Efficacy of Focal Primaquine Mass Administration for Eliminating Plasmodium vivax Malaria in Northern Myanmar: A Cluster-Randomized Trial
Issued Date
2025-08-01
Resource Type
eISSN
23288957
Scopus ID
2-s2.0-105013250550
Journal Title
Open Forum Infectious Diseases
Volume
12
Issue
8
Rights Holder(s)
SCOPUS
Bibliographic Citation
Open Forum Infectious Diseases Vol.12 No.8 (2025)
Suggested Citation
Aung P.L., Soe M.T., Soe T.N., Zhao Y., Cao Y., Aung P.P., Oo T.L., Lawpoolsri S., Nguitragool W., Sattabongkot J., Kaewkungwal J., Kyaw M.P., Parker D.M., Cui L. Efficacy of Focal Primaquine Mass Administration for Eliminating Plasmodium vivax Malaria in Northern Myanmar: A Cluster-Randomized Trial. Open Forum Infectious Diseases Vol.12 No.8 (2025). doi:10.1093/ofid/ofaf465 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/111752
Title
Efficacy of Focal Primaquine Mass Administration for Eliminating Plasmodium vivax Malaria in Northern Myanmar: A Cluster-Randomized Trial
Corresponding Author(s)
Other Contributor(s)
Abstract
Background. Plasmodium vivax poses a major challenge for malaria elimination, primarily because of relapse. Primaquine mass drug administration (PQ-MDA) has played a decisive role in eliminating vivax malaria in many temperate countries, but its efficacy in tropical/subtropical areas remains underexplored. Methods. We conducted a cluster-randomized crossover trial to determine the effect of PQ-MDA on P. vivax transmission in northern Myanmar, a subtropical area in the Greater Mekong subregion with perennial malaria transmission. Participants from two groups of villages (groups 1 and 2) were administered 0.25 mg/kg/day PQ base for 14 days as directly observed therapy. During PQ-MDA administration, each group alternated as the control while the other received the intervention, with the groups switching after 9 months. Clinical malaria incidence and prevalence were monitored to determine the efficacy. Results. PQ was administered in 541 participants in group 1 and 667 in group 2 during August–September 2019 and June–July 2020, respectively. In both groups, clinical P. vivax incidence sharply declined to zero within a month of PQ-MDA and remained vivax-free for almost a year. During round 1 PQ-MDA, group 1 with MDA had a significant reduction in the prevalence of subclinical P. vivax compared to group 2 as the control, with a model-adjusted odds ratio (aOR) of 0.46 [95% confidence interval (CI): 0.25–0.83]. During round 2, group 2 exhibited an even lower aOR of 0.15 (95% CI: 0.03–0.65) for subclinical P. vivax infection. Conclusions. PQ-MDA was effective in reducing both clinical and subclinical P. vivax infections in a subtropical, low-endemicity setting.