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Pava Z, Puspitasari AM, Rumaseb A, Handayuni I, Trianty L, Utami RAS, Tirta YK, Burdam F, Kenangalem E, Wirjanata G, Kho S, Trimarsanto H, Anstey NM, Poespoprodjo JR, Noviyanti R, Price RN, Marfurt J, Auburn S. Molecular surveillance over 14 years confirms reduction of Plasmodium vivax and falciparum transmission after implementation of Artemisinin-based combination therapy in Papua, Indonesia. PLoS Negl Trop Dis 2020; 14:e0008295. [PMID: 32379762 PMCID: PMC7237043 DOI: 10.1371/journal.pntd.0008295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 05/19/2020] [Accepted: 04/15/2020] [Indexed: 01/13/2023] Open
Abstract
Genetic epidemiology can provide important insights into parasite transmission that can inform public health interventions. The current study compared long-term changes in the genetic diversity and structure of co-endemic Plasmodium falciparum and P. vivax populations. The study was conducted in Papua Indonesia, where high-grade chloroquine resistance in P. falciparum and P. vivax led to a universal policy of Artemisinin-based Combination Therapy (ACT) in 2006. Microsatellite typing and population genetic analyses were undertaken on available isolates collected between 2004 and 2017 from patients with uncomplicated malaria (n = 666 P. falciparum and n = 615 P. vivax). The proportion of polyclonal P. falciparum infections fell from 28% (38/135) before policy change (2004-2006) to 18% (22/125) at the end of the study (2015-2017); p<0.001. Over the same period, polyclonal P. vivax infections fell from 67% (80/119) to 35% (33/93); p<0.001. P. falciparum strains persisted for up to 9 years compared to 3 months for P. vivax, reflecting higher rates of outbreeding in the latter. Sub-structure was observed in the P. falciparum population, but not in P. vivax, confirming different patterns of outbreeding. The P. falciparum population exhibited 4 subpopulations that changed in frequency over time. Notably, a sharp rise was observed in the frequency of a minor subpopulation (K2) in the late post-ACT period, accounting for 100% of infections in late 2016-2017. The results confirm epidemiological evidence of reduced P. falciparum and P. vivax transmission over time. The smaller change in P. vivax population structure is consistent with greater outbreeding associated with relapsing infections and highlights the need for radical cure to reduce recurrent infections. The study emphasizes the challenge in disrupting P. vivax transmission and demonstrates the potential of molecular data to inform on the impact of public health interventions.
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Affiliation(s)
- Zuleima Pava
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | | | - Angela Rumaseb
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Irene Handayuni
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Leily Trianty
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | | | | | - Faustina Burdam
- Mimika District Health Authority, Timika, Papua, Indonesia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Enny Kenangalem
- Mimika District Health Authority, Timika, Papua, Indonesia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Grennady Wirjanata
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Steven Kho
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | | | - Nicholas M. Anstey
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Jeanne Rini Poespoprodjo
- Mimika District Health Authority, Timika, Papua, Indonesia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Pediatric Research Office, Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jutta Marfurt
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Sarah Auburn
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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2
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Boyle MJ, Chan JA, Handayuni I, Reiling L, Feng G, Hilton A, Kurtovic L, Oyong D, Piera KA, Barber BE, William T, Eisen DP, Minigo G, Langer C, Drew DR, de Labastida Rivera F, Amante FH, Williams TN, Kinyanjui S, Marsh K, Doolan DL, Engwerda C, Fowkes FJI, Grigg MJ, Mueller I, McCarthy JS, Anstey NM, Beeson JG. IgM in human immunity to Plasmodium falciparum malaria. Sci Adv 2019; 5:eaax4489. [PMID: 31579826 PMCID: PMC6760923 DOI: 10.1126/sciadv.aax4489] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/03/2019] [Indexed: 05/15/2023]
Abstract
Most studies on human immunity to malaria have focused on the roles of immunoglobulin G (IgG), whereas the roles of IgM remain undefined. Analyzing multiple human cohorts to assess the dynamics of malaria-specific IgM during experimentally induced and naturally acquired malaria, we identified IgM activity against blood-stage parasites. We found that merozoite-specific IgM appears rapidly in Plasmodium falciparum infection and is prominent during malaria in children and adults with lifetime exposure, together with IgG. Unexpectedly, IgM persisted for extended periods of time; we found no difference in decay of merozoite-specific IgM over time compared to that of IgG. IgM blocked merozoite invasion of red blood cells in a complement-dependent manner. IgM was also associated with significantly reduced risk of clinical malaria in a longitudinal cohort of children. These findings suggest that merozoite-specific IgM is an important functional and long-lived antibody response targeting blood-stage malaria parasites that contributes to malaria immunity.
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Affiliation(s)
- M. J. Boyle
- Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Corresponding author. (M.J.B.); (J.G.B.)
| | - J. A. Chan
- Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia
| | - I. Handayuni
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - L. Reiling
- Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia
| | - G. Feng
- Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - A. Hilton
- Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia
| | - L. Kurtovic
- Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia
- Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - D. Oyong
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Charles Darwin University, Darwin, Northern Territory, Australia
| | - K. A. Piera
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - B. E. Barber
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - T. William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
- Gleneagles Hospital Kota Kinabalu Sabah, Malaysia
| | - D. P. Eisen
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - G. Minigo
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Charles Darwin University, Darwin, Northern Territory, Australia
| | - C. Langer
- Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia
| | - D. R. Drew
- Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia
| | | | - F. H. Amante
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - T. N. Williams
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Imperial College, London, UK
| | - S. Kinyanjui
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - K. Marsh
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - D. L. Doolan
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - C. Engwerda
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - F. J. I. Fowkes
- Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia
| | - M. J. Grigg
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - I. Mueller
- Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Parasites and Insect Vectors, Institute Pasteur, Paris, France
| | - J. S. McCarthy
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - N. M. Anstey
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Charles Darwin University, Darwin, Northern Territory, Australia
| | - J. G. Beeson
- Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Microbiology and Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Corresponding author. (M.J.B.); (J.G.B.)
