The internet is not going to save the world, says the Microsoft co-founder, whatever Mark Zuckerberg and Silicon Valley’s tech billionaires believe. But eradicating disease just might. Bill Gates describes himself as a technocrat. But he does not believe that technology will save the world. Or, to be more precise, he does not believe it can solve a tangle of entrenched and interrelated problems that afflict humanity’s most vulnerable: the spread of diseases in the developing world and the poverty, lack of opportunity and despair they engender. “I certainly love the IT thing,” he says. “But when we want to improve lives, you’ve got to deal with more basic things like child survival, child nutrition.”
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CDC Warns of Imported Malaria – U.S. Cases Reach 40 Year High
Increase underscores importance of taking recommended medicines to prevent malaria when traveling
In 2011, 1,925 malaria cases were reported in the United States, according to data published in a supplement of the Morbidity and Mortality Weekly Report (MMWR) released today by the Centers for Disease Control and Prevention (CDC). This number is the highest since 1971, more than 40 years ago, and represents a 14% increase since 2010. Five people in the U.S. died from malaria or associated complications.
Almost all of the malaria cases reported in the U.S. were acquired overseas. More than two-thirds (69%) of the cases were imported from Africa, and nearly two-thirds (63%) of those were acquired in West Africa. For the first time, India was the country from which the most cases were imported. Cases showed seasonal peaks in January and August.
“Malaria isn’t something many doctors see frequently in the United States thanks to successful malaria elimination efforts in the 1940s,” said CDC Director Tom Frieden, M.D, M.P.H. “The increase in malaria cases reminds us that Americans remain vulnerable and must be vigilant against diseases like malaria because our world is so interconnected by travel.”
Malaria is caused by a parasite transmitted by the bite of an infective female Anopheles mosquito. In 2010, it caused an estimated 660,000 deaths and 219 million cases globally. The signs and symptoms of malaria illness are varied, but the majority of patients have fever. Other common symptoms include headache, back pain, chills, increased sweating, muscle pain, nausea, vomiting, diarrhea, and cough. Untreated infections can rapidly progress to coma, kidney failure, respiratory distress, and death.
“Malaria is preventable. In most cases, these illnesses and deaths could have been avoided by taking recommended precautions,” said Laurence Slutsker, M.D., M.P.H., director of CDC’s Division of Parasitic Diseases and Malaria. “We have made great strides in preventing and controlling malaria around the world. However, malaria persists in many areas and the use of appropriate prevention measures by travelers is still very important.”
Travelers to areas with malaria transmission can prevent the disease by taking steps such as use of antimalarial drugs, insect repellent, insecticide-treated bed nets, and protective clothing.
Travelers in the United States should consult a health-care provider prior to international travel to receive needed information, medications, and vaccines. CDC provides advice on malaria prevention recommendations on-line. If a traveler has symptoms of malaria, such as fever, headaches, and other flu-like symptoms, while abroad or on returning home, he or she should immediately seek diagnosis and treatment from a health-care provider.
Clinicians should consult the CDC Guidelines for Treatment of Malaria and contact CDC’s Malaria Hotline for case management advice, as needed. Malaria treatment recommendations can be obtained online or by calling the Malaria Hotline (770-488-7788 or toll-free at 855-856-4713).
Source: Centers for Disease Control (CDC)
Sonia Shah: Three Reasons We Still Haven’t Gotten Rid of Malaria
Sonia Shah is an American investigative journalist and author noted for her articles on corporate power—especially with respect to agriculture, oil and pharmaceutical industries—and on gender equality with specific reference to issues that affect developing countries.
Her recent book The Fever: How Malaria Has Ruled Humankind for 500,000 Years , traces the complex history of malaria and how it is intertwined with geography, war, technology, and industry.
Her TED Talk, below:
Math Prof’s Mosquito Control Models Inform Malaria Research
Genetics may provide humankind its most comprehensive answers in controlling the age-old scourges of malaria, dengue fever and West Nile virus by eliminating the ability of vector mosquitoes to host the diseases.
But the new genetic solutions that involve introducing engineered malaria-resistant mosquitoes or mosquitoes replete with engineered resistant gut bacteria raise questions of their own. How large of a population with the genetic trait will be needed to be viable? Will the population survive, persist and mate with wild mosquitoes? Is it possible to completely overtake the susceptible wild population with resistant mosquitoes? Among the large number of biological factors involved in such a process, what are the most sensitive and important ones to make the genetic solutions work? As far as the release of genetically altered mosquitoes into the field is concerned, what are the better strategies for that biologically as well as economically?
