Mass drug administration for the control and elimination of Plasmodium vivax malaria: an ecological study from Jiangsu province, China

Michelle S Hsiang, Jimee Hwang, Amy R Tao, Yaobao Liu, Adam Bennett, George Dennis Shanks, Jun Cao, Stephen Patrick Kachur, Richard G A Feachem, Roly D Gosling, Qi Gao, Michelle S Hsiang, Jimee Hwang, Amy R Tao, Yaobao Liu, Adam Bennett, George Dennis Shanks, Jun Cao, Stephen Patrick Kachur, Richard G A Feachem, Roly D Gosling, Qi Gao

Abstract

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.

Figures

Figure 1
Figure 1
Incidence maps of Jiangsu Province, 1973-1983. A) Map of China showing location of Jiangsu Province, B) Prefecture level incidence in Jiangsu Province, 1973, C) Prefecture level incidence in Jiangsu Province, 1976, D) Prefecture level incidence in Jiangsu Province, 1983.
Figure 2
Figure 2
Mass drug administration to villagers by directly observed therapy. A) Xuzhou prefecture 1974, B) Sihong county 2009.
Figure 3
Figure 3
Monthly incidence and total population of mass drug administration, chemoprophylaxis and drug salts, Jiangsu Province, 1973-1983.
Figure 4
Figure 4
Incidence with total population coverage of focal mass drug administration, 2000-2009. A) Sihong county, B) Xuyi county.

