Malaria Transmission After Artemether-Lumefantrine and Dihydroartemisinin-Piperaquine: A Randomized Trial
Malaria Transmission After Artemether-Lumefantrine and Dihydroartemisinin-Piperaquine: A Randomized Trial
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DOI：
10.1093/infdis/jit077
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发表时间：
2013-06-01
影响因子：
6.4
通讯作者：
Bousema, Teun
中科院分区：
文献类型：
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作者：
Sawa, Patrick;Shekalaghe, Seif A.;Bousema, Teun
背景与非青蒿素综合疗法相比，青蒿素综合疗法降低了疟疾传播的可能性。目前尚不清楚青蒿素综合疗法的这种效果是否不同。在肯尼亚西部的Mbita社区，共有298名患有单纯性恶性疟疾的儿童（年龄，6个月至10岁）被随机分配到蒿甲醚-苯芴醇（AL; n = 153）或双氢青蒿素-哌喹（DP; n = 145）组。在处理开始后第0、1、2、3、7、14、28和42天，通过分子方法测定配子细胞携带。在开始治疗后第7天，通过蚊虫喂养试验测定配子体对蚊虫的感染性。在治疗开始后第42天，未经聚合酶链反应结果校正，AL患者寄生虫血症复发的累积风险为20.7%（95%置信区间[CI]，14.4-28.2），DP患者为3.7%（95% CI，1.2-8.5）（P <0.001）。AL和DP的配子母细胞携带平均持续时间分别为5.5天（95% CI，3.6-8.5）和15.3天（95% CI，9.7-24.2）（P = .001）。以AL治疗儿童的血液喂养后感染的蚊子比例为1.88%（43/2293），而以DP治疗儿童的血液喂养的蚊子比例为3.50%（83/2371）（P = .06）;以AL治疗儿童的血液喂养的蚊子中的卵囊负担较低（P = .005）。虽然DP与治疗后较长的预防时间相关，但AL治疗后配子体携带和疟疾向蚊子的传播较低。
Background. Artemisinin-based combination therapy (ACT) reduces the potential for malaria transmission, compared with non-ACTs. It is unclear whether this effect differs between ACTs.Methods. A total of 298 children (age, 6 months to 10 years) with uncomplicated falciparum malaria were randomized to artemether-lumefantrine (AL; n = 153) or dihydroartemisinin-piperaquine (DP; n = 145) in Mbita, a community in western Kenya. Gametocyte carriage was determined by molecular methods on days 0, 1, 2, 3, 7, 14, 28, and 42 after treatment initiation. The gametocyte infectiousness to mosquitoes was determined by mosquito-feeding assays on day 7 after beginning therapy.Results. The cumulative risk of recurrent parasitemia on day 42 after initiation of treatment, unadjusted by polymerase chain reaction findings, was 20.7% (95% confidence interval [CI], 14.4-28.2) for AL, compared with 3.7% (95% CI, 1.2-8.5) for DP (P < .001). The mean duration of gametocyte carriage was 5.5 days (95% CI, 3.6-8.5) for AL and 15.3 days (95% CI, 9.7-24.2) for DP (P = .001). The proportion of mosquitoes that became infected after feeding on blood from AL-treated children was 1.88% (43 of 2293), compared with 3.50% (83 of 2371) for those that fed on blood from DP-treated children (P = .06); the oocyst burden among mosquitoes was lower among those that fed on blood from AL-treated children (P = .005)Conclusions. While DP was associated with a longer prophylactic time after treatment, gametocyte carriage and malaria transmission to mosquitoes was lower after AL treatment.Clinical Trials Registration: NCT00868465.