Theoretical mathematical models developed by Department of Mathematical Sciences Chair Dr. Jia Li at The University of Alabama in Huntsville (UAH) can help in answering those questions. Following 20 years of disease modeling research that includes influenza and sexually transmitted diseases such as AIDS/human immunodeficiency virus (HIV), Dr. Li began working on mosquito population models in 2004, when scientists discovered they could genetically alter mosquitoes to be resistant to the malaria parasite with a process called transgenesis.
His work has been funded through a series of National Science Foundation grants since then. Recent papers are “Discrete-time models with mosquitoes carrying genetically-modified bacteria,” Mathematical Bioscience, 240.1; November, 2012: pp 35-44, and “Simple discrete-time malarial models,” Jia Li; Journal of Difference Equations and Applications; 19.4; April, 2013: pp 649-666.
“Our work builds a theoretical framework that provides guidance to biologists, public health workers and policy makers,” Dr. Li said. “We can apply our models to malaria, dengue fever and West Nile virus. It is an interesting application of mathematics, and it shows people that mathematics is not just purely theoretic or only in the classroom.”
GLOBAL MENACES
Transmitted back and forth between humans and mosquitoes, malaria and dengue fever have no vaccine protections available and are global health menaces. Malaria is caused by parasitic protozoans. Dengue fever is viral. Both can be fatal. In 2010, the World Health Organization estimated there were 50-100 million cases of dengue fever and over 2.5 billion people – 40 percent of the world’s population – are at risk from dengue. The WHO estimated 219 million cases of malaria in 2010 worldwide, causing 660,000 deaths. It is a major problem in Asia, Central America and regions of Africa.
“If you want to control malaria, the most effective way is to control the mosquito,” said Dr. Li. Besides the use of pesticides and release of sterile mosquitoes to reduce vector populations, scientists have developed newer methodologies to control malaria’s spread that include the transgenic parasite-resistant mosquitoes and also paratransgenic mosquitoes, which are colonized by a gut bacteria that has been altered to be resistant.
“These biological control measures have shown great success and are promising in laboratories, but what happens if you release them into the field?” Dr. Li asked. His theoretical models may be helpful by indicating potential outcomes of various approaches and expenditures on future vector populations.
“For the transgenic mosquitoes, there are some ecological concerns, because they change the gene of the mosquito, and then these mosquitoes bite people,” Dr. Li said. “It is also very expensive to alter the genes of each mosquito one by one in the lab.”
The bacteria colonization approach doesn’t have the same environmental concerns because the bacteria don’t change the genetic makeup of the mosquito, he said, and bacterial innoculation of mosquitoes in the lab is much less expensive than transgenesis.
SURVIVAL FIRST
In either case, success lies first in survival. The introduced mosquitoes must be able to successfully compete with native wild mosquitoes to establish viable populations after release. Transgenic mosquitoes must be able to successfully reproduce with wild mosquitoes and pass along the genetic trait modification that resists disease transmission to their progeny. Paratransgenic mosquitoes also need to reproduce, after which their eggs are infected by the bacteria they carry and pass some bacteria through the water they are laid in to wild eggs that are present.
The mathematical models can provide researchers with “some idea about whether their approach is working,” Dr. Li said, through quantitative or qualitative analysis and asymptotic analysis. Quantitative analysis is used to model near-term numerical results of a vector control action. Qualitative and asymptotic analyses are used to model the much longer-term results and the limiting behavior of the model dynamics.
“We want to determine key biological, vital parameters, like the birth rate and the death rate, for the transgenic and paratransgenic mosquitoes,” Dr Li said. “What are the key parameters to ensure the survival of the mosquitoes released and the transgenes inherited?”
Also of concern to researchers is the threshold release value. At what population level should lab-treated mosquitoes be released to cross the threshold of viability? What are optimal release levels for given disease control goals? What will be the effects of various release quantities on a disease control goal?
Then there is the question of how persistent a dominant or recessive trait malaria resistance transgene in a lab-produced mosquito would be when interbred into a wild population.