References

    1. Hotez PJ. Mass drug administration and integrated control for the world’s high-prevalence neglected tropical diseases. Clin Pharmacol Ther. 2009;85:659–664. doi: 10.1038/clpt.2009.16.
    1. Onori E. Experience with mass drug administration as a supplementary attack measure in areas of vivax malaria. Bull World Health Organ. 1972;47:543–548.
    1. von Seidlein L, Greenwood BM. Mass administrations of antimalarial drugs. Trends Parasitol. 2003;19:452–460. doi: 10.1016/j.pt.2003.08.003.
    1. Poirot E, Hwang J, Kachur SP, Slutsker L, Skarbinski J. Mass drug administration for malaria. Cochrane Database Syst Rev. 2010. p. CD008846. DOI: 008810.001002/14651858.CD14008846.
    1. Greenwood B. The use of anti-malarial drugs to prevent malaria in the population of malaria-endemic areas. Am J Trop Med Hyg. 2004;70:1–7.
    1. The malERA Consultative Group on Drugs. A research agenda for malaria eradication: drugs. PLoS Med. 2011;8:e1000402.
    1. Cotter C, Sturrock HJW, Hsiang MS, Liu J, Phillips AA, Hwang J, Smith-Gueye C, Fullman N, Gosling RD, Feachem RGA. The changing epidemiology of malaria elimination: new strategies for new challenges. Lancet. 2013;382:900–911. doi: 10.1016/S0140-6736(13)60310-4.
    1. Maude RJ, Socheat D, Nguon C, Saroth P, Dara P, Li G, Song J, Yeung S, Dondorp AM, Day NP, White NJ, White LJ. Optimising strategies for Plasmodium falciparum malaria elimination in Cambodia: primaquine, mass drug administration and artemisinin resistance. PLoS One. 2012;7:e37166. doi: 10.1371/journal.pone.0037166.
    1. World Health Organization. Consideration of mass drug administration for the containment of artemisinin-resistant malaria in the Greater Mekong subregion, Report of a consensus meeting, 27-28 September 2010. Geneva, Switzerland: World Health Organization; 2011.
    1. Kaneko A, Taleo G, Kalkoa M, Yamar S, Kobayakawa T, Bjorkman A. Malaria eradication on islands. Lancet. 2000;356:1560–1564. doi: 10.1016/S0140-6736(00)03127-5.
    1. Song J, Socheat D, Tan B, Dara P, Deng C, Sokunthea S, Seila S, Ou F, Jian H, Li G. Rapid and effective malaria control in Cambodia through mass administration of artemisinin-piperaquine. Malar J. 2010;9:57. doi: 10.1186/1475-2875-9-57.
    1. Von Seidlein L, Walraven G, Milligan PJ, Alexander N, Manneh F, Deen JL, Coleman R, Jawara M, Lindsay SW, Drakeley C, De Martin S, Olliaro P, Bennett S, Schim van der Loeff M, Okunoye K, Targett GA, McAdam KP, Doherty JF, Greenwood BM, Pinder M. The effect of mass administration of sulfadoxine-pyrimethamine combined with artesunate on malaria incidence: a double-blind, community-randomized, placebo-controlled trial in The Gambia. Trans R Soc Trop Med Hyg. 2003;97:217–225. doi: 10.1016/S0035-9203(03)90125-8.
    1. Bardaji A, Bassat Q, Alonso PL, Menendez C. Intermittent preventive treatment of malaria in pregnant women and infants: making best use of the available evidence. Expert Opin Pharmacother. 2012;13:1719–1736. doi: 10.1517/14656566.2012.703651.
    1. Meremikwu MM, Donegan S, Sinclair D, Esu E, Oringanje C. Intermittent preventive treatment for malaria in children living in areas with seasonal transmission. Cochrane Database Syst Rev. 2012;2 CD003756.
    1. Feachem RG, Phillips AA, Hwang J, Cotter C, Wielgosz B, Greenwood BM, Sabot O, Rodriguez MH, Abeyasinghe RR, Ghebreyesus TA, Snow RW. Shrinking the malaria map: progress and prospects. Lancet. 2010;376:1566–1578. doi: 10.1016/S0140-6736(10)61270-6.
    1. John GK, Douglas NM, von Seidlein L, Nosten F, Baird KJ, White NJ, Price RN. Primaquine radical cure of Plasmodium vivax: a critical review of the literature. Malar J. 2012;11:280. doi: 10.1186/1475-2875-11-280.
    1. Douglas NM, John GK, von Seidlein L, Anstey NM, Price RN. Chemotherapeutic strategies for reducing transmission of Plasmodium vivax malaria . Advances in parasitology. 2012;80:271–300.
    1. Sattabongkot J, Tsuboi T, Zollner GE, Sirichaisinthop J, Cui L. Plasmodium vivax transmission: chances for control? Trends Parasitol. 2004;20:192–198. doi: 10.1016/j.pt.2004.02.001.
    1. Dapeng L, Leyuan S, Xili L, Xiance Y. A successful control programme for falciparum malaria in Xinyang, China. Trans R Soc Trop Med Hyg. 1996;90:100–102. doi: 10.1016/S0035-9203(96)90099-1.
    1. Chen W, Wu K, Lin M, Tang L, Gu Z, Wang S, Lan C, Lan X, Li H, Huang M, Chen X, Sheng H. [A pilot study on malaria control by using a new strategy of combining strengthening infection source treatment and health education in mountainous areas of Hainan province](in Chinese) Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi. 1999;17:1–4.
    1. Tang LH, Qian HL, Xu SH. Malaria and its control in the People’s Republic of China. Southeast Asian J Trop Med Public Health. 1991;22:467–476.
    1. Tang LH. Progress in malaria control in China. Chin Med J. 2000;113:89–92.
    1. Huang F, Zhou S, Zhang S, Li W, Zhang H. Monitoring resistance of Plasmdium vivax: point mutations in dihydrofolate reductase gene in isolates from Central China. Parasit Vectors. 2011;4:80. doi: 10.1186/1756-3305-4-80.
    1. Xu BL, Su YP, Shang LY, Zhang HW. Malaria control in Henan Province, People’s Republic of China. Am J Trop Med Hyg. 2006;74:564–567.
    1. Huang GQ, Yuan FY, Jin XL, Zhao CL, Su YP, Shen YZ. To analyze epidemic situation and control of malaria in Jiangsu, Shandong, Henan, Anhui, and Hubei province. Chin J Vector Biol Control. 2007;18:398–401.
    1. Sleigh AC, Liu XL, Jackson S, Li P, Shang LY. Resurgence of vivax malaria in Henan Province, China. Bull World Health Organ. 1998;76:265–270.
    1. Zhou SS, Wang Y, Tang LH. [Malaria situation in the People’s Republic of China in 2006](in Chinese) Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi. 2007;25:439–441.
    1. Zhang W, Wang L, Fang L, Ma J, Xu Y, Jiang J, Hui F, Wang J, Liang S, Yang H, Cao W. Spatial analysis of malaria in Anhui province, China. Malar J. 2008;7:206. doi: 10.1186/1475-2875-7-206.