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3
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Auburn S, Benavente ED, Miotto O, Pearson RD, Amato R, Grigg MJ, Barber BE, William T, Handayuni I, Marfurt J, Trimarsanto H, Noviyanti R, Sriprawat K, Nosten F, Campino S, Clark TG, Anstey NM, Kwiatkowski DP, Price RN. Genomic analysis of a pre-elimination Malaysian Plasmodium vivax population reveals selective pressures and changing transmission dynamics. Nat Commun 2018; 9:2585. [PMID: 29968722 PMCID: PMC6030216 DOI: 10.1038/s41467-018-04965-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/01/2018] [Indexed: 01/13/2023] Open
Abstract
The incidence of Plasmodium vivax infection has declined markedly in Malaysia over the past decade despite evidence of high-grade chloroquine resistance. Here we investigate the genetic changes in a P. vivax population approaching elimination in 51 isolates from Sabah, Malaysia and compare these with data from 104 isolates from Thailand and 104 isolates from Indonesia. Sabah displays extensive population structure, mirroring that previously seen with the emergence of artemisinin-resistant P. falciparum founder populations in Cambodia. Fifty-four percent of the Sabah isolates have identical genomes, consistent with a rapid clonal expansion. Across Sabah, there is a high prevalence of loci known to be associated with antimalarial drug resistance. Measures of differentiation between the three countries reveal several gene regions under putative selection in Sabah. Our findings highlight important factors pertinent to parasite resurgence and molecular cues that can be used to monitor low-endemic populations at the end stages of P. vivax elimination.
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Affiliation(s)
- Sarah Auburn
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT 0811 Australia ,Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Old Road Campus, Oxford, OX3 7LF UK
| | - Ernest D. Benavente
- 0000 0004 0425 469Xgrid.8991.9Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Olivo Miotto
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Old Road Campus, Oxford, OX3 7LF UK ,0000 0004 0606 5382grid.10306.34Wellcome Trust Sanger Institute, Hinxton Cambridge, CB10 1SA UK ,0000 0004 1937 0490grid.10223.32Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, 10400 Thailand
| | - Richard D. Pearson
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Old Road Campus, Oxford, OX3 7LF UK ,0000 0004 0606 5382grid.10306.34Wellcome Trust Sanger Institute, Hinxton Cambridge, CB10 1SA UK
| | - Roberto Amato
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Old Road Campus, Oxford, OX3 7LF UK ,0000 0004 0606 5382grid.10306.34Wellcome Trust Sanger Institute, Hinxton Cambridge, CB10 1SA UK
| | - Matthew J. Grigg
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT 0811 Australia ,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, 88300 Kota Kinabalu Sabah, Malaysia
| | - Bridget E. Barber
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT 0811 Australia ,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, 88300 Kota Kinabalu Sabah, Malaysia
| | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, 88300 Kota Kinabalu Sabah, Malaysia ,0000 0004 1772 8727grid.415560.3Clinical Research Centre, Queen Elizabeth Hospital, 88300 Kota Kinabalu Sabah, Malaysia ,Jesselton Medical Centre, 88300 Kota Kinabalu Sabah, Malaysia
| | - Irene Handayuni
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT 0811 Australia
| | - Jutta Marfurt
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT 0811 Australia
| | - Hidayat Trimarsanto
- 0000 0004 1795 0993grid.418754.bEijkman Institute for Molecular Biology, Jakarta, 10430 Indonesia ,0000 0001 0746 0534grid.432292.cAgency for Assessment and Application of Technology, Jl. MH Thamrin 8, Jakarta, 10340 Indonesia
| | - Rintis Noviyanti
- 0000 0004 1795 0993grid.418754.bEijkman Institute for Molecular Biology, Jakarta, 10430 Indonesia
| | - Kanlaya Sriprawat
- 0000 0004 1937 0490grid.10223.32Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot Tak, 63110 Thailand
| | - Francois Nosten
- 0000 0004 1937 0490grid.10223.32Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot Tak, 63110 Thailand ,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine Research Building, University of Oxford Old Road Campus, Oxford, OX3 7LJ UK
| | - Susana Campino
- 0000 0004 0425 469Xgrid.8991.9Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Taane G. Clark
- 0000 0004 0425 469Xgrid.8991.9Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK ,0000 0004 0425 469Xgrid.8991.9Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Nicholas M. Anstey
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT 0811 Australia
| | - Dominic P. Kwiatkowski
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Old Road Campus, Oxford, OX3 7LF UK ,0000 0004 0606 5382grid.10306.34Wellcome Trust Sanger Institute, Hinxton Cambridge, CB10 1SA UK
| | - Ric N. Price
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT 0811 Australia ,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine Research Building, University of Oxford Old Road Campus, Oxford, OX3 7LJ UK
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4
