TY - JOUR
T1 - Mass drug administration with dihydroartemisinin-piperaquine and malaria transmission dynamics in The Gambia - a prospective cohort study
AU - Mwesigwa, Julia
AU - Achan, Jane
AU - Affara, Muna
AU - Miriam, Wathua
AU - Worwui, Archibald
AU - Muhommed, Nuredin Ibrahim
AU - Kanuteh, Fatoumatta
AU - Prom, Aurelie
AU - Dierickx, Susan
AU - Tanna, Gian Luca di
AU - Nwakanma, Davis
AU - Bousema, Teun
AU - Drakeley, Chris
AU - Van Geertruyden, Jean-Pierre
AU - D'Alessandro, Umberto
N1 - © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America.
PY - 2019/7/15
Y1 - 2019/7/15
N2 - BACKGROUND: Mass drug administration (MDA) may further reduce malaria transmission in low-transmission areas. The impact of MDA on the dynamics of malaria transmission was determined in a prospective cohort study. METHODS: Annual rounds of MDA with dihydroartemisinin-piperaquine (DP) were implemented were implemented in 2014 and 2015 in six village pairs before the malaria transmission season. Blood samples were collected from residents between July and December for microscopy and nested PCR. Incidence and prevalence of infection, clinical disease, and risk of malaria reinfection post-MDA were determined. RESULTS: Coverage of three DP doses was 68.2% (2014) and 65.6% (2015), compliance was greater than 80%. Incidence of infection was significantly lower in 2014 (incidence rate [IR] = 0.2 per person year [PPY]) than in 2013 (IR = 1.1 PPY; P < .01); monthly infection prevalence declined in the first three months post-MDA. Clinical malaria incidence was lower in 2014 (IR = 0.1 PPY) and 2015 (IR = 0.2 PPY) than in 2013 (IR = 0.4 PPY; P < .01), but remained higher in eastern Gambia. Individuals infected before MDA had a 2-fold higher odds of reinfection post-MDA (adjusted odds ratio = 2.5, 95% confidence interval 1.5-4.3; P < .01). CONCLUSIONS: MDA reduced malaria infection and clinical disease during the first months. The reduction was maintained in low-transmission areas, but not in eastern Gambia. Annual MDA could be followed by focal MDA targeting individuals infected during the dry season. Repeated MDA rounds, some during the dry season over larger geographical areas, may result in a more marked and sustained decrease of malaria transmission.
AB - BACKGROUND: Mass drug administration (MDA) may further reduce malaria transmission in low-transmission areas. The impact of MDA on the dynamics of malaria transmission was determined in a prospective cohort study. METHODS: Annual rounds of MDA with dihydroartemisinin-piperaquine (DP) were implemented were implemented in 2014 and 2015 in six village pairs before the malaria transmission season. Blood samples were collected from residents between July and December for microscopy and nested PCR. Incidence and prevalence of infection, clinical disease, and risk of malaria reinfection post-MDA were determined. RESULTS: Coverage of three DP doses was 68.2% (2014) and 65.6% (2015), compliance was greater than 80%. Incidence of infection was significantly lower in 2014 (incidence rate [IR] = 0.2 per person year [PPY]) than in 2013 (IR = 1.1 PPY; P < .01); monthly infection prevalence declined in the first three months post-MDA. Clinical malaria incidence was lower in 2014 (IR = 0.1 PPY) and 2015 (IR = 0.2 PPY) than in 2013 (IR = 0.4 PPY; P < .01), but remained higher in eastern Gambia. Individuals infected before MDA had a 2-fold higher odds of reinfection post-MDA (adjusted odds ratio = 2.5, 95% confidence interval 1.5-4.3; P < .01). CONCLUSIONS: MDA reduced malaria infection and clinical disease during the first months. The reduction was maintained in low-transmission areas, but not in eastern Gambia. Annual MDA could be followed by focal MDA targeting individuals infected during the dry season. Repeated MDA rounds, some during the dry season over larger geographical areas, may result in a more marked and sustained decrease of malaria transmission.
KW - clinical malaria
KW - dihydroartemisinin-piperaquine
KW - gametocytes
KW - malaria infection
KW - mass drug administration
UR - http://www.scopus.com/inward/record.url?scp=85069267982&partnerID=8YFLogxK
U2 - 10.1093/cid/ciy870
DO - 10.1093/cid/ciy870
M3 - Article
C2 - 30304511
SN - 1058-4838
VL - 69
SP - 278
EP - 286
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 2
ER -