ArticleMalaria journal2016
Where chloroquine still works: the genetic make-up and susceptibility of Plasmodium vivax to chloroquine plus primaquine in Bhutan.
Article in Malaria journal, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed, 2 syntheses or guidelines pooled it, 65 citations in OpenAlex.
- Pooled it
- The effect of chloroquine dose and primaquine on Plasmodium vivax recurrence: a WorldWide Antimalarial Resistance Network systematic review and individual patient pooled meta-analysis.The Lancet. Infectious diseases · 2018Pooled it
- Efficacy of directly-observed chloroquine-primaquine treatment for uncomplicated acute Plasmodium vivax malaria in northeast Myanmar: A prospective open-label efficacy trial.Travel medicine and infectious diseaseTrial
- Genetic Evidence of Cross-Border Plasmodium vivax Spread in a Malaria Pre-elimination Region of South Asia.The Journal of infectious diseases · 2026Article
- Spatial patterns and climate drivers of malaria in three border areas of Brazil, Venezuela and Guyana, 2016-2018.Scientific reports · 2022Article
- Novel highly-multiplexed AmpliSeq targeted assay forFrontiers in cellular and infection microbiology · 2022Article
- Phthalimide analogs for antimalarial drug discovery.RSC medicinal chemistry · 2021Review
- Space-Time Clustering Characteristics of Malaria in Bhutan at the End Stages of Elimination.International journal of environmental research and public health · 2021Article
- The changing epidemiology of Plasmodium vivax: Insights from conventional and novel surveillance tools.PLoS medicine · 2021Review
- Chloroquine and hydroxychloroquine in the treatment of malaria and repurposing in treating COVID-19.Pharmacology & therapeutics · 2020Review
- Implementing parasite genotyping into national surveillance frameworks: feedback from control programmes and researchers in the Asia-Pacific region.Malaria journal · 2020Article
- Malaria elimination in Bhutan: asymptomatic malaria cases in the Bhutanese population living in malaria-risk areas and in migrant workers from India.Revista do Instituto de Medicina Tropical de Sao Paulo · 2019Article
- Genomic analysis of a pre-elimination Malaysian Plasmodium vivax population reveals selective pressures and changing transmission dynamics.Nature communications · 2018Article
- A Unified Approach to Targeting the Lysosome's Degradative and Growth Signaling Roles.Cancer discovery · 2017Article
- VivaxGEN: An open access platform for comparative analysis of short tandem repeat genotyping data in Plasmodium vivax populations.PLoS neglected tropical diseases · 2017Article
- Higher Complexity of Infection and Genetic Diversity ofThe American journal of tropical medicine and hygiene · 2017Article
- Article
Corrections and comments
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Authors and funding
14 authors at 7 institutions in 5 countries.
Funding
Abstract
backgroundBhutan has made substantial progress in reducing malaria incidence. The national guidelines recommend chloroquine (CQ) and primaquine (PQ) for radical cure of uncomplicated Plasmodium vivax, but the local efficacy has not been assessed. The impact of cases imported from India on the genetic make-up of the local vivax populations is currently unknown.
methodsPatients over 4 years of age with uncomplicated P. vivax mono-infection were enrolled into a clinical efficacy study and molecular survey. Study participants received a standard dose of CQ (25 mg/kg over 3 days) followed by weekly review until day 28. On day 28 a 14-day regimen of PQ (0.25 mg/kg/day) was commenced under direct observation. After day 42, patients were followed up monthly for a year. The primary and secondary endpoints were risk of treatment failure at day 28 and at 1 year. Parasite genotyping was undertaken at nine tandem repeat markers, and standard population genetic metrics were applied to examine population diversity and structure in infections thought to be acquired inside or outside of Bhutan.
resultsA total of 24 patients were enrolled in the clinical study between April 2013 and October 2015. Eight patients (33.3 %) were lost to follow-up in the first 6 months and another eight patients lost between 6 and 12 months. No (0/24) treatment failures occurred by day 28 and no (0/8) parasitaemia was detected following PQ treatment. Some 95.8 % (23/24) of patients were aparasitaemic by day 2. There were no haemolytic or serious events. Genotyping was undertaken on parasites from 12 autochthonous cases and 16 suspected imported cases. Diversity was high (H E 0.87 and 0.90) in both populations. There was no notable differentiation between the autochthonous and imported populations.
conclusionsCQ and PQ remains effective for radical cure of P. vivax in Bhutan. The genetic analyses indicate that imported infections are sustaining the local vivax population, with concomitant risk of introducing drug-resistant strains.
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