National Malaria Control Program, Ministry of Health, Luanda, Angola.
Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Antimicrob Agents Chemother. 2021 Jan 20;65(2). doi: 10.1128/AAC.01949-20.
Biennial therapeutic efficacy monitoring is a crucial activity for ensuring the efficacy of currently used artemisinin-based combination therapy in Angola. Children with acute uncomplicated infection in sentinel sites in the Benguela, Zaire, and Lunda Sul Provinces were treated with artemether-lumefantrine (AL) or artesunate-amodiaquine (ASAQ) and monitored for 28 days to assess clinical and parasitological responses. Molecular correction was performed using seven microsatellite markers. Samples from treatment failures were genotyped for the , , and genes. Day 3 clearance rates were ≥95% in all arms. Uncorrected day 28 Kaplan-Meier efficacy estimates ranged from 84.2 to 90.1% for the AL arms and 84.7 to 100% for the ASAQ arms. Corrected day 28 estimates were 87.6% (95% confidence interval [CI], 81 to 95%) for the AL arm in Lunda Sul, 92.2% (95% CI, 87 to 98%) for AL in Zaire, 95.6% (95% CI, 91 to 100%) for ASAQ in Zaire, 98.4% (95% CI, 96 to 100%) for AL in Benguela, and 100% for ASAQ in Benguela and Lunda Sul. All 103 analyzed samples had wild-type sequences. The 76T allele was found in most (92%; 11/12) ASAQ late-failure samples but in only 16% (4/25) of AL failure samples. The N86 allele was found in 97% (34/35) of treatment failures. The AL efficacy in Lunda Sul was below the 90% World Health Organization threshold, the third time in four rounds that this threshold was crossed for an AL arm in Angola. In contrast, the observed ASAQ efficacy has not been below 95% to date in Angola, including this latest round.
在安哥拉，每两年进行一次疗效监测是确保目前使用的青蒿素联合疗法疗效的关键活动。在本格拉、扎伊尔和南隆达三省的哨点地区，患有急性无并发症感染的儿童接受青蒿琥酯- 本芴醇（AL）或青蒿琥酯- 阿莫地喹（ASAQ）治疗，并监测 28 天以评估临床和寄生虫学反应。采用 7 个微卫星标记进行分子校正。对治疗失败的样本进行基因分型，以检测 、 和 基因。所有 AL 组的第 3 天清除率均≥95%。未经校正的第 28 天 Kaplan-Meier 疗效估计值在 AL 组为 84.2%至 90.1%，在 ASAQ 组为 84.7%至 100%。在南隆达的 AL 组中，校正后的第 28 天估计值为 87.6%（95%置信区间[CI]，81 至 95%），在扎伊尔的 AL 组中为 92.2%（95%CI，87 至 98%），在扎伊尔的 ASAQ 组中为 95.6%（95%CI，91 至 100%），在本格拉的 AL 组中为 98.4%（95%CI，96 至 100%），在本格拉和南隆达的 ASAQ 组中为 100%。所有 103 个分析样本均具有野生型 序列。76T 等位基因存在于大多数（92%；11/12）ASAQ 迟发性失败样本中，但仅存在于 16%（4/25）AL 失败样本中。N86 等位基因存在于 97%（34/35）治疗失败样本中。在 Lunda Sul，AL 的疗效低于 90%的世界卫生组织阈值，这是安哥拉第四次在 AL 组中出现这一阈值。相比之下，迄今为止，在安哥拉，包括这一轮，观察到的 ASAQ 疗效从未低于 95%。
