Details:

Alternative Title:
Malar J
Publisher's site:
http://dx.doi.org/10.1186/1475-2875-12-383
Personal Author:
Hsiang, Michelle S ; Hwang, Jimee ; Tao, Amy R ; Liu, Yaobao ; Bennett, Adam ; ... More +
Hsiang, Michelle S ; Hwang, Jimee ; Tao, Amy R ; Liu, Yaobao ; Bennett, Adam ; Shanks, George Dennis ; Cao, Jun ; Kachur, Stephen Patrick ; Feachem, Richard GA ; Gosling, Roly D ; Gao, Qi ; Less -
Description:
Background Recent progress in malaria control has caused renewed interest in mass drug administration (MDA) as a potential elimination strategy but the evidence base is limited. China has extensive experience with MDA, but it is not well documented. Methods An ecological study was conducted to describe the use of MDA for the control and elimination of Plasmodium vivax in Jiangsu Province and explore the association between MDA and malaria incidence. Two periods were focused on: 1973 to 1983 when malaria burden was high and MDA administered to highly endemic counties province-wide, and 2000 to 2009, when malaria burden was low and a focal approach was used in two counties. All available data about the strategies implemented, MDA coverage, co-interventions, incidence, and adverse events were collected and described. Joinpoint analysis was used to describe trends in incidence and the relationship between MDA coverage and incidence was explored in negative binomial regression models. Results From 1973 to 1983, MDA with pyrimethamine and primaquine was used on a large scale, with up to 30 million people in target counties covered in a peak year (50% of the total population). Joinpoint analyses identified declines in annual incidence, -56.7% (95% CI -75.5 to -23.7%) from 1973–1976 and -12.4% (95% CI -24.7 to 2.0%) from 1976–1983. Population average negative binomial models identified a relationship between higher total population MDA coverage and lower monthly incidence from 1973–1976, IRR 0.98 (95% CI 0.97 to 1.00), while co-interventions, rainfall and GDP were not associated. From 2000–2009, incidence in two counties declined (annual change -43.7 to -14.0%) during a time when focal MDA using chloroquine and primaquine was targeted to villages and/or individuals residing near passively detected index cases (median 0.04% of total population). Although safety data were not collected systematically, there were rare reports of serious but non-fatal events. Conclusions In Jiangsu Province, China, large-scale MDA was implemented and associated with declines in high P. vivax malaria transmission; a more recent focal approach may have contributed to interruption of transmission. MDA should be considered a potential key strategy for malaria control and elimination.
Subject:
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Adolescent
Adult
Aged
Aged, 80 And Over
Antimalarials
Chemoprevention
Child
Child, Preschool
Disease Transmission, Infectious
Female
Humans
Incidence
Infant
Malaria, Vivax
Male
Middle Aged
Research
Young Adult

Source:
Malar J. 2013; 12:383.
Document Type:
Journal Article ;
Funding:
K23 AI101012/AI/NIAID NIH HHS/United States ; P0045532/PHS HHS/United States ;
K23 AI101012/AI/NIAID NIH HHS/United States ; P0045532/PHS HHS/United States ; Less -
Place as Subject:
China ;
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:343cd55be945610af5cb6c02662d310ff917897df8fb48daa7ca1d962cd1b71e
File Type:

Supporting Files

• 	1475-2875-12-383-S1.pdf	pdf
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