Prevention Strategy for Papua New Guinea

Intermittent preventive treatment with azithromycin-containing regimens for the prevention of malarial infections and anaemia and the control of sexually transmitted infections in pregnant women in Papua New Guinea

Both P. falciparum and P. vivax are common in PNG, and show varying levels of resistance to current drugs, such as chloroquine and sulphadoxine-pyrimethamine (SP). At delivery, around 40% of women show evidence of damage to the placenta from malaria. Malaria is a major cause of low birth weight babies and of severe anaemia in mothers.

The study was set up to examine whether repeated (three throughout the pregnancy) doses of Intermittent Preventive Treatment in pregnancy (IPTp) with SP and azithromycin, an antibiotic that in previous studies has shown some effect against the malaria parasite as well as against a number of sexually transmitted infections, improves babies’ birth weights compared to a single treatment dose of SP and chloroquine.

The study took place in Madang District, PNG, as a partnership between the PNG Institute of Medical Research and the University of Melbourne’s Department of Medicine. Almost 2800 women were enrolled over two years, at the local hospital and nearby health centres.

Results

SP plus azithromycin was associated with a reduction in low birth weight and preterm delivery; maternal parasitaemia and active placental malaria as well as reduced carriage of gonorrhoea.

The future

The results were shared with WHO_ERG in July 2013 and will be considered at a meeting in 2017 on control strategy in Asia and the South Pacific.

Stephen Rogerson MBBS DTM&H FRACP PhD (Gill there is a photo on the MIP website)

Current Appointment: Professor of Medicine, University of Melbourne

Professor Rogerson is an infectious diseases physician by training, and graduated in medicine in 1982. His postgraduate clinical training was in Adelaide, Australia, Papua New Guinea, and Liverpool, UK, where he also took the Diploma in Tropical Medicine and Hygiene and worked for a period before returning to Australia to undertake a PhD at the Walter and Eliza Hall Institute of Medical Research on malaria pathogenesis.

Following his PhD he was awarded a welcome Trust Career Development Fellowship based in Blantyre, Malawi, where he began work on malaria in pregnancy, which he has continued for over 15 years. He returned to Australia on a Wellcome Trust Senior Overseas Fellowship, joining the University of Melbourne’s Department of Medicine.

Research:

His main research interests include the pathogenesis of malaria in pregnancy and childhood, and understanding how malaria causes low birth weight and its effects on placental function.

European Collaborators: Clara Menendez (Spain)

Site PI's: Ivo Mueller and Peter Siba (PNG)

Papers Published

Results

SP plus azithromycin was associated with a reduction in low birth weight and preterm delivery; maternal parasitaemia and active placental malaria as well as reduced carriage of gonorrhoea.

The future 
The results were shared with WHO_ERG in July 2013 and will be considered at a meeting in 2017 on control strategy in Asia and the South Pacific.

Publications

Moore BR, Benjamin JM, Auyeung SO, Salman S, Yadi G, Griffin S, Page-Sharp M, Batty KT, Siba PM, Mueller I, Rogerson SJ, Davis TM. Safety, tolerability and pharmacokinetic properties of co-administered azithromycin and piperaquine in pregnant Papua New Guinean women.. Br J Clin Pharmacol. 2016 Feb 17. doi: 10.1111/bcp.12910

http://www.dx.doi.org/10.1111/bcp.12910

Requena P, Rui E, Padilla N, Martínez-Espinosa FE, Castellanos ME, Bôtto-Menezes C, Malheiro A, Arévalo-Herrera M, Kochar S, Kochar SK, Kochar DK, Umbers AJ, Ome-Kaius M, Wangnapi R, Hans D, Menegon M, Mateo F, Sanz S, Desai M, Mayor A, Chitnis CC, Bardají A, Mueller I, Rogerson S, Severini C, Fernández-Becerra C, Menéndez C, Del Portillo H, Dobaño C. Plasmodium vivax VIR Proteins Are Targets of Naturally-Acquired Antibody and T Cell Immune Responses to Malaria in Pregnant Women. PLoS Negl Trop Dis. 2016 Oct 6;10(10):e0005009. doi: 10.1371/journal.pntd.0005009. eCollection 2016.

http://dx.doi.org/10.1371/journal.pntd.0005009