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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

Identifieur interne : 000402 ( Main/Exploration ); précédent : 000401; suivant : 000403

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

Auteurs : Jordi Landier [Thaïlande] ; Ladda Kajeechiwa [Thaïlande] ; May Myo Thwin [Thaïlande] ; Daniel M. Parker [Thaïlande] ; Victor Chaumeau [Thaïlande, France] ; Jacher Wiladphaingern [Thaïlande] ; Mallika Imwong [Thaïlande] ; Olivo Miotto [Thaïlande, Royaume-Uni] ; Krittaya Patumrat [Thaïlande] ; Jureeporn Duanguppama [Thaïlande] ; Dominique Cerqueira [Thaïlande] ; Benoit Malleret [Singapour] ; Laurent Rénia [Singapour] ; Suphak Nosten [Thaïlande] ; Lorenz Von Seidlein [Thaïlande] ; Clare Ling [Thaïlande] ; Stéphane Proux [Thaïlande] ; Vincent Corbel [France] ; Julie A. Simpson [Australie] ; Arjen M. Dondorp [Thaïlande, Royaume-Uni] ; Nicholas J. White [Thaïlande, Royaume-Uni] ; François H. Nosten [Thaïlande, Royaume-Uni]

Source :

RBID : PMC:5635445

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.


Url:
DOI: 10.12688/wellcomeopenres.12240.1
PubMed: 29062913
PubMed Central: 5635445


Affiliations:


