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Address for correspondence: Guo-Dong Medicine of Amazonas (FMTAM) in vivax malaria outbreaks in malaria-Liang, State Key Laboratory for Infectious Manaus, Brazil, to assess the effi cacy endemic areas within the Amazon.
Disease Control and Prevention, Institute for of standard supervised CQ therapy. Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 100 uncomplicated vivax malaria. Each zilian Ministry of Health and the US Agen- Yingxin St, Xuanwu District, Beijing 100052, volunteer was administered uncoated, cy for International Development as part People’s Republic of China, email: gdliang@ scored, 150-mg CQ tablets (10 + 7.5 of the scientifi c program of the Amazonian + 7.5 mg/kg at 24-hour intervals) (9). Surveillance Network for Antimalarial Primaquine was withheld until day Drugs Resistance (RAVREDA). 28 (dose regimen of 30 mg/day for 7 days). Among the 109 volunteers who completed the in vivo test, 19 had pos- Franklin Simoes
de Santana Filho,*
Ana Ruth de Lima Arcanjo,*
Yonne Melo Chehuan,*
Monica Regina Costa,*
Flor Ernestina Martinez-
Plasmodium vivax, confi rmed in these cases on day 2 with Espinosa,*† Jose Luis Vieira,‡
Maria das Graças
of 785.4 ± 800.1 ng/mL) (10) Suspect- Vale Barbosa,*§
To the Editor:
Wilson Duarte Alecrim,*¶
ed therapeutic failure (P. vivax CQ re- is the protozoan that causes the second sistance) was confi rmed in 11 (10.1%) and Maria das Graças Costa
most common form of malaria. Some of 109 persons with a mean isolated Alecrim*§¶
resistant strains to chloroquine (CQ) choloroquine plasma concentration *Foundation for Tropical Medicine of Ama-occur in a few places in Asia and the >10 ng/mL (356.6 ± 296.1 ng/mL) (9). zonas, Manaus, Amazonas, Brazil; †Foun-Indo-Pacifi c Region (1–4). Although Desethylchloroquine levels in plasma dation for Research Support of Amazonas, resistance of P. vivax to CQ has al- Manaus, Amazonas, Brazil; ‡Federal Uni- Previously, a CQ effi cacy study versity of Pará, Belém, Pará, Brazil; §Ama- ca (5–7), there are limited data regard- zonas State University, Manaus, Amazonas, ed had CQ-resistant P. vivax (7). In Brazil; and ¶Nilton Lins University, Manaus, comparison, the proportion of failures Amazonas, Brazil dard treatment for vivax malaria (10.1%) in the current study seems to worldwide. Presently, this drug regi- be relevant; even though most of the References
men exhibits satisfactory effi cacy in P. vivax infections (98, 89.9%) were 1. Marlar-Than, Myat-Phone-Kyaw, Aye- the Brazilian Amazon. However, in successfully evaluated and adequate to chloroquine by Plasmodium vivax in Myanmar. Trans R Soc Trop Med Hyg. tance, have been reported in the city Manaus Outpatient Clinic is detecting of Manaus (Amazonas) where vivax patients from different areas of the city 2. Congpuong K, Na-Bangchang K, Thi-malaria predominates (7). This obser- vation warrants local attention despite after correct treatment within 28 days Sensitivity of Plasmodium vivax to chlo-roquine in Sa Kaeo Province, Thailand. these cases having no confi rmation of the routine clinical follow-up. This of CQ blood levels on the basis of observation is an indirect indicator of 3. Hamedi Y, Nateghpour M, Tan-ariya P, the appearance of asexual parasites the possible regional spread of P. vivax against CQ plus desethylchloroquine CQ-resistant strains (unpub. data).
reesuwan S. Plasmodium vivax malaria in southeast Iran in 1999–2001: establishing the response to chloroquine in vitro and in tive plasma concentration proposed for portant and merit the attention of sensitive parasite strains (>10 ng/mL) local public health authorities. Con- 4. Baird JK, Wiady I, Fryauff DJ, Sutani- 8), according to Pan American Health Organization recommendations (9).
al. In vivo resistance to chloroquine by From September 2004 to February tance in Manaus, we feel it is essen- Plasmodium vivax and Plasmodium fal- ciparum at Nabire, Irian Jaya, Indonesia. ducted at the Foundation for Tropical documented resistance can copromote Am J Trop Med Hyg. 1997;56:627–31.
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 13, No. 7, July 2007 5. Phillips EJ, Keystone JS, Kain KC. Failure by early 2006, only sporadic cases obtained from the health and market of combined chloroquine and high-dose were found. In July 2006, an outbreak authorities. Oral consent for interview primaquine therapy for Plasmodium vivax malaria acquired in Guyana, South Amer- of HPAI was confi rmed on 2 chicken was obtained from participants.
ica. Clin Infect Dis. 1996;23:1171–3.
