@article{Phiri2021-oy,

title = {The duration of protection from azithromycin against malaria,  acute respiratory, gastrointestinal, and skin infections when  given alongside seasonal malaria chemoprevention: Secondary  analyses of data from a clinical trial in hound\'{e}, Burkina  Faso, and bougouni, Mali},

author = {Mphatso Dennis Phiri and Matthew Cairns and Issaka Zongo and Frederic Nikiema and Modibo Diarra and Rakiswend\'{e} Serge Yerbanga and Amadou Barry and Amadou Tapily and Samba Coumare and Ismaila Thera and Irene Kuepfer and Paul Milligan and Halidou Tinto and Alassane Dicko and Jean Bosco Ou\'{e}draogo and Brian Greenwood and Daniel Chandramohan and Issaka Sagara},

doi = {10.1093/cid/ciaa1905},

issn = {1537-6591 1058-4838},

year  = {2021},

date = {2021-10-01},

urldate = {2021-10-01},

journal = {Clin. Infect. Dis.},

volume = {73},

number = {7},

pages = {e2379--e2386},

publisher = {Oxford University Press (OUP)},

abstract = {BACKGROUND: Mass drug administration (MDA) with azithromycin 

 (AZ) is being considered as a strategy to promote child survival 

 in sub-Saharan Africa, but the mechanism by which AZ reduces 

 mortality is unclear. To better understand the nature and extent 

 of protection provided by AZ, we explored the profile of 

 protection by time since administration, using data from a 

 household-randomized, placebo-controlled trial in Burkina Faso 

 and Mali. METHODS: Between 2014 and 2016, 30 977 children aged 

 3-59 months received seasonal malaria chemoprevention (SMC) with 

 sulfadoxine-pyrimethamine plus amodiaquine and either AZ or 

 placebo monthly, on 4 occasions each year. Poisson regression 

 with gamma-distributed random effects, accounting for the 

 household randomization and within-individual clustering of 

 illness episodes, was used to compare incidence of prespecified 

 outcomes between SMC+AZ versus SMC+placebo groups in fixed time 

 strata post-treatment. The likelihood ratio test was used to 

 assess evidence for a time-treatment group interaction. RESULTS: 

 Relative to SMC+placebo, there was no evidence of protection 

 from SMC+AZ against hospital admissions and deaths. Additional 

 protection from SMC+AZ against malaria was confined to the first 

 2 weeks post-administration (protective efficacy (PE): 24.2% 

 [95% CI: 17.8%, 30.1%]). Gastroenteritis and pneumonia were 

 reduced by 29.9% [21.7; 37.3%], and 34.3% [14.9; 49.3%], 

 respectively, in the first 2 weeks postadministration. 

 Protection against nonmalaria fevers with a skin condition 

 persisted up to 28 days: PE: 46.3% [35.1; 55.6%]. CONCLUSIONS: 

 The benefits of AZ-MDA are broad-ranging but short-lived. To 

 maximize impact, timing of AZ-MDA must address the challenge of 

 targeting asynchronous morbidity and mortality peaks from 

 different causes.},

note = {© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America.

PMID: 33417683 

PMCID: PMC8492219},

keywords = {Antimalarials/therapeutic use, Azithromycin, Azithromycin/therapeutic use, Burkina Faso/epidemiology, Chemoprevention, Child, child mortality, Drug Combinations, duration of protection, Humans, Infant, Malaria/drug therapy/epidemiology/prevention \& control, Mali/epidemiology, Preschool, Sahel, seasonal malaria chemoprevention, Seasons},

pubstate = {published},

tppubtype = {article}

}

@article{Chandramohan2021-qm,

title = {Seasonal malaria vaccination with or without seasonal malaria  chemoprevention},

