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Effectiveness of an Unsupervised Primaquine Regimen for Preventing Plasmodium vivax Malaria Relapses in Northeast Myanmar: A Single-Arm Nonrandomized Observational Study
Journal article   Peer reviewed

Effectiveness of an Unsupervised Primaquine Regimen for Preventing Plasmodium vivax Malaria Relapses in Northeast Myanmar: A Single-Arm Nonrandomized Observational Study

Pallavi Malla, Zenglei Wang, Awtum Brashear, Zhaoqing Yang, Eugenia Lo, Kevin Baird, Chengqi Wang and Liwang Cui
The Journal of infectious diseases, v 229(5), pp 1557-1564
15 May 2024
PMID: 38041857
url
https://doi.org/10.1093/infdis/jiad552View
Published, Version of Record (VoR) Open

Abstract

Adolescent Adult Aged Antimalarials - administration & dosage Antimalarials - therapeutic use Child Child, Preschool Chloroquine - administration & dosage Chloroquine - therapeutic use Female Genotype Humans Malaria, Vivax - drug therapy Malaria, Vivax - epidemiology Malaria, Vivax - prevention & control Male Middle Aged Myanmar - epidemiology Plasmodium vivax - drug effects Plasmodium vivax - genetics Primaquine - administration & dosage Primaquine - therapeutic use Recurrence Secondary Prevention - methods Treatment Outcome Young Adult
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. 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. 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. 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.

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Collaboration types
Domestic collaboration
International collaboration
Web of Science research areas
Immunology
Infectious Diseases
Microbiology
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