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Pava Z, Handayuni I, Trianty L, Utami RAS, Tirta YK, Puspitasari AM, Burdam F, Kenangalem E, Wirjanata G, Kho S, Trimarsanto H, Anstey N, Poespoprodjo JR, Noviyanti R, Price RN, Marfurt J, Auburn S. Passively versus Actively Detected Malaria: Similar Genetic Diversity but Different Complexity of Infection. Am J Trop Med Hyg 2017; 97:1788-1796. [PMID: 29016343 PMCID: PMC5790166 DOI: 10.4269/ajtmh.17-0364] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The surveillance of malaria is generally undertaken on the assumption that samples passively collected at health facilities are comparable to or representative of the broader Plasmodium reservoir circulating in the community. Further characterization and comparability of the hidden asymptomatic parasite reservoir are needed to inform on the potential impact of sampling bias. This study explores the impact of sampling strategy on molecular surveillance by comparing the genetic make-up of Plasmodium falciparum and Plasmodium vivax isolates collected by passive versus active case detection. Sympatric isolates of P. falciparum and P. vivax were collected from a large community survey and ongoing clinical surveillance studies undertaken in the hypomesoendemic setting of Mimika District (Papua, Indonesia). Plasmodium falciparum isolates were genotyped at nine microsatellite loci and P. vivax at eight loci. Measures of diversity and differentiation were used to compare different patient and parasitological sample groups. The results demonstrated that passively detected cases (symptomatic) had comparable population diversity to those circulating in the community (asymptomatic) in both species. In addition, asymptomatic patent infections were as diverse as subpatent infections. However, a significant difference in multiplicity of infection (MOI) and percentage of polyclonal infections was observed between actively and passively detected P. vivax cases (mean MOI: 1.7 ± 0.7 versus 1.4 ± 1.4, respectively; P = 0.001). The study findings infer that, in hypomesoendemic settings, passive sampling is appropriate for molecular parasite surveillance strategies using the predominant clone in any given infection; however, the findings suggest caution when analyzing complexity of infection. Further evaluation is required in other endemic settings.
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Affiliation(s)
- Zuleima Pava
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Irene Handayuni
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Leily Trianty
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | | | | | | | - Faustina Burdam
- Mimika District Health Authority, Timika, Papua, Indonesia;,Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia;,Maternal and Child Health and Reproductive Health, Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Enny Kenangalem
- Mimika District Health Authority, Timika, Papua, Indonesia;,Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Grennady Wirjanata
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Steven Kho
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | - Nicholas Anstey
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jeanne Rini Poespoprodjo
- Mimika District Health Authority, Timika, Papua, Indonesia;,Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia;,Maternal and Child Health and Reproductive Health, Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - 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
| | - Jutta Marfurt
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Sarah Auburn
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia;,Address correspondence to Sarah Auburn, Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811, Australia. E-mail:
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5
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Htun MW, Mon NCN, Aye KM, Hlaing CM, Kyaw MP, Handayuni I, Trimarsanto H, Bustos D, Ringwald P, Price RN, Auburn S, Thriemer K. Chloroquine efficacy for Plasmodium vivax in Myanmar in populations with high genetic diversity and moderate parasite gene flow. Malar J 2017; 16:281. [PMID: 28693552 PMCID: PMC5504659 DOI: 10.1186/s12936-017-1912-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 06/26/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Plasmodium vivax malaria remains a major public health burden in Myanmar. Resistance to chloroquine (CQ), the first-line treatment for P. vivax, has been reported in the country and has potential to undermine local control efforts. METHODS Patients over 6 years of age with uncomplicated P. vivax mono-infection were enrolled into clinical efficacy studies in Myawaddy in 2014 and Kawthoung in 2012. Study participants received a standard dose of CQ (25 mg/kg over 3 days) followed by weekly review until day 28. Pvmdr1 copy number (CN) and microsatellite diversity were assessed on samples from the patients enrolled in the clinical study and additional cross-sectional surveys undertaken in Myawaddy and Shwegyin in 2012. RESULTS A total of 85 patients were enrolled in the CQ clinical studies, 25 in Myawaddy and 60 in Kawthoung. One patient in Myawaddy (1.2%) had an early treatment failure and two patients (2.3%) in Kawthoung presented with late treatment failures on day 28. The day 28 efficacy was 92.0% (95% CI 71.6-97.9) in Myawaddy and 98.3% (95% CI 88.7-99.8) in Kawthoung. By day 2, 92.2% (23/25) in Myawaddy and 85.0% (51/60) in Kawthoung were aparasitaemic. Genotyping and pvmdr1 CN assessment was undertaken on 43, 52 and 46 clinical isolates from Myawaddy, Kawthoung and Shwegyin respectively. Pvmdr1 amplification was observed in 3.2% (1/31) of isolates in Myawaddy, 0% (0/49) in Kawthoung and 2.5% (1/40) in Shwegyin. Diversity was high in all sites (H E 0.855-0.876), with low inter-population differentiation (F ST 0.016-0.026, P < 0.05). CONCLUSIONS Treatment failures after chloroquine were observed following chloroquine monotherapy, with pvmdr1 amplification present in both Myawaddy and Shwegyin. The results emphasize the importance of ongoing P. vivax drug resistance surveillance in Myanmar, particularly given the potential connectivity between parasite population at different sites.