    1. Sihong County Centers for Disease Control and Prevention. Malaria anti-relapse therapy guidelines. Sihong, Jiangsu, China: Sihong County Centers for Disease Control and Prevention; 2008.
    1. Jiangsu Institute of Parasitic Diseases. Jiangsu Province Malaria Records 1973-1983. Wuxi, Jiangsu, China: Jiangsu Institute of Parasitic Diseases; 1984.
    1. Xuyi County Centers for Disease Control and Prevention. Xuyi County Malaria Reports 2000-2009. Xuyi, Jiangsu, China: Xuyi County Center for Disease Control and Prevention; 2010.
    1. Sihong County Centers for Disease Control and Prevention. Sihong County Malaria Reports 2000-2009. Sihong, Jiangsu, China: Sihong County Centers for Disease Control and Prevention; 2010.
    1. Sihong County Centers for Disease Control and Prevention. Sihong Statistical yearbooks 2000-2009. Sihong, Jiangsu, China: Sihong County Bureau of Statistics; 2010.
    1. Xuyi County Centers for Disease Control and Prevention. Xuyi Statistical yearbooks 2000-2009. Xuyi, Jiangsu, China: Xuyi County Bureau of Statistics; 2010.
    1. International Research Institute for Climate and Society. .
    1. Stracci F, Canosa A, Minelli L, Petrinelli AM, Cassetti T, Romagnoli C, La Rosa F. Cancer mortality trends in the Umbria region of Italy 1978-2004: a joinpoint regression analysis. BMC Cancer. 2007;7:10. doi: 10.1186/1471-2407-7-10.
    1. Jiangsu Institute of Parasitic Diseases. Jiangsu Eight Main Counties, Malaria Control Report. Wuxi, Jiangsu, China: Jiangsu Institute of Parasitic Diseases; 1984.
    1. Jiangsu Institute of Parasitic Diseases. Primaquine adverse reaction: 9 case reports, Jiangsu Province Schistosomiasis Prevention Research Center and Liuhe County Health and Immunization Station, in: Selected Malaria Records from 1974-1983. Wuxi, Jiangsu, China: Jiangsu Institute of Parasitic Diseases; 1984. p. 122.
    1. Jiangsu Institute of Parasitic Diseases. Primaquine causing hemolysis, 40 cases report, Jiangsu Province Schistosomiasis Prevention Research Center and Liuhe County Health and Immunization Station, in: Selected Malaria Records from 1974-1983. Wuxi, Jiangsu, China: Jiangsu Institute of Parasitic Diseases; 1984. pp. 104–107.
    1. Jiangsu Institute of Parasitic Diseases. Survey of family members: 3 cases, Jiangsu Province Schistosomiasis Prevention Research Center and Liuhe County Health and Immunization Station, in: Selected Malaria Records from 1974-1983. Wuxi, Jiangsu, China: Jiangsu Institute of Parasitic Diseases; 1984. p. 116.
    1. Bian S, Li C, Zhang X, Huang B, Wang Y, Zhao L. Jiangsu Province Liuhe Region Hereditary RBC G6PD Defect Preliminary Investigation Report, Jiangsu Province Schistosomiasis Prevention Research Center and Liuhe County Health and Immunization Station, in: Selected Malaria Records from 1974-1983. Wuxi, Jiangsu, China: Jiangsu Institute of Parasitic Diseases; 1984. pp. 110–115.
    1. Jiangsu Institute of Parasitic Diseases. Primaquine adverse event: 1 case report, Jiangsu Province Schistosomiasis Prevention Research Center and Liuhe County Health and Immunization Station, in: Selected Malaria Records from 1974-1983. Wuxi, Jiangsu, China: Jiangsu Institute of Parasitic Diseases; 1984. p. 121.
    1. Yin JH, Yang MN, Zhou SS, Wang Y, Feng J, Xia ZG. Changing Malaria Transmission and Implications in China towards National Malaria Elimination Programme between 2010 and 2012. PLoS One. 2013;8:e74228. doi: 10.1371/journal.pone.0074228.
    1. White NJ. Primaquine to prevent transmission of falciparum malaria. Lancet Infect Dis. 2013;13:175–181. doi: 10.1016/S1473-3099(12)70198-6.
    1. Shanks GD. Control and elimination of Plasmodium vivax. Adv Parasitol. 2012;80:301–341.
    1. Garfield RM, Vermund SH. Changes in malaria incidence after mass drug administration in Nicaragua. Lancet. 1983;2:500–503.
    1. World Health Organization. Interregional workshop on the control of vivax malaria in East Asia, Shanghai, China, 2003. Regional Office for the Western Pacific: World Health Organization; 2004.
    1. WHO. Inter-regional meeting on vivax malaria in Asia. Regional Office for South-East Asia: World Health Organization; 2009.
    1. Simeons ATW. Follow-up of a mass treatment with injectable atebrin. Ind Med Gaz. 1938;73:713–715.
    1. Caceres JL. Malaria before and after massive radical cure in Sucre state, Venezuela. Bol Malar Salud Ambi. 2008;48:83–90.
    1. Gabaldon A, Guerrero L. An attempt to eradicate malaria by the weekly administration of pyrimethamine in areas of out-of-doors transmission in Venezuela. Am J Trop Med Hyg. 1959;8:433–439.
    1. Greenwood BM. Control to elimination: implications for malaria research. Trends Parasitol. 2008;24:449–454. doi: 10.1016/j.pt.2008.07.002.
    1. Ho C. Studies on malaria in new China. Chin Med J. 1965;84:491–497.
    1. Okell LC, Griffin JT, Kleinschmidt I, Hollingsworth TD, Churcher TS, White MJ, Bousema T, Drakeley CJ, Ghani AC. The potential contribution of mass treatment to the control of Plasmodium falciparum malaria. PLoS One. 2011;6:e20179. doi: 10.1371/journal.pone.0020179.
    1. White NJ, Qiao LG, Qi G, Luzzatto L. Rationale for recommending a lower dose of primaquine as a Plasmodium falciparum gametocytocide in populations where G6PD deficiency is common. Malar J. 2012;11:418. doi: 10.1186/1475-2875-11-418.
    1. Jiang W, Yu G, Liu P, Geng Q, Chen L, Lin Q, Ren X, Ye W, He Y, Guo Y, Duan S, Wen J, Li H, Qi Y, Jiang C, Zheng Y, Liu C, Si E, Zhang Q, Tian Q, Du C. Structure and function of glucose-6-phosphate dehydrogenase-deficient variants in Chinese population. Hum Genet. 2006;119:463–478. doi: 10.1007/s00439-005-0126-5.
    1. Alving AS. Clinical treatment of malaria. US Army Medical Science Publication No 4. 1954;22:210–218.

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