Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
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Query Trace: Davlantes E[original query] |
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Notes from the field: Circulating vaccine-derived poliovirus type 2 emergences linked to novel oral poliovirus vaccine type 2 use - six African countries, 2021-2023
Davlantes E , Jorba J , Henderson E , Bullard K , Deka MA , Kfutwah A , Martin J , Bessaud M , Shulman LM , Hawes K , Diop OM , Bandyopadhyay AS , Zipursky S , Burns CC . MMWR Morb Mortal Wkly Rep 2023 72 (38) 1041-1042 Circulating vaccine-derived poliovirus (cVDPV) outbreaks can occur when oral poliovirus vaccine strains (most often, Sabin monovalent oral poliovirus vaccine type 2 [mOPV2]) undergo prolonged circulation in undervaccinated populations, resulting in genetic reversion to neurovirulence. A novel type 2 oral poliovirus vaccine (nOPV2) has been developed, which has been shown in clinical trials to be less likely than mOPV2 to revert to paralytic variants and to have limited genetic modifications in initial field use (1–4). Approximately 700 million doses of nOPV2 have been administered worldwide in response to outbreaks of cVDPV type 2 (cVDPV2). cVDPV2 detections originating from nOPV2 use from initial rollout during March 2021–September 7, 2023, are described in this report. |
Initial public health response and interim clinical guidance for the 2019 novel coronavirus outbreak - United States, December 31, 2019-February 4, 2020.
Patel A , Jernigan DB , 2019-nCOV CDC Response Team , Abdirizak Fatuma , Abedi Glen , Aggarwal Sharad , Albina Denise , Allen Elizabeth , Andersen Lauren , Anderson Jade , Anderson Megan , Anderson Tara , Anderson Kayla , Bardossy Ana Cecilia , Barry Vaughn , Beer Karlyn , Bell Michael , Berger Sherri , Bertulfo Joseph , Biggs Holly , Bornemann Jennifer , Bornstein Josh , Bower Willie , Bresee Joseph , Brown Clive , Budd Alicia , Buigut Jennifer , Burke Stephen , Burke Rachel , Burns Erin , Butler Jay , Cantrell Russell , Cardemil Cristina , Cates Jordan , Cetron Marty , Chatham-Stephens Kevin , Chatham-Stevens Kevin , Chea Nora , Christensen Bryan , Chu Victoria , Clarke Kevin , Cleveland Angela , Cohen Nicole , Cohen Max , Cohn Amanda , Collins Jennifer , Conners Erin , Curns Aaron , Dahl Rebecca , Daley Walter , Dasari Vishal , Davlantes Elizabeth , Dawson Patrick , Delaney Lisa , Donahue Matthew , Dowell Chad , Dyal Jonathan , Edens William , Eidex Rachel , Epstein Lauren , Evans Mary , Fagan Ryan , Farris Kevin , Feldstein Leora , Fox LeAnne , Frank Mark , Freeman Brandi , Fry Alicia , Fuller James , Galang Romeo , Gerber Sue , Gokhale Runa , Goldstein Sue , Gorman Sue , Gregg William , Greim William , Grube Steven , Hall Aron , Haynes Amber , Hill Sherrasa , Hornsby-Myers Jennifer , Hunter Jennifer , Ionta Christopher , Isenhour Cheryl , Jacobs Max , Jacobs Slifka Kara , Jernigan Daniel , Jhung Michael , Jones-Wormley Jamie , Kambhampati Anita , Kamili Shifaq , Kennedy Pamela , Kent Charlotte , Killerby Marie , Kim Lindsay , Kirking Hannah , Koonin Lisa , Koppaka Ram , Kosmos Christine , Kuhar David , Kuhnert-Tallman Wendi , Kujawski Stephanie , Kumar Archana , Landon Alexander , Lee Leslie , Leung Jessica , Lindstrom Stephen , Link-Gelles Ruth , Lively Joana , Lu Xiaoyan , Lynch Brian , Malapati Lakshmi , Mandel Samantha , Manns Brian , Marano Nina , Marlow Mariel , Marston Barbara , McClung Nancy , McClure Liz , McDonald Emily , McGovern Oliva , Messonnier Nancy , Midgley Claire , Moulia Danielle , Murray Janna , Noelte Kate , Noonan-Smith Michelle , Nordlund Kristen , Norton Emily , Oliver Sara , Pallansch Mark , Parashar Umesh , Patel Anita , Patel Manisha , Pettrone Kristen , Pierce Taran , Pietz Harald , Pillai Satish , Radonovich Lewis , Reagan-Steiner Sarah , Reel Amy , Reese Heather , Rha Brian , Ricks Philip , Rolfes Melissa , Roohi Shahrokh , Roper Lauren , Rotz Lisa , Routh Janell , Sakthivel Senthil Kumar Sarmiento Luisa , Schindelar Jessica , Schneider Eileen , Schuchat Anne , Scott Sarah , Shetty Varun , Shockey Caitlin , Shugart Jill , Stenger Mark , Stuckey Matthew , Sunshine Brittany , Sykes Tamara , Trapp Jonathan , Uyeki Timothy , Vahey Grace , Valderrama Amy , Villanueva Julie , Walker Tunicia , Wallace Megan , Wang Lijuan , Watson John , Weber Angie , Weinbaum Cindy , Weldon William , Westnedge Caroline , Whitaker Brett , Whitaker Michael , Williams Alcia , Williams Holly , Willams Ian , Wong Karen , Xie Amy , Yousef Anna . Am J Transplant 2020 20 (3) 889-895 This article summarizes what is currently known about the 2019 novel coronavirus and offers interim guidance. |
Update on wild poliovirus type 1 outbreak - Southeastern Africa, 2021-2022
Davlantes E , Greene SA , Tobolowsky FA , Biya O , Wiesen E , Abebe F , Weldetsadik MB , Eboh VA , Chisema MN , da Conceição Mário B , Tinuga F , Bobo PM , Chigodo CK , Sethy G , Hellström JM , Goundara AM , Burny ME , Mwale JC , Jorba J , Makua KS , Howard W , Seakamela L , Okiror S , Thompson A , Ali A , Samba D , Agbo C , Kabamba L , Kazoka A , Zomahoun DL , Manneh F , Abdelrahim K , Kamugisha C , Umar AS . MMWR Morb Mortal Wkly Rep 2023 72 (15) 391-397 ![]() ![]() Since the Global Polio Eradication Initiative (GPEI) began in 1988, the number of wild poliovirus (WPV) cases has declined by >99.99%. Five of the six World Health Organization (WHO) regions have been certified free of indigenous WPV, and WPV serotypes 2 and 3 have been declared eradicated globally (1). WPV type 1 (WPV1) remains endemic only in Afghanistan and Pakistan (2,3). Before the outbreak described in this report, WPV1 had not been detected in southeastern Africa since the 1990s, and on August 25, 2020, the WHO African Region was certified free of indigenous WPV (4). On February 16, 2022, WPV1 infection was confirmed in one child living in Malawi, with onset of paralysis on November 19, 2021. Genomic sequence analysis of the isolated poliovirus indicated that it originated in Pakistan (5). Cases were subsequently identified in Mozambique. This report summarizes progress in the outbreak response since the initial report (5). During November 2021-December 2022, nine children and adolescents with paralytic polio caused by WPV1 were identified in southeastern Africa: one in Malawi and eight in Mozambique. Malawi, Mozambique, and three neighboring countries at high risk for WPV1 importation (Tanzania, Zambia, and Zimbabwe) responded by increasing surveillance and organizing up to six rounds of national and subnational polio supplementary immunization activities (SIAs).* Although no cases of paralytic WPV1 infection have been reported in Malawi since November 2021 or in Mozambique since August 2022, undetected transmission might be ongoing because of poliovirus surveillance gaps and testing delays. Efforts to further enhance poliovirus surveillance sensitivity, improve SIA quality, and strengthen routine immunization are needed to ensure that WPV1 transmission has been interrupted within 12 months of the first case, thereby preserving the WHO African Region's WPV-free status. |
Genetic and epidemiological description of an outbreak of circulating vaccine-derived polio-virus type 2 (cVDPV2) in Angola, 2019-2020.
