Troublesome genes

Artemisinin, a plant-based remedy, is one of the most effective drugs used to combat malaria. "In many countries where the [malaria] parasite has developed resistance to previously effective common treatments such as chloroquine, artemisinin remains the only effective treatment against the infection. However, malarial resistance to artemisinin appears to be developing, potentially creating problems in controlling malaria."

A recent study conducted "by scientists from the University of Edinburgh and the Universidade Nova de Lisboa, used emerging technology to scan the genetic fingerprint of drug resistant parasites that infect rodents. This technology allows rapid identification of genes that enable the parasite to withstand existing drug treatments", particularly the "gene that enables the parasite" to resist treatment with artemisinin.

Dr Paul Hunt, from the University of Edinburgh's School of Biological Sciences, said: "This knowledge from rodent malaria parasites opens up new directions that will allow this gene to be investigated in human malaria. This may help track the evolution of drug resistance and may eventually enable the design of alternative, effective drugs."


Sources:
Paul Hunt, Axel Martinelli, Katarzyna Modrzynska, Sofia Borges, Alison Creasey, Louise Rodrigues, Dario Beraldi, Laurence Loewe, Richard Fawcett, Sujai Kumar, Marian Thomson, Urmi Trivedi, Thomas D Otto, Arnab Pain, Mark Blaxter, Pedro Cravo. Experimental evolution, genetic analysis and genome re-sequencing reveal the mutation conferring artemisinin resistance in an isogenic lineage of malaria parasites. BMC Genomics, 2010; 11 (1): 499 DOI: 10.1186/1471-2164-11-499

University of Edinburgh (2010, October 12). Gene linked to drug resistance in malaria pinpointed. ScienceDaily. Retrieved October 16, 2010, from http://www.sciencedaily.com­ /releases/2010/10/101012101629.htm

Sweet incentives

Incentives to develop treatments for "neglected diseases including malaria, tuberculosis and leishmanaisis" may encourage drug companies to focus more on potentially life-saving research and development, declares a U.S. business professor. The suggested incentive comes in the form of a "priority review voucher", which "would give a company accelerated regulatory review of one of its other drugs as a reward for developing a treatment for neglected disease".

Although these diseases affect more than 1 billion people, they occur most frequently in developing nations, providing little financial incentive for pharmaceutical companies to create and test new treatments.

Writing in the Sept. 11 issue of The Lancet, professor David Ridley of Duke University's Fuqua School of Business and Alfonso Calles-Sánchez, a patent expert with the Spanish Patent Office and former pharmaceutical policy maker at the European Commission, propose a European Union version of the priority review voucher system instituted in the United States in 2007.

Bill Gates explained an example of such incentives at the 2008 World Economic Forum in Davos. "If you develop a new drug for malaria, your profitable cholesterol-lowering drug could go on the market a year earlier...This priority review could be worth hundreds of millions of dollars [to the company]," Gates said.


In the U.S., the vouchers and other incentives are working. Firms and drug companies are motivated to begin clinical testing; although, these drugs may take several years to reach patients in need. Still, any forward movement in these fields is improvement. With continued encouragement, drug companies may enact the demise of malaria and other currently neglected diseases.

Do you have ideas or suggestions for other incentives that may encourage the eradication of malaria?


Sources:
David B Ridley, Alfonso Calles Sánchez. Introduction of European priority review vouchers to encourage development of new medicines for neglected diseases. The Lancet, 2010; 376 (9744): 922-927 DOI: 10.1016/S0140-6736(10)60669-1

Duke University (2010, September 9). European Union could create incentive for new drug treatments, experts propose. ScienceDaily. Retrieved September 19, 2010, from http://www.sciencedaily.com­ /releases/2010/09/100909193359.htm

Image by Petar Marjanovic

A new treatment

A new anti-malarial drug may soon progress to clinical trials. This new treatment "is made from simple organic molecules and will be cheaper to mass produce compared to existing therapies."

