PDF(Pubmed)
Abstract：
BACKGROUND: Plasmodium vivax presents a significant challenge for malaria elimination in the Greater Mekong Subregion. We evaluated the effectiveness of primaquine for reducing relapses of vivax malaria.
METHODS: Patients with uncomplicated P vivax malaria from eastern Myanmar received chloroquine (25-mg base/kg given in 3 days) plus unsupervised PQ (0.25 mg/kg/d for 14 days) without screening for glucose-6-phosphate dehydrogenase deficiency and were followed for a year.
RESULTS: A total of 556 patients were enrolled to receive the chloroquine/primaquine treatment from February 2012 to August 2013. During the follow-up, 38 recurrences were detected, presenting a cumulative recurrence rate of 9.1% (95% CI, 4.1%-14.1%). Genotyping at the pvmsp1 and pvmsp3α loci by amplicon deep sequencing and model prediction indicated that 13 of the 27 recurrences with genotyping data were likely due to relapses. Notably, all confirmed relapses occurred within the first 6 months.
CONCLUSIONS: The unsupervised standard dose of primaquine was highly effective as a radical cure for P vivax malaria in eastern Myanmar. The high presumed effectiveness might have benefited from the health messages delivered during the enrollment and follow-up activities. Six-month follow-ups in the Greater Mekong Subregion are sufficient for detecting most relapses.
METHODS: Patients with uncomplicated P vivax malaria from eastern Myanmar received chloroquine (25-mg base/kg given in 3 days) plus unsupervised PQ (0.25 mg/kg/d for 14 days) without screening for glucose-6-phosphate dehydrogenase deficiency and were followed for a year.
RESULTS: A total of 556 patients were enrolled to receive the chloroquine/primaquine treatment from February 2012 to August 2013. During the follow-up, 38 recurrences were detected, presenting a cumulative recurrence rate of 9.1% (95% CI, 4.1%-14.1%). Genotyping at the pvmsp1 and pvmsp3α loci by amplicon deep sequencing and model prediction indicated that 13 of the 27 recurrences with genotyping data were likely due to relapses. Notably, all confirmed relapses occurred within the first 6 months.
CONCLUSIONS: The unsupervised standard dose of primaquine was highly effective as a radical cure for P vivax malaria in eastern Myanmar. The high presumed effectiveness might have benefited from the health messages delivered during the enrollment and follow-up activities. Six-month follow-ups in the Greater Mekong Subregion are sufficient for detecting most relapses.
摘要：
背景：间日疟原虫对大湄公河次区域（GMS）消除疟疾提出了重大挑战。我们评估了伯氨喹（PQ）减少间日疟疾复发的有效性。
方法：来自缅甸东部的无并发症间日疟原虫患者接受氯喹（CQ，在3天内给予25mg碱/kg）加上无监督的PQ（0.25mg/kg/天，持续14天），未筛查葡萄糖-6-磷酸脱氢酶缺乏症，并随访一年。
结果：2012年2月至2013年8月共纳入556例患者接受CQ/PQ治疗。在后续行动中,检测到38例复发，累积复发率为9.1%(95%置信区间，4.1-14.1%）。通过Amplicon深度测序和模型预测对pvmsp1和pvmsp3α基因座进行基因分型表明，具有基因分型数据的27例复发中有13例可能是由于复发。值得注意的是,所有确诊的复发均发生在前6个月内.
结论：无监督标准剂量的PQ作为缅甸东部间日疟原虫的根治非常有效。假定的高有效性可能受益于在注册和后续活动期间传递的健康信息。GMS的六个月随访足以检测大多数复发。
方法：来自缅甸东部的无并发症间日疟原虫患者接受氯喹（CQ，在3天内给予25mg碱/kg）加上无监督的PQ（0.25mg/kg/天，持续14天），未筛查葡萄糖-6-磷酸脱氢酶缺乏症，并随访一年。
结果：2012年2月至2013年8月共纳入556例患者接受CQ/PQ治疗。在后续行动中,检测到38例复发，累积复发率为9.1%(95%置信区间，4.1-14.1%）。通过Amplicon深度测序和模型预测对pvmsp1和pvmsp3α基因座进行基因分型表明，具有基因分型数据的27例复发中有13例可能是由于复发。值得注意的是,所有确诊的复发均发生在前6个月内.
结论：无监督标准剂量的PQ作为缅甸东部间日疟原虫的根治非常有效。假定的高有效性可能受益于在注册和后续活动期间传递的健康信息。GMS的六个月随访足以检测大多数复发。
