World Malaria Day 2014 – How Best to Invest in Malaria Prevention and Control

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Each year, April 25 provides an opportunity to reflect on the current status of the fight against malaria. We are in the middle year of the World Malaria Day theme of “Invest in the Future. Defeat Malaria,” which is set to last until 2015.

Funding for malaria control and prevention, as with all international public health endeavors, has always been perceived as a critical issue, but there is a refreshing diversity to the ways in which it is being discussed this World Malaria Day.  The U.S. Centers for Disease Control and Prevention (CDC), who spear-headed the successful eradication of malaria in the U.S. back in the 1950s, specifically mention their efforts to maximize effectiveness, and their strategies for using and evaluating new tools such that they can get the most impact per precious dollar spent.  The WHO has highlighted the importance of sustained political commitment, as a crucial factor related to ensuring continued financial support for malaria initiatives. The Global Fund to Fight AIDS, TB, and Malaria recently announced a new funding model, designed to enable “strategic investment for maximum impact.” [Read more…]

Ranbaxy Drug Synriam Receives Indian Government Approval to Treat Plasmodium Vivax

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Single treatment for both Plasmodium vivax and Plasmodium falciparum malaria Permission received to conduct Phase III clinical trials for pediatric formulation

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

Discovery of Malaria

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QUESTION

How was malaria discovered?

ANSWER

Malaria has long been known to human populations from across the world. In fact, the first mention of the symptoms of malaria comes from an ancient Chinese manuscript from 2700 BCE! However, the actual cause and mechanism of transmission of the disease was only discovered in the 19th century.

It was Charles Louis Alphonse Laveran, a French physician working in Algeria, who first observed the parasites that cause malaria in 1880, by looking at the blood of a patient that had recently died of malaria. However, at this point, it still wasn’t understood how malaria was transmitted. That was not discovered until 1897, when Ronald Ross, a British physician dedicated to curing malaria, observed malaria parasites in a mosquito that had been experimentally fed the blood of a patient infected with malaria. Working in India, Ross also later showed that mosquitoes could also transmit malaria to birds, if they had previously fed on the blood of birds which had malaria. In this way, he showed that mosquitoes of the genus Anopheles are responsible for transmitting malaria between hosts.

Sterilizing Mosquitoes to Fight Malaria

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QUESTION

Is it possible to breed mosquitoes in the laboratory and then sterilize them and release them into the environment in order to reduce their rate of reproducing.

ANSWER

That is a very good question, and indeed efforts to genetically modify mosquitoes in order to control the various diseases they transmit are underway in many laboratories across the world.

For almost 15 years, scientists have had the ability to modify mosquitoes so that they are sterile. The aim, as you rightly describe, is then to release these sterile mosquitoes into the wild in order to reduce numbers. If the gene that causes sterility can be passed to future offspring, without any reduction in survival of the insect, then the eventual result will be a total population extinction.

To date, many of the major mosquito disease vector species have been successfully genetically modified, though there are many fewer instances of field testing of these modified insects. For example, in 2000/2001, a World Health Organisation-led project in India created sterile mosquitoes of one species of each of the three main disease vector genera: Culex, Aedes and Anopheles, the latter of which acts as vectors for malaria. However, the project did not, in the end, release any of the modified Anopheles vectors into the wild.

While many scientists applaud the benefits of this approach (such as being very species-specific and being more environmentally friendly than spraying), there are also causes for caution. For example, there are concerns that the loss of mosquitoes in the food chain will have a negative impact on animals that rely on them for food. Similarly, if mosquitoes vanish from an ecosystem, their “niche” may be filled by another organism that is equally or even more dangerous and destructive, such as a crop pest or another disease vector. There is also a worry that changing mosquitoes may have unexpected and dangerous effects on the disease itself, for example forcing it to evolve into a more severe disease or changing its epidemiological patterns in ways we cannot predict in advance.

Finally, not all scientists are convinced that the approach will work in the first place—the sterile mosquitoes will have to survive equally well or better than normal mosquitoes in order to establish in the population, and must be equally or more successful at reproducing. As such, while a lot of money is being poured into GM mosquitoes, it is still the center of vigorous debate.

Perhaps the best indication of this controversy came last year, when Oxitec, a British company, released sterile Aedes aegypti mosquitoes on the Cayman Islands. These mosquitoes are the vectors of dengue fever, and so all eyes are on this study to see whether indeed sterile mosquitoes can survive in a population, and if they do, what other effects they will have longer term on the population size of mosquitoes and the rest of the ecosystem. You can read more information about that here: Oxitec: GM Mosquito Factory.

Distribution of Malaria

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QUESTION

Where does malaria mostly take place?

ANSWER

Malaria is mainly transmitted in tropical regions of the world; while some transmission does occur outside of the tropics, it tends to be seasonal in these areas (i.e. usually only during periods of high temperature/high rainfall). Within the tropics, malaria is found on all continents, though the highest number of cases is in Africa, which is also where over 90% of deaths due to malaria occur (of these, most are children under the age of 5). Outside Africa, the next highest levels of malaria are in India and south-east Asia and the western Pacific (such as Papua New Guinea).

What does the goverment do to help malaria?

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QUESTION

Does the goverment help malaria?

ANSWER

Many governments around the world assist in controlling malaria. Some countries, like Australia and the United States, used to have malaria transmission occur within their own borders, but through dedicated control programs, have managed to eradicate the disease locally. In these cases, the government coordinated huge programs of draining standing water, spraying insecticides and ensuring that health clinics were equipped to diagnose and quickly treat any human cases.