Morais A , Morais J , Felix M , Neto Z , Madaleno V , Umar AS , Panda N , Lemma F , Chivale JAL , Cavalcante DG , Davlantes E , Ghiselli M , Espinosa C , Whiteman A , Iber J , Henderson E , Bullard K , Jorba J , Burns CC , Diop O , Gumede N , Seakamela L , Howard W , Frawley A . Vaccine 2023 41 Suppl 1 A48-A57 ![]() ![]() After six years without any detection of poliomyelitis cases, Angola reported a case of circulating vaccine-derived poliovirus type 2 (cVDPV2) with paralysis onset date of 27 March 2019. Ultimately, 141 cVDPV2 polio cases were reported in all 18 provinces in 2019-2020, with particularly large hotspots in the south-central provinces of Luanda, Cuanza Sul, and Huambo. Most cases were reported from August to December 2019, with a peak of 15 cases in October 2019. These cases were classified into five distinct genetic emergences (emergence groups) and have ties with cases identified in 2017-2018 in the Democratic Republic of Congo. From June 2019 to July 2020, the Angola Ministry of Health and partners conducted 30 supplementary immunization activity (SIA) rounds as part of 10 campaign groups, using monovalent OPV type 2 (mOPV2). There were Sabin 2 vaccine strain detections in the environmental (sewage) samples taken after mOPV2 SIAs in each province. Following the initial response, additional cVDPV2 polio cases occurred in other provinces. However, the national surveillance system did not detect any new cVDPV2 polio cases after 9 February 2020. While reporting subpar indicator performance in epidemiological surveillance, the laboratory and environmental data as of May 2021 strongly suggest that Angola successfully interrupted transmission of cVDPV2 early in 2020. Additionally, the COVID-19 pandemic did not allow a formal Outbreak Response Assessment (OBRA). Improving the sensitivity of the surveillance system and the completeness of AFP case investigations will be vital to promptly detect and interrupt viral transmission if a new case or sewage isolate are identified in Angola or central Africa. |
Notes from the field: Initial outbreak response activity following wild poliovirus Type 1 detection - Malawi, February 2022
Davlantes E . MMWR Morb Mortal Wkly Rep 2022 71 (23) 776-777 Since the Global Polio Eradication Initiative (GPEI) began in 1988, the number of wild poliovirus (WPV) cases has decreased by >99.99%, and five of the six World Health Organization (WHO) regions are now certified WPV-free.* WPV serotypes 2 and 3 have been declared eradicated (1), and WPV type 1 (WPV1) is currently endemic only in Pakistan and Afghanistan in the WHO’s Eastern Mediterranean Region (2,3). | | The WHO African Region was certified free of indigenous WPV transmission on August 25, 2020 (4). Approximately 18 months later on February 16, 2022, a paralytic WPV1 case was confirmed in a child aged 3 years residing in Lilongwe, Malawi, in southeastern Africa, with paralysis onset November 19, 2021. The affected child had no history of travel or contact with anyone who had traveled internationally and had received only 1 of 5 doses of poliovirus vaccine recommended by the Malawi Ministry of Health through routine childhood immunization services. Genomic sequence analysis of the isolated poliovirus indicated that its closest relative was a WPV1 lineage isolated from samples taken in Sindh Province, Pakistan, in October 2019. Before this detection in Malawi, the last WPV1 case in Africa had been reported in Nigeria in 2016 (4). |
Mitigating SARS-CoV-2 Transmission in Hispanic and Latino Communities-Prince William Health District, Virginia, June 2020.
