Molecular surveillance over 14 years confirms reduction of Plasmodium vivax and falciparum transmission after implementation of Artemisinin-based combination therapy in Papua, Indonesia.
Adolescent
Adult
Aged
Aged, 80 and over
Antimalarials
/ therapeutic use
Artemisinins
/ therapeutic use
Drug Therapy, Combination
/ methods
Epidemiological Monitoring
Female
Genetic Variation
Genotyping Techniques
Humans
Indonesia
Lactones
/ therapeutic use
Malaria, Falciparum
/ drug therapy
Malaria, Vivax
/ drug therapy
Male
Microsatellite Repeats
Middle Aged
Molecular Epidemiology
Plasmodium falciparum
/ classification
Plasmodium vivax
/ classification
Young Adult
Journal
PLoS neglected tropical diseases
ISSN: 1935-2735
Titre abrégé: PLoS Negl Trop Dis
Pays: United States
ID NLM: 101291488
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
received:
27
10
2019
accepted:
15
04
2020
revised:
19
05
2020
pubmed:
8
5
2020
medline:
22
7
2020
entrez:
8
5
2020
Statut:
epublish
Résumé
Genetic epidemiology can provide important insights into parasite transmission that can inform public health interventions. The current study compared long-term changes in the genetic diversity and structure of co-endemic Plasmodium falciparum and P. vivax populations. The study was conducted in Papua Indonesia, where high-grade chloroquine resistance in P. falciparum and P. vivax led to a universal policy of Artemisinin-based Combination Therapy (ACT) in 2006. Microsatellite typing and population genetic analyses were undertaken on available isolates collected between 2004 and 2017 from patients with uncomplicated malaria (n = 666 P. falciparum and n = 615 P. vivax). The proportion of polyclonal P. falciparum infections fell from 28% (38/135) before policy change (2004-2006) to 18% (22/125) at the end of the study (2015-2017); p<0.001. Over the same period, polyclonal P. vivax infections fell from 67% (80/119) to 35% (33/93); p<0.001. P. falciparum strains persisted for up to 9 years compared to 3 months for P. vivax, reflecting higher rates of outbreeding in the latter. Sub-structure was observed in the P. falciparum population, but not in P. vivax, confirming different patterns of outbreeding. The P. falciparum population exhibited 4 subpopulations that changed in frequency over time. Notably, a sharp rise was observed in the frequency of a minor subpopulation (K2) in the late post-ACT period, accounting for 100% of infections in late 2016-2017. The results confirm epidemiological evidence of reduced P. falciparum and P. vivax transmission over time. The smaller change in P. vivax population structure is consistent with greater outbreeding associated with relapsing infections and highlights the need for radical cure to reduce recurrent infections. The study emphasizes the challenge in disrupting P. vivax transmission and demonstrates the potential of molecular data to inform on the impact of public health interventions.
Identifiants
pubmed: 32379762
doi: 10.1371/journal.pntd.0008295
pii: PNTD-D-19-01519
pmc: PMC7237043
doi:
Substances chimiques
Antimalarials
0
Artemisinins
0
Lactones
0
artemisin
Y1R67R7XWU
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0008295Subventions
Organisme : Wellcome Trust
ID : 200909
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 200909/Z/16/Z
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 200909
Pays : United Kingdom
Organisme : Wellcome Trust
ID : GR071614MA
Pays : United Kingdom
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
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