Contribution of Asymptomatic Plasmodium Infections to the Transmission of Malaria in Kayin State, Myanmar. (29th November 2018)

• Record Type: Journal Article
• Authors: Chaumeau, Victor; Kajeechiwa, Ladda; Fustec, Bénédicte; Landier, Jordi; Naw Nyo, Saw; Nay Hsel, Saw; Phatharakokordbun, Phabele; Kittiphanakun, Prapan; Nosten, Suphak; Thwin, May Myo; Win Tun, Saw; Wiladphaingern, Jacher; Cottrell, Gilles; Parker, Daniel M; Minh, Myo Chit; Kwansomboon, Nittpha; Metaane, Selma; Montazeau, Céline; Kunjanwong, Kitti; Sawasdichai, Sunisa; Andolina, Chiara; Ling, Clare; Haohankhunnatham, Warat; Christiensen, Peter; Wanyatip, Sunaree; Konghahong, Kamonchanok; Cerqueira, Dominique; Imwong, Mallika; Dondorp, Arjen M; Chareonviriyaphap, Theeraphap; White, Nicholas J; Nosten, François H; Corbel, Vincent;
• Is Part Of: Journal of infectious diseases. Volume 219:Number 9(2019)
• Page Start: 1499
• Page End: 1509
• Publication Date: 2018-11-29
• Subjects: Mass drug administration -- malaria -- entomological inoculation rate -- primaquine -- Plasmodium falciparum -- Plasmodium vivax -- elimination -- artemisinin resistance -- Southeast Asia; Communicable diseases -- Periodicals; Diseases -- Causes and theories of causation -- Periodicals; Medicine -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.9
• DOI: 10.1093/infdis/jiy686
• Languages: English
• ISSNs: 0022-1899

Abstract

Abstract: Background: The objective of mass antimalarial drug administration (MDA) is to eliminate malaria rapidly by eliminating the asymptomatic malaria parasite reservoirs and interrupting transmission. In the Greater Mekong Subregion, where artemisinin-resistant Plasmodium falciparum is now widespread, MDA has been proposed as an elimination accelerator, but the contribution of asymptomatic infections to malaria transmission has been questioned. The impact of MDA on entomological indices has not been characterized previously. Methods: MDA was conducted in 4 villages in Kayin State (Myanmar). Malaria mosquito vectors were captured 3 months before, during, and 3 months after MDA, and their Plasmodium infections were detected by polymerase chain reaction (PCR) analysis. The relationship between the entomological inoculation rate, the malaria prevalence in humans determined by ultrasensitive PCR, and MDA was characterized by generalized estimating equation regression. Results: Asymptomatic P. falciparum and Plasmodium vivax infections were cleared by MDA. The P. vivax entomological inoculation rate was reduced by 12.5-fold (95% confidence interval [CI], 1.6–100-fold), but the reservoir of asymptomatic P. vivax infections was reconstituted within 3 months, presumably because of relapses. This was coincident with a 5.3-fold (95% CI, 4.8–6.0-fold) increase in the vector infection rate. Conclusion: Asymptomatic infections are a major source of malaria transmission in Southeast Asia. Abstract : This study demonstrates the major contribution of asymptomatic low-density Plasmodium infections to the transmission of malaria in Southeast Asian settings. Mass drug administration with dihydroartemisinin-piperaquine can interrupt malaria transmission rapidly in areas where the prevalence of asymptomatic infection is high.