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1.
Malar J ; 19(1): 386, 2020 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-33138814

RESUMO

The COVID-19 pandemic has had a considerable impact on other health programmes in countries, including on malaria, and is currently under much discussion. As many countries are accelerating efforts to eliminate malaria or to prevent the re-establishment of malaria from recently eliminated countries, the COVID-19 pandemic has the potential to cause major interruptions to ongoing anti-malaria operations and risk jeopardizing the gains that have been made so far. Sri Lanka, having eliminated malaria in 2012, was certified by the World Health Organization as a malaria-free country in 2016 and now implements a rigorous programme to prevent its re-establishment owing to the high receptivity and vulnerability of the country to malaria. Sri Lanka has also dealt with the COVID-19 epidemic quite successfully limiting the cumulative number of infections and deaths through co-ordinated efforts between the health sector and other relevant sectors, namely the military, the Police Department, Departments of Airport and Aviation and Foreign Affairs, all of which have been deployed for the COVID-19 epidemic under the umbrella of a Presidential Task Force. The relevance of imported infections and the need for a multi-sectoral response are features common to both the control of the COVID-19 epidemic and the Prevention of Re-establishment (POR) programme for malaria. Sri Lanka's malaria POR programme has, therefore, creatively integrated its activities with those of the COVID-19 control programme. Through highly coordinated operations the return to the country of Sri Lankan nationals stranded overseas by the COVID-19 pandemic, many from malaria endemic countries, are being monitored for malaria as well as COVID-19 in an integrated case surveillance system under quarantine conditions, to the success of both programmes. Twenty-three imported malaria cases were detected from February to October through 2773 microscopic blood examinations performed for malaria in quarantine centres, this number being not much different to the incidence of imported malaria during the same period last year. This experience highlights the importance of integrated case surveillance and the need for a highly coordinated multi-sectoral approach in dealing with emerging new infections. It also suggests that synergies between the COVID-19 epidemic control programme and other health programmes may be found and developed to the advantage of both.


Assuntos
Doenças Transmissíveis Emergentes/prevenção & controle , Doenças Transmissíveis Importadas/prevenção & controle , Infecções por Coronavirus/complicações , Malária/prevenção & controle , Pandemias , Pneumonia Viral/complicações , Doenças Transmissíveis Emergentes/complicações , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Importadas/complicações , Doenças Transmissíveis Importadas/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Malária/complicações , Malária/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Quarentena , Sri Lanka/epidemiologia , Viagem , Doença Relacionada a Viagens
2.
J Diabetes Res ; 2020: 8205261, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33134395

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic continues to cause havoc to many countries of the globe, with no end in sight, due to nonavailability of a given vaccine or treatment regimen. The pandemic has so far had a relatively limited impact on the African continent, which contributes more than 93% of global malaria burden. However, the limited burden of COVID-19 pandemic on the African region could have long-term implications on the health and wellbeing of affected inhabitants due to its malaria-endemic status. Malaria causes recurrent insulin resistance with episodes of infection at relatively low parasitaemia. Angiotensin-converting enzyme 2 (ACE2) which is widely distributed in the human body is implicated in the pathogenesis of malaria, type 2 diabetes mellitus (T2DM), and COVID-19. Use of ACE2 by the COVID-19 virus induces inflammation and oxidative stress, which can lead to insulin resistance. Although COVID-19 patients in malaria-endemic African region may not exhibit severe signs and symptoms of the disease, their risk of exhibiting heightened insulin resistance and possible future development of T2DM is high due to their prior exposure to malaria. African governments must double efforts at containing the continued spread of the virus without neglecting existing malarial control measures if the region is to avert the plausible long-term impact of the pandemic in terms of future development of T2DM.


Assuntos
Infecções por Coronavirus/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/patologia , Doenças Endêmicas , Malária/epidemiologia , Pneumonia Viral/epidemiologia , África/epidemiologia , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Betacoronavirus/fisiologia , Infecções por Coronavirus/complicações , Diabetes Mellitus Tipo 2/complicações , Progressão da Doença , Humanos , Resistência à Insulina/fisiologia , Malária/complicações , Pandemias , Peptidil Dipeptidase A/fisiologia , Pneumonia Viral/complicações , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/patologia , Estado Pré-Diabético/virologia , Sistema Renina-Angiotensina/efeitos dos fármacos , Sistema Renina-Angiotensina/fisiologia
3.
Malar J ; 19(1): 410, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-33198754

