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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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Incidence rate of P. falciparum malaria (a), P. falciparum/P. v ivax ratio (b), and hospital admissions (c) due to malaria in the Juruá valley between 2004 and 2008.
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Figure 2: Incidence rate of P. falciparum malaria (a), P. falciparum/P. v ivax ratio (b), and hospital admissions (c) due to malaria in the Juruá valley between 2004 and 2008.

Mentions: The P. falciparum malaria cumulative incidence rates (per 10,000 inhabitants) over one year were stratified by age range in the Juruá valley (Table 2). Following the introduction of ASMQ treatment in 2006, a large decrease in the P. falciparum yearly incidence was observed across all age groups of subjects living in the study area. The P. falciparum malaria incidence rate had sharply increased in the Juruá valley during the second half of 2005, with an epidemic peak at the beginning of 2006 before the introduction of ASMQ treatment (Figure 2a).


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)

Incidence rate of P. falciparum malaria (a), P. falciparum/P. v ivax ratio (b), and hospital admissions (c) due to malaria in the Juruá valley between 2004 and 2008.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Incidence rate of P. falciparum malaria (a), P. falciparum/P. v ivax ratio (b), and hospital admissions (c) due to malaria in the Juruá valley between 2004 and 2008.
Mentions: The P. falciparum malaria cumulative incidence rates (per 10,000 inhabitants) over one year were stratified by age range in the Juruá valley (Table 2). Following the introduction of ASMQ treatment in 2006, a large decrease in the P. falciparum yearly incidence was observed across all age groups of subjects living in the study area. The P. falciparum malaria incidence rate had sharply increased in the Juruá valley during the second half of 2005, with an epidemic peak at the beginning of 2006 before the introduction of ASMQ treatment (Figure 2a).

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