author = {Daniel Chandramohan and Issaka Zongo and Issaka Sagara and Matthew Cairns and Rakiswend\'{e}-Serge Yerbanga and Modibo Diarra and Fr\'{e}d\'{e}ric Niki`ema and Amadou Tapily and Fr\'{e}d\'{e}ric Sompougdou and Djibrilla Issiaka and Charles Zoungrana and Koualy Sanogo and Alassane Haro and Mahamadou Kaya and Abdoul-Aziz Sienou and Seydou Traore and Almahamoudou Mahamar and Ismaila Thera and Kalifa Diarra and Amagana Dolo and Irene Kuepfer and Paul Snell and Paul Milligan and Christian Ockenhouse and Opokua Ofori-Anyinam and Halidou Tinto and Abdoulaye Djimde and Jean-Bosco Ou\'{e}draogo and Alassane Dicko and Brian Greenwood},

doi = {10.1056/NEJMoa2026330},

issn = {1533-4406 0028-4793},

year  = {2021},

date = {2021-09-09},

urldate = {2021-09-09},

journal = {N. Engl. J. Med.},

volume = {385},

number = {11},

pages = {1005--1017},

publisher = {Massachusetts Medical Society},

abstract = {BACKGROUND: Malaria control remains a challenge in many parts of 

 the Sahel and sub-Sahel regions of Africa. METHODS: We conducted 

 an individually randomized, controlled trial to assess whether 

 seasonal vaccination with RTS,S/AS01E was noninferior to 

 chemoprevention in preventing uncomplicated malaria and whether 

 the two interventions combined were superior to either one alone 

 in preventing uncomplicated malaria and severe malaria-related 

 outcomes. RESULTS: We randomly assigned 6861 children 5 to 17 

 months of age to receive sulfadoxine-pyrimethamine and 

 amodiaquine (2287 children [chemoprevention-alone group]), 

 RTS,S/AS01E (2288 children [vaccine-alone group]), or 

 chemoprevention and RTS,S/AS01E (2286 children [combination 

 group]). Of these, 1965, 1988, and 1967 children in the three 

 groups, respectively, received the first dose of the assigned 

 intervention and were followed for 3 years. Febrile seizure 

 developed in 5 children the day after receipt of the vaccine, 

 but the children recovered and had no sequelae. There were 305 

 events of uncomplicated clinical malaria per 1000 person-years 

 at risk in the chemoprevention-alone group, 278 events per 1000 

 person-years in the vaccine-alone group, and 113 events per 1000 

 person-years in the combination group. The hazard ratio for the 

 protective efficacy of RTS,S/AS01E as compared with 

 chemoprevention was 0.92 (95% confidence interval [CI], 0.84 to 

 1.01), which excluded the prespecified noninferiority margin of 

 1.20. The protective efficacy of the combination as compared 

 with chemoprevention alone was 62.8% (95% CI, 58.4 to 66.8) 

 against clinical malaria, 70.5% (95% CI, 41.9 to 85.0) against 

 hospital admission with severe malaria according to the World 

 Health Organization definition, and 72.9% (95% CI, 2.9 to 

 92.4) against death from malaria. The protective efficacy of the 

 combination as compared with the vaccine alone against these 

 outcomes was 59.6% (95% CI, 54.7 to 64.0), 70.6% (95% CI, 

 42.3 to 85.0), and 75.3% (95% CI, 12.5 to 93.0), respectively. 

 CONCLUSIONS: Administration of RTS,S/AS01E was noninferior to 

 chemoprevention in preventing uncomplicated malaria. The 

 combination of these interventions resulted in a substantially 

 lower incidence of uncomplicated malaria, severe malaria, and 

 death from malaria than either intervention alone. (Funded by 

 the Joint Global Health Trials and PATH; ClinicalTrials.gov 

 number, NCT03143218.).},

note = {Copyright © 2021 Massachusetts Medical Society.

Place: United States

PMID: 34432975},

keywords = {Amodiaquine/therapeutic use, Antimalarials/adverse effects/therapeutic use, Burkina Faso/epidemiology, Chemoprevention, Combination, Combined Modality Therapy, Double-Blind Method, Drug Combinations, Drug Therapy, Falciparum/epidemiology/mortality/prevention \& control, Febrile/etiology, Female, Hospitalization/statistics \& numerical data, Humans, Infant, Malaria, Malaria Vaccines/administration \& dosage/adverse effects, Male, Mali/epidemiology, Pyrimethamine/therapeutic use, Seasons, Seizures, Sulfadoxine/therapeutic use},

pubstate = {published},

tppubtype = {article}

}