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

Nicholas Douglas, Julie Simpson, Aung Pyae Phyo, H Siswantoro, A Hasugian, E Kenangalem, Jeanne Poespoprodjo, Nicholas Anstey, Nicholas White, E Tjitra, Francois Nosten, Ric Price

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    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.

    Original languageEnglish
    Pages (from-to)801-812
    Number of pages12
    JournalJournal of Infectious Diseases
    Volume208
    Issue number5
    DOIs
    Publication statusPublished - 1 Sep 2013

    Keywords

    • antimalarial drugs
    • epidemiology
    • gametocytes
    • Plasmodium vivax
    • transmission

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    Douglas, N., Simpson, J., Phyo, A. P., Siswantoro, H., Hasugian, A., Kenangalem, E., Poespoprodjo, J., Anstey, N., White, N., Tjitra, E., Nosten, F., & Price, R. (2013). Gametocyte dynamics and the role of drugs in reducing the transmission potential of plasmodium vivax. Journal of Infectious Diseases, 208(5), 801-812. https://doi.org/10.1093/infdis/jit261