RESUMO

BACKGROUND: In the past decade substantial reduction in malaria morbidity and mortality has been observed through well-implemented case management and vector control strategies. India has also achieved a significant reduction in malaria burden in 2018 and has committed to eliminate malaria by 2030. The Mandla Malaria Elimination Demonstration Project (MEDP) was started in 2017 in 1233 villages of District Mandla to demonstrate malaria elimination in a tribal district with hard-to-reach areas was possible using active and passive surveillance, case management, vector control, and targeted information, education and communication campaigns. An operational plan was developed to strengthen the existing surveillance and malaria elimination systems, through fortnightly active case detection to ensure that all cases including those that are introduced into the communities are rapidly identified and treated promptly. The plan also focused on the reduction of human-mosquito contact through the use of Long-Lasting Insecticial Nets (LLINs) and Indoor Residual Spray (IRS). The operational plan was modified in view of the present COVID-19 pandemic by creating systems of assistance for the local administration for COVID-related work while ensuring the operational integrity of malaria elimination efforts. RESULTS: The use of MEDP study design and operational plan, with its built-in management control systems, has yielded significant (91%) reduction of indigenous cases of malaria during the period from June 2017 to May 2020. The malaria positivity rate was 0.33% in 2017-18, 0.13% in 2018-19, and 0.06% in 2019-20. Mass screening revealed 0.18% malaria positivity in September-October 2018, followed by 0.06% in June 2019, and 0.03% in December 2019, and these were mostly asymptomatic cases in the community. The project has been able to sustain the gains of the past three years during the ongoing COVID-19 pandemic. CONCLUSION: This paper provides the study design and the operational plan for malaria elimination in a high-burden district of Central India, which presented difficulties of hard to reach areas, forest malaria, and complex epidemiology of urban and rural malaria. The lessons learned could be used for malaria elimination efforts in rest of the country and other parts of South Asia with comparable demography and epidemiology.


Assuntos
Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/métodos , Doenças Endêmicas/prevenção & controle , Malária/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Vigilância da População/métodos , Altitude , Animais , Infecções por Coronavirus/epidemiologia , Assistência à Saúde/organização & administração , Doenças Endêmicas/estatística & dados numéricos , Florestas , Instalações de Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Humanos , Índia/epidemiologia , Mosquiteiros Tratados com Inseticida , Malária/epidemiologia , Controle de Mosquitos , Pneumonia Viral/epidemiologia , Prevalência , Chuva , População Rural , População Urbana
4.
BMC Infect Dis ; 20(1): 835, 2020 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-33176708

RESUMO

BACKGROUND: The spatial distribution and burden of dengue in sub-Saharan Africa remains highly uncertain, despite high levels of ecological suitability. The goal of this study was to describe the epidemiology of dengue among a cohort of febrile children presenting to outpatient facilities located in areas of western Uganda with differing levels of urbanicity and malaria transmission intensity. METHODS: Eligible children were first screened for malaria using rapid diagnostic tests. Children with a negative malaria result were tested for dengue using a combination NS1/IgM/IgG rapid test (SD Bioline Dengue Duo). Confirmatory testing by RT-PCR was performed in a subset of participants. Antigen-capture ELISA was performed to estimate seroprevalence. RESULTS: Only 6 of 1416 (0.42%) children had a positive dengue rapid test, while none of the RT-PCR results were positive. ELISA testing demonstrated reactive IgG antibodies in 28 (2.2%) participants with the highest prevalence seen at the urban site in Mbarara (19 of 392, 4.9%, p < 0.001). CONCLUSIONS: Overall, these findings suggest that dengue, while present, is an uncommon cause of non-malarial, pediatric febrile illness in western Uganda. Further investigation into the eocological factors that sustain low-level transmission in urban settings are urgently needed to reduce the risk of epidemics.


Assuntos
Vírus da Dengue/genética , Vírus da Dengue/imunologia , Dengue/diagnóstico , Dengue/epidemiologia , Febre/diagnóstico , Adolescente , Criança , Pré-Escolar , Dengue/virologia , Testes Diagnósticos de Rotina/efeitos adversos , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Malária/diagnóstico , Malária/epidemiologia , Malária/parasitologia , Masculino , Plasmodium/imunologia , Plasmodium/isolamento & purificação , Prevalência , Estudos Prospectivos , Reação em Cadeia da Polimerase em Tempo Real , Estudos Soroepidemiológicos , Uganda/epidemiologia
5.
BMC Infect Dis ; 20(1): 757, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33059623

RESUMO

BACKGROUND: Individuals that work and sleep in remote forest and farm locations in the Greater Mekong Subregion continue to remain at high risk of both acquiring and transmitting malaria. These difficult-to-access population groups largely fall outside the reach of traditional village-centered interventions, presenting operational challenges for malaria programs. In Vietnam, over 60% of malaria cases are thought to be individuals who sleep in forests or on farms. New malaria elimination strategies are needed in countries where mobile and migrant workers frequently sleep outside of their homes. The aim of this study was to apply targeted surveillance-response based investigative approaches to gather location-specific data on confirmed malaria cases, with an objective to identify associated malaria prevention, treatment and risk behaviors of individuals sleeping in remote forest and farms sites in Vietnam. METHODS: A cross-sectional study using novel targeted reactive investigative approaches at remote area sleeping sites was conducted in three mountainous communes in Phu Yen province in 2016. Index cases were defined as individuals routinely sleeping in forests or farms who had tested positive for malaria. Index cases and non-infected neighbors from forest and farm huts within 500 m of the established sleeping locations of index cases were interviewed at their remote-area sleeping sites. RESULTS: A total of 307 participants, 110 index cases and 197 neighbors, were enrolled. Among 93 participants who slept in the forest, index cases were more likely to make > 5 trips to the forest per year (prevalence odds ratio (POR) 7.41, 95% confidence interval (CI) 2.66-20.63), sleep in huts without walls (POR 44.00, 95% CI 13.05-148.33), sleep without mosquito nets (POR 2.95, 95% CI 1.26-6.92), and work after dark (POR 5.48, 95% CI 1.84-16.35). Of the 204 farm-based respondents, a significantly higher proportion of index cases were involved in non-farming activities (logging) (POR 2.74, 95% CI 1.27-5.91). CONCLUSION: Investigative approaches employed in this study allowed for the effective recruitment and characterization of high-priority individuals frequently sleeping in remote forest and farm locations, providing relevant population and site-specific data that decision makers can use to design and implement targeted interventions to support malaria elimination.


