153 DOI: 10.4269/ajtmh.18-0373] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/04/2018] [Indexed: 01/10/2023] Open
Abstract
Malaria is endemic in the southern plain of Nepal which shares a porous border with India. More than 80% cases of malaria in Nepal are caused by Plasmodium vivax. The main objective of this study was to review the epidemiology of P. vivax malaria infections as recorded by the national malaria control program of Nepal between 1963 and 2016. National malaria data were retrieved from the National Malaria program in the Ministry of Health, Government of Nepal. The epidemiological trends and malariometric indicators were analyzed. Vivax malaria has predominated over falciparum malaria in the past 53 years, with P. vivax malaria comprising 70-95% of the annual malaria infections. In 1985, a malaria epidemic occurred with 42,321 cases (82% P. vivax and 17% Plasmodium falciparum). Nepal had experienced further outbreaks of malaria in 1991 and 2002. Plasmodium falciparum cases increased from 2005 to 2010 but since then declined. Analyzing the overall trend between 2002 (12,786 cases) until 2016 (1,009 cases) shows a case reduction by 92%. The proportion of imported malaria cases has increased from 18% of cases in 2001 to 50% in 2016. The current trends of malariometric indices indicate that Nepal is making a significant progress toward achieving the goal of malaria elimination by 2025. Most of the cases are caused by P. vivax with imported malaria comprising an increasing proportion of cases. The malaria control program in Nepal needs to counter importation of malaria at high risk areas with collaborative cross border malaria control activities.
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Affiliation(s)
- Komal Raj Rijal
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Topical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Borimas Hanboonkunupakarn
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Topical Medicine, Mahidol University, Bangkok, Thailand
| | - Mallika Imwong
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Topical Medicine, Mahidol University, Bangkok, Thailand
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kesinee Chotivanich
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Topical Medicine, Mahidol University, Bangkok, Thailand
| | - Kedar Prasad Ceintury
- Epidemiology and Diseases Control Division (EDCD), Department of Health Service, Ministry of Health and Population, Teku, Kathmandu, Nepal
| | - Bibek Kumar Lal
- Epidemiology and Diseases Control Division (EDCD), Department of Health Service, Ministry of Health and Population, Teku, Kathmandu, Nepal
| | - Garib Das Thakur
- Epidemiology and Diseases Control Division (EDCD), Department of Health Service, Ministry of Health and Population, Teku, Kathmandu, Nepal
| | - Nicholas P. J. Day
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Topical Medicine, Mahidol University, Bangkok, Thailand
- 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 Topical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Sasithon Pukrittayakamee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Topical Medicine, Mahidol University, Bangkok, Thailand
- The Royal Institute, Grand Palace, Bangkok, Thailand
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Fukuda MM, Krudsood S, Mohamed K, Green JA, Warrasak S, Noedl H, Euswas A, Ittiverakul M, Buathong N, Sriwichai S, Miller RS, Ohrt C. A randomized, double-blind, active-control trial to evaluate the efficacy and safety of a three day course of tafenoquine monotherapy for the treatment of Plasmodium vivax malaria. PLoS One 2017; 12:e0187376. [PMID: 29121061 PMCID: PMC5679603 DOI: 10.1371/journal.pone.0187376] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/09/2017] [Indexed: 12/19/2022] Open
Abstract
Background Tafenoquine is an investigational 8-aminoquinoline for the prevention of Plasmodium vivax relapse. Tafenoquine has a long half-life and the potential for more convenient dosing, compared with the currently recommended 14-day primaquine regimen. Methods This randomized, active-control, double-blind trial was conducted in Bangkok, Thailand. Seventy patients with microscopically confirmed P. vivax were randomized (2:1) to tafenoquine 400 mg once daily for 3 days or 2500 mg total dose chloroquine phosphate (1500 mg chloroquine base) given over 3 days plus primaquine 15 mg daily for 14 days. Patients were followed to day 120. Results Day 28 adequate clinical response rate in the per-protocol population was 93% (40/43) (90%CI 83–98%) with tafenoquine, and 100% (22/22) (90%CI 87–100%) with chloroquine/primaquine. Day 120 relapse prevention was 100% (35/35) with tafenoquine (90%CI 92–100%), and 95% (19/20) (90%CI 78–100%) with chloroquine/primaquine. Mean (SD) parasite, gametocyte and fever clearance times with tafenoquine were 82.5 h (32.3), 49.1 h (33.0), and 41.1 h (31.4) versus 40.0 h (15.7), 22.7 h (16.4), and 24.7 h (17.7) with chloroquine/primaquine, respectively. Peak methemoglobin was 1.4–25.6% (median 7.4%, mean 9.1%) in the tafenoquine arm, and 0.5–5.9% (median 1.5%, mean 1.9%) in the chloroquine/primaquine arm. There were no clinical symptoms of methemoglobinemia in any patient. Discussion Although there was no difference in efficacy in this study, the slow rate of parasite, gametocyte and fever clearance indicates that tafenoquine should not be used as monotherapy for radical cure of P. vivax malaria. Also, monotherapy increases the potential risk of resistance developing to this long-acting agent. Clinical trials of single-dose tafenoquine 300 mg combined with standard 3-day chloroquine or artemisinin-based combination therapy are ongoing. Trial registration Clinicaltrials.gov NCT01290601
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Affiliation(s)
- Mark M. Fukuda
- Armed Forces Research Institute of Medical Science, Bangkok, Thailand
- * E-mail:
| | | | - Khadeeja Mohamed
- GlaxoSmithKline Research and Development, Uxbridge, Middlesex, United Kingdom
| | - Justin A. Green
- GlaxoSmithKline Research and Development, Uxbridge, Middlesex, United Kingdom
| | | | - Harald Noedl
- Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - Ataya Euswas
- Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Mali Ittiverakul
- Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - Nillawan Buathong
- Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | | | - R. Scott Miller
- Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - Colin Ohrt
- Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
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