Dynamics of malaria transmission and susceptibility to clinical malaria episodes following treatment of Plasmodium falciparum asymptomatic carriers: results of a cluster-randomized study of community-wide screening and treatment, and a parallel entomology study
| Autor: | Amitava Mukhopadhyay, Sodiomon B. Sirima, Moussa W. Guelbeogo, Alfred B. Tiono, N 'Fale Sagnon, Kamal Hamed, Issa Nebie |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Community screening Plasmodium falciparum Disease transmission Context (language use) Kaplan-Meier Estimate Biology Asymptomatic Antimalarials Young Adult Parasite density Internal medicine parasitic diseases Burkina Faso Gametocyte medicine Prevalence Animals Humans Malaria Falciparum Child Rapid diagnostic test Incidence (epidemiology) Incidence Entomological inoculation rate medicine.disease biology.organism_classification Artemisinins Insect Vectors Malaria Infectious Diseases Culicidae Child Preschool Immunology Asymptomatic Diseases Carrier State Female Seasons Asymptomatic carriers medicine.symptom Asymptomatic carrier Entomology Research Article |
| Zdroj: | BMC Infectious Diseases |
| ISSN: | 1471-2334 |
| Popis: | Background In malaria-endemic countries, large proportions of individuals infected with Plasmodium falciparum are asymptomatic and constitute a reservoir of parasites for infection of newly hatched mosquitoes. Methods Two studies were run in parallel in Burkina Faso to evaluate the impact of systematic identification and treatment of asymptomatic carriers of P. falciparum, detected by rapid diagnostic test, on disease transmission and susceptibility to clinical malaria episodes. A clinical study assessed the incidence of symptomatic malaria episodes with a parasite density >5,000/μL after three screening and treatment campaigns ~1 month apart before the rainy season; and an entomological study determined the effect of these campaigns on malaria transmission as measured by entomological inoculation rate. Results The intervention arm had lower prevalence of asymptomatic carriers of asexual parasites and lower prevalence of gametocyte carriers during campaigns 2 and 3 as compared to the control arm. During the entire follow-up period, out of 13,767 at-risk subjects, 2,516 subjects (intervention arm 1,332; control arm 1,184) had symptomatic malaria. Kaplan-Meier analysis of the incidence of first symptomatic malaria episode with a parasite density >5,000/μL showed that, in the total population, the two treatment arms were similar until Week 11–12 after campaign 3, corresponding with the beginning of the malaria transmission season, after which the probability of being free of symptomatic malaria was lower in the intervention arm (logrank p P. falciparum density was lower in the intervention arm than the control arm. This trend was not seen in those individuals aged ≥5 years. Over the year, monthly variation in mosquito density and entomological inoculation rate was comparable in both arms, with September peaks in both indices. Conclusion Community screening and targeted treatment of asymptomatic carriers of P. falciparum had no effect on the dynamics of malaria transmission, but seemed to be associated with an increase in the treated community’s susceptibility to symptomatic malaria episodes after the screening campaigns had finished. These results highlight the importance of further exploratory studies to better understand the dynamics of disease transmission in the context of malaria elimination. |
| Databáze: | OpenAIRE |
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