Effect of artesunate-mefloquine fixed-dose combination in malaria transmission in Amazon basin communities.

BACKGROUND: Studies in South-East Asia have suggested that early diagnosis and treatment with artesunate (AS) and mefloquine (MQ) combination therapy may reduce the transmission of Plasmodium falciparum malaria and the progression of MQ resistance. METHODS: The effectiveness of a fixed-dose combination of AS and MQ (ASMQ) in reducing malaria transmission was tested in isolated communities of the Juruá valley in the Amazon region.Priority municipalities within the Brazilian Legal Amazon area were selected according to pre-specified criteria. Routine national malaria control programmatic procedures were followed. Existing health structures were reinforced and health care workers were trained to treat with ASMQ all confirmed falciparum malaria cases that match inclusion criteria. A local pharmacovigilance structure was implemented. Incidence of malaria and hospitalizations were recorded two years before, during, and after the fixed-dose ASMQ intervention. In total, between July 2006 and December 2008, 23,845 patients received ASMQ. Two statistical modelling approaches were applied to monthly time series of P. falciparum malaria incidence rates, P. falciparum/Plasmodium vivax infection ratio, and malaria hospital admissions rates. All the time series ranged from January 2004 to December 2008, whilst the intervention period span from July 2006 to December 2008. RESULTS: The ASMQ intervention had a highly significant impact on the mean level of each time series, adjusted for trend and season, of 0.34 (95% CI 0.20 - 0.58) for the P. falciparum malaria incidence rates, 0.67 (95% CI 0.50 - 0.89) for the P. falciparum/P. vivax infection ratio, and 0.53 (95% CI 0.41 - 0.69) for the hospital admission rates. There was also a significant change in the seasonal (or monthly) pattern of the time series before and after intervention, with the elimination of the malaria seasonal peak in the rainy months of the years following the introduction of ASMQ. No serious adverse events relating to the use of fixed-dose ASMQ were reported. CONCLUSIONS: In the remote region of the Juruá valley, the early detection of malaria by health care workers and treatment with fixed-dose ASMQ was feasible and efficacious, and significantly reduced the incidence and morbidity of P. falciparum malaria.

[Entomological survey and infectivity during malaria outbreak in the Anajás municipality, Pará State]. / Inquérito entomológico e infectividade durante epidemia de malária no município de Anajás, Estado do Pará.

An entomological survey was conducted in the urban area of Anajás municipality, Para State, in order to verify the risk of malaria transmission. Although the density of Anopheles species was low, the anopheline infectivity rate of 6% demonstrated there is a high risk of infection by the malaria parasites.

Anopheles albitarsis s.l. (Diptera: Culicidae) survivorship and density in a rice irrigation area of the state of São Paulo, Brazil.

Collections of Anopheles albitarsis Arribalzaga s.l. were conducted from May 1996 to June 2000 to estimate the human biting rate, and mark-release-recapture experiments were carried out to estimate the daily survival probability. The density of An. albitarsis females showed a marked seasonal variation, with peaks as high as 629 individuals per human per night in the wet season. The low daily survival probability of 0.61 is an important factor limiting the vectorial capacity of An. albitarsis s.l. in southeastern Brazil.

Underreporting of Dengue-4 in Brazil due to low sensitivity of the NS1 Ag test in routine control programs.

We have identified fifty-eight samples that were positive for Dengue-4 among 119 samples with negative diagnoses for dengue via the Platelia™ dengue NS1 Ag in Aracaju, State of Sergipe, Brazil. We determined that the low sensitivity of the NS1 Ag test could be related to secondary dengue infections in the studied population. Therefore, we concluded that the sensitivity and specificity of the Platelia™ dengue NS1 Ag test as a screening method for monitoring circulating dengue serotypes must be reevaluated. In addition, regional endo-epidemic profiles should also be considered due to the prevalence of secondary responses.

Chemical composition and antioxidant, antimicrobial, and larvicidal activities of the essential oils of Annona salzmannii and A. pickelii (Annonaceae).

The essential oils from the leaves of Annona salzmannii and A. pickelii (Annonaceae) growing in Sergipe, northeastern region of Brazil, were obtained by hydrodistillation using a Clevenger-type apparatus, and analyzed by GC/MS and GC/FID. Thirty-four compounds were identified in the essential oil of A. salzmannii and twenty-seven in that of A. pickelii; sesquiterpenes predominated in both essential oils. Bicyclogermacrene (20.3%), (E)-caryophyllene (19.9%), delta-cadinene (15.3%), alpha-copaene (10.0%), and allo-aromadendrene (5.7%) were the main components of A. salzmannii, and bicyclogermacrene (45.4%), (E)-caryophyllene (14.6%), and alpha-copaene (10.6%) of A. pickelii. The essential oils showed significant antioxidant capacity in the ORAC(FL) and DPPH assays. The antimicrobial activity of these essential oils was also evaluated against bacteria and fungi, as well as the larvicidal activity against Aedes aegypti larvae.