Large-scale Artemisinin-Piperaquine Mass Drug Administration With or Without Primaquine Dramatically Reduces Malaria in a Highly Endemic Region of Africa

作者：Deng, Changsheng; Huang, Bo; Wang, Qi; Wu, Wanting; Zheng, Shaoqin; Zhang, Hongying; Li, Di; Feng, Danghong; Li, Guoming; Xue, Linlu; Yang, Tao; Tuo, Fei; Mohadji, Fouad; Su, Xin-zhuan; Xu, Gin; Wu, Zhibing; Lin, Li; Zhou, Jiuyao; Yang, Hong; Bacar, Affane; Abdallah, Kamal Said; Keke, Rachadi A.; Mliva, Ahamada Msa; Mohamed, Moussa; Wang, Xinhua; Huang, Shiguang; Oithik, Fatihou; Li, Xiao-bo; Lu, Fangli; Fay, Michael P.; Liu, Xiao-hong; Wellems, Thomas E.; Song, Jianping^*

来源：Clinical Infectious Diseases, 2018, 67(11): 1670-1676.

DOI：10.1093/cid/ciy364

• malaria control
• Plasmodium falciparum
• artemisinin-based combination therapy
• PfK13 Kelch-propeller gene
• Comoros Islands

Background. Mass drug administration (MDA), with or without low-dose primaquine (PMQ(LD)), is being considered for malaria elimination programs. The potential of PMQ(LD) to block malaria transmission by mosquitoes must be balanced against liabilities of its use. @@@ Methods. Artemisinin-piperaquine (AP), with or without PMQ(LD), 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. @@@ Results. Coverage of 85 to 93% of the Anjouan population was achieved with AP plus PMQ(LD) (AP+PMQ(LD)) in 2 districts (population 97 164) and with AP alone in 5 districts (224 471). Between the months of April-September in both 2012 and 2013, average monthly malaria hospital rates per 100 000 people fell from 310.8 to 2.06 in the AP+PMQ(LD) 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+PMQ(LD) 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. @@@ Conclusions. Steep reductions of malaria cases were achieved by 3 monthly rounds of either AP+PMQ(LD) or AP alone, suggesting potential for highly successful MDA without PMQ(LD) 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.

• 出版日期2018-12-1
• 单位广州医科大学; 广州中医药大学; 暨南大学; 中山大学; 广州中医药大学第一附属医院