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Title: A Controlled Trial of Mass Drug Administration to Interrupt Transmission of Multidrug-Resistant Falciparum Malaria in Cambodian Villages
Authors: Rupam Tripura
Thomas J. Peto
Nguon Chea
Davoeung Chan
Mavuto Mukaka
Pasathorn Sirithiranont
Mehul Dhorda
Cholrawee Promnarate
Mallika Imwong
Lorenz Von Seidlein
Jureeporn Duanguppama
Krittaya Patumrat
Rekol Huy
Martin P. Grobusch
Nicholas P.J. Day
Nicholas J. White
Arjen M. Dondorp
Mahidol University
Nuffield Department of Clinical Medicine
Amsterdam UMC - University of Amsterdam
National Center for Parasitology, Entomology and Malaria Control
Provincial Health Department
Keywords: Medicine
Issue Date: 31-Aug-2018
Citation: Clinical Infectious Diseases. Vol.67, No.6 (2018), 817-826
Abstract: © The Author(s) 2018. Background. The increase in multidrug-resistant Plasmodium falciparum in Southeast Asia suggests a need for acceleration of malaria elimination. We evaluated the effectiveness and safety of mass drug administration (MDA) to interrupt malaria transmission. Methods. Four malaria-endemic villages in western Cambodia were randomized to 3 rounds of MDA (a 3-day course of dihydroartemisinin with piperaquine-phosphate), administered either early in or at the end of the study period. Comprehensive malaria treatment records were collected during 2014-2017. Subclinical parasite prevalence was estimated by ultrasensitive quantitative polymerase chain reaction quarterly over 12 months. Results. MDA coverage with at least 1 complete round was 88% (1999/2268), =2 ounds 73% (1645/2268), and all 3 rounds 58% (1310/2268). Plasmodium falciparum incidence in intervention and control villages was similar over the 12 months prior to the study: 39 per 1000 person-years (PY) vs 45 per 1000 PY (P = .50). The primary outcome, P. falciparum incidence in the 12 months after MDA, was lower in intervention villages (1.5/1000 PY vs 37.1/1000 PY; incidence rate ratio, 24.5 [95% confidence interval], 3.4-177; P = .002). Following MDA in 2016, there were no clinical falciparum malaria cases over 12 months (0/2044 PY) in all 4 villages. Plasmodium vivax prevalence decreased markedly in intervention villages following MDA but returned to approximately half the baseline prevalence by 12 months. No severe adverse events were attributed to treatment. Conclusions. Mass drug administrations achieved high coverage, were safe, and associated with the absence of clinical P. falciparum cases for at least 1 year.
ISSN: 15376591
Appears in Collections:Scopus 2018

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