“Our model is showing that it is not the dominance that is most important,” said Dr. Li. “The fitness – that is, the ability to both survive and reproduce – is more important than the dominance. We must make the mosquitoes so they live longer and reproduce more” than the wild populations.
In the models, longevity success can lead to a state of equilibrium between native and introduced mosquitoes. Dr. Li’s models are either of discrete time, based on difference equations, or of continuous time, based on differential equations, to help predict qualitative outcomes over a very long period of time. Difference equations compute an output at a certain times based on past and present input samples in the discrete time domain. Differential equations relate the value of an unknown function and its derivatives of various orders in a continuous time setting.
“With the difference equations, the advantage is that it is more intuitive, but its theory and development have a short history and the analysis is relatively more difficult,” said Dr. Li. “The theory of differential equations, on the other hand, has a very long history and is well developed so that it provides more tools that we can use.”
Through mathematical analysis, the models show that in theory over a very long period of time, the wild malaria-susceptible mosquitoes succumb to the introduced bugs under certain conditions, or coexist with the introduced bugs under other conditions.
“We are trying to satisfy those certain conditions under which the wild mosquitoes will be wiped out,” Dr. Li said. “If it is necessary to have the other conditions satisfied and then the two types of mosquitoes coexist, we can still manage to bring the number of the wild mosquitoes down via controlling some parameters.”
Source: University of Alabama Huntsville
Ranbaxy Drug Synriam Receives Indian Government Approval to Treat Plasmodium Vivax
Gurgaon, India,: Ranbaxy Laboratories Limited (Ranbaxy) today announced that the company has received approval from the Central Drugs Standard Control Organisation (CDSCO), Government of India to manufacture and market Synriam (arterolane maleate and piperaquine phosphate tablet 150+750 mg) in India for the treatment of uncomplicated malaria in adults caused by Plasmodium vivax parasite.
Phase III clinical trials for the drug conducted in India, successfully demonstrated the efficacy and tolerability of Synriam as comparable to chloroquine.
Last year on World Malaria Day, April 25, Ranbaxy had launched India’s first new drug, Synriam for the treatment of uncomplicated Plasmodium falciparum malaria in India. Since its launch, Synriam has successfully treated around one million patients.
The company has also received permission to conduct Phase III clinical trials for the pediatric formulation in pediatric patients of uncomplicated Plasmodium falciparum malaria.
Commenting on the approval, Arun Sawhney, CEO & Managing Director, Ranbaxy, said, “Synriam is a new age cure for malaria and is fast emerging as the preferred option in the hands of doctors. This approval makes Synriam one of the few therapies in the world that successfully treats both, Plasmodium vivax and Plasmodium falciparum malaria. Ranbaxy remains committed in its fight against malaria and we are making all efforts to make this new therapy accessible to patients around the world.”
Ranbaxy is working to make this new treatment available in African, Asian and South American markets where malaria is rampant. The company has filed New Drug Applications (NDAs) for marketing Synriam in some African countries and will be filing more applications during the year. Once approved, the product will be launched in these markets.
Synriam provides quick relief from most malaria-related symptoms, including fever, and has a high cure rate of over 95%. It conforms to the recommendations of the World Health Organization (WHO) for using combination therapy in malaria.
As the dosage regimen for Synriam is simple, it leads to better compliance. A patient is required to take just one tablet per day, for three days, compared to other medicines where two to four tablets are required to be taken, twice daily, for three or more days. The drug is also independent of dietary restrictions for fatty foods or milk, as is the case with older anti-malarial therapies. Since Synriam has a synthetic source, unlike artemisinin-based drugs, production can be scaled up whenever required and a consistent supply can be maintained at a low cost.
According to the World Malaria Report 2012 published by WHO, India sees about 1.3 million confirmed cases of malaria each year, about 50% of which are caused by Plasmodium vivax, the second most important species after Plasmodium falciparum. Worldwide, 40% of total malaria burden globally is due to Plasmodium vivax , which shows the vast potential of Synriam in India and globally.
Traditional drugs are proving ineffective against the deadly malarial parasite because it has progressively acquired marked resistance to available drugs. Availability of plant based Artemesinin, a primary ingredient in established anti-malarial therapies is finite and unreliable. This leads to price fluctuations and supply constraints, which is not the case with a synthetic drug like Synriam.
