Effect of artesunate-mefloquine fixed-dose combination in malaria transmission in amazon basin communities

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorSantelli, Ana C.
dc.contributor.authorRibeiro, Isabela
dc.contributor.authorDaher, Andre
dc.contributor.authorBoulos, Marcos
dc.contributor.authorMarchesini, Paola B.
dc.contributor.authordos Santos, Roseli La Corte
dc.contributor.authorLucena, Marize B. F.
dc.contributor.authorMagalhaes, Izanelda
dc.contributor.authorLeon, Antonio P.
dc.contributor.authorJunger, Washington
dc.contributor.authorLadislau, Jose L. B.
dc.date.accessioned2014-02-25T14:56:05Z
dc.date.available2014-02-25T14:56:05Z
dc.date.issued2012
dc.description.abstractBackground: Studies in South-East Asia have suggested that early diagnosis and treatment with artesunate (AS) and mefloquine (MQ) combination therapy may reduce the transmission of Plasmodium falciparum malaria and the progression of MQ resistance. Methods: The effectiveness of a fixed-dose combination of AS and MQ (ASMQ) in reducing malaria transmission was tested in isolated communities of the Jurua valley in the Amazon region. Priority municipalities within the Brazilian Legal Amazon area were selected according to pre-specified criteria. Routine national malaria control programmatic procedures were followed. Existing health structures were reinforced and health care workers were trained to treat with ASMQ all confirmed falciparum malaria cases that match inclusion criteria. A local pharmacovigilance structure was implemented. Incidence of malaria and hospitalizations were recorded two years before, during, and after the fixed-dose ASMQ intervention. In total, between July 2006 and December 2008, 23,845 patients received ASMQ. Two statistical modelling approaches were applied to monthly time series of P. falciparum malaria incidence rates, P. falciparum/Plasmodium vivax infection ratio, and malaria hospital admissions rates. All the time series ranged from January 2004 to December 2008, whilst the intervention period span from July 2006 to December 2008. Results: The ASMQ intervention had a highly significant impact on the mean level of each time series, adjusted for trend and season, of 0.34 (95% CI 0.20 - 0.58) for the P. falciparum malaria incidence rates, 0.67 (95% CI 0.50 - 0.89) for the P. falciparum/P. vivax infection ratio, and 0.53 (95% CI 0.41 - 0.69) for the hospital admission rates. There was also a significant change in the seasonal (or monthly) pattern of the time series before and after intervention, with the elimination of the malaria seasonal peak in the rainy months of the years following the introduction of ASMQ. No serious adverse events relating to the use of fixed-dose ASMQ were reported. Conclusions: In the remote region of the Jurua valley, the early detection of malaria by health care workers and treatment with fixed-dose ASMQ was feasible and efficacious, and significantly reduced the incidence and morbidity of P. falciparum malaria.
dc.description.indexMEDLINE
dc.description.sponsorshipCNPq [309156/2007-6]
dc.description.sponsorshipPAHO/WHO
dc.description.sponsorshipBrazilian Ministry of Health
dc.description.sponsorshipUSAID
dc.identifier.citationMALARIA JOURNAL, v.11, article ID 286, 12p, 2012
dc.identifier.doi10.1186/1475-2875-11-286
dc.identifier.issn1475-2875
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/5024
dc.language.isoeng
dc.publisherBIOMED CENTRAL LTD
dc.relation.ispartofMALARIA JOURNAL
dc.rightsopenAccess
dc.rights.holderCopyright BIOMED CENTRAL LTD
dc.subjectMalaria
dc.subjectACT
dc.subjectartesunate
dc.subjectmefloquine
dc.subjectFixed-dose combination
dc.subjectP. falciparum
dc.subjectBrazil
dc.subjectAmazon
dc.subject.otherPLASMODIUM-FALCIPARUM MALARIA
dc.subject.otherBRAZILIAN AMAZON
dc.subject.otherTHAILAND
dc.subject.otherEFFICACY
dc.subject.otherPOPULATION
dc.subject.otherRESISTANCE
dc.subject.otherDEPLOYMENT
dc.subject.otherACRE
dc.subject.wosParasitology
dc.subject.wosTropical Medicine
dc.titleEffect of artesunate-mefloquine fixed-dose combination in malaria transmission in amazon basin communities
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.author.externalRibeiro, Isabela: Fundacao Oswaldo Cruz, Inst Tecnol Farmacos Farmanguinhos, Rio De Janeiro, Brazil
hcfmusp.author.externalDaher, Andre: Fundacao Oswaldo Cruz, Inst Tecnol Farmacos Farmanguinhos, Rio De Janeiro, Brazil; Drugs Neglected Dis Initiat, Rio De Janeiro, Brazil
hcfmusp.author.externalMarchesini, Paola B.: Pan Amer Hlth Org, Brasilia, DF, Brazil
hcfmusp.author.externaldos Santos, Roseli La Corte: Univ Fed Sergipe, Sergipe, Brazil
hcfmusp.author.externalLucena, Marize B. F.: Secretaria Estadual Saude, Acre, Brazil
hcfmusp.author.externalMagalhaes, Izanelda: Secretaria Estadual Saude, Acre, Brazil
hcfmusp.author.externalLeon, Antonio P.: Univ Estado Rio de Janeiro, BR-20550011 Rio De Janeiro, Brazil
hcfmusp.author.externalJunger, Washington: Univ Estado Rio de Janeiro, BR-20550011 Rio De Janeiro, Brazil
hcfmusp.citation.scopus20
hcfmusp.contributor.author-fmusphcMARCOS BOULOS
hcfmusp.description.articlenumber286
hcfmusp.description.volume11
hcfmusp.lim.ref2012
hcfmusp.origemWOS
hcfmusp.origem.pubmed22905900
hcfmusp.origem.scopus2-s2.0-84865048317
hcfmusp.origem.wosWOS:000309871600001
hcfmusp.publisher.cityLONDON
hcfmusp.publisher.countryENGLAND
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hcfmusp.remissive.sponsorshipCNPq
hcfmusp.remissive.sponsorshipPAHO
hcfmusp.remissive.sponsorshipMinistério da Saúde
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