Title: Novel Approaches to Control Malaria in Forested Areas of Southeast Asia
Abstract: Much progress has been made in the control of falciparum malaria in the GMS, but transmission persists in forested areas. The programmatic use of chemoprevention for malaria control has been controversial in the past but is increasingly accepted. For example, seasonal malaria chemoprevention is successfully rolled out to prevent malaria in children living in the Sahel. Forest workers are another population exposed to malaria transmission for limited periods who could benefit from antimalarial prophylaxis. Research is ongoing to explore and optimize antimalarial regimens to protect forest workers against malaria. The emergence and spread of drug resistance in the Greater Mekong Subregion (GMS) have added urgency to accelerate malaria elimination while reducing the treatment options. The remaining foci of malaria transmission are often in forests, where vectors tend to bite during daytime and outdoors, thus reducing the effectiveness of insecticide-treated bed nets. Limited periods of exposure suggest that chemoprophylaxis could be a promising strategy to protect forest workers against malaria. Here we discuss three major questions in optimizing malaria chemoprophylaxis for forest workers: which antimalarial drug regimens are most appropriate, how frequently the chemoprophylaxis should be delivered, and how to motivate forest workers to use, and adhere to, malaria prophylaxis. The emergence and spread of drug resistance in the Greater Mekong Subregion (GMS) have added urgency to accelerate malaria elimination while reducing the treatment options. The remaining foci of malaria transmission are often in forests, where vectors tend to bite during daytime and outdoors, thus reducing the effectiveness of insecticide-treated bed nets. Limited periods of exposure suggest that chemoprophylaxis could be a promising strategy to protect forest workers against malaria. Here we discuss three major questions in optimizing malaria chemoprophylaxis for forest workers: which antimalarial drug regimens are most appropriate, how frequently the chemoprophylaxis should be delivered, and how to motivate forest workers to use, and adhere to, malaria prophylaxis. is the combination of an artemisinin derivative with a partner drug. The artemisinin component reduces the number of susceptible parasites during the first 3 days of treatment (reduction of parasite biomass), while the role of the partner drug is to eliminate the remaining parasites, including artemisinin-tolerant parasites. ACTs fail when both partner drugs no longer clear the parasites. The spread of parasites resistant to artemisinin derivatives and partner drugs currently ongoing in the GMS has the potential to evolve into an international public health emergency. a term chemoprophylaxis which clears the liver stages of Plasmodium and thus removes the need for terminal prophylaxis. interchangeably used with chemoprophylaxis, prevention, or prophylaxis. diethyltoluamide, the most common active ingredient in insect repellents. refers to outdoor-feeding mosquitoes. refers to outdoor-living mosquitoes. or forest goers or forest visitors are people who supplement their income by working in forested areas. glucose-6-phosphate dehydrogenase, a cytosolic enzyme in the pentose phosphate pathway critical for the metabolism of red blood cells. People deficient in G6PD enzyme activity are at increased risk for haemolysis when exposed to a range of factors, including 8- aminoquinolines. the Greater Mekong Subregion comprises Cambodia, Lao PDR, Myanmar, Thailand, Vietnam, and the People's Republic of China (Yunnan Province and Guangxi Zhuang Autonomous Region). It is home to more than 300 million people. a stage in the life cycle of Plasmodium vivax. Clearing hypnozoites requires 8-aminoquinoline, for example primaquine, a class of drugs which can trigger haemolysis in G6PD-deficient individuals. intermittent preventive treatment in pregnancy; women should receive at least three doses of sulfadoxine/pyrimethamine (SP) 1 month apart during pregnancy. a mosquito-repelling incense, made of the dried paste of pyrethrum powder shaped into a spiral. a mixture of the four stereoisomers of icaridin which are used as an insect repellent. spatial mosquito repellents released from smouldering mosquito coils. a group of malarias which predominantly infect monkeys. Plasmodium knowlesi and Plasmodium cynomolgi are examples of species which have been shown to infect humans in the GMS. seasonal malaria chemoprevention consists of the administration of a minimum of three rounds of a full course of sulfadoxine–pyrimethamine + amodiaquine in areas with highly seasonal malaria transmission in the Sahel subregion of sub-Saharan Africa. The primary target group are children under 5 years, but older children and more rounds of antimalarials are increasingly included in SMC. refers to chemoprophylaxis with antimalarial drugs which do not clear the liver stages of P. falciparum, thus necessitating a need for terminal prophylaxis. the terminal plasma half-life of a drug is the time required to divide the plasma concentration by two after reaching pseudoequilibrium. following suppressive chemoprophylaxis there remains a need to continue prophylaxis for at least 2 weeks after the last forest visit.
Publication Year: 2019
Publication Date: 2019-05-08
Language: en
Type: review
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 42
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