Assuntos
Florestas , Malária/epidemiologia , Malária/transmissão , Adulto , Terapia Comportamental , Estudos Transversais , Fazendas , Feminino , Habitação , Humanos , Malária/tratamento farmacológico , Malária/prevenção & controle , Masculino , Pessoa de Meia-Idade , Mosquiteiros , Razão de Chances , Assunção de Riscos , Vietnã/epidemiologia , Vietnã/etnologia
6.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(9): 1494-1498, 2020 Sep 10.
Artigo em Chinês | MEDLINE | ID: mdl-33076605

RESUMO

Objective: To understand epidemiological characteristics of imported cases of malaria in Shandong province and provide scientific basis for timely adjustment of prevention and control measures. Methods: The incidence data of malaria, case investigation data and case review data by Shandong Provincial Reference Laboratory for Malaria Diagnosis from 2017 to 2018 were collected. Software SPSS 18.0 was used for statistical analysis and software QGIS 2.18 was used for mapping. Results: A total of 442 imported cases of malaria were reported in Shandong from 2017 to 2018, and the main infection source was in Africa (97.96%, 433/442). All the 17 prefectures in Shandong reported imported malaria cases, mainly in Jining (88 cases), Yantai (65 cases), Weihai (46 cases), Qingdao (44 cases) and Dezhou (42 cases), accounting for 64.48% (285/442). The cases were distributed in 77.37%(106/137) of counties of the province. The cases were reported in every month without seasonal characteristics. The median (M) of time interval between onset and the first medical care seeking was 2 days, and the interquartile range (IQR) was 3 days. The M of time interval between the first medical care seeking and final diagnosis was 0 day, and the IQR was 3 days. The proportion of medical care seeking on onset day was only 27.83% (123/442). Only 69.68% (308/442) of cases were diagnosed with malaria in the first medical care seeking, and the diagnostic accuracy of medical institutions below the county level was lower than other medical institutions (all P<0.01). Only 51.13% (226/442) of cases were diagnosed with malaria in the first medical care seeking, the differences in the rates among medical institutions at different levels were not significant (P>0.05). Conclusions: The imported malaria in Shandong was characterized by a large number of cases, multiple infection sources and wide area distribution during 2017-2018. The awareness of timely medical care seeking in the cases was low, meanwhile the awareness and ability of malaria diagnosis and treatment in primary medical institutions were still inadequate. It is necessary to adjust the prevention and control measures accordingly.


Assuntos
Doenças Transmissíveis Importadas , Malária , África , China/epidemiologia , Doenças Transmissíveis Importadas/epidemiologia , Humanos , Incidência , Malária/epidemiologia
7.
Afr J Prim Health Care Fam Med ; 12(1): e1-e3, 2020 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-33054263

RESUMO

For Africa, the backdrop1 against which COVID-19 emerged is a stark one. Although sub-Saharan Africa accounts for 11% of the world's population, it bears 24% of the global disease burden. The continent is home to 60% of the people with human immunodeficiency virus (HIV), and over 90% of malarial patients. In this region, infectious diseases such as malaria and HIV cause 69% of deaths. As states respond to COVID-19, we need to keep our eyes open to what effective responses are notifying us about our healthcare systems, so that we can craft sustainable interventions as a result and uphold the right to health. This is especially true in the light of the ongoing nature of pandemics on the continent, making urgent the need to maximise the value of our health system and its resources, as we seek lasting transformation.


Assuntos
Infecções por Coronavirus , Acesso aos Serviços de Saúde , Pandemias , Pneumonia Viral , Pobreza , Privatização , Direito à Saúde , África ao Sul do Saara/epidemiologia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Assistência à Saúde/métodos , Infecções por HIV/epidemiologia , Humanos , Malária/epidemiologia , Defesa do Paciente , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia
8.
BMC Infect Dis ; 20(1): 796, 2020 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-33109111

