Department of Pharmacology and Therapeutics and Malaria Research Laboratories, Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria.
Mem Inst Oswaldo Cruz. 2011 Sep;106(6):685-90. doi: 10.1590/s0074-02762011000600007.
The effects of artemisinin-based combination therapies (ACTs) on transmission of Plasmodium falciparum were evaluated after a policy change instituting the use of ACTs in an endemic area. P. falciparum gametocyte carriage, sex ratios and inbreeding rates were examined in 2,585 children at presentation with acute falciparum malaria during a 10-year period from 2001-2010. Asexual parasite rates were also evaluated from 2003-2010 in 10,615 children before and after the policy change. Gametocyte carriage declined significantly from 12.4% in 2001 to 3.6% in 2010 (χ2 for trend = 44.3, p < 0.0001), but sex ratios and inbreeding rates remained unchanged. Additionally, overall parasite rates remained unchanged before and after the policy change (47.2% vs. 45.4%), but these rates declined significantly from 2003-2010 (χ2 for trend 35.4, p < 0.0001). Chloroquine (CQ) and artemether-lumefantrine (AL) were used as prototype drugs before and after the policy change, respectively. AL significantly shortened the duration of male gametocyte carriage in individual patients after treatment began compared with CQ (log rank statistic = 7.92, p = 0.005). ACTs reduced the rate of gametocyte carriage in children with acute falciparum infections at presentation and shortened the duration of male gametocyte carriage after treatment. However, parasite population sex ratios, inbreeding rates and overall parasite rate were unaffected.
在一个流行地区实施青蒿素类复方疗法（ACT）政策改变后，评估了 ACT 对恶性疟原虫传播的影响。在 2001-2010 年的 10 年期间，对 2585 例患有急性恶性疟原虫疟疾的儿童在就诊时进行了恶性疟原虫配子体携带、性别比和近亲繁殖率的检查。还评估了 2003-2010 年政策改变前后 10615 例儿童的无性寄生虫率。配子体携带率从 2001 年的 12.4%显著下降到 2010 年的 3.6%（趋势 χ2=44.3，p<0.0001），但性别比和近亲繁殖率保持不变。此外，政策改变前后总寄生虫率保持不变（47.2%对 45.4%），但从 2003-2010 年显著下降（趋势 χ2=35.4，p<0.0001）。在政策改变前后，分别使用了氯喹（CQ）和青蒿琥酯-甲氟喹（AL）作为原型药物。与 CQ 相比，AL 治疗开始后明显缩短了个体患者的雄性配子体携带时间（对数秩检验统计量=7.92，p=0.005）。ACT 降低了就诊时患有急性恶性疟原虫感染儿童的配子体携带率，并缩短了治疗后雄性配子体携带的持续时间。然而，寄生虫群体性别比、近亲繁殖率和总寄生虫率不受影响。
