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Optimising Strategies for Plasmodium falciparum Malaria Elimination in Cambodia: Primaquine, Mass Drug Administration and Artemisinin Resistance

BACKGROUND: Malaria elimination requires a variety of approaches individually optimized for different transmission settings. A recent field study in an area of low seasonal transmission in South West Cambodia demonstrated dramatic reductions in malaria parasite prevalence following both mass drug ad...

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Autores principales: Maude, Richard J., Socheat, Duong, Nguon, Chea, Saroth, Preap, Dara, Prak, Li, Guoqiao, Song, Jianping, Yeung, Shunmay, Dondorp, Arjen M., Day, Nicholas P., White, Nicholas J., White, Lisa J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3360685/
https://www.ncbi.nlm.nih.gov/pubmed/22662135
http://dx.doi.org/10.1371/journal.pone.0037166
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author Maude, Richard J.
Socheat, Duong
Nguon, Chea
Saroth, Preap
Dara, Prak
Li, Guoqiao
Song, Jianping
Yeung, Shunmay
Dondorp, Arjen M.
Day, Nicholas P.
White, Nicholas J.
White, Lisa J.
author_facet Maude, Richard J.
Socheat, Duong
Nguon, Chea
Saroth, Preap
Dara, Prak
Li, Guoqiao
Song, Jianping
Yeung, Shunmay
Dondorp, Arjen M.
Day, Nicholas P.
White, Nicholas J.
White, Lisa J.
author_sort Maude, Richard J.
collection PubMed
description BACKGROUND: Malaria elimination requires a variety of approaches individually optimized for different transmission settings. A recent field study in an area of low seasonal transmission in South West Cambodia demonstrated dramatic reductions in malaria parasite prevalence following both mass drug administration (MDA) and high treatment coverage of symptomatic patients with artemisinin-piperaquine plus primaquine. This study employed multiple combined strategies and it was unclear what contribution each made to the reductions in malaria. METHOD AND FINDINGS: A mathematical model fitted to the trial results was used to assess the effects of the various components of these interventions, design optimal elimination strategies, and explore their interactions with artemisinin resistance, which has recently been discovered in Western Cambodia. The modelling indicated that most of the initial reduction of P. falciparum malaria resulted from MDA with artemisinin-piperaquine. The subsequent continued decline and near elimination resulted mainly from high coverage with artemisinin-piperaquine treatment. Both these strategies were more effective with the addition of primaquine. MDA with artemisinin combination therapy (ACT) increased the proportion of artemisinin resistant infections, although much less than treatment of symptomatic cases with ACT, and this increase was slowed by adding primaquine. Artemisinin resistance reduced the effectiveness of interventions using ACT when the prevalence of resistance was very high. The main results were robust to assumptions about primaquine action, and immunity. CONCLUSIONS: The key messages of these modelling results for policy makers were: high coverage with ACT treatment can produce a long-term reduction in malaria whereas the impact of MDA is generally only short-term; primaquine enhances the effect of ACT in eliminating malaria and reduces the increase in proportion of artemisinin resistant infections; parasite prevalence is a better surveillance measure for elimination programmes than numbers of symptomatic cases; combinations of interventions are most effective and sustained efforts are crucial for successful elimination.
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spelling pubmed-33606852012-06-01 Optimising Strategies for Plasmodium falciparum Malaria Elimination in Cambodia: Primaquine, Mass Drug Administration and Artemisinin Resistance Maude, Richard J. Socheat, Duong Nguon, Chea Saroth, Preap Dara, Prak Li, Guoqiao Song, Jianping Yeung, Shunmay Dondorp, Arjen M. Day, Nicholas P. White, Nicholas J. White, Lisa J. PLoS One Research Article BACKGROUND: Malaria elimination requires a variety of approaches individually optimized for different transmission settings. A recent field study in an area of low seasonal transmission in South West Cambodia demonstrated dramatic reductions in malaria parasite prevalence following both mass drug administration (MDA) and high treatment coverage of symptomatic patients with artemisinin-piperaquine plus primaquine. This study employed multiple combined strategies and it was unclear what contribution each made to the reductions in malaria. METHOD AND FINDINGS: A mathematical model fitted to the trial results was used to assess the effects of the various components of these interventions, design optimal elimination strategies, and explore their interactions with artemisinin resistance, which has recently been discovered in Western Cambodia. The modelling indicated that most of the initial reduction of P. falciparum malaria resulted from MDA with artemisinin-piperaquine. The subsequent continued decline and near elimination resulted mainly from high coverage with artemisinin-piperaquine treatment. Both these strategies were more effective with the addition of primaquine. MDA with artemisinin combination therapy (ACT) increased the proportion of artemisinin resistant infections, although much less than treatment of symptomatic cases with ACT, and this increase was slowed by adding primaquine. Artemisinin resistance reduced the effectiveness of interventions using ACT when the prevalence of resistance was very high. The main results were robust to assumptions about primaquine action, and immunity. CONCLUSIONS: The key messages of these modelling results for policy makers were: high coverage with ACT treatment can produce a long-term reduction in malaria whereas the impact of MDA is generally only short-term; primaquine enhances the effect of ACT in eliminating malaria and reduces the increase in proportion of artemisinin resistant infections; parasite prevalence is a better surveillance measure for elimination programmes than numbers of symptomatic cases; combinations of interventions are most effective and sustained efforts are crucial for successful elimination. Public Library of Science 2012-05-25 /pmc/articles/PMC3360685/ /pubmed/22662135 http://dx.doi.org/10.1371/journal.pone.0037166 Text en Maude et al. http://creativecommons.org/licenses/by/4.0/ 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 properly credited.
spellingShingle Research Article
Maude, Richard J.
Socheat, Duong
Nguon, Chea
Saroth, Preap
Dara, Prak
Li, Guoqiao
Song, Jianping
Yeung, Shunmay
Dondorp, Arjen M.
Day, Nicholas P.
White, Nicholas J.
White, Lisa J.
Optimising Strategies for Plasmodium falciparum Malaria Elimination in Cambodia: Primaquine, Mass Drug Administration and Artemisinin Resistance
title Optimising Strategies for Plasmodium falciparum Malaria Elimination in Cambodia: Primaquine, Mass Drug Administration and Artemisinin Resistance
title_full Optimising Strategies for Plasmodium falciparum Malaria Elimination in Cambodia: Primaquine, Mass Drug Administration and Artemisinin Resistance
title_fullStr Optimising Strategies for Plasmodium falciparum Malaria Elimination in Cambodia: Primaquine, Mass Drug Administration and Artemisinin Resistance
title_full_unstemmed Optimising Strategies for Plasmodium falciparum Malaria Elimination in Cambodia: Primaquine, Mass Drug Administration and Artemisinin Resistance
title_short Optimising Strategies for Plasmodium falciparum Malaria Elimination in Cambodia: Primaquine, Mass Drug Administration and Artemisinin Resistance
title_sort optimising strategies for plasmodium falciparum malaria elimination in cambodia: primaquine, mass drug administration and artemisinin resistance
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3360685/
https://www.ncbi.nlm.nih.gov/pubmed/22662135
http://dx.doi.org/10.1371/journal.pone.0037166
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