Duration of Protection Against Clinical Malaria Provided by Three Regimens of Intermittent Preventive Treatment in Tanzanian Infants 英文参考文献.docVIP

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Duration of Protection Against Clinical Malaria Provided by Three Regimens of Intermittent Preventive Treatment in Tanzanian Infants 英文参考文献.doc

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Duration of Protection Against Clinical Malaria Provided by Three Regimens of Intermittent Preventive Treatment in Tanzanian Infants 英文参考文献

DurationofProtectionAgainstClinicalMalariaProvided byThreeRegimensofIntermittentPreventiveTreatment inTanzanianInfants MatthewCairns1*,RolyGosling2,IlonaCarneiro2,SamwelGesase3,JacklinF.Mosha4 ,Ramadhan Hashim3,HarparkashKaur2,MarthaLemnge3,FrankW.Mosha4,BrianGreenwood2 ,Daniel Chandramohan2 1DepartmentofEpidemiologyandPopulationHealth,LondonSchoolofHygieneTropicalMedicine,London,UnitedKingdom,2DepartmentofInfectiousandTropical Diseases,LondonSchoolofHygieneTropicalMedicine,London,UnitedKingdom,3NationalInstituteforMedicalResearch,TangaCentre,Tanga,Tanzania,4Kilimanjaro ChristianMedicalCollege,Moshi,Tanzania Abstract Background: Intermittent preventive treatment in infants (IPTi) is a new malaria control tool. However, it is uncertain whetherIPTiworksmainlythroughchemoprophylaxisortreatmentofexistinginfections.Understandingthemechanismis essentialfordevelopmentofreplacementsforsulfadoxine-pyrimethamine(SP)whereitisnolongereffective.Thisstudy investigatedhowprotectionagainstmalariagivenbySP,chlorproguanil-dapsone(CD)andmefloquine(MQ),variedwith timesinceadministrationofIPTi. Methods and Findings: A secondary analysis of data from a randomised, placebo-controlled trial in an area of high antifolateresistanceinTanzaniawasconducted.IPTiusingSP,CD,MQorplacebowasgivento1280infantsat2,3and9 monthsofage.Poissonregressionwithrandomeffectstoadjustforpotentialclusteringofmalariaepisodeswithinchildren was used to calculate incidence rate ratios for clinical malaria in defined time strata following IPTi. The short-acting antimalarial CD gave no protection against clinical malaria, whereas long-acting MQ gave two months of substantial protection (protective efficacy (PE) 73.1% (95% CI: 23.9, 90.5) and 73.3% (95% CI: 0, 92.9) in the first and second month respectively).SPgavesomeprotectioninthefirstmonthaftertreatment(PE64.5%(95%CI:10.6,85.9))althoughitdidnot reducetheincidenceofmalariaupto12monthsofage.Therewasnoevidenceofeitherlong-termprotectionorincreased riskofmalariaforany