Seasonal malaria chemoprevention (SMC) consists of administration of sulfadoxine-pyrimethamine (SP) + amodiaquine (AQ) at monthly intervals to children during the malaria transmission period. Whether the addition of azithromycin (AZ) to SMC could potentiate the benefit of the intervention was tested through a double-blind, randomized, placebo-controlled trial. The effect of SMC and the addition of AZ, on malaria transmission and on the life history traits of Anopheles gambiae mosquitoes have been investigated. The study included 438 children randomly selected from among participants in the SMC + AZ trial and 198 children from the same area who did not receive chemoprevention. For each participant in the SMC + AZ trial, blood was collected 14 to 21 days post treatment, examined for the presence of malaria sexual and asexual stages and provided as a blood meal to An. gambiae females using a direct membrane-feeding assay. The SMC treatment, with or without AZ, significantly reduced the prevalence of asexual Plasmodium falciparum (LRT X22 = 69, P < 0.0001) and the gametocyte prevalence (LRT X22 = 54, P < 0.0001). In addition, the proportion of infectious feeds (LRT X22 = 61, P < 0.0001) and the prevalence of oocysts among exposed mosquitoes (LRT X22 = 22.8, P < 0.001) was reduced when mosquitoes were fed on blood from treated children compared to untreated controls. The addition of AZ to SPAQ was associated with an increased proportion of infectious feeds (LRT X21 = 5.2, P = 0.02), suggesting a significant effect of AZ on gametocyte infectivity. There was a slight negative effect of SPAQ and SPAQ + AZ on mosquito survival compared to mosquitoes fed with blood from control children (LRTX22 = 330, P < 0.0001). This study demonstrates that SMC may contribute to a reduction in human to mosquito transmission of P. falciparum, and the reduced mosquito longevity observed for females fed on treated blood may increase the benefit of this intervention in control of malaria. The addition of AZ to SPAQ in SMC appeared to enhance the infectivity of gametocytes providing further evidence that this combination is not an appropriate intervention.

中文翻译：

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季节性疟疾化学预防加阿奇霉素对恶性疟原虫传播的影响：配子体感染性和蚊子适应性

季节性疟疾化学预防 (SMC) 包括在疟疾传播期间每月向儿童施用磺胺多辛-乙胺嘧啶 (SP) + 氨地喹 (AQ)。通过一项双盲、随机、安慰剂对照试验测试了在 SMC 中添加阿奇霉素 (AZ) 是否可以增强干预的益处。已经研究了 SMC 和添加 AZ 对疟疾传播和冈比亚按蚊生活史特征的影响。该研究包括从 SMC + AZ 试验参与者中随机选择的 438 名儿童和来自同一地区的 198 名未接受化学预防的儿童。对于 SMC + AZ 试验的每位参与者，在治疗后 14 至 21 天收集血液，检查是否存在有性和无性阶段的疟疾，并作为血粉提供给 An。冈比亚雌性使用直接膜喂养试验。有或没有 AZ 的 SMC 治疗显着降低了无性恶性疟原虫的患病率（LRT X22 = 69，P < 0.0001）和配子细胞的患病率（LRT X22 = 54，P < 0.0001）。此外，与未经治疗的儿童相比，当蚊子以接受治疗的儿童的血液为食时，传染性饲料的比例（LRT X22 = 61，P < 0.0001）和暴露蚊子中卵囊的流行率（LRT X22 = 22.8，P < 0.001）降低了控件。在 SPAQ 中添加 AZ 与感染性饲料的比例增加有关（LRT X21 = 5.2，P = 0.02），表明 AZ 对配子细胞感染性有显着影响。与用对照儿童的血液喂养的蚊子相比，SPAQ 和 SPAQ + AZ 对蚊子存活率有轻微的负面影响（LRTX22 = 330，P < 0.0001）。这项研究表明，SMC 可能有助于减少恶性疟原虫在人与蚊子之间的传播，观察到以处理过的血液为食的雌性蚊子寿命缩短可能会增加这种干预措施在控制疟疾方面的益处。将 AZ 添加到 SMC 中的 SPAQ 似乎增强了配子体的感染性，这进一步证明了这种组合不是适当的干预措施。观察到以处理过的血液为食的雌性蚊子寿命缩短可能会增加这种干预措施在控制疟疾方面的益处。将 AZ 添加到 SMC 中的 SPAQ 似乎增强了配子体的感染性，这进一步证明了这种组合不是适当的干预措施。观察到以处理过的血液为食的雌性蚊子寿命缩短可能会增加这种干预措施在控制疟疾方面的益处。将 AZ 添加到 SMC 中的 SPAQ 似乎增强了配子体的感染性，这进一步证明了这种组合不是适当的干预措施。