Large-scale Artemisinin-Piperaquine Mass Drug Administration With or Without Primaquine Dramatically Reduces Malaria in a Highly Endemic Region of Africa.
机构：[1]Institute of Tropical Medicine,Guangzhou University of Chinese Medicine, Guangdong, People’s Republic of China[2]Science and Technology Park,Guangzhou University of Chinese Medicine, Guangdong, People’s Republic of China[3]Ministry of Health Comoros, Moroni, Union of Comoros[4]Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland[5]First Affiliated Hospital,Guangzhou University of Chinese Medicine, Guangdong, People’s Republic of China[6]Traditional Chinese Medicine College, Guangzhou University of Chinese Medicine, Guangdong, People’s Republic of China[7]National Malaria Control Programme, Moroni, Union of Comoros[8]Guangzhou Medical University,Sun Yat-sen University, Guangdong, People’s Republic of China[9]School of Stomatology, Jinan University,Sun Yat-sen University, Guangdong, People’s Republic of China[10]Department of Parasitology, Zhongshan School of Medicine,Sun Yat-sen University, Guangdong, People’s Republic of China[11]Key Laboratory of Tropical Disease Control in Ministry of Education, Sun Yat-sen University, Guangdong, People’s Republic of China[12]Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland[13]First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangdong, People’s Republic of China
Mass drug administration (MDA), with or without low-dose primaquine (PMQLD), is being considered for malaria elimination programs. The potential of PMQLD to block malaria transmission by mosquitoes must be balanced against liabilities of its use.
Artemisinin-piperaquine (AP), with or without PMQLD, was administered in 3 monthly rounds across Anjouan Island, Union of Comoros. Plasmodium falciparum malaria rates, mortality, parasitemias, adverse events, and PfK13 Kelch-propeller gene polymorphisms were evaluated.
Coverage of 85 to 93% of the Anjouan population was achieved with AP plus PMQLD (AP+PMQLD) in 2 districts (population 97164) and with AP alone in 5 districts (224471). Between the months of April-September in both 2012 and 2013, average monthly malaria hospital rates per 100000 people fell from 310.8 to 2.06 in the AP+PMQLD population (ratio 2.06/310.8 = 0.66%; 95% CI: 0.02%, 3.62%; P = .00007) and from 412.1 to 2.60 in the AP population (ratio 0.63%; 95% CI: 0.11%, 1.93%; P < .00001). Effectiveness of AP+PMQLD was 0.9908 (95% CI: 0.9053, 0.9991), while effectiveness of AP alone was 0.9913 (95% CI: 0.9657, 0.9978). Both regimens were well tolerated, without severe adverse events. Analysis of 52 malaria samples after MDA showed no evidence for selection of PfK13 Kelch-propeller mutations.
Steep reductions of malaria cases were achieved by 3 monthly rounds of either AP+PMQLD or AP alone, suggesting potential for highly successful MDA without PMQLD in epidemiological settings such as those on Anjouan. A major challenge is to sustain and expand the public health benefits of malaria reductions by MDA.
基金：
This work was supported by grants from
Guangdong Provincial Science and Technology Program [grant number
2015B020234003] and China-UK Global Health Support Programme,
funded by UK Government Department for International Development
[DFID, grant number 202708], to J. S.; the National Science Foundation
of China [grant number 81702020], Guangdong Provincial Science
Foundation [grant number 2015A030310107], and Guangdong Provincial
Medicine Science Foundation [grant number A2016315] to B. H.; the
YangFan Innovative and Entrepreneurial Research Team Project [grant
number 2014YT02S008] to C. D.; the Guangdong Provincial Science and
Technology Program [grant number 2013B090800024] to Q. W.; and
the Division of Intramural Research, National Institute of Allergy and
Infectious Diseases, National Institutes of Health (X.-z. S., M. P. F., T. E. W.).
第一作者机构：[1]Institute of Tropical Medicine,Guangzhou University of Chinese Medicine, Guangdong, People’s Republic of China
共同第一作者：
通讯作者：
通讯机构：[1]Institute of Tropical Medicine,Guangzhou University of Chinese Medicine, Guangdong, People’s Republic of China[2]Science and Technology Park,Guangzhou University of Chinese Medicine, Guangdong, People’s Republic of China[*1]Institute of Tropical Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, People’s Republic of China
推荐引用方式(GB/T 7714)：
Changsheng Deng,Bo Huang,Qi Wang,et al.Large-scale Artemisinin-Piperaquine Mass Drug Administration With or Without Primaquine Dramatically Reduces Malaria in a Highly Endemic Region of Africa.[J].CLINICAL INFECTIOUS DISEASES.2018,67(11):1670-1676.doi:10.1093/cid/ciy364.
APA：
Changsheng Deng,Bo Huang,Qi Wang,Wanting Wu,Shaoqin Zheng...&Jianping Song.(2018).Large-scale Artemisinin-Piperaquine Mass Drug Administration With or Without Primaquine Dramatically Reduces Malaria in a Highly Endemic Region of Africa..CLINICAL INFECTIOUS DISEASES,67,(11)
MLA：
Changsheng Deng,et al."Large-scale Artemisinin-Piperaquine Mass Drug Administration With or Without Primaquine Dramatically Reduces Malaria in a Highly Endemic Region of Africa.".CLINICAL INFECTIOUS DISEASES 67..11(2018):1670-1676
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