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<title xml:lang="en" level="a" type="main">Safety and effectiveness of mass drug administration to accelerate elimination of artemisinin-resistant falciparum malaria: A pilot trial in four villages of Eastern Myanmar</title>
<author>
<name sortKey="Landier, Jordi" sort="Landier, Jordi" uniqKey="Landier J" first="Jordi" last="Landier">Jordi Landier</name>
<affiliation wicri:level="1">
<nlm:aff id="a1">Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot</wicri:regionArea>
<wicri:noRegion>Mae Sot</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Kajeechiwa, Ladda" sort="Kajeechiwa, Ladda" uniqKey="Kajeechiwa L" first="Ladda" last="Kajeechiwa">Ladda Kajeechiwa</name>
<affiliation wicri:level="1">
<nlm:aff id="a1">Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot</wicri:regionArea>
<wicri:noRegion>Mae Sot</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Thwin, May Myo" sort="Thwin, May Myo" uniqKey="Thwin M" first="May Myo" last="Thwin">May Myo Thwin</name>
<affiliation wicri:level="1">
<nlm:aff id="a1">Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot</wicri:regionArea>
<wicri:noRegion>Mae Sot</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Parker, Daniel M" sort="Parker, Daniel M" uniqKey="Parker D" first="Daniel M." last="Parker">Daniel M. Parker</name>
<affiliation wicri:level="1">
<nlm:aff id="a1">Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot</wicri:regionArea>
<wicri:noRegion>Mae Sot</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Chaumeau, Victor" sort="Chaumeau, Victor" uniqKey="Chaumeau V" first="Victor" last="Chaumeau">Victor Chaumeau</name>
<affiliation wicri:level="1">
<nlm:aff id="a1">Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot</wicri:regionArea>
<wicri:noRegion>Mae Sot</wicri:noRegion>
</affiliation>
<affiliation wicri:level="3">
<nlm:aff id="a2">Maladies Infectieuses et Vecteurs Ecologie, Génétique, Evolution et Contrôle (IRD 224-CNRS 4280 UM1-UM2), Institut de Recherche pour le Développement, Montpellier, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Maladies Infectieuses et Vecteurs Ecologie, Génétique, Evolution et Contrôle (IRD 224-CNRS 4280 UM1-UM2), Institut de Recherche pour le Développement, Montpellier</wicri:regionArea>
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<region type="old region">Languedoc-Roussillon</region>
<settlement type="city">Montpellier</settlement>
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</affiliation>
<affiliation wicri:level="3">
<nlm:aff id="a3">Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Centre Hospitalier Régional Universitaire de Montpellier, Montpellier</wicri:regionArea>
<placeName>
<region type="region">Occitanie (région administrative)</region>
<region type="old region">Languedoc-Roussillon</region>
<settlement type="city">Montpellier</settlement>
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</affiliation>
</author>
<author>
<name sortKey="Wiladphaingern, Jacher" sort="Wiladphaingern, Jacher" uniqKey="Wiladphaingern J" first="Jacher" last="Wiladphaingern">Jacher Wiladphaingern</name>
<affiliation wicri:level="1">
<nlm:aff id="a1">Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot</wicri:regionArea>
<wicri:noRegion>Mae Sot</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Imwong, Mallika" sort="Imwong, Mallika" uniqKey="Imwong M" first="Mallika" last="Imwong">Mallika Imwong</name>
<affiliation wicri:level="1">
<nlm:aff id="a4">Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok</wicri:regionArea>
<wicri:noRegion>Bangkok</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1">
<nlm:aff id="a5">Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok</wicri:regionArea>
<wicri:noRegion>Bangkok</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Miotto, Olivo" sort="Miotto, Olivo" uniqKey="Miotto O" first="Olivo" last="Miotto">Olivo Miotto</name>
<affiliation wicri:level="1">
<nlm:aff id="a4">Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok</wicri:regionArea>
<wicri:noRegion>Bangkok</wicri:noRegion>
</affiliation>
<affiliation wicri:level="4">
<nlm:aff id="a6">Centre for Genomics and Global Health, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Centre for Genomics and Global Health, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN</wicri:regionArea>
<orgName type="university">Université d'Oxford</orgName>
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<settlement type="city">Oxford</settlement>
<region type="nation">Angleterre</region>
<region type="région" nuts="1">Oxfordshire</region>
</placeName>
</affiliation>
<affiliation wicri:level="1">
<nlm:aff id="a7">Wellcome Trust Sanger Institute, Cambridge, CB10 1SA, UK</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Wellcome Trust Sanger Institute, Cambridge, CB10 1SA</wicri:regionArea>
