Table 1.
Studies that interrupted transmission for over 6 months after the end of MDA
| Study author Country Years | Type and goal of MDA | Drug regimen and duration of intervention | Target population description | Method of delivery (no. of treatment days) | Target population size (coverage %) | Parasite species | Additional control measures | Outcomes at conclusion of intervention |
|---|---|---|---|---|---|---|---|---|
| MDA for malaria outbreak response | ||||||||
| Lakshmana-charyulu21 India1961 | Mass treatment: outbreak response | Two rounds CQ + PYR (dosage ND) | All individuals | ND (1 day for two rounds) | 30,000–35,000 (80) | Pf and Pv | IRS | MDA brought PP close to 0; IRS and surveillance over next 4 years led to elimination |
| Total duration: 4 months | ||||||||
| Singh30 India 1962–1964 | Mass treatment: outbreak response | PQ 15 mg daily for 5 days + CQ 600 mg single dose for four rounds; first round treated everyone, subsequent rounds targeted only febrile cases and their contacts | All individuals (except infants, pregnant, seriously ill) | DOT (5 days, for up to four rounds) | 22,369 cumulative over 2 years (average 76) | Pf and Pv | IRS | MDA and IRS combined controlled outbreak and brought PP to 0 |
| Total duration: 2 years | ||||||||
| Liu19 China 1981–1985 | Mass treatment: outbreak response | During low transmission season: CQ 1,200 mg + PQ 180 mg over 8 days During high transmission season: CQ 300 mg + PQ 30 mg twice a month | All individuals | ND (∼20 days per year for 5 years) | 26,369 (100) | ND | Bed nets | Transmission-interrupted PP reduced to 0.05% |
| Total duration: 5 years | ||||||||
| MDA for malaria morbidity reduction and elimination | ||||||||
| Dupoux18 Tunisia 1936 | Mass chemoprophylaxis: reduce morbidity | Premaline (dosage ND) every 10 days for 1 month, then every 14 days for 5 months | All individuals | DOT (∼13 days) | 27,097 (100) | ND | None | Transmission interrupted with parasite indices reduced to 0 in some areas |
| Total duration: 6 months | ||||||||
| Berberian16 Lebanon 1946–1947 | MSAT, then mass treatment: reduce morbidity | CQ 125–500 mg weekly | All individuals ≥ 6 months of age | DOT (1 day for 20–32 rounds) | 93–215 (100) | Pf and Pv | IRS immediately after conclusion of MDA | Case incidence decreased to 0.02/1,000 persons/month; cases were suspected relapsed Pv infections |
| Total duration: 8 months | ||||||||
| Department of Health Taiwan15 Taiwan 1955 | Mass treatment: elimination | CQ 12 mg/kg single dose | All individuals (except infants) | DOT (1 day) | 1,502 (ND) | Pf, Pv, and Pm | IRS | Neither MDA nor IRS alone able to bring PP to 0; combined interventions led to elimination |
| Total duration: 2 months | ||||||||
| De Zulueta31 Uganda 1960 | Mass treatment: elimination | CQ 200–600 mg + PYR 16.5–49.5 mg, two single doses ∼6 months apart | All individuals ≥ 3 months | ND (1 day for two rounds) | 8,000–16,000 (50–100) | Pf and Pm | IRS | Transmission interrupted |
| Total duration: 6 months | ||||||||
| Huehne17 Malaysia Orang Asli 1961–1963 | Mass treatment: elimination | CQ 600 mg + 49.5 mg PYR monthly dose | All individuals | ND (1 day for 31 rounds) | 147 (50–75) | Pf | IRS | IRS + MDA brought PP to 0; outbreak 13 months after MDA ended was due to imported case |
| Total duration: 31 months | ||||||||
| Huehne17 Malaysia Coastal belt 1961–1963 | Mass treatment: elimination | CQ 600 mg + 49.5 mg PYR approximately every 6 months | All individuals | ND (1 day for four rounds) | ND | Pf | IRS | MDA ceased after four rounds with no transmission; interruption of transmission attributed to IRS, with MDA hastening progress |
| Total duration: 24 months | ||||||||
| Dapeng20 China 1985–1994 | Mass treatment: elimination | CQ 1,500 mg + PQ 90 mg once annually for 3 consecutive days | All individuals where incidence was ≥ 5% in previous season | ND (3 days for 10 rounds) | 1,052,170 cumulative over 10 years (ND) | Pf and Pv | IRS, bed nets | Pf incidence reduced to 0 and Pv incidence to 0.05/1,000 persons/month; success attributed to vector control interventions |
| Total duration: 10 years | ||||||||
| Kaneko14 Vanuatu 1991 | Mass treatment: elimination | CQ 600 mg + SP 1,500 mg/75 mg + PQ 45 mg weekly dose in weeks 1, 5, and 9; CQ 300 mg + PQ 45 mg weekly dose in weeks 2–4 and 6–8 | All individuals (pregnant women CQ only; no PQ for infants < 3 months) | DOT (1 day for nine rounds) | 718 (90) | Pf, Pv, and Pm | Bed nets, larviciding, community health education | Malaria eliminated from Aneityum |
| Total duration: 9 weeks | ||||||||
| Song13 Cambodia 2003–2004 | Mass treatment: elimination | Artemisinin-piperaquine 24–750 mg, two doses given at 0 and 24 hours (second round 1 year later in some villages) + PQ 9 mg every 10 days for 6 consecutive months | All individuals ≥ 1 year | DOT (19–20 days) | 2,387–3,653 (ND) | Pf, Pv, and Pm | None | PP reduced to 0 in some villages; gametocytemia reduced to 0.6% after 1 year follow-up |
| Total duration: 6–12 months | ||||||||
CQ = chloroquine; DOT = directly observed treatment; IRS = indoor residual spraying; MDA = mass drug administration; MSAT = mass screen and treat; ND = not described; Pf = Plasmodium falciparum; Pm = Plasmodium malariae; PP = parasite prevalence; PQ = primaquine; Pv = Plasmodium vivax; PYR = pyrimethamine; SP = sulfadoxine-pyrimethamine.