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J Infect Dis. 2013 Sep 1;208(5):801-12. doi: 10.1093/infdis/jit261. Epub 2013 Jun 12.

Gametocyte dynamics and the role of drugs in reducing the transmission potential of Plasmodium vivax.

Author information

1
Global Health Division, Menzies School of Health Research, Charles Darwin University, Darwin 0811, Australia.

Abstract

BACKGROUND:

Designing interventions that will reduce transmission of vivax malaria requires knowledge of Plasmodium vivax gametocyte dynamics.

METHODS:

We analyzed data from a randomized controlled trial in northwestern Thailand and 2 trials in Papua, Indonesia, to identify and compare risk factors for vivax gametocytemia at enrollment and following treatment.

RESULTS:

A total of 492 patients with P. vivax infections from Thailand and 476 patients (162 with concurrent falciparum parasitemia) from Indonesia were evaluable. Also, 84.3% (415/492) and 66.6% (209/314) of patients with monoinfection were gametocytemic at enrollment, respectively. The ratio of gametocytemia to asexual parasitemia did not differ between acute and recurrent infections (P = .48 in Thailand, P = .08 in Indonesia). High asexual parasitemia was associated with an increased risk of gametocytemia during follow-up in both locations. In Thailand, the cumulative incidence of gametocytemia between day 7 and day 42 following dihydroartemisinin + piperaquine (DHA + PIP) was 6.92% vs 29.1% following chloroquine (P < .001). In Indonesia, the incidence of gametocytemia was 33.6% following artesunate + amodiaquine (AS + AQ), 7.42% following artemether + lumefantrine, and 6.80% following DHA + PIP (P < .001 for DHA + PIP vs AS + AQ).

CONCLUSIONS:

P. vivax gametocyte carriage mirrors asexual-stage infection. Prevention of relapses, particularly in those with high asexual parasitemia, is likely the most important strategy for interrupting P. vivax transmission.

KEYWORDS:

Plasmodium vivax; antimalarial drugs; epidemiology; gametocytes; transmission

PMID:
23766527
PMCID:
PMC3733516
DOI:
10.1093/infdis/jit261
[Indexed for MEDLINE]
Free PMC Article

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