Malaria Control by Mass Drug Administration With Artemisinin Plus Piperaquine on Grande Comore Island, Union of Comoros

Authors：Deng, Changsheng; Wu, Wanting; Yuan, Yueming; Li, Guoming; Zhang, Hongying; Zheng, Shaoqin; Li, Mingqiang; Tan, Ruixiang; Wang, Yuxin; Nadia, Julie; Feng, Danhong; Li, Di; Wu, Zhibing; Xu, Qin; Li, Changqing; Wang, Zhenhua; Liang, Yuan; Doehl, Johannes S. P.; Su, Xinzhuan; Bacar, Affane; Abdallah, Kamal Said; Mohamed, Hafidhou; Mliva, Ahamada Msa; Wellems, Thomas E.^*; Song, Jianping^*

Source：Open Forum Infectious Diseases, 2023, 10(3).

DOI：10.1093/ofid/ofad076

• artemisinin-based combination therapy
• chloroquine resistance transporter (PfCRT)
• pfK13 kelch-propeller mutations
• piperaquine resistance
• Plasmodium falciparum malaria

Mass administration of artemisinin-piperaquine in 2 monthly rounds, each comprising 2 daily doses, reduced malaria dramatically on Grande Comore Island. This 2-round regimen may offer practical advantages over 3-round regimens, with or without low-dose primaquine, for malaria control. @@@ Background Mass drug administration (MDA) is a powerful tool for malaria control, but the medicines to use, dosing, number of rounds, and potential selection of drug resistance remain open questions. Methods Two monthly rounds of artemisinin-piperaquine (AP), each comprising 2 daily doses, were administered across the 7 districts of Grande Comore Island. In 3 districts, low-dose primaquine (PMQ(LD)) was also given on the first day of each monthly round. Plasmodium falciparum malaria rates, mortality, parasitemias, adverse events, and genetic markers of potential drug resistance were evaluated. Results Average population coverages of 80%-82% were achieved with AP in 4 districts (registered population 258 986) and AP + PMQ(LD) in 3 districts (83 696). The effectiveness of MDA was 96.27% (95% confidence interval [CI], 95.27%-97.06%; P < .00001) in the 4 AP districts and 97.46% (95% CI, 94.54%-98.82%; P < .00001) in the 3 AP + PMQ(LD) districts. In comparative statistical modeling, the effectiveness of the 2 monthly rounds on Grande Comore Island was nearly as high as that of 3 monthly rounds of AP or AP + PMQ(LD) in our earlier study on Anjouan Island. Surveys of pre-MDA and post-MDA samples showed no significant changes in PfK13 polymorphism rates, and no PfCRT mutations previously linked to piperaquine resistance in Southeast Asia were identified. Conclusions MDA with 2 monthly rounds of 2 daily doses of AP was highly effective on Grande Comore Island. The feasibility and lower expense of this 2-month versus 3-month regimen of AP may offer advantages for MDA programs in appropriate settings.

• Institution
  1; 广州中医药大学