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

Santelli AC, Ribeiro I, Daher A, Boulos M, Marchesini PB, dos Santos RL, Lucena MB, Magalhães I, Leon AP, Junger W, Ladislau JL - Malar. J. (2012)

Bottom Line: 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.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.No serious adverse events relating to the use of fixed-dose ASMQ were reported.

View Article: PubMed Central - HTML - PubMed

Affiliation: Programa Nacional de Controle da Malária, Secretaria de Vigilância emSaúde, Ministério da Saúde, Brazil.

ABSTRACT

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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Related in: MedlinePlus

Location of the study area.
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Figure 1: Location of the study area.

Mentions: In 2008, approximately 320,000 cases of P. falciparum malaria were reported in Latin America, where Brazil has the highest malaria burden [11]. In Brazil, 99.8 % of malaria transmission occurs in eight states (Acre, Amapá, Amazonas, Mato Grosso, Pará, Rondônia, Roraima, Tocantins and part of Maranhão) that together form the Legal Amazon [12]. With a mean incidence of 500,000 cases/year, malaria affects all age groups equally, except individuals below one year and older than 60 years of age, for whom incidence is lower. Transmission increases during the seasonal peak, when climatic conditions are favourable to vector proliferation. New urban growth has been related to malaria burden in cities, such as Cruzeiro do Sul [12]. A decrease in malaria cases was observed as of 2006, which has been related to several factors, namely the introduction of ACT for P. falciparum malaria treatment, greater investments, capacity building on prevention and control, and epidemiologic data analyses, which allow a focus on malaria burdens in real time, both from decision makers and the populations involved [12]. Malaria risk in Brazil is classified according to the Annual Parasite Incidence (API). High risk areas have an API of ≥50/1000 inhabitants, intermediate areas of 10–49/1000 inhabitants, and low risk areas have an API <10/1000 inhabitants. From 2003–2007, in the Acre, Amazonas and Roraima states of the Legal Amazon, 79 municipalities were classified as high risk, including eleven with an API >300/1000 inhabitants, three of which were areas in the Juruá valley of the Acre State included in the present study: Rodrigues Alves, Mâncio Lima and Cruzeiro do Sul (Figure 1).


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

Santelli AC, Ribeiro I, Daher A, Boulos M, Marchesini PB, dos Santos RL, Lucena MB, Magalhães I, Leon AP, Junger W, Ladislau JL - Malar. J. (2012)

Location of the study area.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3472241&req=5

Figure 1: Location of the study area.
Mentions: In 2008, approximately 320,000 cases of P. falciparum malaria were reported in Latin America, where Brazil has the highest malaria burden [11]. In Brazil, 99.8 % of malaria transmission occurs in eight states (Acre, Amapá, Amazonas, Mato Grosso, Pará, Rondônia, Roraima, Tocantins and part of Maranhão) that together form the Legal Amazon [12]. With a mean incidence of 500,000 cases/year, malaria affects all age groups equally, except individuals below one year and older than 60 years of age, for whom incidence is lower. Transmission increases during the seasonal peak, when climatic conditions are favourable to vector proliferation. New urban growth has been related to malaria burden in cities, such as Cruzeiro do Sul [12]. A decrease in malaria cases was observed as of 2006, which has been related to several factors, namely the introduction of ACT for P. falciparum malaria treatment, greater investments, capacity building on prevention and control, and epidemiologic data analyses, which allow a focus on malaria burdens in real time, both from decision makers and the populations involved [12]. Malaria risk in Brazil is classified according to the Annual Parasite Incidence (API). High risk areas have an API of ≥50/1000 inhabitants, intermediate areas of 10–49/1000 inhabitants, and low risk areas have an API <10/1000 inhabitants. From 2003–2007, in the Acre, Amazonas and Roraima states of the Legal Amazon, 79 municipalities were classified as high risk, including eleven with an API >300/1000 inhabitants, three of which were areas in the Juruá valley of the Acre State included in the present study: Rodrigues Alves, Mâncio Lima and Cruzeiro do Sul (Figure 1).

Bottom Line: 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.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.No serious adverse events relating to the use of fixed-dose ASMQ were reported.

View Article: PubMed Central - HTML - PubMed

Affiliation: Programa Nacional de Controle da Malária, Secretaria de Vigilância emSaúde, Ministério da Saúde, Brazil.

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus