Produção Nacional
Prevalence of Glucose 6-Phosphate Dehydrogenase Deficiency in Highly Malaria-Endemic Municipalities in the Brazilian Amazon: A Regionwide Screening Study
2021; RELX Group (Netherlands); Linguagem: Inglês
10.2139/ssrn.3970715
ISSN1556-5068
AutoresJoabi Nascimento, José Diego Brito-Sousa, Anne Cristine Gomes de Almeida, Marly Marques de Melo, Mônica Regina Farias Costa, Laila R. A. Barbosa, Reinaldo Nery Ramos, Alexandre Vilhena Silva-Neto, Patrícia Carvalho da Silva Balieiro, Erick Frota Gomes Figueiredo, Emanuelle Lira Silva, Djane Clarys Baía-da-Silva, Quique Bassat, Gustavo Adolfo Sierra Romero, Gisely Cardoso de Melo, Vanderson de Souza Sampaio, Marcus Lacerda, Wuelton Marcelo Monteiro,
Tópico(s)Metabolism and Genetic Disorders
ResumoBackground: Difficulties associated with the assessment of glucose-6-phosphate dehydrogenase deficiency (G6PDd), particularly in the remote areas, hinders the safe use of 8-aminoquinolines such as primaquine (PQ) and tafenoquine due to the risk of hemolysis. Methods: This cross-sectional study was conducted in 41 malaria-endemic municipalities of six states in the Brazilian Amazon, between 2014 and 2018. Male individuals were screened using the qualitative Fluorescent Spot Test using fingerpick-collected whole blood samples. Point and interval estimates of the G6PDd prevalence were calculated with representativeness for each state. Deficient samples were genotyped for the most prevalent variants in the Amazon. Frequencies of P. vivax malaria recurrences were estimated for G6PDdand non-G6PDd patients. Findings: A total of 14,847 individuals were included, of which 5.6% had G6PDd. The state of Acre had the highest G6PDd prevalence (8.3%), followed by Amapá (5.8%), Pará (5.7%), Rondônia (5.4%), Roraima (4.2%) and Amazonas (4.0%). From 828 genotyped samples, African A+ (6.2%), African A - (39.3%) and wild-type (non-African non-Mediterranean; 54.2%) variants were found. A greater proportion of malaria recurrences was found among G6PD deficient individuals [Odds ratio 4.65 (2.37-9.17) p<0.01]. Interpretation: This is the largest survey ever conducted in Latin America, covering the entire malaria endemic area in the Brazilian Amazon. These results indicate that an important proportion of the population is at risk of hemolysis. The adoption of G6PDd screening protocols is essential to ensure the safety of individuals taking PQ, and its congener drug tafenoquine, and should also be considered when implementing malaria elimination strategies.Funding Information: This study was funded by a collaboration (No 797382/2013) between the Brazilian Ministry of Health and Fundação de Medicina Tropical Dr Heitor Vieira Dourado (Public call nº 20/2013 of the Ministry of Health), through Secretaria de Vigilância em Saúde (SVS). JDB-S and EFGF are funded by Fundação de Amparo à Pesquisa do Estado do Amazonas(FAPEAM), which also funded this work through POSGRAD and Pro-Estado public calls. WMM and MVGL are CNPq Fellows.Declaration of Interests: The authors declare no conflict of interest.Ethics Approval Statement: This study was approved by the Ethics Review Board at Fundação de Medicina Tropical Dr Heitor Vieira Dourado (FMT-HVD) (CAEE: 8307814.7.0000.0005). All study participants (and their legal representatives, if applicable) provided written informed consent to participate.
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