Malaria is widespread and deadly. Many of the nearly 250 million people who contract the malaria parasite each year do not have access or cannot afford adequate treatment. Drugs that are easy and cheap to produce and distribute may save many of the nearly one million lives that are lost each year due to malaria infection.

With the goal of easing the cost of malaria eradication on poor countries and individuals, the research "team at Liverpool" has "created a synthetic drug based on the chemical structure of artemisinin, an extract of a Chinese herb commonly used in malaria treatment. The new drug, which can be taken orally, is more potent than naturally derived artemisinin."

"Malaria affects the world's poorest countries and hospitals are unable to afford expensive treatments. The problem with current artemisinin-based therapies is their limited availability, poor oral absorption and high cost. We have created a new drug that is easily absorbed by the body, chemically stable and highly potent. It is made from very simple organic materials and therefore will be more cost-effective to mass produce than current therapies," says Professor Paul O'Neill.

Artemisinin is known to interact with a substance inside parasite-infected red blood cells, causing a chain of events that destroys malaria. The treatment, however, is difficult to mass produce and can be chemically unstable in the body. Scientists have now found a way of creating the most reactive part of artemisinin synthetically and fusing it with a cage-like structure made of organic molecules to make the drug more chemically stable. The stability of the chemical structure in the body makes the drug last longer, reducing the chance of the parasite reappearing.

Source:
University of Liverpool (2010, August 16). New drug treatment for malaria?. ScienceDaily. Retrieved August 31, 2010, from http://www.sciencedaily.com­ /releases/2010/08/100816095715.htm

Biological warfare

Scientists from Johns Hopkins University are waging biological warfare against mosquitoes by using a "naturally occurring virus" that "may serve as a "late-life-acting" insecticide. The virus only affects adult mosquitoes, which "are responsible for the bulk of malaria transmission."

Malaria is a widespread and deadly disease that is transmitted by mosquitoes and kills approximately one million people each year. "Insecticides are one of the main strategies currently used to control malaria transmission[;] however, evolving resistance to such therapies continues to impact such efforts." Scientists now look to late-life-acting insecticides (LLAIs), which "selectively kill older mosquitoes that spread the disease, while younger mosquitoes survive just long enough to reproduce." In this way, LLAIs kill malaria transmitting mosquitoes without affecting the gene pool in a way that will stimulate the propagation of insecticide-resistant mosquitoes.

"Reproduction allows for relaxation of evolutionary pressures that select for resistance to the agent," say the researchers. "If resistance alleles exert fitness costs, there are theoretical scenarios under which resistance is not expected to evolve, leading some to provocatively term LLAIs as 'evolution-proof'."


Source:
American Society for Microbiology (2010, August 21). Virus may act as 'evolution-proof' biopesticide against malaria. ScienceDaily. Retrieved August 22, 2010, from http://www.sciencedaily.com­ /releases/2010/08/100820133238.htm

Ren et al. Potential for the Anopheles gambiae Densonucleosis Virus To Act as an "Evolution-Proof" Biopesticide. Journal of Virology, 2010; 84 (15): 7726 DOI: 10.1128/JVI.00631-10

Population at risk

Nearly 3 billion people live at risk of infection with Plasmodium vivax, one of the most common varieties of the blood-borne malaria parasite. A global distribution map, "published August 3 in the open-access journal PLoS Neglected Tropical Diseases," estimates that 2.85 billion people live in areas and conditions that put them at risk for contracting deadly malaria.

Malaria is a parasite that infects humans and is transmitted through the bite of an anopheles mosquito. Every year 250-500 million cases of malaria are reported, many malaria cases end in death. In recent years, scientists, doctors, and health-care workers have made progress against malaria. Still, more information is needed to truly understand how effective treatments and preventative techniques are against malaria and where these techniques still need to be applied.

"The map, created as part of the Malaria Atlas Project (MAP), a multinational research collaboration funded mainly by the Wellcome Trust, reviews a host of information that challenges the dogma that P. vivax transmission is absent through large swathes of Africa and uses novel methods...to estimate global populations at risk."