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Affiliation(s)
- Myo Win Htun
- grid.415741.2Department of Medical Research, Yangon, 11191 Myanmar
| | - Nan Cho Nwe Mon
- grid.415741.2Department of Medical Research, Yangon, 11191 Myanmar
| | - Khin Myo Aye
- grid.415741.2Department of Medical Research, Yangon, 11191 Myanmar
| | - Chan Myae Hlaing
- grid.415741.2Department of Medical Research, Yangon, 11191 Myanmar
| | - Myat Phone Kyaw
- grid.415741.2Department of Medical Research, Yangon, 11191 Myanmar
| | - Irene Handayuni
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT 0810 Australia
| | - Hidayat Trimarsanto
- 0000 0004 1795 0993grid.418754.bEijkman Institute for Molecular Biology, Jl. Diponegoro 69, Central Jakarta, 10430 Indonesia ,grid.466915.9The Ministry of Research and Technology (RISTEK), Jakarta, Indonesia ,0000 0001 0746 0534grid.432292.cAgency for Assessment and Application of Technology, Jl. MH Thamrin 8, Jakarta, 10340 Indonesia
| | - Dorina Bustos
- 0000 0004 0576 2573grid.415836.dWorld Health Organization, Country Office for Thailand, Ministry of Public Health, Nonthaburi, Thailand
| | - Pascal Ringwald
- 0000000121633745grid.3575.4Global Malaria Programme, World Health Organization, 20 Avenue Appia, 1211 Geneva, 27, Switzerland
| | - Ric N. Price
- 0000 0000 8523 7955grid.271089.5Global 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
| | - Sarah Auburn
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT 0810 Australia
| | - Kamala Thriemer
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT 0810 Australia
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6
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Pava Z, Noviyanti R, Handayuni I, Trimarsanto H, Trianty L, Burdam FH, Kenangalem E, Utami RAS, Tirta YK, Coutrier F, Poespoprodjo JR, Price RN, Marfurt J, Auburn S. Genetic micro-epidemiology of malaria in Papua Indonesia: Extensive P. vivax diversity and a distinct subpopulation of asymptomatic P. falciparum infections. PLoS One 2017; 12:e0177445. [PMID: 28498860 PMCID: PMC5428948 DOI: 10.1371/journal.pone.0177445] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/27/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Genetic analyses of Plasmodium have potential to inform on transmission dynamics, but few studies have evaluated this on a local spatial scale. We used microsatellite genotyping to characterise the micro-epidemiology of P. vivax and P. falciparum diversity to inform malaria control strategies in Timika, Papua Indonesia. METHODS Genotyping was undertaken on 713 sympatric P. falciparum and P. vivax isolates from a cross-sectional household survey and clinical studies conducted in Timika. Standard population genetic measures were applied, and the data was compared to published data from Kalimantan, Bangka, Sumba and West Timor. RESULTS Higher diversity (HE = 0.847 vs 0.625; p = 0.017) and polyclonality (46.2% vs 16.5%, p<0.001) were observed in P. vivax versus P. falciparum. Distinct P. falciparum substructure was observed, with two subpopulations, K1 and K2. K1 was comprised solely of asymptomatic infections and displayed greater relatedness to isolates from Sumba than to K2, possibly reflecting imported infections. CONCLUSIONS The results demonstrate the greater refractoriness of P. vivax versus P. falciparum to control measures, and risk of distinct parasite subpopulations persisting in the community undetected by passive surveillance. These findings highlight the need for complimentary new surveillance strategies to identify transmission patterns that cannot be detected with traditional malariometric methods.
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Affiliation(s)
- Zuleima Pava
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Rintis Noviyanti
- Malaria Pathogenesis Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Irene Handayuni
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Hidayat Trimarsanto
- Bioinformatics Laboratory, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
- Agency for Assessment and Application of Technology, Jakarta, Indonesia
| | - Leily Trianty
- Malaria Pathogenesis Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Faustina H. Burdam
- Mimika District Health Authority, Timika, Papua, Indonesia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Pediatric Research Office, Department of Child Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Enny Kenangalem
- Mimika District Health Authority, Timika, Papua, Indonesia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Retno A. S. Utami
- Malaria Pathogenesis Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Yusrifar K. Tirta
- Malaria Pathogenesis Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Farah Coutrier
- Malaria Pathogenesis Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Jeanne R. Poespoprodjo
- Mimika District Health Authority, Timika, Papua, Indonesia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Pediatric Research Office, Department of Child Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Jutta Marfurt
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Sarah Auburn
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- * E-mail:
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Hamedi Y, Sharifi-Sarasiabi K, Dehghan F, Safari R, To S, Handayuni I, Trimarsanto H, Price RN, Auburn S. Molecular Epidemiology of P. vivax in Iran: High Diversity and Complex Sub-Structure Using Neutral Markers, but No Evidence of Y976F Mutation at pvmdr1. PLoS One 2016; 11:e0166124. [PMID: 27829067 PMCID: PMC5102416 DOI: 10.1371/journal.pone.0166124] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/24/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Malaria remains endemic at low levels in the south-eastern provinces of Iran bordering Afghanistan and Pakistan, with the majority of cases attributable to P. vivax. The national guidelines recommend chloroquine (CQ) as blood-stage treatment for uncomplicated P. vivax, but the large influx of imported cases enhances the risk of introducing CQ resistance (CQR). METHODOLOGY AND PRINCIPAL FINDINGS The genetic diversity at pvmdr1, a putative modulator of CQR, and across nine putatively neutral short tandem repeat (STR) markers were assessed in P. vivax clinical isolates collected between April 2007 and January 2013 in Hormozgan Province, south-eastern Iran. One hundred blood samples were collected from patients with microscopy-confirmed P. vivax enrolled at one of five district clinics. In total 73 (73%) were autochthonous cases, 23 (23%) imported cases from Afghanistan or Pakistan, and 4 (4%) with unknown origin. 97% (97/100) isolates carried the F1076L mutation, but none carried the Y976F mutation. STR genotyping was successful in 71 (71%) isolates, including 57(57%) autochthonous and 11 (11%) imported cases. Analysis of population structure revealed 2 major sub-populations, K1 and K2, with further sub-structure within K2. The K1 sub-population had markedly lower diversity than K2 (HE = 0.06 vs HE = 0.82) suggesting that the sub-populations were sustained by distinct reservoirs with differing transmission dynamics, possibly reflecting local versus imported/introduced populations. No notable separation was observed between the local and imported cases although the sample size was limited. CONCLUSIONS The contrasting low versus high diversity in the two sub-populations (K1 and K2) infers that a combination of local transmission and cross-border malaria from higher transmission regions shape the genetic make-up of the P. vivax population in south-eastern Iran. There was no molecular evidence of CQR amongst the local or imported cases, but ongoing clinical surveillance is warranted.