Source: Ranbaxy
GlaxoSmithKline Seeks to Market RTS,S Malaria Vaccine
British drugmaker GlaxoSmithKline is seeking approval to market the world’s first malaria vaccine, after trials showed that it significantly cut cases of the disease in children.
Results from latest clinical trial of the RTS,S vaccine were unveiled at a conference in Durban, South Africa on Tuesday.
It showed that after 18 months of follow-up, the vaccine halved the number of malaria cases in young children and reduced the number of cases in infants by about 25 percent.
The trials were conducted on 15,000 infants and young children in seven African countries.
The drugmaker said in a statement that it plans to submit an application for the vaccine to the European Medicines Agency (EMA). It said that the World Health Organization may recommend use of the vaccine starting in 2015, if the EMA gives the vaccine a positive scientific opinion.
The RTS,S vaccine is being developed along with the non-profit PATH Malaria Vaccine Initiative, with grant funding from the Bill & Melinda Gates Foundation.
GSK says that once approved the vaccine will be priced at the manufacturing cost plus a margin of five percent that would be reinvested for research into future malaria vaccines.
The World Health Organization reports that malaria kills up to 800,000 people a year, with most deaths occurring among children in Africa.
Source: VOA
RTS,S Malaria Vaccine Results Promising
Results from a large-scale Phase III trial, presented today in Durban, show that the most clinically advanced malaria vaccine candidate, RTS,S, continued to protect young children and infants from clinical malaria up to 18 months after vaccination. Over 18 months of follow-up, RTS,S was shown to reduce cases of clinical malaria by 46% in young children (aged 5-17 months at first vaccination) and to reduce by 27% the malaria cases in infants (aged 6-12 weeks at first vaccination).
Based on these data, GlaxoSmithKline (GSK) now intends to submit, in 2014, a regulatory application to the European Medicines Agency (EMA). The World Health Organization (WHO) has indicated that a policy recommendation for the RTS,S malaria vaccine candidate is possible as early as 2015 if it is granted a positive scientific opinion by EMA.
Vaccine efficacy was also assessed separately at each of the trial sites, which represent a wide range of malaria transmission settings; efficacy was found to be statistically significant at all sites in young children and at four sites in infants.
Eleven African research centres in seven African countries1 are conducting this trial, together with GlaxoSmithKline (GSK) and the PATH Malaria Vaccine Initiative (MVI), with grant funding from the Bill & Melinda Gates Foundation to MVI.
“In Africa we experience nearly 600,000 deaths annually from malaria, mainly children under five years of age,” says Halidou Tinto, Principal Investigator from the Nanoro, Burkina Faso trial site and chair of the Clinical Trials Partnership Committee (CTPC), which oversees the RTS,S Phase III programme. “Many millions of malaria cases fill the wards of our hospitals. Progress is being made with bed nets and other measures, but we need more tools to battle this terrible disease.”
Efficacy and cases prevented
The efficacy and public health impact of RTS,S were evaluated in the context of existing malaria control measures, such as insecticide treated bed nets, which were used by 78% of children and 86% of infants in the trial. In these latest results over 18 months of follow-up, children aged 5-17 months at first vaccination with RTS,S experienced 46% fewer cases of clinical malaria, compared to children immunised with a control vaccine. An average of 941 cases of clinical malaria were prevented over 18 months of follow-up for every 1,000 children vaccinated in this age group, noting that a child can contract more than one case of malaria. Severe malaria cases were reduced by 36%; 21 cases of severe malaria were prevented over 18 months of follow-up for every 1,000 children vaccinated. Malaria hospitalisations were reduced by 42%.
Infants aged 6-12 weeks at first vaccination with RTS,S had 27% fewer cases of clinical malaria.
Over 18 months of follow-up, 444 cases of clinical malaria were prevented for every 1,000 infants vaccinated. The reduction of severe malaria cases and malaria hospitalisations by 15% and 17%, respectively, were not statistically significant.
“It appears that the RTS,S candidate vaccine has the potential to have a significant public health impact,” says Tinto. “Preventing substantial numbers of malaria cases in a community would mean fewer hospital beds filled with sick children. Families would lose less time and money caring for these children and have more time for work or other activities. And of course the children themselves would reap the benefits of better health.”
Overall, vaccine efficacy declined over time: Previous results from one year follow-up of the Phase 3 trial showed that efficacy of RTS,S was 56% against clinical malaria and 47% against severe malaria for the 5-17 month-old age group and 31% against clinical malaria and 37% against severe malaria in the 6-12 week-old age group.
