Professor Lorenz Von Seidlein
Lorenz Von Seidlein
Targeted Malaria Elimination
Artemisinin resistance has emerged in Cambodia, eastern Myanmar, southern Lao PDR (Laos) and Vietnam. This severely compromises falciparum malaria control efforts in the region, which depends on the continued efficacy of artemisinin combination therapies (ACT). Artemisinin resistance has the potential to spread throughout the malaria endemic regions of the world. The severity of this threat has been recognized and containment efforts have started or are under development. Addressing the problem involves elimination of falciparum malaria in areas of artemisinin resistance. If parasite populations in these foci are allowed to remain, evolving artemisinin resistance related to continuing drug pressure will spread.
In the last decade, P. falciparum transmission in the Greater Mekong Subregion has decreased substantially. A reversal of the current progress in malaria control would have tragic consequences. We explore the use of presumptive antimalarial treatment with Dihydroartemisinin-piperaquine (DHA-PIP) of entire village populations. This intervention will target communities with significant levels of subclinical parasite infections and transmission.
DHA-PIP is a highly efficacious and inexpensive ACT, which is well tolerated by all age groups when used to treat uncomplicated multidrug resistant falciparum malaria in South East Asia. Monthly DHA-PIP treatments have proved highly effective and well tolerated. When used as part of a TME strategy, the addition of a gametocytocidal drug such as primaquine (PQ), will contribute a strong transmission blocking activity by killing gametocytes. PQ, the only currently licensed 8-aminoquinoline, is safe and effective when used at a dose of 0.25 mg base/kg irrespective of G6PD status.
Bejon P. et al, (2008), New England Journal of Medicine, 359, 2521 - 2532
Ali M. et al, (2005), The Lancet, 366, 44 - 49
Lucas MES. et al, (2005), New England Journal of Medicine, 352, 757 - 767
Seidlein LV. et al, (2003), Transactions of the Royal Society of Tropical Medicine and Hygiene, 97, 217 - 225
Jittamala P. et al, (2021), PLoS Negl Trop Dis, 15
Lindsay SW. et al, (2021), Philosophical Transactions of the Royal Society B: Biological Sciences, 376
Lu G. et al, (2021), Global health action, 14
von Seidlein L. et al, (2021), Building and environment, 188
Phommasone K. et al, (2020), Malaria Journal, 19