Davlantes E , Tippins A , Espinosa C , Lofgren H , Leonard S , Solis M , Young A , Sockwell D , Ansher A . J Racial Ethn Health Disparities 2021 9 (2) 1-9 OBJECTIVES: To identify factors contributing to disproportionate rates of COVID-19 among Hispanic or Latino persons in Prince William Health District, Virginia, and to identify measures to better engage Hispanic and Latino communities in COVID-19 mitigation. METHODS: Data collection proceeded via three methods in June 2020: a quantitative survey of Hispanic or Latino residents, key informant interviews with local leaders familiar with this population, and focus group discussions with Hispanic or Latino community members. RESULTS: Those who worked outside the home, lived in larger households, or lived with someone who had tested positive were more likely to report testing positive for SARS-CoV-2 (unadjusted odds ratios of 2.5, 1.2, and 12.9, respectively). Difficulty implementing COVID-19 prevention practices (reported by 46% of survey respondents), immigration-related fears (repeatedly identified in qualitative data), and limited awareness of local COVID-19 resources (57% of survey respondents spoke little or no English) were identified. Survey respondents also reported declines in their food security (25%) and mental health (25%). CONCLUSIONS: Specific attention to the needs of Hispanic or Latino communities could help reduce the burden of COVID-19. The investigation methods can also be used by other jurisdictions to evaluate the needs of and services provided to diverse underserved populations. |
Notes from the Field: COVID-19 Prevention Practices in State Prisons - Puerto Rico, 2020.
Davlantes E , Toro M , Villalobos R , Sanchez-Gonzalez L . MMWR Morb Mortal Wkly Rep 2020 69 (33) 1144 As of August 17, 2020, the Puerto Rico Department of Health had reported 11,723 confirmed cases of coronavirus disease 2019 (COVID-19), 15,037 probable cases, and 335 deaths. Among persons incarcerated in state prisons, a high-risk congregate setting, only two COVID-19 cases and no associated deaths had been reported* (1). These results followed implementation in mid-March of a protocol (2) for the diagnosis, management, and prevention of COVID-19 in all Puerto Rico Department of Correction and Rehabilitation prisons based on CDC’s interim guidance on management of COVID-19 in correctional and detention facilities (3). The protocol featured wide-ranging measures, from visitor restrictions to enhanced cleaning; this report focuses specifically on COVID-19 mitigation measures directed toward incarcerated persons. |
Malaria knowledge and experiences with community health workers among recently pregnant women in Malawi
Malpass A , Chinkhumba J , Davlantes E , Munthali J , Wright K , Ramsey K , Troell P , Kayange M , Kachale F , Mathanga DP , Chatata D , Gutman JR . Malar J 2020 19 (1) 154 BACKGROUND: The World Health Organization recommends three or more doses of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) to mitigate the negative effects of malaria in pregnancy (MIP). Many pregnant women in Malawi are not receiving the recommended number of doses. Community delivery of IPTp (cIPTp) is being piloted as a new approach to increase coverage. This survey assessed recently pregnant women's knowledge of MIP and their experiences with community health workers (CHWs) prior to implementing cIPTp. METHODS: Data were collected via a household survey in Ntcheu and Nkhata Bay Districts, Malawi, from women aged 16-49 years who had a pregnancy resulting in a live birth in the previous 12 months. Survey questions were primarily open response and utilized review of the woman's health passport whenever possible. Analyses accounted for selection weighting and clustering at the health facility level and explored heterogeneity between districts. RESULTS: A total of 370 women were interviewed. Women in both districts found their community health workers (CHWs) to be helpful (77.9%), but only 35.7% spoke with a CHW about antenatal care and 25.8% received assistance for malaria during their most recent pregnancy. A greater proportion of women in Nkhata Bay than Ntcheu reported receiving assistance with malaria from a CHW (42.7% vs 21.9%, p = 0.01); women in Nkhata Bay were more likely to cite IPTp-SP as a way to prevent MIP (41.0% vs 24.8%, p = 0.02) and were more likely to cite mosquito bites as the only way to spread malaria (70.6% vs 62.0% p = 0.03). Women in Nkhata Bay were more likely to receive 3 + doses of IPTp-SP (IPTp3) (59.2% vs 41.8%, p = 0.0002). Adequate knowledge was associated with increased odds of receiving IPTp3, although not statistically significantly so (adjusted odds ratio = 1.50, 95% confidence interval 0.97-2.32, p-value 0.066). CONCLUSIONS: Women reported positive experiences with CHWs, but there was not a focus on MIP. Women in Nkhata Bay were more likely to be assisted by a CHW, had better knowledge, and were more likely to receive IPTp3+ . Increasing CHW focus on the dangers of MIP and implementing cIPTp has the potential to increase IPTp coverage. |