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Affiliation(s)
- Yaghoob Hamedi
- Infectious and Tropical Diseases Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Hormozgan Province, Iran
| | - Khojasteh Sharifi-Sarasiabi
- Infectious and Tropical Diseases Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Hormozgan Province, Iran
| | - Farzaneh Dehghan
- Molecular Medicine Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Hormozgan Province, Iran
| | - Reza Safari
- Hormozgan University of Medical Sciences, Bandar Abbas, Hormozgan Province, Iran
| | - Sheren To
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Irene Handayuni
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Hidayat Trimarsanto
- Bioinformatics Laboratory, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
- The Ministry of Research and Technology (RISTEK), Jakarta, Indonesia
- Agency for Assessment and Application of Technology, Jakarta, Indonesia
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research and 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
| | - Sarah Auburn
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
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Pava Z, Burdam FH, Handayuni I, Trianty L, Utami RAS, Tirta YK, Kenangalem E, Lampah D, Kusuma A, Wirjanata G, Kho S, Simpson JA, Auburn S, Douglas NM, Noviyanti R, Anstey NM, Poespoprodjo JR, Marfurt J, Price RN. Submicroscopic and Asymptomatic Plasmodium Parasitaemia Associated with Significant Risk of Anaemia in Papua, Indonesia. PLoS One 2016; 11:e0165340. [PMID: 27788243 PMCID: PMC5082812 DOI: 10.1371/journal.pone.0165340] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/10/2016] [Indexed: 11/19/2022] Open
Abstract
Submicroscopic Plasmodium infections are an important parasite reservoir, but their clinical relevance is poorly defined. A cross-sectional household survey was conducted in southern Papua, Indonesia, using cluster random sampling. Data were recorded using a standardized questionnaire. Blood samples were collected for haemoglobin measurement. Plasmodium parasitaemia was determined by blood film microscopy and PCR. Between April and July 2013, 800 households and 2,830 individuals were surveyed. Peripheral parasitaemia was detected in 37.7% (968/2,567) of individuals, 36.8% (357) of whom were identified by blood film examination. Overall the prevalence of P. falciparum parasitaemia was 15.4% (396/2567) and that of P. vivax 18.3% (471/2567). In parasitaemic individuals, submicroscopic infection was significantly more likely in adults (adjusted odds ratio (AOR): 3.82 [95%CI: 2.49-5.86], p<0.001) compared to children, females (AOR = 1.41 [1.07-1.86], p = 0.013), individuals not sleeping under a bednet (AOR = 1.4 [1.0-1.8], p = 0.035), and being afebrile (AOR = 3.2 [1.49-6.93], p = 0.003). The risk of anaemia (according to WHO guidelines) was 32.8% and significantly increased in those with asymptomatic parasitaemia (AOR 2.9 [95% 2.1-4.0], p = 0.007), and submicroscopic P. falciparum infections (AOR 2.5 [95% 1.7-3.6], p = 0.002). Asymptomatic and submicroscopic infections in this area co-endemic for P. falciparum and P. vivax constitute two thirds of detectable parasitaemia and are associated with a high risk of anaemia. Novel public health strategies are needed to detect and eliminate these parasite reservoirs, for the benefit both of the patient and the community.
