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Please use this identifier to cite or link to this item: http://repository.li.mahidol.ac.th/dspace/handle/123456789/42080
Title: Safety and effectiveness of mass drug administration to accelerate elimination of artemisinin-resistant falciparum malaria: A pilot trial in four villages of Eastern Myanmar
Authors: Jordi Landier
Ladda Kajeechiwa
May Myo Thwin
Daniel M. Parker
Victor Chaumeau
Jacher Wiladphaingern
Mallika Imwong
Olivo Miotto
Krittaya Patumrat
Jureeporn Duanguppama
Dominique Cerqueira
Benoit Malleret
Laurent Rénia
Suphak Nosten
Lorenz Von Seidlein
Clare Ling
Stéphane Proux
Vincent Corbel
Julie A. Simpson
Arjen M. Dondorp
Nicholas J. White
François H. Nosten
Mahidol University
IRD Centre de Montpellier
CHU Montpellier
Wellcome Trust Centre for Human Genetics
Wellcome Trust Sanger Institute
Yong Loo Lin School of Medicine
A-Star, Singapore Immunology Network
University of Melbourne
Nuffield Department of Clinical Medicine
Keywords: Biochemistry, Genetics and Molecular Biology
Issue Date: 1-Jan-2017
Citation: Wellcome Open Research. Vol.2, (2017)
Abstract: © 2017 Landier J et al. Background: Artemisinin and partner drug-resistant falciparum malaria is expanding over the Greater Mekong Sub-region (GMS). Eliminating falciparum malaria in the GMS while drugs still retain enough efficacy could prevent global spread of antimalarial resistance. Eliminating malaria rapidly requires targeting the reservoir of asymptomatic parasite carriers. This pilot trial aimed to evaluate the acceptability, safety, feasibility and effectiveness of mass-drug administration (MDA) in reducing malaria in four villages in Eastern Myanmar. Methods: Villages with ≥30% malaria prevalence were selected. Long-lasting insecticidal bednets (LLINs) and access to malaria early diagnosis and treatment (EDT) were provided. Two villages received MDA immediately and two were followed for nine months pre-MDA. MDA consisted of a 3-day supervised course of dihydroartemisinin-piperaquine and single low-dose primaquine administered monthly for three months. Adverse events (AE) were monitored by interviews and consultations. Malaria prevalence was assessed by ultrasensitive PCR quarterly for 24 months. Symptomatic malaria incidence,entomological indices, and antimalarial resistance markers were monitored. Results: MDA was well tolerated. There were no serious AE and mild to moderate AE were reported in 5.6%(212/3931) interviews. In the smaller villages, participation to three MDA courses was 61% and 57%, compared to 28% and 29% in the larger villages. Baseline prevalence was higher in intervention than in control villages (18.7% (95%CI=16.1-21.6) versus 6.8%(5.2-8.7), p<0.0001) whereas three months after starting MDA, prevalence was lower in intervention villages (0.4%(0.04-1.3) versus 2.7%(1.7-4.1), p=0.0014). After nine months the difference was no longer significant (2.0%(1.0-3.5) versus 0.9%(0.04-1.8), p=0.10). M0-M9 symptomatic falciparum incidence was similar between intervention and control. Before/after MDA comparisons showed that asymptomatic P. falciparum carriage and anopheline vector positivity decreased significantly whereas prevalence of the artemisinin-resistance molecular marker remained stable. Conclusions: This MDA was safe and feasible, and, could accelerate elimination of P. falciparum in addition to EDT and LLINs when community participation was sufficient.
URI: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85039147984&origin=inward
http://repository.li.mahidol.ac.th/dspace/handle/123456789/42080
ISSN: 2398502X
Appears in Collections:Scopus 2016-2017

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