Use of electronic medical records to conduct surveillance of malaria among Peace Corps volunteers
Davlantes E , Henderson S , Ferguson RW , Lewis L , Tan KR . JAMIA Open 2019 2 (4) 498-504 Objective: The Peace Corps' disease surveillance for Peace Corps Volunteers (PCVs) was incorporated into an electronic medical records (EMR) system in 2015. We evaluated this EMR-based surveillance system, focusing particularly on malaria as it is deadly but preventable. Material(s) and Method(s): In 2016, we administered a survey to Peace Corps Medical Officers (PCMOs), who manage PCVs' medical care, and semistructured phone interviews to headquarters staff. We assessed the structure of the surveillance system and its utility to stakeholders, evaluated surveillance case definitions for malaria, and compared clinical information in the EMR for malaria cases captured by surveillance during the first half of 2016. Result(s): Of 131 PCMOs, 77 (59%) completed the survey. Of 53 respondents in malaria-endemic nations, 98% believed most PCVs contact them about possible malaria. Of 134 cases with a malaria clinical diagnosis in the EMR between January and August 2016, 58 (43% sensitivity) were reported to the surveillance system by PCMOs. The remaining cases in the surveillance system were added during data cleaning, which is time-intensive. Among the 48 malaria cases identified by surveillance between January and June 2016, positive predictive value was 67%. Discussion(s): Areas for improvement include streamlining PCMO documentation, refining case definitions, and improving data quality. With such improvements, surveillance data can be used to inform epidemiological analysis, clinical care, health education, and policy. Conclusion(s): The EMR is an important tool for malaria surveillance among PCVs and, with the refinements mentioned, could serve as a framework for other multinational organizations to monitor their staff. |
The US Public Health Service and the American Medical Association House of Delegates: Informing policy at the intersection of public health and medical care
Iskander J , Thomas D , Vora NM , Davlantes E , Lewis B , Griffiths S , Toye S , Puddy RW . Public Health Rep 2020 135 (3) 33354920915438 The Commissioned Corps of the US Public Health Service (USPHS) is 1 of the 7 US uniformed services. Under the leadership of the US Surgeon General, USPHS has approximately 6800 commissioned officers, who span multiple categories of health service professionals and work for various agencies within the US Department of Health and Human Services. In addition to the US Air Force, US Army, US Navy, and US Department of Veterans Affairs, USPHS is recognized as an American Medical Association (AMA) Federal Services Member Organization and, therefore, holds a seat in the AMA House of Delegates (HOD). |
Quality of malaria case management and reporting at public health facilities in six health districts in Guinea, 2018
Davlantes E , Camara A , Guilavogui T , Fofana A , Balde M , Diallo T , Bah I , Florey L , Sarr A , Butts J , Plucinski MM . Am J Trop Med Hyg 2019 101 (1) 148-156 Data on fever and malaria cases reported by health facilities are used for tracking incidence and quantification of malaria commodity needs in Guinea. Periodic assessments of the quality of malaria case management and routine data are a critical activity for the malaria program. In May-June 2018, survey teams visited 126 health facilities in six health districts purposefully selected to represent a spectrum (Stratum 1-high, Stratum 2-intermediate, and Stratum 3-low) of perceived quality of case management and reporting, as assessed from an a priori analysis of routine data. Surveyors performed exit interviews with 939 outpatients and compared results with registry data for interviewed patients. Availability