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Affiliation(s)
- Zuleima Pava
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Faustina H. Burdam
- Mimika District Health Authority, Timika, Papua, Indonesia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Maternal and Child Health and Reproductive Health, Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Irene Handayuni
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Leily Trianty
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | | | | | - Enny Kenangalem
- Mimika District Health Authority, Timika, Papua, Indonesia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Daniel Lampah
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Andreas Kusuma
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Grennady Wirjanata
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Steven Kho
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Julie A. Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Sarah Auburn
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Nicholas M. Douglas
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Division of Medicine, Christchurch Hospital, Christchurch, New Zealand
| | | | - Nicholas M. Anstey
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Jeanne R. Poespoprodjo
- Mimika District Health Authority, Timika, Papua, Indonesia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Maternal and Child Health and Reproductive Health, Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Jutta Marfurt
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, 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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Auburn S, Serre D, Pearson RD, Amato R, Sriprawat K, To S, Handayuni I, Suwanarusk R, Russell B, Drury E, Stalker J, Miotto O, Kwiatkowski DP, Nosten F, Price RN. Genomic Analysis Reveals a Common Breakpoint in Amplifications of the Plasmodium vivax Multidrug Resistance 1 Locus in Thailand. J Infect Dis 2016; 214:1235-42. [PMID: 27456706 PMCID: PMC5034950 DOI: 10.1093/infdis/jiw323] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/20/2016] [Indexed: 01/13/2023] Open
Abstract
In regions of coendemicity for Plasmodium falciparum and Plasmodium vivax where mefloquine is used to treat P. falciparum infection, drug pressure mediated by increased copy numbers of the multidrug resistance 1 gene (pvmdr1) may select for mefloquine-resistant P. vivax Surveillance is not undertaken routinely owing in part to methodological challenges in detection of gene amplification. Using genomic data on 88 P. vivax samples from western Thailand, we identified pvmdr1 amplification in 17 isolates, all exhibiting tandem copies of a 37.6-kilobase pair region with identical breakpoints. A novel breakpoint-specific polymerase chain reaction assay was designed to detect the amplification. The assay demonstrated high sensitivity, identifying amplifications in 13 additional, polyclonal infections. Application to 132 further samples identified the common breakpoint in all years tested (2003-2015), with a decline in prevalence after 2012 corresponding to local discontinuation of mefloquine regimens. Assessment of the structure of pvmdr1 amplification in other geographic regions will yield information about the population-specificity of the breakpoints and underlying amplification mechanisms.
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Affiliation(s)
- Sarah Auburn
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia
| | - David Serre
- Genomic Medicine Institute, Cleveland Clinic Lerner Research institute, Ohio
| | - Richard D. Pearson
- Wellcome Trust Sanger Institute, Hinxton,Wellcome Trust Centre for Human Genetics
| | - Roberto Amato
- Wellcome Trust Sanger Institute, Hinxton,Wellcome Trust Centre for Human Genetics
| | - Kanlaya Sriprawat
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Tak
| | - Sheren To
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia
| | - Irene Handayuni
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia
| | - Rossarin Suwanarusk
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand,Singapore Immunology Network, Agency for Science, Technology and Research, Singapore
| | - Bruce Russell
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | | | | | - Olivo Miotto
- Wellcome Trust Sanger Institute, Hinxton,Medical Research Council Centre for Genomics and Global Health,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Dominic P. Kwiatkowski
- Wellcome Trust Sanger Institute, Hinxton,Wellcome Trust Centre for Human Genetics,Medical Research Council Centre for Genomics and Global Health
| | - Francois Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, United Kingdom,Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Tak
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, United Kingdom
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10
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Burdam FH, Hakimi M, Thio F, Kenangalem E, Indrawanti R, Noviyanti R, Trianty L, Marfurt J, Handayuni I, Soenarto Y, Douglas NM, Anstey NM, Price RN, Poespoprodjo JR. Asymptomatic Vivax and Falciparum Parasitaemia with Helminth Co-Infection: Major Risk Factors for Anaemia in Early Life. PLoS One 2016; 11:e0160917. [PMID: 27504828 PMCID: PMC4978495 DOI: 10.1371/journal.pone.0160917] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/27/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Anaemia in children under five years old is associated with poor health, growth and developmental outcomes. In Papua, Indonesia, where the burden of anaemia in infants is high, we conducted a community survey to assess the association between Plasmodium infection, helminth carriage and the risk of anaemia. METHODS A cross sectional household survey was carried out between April and July 2013 in 16 villages in the District of Mimika using a multistage sampling procedure. A total of 629 children aged 1-59 months from 800 households were included in the study. Demographic, symptom and anthropometry data were recorded using a standardized questionnaire. Blood and stool samples were collected for examination. RESULTS Of the 533 children with blood film examination, 8.8% (47) had P. vivax parasitaemia and 3.9% (21) had P. falciparum; the majority of children with malaria were asymptomatic (94.4%, 68/72). Soil transmitted helminth (STH) infection was present in 43% (105/269) of children assessed; those with STH were at significantly greater risk of P. vivax parasitaemia compared to those without STH (OR = 3.7 [95%CI 1.5-9.2], p = 0.004). Anaemia (Hb<10 g/dl) was present in 24.5% (122/497) of children and associated with P. vivax parasitaemia (OR = 2.9 [95%CI, 1.7-4.9], p = 0.001), P. falciparum parasitaemia (OR = 4.3 [95%CI, 2.0-9.4], p<0.001), hookworm carriage (OR = 2.6 [95%CI, 1.2-5.8], p = 0.026), Plasmodium-helminth coinfection (OR 4.0 [95%CI, 1.4-11.3], p = 0.008) and severe stunting (OR = 1.9 ([95%CI, 1.1-3.3], p = 0.012). CONCLUSIONS Asymptomatic P. vivax and P. falciparum infections and hookworm all contribute to risk of paediatric anaemia in coendemic areas and should be targeted with prevention and treatment programs. The relationship between helminth infections and the increased risk of P. vivax parasitaemia should be explored prospectively.
