Gametocyte Dynamics and the Role of Drugs in Reducing the Transmission Potential of Plasmodium vivax

Nicholas (Nick) DOUGLAS, J SIMPSON, Aung Pyae Phyo, H SISWANTORO, A HASUGIAN, Enny Kenangalem, Jeanne Rini Poespoprodjo, Pratap Singhasivanon, Nicholas Anstey, Nicholas J White, Emiliana Tjitra, François Nosten, Ric Price

Research output: Contribution to journalArticlepeer-review

43 Citations (Scopus)

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. � 2013 The Author.
Original languageEnglish
Pages (from-to)801-812
Number of pages12
JournalJournal of Infectious Diseases
Volume208
Issue number5
DOIs
Publication statusPublished - 2013

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