Safety
RTS,S continued to display an acceptable safety and tolerability profile during the 18 month follow-up. Apart from the meningitis signal previously reported2, no other safety signal was identified. The occurrence of meningitis will be followed closely during the remainder of the trial.
Next year
Further data from 32 months follow-up and the impact of a fourth ‘booster’ dose given 18 months after the initial three doses are expected to become available in 2014.
Comments on results
Sir Andrew Witty, CEO of GSK, said: “We’re very encouraged by these latest results, which show that RTS,S continued to provide meaningful protection over 18 months to babies and young children across different regions of Africa. While we have seen some decline in vaccine efficacy over time, the sheer number of children affected by malaria means that the number of cases of the disease the vaccine can help prevent is impressive. These data support our decision to submit a regulatory application for the vaccine candidate which, if successful, would bring us a step closer to having an additional tool to fight this deadly disease. We are grateful to the scientists across Africa and GSK and to our partners who have worked tirelessly for almost 30 years to bring us to this point.”
Dr David C. Kaslow, vice president of product development at PATH, said: “Given the huge disease burden of malaria among African children, we cannot ignore what these latest results tell us about the potential for RTS,S to have a measurable and significant impact on the health of millions of young children in Africa. While we want to be careful about not getting ahead of the data, this trial continues to show that a malaria vaccine could potentially bring an important additional benefit beyond that provided by the tools already in use.”
About RTS,S
RTS,S is a scientific name given to this malaria vaccine candidate and represents the composition of this vaccine candidate that also contains the AS01 adjuvant system3. RTS,S aims to trigger the immune system to defend against the Plasmodium falciparum malaria parasite when it first enters the human host’s bloodstream and/or when the parasite infects liver cells. It is designed to prevent the parasite from infecting, maturing, and multiplying in the liver, after which time the parasite would re-enter the bloodstream and infect red blood cells, leading to disease symptoms. In the Phase III efficacy trial, RTS,S has been administered in three doses, one month apart. With more than US$200 million in grant monies from the Bill & Melinda Gates Foundation, MVI contributes financial, scientific, managerial, and field expertise to the development of RTS,S. GSK takes the lead in the overall development of RTS,S and has invested more than $350 million to date and expects to invest more than $260 million until development is completed.
Looking ahead
These new data support GSK’s plans to submit, in 2014, an application for a scientific opinion by the Committee for Medicinal Products for Human Use (CHMP) on RTS,S through the EMA Article 58 procedure. The EMA, in the context of cooperation with the WHO, will evaluate data on the quality, safety, and efficacy of the RTS,S vaccine candidate. A positive CHMP scientific opinion would facilitate the registration of RTS,S by national regulatory authorities in Africa. Furthermore, if the EMA gives a positive opinion, and the public health information is satisfactory, including safety and efficacy data from the Phase III programme, the WHO has indicated that a policy recommendation for the RTS,S malaria vaccine candidate is possible as early as 2015, paving the way for decisions by African nations regarding large-scale implementation of the vaccine through their national immunisation programmes. An effective vaccine for use alongside other measures such as bed nets and anti-malarial medicines would represent a positive advance in malaria control.
The PATH Malaria Vaccine Initiative (MVI) is a global program established at PATH through an initial grant from the Bill & Melinda Gates Foundation. MVI’s mission is to accelerate the development of malaria vaccines and catalyse timely access in endemic countries. MVI’s vision is a world free from malaria. For more information, please visit www.malariavaccine.org.
PATH is an international nonprofit organization that transforms global health through innovation. PATH take an entrepreneurial approach to developing and delivering high-impact, low-cost solutions, from lifesaving vaccines, drugs, diagnostics, and devices to collaborative programs with communities. Through its work in more than 70 countries, PATH and its partners empower people to achieve their full potential. For more information, please visit www.path.org.
Source: GSK Press Rls Oct 8 2013
Malaria Threatens Penguins
As carefree as penguins might look, torpedoing through the water or rocketing into the air like a Poseidon missile, zoo penguins are stalked by an unrelenting killer: malaria.
