Mass Drug Administration to Control and Eliminate Malaria in Africa: How Do We Best Utilize the Tools at Hand?
Mass Drug Administration to Control and Eliminate Malaria in Africa: How Do We Best Utilize the Tools at Hand?
复制标题
在非洲控制和消除疟疾的大规模药物管理：我们如何最好地利用手头的工具？
DOI：
10.1093/cid/ciy871
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Rosenthal,PhilipJ
中科院分区：
文献类型：
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作者：
Guler,JenniferL;Rosenthal,PhilipJ
Plasmodium falciparum, remains an overwhelming problem in Africa [1]. Approaches to better control—and eventually eradicate—malaria focus on insecticides and drugs. Mosquito control with insecticide-treated bed nets and indoor residual spraying of insecticides can greatly decrease malaria transmission, but these strategies are limited by cost, logistical constraints, and insecticide resistance. Antimalarial drugs are essential to treat symptomatic malaria infections. By eliminating circulating parasites, effective drugs also limit transmission. The broad use of artemisinin-based combination therapies (ACTs) over the last 15 years has been an important contribution to the improved treatment and control of malaria. Antimalarial drugs are also used to prevent malaria, as is routine in nonimmune travelers to endemic areas. However, the use of chemoprevention within malaria-endemic areas has been limited. There are 2 drug-based prevention approaches now recommended by the World Health Organization and routinely utilized inAfrica: intermittent preventive therapy in pregnancy, using sulfadoxine-pyrimethamine (SP), a strategy challenged by widespread SP resistance; and seasonal malaria chemoprevention (SMC), using amodiaquine plus SP, which is effective in regions with seasonal transmission and limited drug resistance. Of great interest is the broader use of drugs to control malaria, with mass drug administration (MDA) to entire communities at risk. MDA typically entails treating all members of a community, regardless of infection status, with a full treatment course of antimalarial drugs. This strategy eliminates circulating parasites and also prevents reinfection over a time frame determined by the pharmacokinetics of the drugs used. Not surprisingly, mass administration of effective antimalarials decreases subsequent malaria risks [2–4] but, also not surprisingly, in areas with continued transmission, MDA benefits can be transient [5]. Our current challenge is to best utilize the available tools to offer more than transient benefits, and to sustainably decrease disease. In this regard, areas of Africa with relatively low transmission intensity are the low-hanging fruit; here, adding preventive drug treatments may tip the scales towards elimination. In areas with seasonal transmission, MDA can be implemented before the transmission season to decrease the parasite burden just before transmission surges. An example of such
