Changes in the resistance of Plasmodium falciparum to chloroquine in Hainan, China.

In 1979, in view of the widespread resistance of Plasmodium falciparum to chloroquine in the island of Hainan, China, it use as an antimalarial was suspended throughout the island. A longitudinal survey of the chloroquine-sensitivity of P. falciparum was carried out over the period 1981-91 to investigate whether its resistance had changed from the 1979 level. In-vitro assays were carried out every 2-3 years, while in-vivo tests were performed annually over the period 1981-83 and also in 1991. Resistance to chloroquine declined progressively after its use had stopped. The in-vitro tests indicated that the rate of chloroquine-resistant P. falciparum was 97.9% in 1981, but dropped to 60.9% in 1991 (P < 0.001). The mean concentration of chloroquine for complete inhibition of schizont formation was 10.4 pmol/microliters in 1981, but decreased to 3.0 pmol/microliters in 1991 (P < 0.001). The proportion of samples taken from malaria cases that required high concentrations ( > 6.4 pmol/microliters) of chloroquine for complete inhibition of schizont formation was 83.3% in 1981, but only 17.4% in 1991 (P < 0.001); at low concentrations ( > 1.6 pmol/microliters), the corresponding proportions increased from 4.2% in 1981 to 60.8% in 1991 (P < 0.001). In the 4-week in-vivo test, the rate of chloroquine-resistant P. falciparum decreased from 84.2% in 1981 to 40% in 1991 (P < 0.001). RII + RIII cases represented 59.4% of the total resistant cases in 1981, but decreased to 37.5% in 1991 (0.02 > P > 0.01).