of rapid diagnostic tests (RDTs) and artemisinin-based combination therapies (ACTs) was 100% in Strata 1 and 2, compared with 82% (95% CI: 63-92%) for RDTs and 86% (68-95%) for any formulation of ACT in Stratum 3. Correct case management for suspect malaria cases was 85% in both Stratum 1 (95% CI: 78-90%) and Stratum 2 (79-89%), but only 52% (37-67%) in Stratum 3. Concordance between exit interviews and registry entries for key malaria indicators was significantly higher in Strata 1 and 2 than in Stratum 3. Both adherence to national guidelines for testing and treatment and data quality were high in Strata 1 and 2, but substandard in Stratum 3. The survey results reflected the trends seen in the routine data, suggesting that analysis of routine data can identify areas requiring more attention to improve malaria case management and reporting. |
Malaria case management commodity supply and use by community health workers in Mozambique, 2017
Davlantes E , Salomao C , Wate F , Sarmento D , Rodrigues H , Halsey ES , Lewis L , Candrinho B , Zulliger R . Malar J 2019 18 (1) 47 BACKGROUND: Community health workers (CHWs) provide preventive care and integrated community case management (iCCM) to people with low healthcare access worldwide. CHW programmes have helped reduce mortality in myriad countries, but little data on malaria supply chain management has been shared. This project evaluated the current composition, use, and delivery of malaria iCCM kit commodities in Mozambique-rapid diagnostic tests (RDTs) and artemether-lumefantrine (AL) treatments-to better tailor existing resources to the needs of CHWs in diverse practice settings. METHODS: Health facilities in Maputo (low malaria burden), Inhambane (moderate), and Nampula (high) Provinces were selected using probability proportionate to the number of CHWs at each facility. All CHWs and their supervisors at selected facilities were interviewed using a structured questionnaire to document experiences with kit commodities. Data were analysed to assess CHW commodity stock levels by province and season. RESULTS: In total, 216 CHWs and 56 supervisors were interviewed at 56 health facilities. CHWs reported receiving an average of 6.7 kits in the last year, although they are intended to receive kits monthly. One-tenth of CHWs reported receiving kits with missing RDTs, and 28% reported lacking some AL treatments. Commodity use was highest in the rainy season. Stockouts were reported by CHWs in all provinces, more commonly in the rainy season. Facility-level stockouts of RDTs or some AL formulation in the past year were reported by 66% of supervisors. Use of CHW kit materials by health facilities was reported by 43% of supervisors; this was most common at facilities experiencing stockouts. CONCLUSIONS: Variations in geographic and seasonal malaria commodity needs should be considered in CHW kit distribution planning in Mozambique. Improvements in provision of complete, monthly CHW kits are needed in parallel with improvements in the broader commodity system strengthening. The findings of this evaluation can help other CHW programmes determine best practices for management of iCCM supply chains. |
Malaria risk in travellers: a holistic approach is needed
Davlantes EA , Tan KR , Arguin PM . J Travel Med 2018 25 (1) In their response to our August 2017 editorial, Behrens et al.1 make assertions and assumptions that are not reflective of the main points of our editorial or our current methodologies for making prophylaxis recommendations. We would like to provide further clarification on these points. | | The authors may have misunderstood the main premise of our argument. We are not advocating that risk calculations for travellers be derived from malaria rates among the endemic population. What we were emphasizing were the perils of trying to calculate precise attack rates and risks, and that these numbers should not be seen as concrete values of risk when there are flaws with the numerators and denominators being used. Behrens and colleagues claim to be calculating rates among European travellers, but because they are not counting prevented cases or the cases not captured by surveillance, their rates are most likely underestimated. |
Efficacy and safety of artemether-lumefantrine, artesunate-amodiaquine, and dihydroartemisinin-piperaquine for the treatment of uncomplicated Plasmodium falciparum malaria in three provinces in Angola, 2017.
