Determinants of compliance with malaria chemoprophylaxis among French soldiers during missions in inter-tropical Africa

International audienc

Determinants of compliance with anti-vectorial protective measures among non-immune travellers during missions to tropical Africa

International audienceThe effectiveness of anti-vectorial malaria protective measures in travellers and expatriates is hampered by incorrect compliance. The objective of the present study was to identify the determinants of compliance with anti-vectorial protective measures (AVPMs) in this population that is particularly at risk because of their lack of immunity

A multiplex assay for the simultaneous detection of antibodies against 15 Plasmodium falciparum and Anopheles gambiae saliva antigens

<p>Abstract</p> <p>Background</p> <p>Assessment exposure and immunity to malaria is an important step in the fight against the disease. Increased malaria infection in non-immune travellers under anti-malarial chemoprophylaxis, as well as the implementation of malaria elimination programmes in endemic countries, raises new issues that pertain to these processes. Notably, monitoring malaria immunity has become more difficult in individuals showing low antibody (Ab) responses or taking medications against the <it>Plasmodium </it><it>falciparum </it>blood stages. Commonly available techniques in malaria seroepidemiology have limited sensitivity, both against pre-erythrocytic, as against blood stages of the parasite. Thus, the aim of this study was to develop a sensitive tool to assess the exposure to malaria or to bites from the vector <it>Anopheles gambiae</it>, despite anti-malarial prophylactic treatment.</p> <p>Methods</p> <p>Ab responses to 13 pre-erythrocytic <it>P. falciparum</it>-specific peptides derived from the proteins Lsa1, Lsa3, Glurp, Salsa, Trap, Starp, CSP and Pf11.1, and to 2 peptides specific for the <it>Anopheles gambiae </it>saliva protein gSG6 were tested. In this study, 253 individuals from three Senegalese areas with different transmission intensities and 124 European travellers exposed to malaria during a short period of time were included.</p> <p>Results</p> <p>The multiplex assay was optimized for most but not all of the antigens. It was rapid, reproducible and required a small volume of serum. Proportions of Ab-positive individuals, Ab levels and the mean number of antigens (Ags) recognized by each individual increased significantly with increases in the level of malaria exposure.</p> <p>Conclusion</p> <p>The multiplex assay developed here provides a useful tool to evaluate immune responses to multiple Ags in large populations, even when only small amounts of serum are available, or Ab titres are low, as in case of travellers. Finally, the relationship of Ab responses with malaria endemicity levels provides a way to monitor exposure in differentially exposed autochthonous individuals from various endemicity areas, as well as in travellers who are not immune, thus indirectly assessing the parasite transmission and malaria risk in the new eradication era.</p

Assessment of exposure to Plasmodium falciparum transmission in a low endemicity area by using multiplex fluorescent microsphere-based serological assays

Background: The evaluation of malaria transmission intensity is a crucial indicator for estimating the burden of malarial disease. In this respect, entomological and parasitological methods present limitations, especially in low transmission areas. The present study used a sensitive multiplex assay to assess the exposure to Plasmodium falciparum infection in children living in an area of low endemicity. In three Senegalese villages, specific antibody (IgG) responses to 13 pre-erythrocytic P. falciparum peptides derived from Lsa1, Lsa3, Glurp, Salsa, Trap, Starp, Csp and Pf11.1 proteins were simultaneously evaluated before (June), at the peak (September) and after (December) the period of malaria transmission, in children aged from 1 to 8 years. Results: Compared to other antigens, a high percentage of seropositivity and specific antibody levels were detected with Glurp, Salsa1, Lsa3NR2, and Lsa1J antigens. The seropositivity increased with age for all tested antigens. Specific IgG levels to Glurp, Salsa1, Lsa3NR2, and Lsa1J were significantly higher in P. falciparum infected children compared to non-infected and this increase is significantly correlated with parasite density. Conclusion: The multiplex assay represents a useful technology for a serological assessment of rapid variations in malaria transmission intensity, especially in a context of low parasite rates. The use of such combined serological markers (i.e. Glurp, Lsa1, Lsa3, and Salsa) could offer the opportunity to examine these variations over time, and to evaluate the efficacy of integrated malaria control strategies

Exposition de voyageurs à la transmission de plasmodium falciparum et aux moustiques vecteurs en afrique inter-tropicale

Dans les zones d endémie palustre, plusieurs méthodes de protection anti-vectorielle sont préconisées chez les voyageurs. Pour évaluer l efficacité de ces méthodes, il est nécessaire d'évaluer le niveau individuel d exposition aux vecteurs et à la transmission de Plasmodium falciparum. Les objectifs de la thèse étaient d évaluer cette exposition et cette transmission chez des militaires en mission de courte durée (4-5 mois) en Afrique intertropicale par méthodes entomologiques, sérologiques et par télédétection. Les résultats ont montré une grande hétérogénéité temporo-spatiale de l'exposition, ont permis d'identifier des antigènes de P. falciparum et de salive de moustiques utilisables pour évaluer cette exposition et ont démontré l'utilité de données de télédétection pour prédire le risque palustre chez des voyageurs. Ils ont aussi permis d'objectiver la protection conférée par les moustiquaires et le port de vêtement longs chez des voyageurs.AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocSudocFranceF

Salivary gland protein repertoire from Aedes aegypti mosquitoes.

