青蒿琥酯-甲氟喹固定剂量复方在亚马逊流域社区疟疾传播中的效果。
Effect of artesunate-mefloquine fixed-dose combination in malaria transmission in Amazon basin communities.
机构信息
Programa Nacional de Controle da Malária, Secretaria de Vigilância emSaúde, Ministério da Saúde, Brazil.
出版信息
Malar J. 2012 Aug 20;11:286. doi: 10.1186/1475-2875-11-286.
BACKGROUND
Studies in South-East Asia have suggested that early diagnosis and treatment with artesunate (AS) and mefloquine (MQ) combination therapy may reduce the transmission of Plasmodium falciparum malaria and the progression of MQ resistance.
METHODS
The effectiveness of a fixed-dose combination of AS and MQ (ASMQ) in reducing malaria transmission was tested in isolated communities of the Juruá valley in the Amazon region.Priority municipalities within the Brazilian Legal Amazon area were selected according to pre-specified criteria. Routine national malaria control programmatic procedures were followed. Existing health structures were reinforced and health care workers were trained to treat with ASMQ all confirmed falciparum malaria cases that match inclusion criteria. A local pharmacovigilance structure was implemented. Incidence of malaria and hospitalizations were recorded two years before, during, and after the fixed-dose ASMQ intervention. In total, between July 2006 and December 2008, 23,845 patients received ASMQ. Two statistical modelling approaches were applied to monthly time series of P. falciparum malaria incidence rates, P. falciparum/Plasmodium vivax infection ratio, and malaria hospital admissions rates. All the time series ranged from January 2004 to December 2008, whilst the intervention period span from July 2006 to December 2008.
RESULTS
The ASMQ intervention had a highly significant impact on the mean level of each time series, adjusted for trend and season, of 0.34 (95% CI 0.20 - 0.58) for the P. falciparum malaria incidence rates, 0.67 (95% CI 0.50 - 0.89) for the P. falciparum/P. vivax infection ratio, and 0.53 (95% CI 0.41 - 0.69) for the hospital admission rates. There was also a significant change in the seasonal (or monthly) pattern of the time series before and after intervention, with the elimination of the malaria seasonal peak in the rainy months of the years following the introduction of ASMQ. No serious adverse events relating to the use of fixed-dose ASMQ were reported.
CONCLUSIONS
In the remote region of the Juruá valley, the early detection of malaria by health care workers and treatment with fixed-dose ASMQ was feasible and efficacious, and significantly reduced the incidence and morbidity of P. falciparum malaria.
背景
东南亚的研究表明，青蒿琥酯（AS）和甲氟喹（MQ）联合疗法的早期诊断和治疗可能会降低恶性疟原虫疟疾的传播，并减缓 MQ 耐药性的发展。
方法
在亚马逊地区的朱鲁阿河谷的隔离社区中测试了青蒿琥酯和甲氟喹固定剂量组合（ASMQ）减少疟疾传播的效果。根据预先规定的标准，选择了巴西亚马孙地区内的重点市。遵循国家疟疾控制规划的常规程序。加强现有卫生结构，并培训卫生保健工作者，以便用 ASMQ 治疗所有符合纳入标准的确诊恶性疟病例。建立了当地药物警戒结构。在固定剂量 ASMQ 干预之前、期间和之后两年记录疟疾发病率和住院率。在 2006 年 7 月至 2008 年 12 月期间，共有 23845 名患者接受了 ASMQ 治疗。采用两种统计建模方法对恶性疟发病率、恶性疟/间日疟感染率和疟疾住院率的月度时间序列进行分析。所有时间序列的范围均为 2004 年 1 月至 2008 年 12 月，而干预期为 2006 年 7 月至 2008 年 12 月。
结果
ASMQ 干预对调整趋势和季节性后的每个时间序列的平均水平产生了非常显著的影响，恶性疟发病率的影响为 0.34（95%CI 0.20-0.58），恶性疟/间日疟感染率为 0.67（95%CI 0.50-0.89），住院率为 0.53（95%CI 0.41-0.69）。干预前后时间序列的季节性（或月度）模式也发生了显著变化，引入 ASMQ 后，疟疾在雨季的季节性高峰消失了。没有报告与使用固定剂量 ASMQ 相关的严重不良事件。
结论
在朱鲁阿河谷偏远地区，卫生保健工作者早期发现疟疾并使用固定剂量 ASMQ 进行治疗是可行且有效的，可显著降低恶性疟疟疾的发病率和发病率。
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