1491

Malaria persistence after weekly active case detection

in an indigenous community in the Peruvian Amazon
Luis Cabrera-Sosa , Oscar Nolasco , Carlos Fernandez-Miñope , Silvia Arévalo de los Rios , Hugo
1 1 2 3

Rodriguez Ferrucci , Jean-Pierre Van geertruyden , Dionicia Gamboa , Christopher Delgado-Ratto

4 2 1 2✉️

1
Laboratorio de Malaria: Parásitos y Vectores, Universidad Peruana Cayetano Heredia, Lima, Peru;
2
Malaria Research group MARCH, Global Health Institute, University of Antwerp, Antwerp, Belgium;
3
Laboratorio de Salud Pública de Loreto, Dirección Regional de Salud de Loreto, Iquitos, Peru;
4
Universidad Nacional de la Amazonía Peruana, Iquitos, Peru

SUMMARY
METHODS
Malaria persistence in remote communities represents a significant challenge for Peru's current national
elimination program. Here, we assessed the impact of an active case detection intervention (ACD) –
carried out by the Ministry of Health – in 2019 in Nueva Jerusalen (NJ), an indigenous community in
the Peruvian Amazon. There was no significant difference in the number of malaria infections by light
microscopy or PCR in NJ within the 3 week – ACD intervention.
BACKGROUND
METHODS
• The current national malaria elimination program in Peru calls for research-based evidence to develop
specific strategies to remote, indigenous communities, as they currently accumulate a high proportion of
the total number of cases (1).
• No studies focused on indigenous areas in Loreto region are reported (2).
• AIM: To describe the short-term effect of an ACD intervention on reducing malaria cases in NJ.

METHODS
METHODS RESULTS
METHODS

Study site: Nueva Jerusalen (NJ) 521 inhabitants Gender: Median age:
Participants
community LORETO
485 participants 55.7% 12 years
region
616 samples
• Achuar native community in
Trompeteros district, Loreto region. Trompeteros
district Table 1. Effect of ACD intervention on malaria positive rate in NJ
• Highly mobile population
• ~500 inhabitants, ~100 households, ACD1 ACD2 ACD3
and 1 health post.
# participants
202 208 206
• Ministry of Health’s interventions have Coverage
38.77% 39.92% 39.54%
failed to reduce malaria cases in NJ in
the last years. Microscopy
9.90% 14.90% 15.53%
PCR
Nueva Jerusalen (NJ) 15.35% 22.12% 22.33%

 ACD Intervention: In Nov - Dec 2019, three consecutive ACD visits were conducted at intervals of 1
week in NJ (Fig. 2). In each visit, inhabitants were called for voluntary malaria diagnosis. These activities
were carried out by the Ministry of Health.
 Sample Collection and Diagnosis: Blood smears and blood spots on paper filter samples were collected
for light microscopy (LM) and qPCR detection, respectively.
• The age (p = 0.11) and the gender (p = 0.10) of the participants in each ACD visit were
similar.
• Accumulative coverage (proportion of the population with at least one collected sample)
was 93% at the end of ACD intervention.
• >90% of the infections detected by microscopy or PCR was due to P. vivax.

 Treatment: Species-specific treatment following the national guidelines was provided to any microscopy- • There was no difference in the malaria positive rate by LM (p = 0.19) or PCR (p = 0.13)
confirmed malaria infection, regardless of the symptoms. Treatment adherence was not always among the 3 ACD visits.
ensured.
• Malaria positive rate of children (<18 y) and adults were similar in each ACD visit.

CONCLUSIONS

• NJ presented a high prevalence of malaria infections after each ACD visit (>20% by
PCR).
• ACD intervention did not reduce the number of malaria infections in NJ during a
short-term period.
• We are currently studying on the transmission dynamics and drug resistance
through genomic surveillance in this indigenous area.
REFERENCES
P. vivax: 1. MINSA. Plan hacia la eliminación de la Malaria en el Perú. 2022. https://www.gob.pe/institucion/minsa/normas-
CQ: 10 mg/kg x 2 days + legales/2723757-034-2022-minsa
5 mg/kg x 1 day 2. Montenegro C, et al. Plasmodium falciparum outbreak in native communities of Condorcanqui, Amazonas, Perú.
LM PCR Malar J. 2021 Feb 12;20(1):88..
PQ: 0.5 mg/kg x 7 days

FUNDING:
+

P. falciparum:
AS: 4 mg/kg x 3 days CORRESPONDENCE:
MQ: 12.5 mg/kg x 2 days Christopher Delgado-Ratto
PQ: 0.75 mg/kg x 1 day chris.delgadoratto@uantwerpen.be
PhD scholarship
Active Case Detection (ACD) Intervention at NJ PE2018TEA470A102 VLIR TEAM EC-165-2020-FONDECYT

Pictures taken in Nueva Jerusalen