Biology Reference
In-Depth Information
renal failure (
Reeve et al., 1992
;
Ganczakowski et al., 1995
;
Kaneko et al.,
1998
;
Hill et al., 2006
). Primaquine is also contraindicated in persons with
methaemoglobin reductase deficiency (
Hill et al., 2006
). In areas with essen-
tially no G6PD deficiency as in parts of Latin America and China, primaquine
can be given confidently without blood testing. It was discovered prior to the
use of primaquine for MDA that G6PD deficiency did not exist in the island
of Aneityum, but that was untrue of other nearby islands inVanuatu (
Kaneko
et al., 1998
). There are other G6PD variants that are severely enzyme defi-
cient, particularly in persons who are descended from groups that originally
lived around the Mediterranean Sea (Italy, Greece and North Africa) (
Cap-
pellini and Fiorelli, 2008
). Blood testing for G6PD deficiency must be done
to avoid drug-induced haemolytic events in most populations prior to the
use of primaquine. Pregnant women should not receive primaquine as even if
they test normally for the enzyme, it is not possible to test the foetus. Women
with normal G6PD status who require primaquine can safely receive it after
delivery of their child. Having a drug that requires a specific blood test prior
to use does not invalidate a public health indication such as malaria elimina-
tion, but it does make it extremely difficult especially under the limited cir-
cumstances common in developing countries (
A research agenda for malaria
eradication: drugs, 2011
;
Kuwahata et al., 2010
).
The record of using primaquine MDA for malaria control/elimination
has been mixed in terms of it public health effect (
Table 6.1
). In 1968, in
the island of Zanzibar, >120,000 persons (estimated 83% of total popula-
tion) received amodiaquine and primaquine to supplement the DDT spray
program. Although no severe toxic events were documented, the malaria
parasitemia rate did not change much and the huge effort involved in drug
distribution was felt to have been wasted (
Dola, 1974
). One of the largest
uses of MDA including primaquine was in Nicaragua in 1981 (
Garfield and
Vermund, 1983
). Close to 2 million persons or 70% of the total population
received a 3-day course of chloroquine/primaquine in a nation-wide cam-
paign. After a short period of decreased parasitaemia, malaria rates returned
to baseline. Occasional haemolytic events were reported in Nicaragua, but
it is unclear how much surveillance might have been done for such adverse
events. Malaria transmission was not interrupted although an estimated
9200 malaria cases were prevented (
Garfield and Vermund, 1983
).
3.4. Role of MDA in Future Malaria Elimination Efforts
The objective of using MDA for malaria elimination is to kill the human res-
ervoir of parasites responsible for malaria transmission (hypnozoites which
subsequently produce mature gametocytes) not decreasing disease burden
