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Title: Mass drug administrations with dihydroartemisinin-piperaquine and single low dose primaquine to eliminate Plasmodium falciparum have only a transient impact on Plasmodium vivax: Findings from randomised controlled trials
Authors: Koukeo Phommasone
Frank van Leth
Thomas J. Peto
Jordi Landier
Thuy Nhien Nguyen
Rupam Tripura
Tiengkham Pongvongsa
Khin Maung Lwin
Ladda Kajeechiwa
May Myo Thwin
Daniel M. Parker
Jacher Wiladphaingern
Suphak Nosten
Stephane Proux
Chea Nguon
Chan Davoeung
Huy Rekol
Bipin Adhikari
Cholrawee Promnarate
Kesinee Chotivanich
Borimas Hanboonkunupakarn
Podjanee Jittmala
Phaik Yeong Cheah
Mehul Dhorda
Mallika Imwong
Mavuto Mukaka
Pimnara Peerawaranun
Sasithon Pukrittayakamee
Paul N. Newton
Guy E. Thwaites
Nicholas P.J. Day
Mayfong Mayxay
Tran Tinh Hien
Francois H. Nosten
Frank Cobelens
Arjen M. Dondorp
Nicholas J. White
Lorenz von Seidlein
Aix Marseille Université
Mahidol University
Nuffield Department of Clinical Medicine
University of California, Irvine
Amsterdam UMC - University of Amsterdam
Oxford University Clinical Research Unit
University of Health Sciences
Amsterdam Institute for Global Health and Development
Mahosot Hospital
Savannakhet Provincial Health Department
Royal Institute of Thailand
National Center for Parasitology, Entomology and Malaria Control
Provincial Health Department
Keywords: Agricultural and Biological Sciences;Biochemistry, Genetics and Molecular Biology;Multidisciplinary
Issue Date: 1-Jan-2020
Citation: PLoS ONE. Vol.15, No.2 (2020)
Abstract: Copyright: © 2020 Phommasone et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Mass administrations of antimalarial drugs (MDA) have reduced the incidence and prevalence of P. falciparum infections in a trial in the Greater Mekong Subregion. Here we assess the impact of the MDA on P. vivax infections. Methods Between May 2013 and July 2017, four villages in each Myanmar, Vietnam, Cambodia and Lao PDR were selected based on high prevalence of P. falciparum infections. Eight of the 16 villages were randomly assigned to receive MDA consisting of three-monthly rounds of three-day courses of dihydroartemisinin-piperaquine and, except in Cambodia, a single low-dose of primaquine. Cross-sectional surveys were conducted at quarterly intervals to detect Plasmodium infections using ultrasensitive qPCR. The difference in the cumulative incidence between the groups was assessed through a discrete time survival approach, the difference in prevalence through a difference-in-difference analysis, and the difference in the number of participants with a recurrence of P. vivax infection through a mixed-effect logistic regression. Results 3,790 (86%) residents in the intervention villages participated in at least one MDA round, of whom 2,520 (57%) participated in three rounds. The prevalence of P. vivax infections fell from 9.31% to 0.89% at month 3 but rebounded by six months to 5.81%. There was no evidence that the intervention reduced the cumulative incidence of P.vivax infections (95% confidence interval [CI] Odds ratio (OR): 0.29 to 1.36). Similarly, there was no evidence of MDA related reduction in the number of participants with at least one recurrent infection (OR: 0.34; 95% CI: 0.08 to 1.42). Conclusion MDA with schizontocidal drugs had a lasting effect on P. falciparum infections but only a transient effect on the prevalence of P. vivax infections. Radical cure with an 8-aminoquino-line will be needed for the rapid elimination of vivax malaria.
ISSN: 19326203
Appears in Collections:Scopus 2020

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