Presumptive malaria treatment in immunisation programmes

Abstract

Courses of malaria treatment given intermittently to asymptomatic individuals known as intermittent presumptive treatment (IPT) is gaining momentum as evidence accumulates that this strategy can reduce malaria infections and anaemia. In infants the withdrawal of malaria prophylaxis has been associated with a rebound increase in clinical malaria so will IPT be safe? The paper by David Schellenberg and colleagues in today’s Lancet provides reassurance that rebound infection is probably not a major problem with IPT in infants. The researchers found that IPT given with routine immunisations to infants at the ages of 2 3 and 9 months conferred a 36% protective effect against clinical malaria compared with placebo in children followed up from the age of 10 months to 2 years. IPT reduces episodes of clinical malaria and severe anaemia during the first year of life12 but a surprising result from this study is that the effect of IPT lasts for at least one further year. This result is well beyond the few days that would be explained by a direct effect of anti-malaria drugs and suggests that IPT influences biological interactions. (excerpt)