“It’s probably the top cause of mortality for penguins exposed outdoors,” said Dr. Allison N. Wack, a veterinarian at the Maryland Zoo in Baltimore. The avian version is not a threat to humans because mosquitoes carrying malaria and the parasites are species-specific; mosquitoes that bite birds or reptiles tend not to bite mammals, said Dr. Paul P. Calle, chief veterinarian for the Wildlife Conservation Society, which runs New York City’s zoos. And avian malaria is caused by strains of the Plasmodium parasite that do not infect humans.
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Malaria No More Debuts “Power of One” (Po1) Campaign to Fight Malaria
Malaria No More announced today the debut of its most aggressive campaign to date: Power of One (Po1), where a one dollar donation provides a life-saving test and treatment for a child in Africa. The Power of One campaign uses the latest social, mobile, and e-commerce technologies to rally the global public to close malaria testing and treatment gaps in Africa, starting with Zambia. Malaria No More’s Power of One campaign is supported by some of the world’s most innovative companies, including Novartis, Alere Inc., 21st Century Fox, AHAlife.com, Causes.com, Time Warner, Twitter, Venmo and others.
A child dies every minute from malaria, making it one of the top killer diseases among children worldwide. Every dollar donated to the campaign – via the campaign’s new, mobile-friendly website Po1.org — funds a life-saving treatment for a child with malaria. The campaign aims to accelerate progress toward ending malaria deaths by closing critical treatment gaps in Africa. In 2014 and 2015, it’s estimated that over 300 million treatments are needed in Africa. Malaria No More has chosen Zambia as the first country for its Power of One campaign, as it has emerged as one of the best examples of innovation and progress in the malaria fight, and is working with the government and partners on the ground to provide 3 million treatments for children with malaria.
Power of One is using mobile phones in Africa and the U.S. in new ways to track impact and engage the public, and the campaign site, Po1.org, will leverage new tools from popular digital platforms, like Twitter and Venmo, in the coming weeks.
“It’s unacceptable that a child dies every minute for lack of malaria diagnosis and treatment, worth only a dollar,” said Martin Edlund, CEO, Malaria No More. “We’re challenging the world to help us fix that through the Power of One campaign where users can donate, track and share impact, and engage their friends using the latest mobile tools. One dollar really can save a life – and we’ll prove it.”
To debut the platform, Malaria No More will distribute 1 million “life-saving vouchers” over the next week through supporting online and physical retailers, such as AHAlife.com, as well as at high level events taking place in New York City, including Mashable’s Social Good Summit, the United Nation’s MDG Innovation Forum, and the Global Citizen Festival in Central Park. Audiences making everyday purchases will receive a ticket featuring a special code that, when redeemed on act.Po1.org, provides a test and treatment, without a donation, to save a child’s life in Zambia.
Top media partners, 21st Century Fox and Time Warner, are airing campaign PSAs and digital ads nationally this week, and ads will run across dozens of other national broadcast channels, cable networks, radio stations, popular websites, and on prominent billboards. Additionally, as a feature partner on the new platform release of Causes.com this week, the Power of One campaign is being highlighted and heavily promoted to users.
Novartis, the world’s leading provider of malaria treatments and exclusive treatment sponsor of the Power of One campaign, is donating up to three million full courses of its pediatric antimalarial drug and will support the campaign financially over the next three years. “I am proud of the significant and longstanding commitment Novartis has to the fight against malaria. For all our progress though, there’s still more work to do,” said Joseph Jimenez, CEO of Novartis. “We need more help to close the treatment gap and Power of One offers everyone a chance to engage and make a difference for children suffering from malaria.”
Alere, the world’s leading provider of rapid diagnostic tests for malaria and exclusive diagnostics partner to Malaria No More, will donate over the course of the campaign two million rapid diagnostic tests to aid point-of-care diagnosis of the disease in sub-Saharan Africa. “Accurate diagnosis of malaria significantly improves the odds in treating the disease and ending premature deaths of children,” said Ron Zwanziger, Chairman and CEO of Alere. “Alere is proud to partner with Malaria No More and to support the Power of One campaign in its goal of preventing deaths from this devastating disease.”
Every dollar donated to the Power of One campaign provides a life-saving test and treatment for a child in Africa. Thanks to our corporate partners, Power of One will be able to amplify public impact. For the first million dollars raised by the public every year, Novartis will match the global public’s contribution and donate up to an additional one million treatments and Alere will donate one million rapid diagnostic tests – this translates to two treatments and one test for every dollar donated.
