Molecular Evidence of Drug Resistance in Asymptomatic Malaria Infections, Myanmar, 2015

Artemisinin resistance containment in Myanmar was initiated in 2011 after artemisinin-resistant Plasmodium falciparum malaria was reported. Molecular evidence suggests that asymptomatic malaria infections harboring drug resistance genes are present among residents of the Myanmar artemisinin resistance containment zone. This evidence supports efforts to eliminate these hidden infections.

Estimation on local transmission of malaria by serological approach under low transmission setting in Myanmar

Background

As the prevalence of the malaria has been decreasing in many endemic countries including Myanmar, malaria elimination in Greater Mekong Region was targeted not later than 2030. The relevance of molecular and serological tools to identify residual transmission remains to be established in this setting.

Methods

One-year cohort study was conducted and sera samples were collected in every 3 months with active and passive case detection for clinical malaria episodes by RDT, microscopy and molecular method. The sera were used to detect the malaria antibody against PfMSP1-19, PvAMA1, PvDBPII and PvMSP1-19 by protein microarray.

Results

Among the recruited 1182 participants, there was no RDT positive case for malaria infection although two vivax infections were detected by microscopy in initial collection. Molecular methods detected the asymptomatic cases of 28/1182 (2.37%) in first, 5/894 (0.42%) in second, 12/944 (1.02%) in third, 6/889 (0.51%) in fourth collection, respectively. Seropositivity rates against the PfMSP1-19, PvMSP1-19, PvAMA1 and PvDBPII were 73/270 (27.0%), 85/270 (31.5%), 65/270 (24.1%) and 160/270 (59.3%), respectively. PfMSP1-19 and PvMSP1-19 showed high and stable antigenicity in acute and subacute samples but declining in 1-year history samples. No cross reactivity of PfMSP1-19 and PvMSP1-19 between the two species and higher seropositivity among the asymptomatic carriers were observed. Mapping data indicated serological surveillance can detect the geographical pattern of malaria infection under low transmission setting.

Conclusions

These findings support that PfMSP1-19 and PvMSP1-19 are suggested for serosurveillance of the malaria especially in low transmission setting for further necessary actions have to be carried out to eliminate the malaria.

Use of foldback analysis to foster consolidation between academic and public health practice

INTRODUCTION

Departments of health can provide applied settings for students from academic public health programs to explore the connection of course work to real-life circumstances. Barriers exist for public health practitioners, however, that restrict their willingness to engage in joint efforts with academe. To address these barriers, they must be identified and characterized. That is, it is important for academics in public health to respect both barrier-issues and to understand underlying value constructs, if they hope to employ public health practice settings to advance their students' training.

METHODS

A 100% sample of all midmanagers was surveyed at the Hawaii Department of Health by the School of Public Health. Nine clusters of "key issues for continued collaboration" were identified and rank-ordered in importance. Further analysis of the rank-orders, using multidimensional scaling, distinguished important underlying value constructs crucial to improving joint activities between the school and department.

RESULTS

Working together, representatives from the Department and School identified the first three value dimensions as cooperation, implying the need for true reciprocal and equal interaction; obligation, signifying mutual responsibility and parallel investment; and, professional practice, suggesting the balanced interdigitation of research with practice. These value dimensions account for three fifths (58%) of the variance in opinion.

CONCLUSIONS

Detailed analysis of these dimensions suggests that low-cost strategies improve collaboration, and foster possible consolidation, between academic and clinical public health settings. A stronger partnership between the school and the department is likely, provided the two agencies can address these issues satisfactorily. Insights from the Hawaii experience may prove useful to other academic public health practice settings. Recommendations that may improve collaboration include holding joint semi-annual meetings, a school bulletin board listing practica at the department, a public health leadership course, improved electronic communications between the school and the department, joint appointments to the two agencies, faculty release time to conduct research to improve practices at the department, and the establishment of a steering committee for the collaboration.