Davlantes E , Dimbu PR , Ferreira CM , Florinda Joao M , Pode D , Felix J , Sanhangala E , Andrade BN , Dos Santos Souza S , Talundzic E , Udhayakumar V , Owens C , Mbounga E , Wiesner L , Halsey ES , Martins JF , Fortes F , Plucinski MM . Malar J 2018 17 (1) 144 ![]() BACKGROUND: The Angolan government recommends three artemisinin-based combinations for the treatment of uncomplicated Plasmodium falciparum malaria: artemether-lumefantrine (AL), artesunate-amodiaquine (ASAQ), and dihydroartemisinin-piperaquine (DP). Due to the threat of emerging anti-malarial drug resistance, it is important to periodically monitor the efficacy of artemisinin-based combination therapy (ACT). This study evaluated these medications' therapeutic efficacy in Benguela, Lunda Sul, and Zaire Provinces. METHODS: Enrollment occurred between March and July 2017. Study participants were children with P. falciparum monoinfection from each provincial capital. Participants received a 3-day course of a quality-assured artemisinin-based combination and were monitored for 28 (AL and ASAQ arms) or 42 days (DP arm). Each ACT was assessed in two provinces. The primary study endpoints were: (1) follow-up without complications and (2) failure to respond to treatment or development of recurrent P. falciparum infection. Parasites from each patient experiencing recurrent infection were genotyped to differentiate new infection from recrudescence of persistent parasitaemia. These parasites were also analysed for molecular markers associated with ACT resistance. RESULTS: Of 608 children enrolled in the study, 540 (89%) reached a primary study endpoint. Parasitaemia was cleared within 3 days of medication administration in all participants, and no early treatment failures were observed. After exclusion of reinfections, the corrected efficacy of AL was 96% (91-100%, 95% confidence interval) in Zaire and 97% (93-100%) in Lunda Sul. The corrected efficacy of ASAQ was 100% (97-100%) in Benguela and 93% (88-99%) in Zaire. The corrected efficacy of DP was 100% (96-100%) in Benguela and 100% in Lunda Sul. No mutations associated with artemisinin resistance were identified in the pfk13 gene in the 38 cases of recurrent P. falciparum infection. All 33 treatment failures in the AL and ASAQ arms carried pfmdr1 or pfcrt mutations associated with lumefantrine and amodiaquine resistance, respectively, on day of failure. CONCLUSIONS: AL, ASAQ, and DP continue to be efficacious against P. falciparum malaria in these provinces of Angola. Rapid parasite clearance and the absence of genetic evidence of artemisinin resistance are consistent with full susceptibility to artemisinin derivatives. Periodic monitoring of in vivo drug efficacy remains a priority routine activity for Angola. |
Quantifying malaria risk in travellers: a quixotic pursuit
Davlantes EA , Tan KR , Arguin PM . J Travel Med 2017 24 (6) Every year, millions of travellers visit countries in which malaria is endemic. To help inform prevention guidelines, there have been many attempts to quantify malaria risk in travellers. Unfortunately, the data needed to accurately calculate such risk do not exist. Current methods and datasets can provide approximations, but as we will explain, they greatly underestimate the true risk value. Presenting such underestimates as precise measurements and using them as the basis for policy decisions has the potential to cause real harm or death to travellers from a disease easily preventable by chemoprophylaxis. Instead, a more holistic approach to determining malaria risk is needed to best protect travellers. Such an approach could include a qualitative assessment of surveillance data and individual characteristics of the traveller. | It is common to use attack rates to estimate risk. However, in the travel medicine literature, the methods used to calculate malaria attack rates to approximate individual risk1–3 are flawed. For example, authors often determine the number of cases of imported malaria from an endemic area to non-endemic countries reported in national surveillance systems, divide by the estimated total number of travellers from non-endemic countries to this region, and use the resulting quotient to make recommendations on chemoprophylaxis for travellers. Such a calculation has limitations that have been acknowledged in passing, but as we will describe, these limitations are actually quite major and if overlooked can result in very dangerous and erroneous conclusions. |
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