<wicri:noRegion>CB10 1SA</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Patumrat, Krittaya" sort="Patumrat, Krittaya" uniqKey="Patumrat K" first="Krittaya" last="Patumrat">Krittaya Patumrat</name>
<affiliation wicri:level="1">
<nlm:aff id="a5">Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok</wicri:regionArea>
<wicri:noRegion>Bangkok</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Duanguppama, Jureeporn" sort="Duanguppama, Jureeporn" uniqKey="Duanguppama J" first="Jureeporn" last="Duanguppama">Jureeporn Duanguppama</name>
<affiliation wicri:level="1">
<nlm:aff id="a5">Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok</wicri:regionArea>
<wicri:noRegion>Bangkok</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Cerqueira, Dominique" sort="Cerqueira, Dominique" uniqKey="Cerqueira D" first="Dominique" last="Cerqueira">Dominique Cerqueira</name>
<affiliation wicri:level="1">
<nlm:aff id="a4">Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok</wicri:regionArea>
<wicri:noRegion>Bangkok</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Malleret, Benoit" sort="Malleret, Benoit" uniqKey="Malleret B" first="Benoit" last="Malleret">Benoit Malleret</name>
<affiliation wicri:level="4">
<nlm:aff id="a8">Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119077, Singapore</nlm:aff>
<country xml:lang="fr">Singapour</country>
<wicri:regionArea>Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119077</wicri:regionArea>
<orgName type="university">Université nationale de Singapour</orgName>
</affiliation>
<affiliation wicri:level="1">
<nlm:aff id="a9">Singapore Immunology Network (SIgN), Agency for Science & Technology, Singapore, 138632, Singapore</nlm:aff>
<country xml:lang="fr">Singapour</country>
<wicri:regionArea>Singapore Immunology Network (SIgN), Agency for Science & Technology, Singapore, 138632</wicri:regionArea>
<wicri:noRegion>138632</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Renia, Laurent" sort="Renia, Laurent" uniqKey="Renia L" first="Laurent" last="Rénia">Laurent Rénia</name>
<affiliation wicri:level="1">
<nlm:aff id="a9">Singapore Immunology Network (SIgN), Agency for Science & Technology, Singapore, 138632, Singapore</nlm:aff>
<country xml:lang="fr">Singapour</country>
<wicri:regionArea>Singapore Immunology Network (SIgN), Agency for Science & Technology, Singapore, 138632</wicri:regionArea>
<wicri:noRegion>138632</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Nosten, Suphak" sort="Nosten, Suphak" uniqKey="Nosten S" first="Suphak" last="Nosten">Suphak Nosten</name>
<affiliation wicri:level="1">
<nlm:aff id="a1">Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot</wicri:regionArea>
<wicri:noRegion>Mae Sot</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Von Seidlein, Lorenz" sort="Von Seidlein, Lorenz" uniqKey="Von Seidlein L" first="Lorenz" last="Von Seidlein">Lorenz Von Seidlein</name>
<affiliation wicri:level="1">
<nlm:aff id="a4">Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok</wicri:regionArea>
<wicri:noRegion>Bangkok</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Ling, Clare" sort="Ling, Clare" uniqKey="Ling C" first="Clare" last="Ling">Clare Ling</name>
<affiliation wicri:level="1">
<nlm:aff id="a1">Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot</wicri:regionArea>
<wicri:noRegion>Mae Sot</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Proux, Stephane" sort="Proux, Stephane" uniqKey="Proux S" first="Stéphane" last="Proux">Stéphane Proux</name>
<affiliation wicri:level="1">
<nlm:aff id="a1">Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot</wicri:regionArea>
<wicri:noRegion>Mae Sot</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Corbel, Vincent" sort="Corbel, Vincent" uniqKey="Corbel V" first="Vincent" last="Corbel">Vincent Corbel</name>
<affiliation wicri:level="3">
<nlm:aff id="a2">Maladies Infectieuses et Vecteurs Ecologie, Génétique, Evolution et Contrôle (IRD 224-CNRS 4280 UM1-UM2), Institut de Recherche pour le Développement, Montpellier, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Maladies Infectieuses et Vecteurs Ecologie, Génétique, Evolution et Contrôle (IRD 224-CNRS 4280 UM1-UM2), Institut de Recherche pour le Développement, Montpellier</wicri:regionArea>
<placeName>
<region type="region">Occitanie (région administrative)</region>
<region type="old region">Languedoc-Roussillon</region>
<settlement type="city">Montpellier</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Simpson, Julie A" sort="Simpson, Julie A" uniqKey="Simpson J" first="Julie A." last="Simpson">Julie A. Simpson</name>
<affiliation wicri:level="4">
<nlm:aff id="a10">Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3053, Australia</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3053</wicri:regionArea>
<orgName type="university">Université de Melbourne</orgName>
