Médecins Sans Frontières Calls for Switch from Quinine to Artesunate

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After the revision of World Health Organization (WHO) guidelines yesterday,  international medical humanitarian organization Médecins Sans Frontières (Doctors Without Borders) calls for a drug proven to reduce deaths in children suffering from severe malaria to be immediately rolled out in African countries.

In its new report, entitled “Making the Switch,” Médecins Sans Frontières (MSF) calls on African governments to follow new World Health Organization (WHO) guidelines, and switch from the far less effective quinine to artesunate, which could avert nearly 200,000 deaths each year. MSF also calls on WHO and donors to support governments so this urgent treatment change can happen quickly.

“When children arrive at the clinic with severe malaria, they often are having convulsions, vomiting or at risk of going into shock, and you just want to be able to give them effective treatment quickly,” said Veronique De Clerck, Medical Coordinator for MSF in Uganda. “For decades, quinine has been used in severe malaria, but it can be both difficult to use and dangerous, so it’s time to bid it farewell.  With artesunate, we now have a drug that saves more lives from severe malaria, and is safer, easier and more effective than quinine.”

Quinine has to be given three times a day in a slow intravenous drip that takes four hours, a treatment that is burdensome for both patients and health staff. Artesunate, in contrast, can be given in just four minutes, by giving a patient an intravenous or intramuscular injection.

A landmark clinical trial in late 2010 concluded that the use of artesunate to treat children with severe malaria reduces the risk of death by nearly a quarter.  The study, carried out in nine African countries, found that for every 41 children given artesunate over quinine, one extra life was saved.  Because of the complexities of administering quinine, children in the trial who were assigned to receive quinine were almost four times more likely to die before even receiving treatment.

MSF participated in the trial through its research affiliate Epicentre, with a research site in Uganda. MSF has since changed its own treatment protocols and now plans to work with national health authorities to roll out artesunate in its projects over the coming months.

The evidence is overwhelming, but MSF’s report stresses that change will not happen on its own. While WHO has now issued new guidelines recommending artesunate for treating severe malaria in children in Africa, it needs to also develop a plan to help countries make this switch.  African governments must urgently change their treatment protocols and donors must send a clear signal to countries that they will support the additional cost where needed.  Artesunate is three times more expensive, but the difference in cost of US$31 million each year for a global switch is very little for the nearly 200,000 lives that researchers say could be saved.

“We’ve been here before—when WHO changed its treatment recommendations for simple malaria in 2001 it took years for countries to actually make the switch, and shockingly, in some countries the far inferior drugs are still being used ten years on,” said Dr. Martin De Smet, who coordinates MSF’s malaria work.  “With severe malaria, WHO needs to make sure that the change is much less sluggish, so lives can be saved immediately.  There’s simply no excuse not to make the switch now.”

MSF provided malaria treatment to around one million people in 2010.  Severe malaria kills over 600,000 African children under the age of five annually.  Each year, around eight million simple malaria cases progress to severe malaria, where patients show clinical signs of organ damage, which may involve the brain, lungs, kidneys or blood vessels.

More information: Full MSF Report (PDF)

Source: MSF

Drinking Milk While Infected with Malaria

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QUESTION:

Can a malaria-infected person drink milk?

ANSWER:

As far as I know, there isn’t a problem with drinking milk while suffering from malaria. In fact, it is generally a good idea to keep as hydrated as possible while feverish (although water or diluted juice would probably be better for hydration). There is also some evidence that drinking milk can settle the stomach while taking medication for malaria, such as chlorquine.

If there are medical professionals who read this and can comment further on the benefits/problems of drinking milk while suffering from malaria, then please comment below!

Canadian Researchers Develop Inexpensive Malaria Treatment

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Scientists in Saskatoon, Canada have developed a malaria treatment that will help fight malaria, which kills about one million people each year.

The new developments which will provide an affordable, reliable, and stable treatment for malaria and is likely to save millions of lives, especially those of women and children in Africa. The Honourable Gary Goodyear, Minister of State for Science and Technology, along with Mr. Brad Trost, Member of Parliament for Saskatoon–Humboldt, announced the breakthrough today and highlighted the Government’s research support.

“Our government is committed to improving the health of women and children in developing countries,” said Minister Goodyear. “This new development in the production of a malaria treatment represents a major development in the fight against the disease. It will strengthen Canada’s position as a world leader in health research and provide a reliable and affordable solution.”

Today’s announcement is a result of  The Artemisinin Project, a public-private partnership led by OneWorld Health in collaboration with sanofi-aventis, Amyris, the University of California at Berkeley, and the National Research Council Canada. Artemisinin is a natural compound found in a traditional Chinese medicinal plant grown mainly in Africa and Asia to treat malaria. The Government of Canada’s investment of approximately $869,000 in this research has led to technology that can produce a stable and affordable supply of artemisinin for the developing world on a not-for-profit basis.

