Epidemiology of Malaria

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QUESTION:

Epidemology of malaria

ANSWER:

I’m afraid that without a bit more detail in the question, it is difficult to answer – there are many facets to the epidemiology of malaria, from the distribution of the disease globally to its prevalence in different age and risk groups among human populations. Human migration and movement can also play a large role in the epidemiology of malaria, as can mosquito vector behaviour and population dynamics.

Malaria is also known to vary widely based on climatic conditions, and there are concerns that climate change will affect what we know about the epidemiology of malaria, making it harder to control. There are also cases of cross-over between human forms of malaria and those from other primates, such as with Plasmodium knowlesi in macaques in south-east Asia. If you re-submit a more specific question, I’ll be happy to answer it more fully!

Symptoms of Malaria

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QUESTION

What are the symptoms of malaria?

ANSWER

The symptoms of malaria include fever and flu-like illness, including shaking chills, headache, muscle aches, and tiredness. Nausea, vomiting, and diarrhea may also occur. Malaria may cause anemia and jaundice (yellow coloring of the skin and eyes) because of the loss of red blood cells. Infection with one type of malaria, Plasmodium falciparum, if not promptly treated, may cause kidney failure, seizures, mental confusion, coma, and death. Since the early symptoms of malaria are very similar to many other conditions, including flu and the common cold, if you live in a malaria area it is important not to ignore these symptoms but to seek medical help and have a blood test to check for malaria early on. 

Fever

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QUESTION

I am suffering from fever—what should I do?

ANSWER

I am afraid I cannot answer your question adequately—this site is not intended for diagnosis or as a substitute for medical care, just to answer specific questions about malaria.

Treatment for Malaria

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QUESTION:

What is the main medicine to cure malaria and about safety precautions?

ANSWER:

There are a number of medicines used to treat malaria. Traditionally, chloroquine has been the first line drug of choice for uncomplicated, non-resistant malaria. However, several types of malaria, and most notably Plasmodium falciparum, the most severe and deadly kind, has become resistant to chloroquine in many places. In some parts of south-east Asia, Plasmodium vivax has also begun to show worrying signs of chloroquine resistance. In such settings, where resistance to chloroquine is suspected, the first line medications for uncomplicated cases are artemisinin-based combination therapies (ACTs), such as Coartem.

The World Health Organization has recommended that artemisinin only be given in combination with another drug to prevent malaria also becoming resistant to this therapy as well. Cases of malaria which have progressed beyond the grasp of that treatable with oral medication as described above (so-called “complicated” cases, most common with P. falciparum infection) are usually given intravenous quinine as a first-line response.

All of these treatments have been rigorously tested in strictly controlled clinical and field trials, and while they may have side effects, they are generally mild and in most cases, the patient will be given the dose without prior testing for reaction to the drug. One exception is with primaquine, which is sometimes used as a preventative medication against malaria and can also be used to treat the liver stages of P. vivax and P. ovale. Primaquine is known to cause severe haemolysis in people with G6DP deficiency, and so people with a high statistical probability of having this condition (for example due to family history or ethnicity) should be tested prior to being given primaquine.

Drugs for Malaria

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QUESTION

What drugs are used in the treatment of malaria?

ANSWER

There are a number of medicines used to treat malaria. Traditionally, chloroquine has been the first line drug of choice for uncomplicated, non-resistant malaria. However, several types of malaria, and most notably Plasmodium falciparum, the most severe and deadly kind, has become resistant to chloroquine in many places. In some parts of south-east Asia, Plasmodium vivax has also begun to show worrying signs of chloroquine resistance. In such settings, where resistance to chloroquine is suspected, the first line medications for uncomplicated cases are artemisinin-based combination therapies (ACTs), such as Coartem.

The World Health Organization has recommended that artemisinin only be given in combination with another drug to prevent malaria also becoming resistant to this therapy as well. Cases of malaria which have progressed beyond the grasp of that treatable with oral medication as described above (so-called “complicated” cases, most common with P. falciparum infection) are usually given intravenous quinine as a first-line response.

All of these treatments have been rigorously tested in strictly controlled clinical and field trials, and while they may have side effects, they are generally mild and in most cases, the patient will be given the dose without prior testing for reaction to the drug. One exception is with primaquine, which is sometimes used as a preventative medication against malaria and can also be used to treat the liver stages of P. vivax and P. ovale. Primaquine is known to cause severe haemolysis in people with G6DP deficiency, and so people with a high statistical probability of having this condition (for example due to family history or ethnicity) should be tested prior to being given primaquine.

 

I am getting malaria every 6 months

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QUESTION:

I am getting malaria every six months, after taken chloroquine medicine tablets. Is this  normal,when my resistance is low, or is it coming aging, is there any medicine to clear the malaria?