<placeName>
<settlement type="city">Melbourne</settlement>
<region type="état">Victoria (État)</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Dondorp, Arjen M" sort="Dondorp, Arjen M" uniqKey="Dondorp A" first="Arjen M." last="Dondorp">Arjen M. Dondorp</name>
<affiliation wicri:level="1">
<nlm:aff id="a4">Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok</wicri:regionArea>
<wicri:noRegion>Bangkok</wicri:noRegion>
</affiliation>
<affiliation wicri:level="4">
<nlm:aff id="a11">Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN</wicri:regionArea>
<orgName type="university">Université d'Oxford</orgName>
<placeName>
<settlement type="city">Oxford</settlement>
<region type="nation">Angleterre</region>
<region type="région" nuts="1">Oxfordshire</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="White, Nicholas J" sort="White, Nicholas J" uniqKey="White N" first="Nicholas J." last="White">Nicholas J. White</name>
<affiliation wicri:level="1">
<nlm:aff id="a4">Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok</wicri:regionArea>
<wicri:noRegion>Bangkok</wicri:noRegion>
</affiliation>
<affiliation wicri:level="4">
<nlm:aff id="a11">Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN</wicri:regionArea>
<orgName type="university">Université d'Oxford</orgName>
<placeName>
<settlement type="city">Oxford</settlement>
<region type="nation">Angleterre</region>
<region type="région" nuts="1">Oxfordshire</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Nosten, Francois H" sort="Nosten, Francois H" uniqKey="Nosten F" first="François H." last="Nosten">François H. Nosten</name>
<affiliation wicri:level="1">
<nlm:aff id="a1">Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot</wicri:regionArea>
<wicri:noRegion>Mae Sot</wicri:noRegion>
</affiliation>
<affiliation wicri:level="4">
<nlm:aff id="a11">Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN</wicri:regionArea>
<orgName type="university">Université d'Oxford</orgName>
<placeName>
<settlement type="city">Oxford</settlement>
<region type="nation">Angleterre</region>
<region type="région" nuts="1">Oxfordshire</region>
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</affiliation>
</author>
</analytic>
<series>
<title level="j">Wellcome Open Research</title>
<idno type="eISSN">2398-502X</idno>
<imprint>
<date when="2017">2017</date>
</imprint>
</series>
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</teiHeader>
<front>
<div type="abstract" xml:lang="en">
<p>
<bold>Background: </bold>
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.</p>
<p> 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.</p>
<p>
<bold>Methods: </bold>
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.</p>
<p>
<bold>Results: </bold>
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
<italic>P. falciparum </italic>
carriage and anopheline vector positivity decreased significantly whereas prevalence of the artemisinin-resistance molecular marker remained stable.</p>
<p>
<bold>Conclusions: </bold>
This MDA was safe and feasible, and, could accelerate elimination of
<italic>P. falciparum </italic>
in addition to EDT and LLINs
<italic></italic>
when community participation was sufficient.</p>
</div>
</front>
<back>
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<author>
<name sortKey="Stepniewska, K" uniqKey="Stepniewska K">K Stepniewska</name>
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<name sortKey="Tripura, R" uniqKey="Tripura R">R Tripura</name>
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</analytic>
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<name sortKey="Imwong, M" uniqKey="Imwong M">M Imwong</name>
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<author>
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</author>
<author>
<name sortKey="Tripura, R" uniqKey="Tripura R">R Tripura</name>
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<name sortKey="Von Seidlein, L" uniqKey="Von Seidlein L">L von Seidlein</name>
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<author>
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<author>
<name sortKey="Msellem, M" uniqKey="Msellem M">M Msellem</name>
</author>
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<author>
<name sortKey="Hwang, J" uniqKey="Hwang J">J Hwang</name>
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<name sortKey="Dicko, A" uniqKey="Dicko A">A Dicko</name>
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</author>
<author>
<name sortKey="Phaiphun, L" uniqKey="Phaiphun L">L Phaiphun</name>
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<author>
<name sortKey="Thwin, Mm" uniqKey="Thwin M">MM Thwin</name>
</author>
<author>
<name sortKey="Nosten, S" uniqKey="Nosten S">S Nosten</name>
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<author>
