Rapid and effective malaria control in Cambodia through mass administration of artemisinin-piperaquine.
BACKGROUND
Previous efforts to eradicate malaria parasites, particularly Plasmodium falciparum, have failed in part due to the emergence of drug resistant parasites and mosquitoes resistant to insecticides. Using an artemisinin-based combination therapy (ACT) that kills parasites quickly, a strategy was designed to eliminate the source of transmission by mass treatment of human populations in malaria-endemic areas Cambodia.


METHODS
A combination drug of artemisinin and piperaquine given with low doses of primaquine was used to eliminate all stages of parasites from human carriers.


RESULTS
In a pilot study, mass administration of artemisinin-piperaquine (two tablets of 62.5 mg artemisinin and 375 mg piperaquine for adults aged > or =16 years at 0 and 24 hrs; 1.5 tablet for children aged 11-15 years; and one tablet for children aged 6-10 years) and primaquine (9 mg for adults, at 10 day intervals for 6 months) was carried out in 17 villages (3,653 individuals). Parasite rates were dramatically reduced from 52.3% to 2.6% after three years. The P. falciparum rate in children decreased from 37.0% to 1.4%, reaching 0% in eight of 17 villages. In a second field study, that included one additional mass treatment of artemisinin-piperaquine, the P. falciparum rate in children was reduced from 20.8% to 0% within six months. No major adverse effects were observed.


CONCLUSIONS
Mass administration of artemisinin-piperaquine and low doses of primaquine can be an effective, safe, and affordable strategy for efficiently eliminating malaria parasites in human carriers and interrupting parasite transmission. This study provides important information for future strategies for the eradication of malaria.
Song
Jianping
J
Research Centre for Qinghao, Guangzhou University of Chinese Medicine, Guangzhou, PR China.
Socheat
Duong
D
Tan
Bo
B
Dara
Prak
P
Deng
Changsheng
C
Sokunthea
Sreng
S
Seila
Suon
S
Ou
Fengzhen
F
Jian
Huaxiang
H
Li
Guoqiao
G
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use*; D002160:Cambodia; D002648:Child; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000469:parasitology / Q000517:prevention & control / Q000635:transmission; D008297:Male; D018512:Parasitemia / Q000469:parasitology / Q000517:prevention & control; D010865:Pilot Projects; D010963:Plasmodium falciparum / Q000187:drug effects*; D011159:Population Surveillance; D011319:Primaquine / Q000627:therapeutic use; D011804:Quinolines / Q000627:therapeutic use*; D016896:Treatment Outcome; D010879:Piperazines
D000890:Anti-Infective Agents; D000962:Antimalarials; D037621:Artemisinins; D011319:Primaquine; D011804:Quinolines; C031327:artemisinin; C034759:piperaquine; D010879:Piperazines