“Collaboration on the development of this new technology promises to have a major impact on supply of malaria treatment across the developing world, which will be an important contribution towards the global effort to combat malaria,” said Dr. Richard Chin, Chief Executive Officer of OneWorld Health.

According to the World Health Organization, malaria causes approximately 250 million illnesses and more than one million deaths each year, of which 90 percent occur in Africa, mostly in pregnant women and in children. The disease is endemic in nearly 100 countries, including 28 on the African continent. This project is expected to help treat 200 million cases and prevent over one million deaths annually.

About the National Research Council of Canada’s Artemisinin Research

In 2003, researchers at the National Research Council of Canada (NRC) in Saskatoon set out to identify the genes that control the synthesis of artemisinin. Produced by Artemisia annua (a traditional Chinese medicinal plant), this natural compound is extracted from plants grown in Africa and Asia to treat malaria — a major threat to maternal and child health around the world.

Led by Dr. Patrick Covello, the NRC team identified various genes in the plant’s metabolic pathway that produce artemisinin. Using various microbial and plant platforms, such as yeast and tobacco, they conducted research to find alternative means of supplying low cost artemisinin-based drugs.

The Government of Canada has invested approximately $869,000 in this research. In partnership with Amyris, OneWorld Health and sanofi-aventis, NRC’s technology promises to have a major impact on malaria treatment across the developing world.

The NRC worked in partnership with “The Artemisinin Project,” funded by the Bill & Melinda Gates Foundation. This project is led by OneWorld Health, in collaboration with Amyris Biotechnologies, the University of California at Berkeley, and sanofi-aventis.

In 2004, the Institute for OneWorld Health was awarded $42.6 million from the Bill & Melinda Gates Foundation to develop a new source of artemisinin for distribution to the developing world. OneWorld Health created a collaboration between researchers at the University of California, Berkeley who were using yeast to synthesize high-value natural compounds produced by higher plants and other organisms. This work led to the creation of Amyris, a spin-off company, who also joined the collaboration. The aim of the Artemisinin Project was to identify genes in the artemisinin pathway and develop yeast strains that could produce large amounts of artemisinic acid, a key intermediate for the synthesis of artemisinin.

In 2008, the NRC and Amyris signed a license agreement, allowing the company to incorporate NRC’s discovery of two key genes in the artemisinin pathway into Amyris’ proprietary system, effectively doubling the yield of the end-product.

Subsequent to these research milestones, in July 2010, OneWorld Health announced an additional grant of $10.7 million from the Bill & Melinda Gates Foundation to scale-up production and commercialize the drug. Global pharmaceutical company, sanofi-aventis, is the partner that will formulate the drug for distribution on a not-for-profit basis across Africa and other regions vulnerable to the disease.

About Malaria

Malaria is a life-threatening parasitic disease transmitted by infected mosquitoes. Its symptoms include extreme exhaustion, fits of high fever, sweating, shaking chills and anemia.

Malaria parasites destroy red blood cells in the body, leading to anemia. Without adequate treatment, infected red blood cells block vessels leading to the brain or damage other vital organs, often resulting in death.

Infected people living in highly endemic areas often develop immunity to the disease and become asymptomatic carriers of malaria, contributing to epidemics.

According to the World Health Organization, malaria causes approximately 250 million illnesses and more than one million deaths per year, of which 90 percent occur in Sub-Saharan Africa. Malaria is endemic in nearly 100 countries, including 28 countries on the African continent.

In many countries, malaria is the leading killer of children under 5 years of age. Many children who survive an episode of severe malaria suffer learning impairments or brain damage.

Pregnant women and their unborn children are particularly vulnerable to malaria. More than 45 million women — 30 million in Africa — become pregnant in malaria-endemic areas each year.

During pregnancy, malaria can cause maternal anemia, impaired fetal growth, spontaneous abortion, stillbirth, premature birth and low birth weight. In sub-Saharan Africa, up to 40 percent of low birth weight is due to maternal malaria, resulting in up to 400,000 infant deaths per year.

In many areas, the malaria parasite is increasingly resistant to older, inexpensive, single drugs such as chloroquine. Currently, the most effective treatments involve combinations of artemisinin-based therapies and other antimalarials to prolong each drug’s effectiveness and delay resistance.

The source of artemisinin — Artemisia annua (also known as wormwood) — is cultivated mainly in Africa and Asia. However, because of the agricultural time scale, the delay between increased demand and new supply can be up to 14 months, causing shortages and limiting the ability to control the disease.

Source: National Research Council Canada

Malaria Treatment

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Malaria can be a severe, potentially fatal disease (especially when caused by Plasmodium falciparum) and treatment should be initiated as soon as possible.

Patients who have severe P. falciparum malaria or who cannot take oral medications should be given the treatment by continuous intravenous infusion.