<name sortKey="Thwin, Mm" uniqKey="Thwin M">MM Thwin</name>
</author>
<author>
<name sortKey="Shee, Pw" uniqKey="Shee P">PW Shee</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Imwong, M" uniqKey="Imwong M">M Imwong</name>
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<author>
<name sortKey="Hanchana, S" uniqKey="Hanchana S">S Hanchana</name>
</author>
<author>
<name sortKey="Malleret, B" uniqKey="Malleret B">B Malleret</name>
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<author>
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<li>France</li>
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<li>Singapour</li>
<li>Thaïlande</li>
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<li>Angleterre</li>
<li>Languedoc-Roussillon</li>
<li>Occitanie (région administrative)</li>
<li>Oxfordshire</li>
<li>Victoria (État)</li>
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<li>Oxford</li>
</settlement>
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<li>Université nationale de Singapour</li>
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<name sortKey="Chaumeau, Victor" sort="Chaumeau, Victor" uniqKey="Chaumeau V" first="Victor" last="Chaumeau">Victor Chaumeau</name>
<name sortKey="Dondorp, Arjen M" sort="Dondorp, Arjen M" uniqKey="Dondorp A" first="Arjen M." last="Dondorp">Arjen M. Dondorp</name>
<name sortKey="Duanguppama, Jureeporn" sort="Duanguppama, Jureeporn" uniqKey="Duanguppama J" first="Jureeporn" last="Duanguppama">Jureeporn Duanguppama</name>
<name sortKey="Imwong, Mallika" sort="Imwong, Mallika" uniqKey="Imwong M" first="Mallika" last="Imwong">Mallika Imwong</name>
<name sortKey="Imwong, Mallika" sort="Imwong, Mallika" uniqKey="Imwong M" first="Mallika" last="Imwong">Mallika Imwong</name>
<name sortKey="Kajeechiwa, Ladda" sort="Kajeechiwa, Ladda" uniqKey="Kajeechiwa L" first="Ladda" last="Kajeechiwa">Ladda Kajeechiwa</name>
<name sortKey="Ling, Clare" sort="Ling, Clare" uniqKey="Ling C" first="Clare" last="Ling">Clare Ling</name>
<name sortKey="Miotto, Olivo" sort="Miotto, Olivo" uniqKey="Miotto O" first="Olivo" last="Miotto">Olivo Miotto</name>
<name sortKey="Nosten, Francois H" sort="Nosten, Francois H" uniqKey="Nosten F" first="François H." last="Nosten">François H. Nosten</name>
<name sortKey="Nosten, Suphak" sort="Nosten, Suphak" uniqKey="Nosten S" first="Suphak" last="Nosten">Suphak Nosten</name>
<name sortKey="Parker, Daniel M" sort="Parker, Daniel M" uniqKey="Parker D" first="Daniel M." last="Parker">Daniel M. Parker</name>
<name sortKey="Patumrat, Krittaya" sort="Patumrat, Krittaya" uniqKey="Patumrat K" first="Krittaya" last="Patumrat">Krittaya Patumrat</name>
<name sortKey="Proux, Stephane" sort="Proux, Stephane" uniqKey="Proux S" first="Stéphane" last="Proux">Stéphane Proux</name>
<name sortKey="Thwin, May Myo" sort="Thwin, May Myo" uniqKey="Thwin M" first="May Myo" last="Thwin">May Myo Thwin</name>
<name sortKey="Von Seidlein, Lorenz" sort="Von Seidlein, Lorenz" uniqKey="Von Seidlein L" first="Lorenz" last="Von Seidlein">Lorenz Von Seidlein</name>
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<name sortKey="Wiladphaingern, Jacher" sort="Wiladphaingern, Jacher" uniqKey="Wiladphaingern J" first="Jacher" last="Wiladphaingern">Jacher Wiladphaingern</name>
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<country name="France">
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<name sortKey="Chaumeau, Victor" sort="Chaumeau, Victor" uniqKey="Chaumeau V" first="Victor" last="Chaumeau">Victor Chaumeau</name>
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<name sortKey="Chaumeau, Victor" sort="Chaumeau, Victor" uniqKey="Chaumeau V" first="Victor" last="Chaumeau">Victor Chaumeau</name>
<name sortKey="Corbel, Vincent" sort="Corbel, Vincent" uniqKey="Corbel V" first="Vincent" last="Corbel">Vincent Corbel</name>
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<name sortKey="Miotto, Olivo" sort="Miotto, Olivo" uniqKey="Miotto O" first="Olivo" last="Miotto">Olivo Miotto</name>
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<name sortKey="Dondorp, Arjen M" sort="Dondorp, Arjen M" uniqKey="Dondorp A" first="Arjen M." last="Dondorp">Arjen M. Dondorp</name>
<name sortKey="Miotto, Olivo" sort="Miotto, Olivo" uniqKey="Miotto O" first="Olivo" last="Miotto">Olivo Miotto</name>
<name sortKey="Nosten, Francois H" sort="Nosten, Francois H" uniqKey="Nosten F" first="François H." last="Nosten">François H. Nosten</name>
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<name sortKey="Renia, Laurent" sort="Renia, Laurent" uniqKey="Renia L" first="Laurent" last="Rénia">Laurent Rénia</name>
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<name sortKey="Simpson, Julie A" sort="Simpson, Julie A" uniqKey="Simpson J" first="Julie A." last="Simpson">Julie A. Simpson</name>
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