TY - JOUR
T1 - Mass drug administration for the control and elimination of Plasmodium vivax malaria
T2 - An ecological study from Jiangsu province, China
AU - Hsiang, Michelle S.
AU - Hwang, Jimee
AU - Tao, Amy R.
AU - Liu, Yaobao
AU - Bennett, Adam
AU - Shanks, George Dennis
AU - Cao, Jun
AU - Kachur, Stephen Patrick
AU - Feachem, Richard G A
AU - Gosling, Roly D.
AU - Gao, Qi
N1 - Funding Information:
This work has been an output of the Asia Pacific Malaria Elimination Network (APMEN) as well as the Malaria Elimination Group (MEG). Funding for the work was provided through a grant from the Bill and Melinda Gates Foundation to the UCSF Global Heath Group (MSH, RGAF, RG) as well as a grant from the UCSF Pathways Funding Committee Research Fellowship program (ART). MSH is additionally funded by a National Institutes of Health/ National Institute of Allergy and Infectious Diseases K23 grant (P0045532) and a Burroughs Wellcome Fund/American Society of Tropical Medicine and Hygiene Fellowship Award (P0049395). JH and SPK are funded by the Centers for Diseases Control and Prevention. YL, JC, and QG are funded by Jiangsu Province’s Medical High Tech Platform (ZX201108) and Jiangsu Science and Technology Department (BM2009902). AB is funded by a grant from the President’s Malaria Initiative. GDS is funded by the Australian Defence Force. The paper represents the views of the authors and not the opinion or policy of their organization or the funders. We thank Huayun Zhou, Julin Li, Weiming Wang, Yaping Gu, Guizhi She, Song Xu, Yue Tang, and Zhaodong Wang for their support in data collection; Yuanyuan Cao for support on the maps; Andy Anglemeyer, Allen Hightower, Ann Lazar, and Jenny Liu for their input in data analysis; Edmund Seto and Hugh Sturrock for helping to gather weather data; Gavin Yamey for his review of the paper; and Michael Wang for translation support.
PY - 2013
Y1 - 2013
N2 - 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.
AB - 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.
KW - China
KW - Malaria elimination
KW - Mass drug administration
KW - Plasmodium vivax
KW - Primaquine
UR - http://www.scopus.com/inward/record.url?scp=84886744593&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84886744593&partnerID=8YFLogxK
U2 - 10.1186/1475-2875-12-383
DO - 10.1186/1475-2875-12-383
M3 - Article
C2 - 24175930
AN - SCOPUS:84886744593
SN - 1475-2875
VL - 12
JO - Malaria journal
JF - Malaria journal
IS - 1
M1 - 383
ER -