Abstract

Intermittent preventive antimalarial treatment in infants (IPTi) involves the administration of a curative dose of an antimalarial drug to infants at the time of routine immunization, without determining whether the infant is parasitemic. This approach to the prevention of malaria in infants was tried first by Schellenberg et al. [1] in Ifakara, Tanzania, in 1999. They found that administration of sulfadoxinepyrimethamine (SP) to infants when they presented for vaccination with diphtheria, pertussis, and tetanus or measles vaccines at 2, 3, and 9 months of age reduced the incidence of clinical attacks of malaria and anemia (packed cell volume, !25%) by 59% (95% CI, 41%‐72%) and 50% (95% CI, 8%‐73%), respectively. Remarkably, protection persisted throughout the second year of life, long after SP had disappeared from circulation [2]. A second trial conducted in Tanzania at approximately the same time found that administration of amodiaquine to infants at 3-month intervals during the first year of life had a similar impact on the incidence of clinical attacks of malaria and anemia [3]. These very promising results led to the creation of the IPTi Consortium [4], whose brief is to determine the efficacy, safety, relation of efficacy to drug sensitivity, cost-effectiveness, and acceptability of this promising new approach to the prevention of malaria. Since the results of the initial studies in Tanzania were reported, 5 additional trials of IPTi with SP have been completed, and the results of 3 of these studies have been published—the latest in this issue of Clinical Infectious Diseases [5‐7]. Preliminary results from 2 other trials have been presented at open meetings. A large effectiveness trial of IPTi with SP is underway in southern Tanzania, and the United Nations Children’s Fund is performing pilot implementation studies of IPTi with SP in several countries in Africa. The carefully conducted study reported by Kobbe et al. [7] in this issue of Clinical Infectious Diseases was performed in the Ashanti region of central Ghana. Rainfall in the area is high, and malaria transmission occurs throughout the year, although with seasonal peaks. The entomological inoculation rate is estimated to be ∼400 infectious bites per year. Local strains of Plasmodium falciparum are still moderately sensitive to SP. The design of this new trial did not mimic exactly that of the initial Tanzanian study, because SP was administered to infants aged 3, 9, and 15 months, and cases of malaria were detected predominantly through monthly home visits; in Ifakara, passive case detection was used. One thousand seventy infants were individually randomized to receive SP treatment or placebo, and the groups were matched at entry into the study. In infants and children aged 3‐18 months (including the period 3 months after the last administration of IPTi), the protective efficacy of IPTi against first or single episodes of clinical malaria was 18% (95% CI, 4%‐31%), and the protective efficacy of IPTi against all episodes of clinical malaria was 20% (95% CI, 11%,‐ 29%). No significant protection was ob

Full Text
Paper version not known

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call