6. Ruebush TK II, Zegarra J., Cairo EM, Lao PDR (1,3). Most of Laos’ ≈20 interviewed (Table). Differences in Chloroquine-resistant Plasmodium vivax malaria in Peru. Am J Trop Med Hyg. owned backyard farms; 3.2 million ated with different study areas. Differ-2003;69:548–52.
are on commercial farms (4). This ences in participant sex and age were 7. Alecrim MGC. Estudo clínico, resistência production meets 80% of Lao poultry also noted because, in the rural areas, e polimorfi smo parasitário na malária pelo (chicken, duck, goose, quail) needs; interviews took place in the home. A Plasmodium vivax, Manaus – AM. Brasí-lia: UNB, 2000. PhD Thesis, Faculdade de imports from neighboring countries, total of 583 (69.3%) participants were Medicina, Núcleo de Medicina Tropical, either through legal trade or cross- border smuggling, account for the rest and 150 (79.3%), in urban, semiur- 8. Baird JK, Leksana B, Masbar S, Fryauff (3). Common poultry diseases occur ban, and rural areas, respectively; p = DJ, Sutanihardja MA, Suradi FS, et al. Diagnosis of resistance to chloroquine by frequently during the cold season, and 0.002, 95% confi dence interval 66–72. Plasmodium vivax: timing of recurrence lack of reporting of poultry deaths is Mean ages for participants in these ar-and whole blood levels. Am J Trop Med Until February 2007, no human 32–36), and 38 (range 37–41) years, 9. Pan-American Health Organization. Gener- ic protocol for antimalarial drug-effi cacy cases of infl uenza A (H5N1) had been respectively; p<0.001. Animal breed- studies in the Américas. Effi cacy of chlo- reported in Lao PDR. To learn more ing was conducted by 50% of fami- roquine for the treatment of Plasmodium about Laotians’ knowledge of HPAI lies. Daily close exposure to poultry vivax malaria. 2004. [cited 2007 May 15]. Available from http://www.paho.org/eng-lish/AD/DPC/CD/mal-antimalarials.htm 10. Yonemitsu K, Koreeda A, Kibayashi K, In March–April 2006, participants dling of poultry was reported. Rates of Ng’walali P, Mbonde M, Kitinya J, et in 3 settings (Vientiane, urban; Oudo- al. HPLC analysis of anti-malaria agent, mxay, semiurban; Attapeu Province poultry diseases were higher in urban chloroquine in blood and tissue from fo-rensic autopsy cases in Tanzania. Leg Med and Hinheub District, both rural) were and semiurban areas; veterinary sur- interviewed in the Lao language by veillance was low (10.2%).
means of a standardized 33-question Address for correspondence: Franklin Simoes survey. We recorded information about already heard of HPAI, mainly through de Santana Filho, The Foundation for Tropical behavior, poultry handling and keeping television. Urban residents ranked it Medicine of Amazonas, Av Pedro Teixeira 25 practices, and poultry deaths. We used as the most well-known poultry dis-Planalto, Manaus, Amazonas 69040000, Brazil; multivariate analysis (Stata, version 8; ease, but rural residents ranked it fi fth. Stata Corporation, College Station, TX, Less than half of the respondents had USA) to analyze the factors associated some knowledge of the disease signs with behavior changes.
Using a random sampling list of try; 28.4% could describe 1 symptom. visitors and vendors, we interviewed Half of the respondents believed that 461 respondents in 4 Vientiane city they were not at risk for human avian markets (Vientiane has 114,793 infl uenza or that their poultry were not households and 3,700 registered poul- at risk for it. Respondents in urban and try farms) (5). Semiurban respondents semiurban areas knew more about avi-were recruited in Oudomxay (40,987 an infl uenza than those in rural areas.
Risk Perceptions, households, 715 poultry farms), an ac- der. Rural respondents were recruited er) and south than in Vientiane. The To the Editor: After the 2004 from Hinheup District and in Attapeu poultry mortality rate during the cold
outbreak of highly pathogenic avian (19,050 households, 360 poultry season was similar to that of Cambo-infl uenza (HPAI) in poultry in Lao farms), near the Vietnam border. dia (6). Behavior regarding poultry People’s Democratic Republic (PDR), Twenty villages were randomly se- the Ministry of Health implemented lected, and 10 participants per village a high rate of poultry deaths, none of extensive virologic surveillance (1,2). were randomly selected for interview. the interviewees had notifi ed authori-Surveillance began in July 2005, and Approval for the investigation was ties. Since hearing about HPAI, 67.1% Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 13, No. 7, July 2007

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