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Affiliation(s)
- Faustina Helena Burdam
- Mimika District Health Authority, Timika, Papua, Indonesia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Maternal and Child Health and Reproductive Health, Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mohammad Hakimi
- Maternal and Child Health and Reproductive Health, Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Franciscus Thio
- Mimika District Hospital, Timika, Papua, Indonesia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Enny Kenangalem
- Mimika District Health Authority, Timika, Papua, Indonesia
- Mimika District Hospital, Timika, Papua, Indonesia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Ratni Indrawanti
- Department of Child Health, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | | | - Leily Trianty
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Jutta Marfurt
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Irene Handayuni
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Yati Soenarto
- Department of Child Health, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Nicholas M. Douglas
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Nicholas M. Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Ric N. Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Jeanne Rini Poespoprodjo
- Mimika District Hospital, Timika, Papua, Indonesia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Department of Child Health, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
- * E-mail:
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Kho S, Marfurt J, Handayuni I, Pava Z, Noviyanti R, Kusuma A, Piera KA, Burdam FH, Kenangalem E, Lampah DA, Engwerda CR, Poespoprodjo JR, Price RN, Anstey NM, Minigo G, Woodberry T. Characterization of blood dendritic and regulatory T cells in asymptomatic adults with sub-microscopic Plasmodium falciparum or Plasmodium vivax infection. Malar J 2016; 15:328. [PMID: 27328659 PMCID: PMC4915178 DOI: 10.1186/s12936-016-1382-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/10/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Plasmodium falciparum and Plasmodium vivax infections compromise dendritic cell (DC) function and expand regulatory T (Treg) cells in both clinical disease (malaria) and experimental human sub-microscopic infection. Conversely, in asymptomatic microscopy-positive (patent) P. falciparum or P. vivax infection in endemic areas, blood DC increase or retain HLA-DR expression and Treg cells exhibit reduced activation, suggesting that DC and Treg cells contribute to the control of patent asymptomatic infection. The effect of sub-microscopic (sub-patent) asymptomatic Plasmodium infection on DC and Treg cells in malaria-endemic area residents remains unclear. METHODS In a cross-sectional household survey conducted in Papua, Indonesia, 162 asymptomatic adults were prospectively evaluated for DC and Treg cells using field-based flow cytometry. Of these, 161 individuals (99 %) were assessed retrospectively by polymerase chain reaction (PCR), 19 of whom had sub-microscopic infection with P. falciparum and 15 with sub-microscopic P. vivax infection. Flow cytometric data were re-analysed after re-grouping asymptomatic individuals according to PCR results into negative controls, sub-microscopic and microscopic parasitaemia to examine DC and Treg cell phenotype in sub-microscopic infection. RESULTS Asymptomatic adults with sub-microscopic P. falciparum or P. vivax infection had DC HLA-DR expression and Treg cell activation comparable to PCR-negative controls. Sub-microscopic P. falciparum infection was associated with lower peripheral CD4(+) T cells and lymphocytes, however sub-microscopic Plasmodium infection had no apparent effect on DC sub-set number or Treg cell frequency. CONCLUSIONS In contrast to the impairment of DC maturation/function and the activation of Treg cells seen with sub-microscopic parasitaemia in primary experimental human Plasmodium infection, no phenotypic evidence of dysregulation of DC and Treg cells was observed in asymptomatic sub-microscopic Plasmodium infection in Indonesian adults. This is consistent with DC and Treg cells retaining their functional capacity in sub-microscopic asymptomatic infection with P. falciparum or P. vivax in malaria-endemic areas.
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Affiliation(s)
- Steven Kho
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
| | - Jutta Marfurt
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Irene Handayuni
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Zuleima Pava
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | | | - Andreas Kusuma
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Kim A Piera
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Faustina H Burdam
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Enny Kenangalem
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia.,Rumah Sakit Umum Daerah Kabupaten Mimika, Timika, Papua, Indonesia
| | - Daniel A Lampah
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | | | - Jeanne R Poespoprodjo
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Papua, Indonesia.,Rumah Sakit Umum Daerah Kabupaten Mimika, Timika, Papua, Indonesia.,Department of Paediatrics, University of Gadjah Mada, Yogyakarta, Indonesia
| | - Ric N Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Gabriela Minigo
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Tonia Woodberry
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
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12
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Wirjanata G, Handayuni I, Zaloumis SG, Chalfein F, Prayoga P, Kenangalem E, Poespoprodjo JR, Noviyanti R, Simpson JA, Price RN, Marfurt J. Analysis of ex vivo drug response data of Plasmodium clinical isolates: the pros and cons of different computer programs and online platforms. Malar J 2016; 15:137. [PMID: 26935745 PMCID: PMC4776429 DOI: 10.1186/s12936-016-1173-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 02/17/2016] [Indexed: 11/30/2022] Open
Abstract
Background In vitro drug susceptibility testing of malaria parasites remains an important component of surveillance for anti-malarial drug resistance. The half-maximal inhibition of growth (IC50) is the most commonly reported parameter expressing drug susceptibility, derived by a variety of statistical approaches, each with its own advantages and disadvantages. Methods In this study, licensed computer programs WinNonlin and GraphPad Prism 6.0, and the open access programs HN-NonLin, Antimalarial ICEstimator (ICE), and In Vitro Analysis and Reporting Tool (IVART) were tested for their ease of use and ability to estimate reliable IC50 values from raw drug response data from 31 Plasmodium falciparum and 29 P. vivax clinical isolates tested with five anti-malarial agents: chloroquine, amodiaquine, piperaquine, mefloquine, and artesunate. Results The IC50 and slope estimates were similar across all statistical packages for all drugs tested in both species. There was good correlation of results derived from alternative statistical programs and non-linear mixed-effects modelling (NONMEM) which models all isolate data simultaneously. The user-friendliness varied between packages. While HN-NonLin and IVART allow users to enter the data in 96-well format, IVART and GraphPad Prism 6.0 are capable to analyse multiple isolates and drugs in parallel. WinNonlin, GraphPad Prism 6.0, IVART, and ICE provide alerts for non-fitting data and incorrect data entry, facilitating data interpretation. Data analysis using WinNonlin or ICE took the longest computationally, whilst the offline ability of GraphPad Prism 6.0 to analyse multiple isolates and drugs simultaneously made it the fastest among the programs tested. Conclusion IC50 estimates obtained from the programs tested were comparable. In view of processing time and ease of analysis, GraphPad Prism 6.0 or IVART are best suited for routine and large-scale drug susceptibility testing. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1173-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Grennady Wirjanata
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia.
