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Efficacy of Chloroquine and Primaquine for the Treatment of Uncomplicated Plasmodium vivax Malaria in Cruzeiro do Sul, Brazil
We evaluated the efficacy of chloroquine and primaquine on uncomplicated Plasmodium vivax malaria in Cruzeiro do Sul, Brazil, in 2014. Patients ≥ 5 years of age with either fever or history of fever, and laboratory-confirmed P. vivax monoinfection received chloroquine (total dose = 25 mg/kg) and primaquine (total dose = 3.5 mg/kg), and were followed up for 168 days (24 weeks). We used microsatellite genotyping to differentiate recurrent infections caused by heterologous parasites from those caused by homologous ones. No new P. vivax episode occurred by Day 28 among 119 enrolled patients, leading to Day 28, with adequate clinical and parasitological response (ACPR) of 100% (95% confidence interval [CI] = 96.7–100%). Twenty-eight P. vivax episodes occurred by Day 168, with uncorrected ACPR of 69.9% (95% CI = 59.5–79.0%). Fifteen of these episodes were caused by either homologous haplotypes or haplotypes that could not be determined. Excluding the 13 recurrent episodes caused by heterologous parasites, Day 168 microsatellite-corrected ACPR was estimated at 81.2% (95% CI = 71.0–89.1%). Chloroquine and primaquine remain efficacious to treat acute uncomplicated P. vivax infection, but moderate recurrence rates were observed within 24 weeks of follow-up.
Author Notes
Financial support: Funding for this evaluation was partially provided by the U.S. Agency for International Development (USAID) through the Amazon Malaria Initiative (AMI). Stella M. Chenet was supported by the American Society of Microbiology/CDC Postdoctoral Fellowship.
Authors' addresses: Suiane Negreiros, Samela Farias, and Thayna Maria Holanda de Souza, Acre State Health Secretariat, Cruzeiro do Sul, Acre, Brazil, E-mails: omsvalle@hotmail.com, samela_86@hotmail.com, and thayna.souza21@gmail.com. Giselle Maria Rachid Viana and Marinete Marins Povoa, Instituto Evandro Chagas, Brazilian Ministry of Health, Ananindeua, Brazil, E-mails: giselleviana@iec.pa.gov.br and povoamm@gmail.com. Sheila Akinyi Okoth, Stella M. Chenet, and Alexandre Macedo de Oliveira, Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: jyo3@cdc.gov, ynw0@cdc.gov, and acq7@cdc.gov. Paola Marchesini and Ana Carolina Faria e Silva Santelli, National Malaria Control Program, Brazilian Ministry of Health, Brasilia, Brazil, E-mails: paola.marchesini@saude.gov.br and anacarolina.santelli@gmail.com. Venkatachalam Udhayakumar, Malaria Branch, Centers for Disease Control and Prevention, Chamblee, GA, E-mail: vxu0@cdc.gov.