Mefloquine--its 20 years in the Thai Malaria Control Program.

Due to the deteriorating efficacy of sulfadoxine-pyrimethamine (SP or Fansidar), from the mid-1970s the Thai Malaria Control Program was actively involved in testing potential replacement drugs to be used as the primary therapy for falciparum malaria in Thailand. In 1983, a large-scale field trial of mefloquine, a long-acting antimalarial drug known for its efficacy against chloroquine- and SP-resistant Plasmodium falciparum, was initiated on the Thai-Cambodian border. The study enrolled over 60,000 patients and eventually led to the formal establishment of mefloquine as the first line drug for the treatment of uncomplicated falciparum malaria in the country. Mefloquine has played a significant role in the control of malaria in Thailand for the past two decades, initially in combination with SP, then by itself, and currently in selected areas as a partner drug in the combination therapy with artesunate. Thailand is the country with the most experience in the use of this drug in a malaria control program. We present here a review of mefloquine's pharmacology and usage in Thailand.

Changes in malaria vector densities over a twenty-three year period in Mae Hong Son Province, northern Thailand.

Mae Hong Son Province in northwestern Thailand has a long history of malaria. During the last two decades the province has had one of the highest malaria incidences of all provinces in Thailand. Data were analyzed to determine whether the vector populations were stable or increasing during the last two decades and to determine the seasonal prevalence of the main vectors, and whether or not they were related to the malaria transmission peak, in the wet season. We compiled and analyzed accumulated entomological records from 1977 to 1999. The aim was to investigate long-term changes in mean densities of malaria vectors between two periods (1977-1989 and 1990-1999), and the differences in vector densities between two seasons (wet and dry). A total of 141,144 adult anophelines of 29 species were collected on indoor and outdoor human baits and animal baits during the study period. Of the main malaria vectors, the densities of Anopheles minimus s.l. and Anopheles maculatus complex increased significantly. Anopheles dirus s.l., however, was stable between the two periods. These vector populations were associated with consistently high malaria incidence in the province during the last two decades. An. minimus s.l. density was not significantly different between seasons. However, in the second period, both An. dirus s.l. and An. maculatus complex showed a tendency for higher wet season densities. This can explain the high malaria incidence in the rainy season in Mae Hong Son. Environmental and climatic factors seem to have been favorable for supporting a consistently high vector population in the province, and consequently a high malaria transmission rate during the period of study.

Mekong malaria. II. Update of malaria, multi-drug resistance and economic development in the Mekong region of Southeast Asia.

In an expansion of the first Mekong Malaria monograph published in 1999, this second monograph updates the malaria database in the countries comprising the Mekong region of Southeast Asia. The update adds another 3 years' information to cover cumulative data from the 6 Mekong countries (Cambodia, China/Yunnan, Lao PDR, Myanmar, Thailand, Viet Nam) for the six-year period 1999-2001. The objective is to generate a more comprehensive regional perspective in what is a global epicenter of drug resistant falciparum malaria, in order to improve malaria control on a regional basis in the context of social and economic change. The further application of geographical information systems (GIS) to the analysis has underscored the overall asymmetry of disease patterns in the region, with increased emphasis on population mobility in disease spread. Of great importance is the continuing expansion of resistance of P. falciparum to antimalarial drugs in common use and the increasing employment of differing drug combinations as a result. The variation in drug policy among the 6 countries still represents a major obstacle to the institution of region-wide restrictions on drug misuse. An important step forward has been the establishment of 36 sentinel sites throughout the 6 countries, with the objective of standardizing the drug monitoring process; while not all sentinel sites are fully operational yet, the initial implementation has already given encouraging results in relation to disease monitoring. Some decreases in malaria mortality have been recorded. The disease patterns delineated by GIS are particularly instructive when focused on inter-country distribution, which is where more local collaborative effort can be made to rationalize resource utilization and policy development. Placing disease data in the context of socio-economic trends within and between countries serves to further identify the needs and the potential for placing emphasis on resource rationalization on a regional basis. Despite the difficulties, the 6-year time frame represented in this monograph gives confidence that the now well established collaboration is becoming a major factor in improving malaria control on a regional basis and hopefully redressing to a substantial degree the key problem of spread of drug resistance regionally and eventually globally.