Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Laos; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Timika Research Facility, Papuan Health and Community Development Foundation, Timika, Indonesia; Department of Child Health, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia.
Lancet Child Adolesc Health. 2020 Oct;4(10):775-789. doi: 10.1016/S2352-4642(20)30127-9.
Malaria disproportionately affects children younger than 5 years. Falciparum malaria is responsible for more than 200 000 child deaths per year in Africa and vivax malaria is well documented as a cause of severe anaemia and excess mortality in children in Asia and Oceania. For the treatment of malaria in children, paediatric dosing recommendations for several agents, including parenteral artesunate and dihydroartemisinin-piperaquine, have belatedly been shown to be suboptimal. Worsening antimalarial resistance in Plasmodium falciparum in the Greater Mekong Subregion threatens to undermine global efforts to control malaria. Triple antimalarial combination therapies are being evaluated to try to impede this threat. The RTS,S/AS01 vaccine gives partial protection against falciparum malaria and is being evaluated in large, pilot studies in Ghana, Malawi, and Kenya as a complementary tool to other preventive measures. Seasonal malaria chemoprevention in west Africa has resulted in declines in malaria incidence and deaths and there is interest in scaling up efforts by expanding the age range of eligible recipients. Preventing relapse in Plasmodium vivax infection with primaquine is challenging because treating children who have G6PD deficiency with primaquine can cause acute haemolytic anaemia. The safety of escalating dose regimens for primaquine is being studied to mitigate this risk.
疟疾对 5 岁以下儿童的影响尤为严重。在非洲，每年有超过 20 万儿童死于恶性疟；在亚洲和大洋洲，间日疟也被明确记录为导致儿童严重贫血和死亡的原因之一。在儿童疟疾治疗方面，包括注射用青蒿琥酯和双氢青蒿素哌喹在内的几种药物的儿科剂量建议最近被证明并不理想。大湄公河次区域恶性疟原虫抗药性的恶化，有可能破坏全球控制疟疾的努力。正在评估三联抗疟组合疗法，试图阻止这一威胁。RTS,S/AS01 疫苗对恶性疟有一定的保护作用，目前正在加纳、马拉维和肯尼亚的大型试点研究中进行评估，作为其他预防措施的补充手段。西非季节性疟疾化学预防已导致疟疾发病率和死亡率下降，人们有兴趣扩大符合条件的接受者年龄范围，扩大这方面的工作。用伯氨喹预防间日疟复发具有挑战性，因为用伯氨喹治疗患有 G6PD 缺乏症的儿童可能会导致急性溶血性贫血。目前正在研究增加伯氨喹剂量方案的安全性，以降低这种风险。