RESUMO

BACKGROUND: Malaria infection during pregnancy has negative health consequences for both mothers and offspring. Sub-microscopic malaria infection during pregnancy is common in most African countries. We sought to identify factors associated with sub-microscopic placental malaria, and its association with adverse pregnancy outcomes among HIV-negative pregnant women in Dar es Salaam, Tanzania. METHODS: We recruited a cohort of pregnant women during their first trimester and assessed for the occurrence of placental malaria and pregnancy outcomes. The follow-up was done monthly from recruitment until delivery. Histopathology placental malaria positive results were defined as the presence of malaria pigment or parasitized erythrocytes on the slide (histology-positive (HP)), and the sub-microscopic placental infection was defined as positive Plasmodium falciparum DNA by polymerase chain reaction (DNA PCR) amplification in a negative histopathology test. Adverse pregnancy outcomes investigated included low birth weight (birth weight below 2.5 kg), prematurity (live birth below 37 weeks), and small-for-gestational-age (SGA) (live born with a birth weight below 10th percentile for gestational age and sex). Weighted baseline category logit, log-binomial, and log-Poisson models were used to assess factors associated with placental malaria, and its association with adverse pregnancy outcomes. RESULTS: Among 1115 women who had histopathology and DNA PCR performed, 93 (8%) had HP placental infection, and 136 (12%) had the sub-microscopic placental infection. The risk of sub-microscopic placental malaria was greater in women who did not use mosquito prevention methods such as bed nets, fumigation, or mosquito coils (odds ratio (OR) = 1.75; 95% confidence interval (CI): 1.05-2.92; P = 0.03) and in women who were anemic (OR = 1.59; 95% CI: 1.20-2.11; P = 0.001). Women who were underweight had reduced odds of sub-microscopic placental malaria infection (OR = 0.33; 95% CI: 0.17-0.62; P = 0.001). Women who were overweight/obese had 1.48 times higher the odds of HP placental malaria compared to normal weight (OR = 1.48; 95% CI: 1.03-2.11; P = 0.03). HP placental malaria infection was associated with an increased risk of SGA births (RR = 1.30, 95% CI: 0.98-1.72, P = 0.07). In contrast, the sub-microscopic infection was associated with a reduced risk of SGA births (RR = 0.61, 95% CI: 0.43-0.88, P = 0.01). Placental malaria was not associated with low birth weight or prematurity. CONCLUSION: Malaria prevention methods and maternal nutrition status during early pregnancy were important predictors of sub-microscopic placental malaria. More research is needed to understand sub-microscopic placental malaria and the possible mechanisms mediating the association between placental malaria and SGA.


Assuntos
Infecções por HIV/epidemiologia , HIV , Malária/epidemiologia , Placenta/parasitologia , Plasmodium falciparum/genética , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez , Adulto , Anemia/etiologia , Peso ao Nascer , Feminino , Seguimentos , Idade Gestacional , Infecções por HIV/virologia , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Malária/complicações , Malária/parasitologia , Gravidez , Complicações Infecciosas na Gravidez/parasitologia , Nascimento Prematuro , Risco , Tanzânia/epidemiologia , Adulto Jovem
10.
PLoS One ; 15(9): e0238504, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32911503

RESUMO

Every year, 435,000 people worldwide die from Malaria, mainly in Africa and Asia. However, malaria is a curable and preventable disease. Most countries are developing malaria elimination plans to meet sustainable development goal three, target 3.3, which includes ending the epidemic of malaria by 2030. Rwanda, through the malaria strategic plan 2012-2018 set a target to reduce malaria incidence by 42% from 2012 to 2018. Assessing the health policy and taking a decision using the incidence rate approach is becoming more challenging. We are proposing suitable statistical methods that handle spatial structure and uncertainty on the relative risk that is relevant to National Malaria Control Program. We used a spatio-temporal model to estimate the excess probability for decision making at a small area on evaluating reduction of incidence. SIR and BYM models were developed using routine data from Health facilities for the period from 2012 to 2018 in Rwanda. The fitted model was used to generate relative risk (RR) estimates comparing the risk with the malaria risk in 2012, and to assess the probability of attaining the set target goal per area. The results showed an overall increase in malaria in 2013 to 2018 as compared to 2012. Ofall sectors in Rwanda, 47.36% failed to meet targeted reduction in incidence from 2012 to 2018. Our approach of using excess probability method to evaluate attainment of target or identifying threshold is a relevant statistical method, which will enable the Rwandan Government to sustain malaria control and monitor the effectiveness of targeted interventions.


Assuntos
Malária/epidemiologia , Teorema de Bayes , Política de Saúde , Humanos , Incidência , Probabilidade , Medição de Risco , Ruanda/epidemiologia
11.
PLoS Pathog ; 16(8): e1008131, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32866196

RESUMO

Invasion of hepatocytes by Plasmodium sporozoites initiates the pre-erythrocytic step of a malaria infection. Subsequent development of the parasite within hepatocytes and exit from them is essential for starting the disease-causing erythrocytic cycle. Identification of signaling pathways that operate in pre-erythrocytic stages provides insight into a critical step of infection and potential targets for chemoprotection from malaria. We demonstrate that P. berghei homologs of Calcium Dependent Protein Kinase 1 (CDPK1), CDPK4 and CDPK5 play overlapping but distinct roles in sporozoite invasion and parasite egress from hepatocytes. All three kinases are expressed in sporozoites. All three are required for optimal motility of sporozoites and consequently their invasion of hepatocytes. Increased cGMP can compensate for the functional loss of CDPK1 and CDPK5 during sporozoite invasion but cannot overcome loss of CDPK4. CDPK1 and CDPK5 expression is downregulated after sporozoite invasion. CDPK5 reappears in a subset of late stage liver stages and is present in all merosomes. Chemical inhibition of CDPK4 and depletion of CDPK5 in liver stages implicate these kinases in the formation and/or release of merosomes from mature liver stages. Furthermore, depletion of CDPK5 in merosomes significantly delays initiation of the erythrocytic cycle without affecting infectivity of hepatic merozoites. These data suggest that CDPK5 may be required for the rupture of merosomes. Our work provides evidence that sporozoite invasion requires CDPK1 and CDPK5, and suggests that CDPK5 participates in the release of hepatic merozoites.


