TY - JOUR
T1 - A Controlled Trial of Mass Drug Administration to Interrupt Transmission of Multidrug-Resistant Falciparum Malaria in Cambodian Villages
AU - Tripura, Rupam
AU - Peto, Thomas J.
AU - Chea, Nguon
AU - Chan, Davoeung
AU - Mukaka, Mavuto
AU - Sirithiranont, Pasathorn
AU - Dhorda, Mehul
AU - Promnarate, Cholrawee
AU - Imwong, Mallika
AU - von Seidlein, Lorenz
AU - Duanguppama, Jureeporn
AU - Patumrat, Krittaya
AU - Huy, Rekol
AU - Grobusch, Martin P.
AU - Day, Nicholas P. J.
AU - White, Nicholas J.
AU - Dondorp, Arjen M.
PY - 2018
Y1 - 2018
N2 - Background. The increase in multidrug-resistant Plasmodium falciparum in Southeast Asia suggests a need for acceleration of malaria elimination. We evaluated the effectiveness and safety of mass drug administration (MDA) to interrupt malaria transmission. Methods. Four malaria-endemic villages in western Cambodia were randomized to 3 rounds of MDA (a 3-day course of dihydroartemisinin with piperaquine-phosphate), administered either early in or at the end of the study period. Comprehensive malaria treatment records were collected during 2014-2017. Subclinical parasite prevalence was estimated by ultrasensitive quantitative polymerase chain reaction quarterly over 12 months. Results. MDA coverage with at least 1 complete round was 88% (1999/2268), =2 ounds 73% (1645/2268), and all 3 rounds 58% (1310/2268). Plasmodium falciparum incidence in intervention and control villages was similar over the 12 months prior to the study: 39 per 1000 person-years (PY) vs 45 per 1000 PY (P = .50). The primary outcome, P. falciparum incidence in the 12 months after MDA, was lower in intervention villages (1.5/1000 PY vs 37.1/1000 PY; incidence rate ratio, 24.5 [95% confidence interval], 3.4-177; P = .002). Following MDA in 2016, there were no clinical falciparum malaria cases over 12 months (0/2044 PY) in all 4 villages. Plasmodium vivax prevalence decreased markedly in intervention villages following MDA but returned to approximately half the baseline prevalence by 12 months. No severe adverse events were attributed to treatment. Conclusions. Mass drug administrations achieved high coverage, were safe, and associated with the absence of clinical P. falciparum cases for at least 1 year.
AB - Background. The increase in multidrug-resistant Plasmodium falciparum in Southeast Asia suggests a need for acceleration of malaria elimination. We evaluated the effectiveness and safety of mass drug administration (MDA) to interrupt malaria transmission. Methods. Four malaria-endemic villages in western Cambodia were randomized to 3 rounds of MDA (a 3-day course of dihydroartemisinin with piperaquine-phosphate), administered either early in or at the end of the study period. Comprehensive malaria treatment records were collected during 2014-2017. Subclinical parasite prevalence was estimated by ultrasensitive quantitative polymerase chain reaction quarterly over 12 months. Results. MDA coverage with at least 1 complete round was 88% (1999/2268), =2 ounds 73% (1645/2268), and all 3 rounds 58% (1310/2268). Plasmodium falciparum incidence in intervention and control villages was similar over the 12 months prior to the study: 39 per 1000 person-years (PY) vs 45 per 1000 PY (P = .50). The primary outcome, P. falciparum incidence in the 12 months after MDA, was lower in intervention villages (1.5/1000 PY vs 37.1/1000 PY; incidence rate ratio, 24.5 [95% confidence interval], 3.4-177; P = .002). Following MDA in 2016, there were no clinical falciparum malaria cases over 12 months (0/2044 PY) in all 4 villages. Plasmodium vivax prevalence decreased markedly in intervention villages following MDA but returned to approximately half the baseline prevalence by 12 months. No severe adverse events were attributed to treatment. Conclusions. Mass drug administrations achieved high coverage, were safe, and associated with the absence of clinical P. falciparum cases for at least 1 year.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85054981328&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29522113
U2 - https://doi.org/10.1093/cid/ciy196
DO - https://doi.org/10.1093/cid/ciy196
M3 - Article
C2 - 29522113
SN - 1058-4838
VL - 67
SP - 817
EP - 826
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 6
ER -