Volume 13, Number 11—November 2007
Dispatch
Drug-Resistant Malaria Parasites Introduced into Madagascar from Comoros Islands
Didier Ménard*
, Armand Eugène Randrianarivo-Solofoniaina†, Bedja Said Ahmed‡, Martial Jahevitra*, Landy Valérie Andriantsoanirina*, Justin Ranjalahy Rasolofomanana†, and Léon Paul Rabarijaona*
, Armand Eugène Randrianarivo-Solofoniaina†, Bedja Said Ahmed‡, Martial Jahevitra*, Landy Valérie Andriantsoanirina*, Justin Ranjalahy Rasolofomanana†, and Léon Paul Rabarijaona*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).