Assuntos
Regulação para Baixo , Regulação Enzimológica da Expressão Gênica , Malária/epidemiologia , Merozoítos/enzimologia , Plasmodium berghei/enzimologia , Proteínas Quinases/biossíntese , Proteínas de Protozoários/biossíntese , Esporozoítos/enzimologia , Animais , Eritrócitos/enzimologia , Eritrócitos/parasitologia , Feminino , Células Hep G2 , Humanos , Fígado/enzimologia , Fígado/parasitologia , Malária/patologia , Camundongos
12.
PLoS Negl Trop Dis ; 14(9): e0008617, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32886679

RESUMO

The zoonotic malaria parasite, Plasmodium knowlesi, is now a substantial public health problem in Malaysian Borneo. Current understanding of P. knowlesi vector bionomics and ecology in Sabah comes from a few studies near the epicentre of human cases in one district, Kudat. These have incriminated Anopheles balabacensis as the primary vector, and suggest that human exposure to vector biting is peri-domestic as well as in forest environments. To address the limited understanding of vector ecology and human exposure risk outside of Kudat, we performed wider scale surveillance across four districts in Sabah with confirmed transmission to investigate spatial heterogeneity in vector abundance, diversity and infection rate. Entomological surveillance was carried out six months after a cross-sectional survey of P. knowlesi prevalence in humans throughout the study area; providing an opportunity to investigate associations between entomological indicators and infection. Human-landing catches were performed in peri-domestic, farm and forest sites in 11 villages (3-4 per district) and paired with estimates of human P. knowlesi exposure based on sero-prevalence. Anopheles balabacensis was present in all districts but only 6/11 villages. The mean density of An. balabacensis was relatively low, but significantly higher in farm (0.094/night) and forest (0.082/night) than peri-domestic areas (0.007/night). Only one An. balabacensis (n = 32) was infected with P. knowlesi. Plasmodium knowlesi sero-positivity in people was not associated with An. balabacensis density at the village-level however post hoc analyses indicated the study had limited power to detect a statistical association due low vector density. Wider scale sampling revealed substantial heterogeneity in vector density and distribution between villages and districts. Vector-habitat associations predicted from this larger-scale surveillance differed from those inferred from smaller-scale studies in Kudat; highlighting the importance of local ecological context. Findings highlight potential trade-offs between maximizing temporal versus spatial breadth when designing entomological surveillance; and provide baseline entomological and epidemiological data to inform future studies of entomological risk factors for human P. knowlesi infection.


Assuntos
Anopheles/parasitologia , Malária/epidemiologia , Malária/transmissão , Mosquitos Vetores/parasitologia , Plasmodium knowlesi/isolamento & purificação , Animais , Bornéu/epidemiologia , Estudos Transversais , Fazendas , Florestas , Humanos , Malásia/epidemiologia , População Rural/estatística & dados numéricos , Soroconversão
13.
PLoS One ; 15(9): e0238323, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32898853

RESUMO

India, a persistently significant contributor to the global malaria burden, rolled out several anti-malaria interventions at the national and state level to control and recently, to eliminate the disease. Odisha, the eastern Indian state with the highest malaria burden experienced substantial gains shown by various anti-malaria initiatives implemented under the National Vector-borne Disease Control Programme (NVBDCP). However, recalcitrant high-transmission "pockets" of malaria persist in hard-to-reach stretches of the state, characterised by limited access to routine malaria surveillance and the forested hilly topography favouring unbridled vector breeding. The prevalence of asymptomatic malaria in such pockets serves as perpetual malaria reservoir, thus hindering its elimination. Therefore, a project with the acronym DAMaN was initiated since 2017 by state NVBDCP, targeting locally identified high endemic 'pockets' in 23 districts. DAMaN comprised biennial mass screening and treatment, provisioning of long-lasting insecticidal net (LLIN) and behavioural change communication. Subsequently, to inform policy, assessment of DAMaN was conceived that aims to estimate the coverage of the various components of the project; the prevalence of malaria, even at sub-patent level especially among pregnant/lactating women and children; and its impact on malaria incidence. A survey of DAMaN beneficiaries will measure coverage; and knowledge and practices related to LLIN; along with collection of blood specimens from a probability sample. A multi-stage stratified clustered sample of 2228 households (~33% having pregnant/lactating women) will be selected from 6 DAMaN districts. Routine DAMaN project data (2017-2018) and NVBDCP data (2013-2018) will be extracted. Rapid Diagnostic Test, Polymerase Chain Reaction and blood smear microscopy will be conducted to detect malarial parasitemia. In addition to measuring DAMaN's coverage and malarial prevalence in DAMaN pockets, its impact will be estimated using pre-post differences and Interrupted Time Series analysis using 2017 as the "inflection" point. The assessment may help to validate the unique strategies employed by DAMaN.


