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Abstract
In this study, we determined whether the treatment of asymptomatic parasites carriers (APCs), which are frequently found in the riverside localities of the Brazilian Amazon that are highly endemic for malaria, would decrease the local malaria incidence by decreasing the overall pool of parasites available to infect mosquitoes. In one village, the treatment of the 19 Plasmodium falciparum-infected APCs identified among the 270 residents led to a clear reduction (Z = -2.39, p = 0.017) in the incidence of clinical cases, suggesting that treatment of APCs is useful for controlling falciparum malaria. For vivax malaria, 120 APCs were identified among the 716 residents living in five villages. Comparing the monthly incidence of vivax malaria in two villages where the APCs were treated with the incidence in two villages where APCs were not treated yielded contradictory results and no clear differences in the incidence were observed (Z = -0.09, p = 0.933). Interestingly, a follow-up study showed that the frequency of clinical relapse in both the treated and untreated APCs was similar to the frequency seen in patients treated for primary clinical infections, thus indicating that vivax clinical immunity in the population is not species specific but only strain specific.
Highlights
Asymptomatic infections by Plasmodium falciparum were first considered to be a consequence of naturally acquired immunity (NAI) (Christophers 1924) and were later designated as premonition (Sergent & Parrot 1935)
It is important to note that the malaria surveillance revealed that 14 of the 51 untreated vivax asymptomatic parasites carriers (APCs) from Vila Candelária (VC), Cachoeira do Teotônio (CT) and Vila Amazonas (VA) presented with clinical episodes with positive microscopy examinations that were classified as relapses using the criteria adopted in this study
The present study aimed to address whether treatment of malaria APCs in an endemic area would decrease malaria transmission within the community
Summary
First preliminary survey - Effects of the treatment of asymptomatic carriers on the incidence of falciparum malaria in VC. No decrease in the incidence of P. vivax malaria was observed in EV in the months following the treatment of APCs in August 2006 (Z = -0.30, p = 0.762), whereas in SA, a 2.25-fold increase in the mean number of cases was observed (Z = -2.84, p = 0.005). The follow-up of malaria cases in VC suffered from a discontinuity of more than three months due to a failure of a health agent responsible for the task and the difficulties in reorganising the surveillance team led us to eliminate VC from follow-up These contradictory results do not allow for elucidation of the effect of treatment of vivax APCs (see Discussion). Table i Comparison of micro-satellite allele sizes of Vila Candelaria’s consensus and new Plasmodium falciparum cases
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