Nowadays, the governments of the US and Australia, along with many other countries which do not have malaria, still assist in the fight against malaria by funding malaria control programs in other countries, either directly (for example, the US funds international health projects through the US Agency for International Development) or indirectly, through international organisations like the World Health Organisation and the Global Fund for HIV, TB and Malaria. They also provide training in technical expertise to scientists, doctors and clinicians from malaria-endemic countries.

The governments of countries which have malaria are also deeply engaged in fighting the disease, mostly through their respective Ministries of Health, which often have specific malaria departments. In India, for example, malaria control is carried out by the National Vector Borne Disease Control Programme (NVBDCP), which is part of the Directorate General of Health Services. The NVBDCP carries out a multi-pronged strategy to combat malaria, including early case detection and treatment, vector control (with spraying, biological control and personal protection), community participation, etc. In Uganda, the Malaria Control Programme also carries out the above activities, and also provides intermittent preventative treatment against malaria for young children and pregnant women and has in the past engaged in large-scale distribution of long-lasting insecticide treated bednets. Both countries also explicitly include monitoring and evaluation as part of their control strategies, to make sure that any interventions or control efforts they make are having a positive impact on reducing malaria morbidity and mortality.

Frequent Fever

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QUESTION

I live in Mumbai,India. My mother’s age is 56. She is getting fever from last 1 month and also lost her appetite. We have tested for malaria but it is negative. Tried 4-5 doctors but no one is able to detect the exact cause. She feels better for 3-4 days after medication but then again gets a fever. She feels like vomiting while trying to eat something. Please help.

ANSWER

If the doctors have tested her for malaria and the test was negative, then she probably isn’t suffering from malaria. There are many other potential causes for her illness, from influenza to gastroenteritis. She should try to keep drinking plenty of fluids to stay rehydrated, and plain foods so as not to upset her stomach but keep her strength up. We are not able to give specific medical advice. If she is still feeling sick, you should consult another doctor and ask for a more comprehensive set of tests to determine the cause of illness (including blood tests and a faecal examination to look for parasites).

Annual Blood Examination Rate in Bengal

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QUESTION

What is the annual blood examination rate in West Bengal?

ANSWER

The annual blood examination rate (ABER) is a measure of the level of diagnostic monitoring activity. Data from 2007 suggested the ABER in West Bengal was around 5%, which is well below the level of 10% which is recommended for active surveillance and is the target of the National Vector Borne Disease Control Programme.

However, within West Bengal there is variation in the ABER both geographically and temporally. One study showed that in Naxalbari block in Darjeeling district, ABER in 2003 and 2004 was as low as 3.5%. The region experienced a malaria outbreak in late 2005, and the average ABER for this year soared as high as 16%; however, from January to May of 2005, before the transmission season and the outbreak, the ABER was only 0.5%! This means that monitoring efforts at the start of the outbreak were probably insufficient to detect the emergence of the outbreak and therefore delayed the process of responding to the emerging disease threat. Maintaining sufficient levels of malaria surveillance monitoring is particularly important in West Bengal, since this state is one of the major endemic centres for malaria in India, contribution about 11% of all malaria cases and about 6% of all cases of Plasmodium falciparum.

Treatment of Malaria in India

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QUESTION

In India how to treat a child and adult suffering from malaria?

ANSWER

Chloroquine-resistant malaria has been observed in India and so the first line drug of choice should be an artemisinin-derivative in combination with another drug (this group of medications are more generally known as “artemisinin-based combination therapies” or ACTs). A common example of this is artemether in combination with lumefantrine, which is marketed as Coartem. Coartem is also used to treat malaria in children over 11 pounds (5 kg) in weight.

Chloroquine Resistant Malaria

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QUESTION

What is chloroquine resistant malaria?

ANSWER

Chloroquine-resistant malaria is exactly what it sounds like—particular types of malaria which are not cured by treatment with chloroquine.

Chloroquine was first discovered in the 1930s in Germany and began to be widely used as an anti-malaria post-World War II, in the late 1940s. However, resistance to the drug also rapidly emerged, with the first cases of Plasmodium falciparum not being cured by administration of chloroquine being reported in the 1950s.

Since then, resistance has spread rapidly (since obviously it is beneficial to the parasite to be resistant, so various mutations conferring this protection have arisen multiple times in different areas in the world and also been passed on preferentially to new generations of malaria parasites), and now chloroquine resistant P. falciparum can be found globally in malaria-endemic areas.

Chloroquine resistance in Plasmodium vivax has also now arisen, though more recently—the first reports came from 1989, in Australia, in travellers returning from Papua New Guinea. Now, chloroquine resistant forms of P. vivax are found in multiple locations in south-east Asia, such as Myanmar and India, as well as from Guyana in South America.

Nowadays, other drugs, and notably ones containing artemisinin-based compounds, are preferentially used to treat uncomplicated malaria and especially in areas where chloroquine resistance is known to occur. However, due to fears of resistance to these compounds also developing, the World Health Organisation recommends that artemisinin-based compounds only be administered in conjunction with other anti-malaria drugs, such as lumefantrine (which in combination with artemether forms the widely-used anti-malarial treatment Coartem). These combinations are known as artemisinin-based combination therapies, or ACTs for short.