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Effect of artesunate-mefloquine fixed-dose combination in malaria transmission in amazon basin communities

BACKGROUND: Studies in South-East Asia have suggested that early diagnosis and treatment with artesunate (AS) and mefloquine (MQ) combination therapy may reduce the transmission of Plasmodium falciparum malaria and the progression of MQ resistance. METHODS: The effectiveness of a fixed-dose combinat...

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Autores principales: Santelli, Ana C, Ribeiro, Isabela, Daher, André, Boulos, Marcos, Marchesini, Paola B, dos Santos, Roseli La Corte, Lucena, Marize BF, Magalhães, Izanelda, Leon, Antonio P, Junger, Washington, Ladislau, José LB
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3472241/
https://www.ncbi.nlm.nih.gov/pubmed/22905900
http://dx.doi.org/10.1186/1475-2875-11-286
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author Santelli, Ana C
Ribeiro, Isabela
Daher, André
Boulos, Marcos
Marchesini, Paola B
dos Santos, Roseli La Corte
Lucena, Marize BF
Magalhães, Izanelda
Leon, Antonio P
Junger, Washington
Ladislau, José LB
author_facet Santelli, Ana C
Ribeiro, Isabela
Daher, André
Boulos, Marcos
Marchesini, Paola B
dos Santos, Roseli La Corte
Lucena, Marize BF
Magalhães, Izanelda
Leon, Antonio P
Junger, Washington
Ladislau, José LB
author_sort Santelli, Ana C
collection PubMed
description BACKGROUND: Studies in South-East Asia have suggested that early diagnosis and treatment with artesunate (AS) and mefloquine (MQ) combination therapy may reduce the transmission of Plasmodium falciparum malaria and the progression of MQ resistance. METHODS: The effectiveness of a fixed-dose combination of AS and MQ (ASMQ) in reducing malaria transmission was tested in isolated communities of the Juruá valley in the Amazon region. Priority municipalities within the Brazilian Legal Amazon area were selected according to pre-specified criteria. Routine national malaria control programmatic procedures were followed. Existing health structures were reinforced and health care workers were trained to treat with ASMQ all confirmed falciparum malaria cases that match inclusion criteria. A local pharmacovigilance structure was implemented. Incidence of malaria and hospitalizations were recorded two years before, during, and after the fixed-dose ASMQ intervention. In total, between July 2006 and December 2008, 23,845 patients received ASMQ. Two statistical modelling approaches were applied to monthly time series of P. falciparum malaria incidence rates, P. falciparum/Plasmodium vivax infection ratio, and malaria hospital admissions rates. All the time series ranged from January 2004 to December 2008, whilst the intervention period span from July 2006 to December 2008. RESULTS: The ASMQ intervention had a highly significant impact on the mean level of each time series, adjusted for trend and season, of 0.34 (95%CI 0.20 – 0.58) for the P. falciparum malaria incidence rates, 0.67 (95%CI 0.50 – 0.89) for the P. falciparum/P. vivax infection ratio, and 0.53 (95%CI 0.41 – 0.69) for the hospital admission rates. There was also a significant change in the seasonal (or monthly) pattern of the time series before and after intervention, with the elimination of the malaria seasonal peak in the rainy months of the years following the introduction of ASMQ. No serious adverse events relating to the use of fixed-dose ASMQ were reported. CONCLUSIONS: In the remote region of the Juruá valley, the early detection of malaria by health care workers and treatment with fixed-dose ASMQ was feasible and efficacious, and significantly reduced the incidence and morbidity of P. falciparum malaria.
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spelling pubmed-34722412012-10-23 Effect of artesunate-mefloquine fixed-dose combination in malaria transmission in amazon basin communities Santelli, Ana C Ribeiro, Isabela Daher, André Boulos, Marcos Marchesini, Paola B dos Santos, Roseli La Corte Lucena, Marize BF Magalhães, Izanelda Leon, Antonio P Junger, Washington Ladislau, José LB Malar J Research BACKGROUND: Studies in South-East Asia have suggested that early diagnosis and treatment with artesunate (AS) and mefloquine (MQ) combination therapy may reduce the transmission of Plasmodium falciparum malaria and the progression of MQ resistance. METHODS: The effectiveness of a fixed-dose combination of AS and MQ (ASMQ) in reducing malaria transmission was tested in isolated communities of the Juruá valley in the Amazon region. Priority municipalities within the Brazilian Legal Amazon area were selected according to pre-specified criteria. Routine national malaria control programmatic procedures were followed. Existing health structures were reinforced and health care workers were trained to treat with ASMQ all confirmed falciparum malaria cases that match inclusion criteria. A local pharmacovigilance structure was implemented. Incidence of malaria and hospitalizations were recorded two years before, during, and after the fixed-dose ASMQ intervention. In total, between July 2006 and December 2008, 23,845 patients received ASMQ. Two statistical modelling approaches were applied to monthly time series of P. falciparum malaria incidence rates, P. falciparum/Plasmodium vivax infection ratio, and malaria hospital admissions rates. All the time series ranged from January 2004 to December 2008, whilst the intervention period span from July 2006 to December 2008. RESULTS: The ASMQ intervention had a highly significant impact on the mean level of each time series, adjusted for trend and season, of 0.34 (95%CI 0.20 – 0.58) for the P. falciparum malaria incidence rates, 0.67 (95%CI 0.50 – 0.89) for the P. falciparum/P. vivax infection ratio, and 0.53 (95%CI 0.41 – 0.69) for the hospital admission rates. There was also a significant change in the seasonal (or monthly) pattern of the time series before and after intervention, with the elimination of the malaria seasonal peak in the rainy months of the years following the introduction of ASMQ. No serious adverse events relating to the use of fixed-dose ASMQ were reported. CONCLUSIONS: In the remote region of the Juruá valley, the early detection of malaria by health care workers and treatment with fixed-dose ASMQ was feasible and efficacious, and significantly reduced the incidence and morbidity of P. falciparum malaria. BioMed Central 2012-08-20 /pmc/articles/PMC3472241/ /pubmed/22905900 http://dx.doi.org/10.1186/1475-2875-11-286 Text en Copyright ©2012 Santelli et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Santelli, Ana C
Ribeiro, Isabela
Daher, André
Boulos, Marcos
Marchesini, Paola B
dos Santos, Roseli La Corte
Lucena, Marize BF
Magalhães, Izanelda
Leon, Antonio P
Junger, Washington
Ladislau, José LB
Effect of artesunate-mefloquine fixed-dose combination in malaria transmission in amazon basin communities
title Effect of artesunate-mefloquine fixed-dose combination in malaria transmission in amazon basin communities
title_full Effect of artesunate-mefloquine fixed-dose combination in malaria transmission in amazon basin communities
title_fullStr Effect of artesunate-mefloquine fixed-dose combination in malaria transmission in amazon basin communities
title_full_unstemmed Effect of artesunate-mefloquine fixed-dose combination in malaria transmission in amazon basin communities
title_short Effect of artesunate-mefloquine fixed-dose combination in malaria transmission in amazon basin communities
title_sort effect of artesunate-mefloquine fixed-dose combination in malaria transmission in amazon basin communities
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3472241/
https://www.ncbi.nlm.nih.gov/pubmed/22905900
http://dx.doi.org/10.1186/1475-2875-11-286
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