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Continued Low Efficacy of Artemether-Lumefantrine in Angola in 2019.
Dimbu, Pedro Rafael; Horth, Roberta; Cândido, Ana Luísa M; Ferreira, Carolina Miguel; Caquece, Felismina; Garcia, Luzala Elisabeth Armando; André, Kialanda; Pembele, Garcia; Jandondo, Domingos; Bondo, Belmira José; Nieto Andrade, Benjamin; Labuda, Sarah; Ponce de León, Gabriel; Kelley, Julia; Patel, Dhruviben; Svigel, Samaly S; Talundzic, Eldin; Lucchi, Naomi; Morais, Joana F M; Fortes, Filomeno; Martins, José Franco; Plucinski, Mateusz M.
Afiliação
  • Dimbu PR; National Malaria Control Program, Ministry of Health, Luanda, Angola.
  • Horth R; Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Cândido ALM; National Institute of Health Research, Ministry of Health, Luanda, Angola.
  • Ferreira CM; Population Services International Angola, Luanda, Angola.
  • Caquece F; Field Epidemiology Training Program, Ministry of Health, Luanda, Angola.
  • Garcia LEA; Field Epidemiology Training Program, Ministry of Health, Luanda, Angola.
  • André K; Field Epidemiology Training Program, Ministry of Health, Luanda, Angola.
  • Pembele G; National Institute of Health Research, Ministry of Health, Luanda, Angola.
  • Jandondo D; National Institute of Health Research, Ministry of Health, Luanda, Angola.
  • Bondo BJ; National Malaria Control Program, Ministry of Health, Luanda, Angola.
  • Nieto Andrade B; Population Services International Angola, Luanda, Angola.
  • Labuda S; Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Ponce de León G; U.S. President's Malaria Initiative, Centers for Disease Control and Prevention, Luanda, Angola.
  • Kelley J; Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Patel D; U.S. President's Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Svigel SS; Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Talundzic E; Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Lucchi N; Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Morais JFM; Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Fortes F; Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Martins JF; National Institute of Health Research, Ministry of Health, Luanda, Angola.
  • Plucinski MM; Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Lisbon, Portugal.
Article em En | MEDLINE | ID: mdl-33168604
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 Plasmodium falciparum 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 pfk13, pfcrt, and pfmdr1 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 pfk13 sequences. The 76T pfcrt allele was found in most (92%; 11/12) ASAQ late-failure samples but in only 16% (4/25) of AL failure samples. The N86 pfmdr1 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.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Malária Falciparum / Antimaláricos Limite: Child / Humans / Infant País/Região como assunto: Africa Idioma: En Revista: Antimicrob Agents Chemother Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Angola

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Malária Falciparum / Antimaláricos Limite: Child / Humans / Infant País/Região como assunto: Africa Idioma: En Revista: Antimicrob Agents Chemother Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Angola