International audienceDiseases caused by arthropod-borne viruses are a significant threat to the health of human and animal populations throughout the world. Better knowledge of the molecules synthesized in the salivary gland and saliva of hematophagous arthropods could be of use for improving the control of pathogen transmission. Recently, a sialome analysis of three Aedes aegypti mosquito colonies (PAEA, Rockefeller, and Formosus) carried out in our laboratory allowed us to identify 44 saliva proteins. Of these secreted proteins, none was exclusively expressed in one colony, suggesting that expression of salivary proteins is highly conserved across populations. In another study, we reported that some of these salivary proteins could be used as the genus-specific markers for travelers' exposure to mosquito vectors. Here, comparison of salivary gland protein profiles between these same three Ae. aegypti colonies was performed using the one-dimensional sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) difference gel electrophoresis method. As observed at the saliva level, no significant differences were detected between these three colonies. The salivary gland protein repertoire from the Ae. aegypti mosquito was analyzed using a proteomic approach. One hundred and twenty proteins were identified in these salivary glands representing the largest description of the Ae. aegypti salivary gland protein catalog. We succeeded in identifying 15 secreted proteins, some of which have already been reported as being involved in blood feeding. A comparison of the proteins identified between the salivary glands and the sialome is discussed

Determinants of compliance with anti-vectorial protective measures among non-immune travellers during missions to tropical Africa

Abstract Background The effectiveness of anti-vectorial malaria protective measures in travellers and expatriates is hampered by incorrect compliance. The objective of the present study was to identify the determinants of compliance with anti-vectorial protective measures (AVPMs) in this population that is particularly at risk because of their lack of immunity. Methods Compliance with wearing long clothing, sleeping under insecticide-impregnated bed nets (IIBNs) and using insect repellent was estimated and analysed by questionnaires administered to 2,205 French military travellers from 20 groups before and after short-term missions (approximately four months) in six tropical African countries (Senegal, Ivory Coast, Chad, Central African Republic, Gabon and Djibouti). For each AVPM, the association of "correct compliance" with individual and collective variables was investigated using random-effect mixed logistic regression models to take into account the clustered design of the study. Results The correct compliance rates were 48.6%, 50.6% and 18.5% for wearing long clothing, sleeping under bed nets and using repellents, respectively. Depending on the AVPM, correct compliance was significantly associated with the following factors: country, older than 24 years of age, management responsibilities, the perception of a personal malaria risk greater than that of other travellers, the occurrence of life events, early bedtime (i.e., before midnight), the type of stay (field operation compared to training), the absence of medical history of malaria, the absence of previous travel in malaria-endemic areas and the absence of tobacco consumption. There was no competition between compliance with the different AVPMs or between compliance with any AVPM and malaria chemoprophylaxis. Conclusion Interventions aimed at improving compliance with AVPMs should target young people without management responsibilities who are scheduled for non-operational activities in countries with high risk of clinical malaria. Weak associations between compliance and history of clinical malaria or variables that pertain to threat perception suggest that cognition-based interventions referencing a "bad experience" with clinical malaria could have only a slight impact on the improvement of compliance. Further studies should focus on the cognitive and behavioural predictors of compliance with AVPMs.</p

Major variations in malaria exposure of travellers in rural areas: an entomological cohort study in western Côte d'Ivoire

<p>Abstract</p> <p>Background</p> <p>Malaria remains a major threat, to both travellers and military personnel deployed to endemic areas. The recommendations for travellers given by the World Health Organization is based on the incidence of malaria in an area and do not take the degree of exposure into account. The aim of this article is to evaluate the exposure of travellers by entomologic methods, which are the commonly used measures of the intensity of malaria transmission.</p> <p>Methods</p> <p>From February 2004 to June 2004, five groups of 30 military personnel were stationed in up to 10 sites in western Côte d'Ivoire, from one week to several months. Adult mosquitoes were collected by human landing catches at each site during the five months and the level of exposure to malaria transmission of each group was estimated.</p> <p>Results</p> <p>The level of transmission varied from one site to another one from less than one to approximately more than 100 infective bites per month. In the majority of sites, at least two anopheline species were involved in transmission. The cumulative EIR over the study period varied according to the groups from 29 infected bites per person/per mission to 324.</p> <p>Conclusion</p> <p>The level of malaria transmission and malaria risk varies widely (varying by a factor of eleven) between groups of travellers travelling in the same region and at the same time. Physicians involved in travel medicine or supporting expatriated populations or refugees should consider this heterogeneity and emphasize the importance of combining appropriate measures, such as chemoprophylaxis and protective measures against mosquitoes.</p