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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Artemisinin-based combination therapy does not measurably reduce human infectiousness to vectors in a setting of intense malaria transmission
Malaria Journal, Volume 11, Article 118, Year 2012
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Description
Background: Artemisinin-based combination therapy (ACT) for treating malaria has activity against immature gametocytes. In theory, this property may complement the effect of terminating otherwise lengthy malaria infections and reducing the parasite reservoir in the human population that can infect vector mosquitoes. However, this has never been verified at a population level in a setting with intense transmission, where chronically infectious asymptomatic carriers are common and cured patients are rapidly and repeatedly re-infected. Methods. From 2001 to 2004, malaria vector densities were monitored using light traps in three Tanzanian districts. Mosquitoes were dissected to determine parous and oocyst rates. Plasmodium falciparum sporozoite rates were determined by ELISA. Sulphadoxine-pyrimethamine (SP) monotherapy was used for treatment of uncomplicated malaria in the contiguous districts of Kilombero and Ulanga throughout this period. In Rufiji district, the standard drug was changed to artesunate co-administered with SP (AS+SP) in March 2003. The effects of this change in case management on malaria parasite infection in the vectors were analysed. Results: Plasmodium falciparum entomological inoculation rates exceeded 300 infective bites per person per year at both sites over the whole period. The introduction of AS+SP in Rufiji was associated with increased oocyst prevalence (OR [95%CI]=3.9 [2.9-5.3], p<0.001), but had no consistent effect on sporozoite prevalence (OR [95%CI]=0.9 [0.7-1.2], p=0.5). The estimated infectiousness of the human population in Rufiji was very low prior to the change in drug policy. Emergence rates and parous rates of the vectors varied substantially throughout the study period, which affected estimates of infectiousness. The latter consequently cannot be explained by the change in drug policy. Conclusions: In high perennial transmission settings, only a small proportion of infections in humans are symptomatic or treated, so case management with ACT may have little impact on overall infectiousness of the human population. Variations in infection levels in vectors largely depend on the age distribution of the mosquito population. Benefits of ACT in suppressing transmission are more likely to be evident where transmission is already low or effective vector control is widely implemented. © 2012 Huho et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Huho, Bernadette J.
Tanzania, Ifakara
Ifakara Health Institute
Switzerland, Allschwil
Swiss Tropical and Public Health Institute Swiss Tph
Switzerland, Basel
Universitat Basel
Killeen, Gerry Francis
Tanzania, Ifakara
Ifakara Health Institute
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Ferguson, Heather M.
Tanzania, Ifakara
Ifakara Health Institute
United Kingdom, Glasgow
University of Glasgow
Tami, Adriana
Netherlands, Groningen
Universitair Medisch Centrum Groningen
Netherlands, Amsterdam
Royal Tropical Institute - Kit
Lengeler, Christian H.
Switzerland, Allschwil
Swiss Tropical and Public Health Institute Swiss Tph
Switzerland, Basel
Universitat Basel
Charlwood, J. D.
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Kihonda, Aniset
Tanzania, Ifakara
Ifakara Health Institute
Kihonda, Japhet M.
Tanzania, Ifakara
Ifakara Health Institute
Kachur, Stephen Patrick
Tanzania, Ifakara
Ifakara Health Institute
United States, Atlanta
Centers for Disease Control and Prevention
Smith, Thomas A.
Switzerland, Allschwil
Swiss Tropical and Public Health Institute Swiss Tph
Switzerland, Basel
Universitat Basel
Abdulla, Salim Mohammed K.
Tanzania, Ifakara
Ifakara Health Institute
Statistics
Citations: 18
Authors: 11
Affiliations: 8
Identifiers
Doi:
10.1186/1475-2875-11-118
e-ISSN:
14752875
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study