Malaria Control by Mass Drug Administration With Artemisinin Plus Piperaquine on Grande Comore Island, Union of Comoros

Changsheng Deng; Wanting Wu; Yueming Yuan; Guoming Li; Hongying Zhang; Shaoqin Zheng; Mingqiang Li; Ruixiang Tan; Yuxin Wang; Julie Nadia; Danhong Feng; Di Li; Zhibing Wu; Qin Xu; Changqing Li; Zhenhua Wang; Yuan Liang; Johannes S P Doehl; Xinzhuan Su; Affane Bacar; Kamal Said Abdallah; Hafidhou Mohamed; Ahamada Msa Mliva; Thomas E Wellems; Jianping Song

doi:10.1093/ofid/ofad076

Malaria Control by Mass Drug Administration With Artemisinin Plus Piperaquine on Grande Comore Island, Union of Comoros

Open Forum Infect Dis. 2023 Feb 14;10(3):ofad076. doi: 10.1093/ofid/ofad076. eCollection 2023 Mar.

Authors

Changsheng Deng¹, Wanting Wu¹, Yueming Yuan¹, Guoming Li¹, Hongying Zhang¹, Shaoqin Zheng¹, Mingqiang Li¹, Ruixiang Tan¹, Yuxin Wang¹, Julie Nadia¹, Danhong Feng², Di Li², Zhibing Wu³, Qin Xu^{1

3}, Changqing Li^{1

3}, Zhenhua Wang¹, Yuan Liang², Johannes S P Doehl⁴, Xinzhuan Su⁴, Affane Bacar⁵, Kamal Said Abdallah⁵, Hafidhou Mohamed⁵, Ahamada Msa Mliva⁵, Thomas E Wellems⁴, Jianping Song^{1

3}

Affiliations

¹ Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China.
² Science and Technology Park, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China.
³ First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China.
⁴ Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
⁵ National Malaria Center of The Union of Comoros, Moroni, The Union of Comoros.

Abstract

Background: Mass drug administration (MDA) is a powerful tool for malaria control, but the medicines to use, dosing, number of rounds, and potential selection of drug resistance remain open questions.

Methods: Two monthly rounds of artemisinin-piperaquine (AP), each comprising 2 daily doses, were administered across the 7 districts of Grande Comore Island. In 3 districts, low-dose primaquine (PMQ_LD) was also given on the first day of each monthly round. Plasmodium falciparum malaria rates, mortality, parasitemias, adverse events, and genetic markers of potential drug resistance were evaluated.

Results: Average population coverages of 80%-82% were achieved with AP in 4 districts (registered population 258 986) and AP + PMQ_LD in 3 districts (83 696). The effectiveness of MDA was 96.27% (95% confidence interval [CI], 95.27%-97.06%; P < .00001) in the 4 AP districts and 97.46% (95% CI, 94.54%-98.82%; P < .00001) in the 3 AP + PMQ_LD districts. In comparative statistical modeling, the effectiveness of the 2 monthly rounds on Grande Comore Island was nearly as high as that of 3 monthly rounds of AP or AP + PMQ_LD in our earlier study on Anjouan Island. Surveys of pre-MDA and post-MDA samples showed no significant changes in PfK13 polymorphism rates, and no PfCRT mutations previously linked to piperaquine resistance in Southeast Asia were identified.

Conclusions: MDA with 2 monthly rounds of 2 daily doses of AP was highly effective on Grande Comore Island. The feasibility and lower expense of this 2-month versus 3-month regimen of AP may offer advantages for MDA programs in appropriate settings.

Keywords: Plasmodium falciparum malaria; artemisinin-based combination therapy; chloroquine resistance transporter (PfCRT); pfK13 kelch-propeller mutations; piperaquine resistance.

Published by Oxford University Press on behalf of Infectious Diseases Society of America 2023.