Gametocyte dynamics and the role of drugs in reducing the transmission potential of plasmodium vivax
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2013-09-01
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Journal of Infectious Diseases
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OXFORD UNIV PRESS INC
Melbourne Authors
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Melbourne School of Population and Global Health
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Journal Article
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Douglas, N. M., Simpson, J. A., Phyo, A. P., Siswantoro, H., Hasugian, A. R., Kenangalem, E., Poespoprodjo, J. R., Singhasivanon, P., Anstey, N. M., White, N. J., Tjitra, E., Nosten, F. & Price, R. N. (2013). Gametocyte dynamics and the role of drugs in reducing the transmission potential of plasmodium vivax. Journal of Infectious Diseases, 208 (5), pp.801-812. https://doi.org/10.1093/infdis/jit261.
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Abstract
BACKGROUND: Designing interventions that will reduce transmission of vivax malaria requires knowledge of Plasmodium vivax gametocyte dynamics. METHODS: We analyzed data from a randomized controlled trial in northwestern Thailand and 2 trials in Papua, Indonesia, to identify and compare risk factors for vivax gametocytemia at enrollment and following treatment. RESULTS: A total of 492 patients with P. vivax infections from Thailand and 476 patients (162 with concurrent falciparum parasitemia) from Indonesia were evaluable. Also, 84.3% (415/492) and 66.6% (209/314) of patients with monoinfection were gametocytemic at enrollment, respectively. The ratio of gametocytemia to asexual parasitemia did not differ between acute and recurrent infections (P = .48 in Thailand, P = .08 in Indonesia). High asexual parasitemia was associated with an increased risk of gametocytemia during follow-up in both locations. In Thailand, the cumulative incidence of gametocytemia between day 7 and day 42 following dihydroartemisinin + piperaquine (DHA + PIP) was 6.92% vs 29.1% following chloroquine (P < .001). In Indonesia, the incidence of gametocytemia was 33.6% following artesunate + amodiaquine (AS + AQ), 7.42% following artemether + lumefantrine, and 6.80% following DHA + PIP (P < .001 for DHA + PIP vs AS + AQ). CONCLUSIONS: P. vivax gametocyte carriage mirrors asexual-stage infection. Prevention of relapses, particularly in those with high asexual parasitemia, is likely the most important strategy for interrupting P. vivax transmission.