| | - Irene Handayuni
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia.
| | - Sophie G Zaloumis
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Ferryanto Chalfein
- Papuan Health and Community Development Foundation (PHCDF), Timika, Papua, Indonesia.
| | - Pak Prayoga
- Papuan Health and Community Development Foundation (PHCDF), Timika, Papua, Indonesia.
| | - Enny Kenangalem
- Papuan Health and Community Development Foundation (PHCDF), Timika, Papua, Indonesia. .,District Health Authority, Timika, Papua, Indonesia.
| | - Jeanne Rini Poespoprodjo
- Papuan Health and Community Development Foundation (PHCDF), Timika, Papua, Indonesia. .,District Health Authority, Timika, Papua, Indonesia. .,Department of Paediatrics, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
| | - Rintis Noviyanti
- Eijkman Institute for Molecular Biology, Jl. Diponegoro 69, 10430, Jakarta, Indonesia.
| | - Julie A Simpson
- 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, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
| | - Jutta Marfurt
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia.
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Wirjanata G, Handayuni I, Prayoga P, Apriyanti D, Chalfein F, Sebayang BF, Kho S, Noviyanti R, Kenangalem E, Campo B, Poespoprodjo JR, Price RN, Marfurt J. Quantification of Plasmodium ex vivo drug susceptibility by flow cytometry. Malar J 2015; 14:417. [PMID: 26498665 PMCID: PMC4619360 DOI: 10.1186/s12936-015-0940-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The emergence and spread of multidrug-resistant Plasmodium falciparum and Plasmodium vivax highlights the need for objective measures of ex vivo drug susceptibility. Flow cytometry (FC) has potential to provide a robust and rapid quantification of ex vivo parasite growth. METHODS Field isolates from Papua, Indonesia, underwent ex vivo drug susceptibility testing against chloroquine, amodiaquine, piperaquine, mefloquine, and artesunate. A single nucleic acid stain (i.e., hydroethidine (HE) for P. falciparum and SYBR Green I (SG) for P. vivax) was used to quantify infected red blood cells by FC-based signal detection. Data derived by FC were compared to standard quantification by light microscopy (LM). A subset of isolates was used to compare single and double staining techniques. RESULTS In total, 57 P. falciparum and 23 P. vivax field isolates were collected for ex vivo drug susceptibility testing. Reliable paired data between LM and FC was obtained for 88 % (295/334) of these assays. The median difference of derived IC50 values varied from -5.4 to 6.1 nM, associated with 0.83-1.23 fold change in IC50 values between LM and FC. In 15 assays (5.1 %), the derived difference of IC50 estimates was beyond the 95 % limits of agreement; in eleven assays (3.7 %), this was attributable to low parasite growth (final schizont count < 40 %), and in four assays (1.4 %) due to low initial parasitaemia at the start of assay (<2000 µl(-1)). In a subset of seven samples, LM, single and double staining FC techniques generated similar IC50 values. CONCLUSIONS A single staining FC-based assay using a portable cytometer provides a simple, fast and versatile platform for field surveillance of ex vivo drug susceptibility in clinical P. falciparum and P. vivax isolates.
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Affiliation(s)
- Grennady Wirjanata
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, 0811, Darwin, Australia. .,Papuan Health and Community Development Foundation (PHCDF), Timika, Papua, Indonesia.
| | - Irene Handayuni
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, 0811, Darwin, Australia.
| | - Pak Prayoga
- Papuan Health and Community Development Foundation (PHCDF), Timika, Papua, Indonesia.
| | - Dwi Apriyanti
- Eijkman Institute for Molecular Biology, Jl. Diponegoro 69, Jakarta, 10430, Indonesia.
| | - Ferryanto Chalfein
- Papuan Health and Community Development Foundation (PHCDF), Timika, Papua, Indonesia.
| | - Boni F Sebayang
- Eijkman Institute for Molecular Biology, Jl. Diponegoro 69, Jakarta, 10430, Indonesia.
| | - Steven Kho
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, 0811, Darwin, Australia.
| | - Rintis Noviyanti
- Eijkman Institute for Molecular Biology, Jl. Diponegoro 69, Jakarta, 10430, Indonesia.
| | - Enny Kenangalem
- Papuan Health and Community Development Foundation (PHCDF), Timika, Papua, Indonesia. .,District Health Authority, Timika, Papua, Indonesia.
| | - Brice Campo
- Medicines for Malaria Venture (MMV), 20 rte de Pré-Bois, PO Box 1826, 1215, Geneva 15, Switzerland.
| | - Jeanne Rini Poespoprodjo
- Papuan Health and Community Development Foundation (PHCDF), Timika, Papua, Indonesia. .,District Health Authority, Timika, Papua, Indonesia. .,Department of Paediatrics, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
| | - Ric N Price
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, 0811, Darwin, Australia. .,Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
| | - Jutta Marfurt
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, 0811, Darwin, Australia.
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