Assuntos
Antimaláricos/uso terapêutico , Mosquiteiros Tratados com Inseticida/estatística & dados numéricos , Malária/epidemiologia , Malária/prevenção & controle , Controle de Mosquitos/organização & administração , Controle de Mosquitos/normas , Plasmodium malariae/efeitos dos fármacos , Adolescente , Criança , Pré-Escolar , Feminino , Governo , Humanos , Incidência , Índia/epidemiologia , Lactente , Análise de Séries Temporais Interrompida , Malária/parasitologia , Malária/transmissão , Gravidez , Inquéritos e Questionários
14.
Medicine (Baltimore) ; 99(36): e22044, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899064

RESUMO

BACKGROUND: Malaria remains a global health threat for centuries. In recent years, a rising resistance of Plasmodium falciparum to current standard artemisinin-based combination therapies (ACTs) leads to increasing treatment failures and requires for optimized treatment. Here, we intend to make a systematic review and meta-analysis of optimizing treatment for malaria, so as to find a potential optimal treatment. METHODS: We will search electronic databases: the Cochrane Infectious Diseases Group (CIDG) Specialized Register, the Cochrane Central Register of Controlled Trials (CEN-TRAL), PubMed, Embase, Web of Science from their inception to 1 July, 2020. We will also search International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov, and contact with authors when necessary. Two authors will independently collect and select data, and the statistical analyses will be conducted by Revman V.5.3 software. RESULTS: We will evaluate efficacy and safety of modified ACTs for uncomplicate malaria, comparing with standard ACTs in all eligible clinical studies. CONCLUSION: In this study, we will offer clinical evidence for optimizing treatment for malaria. REGISTRATION NUMBER: INPLASY202070115.


Assuntos
Anti-Infecciosos/uso terapêutico , Artemisininas/uso terapêutico , Malária/tratamento farmacológico , Antimaláricos/uso terapêutico , Terapia Combinada , Feminino , Humanos , Malária/epidemiologia , Malária/parasitologia , Masculino , Plasmodium falciparum/efeitos dos fármacos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Segurança , Falha de Tratamento , Resultado do Tratamento
15.
Lancet Child Adolesc Health ; 4(10): 775-789, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32946831

RESUMO

Malaria disproportionately affects children younger than 5 years. Falciparum malaria is responsible for more than 200 000 child deaths per year in Africa and vivax malaria is well documented as a cause of severe anaemia and excess mortality in children in Asia and Oceania. For the treatment of malaria in children, paediatric dosing recommendations for several agents, including parenteral artesunate and dihydroartemisinin-piperaquine, have belatedly been shown to be suboptimal. Worsening antimalarial resistance in Plasmodium falciparum in the Greater Mekong Subregion threatens to undermine global efforts to control malaria. Triple antimalarial combination therapies are being evaluated to try to impede this threat. The RTS,S/AS01 vaccine gives partial protection against falciparum malaria and is being evaluated in large, pilot studies in Ghana, Malawi, and Kenya as a complementary tool to other preventive measures. Seasonal malaria chemoprevention in west Africa has resulted in declines in malaria incidence and deaths and there is interest in scaling up efforts by expanding the age range of eligible recipients. Preventing relapse in Plasmodium vivax infection with primaquine is challenging because treating children who have G6PD deficiency with primaquine can cause acute haemolytic anaemia. The safety of escalating dose regimens for primaquine is being studied to mitigate this risk.


Assuntos
Antimaláricos/uso terapêutico , Artemisininas/uso terapêutico , Bem-Estar da Criança/estatística & dados numéricos , Vacinas Antimaláricas/uso terapêutico , Malária/tratamento farmacológico , Malária/prevenção & controle , Criança , Relação Dose-Resposta a Droga , Resistência a Múltiplos Medicamentos , Feminino , Humanos , Malária/epidemiologia , Masculino , Estações do Ano , Vacinação/estatística & dados numéricos
16.
PLoS Med ; 17(9): e1003318, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32956354

RESUMO

BACKGROUND: Low-density (LD) Plasmodium infections are missed by standard malaria rapid diagnostic tests (standard mRDT) when the blood antigen concentration is below the detection threshold. The clinical impact of these LD infections is unknown. This study investigates the clinical presentation and outcome of untreated febrile children with LD infections attending primary care facilities in a moderately endemic area of Tanzania. METHODS/FINDINGS: This cohort study includes 2,801 febrile pediatric outpatients (median age 13.5 months [range 2-59], female:male ratio 0.8:1.0) recruited in Dar es Salaam, Tanzania between 01 December 2014 and 28 February 2016. Treatment decisions were guided by a clinical decision support algorithm run on a mobile app, which also collected clinical data. Only standard mRDT+ cases received antimalarials. Outcomes (clinical failure, secondary hospitalization, and death) were collected in follow-up visits or interviews on days 3, 7, and 28. After patient recruitment had ended, frozen blood from all 2,801 patients was tested for Plasmodium falciparum (Pf) by ultrasensitive-quantitative polymerase chain reaction (qPCR), standard mRDT, and "ultrasensitive" mRDT. As the latter did not improve sensitivity beyond standard mRDT, it is hereafter excluded. Clinical features and outcomes in LD patients (standard mRDT-/ultrasensitive-qPCR+, not given antimalarials) were compared with those with no detectable (ND) parasitemia (standard mRDT-/ultrasensitive-qPCR-) or high-density (HD) infections (standard mRDT+/ultrasensitive-qPCR+, antimalarial-treated). Pf positivity rate was 7.1% (n = 199/2,801) and 9.8% (n = 274/2,801) by standard mRDT and ultrasensitive qPCR, respectively. Thus, 28.0% (n = 76/274) of ultrasensitive qPCR+ cases were not detected by standard mRDT and labeled "LD". LD patients were, on average, 10.6 months younger than those with HD infections (95% CI 7.0-14.3 months, p < 0.001). Compared with ND, LD patients more frequently had the diagnosis of undifferentiated fever of presumed viral origin (risk ratio [RR] = 2.0, 95% CI 1.3-3.1, p = 0.003) and were more often suffering from severe malnutrition (RR = 3.2, 95% CI 1.1-7.5, p = 0.03). Despite not receiving antimalarials, outcomes for the LD group did not differ from ND regarding clinical failures (2.6% [n = 2/76] versus 4.0% [n = 101/2,527], RR = 0.7, 95% CI 0.2-3.5, p = 0.7) or secondary hospitalizations (2.6% [n = 2/76] versus 2.8% [n = 72/2,527], RR = 0.7,95% CI 0.2-3.2, p = 0.9), and no deaths were reported in any Pf-positive groups. HD patients experienced more secondary hospitalizations (10.1% [n = 20/198], RR = 0.3, 95% CI 0.1-1.0, p = 0.005) than LD patients. All the patients in this cohort were febrile children; thus, the association between parasitemia and fever cannot be investigated, nor can the conclusions be extrapolated to neonates and adults. CONCLUSIONS: During a 28-day follow-up period, we did not find evidence of a difference in negative outcomes between febrile children with untreated LD Pf parasitemia and those without Pf parasitemia. These findings suggest LD parasitemia may either be a self-resolving fever or an incidental finding in children with other infections, including those of viral origin. These findings do not support a clinical benefit nor additional risk (e.g. because of missed bacterial infections) to using ultrasensitive malaria diagnostics at a primary care level.


