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    Safety and effectiveness of mass drug administration to accelerate elimination of artemisinin-resistant falciparum malaria: A pilot trial in four villages of Eastern Myanmar.

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    Author
    Landier, J; Kajeechiwa, L; Thwin, MM; Parker, DM; Chaumeau, V; Wiladphaingern, J; Imwong, M; Miotto, O; Patumrat, K; Duanguppama, J; ...
    Date
    2017
    Source Title
    Wellcome Open Research
    Publisher
    F1000 Research Ltd
    University of Melbourne Author/s
    Simpson, Julie
    Affiliation
    Melbourne School of Population and Global Health
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Landier, J., Kajeechiwa, L., Thwin, M. M., Parker, D. M., Chaumeau, V., Wiladphaingern, J., Imwong, M., Miotto, O., Patumrat, K., Duanguppama, J., Cerqueira, D., Malleret, B., Rénia, L., Nosten, S., von Seidlein, L., Ling, C., Proux, S., Corbel, V., Simpson, J. A. ,... Nosten, F. H. (2017). Safety and effectiveness of mass drug administration to accelerate elimination of artemisinin-resistant falciparum malaria: A pilot trial in four villages of Eastern Myanmar.. Wellcome Open Res, 2, pp.81-. https://doi.org/10.12688/wellcomeopenres.12240.1.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/257447
    DOI
    10.12688/wellcomeopenres.12240.1
    Open Access at PMC
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5635445
    Abstract
    Background: Artemisinin and partner drug-resistant falciparum malaria is expanding over the Greater Mekong Sub-region (GMS). Eliminating falciparum malaria in the GMS while drugs still retain enough efficacy could prevent global spread of antimalarial resistance. Eliminating malaria rapidly requires targeting the reservoir of asymptomatic parasite carriers. This pilot trial aimed to evaluate the acceptability, safety, feasibility and effectiveness of mass-drug administration (MDA) in reducing malaria in four villages in Eastern Myanmar. Methods: Villages with ≥30% malaria prevalence were selected. Long-lasting insecticidal bednets (LLINs) and access to malaria early diagnosis and treatment (EDT) were provided. Two villages received MDA immediately and two were followed for nine months pre-MDA. MDA consisted of a 3-day supervised course of  dihydroartemisinin-piperaquine and single low-dose primaquine administered monthly for three months. Adverse events (AE) were monitored by interviews and consultations. Malaria prevalence was assessed by ultrasensitive PCR quarterly for 24 months. Symptomatic malaria incidence,entomological indices, and antimalarial resistance markers were monitored. Results: MDA was well tolerated. There were no serious AE and mild to moderate AE were reported in 5.6%(212/3931) interviews. In the smaller villages, participation to three MDA courses was 61% and 57%, compared to 28% and 29% in the larger villages. Baseline prevalence was higher in intervention than in control villages (18.7% (95%CI=16.1-21.6) versus 6.8%(5.2-8.7), p<0.0001) whereas three months after starting MDA, prevalence was lower in intervention villages (0.4%(0.04-1.3) versus 2.7%(1.7-4.1), p=0.0014). After nine months the difference was no longer significant (2.0%(1.0-3.5) versus 0.9%(0.04-1.8), p=0.10). M0-M9 symptomatic falciparum incidence was similar between intervention and control. Before/after MDA comparisons showed that asymptomatic P. falciparum carriage and anopheline vector positivity decreased significantly whereas prevalence of the artemisinin-resistance molecular marker remained stable. Conclusions: This MDA was safe and feasible, and, could accelerate elimination of P. falciparum in addition to EDT and LLINs when community participation was sufficient.

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