Of the nearly "3 billion people exposed to some risk of P. vivax" malaria transmission in 2009, 91% live in Central and South East Asia. It is important to note that "more than half of those exposed to this risk live in areas where P. vivax malaria transmission is extremely low or unstable". In these areas, prospects of sustained malaria control and "elimination are relatively good".

The authors of this study used the most recently available P. vivax data from reported cases for all malaria-endemic countries and classified risk into three classes: malaria free, unstable, and stable. Risk areas were further refined, and some regions were eliminated based on temperature, aridity, and isolation. Some urban regions known to be malaria-free were also excluded from the at-risk population estimate.

"This study represents the first step in our efforts to provide the malaria control and research community with an evidence-based cartography of P. vivax malaria," says co-author Dr. Simon Hay of the University of Oxford. "We can now focus on trying to model the endemicity of the disease to provide more detailed global burden estimates, although this is complicated by the unusual biology of P. vivax."

Co-author Dr Carlos Guerra adds: "New evidence shows that P. vivax malaria is not as benign as was thought, and yet, as our study shows, remains the most widespread form of human malaria. Understanding where transmission of this parasite occurs at the global scale is fundamental in planning strategies for the control of this debilitating, and often lethal, disease."

Further information about the Malaria Atlas Project can be found at www.map.ox.ac.uk.

Sources:
Guerra CA, Howes RE, Patil AP, Gething PW, Van Boeckel TP, et al. The International Limits and Population at Risk of Plasmodium vivax Transmission in 2009. PLoS Neglected Tropical Diseases, 2010; 4 (8): e774 DOI: 10.1371/journal.pntd.0000774

Malaria Atlas Project [MAP]. www.map.ox.ac.uk. Retrieved August 10, 2010.

Public Library of Science (2010, August 4). New estimates of the global population at risk of Plasmodium vivax malaria. ScienceDaily. Retrieved August 10, 2010, from http://www.sciencedaily.com­ /releases/2010/08/100803174854.htm

Antibiotics prevent malaria

Preventative malaria "treatment with affordable and safe antibiotics...has the potential to act as a 'needle-free' natural vaccine against malaria", according to a study published in the journal, Science Translation Medicine. This type of treatment "may likely provide an additional valuable tool for controlling and/or eliminating malaria in resource-poor settings."

During research, the multinational team "found that infection with malaria parasites during administration of preventative antibiotics developed a vaccine-like immunity against re-infection."

Approximately one million people die from malaria each year and nearly half of the world's population is at risk of contracting malaria, a mosquito-transmitted parasite. "Only an estimated 10 to 100 parasites per mosquito bite invade the liver where they replicate. About a week after infection, tens of thousands of parasites are released into the bloodstream where they are responsible for malaria's recurring fevers and cause life-threatening complications."

The proposed treatment attacks parasites "during their passage into the liver of the infected host. The "researchers showed that the antibiotics caused a cellular defect in malaria parasites...This action did not prevent parasite replication in the liver but blocked the malaria parasite's fatal conversion to the disease causing blood stage. The very late arrest of parasites in the liver allowed the immune system to mount a robust defense against subsequent infections." In this way, the body produces results that are comparable to vaccines that use weakened varieties of the parasite.

Further reading:
London School of Hygiene & Tropical Medicine (LSHTM) (2010, July 23). 'Needle-free' intervention as natural vaccine against malaria. ScienceDaily. Retrieved July 23, 2010, from http://www.sciencedaily.com­ /releases/2010/07/100723112711.htm

Outposts

Ten newly funded projects focus on regions where malaria is currently endemic. After receiving "$14 million in first-year funding from the U.S. National Institute of Allergy and Infectious Diseases (NIAID), 10 new research centers are joining the fight to control and ultimately eliminate malaria worldwide."

Malaria parasites infect about 250 million people each year and cause nearly one million deaths annually. Regions that are most plagued by malaria include parts of Africa, Asia, the Pacific islands, and Latin America. These areas are where the NIAID research centers will do the most good.

