ENV 201 Malaria Fowler

8/13/2019 ENV 201 Malaria Fowler

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The Human Burden of Malaria


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Points of this Talk The human burden of

malaria is large & increasing New strategies to combat

malaria exist


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Human Burden of Malaria

1 million deaths/yr

Kills one child/ 30 sec 300-500 million cases/yr

40% of world at risk

> 90% cases in sub-Saharan Africa


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The Human Burden of Malaria on a National LevelSachs Nature 2002;415:680


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Malaria is a disease of poverty (J. Sachs, Nature, 2002)

Malaria

GDP


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Human Burden of Malaria:The Ears of the Hippopotamus

Breman Am J Tr op M ed Hyg 2001;Suppl 1,2:1-11.

Most febrile episodes donot enter healthcaresystemBull WHO 1999;77:624

400-900 million febrileepisodes/yr in Africanchildren Bull WHO 1988;66:61

Up to ~3 million deaths/year


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The Human Burden of Malaria isDifficult to Quantify

Diagnosis of malaria is problematic

Pregnancy & outcome Am J Tr op M ed Hyg 1996;55(suppl):33.

Low birth weight NEJM 1985;312:82

Placental infection Tr ans R Soc Tr op Med H yg 1983;77:232.

Cognitive development Tr ans R Soc Tr op Med H yg 1999;93:529.

Neurologic complications J Pediatr 1997;131:125.


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Malaria & Mortality

Third World: Delay in Therapy Access to medical care/ effective antimalarials Delay in making diagnosis Parasite resistance $

First World: Delay in Diagnosis Failure to consider diagnosis


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Third World: Delay in Therapy

6 year old Zambian girl presented on Friday evening toLivingstone Hospital with 3d F to 104F, 12h lethargy

Thick smear: P. falciparum

Patient given chloroquine orally; lapsed into coma No quinine (QN) in hospital. Mother given Rx for QN

to fill at pharmacy.

Pharmacy closed until Saturday morning. Mother bought QN (1 month wages) and returned to Hospital.

Child dead upon her return.


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First World: Delay in Diagnosis


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Complications of Malaria:Cerebral Malaria


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Complications of Malaria:Pulmonary Edema and Acute Renal Failure


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P. falciparum

40% total malaria

>90% total deaths

Most deaths in Africa

Multidrug resistance


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P. vivax

Most common (55%)

Found everywhere

Temperate zone range #1 cause of death:

Splenic rupture

Hypnozoite

Most blacks resistant


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P. ovale

Rarest (


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P. malar iae

1-5% cases

Originally mostcommon in Europe

Nephroticsyndrome


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The Human Burden of Malaria is Increasing Greenwood Nature 2002;415:670

Drug resistance

Insecticide resistance Civil Disturbance

Environmental Changes

Migration

Population Increase


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Malaria cases sharplyincrease nationwide

January 19, 2002

The Jakarta Post, Indonesia


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Drug Resistance: Chloroquine Greenwood Nature 2002;415:670

1978: Reported in Africa

1988: Reported in allsubSaharan Africancountries Bull WHO 1988;66:61

Degree of Resistance hasintensified

60% of overall mortalityin one study attributedto ineffectiveness of CQAm J Tr op M ed Hyg 1996;55:655


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Drug Resistance and MalariaA health calamity looms within the next few years.

White,N, et al. Lancet 1999;353:1965

Chloroquine resistance:>80% Africa

Change toPyrimethamine/sulfadoxine(P/SD) Kenya, Botswana, Malawi,South Africa

~30% isolates P/SDResistant

Next therapy?


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$ Cost of therapy for CQ & P/SD: $0.50 USD

Cost of drugs for resistant malaria:~$10 USD

Annual per capita health expenditure:~$10 USD


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Insecticide Resistance: Pyrethroids Chandre Bull WHO 1999;77:230


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Environmental Changes

Mi i I H B d f M l i


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Migration Increases Human Burden of MalariaMartens Emerg I nfect Di s 2000;6:103.

Increasing Population Contributes to Human


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Increasing Population Contributes to HumanBurden of Malaria


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Recent Developments

Press Release


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Press Release

Embargoed for Release at 12:01 a.m. London Time, Friday, 15 October 2004(Embargoed for Release at 6:30 pm EDT Thursday, 14 October 2004 in the U.S. and Canada)

For further information contact:CISM, Marc de Semir +34 93 227 5700 (T) +34 62 794 7528 (M)

GlaxoSmithKline Biologicals, Anne P. Walsh + 32 2 656 9831 (T) +32 475 835 782 (M)Malaria Vaccine Initiative, PATH, Ellen Wilson/Preeti Singh +1 301 652-1558 ext. 108

PUBLIC-PRIVATE PARTNERSHIP LEADS TO SCIENTIFICBREAKTHROUGH IN MALARIA VACCINE DEVELOPMENT

Encouraging Results from Largest Pediatric Safety and Efficacy Clinical Trial of Malaria Vaccine inAfrica to be Published in The L ancet

LONDON, Friday 15 October 2004 In a proof-of-concept study to be published this week in The Lancet ,researchers report that GlaxoSmithKline (GSK) Biologicals

RTS,S/AS02A malaria vaccinecandidate protected a significant percentage of children against uncomplicated malaria, infection,and even severe forms of the disease for at least six months. This largest malaria vaccine efficacytrial ever conducted in Africa also re-confirmed the vaccine

s safety in one-to-four year oldchildren. Further efficacy studies will be needed before consideration for licensure.The results will be published on a fast-track basis in the October 16 issue of the journal. Thedouble-blind, controlled trial involved 2,022 children in southern Mozambique and wasconducted by the Centro de Investigao em Saude da Manhia (CISM). GSK Biologicals andPATH

s Malaria Vaccine Initiative (MVI) co-sponsored the trial, which was approved byMozambique

s Ministry of Health.

SOURCE: www.malariavaccine.org

R t D l t


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Recent Developments:Artemisinin drug combinations

Recent De elopments:


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Recent Developments:DDT Revisited


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ENV 201 Malaria Fowler