Assuntos
Parasitemia/diagnóstico , Convulsões Febris/etiologia , Convulsões Febris/parasitologia , Antimaláricos/uso terapêutico , Pré-Escolar , Estudos de Coortes , Feminino , Febre/diagnóstico , Humanos , Lactente , Malária/epidemiologia , Malária Falciparum/tratamento farmacológico , Masculino , Parasitemia/epidemiologia , Plasmodium falciparum/parasitologia , Plasmodium falciparum/patogenicidade , Tanzânia/epidemiologia
17.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 32(4): 374-379, 2020 Aug 24.
Artigo em Chinês | MEDLINE | ID: mdl-32935511

RESUMO

OBJECTIVE: To analyze the diagnosis of imported malaria cases in Henan Province from 2015 to 2019, so as to provide the evidence for malaria surveillance during the post-elimination stage. METHODS: The data pertaining to malaria cases in Henan Province from 2015 to 2019 were extracted via the web-based Chinese Information System for Infectious Diseases Control and Prevention and the Parasitic Diseases Information Reporting Management System (PDIRMS) of Chinese Center for Disease Control and Prevention, and the diagnostic methods, diagnostic institutions and diagnostic time of imported malaria cases were analyzed. RESULTS: A total of 952 imported malaria cases were reported in Henan Province during the period from 2015 through 2019, and all cases were laboratory-confirmed. The positive rate of malaria rapid diagnostic tests (RDTs) was 98.61% (779/790), which was significantly greater than that (94.22%, 897/952) of microscopic examinations (χ2 = 22.773, P < 0.05). The proportion of imported malaria cases diagnosed in medical institutions increased from 65.22% (120/184) in 2015 to 81.50% (185/227) in 2019. Among the 238 imported malaria cases diagnosed in centers for disease control and prevention (CDC), 71.01% (169/238) were diagnosed in county-level CDC, and among the 704 cases diagnosed in medical institutions, only 8.38% (59/704) were diagnosed at county-level medical institutions. The median time from onset to definitive diagnosis of malaria was 3 days, and the median duration between onset and initial diagnosis of malaria was 1 day. The duration between initial diagnosis and definitive diagnosis of malaria varied significantly among years (χ2 = 24.956, P < 0.05), and the interquartile range from initial diagnosis to definitive diagnosis reduced from 4 days in 2016 to 2 days in 2019. In addition, the median time from initial diagnosis to definitive diagnosis was significantly longer in severe falciparum malaria cases than in non-severe falciparum malaria cases (2 days vs. 1 day; Z = 7.557, P < 0.05). CONCLUSIONS: Medical institutions play a more and more important role in the identification and surveillance of malaria cases; however, the diagnostic capability of malaria remains low in county-level medical institutions. The diagnostic awareness and capability of county-level medical institutions requires to be improved, in order to play their roles as sentinel hospitals in the malaria surveillance during the post-elimination stage.


Assuntos
Doenças Transmissíveis Importadas , Malária , China/epidemiologia , Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/epidemiologia , Testes Diagnósticos de Rotina/normas , Humanos , Malária/diagnóstico , Malária/epidemiologia , Microscopia , Vigilância da População
18.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 32(4): 401-404, 2020 Apr 07.
Artigo em Chinês | MEDLINE | ID: mdl-32935517

