The burden of Plasmodium vivax relapses in an Amerindian village in French Guiana
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The burden of Plasmodium vivax relapses in an Amerindian village in French Guiana Mathieu Nacher1,2*, Aurelia Stefani2, Celia Basurko1,2, Delphine Lemonnier3, Félix Djossou4, Magalie Demar4, Narcisse Elenga5, Paul Brousse6, Muriel Ville6 and Bernard Carme2,7
Abstract Malaria is a public health problem in French Guiana. Plasmodium vivax is the most frequent parasite. The objective of this analysis was to estimate the proportion of relapses in the burden of vivax malaria using the statistical rule stating that any case of vivax malaria occurring less than 90 days following a first episode is a relapse. A total of 622 subjects were followed for 2,9 years with 336 first single episodes of P. vivax malaria, and a total of 1,226 episodes of vivax malaria among which 559 were relapses (45.5%). For 194 patients having had falciparum malaria followed by vivax malaria it was estimated that 19% of the vivax episodes occurred less than 90 days following the falciparum episode and thus were possibly relapses due to the activation of latent hypnozoites. Despite the number of vivax cases and the number of relapses, there were only 28 recorded primaquine prescriptions (3.4% of vivax episodes, 4.5% of subjects). The present study points out that despite the fact that nearly half of the P. vivax cases, many of which in children, are caused by latent hypnozoites, only a minority of them benefit from primaquine radical cure. The obstacles to this are discussed and suggestions are made to reduce the burden of vivax malaria in Camopi and other remote health centres in French Guiana.
Background Malaria remains a public health problem in French Guiana, a French overseas territory in South America [1-3]. Ninety four percent of the territory is covered by rainforest. Due to a combination of interventions, the visible part of malaria incidence has decreased to a total of around 800 cases a year in 2012. Malaria mostly affects around 30,000 persons living in remote areas and 10,000-15,000 garimpeiros living in the forest [4]. Much of the malaria problem originates from this last group that is out of the reach of the health system and makes malaria elimination elusive [5]. Before 2008, there were mines 15 km from Camopi. Since the Harpie operations from the French armed forces started in 2008, the closest mines are at least 30 km from Camopi. Garimpeiros do not stay in Camopi, but they may stay in the neighbouring * Correspondence: [email protected] 1 Centre d’Investigation Clinique Epidémiologie clinique Antilles Guyane (Inserm / DGOS CIE 802), Centre Hospitalier de Cayenne, Cayenne, French Guiana 2 Epidemiologie Parasitoses et Mycoses Tropicales, EA 3593, Université Antilles Guyane, Cayenne, French Guiana Full list of author information is available at the end of the article
town across on the Brazilian side. However, some of the persons living in Camopi are involved in supplying mining sites where they may get infected. Between 2001 and 2009, in a cohort of Amerindian children in Camopi, a village on the Ea
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