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Volume 13, Number 11—November 2007

Dispatch

Drug-Resistant Malaria Parasites Introduced into Madagascar from Comoros Islands

Didier Ménard*Comments to Author , Armand Eugène Randrianarivo-Solofoniaina†, Bedja Said Ahmed‡, Martial Jahevitra*, Landy Valérie Andriantsoanirina*, Justin Ranjalahy Rasolofomanana†, and Léon Paul Rabarijaona*
Author affiliations: *Institut Pasteur de Madagascar, Antananarivo, Madagascar; †Institut National de Santé Publique et Communautaire, Antananarivo, Madagascar; ‡Direction Générale de la Santé, Moroni, Union des Comores;

Main Article

Table

Baseline characteristics of enrolled travelers arriving in Mahajanga, Madagascar, from Comoros Islands, 2006*

Characteristic Comorian travelers, n = 662 Malagasy travelers, n = 285 p value
Place of arrival, n (%)
Airport 553 (83.5) 148 (51.9) <10–6
Seaport 109 (16.5) 137 (48.1)
Female 41% 29% <10–3
Age
Mean age in years (SD) 35.4 (14.7) 35.7 (12.5) NS
<5 y, %
3.7
1.5
NS
Declared site of residence, %
Grande Comore 65.2 NA
Anjouan 31.2 NA
Mohéli 3.6 NA
Northwestern Madagascar NA 64.1
Central Highlands Madagascar NA 23.8
North Madagascar NA 7.1
East Madagascar NA 3.6
Southwestern Madagascar NA 1.4
Northeastern Madagascar NA 0.4
Mean duration of stay in days (SD)
63.5 (146.8)
111.8 (300)
NS
Place of stay in Madagascar, %
Northwestern Madagascar 65.1 NA
Central Highlands Madagascar 32.0 NA
North Madagascar 1.9 NA
East Madagascar 0.5 NA
Southwestern Madagascar 0.5 NA
Place of stay in Comoros Islands, %
Grande Comore NA 79.3
Anjouan NA 20.3
Mohéli
NA
0.4

Malaria symptoms at arrival, %† 3.3 3.9 NS
Medical history declared by travellers in the 3 previous months, %
Suspected malaria 4.8 7.4 NS
Confirmed malaria 1.7 2.5 NS
Treated with antimalarial drugs
4.5
7.4
NS
History of travel in past 3 months
In Africa, % 3.5% 4.9% NS
In Asia, %
0.2%
3.9%
NS
No. malaria-positive samples (%) 105 (74.5) 36 (25.5)
Frequency of mutant alleles,‡ %
76T 82.0 75.0 NS
86Y 100.0 97.2 NS
108N 96.2 91.7 NS
Triple mutant type, 76T-86Y-108N 82.2 71.4 NS
Double mutant type 1, 76K-86Y-108N 14.4 17.8 NS
Double mutant type 2, 76T-86Y-108S 2.2 3.6 NS
Single mutant type, 76K-86Y-108S 1.1 3.6 NS
Wild type, 76T-86Y-108N 0 3.6 NS

*NS, not significant; NA, not applicable; boldface indicates mutant types.
†Fever, headache, diarrhea, shivering, vomiting.
‡Associated with resistance to chloroquine (pfcrt and pfmdr-1) and pyrimethamine (dhfr).

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