Therapeutic Efficacy of Chloroquine for the Treatment of Uncomplicated Plasmodium falciparum in Haiti After Many Decades of Its Use

Bernard A. Okech Department of Environmental and Global Health, University of Florida, Gainesville, Florida; Emerging Pathogens Institute, University of Florida, Gainesville, Florida; Laboratoire National de Santé Publique (LNSP), Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti; L'Hospital Saint Croix de Leogane, Pere Thevenot 1, Leogane, Haiti; Blanchard Clinic, Family Health Ministries Haiti, Port-au-Prince, Haiti; Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida; Armed Forces Health Sciences Surveillance Center, Silver Spring, Maryland

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Alexandre Existe Department of Environmental and Global Health, University of Florida, Gainesville, Florida; Emerging Pathogens Institute, University of Florida, Gainesville, Florida; Laboratoire National de Santé Publique (LNSP), Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti; L'Hospital Saint Croix de Leogane, Pere Thevenot 1, Leogane, Haiti; Blanchard Clinic, Family Health Ministries Haiti, Port-au-Prince, Haiti; Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida; Armed Forces Health Sciences Surveillance Center, Silver Spring, Maryland

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Jean R. Romain Department of Environmental and Global Health, University of Florida, Gainesville, Florida; Emerging Pathogens Institute, University of Florida, Gainesville, Florida; Laboratoire National de Santé Publique (LNSP), Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti; L'Hospital Saint Croix de Leogane, Pere Thevenot 1, Leogane, Haiti; Blanchard Clinic, Family Health Ministries Haiti, Port-au-Prince, Haiti; Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida; Armed Forces Health Sciences Surveillance Center, Silver Spring, Maryland

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Gladys Memnon Department of Environmental and Global Health, University of Florida, Gainesville, Florida; Emerging Pathogens Institute, University of Florida, Gainesville, Florida; Laboratoire National de Santé Publique (LNSP), Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti; L'Hospital Saint Croix de Leogane, Pere Thevenot 1, Leogane, Haiti; Blanchard Clinic, Family Health Ministries Haiti, Port-au-Prince, Haiti; Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida; Armed Forces Health Sciences Surveillance Center, Silver Spring, Maryland

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Yves Saint Victor Department of Environmental and Global Health, University of Florida, Gainesville, Florida; Emerging Pathogens Institute, University of Florida, Gainesville, Florida; Laboratoire National de Santé Publique (LNSP), Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti; L'Hospital Saint Croix de Leogane, Pere Thevenot 1, Leogane, Haiti; Blanchard Clinic, Family Health Ministries Haiti, Port-au-Prince, Haiti; Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida; Armed Forces Health Sciences Surveillance Center, Silver Spring, Maryland

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Madsen Beau de Rochars Department of Environmental and Global Health, University of Florida, Gainesville, Florida; Emerging Pathogens Institute, University of Florida, Gainesville, Florida; Laboratoire National de Santé Publique (LNSP), Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti; L'Hospital Saint Croix de Leogane, Pere Thevenot 1, Leogane, Haiti; Blanchard Clinic, Family Health Ministries Haiti, Port-au-Prince, Haiti; Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida; Armed Forces Health Sciences Surveillance Center, Silver Spring, Maryland

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Mark Fukuda Department of Environmental and Global Health, University of Florida, Gainesville, Florida; Emerging Pathogens Institute, University of Florida, Gainesville, Florida; Laboratoire National de Santé Publique (LNSP), Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti; L'Hospital Saint Croix de Leogane, Pere Thevenot 1, Leogane, Haiti; Blanchard Clinic, Family Health Ministries Haiti, Port-au-Prince, Haiti; Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida; Armed Forces Health Sciences Surveillance Center, Silver Spring, Maryland

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DOI:
https://doi.org/10.4269/ajtmh.14-0302
Volume/Issue:
Volume 92: Issue 3
Page(s):
541–545
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Chloroquine (CQ) has been used for malaria treatment in Haiti for several decades, but reports of CQ resistance are scarce. The efficacy of CQ in patients with uncomplicated Plasmodium falciparum undergoing treatment in Haiti was evaluated. Malaria patients were enrolled, treated with CQ, and monitored over a 42-day period. The treatment outcomes were evaluated on day 28 by microscopy. The P. falciparum slide-confirmed rate was 9.5% (121 of 1,277). Malaria infection was seasonal, with peak observations between October and January; 88% (107 of 121) of patients consented to participate. Sixty patients successfully completed the 42-day follow-up, whereas 47 patients withdrew consent or were lost to follow-up. The mean parasite density declined rapidly within the first few days after treatment. Seven patients did not clear their malaria infections and were clinically asymptomatic; therefore, they were considered late parasitological failures. About 90% (95% confidence interval = 84.20–97.90) of patients had no detectable parasitemia by day 28 and remained malaria-free to day 42. Testing for recrudescence, reinfection, and CQ serum levels was not done in the seven patients, and therefore, their CQ resistance status is unresolved. CQ resistance surveillance by patient follow-up, in vitro drug sensitivity studies, and molecular markers is urgently needed in Haiti.

Author Notes

* Address correspondence to Bernard A. Okech, Department of Environmental and Global Health College of Public Health and Health Professions, Emerging Pathogens Institute, 2055 Mowry Road, Gainesville, FL 32611. E-mail: bokech@ufl.edu

Financial support: This material is based on work supported by Department of Defense Global Emerging Infections Surveillance and Response System Grant C0607_12_UN (to B.A.O.).

Authors' addresses: Bernard A. Okech, Department of Environmental and Global Health, University of Florida, Gainesville, FL, E-mail: bokech@ufl.edu. Alexandre Existe, National Public Health Laboratory, Ministry of Health and Population, Port-au-Prince, Haiti, E-mail: Alexandre.existe@gmail.com. Jean R. Romain and Gladys Memnon, Hospital Saint Croix, Leogane, Haiti, E-mails: roosevald2008@yahoo.fr and gmemnon@gmail.com. Yves Saint Victor, Blanchard Clinic, Terre Noire, Haiti, E-mail: jeanyvessaintvictor@yahoo.fr. Madsen Beau de Rochars, Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, E-mail: madsenbeau@phhp.ufl.edu. Mark Fukuda, Division of Global Emerging Infections Surveillance, Armed Forces Health Sciences Surveillance Center, Silver Spring, MD, E-mail: mark.m.fukuda@us.army.mil.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2015
Received:
15 May 2014
|
Accepted:
04 Sep 2014
|
Published Online:
04 Mar 2015
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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