ANSWER:

While taking chloroquine can be used to treat malaria, it will not prevent re-infection, unfortunately. One thing to check though is whether you are living in an area where the local types of malaria might be resistant to chloroquine; if so, it will be worth seeing if you can be treated with artemisinin-based combination therapies (ACTs), such as Coartem or Lonart, instead.

Again, these will not prevent re-infection, however, so you need to also take other preventative actions, such as sleeping under a long-lasting insecticide treated bednet and wearing long-sleeved clothing in the evenings and at night to prevent mosquito bites.

It sounds from your question like you live in an area where malaria is common; however, if you are actually only travelling to malarial areas regularly, you could also ask your doctor about the possibility of taking preventative medicine against malaria for the time that you are travelling (these are called “prophylactics”).

You should also check which species of malaria parasite you are infected with – this can be determined when you are diagnosed with the infection, either through looking at your blood under a microscope or by using a rapid diagnostic test (RDT). If you Plasmodium ovale or Plasmodium vivax, there is a possibility that even though the initial acute phase of the infection is responding to treatment with chloroquine, the parasite is remaining dormant in your liver, and causing the recurrences every 6 months. In this case, you should ask your doctor about the possibility of taking a drug called primaquine, which kills these liver stages and prevents further relapse of the disease.

RTS,S Malaria Vaccine

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QUESTION:

What information can you provide on this vaccine candidate?

ANSWER:

RTS,S is a vaccine candidate against Plasmodium falciparum malaria which works by encouraging the host’s body to produce antibodies and T cells which diminish the malaria parasite’s ability to survive and reproduce in the liver.

Produced by GlaxoSmithKline, RTS,S is the first vaccine candidate against Plasmodium falciparum that has reached advanced (Phase III) clinical field trials on a large scale. It was developed way back in 1987, and had successive trials in the United States in 1992 and then in Africa in 1998. In 2001, GSK and the Malaria Vaccine Initiative at PATH went into a public-private partnership, with grant money from the Bill and Melinda Gates Foundation, to develop the vaccine for use in children and infants in sub-Saharan Africa.

The Phase III trials are currently underway in a number of African countries; if all goes to plan, the vaccine will be submitted for regulation by drug authorities as early as 2012. This information, and more, can be found courtesy of the Malaria Vaccine Initiative website: http://www.malariavaccine.org/index.php.

What can I do to help?

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QUESTION:

What is there I can do to help them?

ANSWER:

Thank you for your concern! Probably the easiest and most direct way you can support the people suffering from malaria infections, especially in the developing world, is by helping to spread awareness about the impact of the disease and how it affects millions of people worldwide.

To help with these campaigns, you can also donate to organisations dedicated to fighting malaria, such as Malaria No More, or the Nothing But Nets campaign.

Finally, if you or people you know are going to be travelling to malarial areas, make sure that you are fully informed of the risks of malaria and take all the preventative actions that you should to make sure you yourself don’t get malaria as well!

How does malaria enter the body?

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QUESTION:

What is the portal of entry for malaria?

ANSWER:

Malaria enters its human hosts via the bite of mosquitoes of the genus Anopheles. The malaria parasites are present in the mosquitoes saliva, and enter into the human bloodstream when the mosquito bites to take a blood meal.

Once in the human body, the malaria parasite then undergoes a number of different life stages, involving reproduction in the liver as well as inside red blood cells. Once the malaria parasite has undergone reproduction in the red blood cells, the new parasites burst out and back into the blood stream, where they can be ingested by another mosquito biting again. Inside the mosquito, the malaria parasites undergo more reproduction and life stage changes, until they are ready to be transferred into a human host again, via another bite. In this way, the cycle continues.

Malaria and Economics

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QUESTION:

Why is malaria the most important cause of economic distress?

ANSWER:

While malaria is clearly a huge burden on many aspects of society, including economies, in many parts of the world, I’m not sure it’s fair to say that it’s the leading cause of economic distress. However, it certainly contributes to slow economic progress, through mechanisms related to the “poverty trap” hypothesis developed by Jeffrey Sachs, a professor at Colombia University in New York City.

Sachs believes that factors such as disease ecology, and especially if magnified through poor public health policy and weak health infrastructure, interact with other variables such as governance and natural resource distribution to create negative feedback loops that lock a country or a region in poverty.

For health specifically, the argument is that people who are sick are more likely to miss work, or school in the case of children, or be less productive even if they do go, because of their illness. This loss of working adults and loss of education for children results in a slower economy and makes it harder for a country to grow and develop. Given that malaria is one of the developing world’s most prevalent and deadly diseases, it certainly makes up a large contribution to this portion of the poverty trap, but other high burden infections such as HIV/AIDS, diarrheal illnesses and worms also contribute heavily.