Climatic and anthropogenic drivers of northern Amazon fires during the 2015-2016 El Niño event.

The strong El Niño Southern Oscillation (ENSO) event that occurred in 2015-2016 caused extreme drought in the northern Brazilian Amazon, especially in the state of Roraima, increasing fire occurrence. Here we map the extent of precipitation and fire anomalies and quantify the effects of climatic and anthropogenic drivers on fire occurrence during the 2015-2016 dry season (from December 2015 to March 2016) in the state of Roraima. To achieve these objectives we first estimated the spatial pattern of precipitation anomalies, based on long-term data from the TRMM (Tropical Rainfall Measuring Mission), and the fire anomaly, based on MODIS (Moderate Resolution Imaging Spectroradiometer) active fire detections during the referred period. Then, we integrated climatic and anthropogenic drivers in a Maximum Entropy (MaxEnt) model to quantify fire probability, assessing (1) the model accuracy during the 2015-2016 and the 2016-2017 dry seasons; (2) the relative importance of each predictor variable on the model predictive performance; and (3) the response curves, showing how each environmental variable affects the fire probability. Approximately 59% (132,900 km2 ) of the study area was exposed to precipitation anomalies ≤-1 standard deviation (SD) in January and ~48% (~106,800 km2 ) in March. About 38% (86,200 km2 ) of the study area experienced fire anomalies ≥1 SD in at least one month between December 2015 and March 2016. The distance to roads and the direct ENSO effect on fire occurrence were the two most influential variables on model predictive performance. Despite the improvement of governmental actions of fire prevention and firefighting in Roraima since the last intense ENSO event (1997-1998), we show that fire still gets out of control in the state during extreme drought events. Our results indicate that if no prevention actions are undertaken, future road network expansion and a climate-induced increase in water stress will amplify fire occurrence in the northern Amazon, even in its humid dense forests. As an additional outcome of our analysis, we conclude that the model and the data we used may help to guide on-the-ground fire-prevention actions and firefighting planning and therefore minimize fire-related ecosystems degradation, economic losses and carbon emissions in Roraima.

Two fixed-dose artemisinin combinations for drug-resistant falciparum and vivax malaria in Papua, Indonesia: an open-label randomised comparison.

BACKGROUND: The burden of Plasmodium vivax infections has been underappreciated, especially in southeast Asia where chloroquine resistant strains have emerged. Our aim was to compare the safety and efficacy of dihydroartemisinin-piperaquine with that of artemether-lumefantrine in patients with uncomplicated malaria caused by multidrug-resistant P falciparum and P vivax. METHODS: 774 patients in southern Papua, Indonesia, with slide-confirmed malaria were randomly assigned to receive either artemether-lumefantrine or dihydroartemisinin-piperaquine and followed up for at least 42 days. The primary endpoint was the overall cumulative risk of parasitological failure at day 42 with a modified intention-to-treat analysis. This trial is registered with ClinicalTrials.gov, trial number 00157833. FINDINGS: Of the 754 evaluable patients enrolled, 466 had infections with P falciparum, 175 with P vivax, and 113 with a mixture of both species. The overall risk of failure at day 42 was 43% (95% CI 38-48) for artemether-lumefantrine and 19% (14-23) for dihydroartemisinin-piperaquine (hazard ratio=3.0, 95% CI 2.2-4.1, p<0.0001). After correcting for reinfections, the risk of recrudescence of P falciparum was 4.4% (2.6-6.2) with no difference between regimens. Recurrence of vivax occurred in 38% (33-44) of patients given artemether-lumefantrine compared with 10% (6.9-14.0) given dihydroartemisinin-piperaquine (p<0.0001). At the end of the study, patients receiving dihydroartemisinin-piperaquine were 2.0 times (1.2-3.6) less likely to be anaemic and 6.6 times (2.8-16) less likely to carry vivax gametocytes than were those given artemether-lumefantrine. INTERPRETATION: Both dihydroartemisinin-piperaquine and artemether-lumefantrine were safe and effective for the treatment of multidrug-resistant uncomplicated malaria. However, dihydroartemisinin-piperaquine provided greater post-treatment prophylaxis than did artemether-lumefantrine, reducing P falciparum reinfections and P vivax recurrences, the clinical public-health importance of which should not be ignored.

Dihydroartemisinin-piperaquine versus artesunate-amodiaquine: superior efficacy and posttreatment prophylaxis against multidrug-resistant Plasmodium falciparum and Plasmodium vivax malaria.

BACKGROUND: Antimalarial drug resistance is now well established in both Plasmodium falciparum and Plasmodium vivax. In southern Papua, Indonesia, where both strains of plasmodia coexist, we have been conducting a series of studies to optimize treatment strategies. METHODS: We conducted a randomized trial that compared the efficacy and safety of dihydroartemisinin-piperaquine (DHP) with artesunate-amodiaquine (AAQ). The primary end point was the overall cumulative parasitological failure rate at day 42. RESULTS: Of the 334 patients in the evaluable patient population, 185 were infected with P. falciparum, 80 were infected with P. vivax, and 69 were infected with both species. The overall parasitological failure rate at day 42 was 45% (95% confidence interval [CI], 36%-53%) for AAQ and 13% (95% CI, 7.2%-19%) for DHP (hazard ratio [HR], 4.3; 95% CI, 2.5-7.2; P<.001). Rates of both recrudescence of P. falciparum infection and recurrence of P. vivax infection were significantly higher after receipt of AAQ than after receipt of DHP (HR, 3.4 [95% CI, 1.2-9.4] and 4.3 [95% CI, 2.2-8.2], respectively; P<.001). By the end of the study, AAQ recipients were 2.95-fold (95% CI, 1.2- to 4.9-fold) more likely to be anemic and 14.5-fold (95% CI, 3.4- to 61-fold) more likely to have carried P. vivax gametocytes. CONCLUSIONS: DHP was more effective and better tolerated than AAQ against multidrug-resistant P. falciparum and P. vivax infections. The prolonged therapeutic effect of piperaquine delayed the time to P. falciparum reinfection, decreased the rate of recurrence of P. vivax infection, and reduced the risk of P. vivax gametocyte carriage and anemia.

Estudo da susceptibilidade da Biomphalaria stramínea (Dunker, 1848) de Taubaté, SP, à infecção por cepa S.J. de Schistosoma mansoni do Vale do Paraíba, SP / Comparative susceptibility of Biomphalaria straminea (Dunker,1848) and B. tenagophila from Taubaté, SP, to infection with the strain of Schistosoma mansoni from Vale do Paraíba, SP

Estudou-se a susceptibilidade de Biomphalaria straminea, originária do município de Taubaté, SP, comparativamente com Biomphalaria tenagophila, à infecção pela cepa S.J. de Schistosoma mansoni de São José dos Campos. Pretendeu-se determinar o potencial epidemiológico destas espécies como hospedeiros intermediários de S. mansoni frente a cepa valeparaibana. Foram inoculados individualmente 250 B. straminea e 250 B. tenagophila e mais o grupo controle. Tais moluscos ficaram sob observaçäo durante 60 dias. Foram depois esmagados para detectar presença de esporocistos nos órgãos internos. Ao término do experimento B. straminea não se mostrou suscetível à infecção pela cepa S.J. e B. tenagophila apresentou 82,2% e 83,2% de infecção nos três lotes (AU).