Publication: Elimination of Plasmodium falciparum in an area of multi‑drug resistance
Issued Date
2015
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Language
eng
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Mahidol University
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BioMed Central
Bibliographic Citation
BMC Public Health. Vol.14, (2015), 319
Suggested Citation
Lwin, Khin Maung, Mallika Imwong, Preyanan Suangkanarat, Atthanee Jeeyapant, Benchawan Vihokhern, Klanarong Wongsaen, Georges Snounou, Lilly Keereecharoen, White, Nicholas J, Francois Nosten Elimination of Plasmodium falciparum in an area of multi‑drug resistance. BMC Public Health. Vol.14, (2015), 319. doi:10.1186/s12936-015-0838-5 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/3094
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Title
Elimination of Plasmodium falciparum in an area of multi‑drug resistance
Abstract
Background: Resistance to the artemisinin derivatives in Plasmodium falciparum has emerged in Cambodia and is
now spreading throughout South-East Asia. The rapid elimination of P. falciparum seems to be the only viable option
to avoid a public health disaster but this is difficult because even in low transmission settings many residents have
asymptomatic parasitaemias.
Methods: In response to a large number of malaria cases reported in three remote villages on the Thai-Myanmar
border where malaria is endemic and the disease is seasonal, surveys were conducted using an ultra-sensitive qPCR
assay (LOD 22 parasites per mL). In one of the villages where it was feasible, mass anti-malarial drug administration
was proposed to the population as a potential solution, and this was adopted.
Results: In the three villages 204/356 (57.3 %), 212/385 (55.1 %) and 195/286 (68.2 %) of the resident populations
were positive by qPCR (approximately one-third P. falciparum and two-thirds P. vivax). Of those positive for P. falciparum
62 % carried single point mutations in the P. falciparum kelch protein (a marker of artemisinin resistance). In one
of the villages 217 of 674 inhabitants received at least one dose of dihydroartemisinin-piperaquine chemoprevention
in June 2012, 155 (71.4 %) received two consecutive months, and 98 (45.2 %) received three treatment doses. The
chemoprevention was generally well tolerated. The sub-microscopic reservoir of P. falciparum malaria was eliminated
during the six-month follow-up period (prevalence fell from 7 to 0 %); P. vivax malaria persisted (prevalence fell from
35 to 8 %). From June to October 2012 (rainy season) the number of clinical episodes of P. falciparum was six times
lower (46), than during the same period in the previous year (290).
Conclusion: Mass drug administration with dihydroartemisinin-piperaquine may be an effective strategy to eliminate
P. falciparum rapidly where multi-drug resistance is present.