Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul.
Department of Global Health, Faculty of Medicine and Health Sciences, University of Antwerp.
Clin Infect Dis. 2019 Jul 2;69(2):278-286. doi: 10.1093/cid/ciy870.
Mass drug administration (MDA) may further reduce malaria transmission in low-transmission areas. The impact of MDA on the dynamics of malaria transmission was determined in a prospective cohort study.
Annual rounds of MDA with dihydroartemisinin-piperaquine (DP) were implemented were implemented in 2014 and 2015 in six village pairs before the malaria transmission season. Blood samples were collected from residents between July and December for microscopy and nested PCR. Incidence and prevalence of infection, clinical disease, and risk of malaria reinfection post-MDA were determined.
Coverage of three DP doses was 68.2% (2014) and 65.6% (2015), compliance was greater than 80%. Incidence of infection was significantly lower in 2014 (incidence rate [IR] = 0.2 per person year [PPY]) than in 2013 (IR = 1.1 PPY; P < .01); monthly infection prevalence declined in the first three months post-MDA. Clinical malaria incidence was lower in 2014 (IR = 0.1 PPY) and 2015 (IR = 0.2 PPY) than in 2013 (IR = 0.4 PPY; P < .01), but remained higher in eastern Gambia. Individuals infected before MDA had a 2-fold higher odds of reinfection post-MDA (adjusted odds ratio = 2.5, 95% confidence interval 1.5-4.3; P < .01).
MDA reduced malaria infection and clinical disease during the first months. The reduction was maintained in low-transmission areas, but not in eastern Gambia. Annual MDA could be followed by focal MDA targeting individuals infected during the dry season. Repeated MDA rounds, some during the dry season over larger geographical areas, may result in a more marked and sustained decrease of malaria transmission.
大规模药物治疗（MDA）可能会进一步降低低传播地区的疟疾传播。本前瞻性队列研究旨在确定 MDA 对疟疾传播动力学的影响。
在疟疾传播季节前的 2014 年和 2015 年，在六个村对中进行了两轮年度的双氢青蒿素-哌喹（DP）MDA。在 7 月至 12 月间，从居民中采集血样，用于显微镜检查和巢式 PCR。确定 MDA 后的感染发生率和流行率、临床疾病和疟疾再感染的风险。
三轮 DP 剂量的覆盖率分别为 68.2%（2014 年）和 65.6%（2015 年），依从性均大于 80%。2014 年的感染发生率显著低于 2013 年（发病率[IR] = 0.2 人年[PPY]）（P <.01）；MDA 后前三个月的每月感染率下降。2014 年（IR = 0.1 PPY）和 2015 年（IR = 0.2 PPY）的临床疟疾发病率均低于 2013 年（IR = 0.4 PPY）（P <.01），但在冈比亚东部仍较高。MDA 前感染的个体 MDA 后再感染的可能性增加了 2 倍（调整优势比= 2.5，95%置信区间 1.5-4.3；P <.01）。
MDA 在最初的几个月内降低了疟疾感染和临床疾病。在低传播地区，这种减少得以维持，但在冈比亚东部没有。每年 MDA 之后可以针对在旱季感染的个体进行局部 MDA。在更大的地理区域内，反复进行 MDA 轮次，一些轮次在旱季进行，可能会导致疟疾传播的显著和持续下降。
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