For more information and to sign up to support the Power of One campaign, visit www.Po1.org.
Source: Malaria No More
Effect of Iron Supplements On Children Living in Malaria-Endemic Areas
Children in a malaria-endemic community in Ghana who received a micronutrient powder with iron did not have an increased incidence of malaria, according to a study in the September 4 issue of JAMA. Previous research has suggested that iron supplementation for children with iron deficiency in malaria-endemic areas may increase the risk of malaria.
“In sub-Saharan Africa, malaria is a leading cause of childhood morbidity and mortality, and iron deficiency is among the most prevalent preventable nutritional deficiencies. The provision of iron to children with iron deficiency anemia can enhance motor and cognitive development and reduce the prevalence of severe anemia. However, studies have suggested that iron deficiency anemia may offer protection against malaria infection and that the provision of iron may increase malaria morbidity and mortality,” according to background information in the article. “In 2006, the World Health Organization and the United Nations Children’s Fund released a joint statement that recommended limiting use of iron supplements (tablets or liquids) among children in malaria-endemic areas because of concern about increased malaria risk. As a result, anemia control programs were either not initiated or stopped in these areas.”
Stanley Zlotkin, M.D., Ph.D., of the Hospital for Sick Children, Toronto, and colleagues conducted a study to determine the effect of providing micronutrient powder (MNP) with or without iron on the incidence of malaria among children living in a high malaria-burden area. The randomized trial, which included children 6 to 35 months of age (n = 1,958 living in 1,552 clusters), was conducted over 6 months in 2010 in a rural community setting in central Ghana, West Africa. A cluster was defined as a compound including 1 or more households. Children were excluded if iron supplement use occurred within the past 6 months, they had severe anemia, or severe wasting. Children were randomized by cluster to receive a MNP with or without iron for 5 months followed by 1-month of further monitoring. Insecticide-treated bed nets were provided at enrollment, as well as malaria treatment when indicated.
Throughout the intervention period, adherence to the use of MNP and insecticide-treated bed nets were similar between the iron group and the no iron group. The researchers found that the overall incidence of malaria was lower in the iron group compared with the no iron group, but after adjustment for baseline values for iron deficiency and moderate anemia, these differences were no longer statistically significant. “Similar associations were found during the 5-month intervention period only for both malaria and malaria with parasite counts greater than 5000/µL (severe malaria). A secondary analysis demonstrated that malaria risk was reduced among the subgroup of those in the iron group who had iron deficiency and anemia at baseline.”
Overall, hospital admission rates did not differ significantly between groups. However, during the 5-month intervention period, there were more children admitted to the hospital in the iron group vs. the no iron group (156 vs. 128, respectively).
“The findings from the current study not only address a gap in the literature, but also have potentially important policy implications for countries like Ghana that have not implemented iron supplementation or fortification as part of anemia control programs in part due to the joint recommendation from the WHO and UNICEF. For ethical reasons, we ensured that all participants were not denied existing malaria prevention (insecticide-treated bed nets) or malaria treatment. As such, our results most likely can be applied to other malaria-endemic settings in which similar malaria control measures are in place. Overall, given our findings and the new WHO guidelines recommending iron fortification for the prevention and treatment of anemia among children younger than 2 years (in whom the prevalence of anemia is ≥20 percent), there should be renewed interest and consideration for implementing iron fortification in Ghana as part of the national nutrition policy.”
Editorial: Iron Fortification and Malaria Risk in Children
In an accompanying editorial, Andrew M. Prentice, Ph.D., of the London School of Hygiene and Tropical Medicine, and colleagues write that the increase seen in this study in hospital admissions among the iron supplementation group, which by definition constitutes a potentially serious adverse event, adds to the concerns about the safety of iron administration in highly malaria-endemic environments.
“Participants in an expert panel convened by the World Health Organization in 2007 speculated that iron given with foods, either by centralized or point-of-use fortification, would be safe. However, the Ghanaian trial reported by Zlotkin et al in this issue of JAMA now becomes the fourth trial to question this suggestion, and leaves global health policy makers with an unresolved dilemma. Until a means of safely administering iron in infectious environments has been developed, there remains an imperative to reduce the infectious burden as a prerequisite to moving poor populations from their current state of widespread iron deficiency and anemia.”
Source: American Medical Association (AMA)
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