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Background  Chloroquine-resistant  Plasmodium falciparum  was first described in the Republic of Vanuatu in the early 1980s. In 1991, the Vanuatu Ministry of Health instituted new treatment guidelines for uncomplicated  P. falciparum  infection consisting of chloroquine/sulphadoxine-pyrimethamine combination therapy. Chloroquine remains the recommended treatment for  Plasmodium vivax .    Methods  In 2005, cross-sectional blood surveys at 45 sites on Malo Island were conducted and 4,060 adults and children screened for malaria. Of those screened, 203 volunteer study subjects without malaria at the time of screening were followed for 13 weeks to observe peak seasonal incidence of infection. Another 54 subjects with malaria were followed over a 28-day period to determine efficacy of anti-malarial therapy; chloroquine alone for  P. vivax  and chloroquine/sulphadoxine-pyrimethamine for  P. falciparum  infections.    Results  The overall prevalence of parasitaemia by mass blood screening was 6%, equally divided between  P. falciparum  and  P. vivax . Twenty percent and 23% of participants with patent  P. vivax  and  P. falciparum  parasitaemia, respectively, were febrile at the time of screening. In the incidence study cohort, after 2,303 person-weeks of follow-up, the incidence density of malaria was 1.3 cases per person-year with  P. vivax  predominating. Among individuals participating in the clinical trial, the 28-day chloroquine  P. vivax  cure rate was 100%. The 28-day chloroquine/sulphadoxine-pyrimethamine  P. falciparum  cure rate was 97%. The single treatment failure, confirmed by  merozoite surface protein-2  genotyping, was classified as a day 28 late parasitological treatment failure. All  P. falciparum  isolates carried the Thr-76  pfcrt  mutant allele and the double Asn-108 + Arg-59  dhfr  mutant alleles.  Dhps  mutant alleles were not detected in the study sample.    Conclusion  Peak seasonal malaria prevalence on Malo Island reached hypoendemic levels during the study observation period. The only  in vivo  malaria drug efficacy trial thus far published from the Republic of Vanuatu showed chloroquine/sulphadoxine-pyrimethamine combination therapy for  P. falciparum  and chloroquine alone for  P. vivax  to be highly efficacious. Although the chloroquine-resistant  pfcrt  allele was present in all  P. falciparum  isolates, mutant alleles in the  dhfr  and  dhps  genes do not yet occur to the extent required to confer sulphadoxine-pyrimethamine resistance in this population.

malaria journal

Active case detection, treatment of falciparum malaria with combined chloroquine and sulphadoxine/pyrimethamine and vivax malaria with chloroquine and molecular markers of anti-malarial resistance in the Republic of Vanuatu