Most drugs used in treatment are active against the parasite forms in the blood (the form that causes disease) and include:

  • chloroquine
  • atovaquone-proguanil (Malarone®)
  • artemether-lumefantrine (Coartem®)
  • mefloquine (Lariam®)
  • quinine
  • quinidine
  • doxycycline (used in combination with quinine)
  • clindamycin (used in combination with quinine)
  • artesunate (not licensed for use in the United States, but available through the CDC malaria hotline)

In addition, primaquine is active against the dormant parasite liver forms (hypnozoites) and prevents relapses. Primaquine should not be taken by pregnant women or by people who are deficient in G6PD (glucose-6-phosphate dehydrogenase). Patients should not take primaquine until a screening test has excluded G6PD deficiency.

How to treat a patient with malaria depends on:

  • The type (species) of the infecting parasite
  • The area where the infection was acquired and its drug-resistance status
  • The clinical status of the patient
  • Any accompanying illness or condition
  • Pregnancy
  • Drug allergies, or other medications taken by the patient

If you have or suspect you have malaria, you should contact your doctor immediately.

Source: Centers for Disease Control (CDC)

Urgent Action Essential to Protect Malaria Therapies, Says WHO

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The world risks losing its most potent treatment for malaria unless steps are quickly taken to prevent the development and spread of drug resistant parasites, according to a new action plan released today by WHO and Roll Back Malaria partnership (RBM).

The Global plan for artemisinin resistance containment outlines the necessary actions to contain and prevent resistance to artemisinins, which are the critical component of artemisinin-based combination therapies (ACTs), the most potent weapon in treating falciparum malaria, the deadliest form of the disease. Resistance to artemisinins has already emerged in areas on the Cambodia-Thailand border. Although ACTs are currently more than 90% efficacious around the world, quick action is essential. If these treatments fail, many countries will have nothing to fall back on.

Stop the emergence of drug resistance at its source

“The usefulness of our most potent weapon in treating malaria is now under threat,” said Dr Margaret Chan, WHO Director-General. “The new plan takes advantage of an unprecedented opportunity in the history of malaria control: to stop the emergence of drug resistance at its source and prevent further international spread. The consequences of widespread artemisinin resistance compel us to seize this opportunity.”

The global plan aims to contain and prevent artemisinin resistance through a five-step action plan:

1. Stop the spread of resistant parasites

A fully funded and implemented malaria control agenda, as outlined in the Global malaria action plan, would address many of the needs for the containment and prevention of artemisinin resistance. However, additional funding will be needed to stop the spread of resistant parasites in areas where there is evidence of artemisinin resistance. The global plan estimates that it will cost an additional US$ 10–20 per person in areas of confirmed resistance (Cambodia-Thailand border) and US$ 8–10 per person in the at-risk areas of the Greater Mekong area.

2. Increase monitoring and surveillance for artemisinin resistance

WHO estimated in 2010 that only 31 of the 75 countries that should be conducting routine testing of the efficacy of ACTs actually did so. There is a risk of artemisinin resistance emerging silently in areas without ongoing surveillance.

3. Improve access to malaria diagnostic testing and rational treatment with ACTs

These therapies are frequently used to treat causes of fever other than malaria. Unnecessary use of ACTs can increase the risk of resistance. In order to reduce the number of patients who do not have malaria taking the therapies, WHO recommends diagnostic testing of all suspected malaria cases prior to treatment.

4. Invest in artemisinin resistance-related research

There is an urgent need to develop more rapid techniques for detecting resistant parasites, and to develop new classes of antimalarial medicines to eventually replace the ACTs.

5. Motivate action and mobilize resources

The success of the global plan will depend on a well-coordinated and adequately funded response from many stakeholders at global, regional and national levels.

”Effective containment of artemisinin resistance will significantly improve our capability to sustain current control achievements at country level,” said Professor Awa Coll-Seck, Executive Director of the Roll Back Malaria Partnership. ”We now have a coordinated plan to stop the spread of resistant parasites, but we need additional funding to fully implement it,” Coll-Seck reminded the international donor community.

WHO estimates that the number of malaria cases has fallen by more than 50% in 43 countries over the past decade. A recent modeling analysis of malaria prevention in 34 African countries estimates that more than 730 000 lives were saved between 2000 and 2010; nearly three quarters of them since 2006, when the use of both insecticide treated mosquito nets and ACTs became more widespread. The loss of ACTs as an effective treatment would likely result in a significant increase in malaria-related deaths.

Tremendous progress against malaria

“We have made tremendous progress over the past decade in the fight against malaria,” noted Dr Robert Newman, Director of the WHO Global Malaria Programme. “If we are to sustain these gains and achieve the health-related Millennium Development Goals, then it is essential that we work together to overcome the threat of artemisinin resistance.”

The Global plan for artemisinin resistance containment was developed by the WHO Global Malaria Programme through consultation with over 100 malaria experts from across the Roll Back Malaria Partnership. Funding was provided by the Bill & Melinda Gates Foundation.

Source: WHO