RESUMO

OBJECTIVE: To analyze the epidemiological characteristics of imported malaria cases in Fujian Province from 2014 to 2018, so as to provide scientific basis for the development of the control strategy for imported malaria. METHODS: The epidemiological data of malaria cases in Fujian Province from 2014 to 2018 were retrieved from the Notifiable Disease Reporting System and Parasitic Disease Information Reporting System of Chinese Center for Disease Control and Prevention, and the classification, origin of infections, temporal distribution, spatial distribution, population distribution, reporting institutions and diagnosis were analyzed. RESULTS: A total of 540 overseas imported malaria cases were reported in Fujian Province from 2014 to 2018, and all cases were laboratory-confirmed, including 398 cases with falciparum malaria, 88 cases with vivax malaria, 38 cases with ovale malaria, 14 cases with malariae malaria and 2 cases with mixed infections. There were 90.56% (489/540) of the imported malaria cases with infections in 27 African countries, 5.92% (32/540) with infections in 5 Asian countries and 3.52% (19/540) with infections in one Oceania country. There was no significant seasonal distribution of the cases, and the imported malaria cases were predominantly detected in Fuzhou City (80.00%, 432/540) and at ages of 20 to 49 years (81.48%, 440/540). Initial diagnosis was predominantly at the city-level medical institutions, and 77.96% (421/540) were diagnosed as malaria at the initial diagnosis institutions. The median duration from onset to initial diagnosis was 2 days and 70.19% (379/540) were diagnosed within 3 days of onset. The interval between initial diagnosis and definitive diagnosis was 0 day, with 85.37% (461/540) definitively diagnosed within 3 days of initial diagnosis. CONCLUSIONS: Overseas imported malaria is a continuous problem challenging the malaria elimination programme of Fujian Province. Improving the healthcare-seeking awareness and the diagnostic capability of healthcare workers, and intensifying the monitoring and management of malaria among overseas labors are strongly recommended.


Assuntos
Doenças Transmissíveis Importadas , Malária , Adulto , China/epidemiologia , Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/epidemiologia , Doenças Transmissíveis Importadas/parasitologia , Humanos , Malária/diagnóstico , Malária/epidemiologia , Malária/parasitologia , Pessoa de Meia-Idade , Plasmodium/fisiologia , Adulto Jovem
19.
Am J Trop Med Hyg ; 103(5): 1773-1776, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32885776

RESUMO

The Peruvian Ministry of Health reports a near absence of malaria cases in the Amazon region during the COVID-19 pandemic. However, the rapid increase in SARS-CoV-2 infections has overwhelmed the Peruvian health system, leading to national panic and closure of public medical facilities, casting doubt on how accurately malaria cases' numbers reflect reality. In the Amazon region of Loreto, where malaria cases are concentrated, COVID-19 has led to near-complete closure of the primary healthcare system, and diagnosis and treatment of acute febrile illnesses, including malaria, has plummeted. Here, we describe the potential association of COVID-19 with a markedly reduced number of reported malaria cases due to the reduced control activities carried out by the Peruvian Malaria Zero Program, which could lead to malaria resurgence and an excess of morbidity and mortality.


Assuntos
Infecções por Coronavirus/epidemiologia , Malária/epidemiologia , Pneumonia Viral/epidemiologia , Betacoronavirus , Humanos , Malária/prevenção & controle , Pandemias , Peru/epidemiologia
20.
Int J Infect Dis ; 99: 437-440, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32805422

RESUMO

OBJECTIVES: At the end of November 2019, a novel coronavirus responsible for respiratory tract infections (COVID-19) emerged in China. Despite drastic containment measures, this virus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spread in Asia and Europe. The pandemic is ongoing with a particular hotspot in Southern Europe and America; many studies predicted a similar epidemic in Africa, as is currently seen in Europe and the United States of America. However, reported data have not confirmed these predictions. One of the hypotheses that could explain the later emergence and spread of COVID-19 pandemic in African countries is the use of antimalarial drugs to treat malaria, and specifically, artemisinin-based combination therapy (ACT). METHODS: The antiviral activity of fixed concentrations of ACT at concentrations consistent with those observed in human plasma when ACT is administered at oral doses for uncomplicated malaria treatment was evaluatedin vitro against a clinically isolated SARS-CoV-2 strain (IHUMI-3) in Vero E6 cells. RESULTS: Mefloquine-artesunate exerted the highest antiviral activity with % inhibition of 72.1 ± 18.3 % at expected maximum blood concentration (Cmax) for each ACT drug at doses commonly administered in malaria treatment. All the other combinations, artesunate-amodiaquine, artemether-lumefantrine, artesunate-pyronaridine, or dihydroartemisinin-piperaquine, showed antiviral inhibition in the same ranges (27.1 to 34.1 %). CONCLUSIONS: Antimalarial drugs for which concentration data in the lungs are available are concentrated from 10 to 160 fold more in the lungs than in blood. Thesein vitro results reinforce the hypothesis that antimalarial drugs could be effective as an anti-COVID-19 treatment.


Assuntos
Amodiaquina/uso terapêutico , Antimaláricos/uso terapêutico , Combinação Arteméter e Lumefantrina/uso terapêutico , Artemisininas/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Infecções por Coronavirus/tratamento farmacológico , Mefloquina/uso terapêutico , Pneumonia Viral/tratamento farmacológico , Replicação Viral/efeitos dos fármacos , Amodiaquina/farmacologia , Animais , Antimaláricos/farmacologia , Combinação Arteméter e Lumefantrina/farmacologia , Artemisininas/farmacologia , Chlorocebus aethiops , Combinação de Medicamentos , Humanos , Malária/epidemiologia , Malária Falciparum/tratamento farmacológico , Mefloquina/farmacologia , Pandemias , Células Vero
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