"The regions include some of the focus countries of the President’s Malaria Initiative, an effort that since 2005 has worked to fight malaria in parts of the world most affected by the disease."

“One of our primary goals with these centers is to fund cutting-edge research in malaria-endemic areas that will keep up with the rapidly changing epidemiology of the disease,” said NIAID Director Anthony S. Fauci.

Although malaria has already been eliminated from many parts of the world, "40 percent of the world’s population still lives in areas where they are at risk of contracting the disease."

Scientists and medical professionals at these new centers hope to find a way to end malaria. "The centers seek to integrate clinical and field approaches with laboratory-based immunologic, molecular and genomic methods. They will adapt their research to changes in malaria epidemiology and emerging research needs as well as opportunities within specific regions."



Source:
"US Health Institute Funds 10 Global..." America.gov. 09 July 2010. http://www.america.gov/st/scitech-english/2010/July/20100709163404frnedloh0.4317896.html

Antioxidants

Adding "antioxidant therapy to traditional antimalarial treatment may prevent long-lasting cognitive impairment in cerebral malaria", based on research from an experimental mouse model.

"Malaria, an infection caused by parasites that invade liver and red blood cells, is transmitted to humans by the female Anopheles mosquito. Malaria is one of the leading infectious diseases worldwide, affecting more than 400 million people and causing more than 2 million deaths each year, mainly among African children."

Cerebral malaria is a "potentially fatal neurologic complication of infection by the most-feared malarial parasite, Plasmodium falciparum." Cerebral malaria is known to cause life-long memory loss, learning impairment, and language and math deficits. Cognitive damage persists even after the malaria illness is cured.

"Cerebral malaria and its molecular mechanisms are under intense study, but the cognitive dysfunction that can persist in survivors in the aftermath of successful treatment has gone unrecognized until recently," says Guy A. Zimmerman M.D., professor and associate chair for research in the University of Utah School of Medicine's Department of Internal Medicine and a contributor to the study. "This complication may impose an enormous social and economic burden because of the number of people at risk for severe malaria worldwide. Our findings demonstrate that, by using experimental models of cerebral malaria in mice, we can explore mechanisms of cognitive damage and also examine potential treatments for reducing or preventing neurologic and cognitive impairment."

Scientists studied "the persistence of cognitive damage in mice with documented cerebral malaria after cure of the acute parasitic disease with chloroquine, an antimalarial therapy". Zimmerman and his colleagues "determined that impairment in memory skills was still present 30 days after the initial malaria infection. Cognitive deficits that persist for years after the episode of cerebral malaria have also been reported in 11 percent to 28 percent of children who survive the infection."

The researchers believe that "it is possible that the mechanisms for persistent cognitive deficits are independent of those that cause neurological injury and death during acute cerebral malaria". They have been able to "demonstrate that oxidative stress is present in the brains of mice infected with cerebral malaria."

Oxidative stress is an imbalance between the production of reactive oxygen-containing molecules. The imbalance "can damage cell structures and the body's ability to detoxify these molecules or repair the resulting damage."

The research group found that "treating mice with a combination of chloroquine" and antioxidant agents "at the first signs of cerebral malaria prevented both inflammatory and vascular changes in the tissues of the brain, as well as the development of persistent cognitive damage." Furthermore, the antioxidants did not diminish the efficacy of the antimalarial.

Although, antioxidants may not treat malaria directly, they may stave off one of the most dreaded results of enduring cerebral malaria.

Source:
University of Utah Health Sciences (2010, June 28). Antioxidants may help prevent malaria complicaton that leads to learning impairment. ScienceDaily. Retrieved July 9, 2010, from http://www.sciencedaily.com­ /releases/2010/06/100625131416.htm

Sponging up the mess

"Healing powers for one of the world's deadliest diseases may lie within sponges, sea worms and other underwater creatures." Malaria, a blood-parasite transmitted by mosquitoes, kills nearly a million people each year and infects hundreds-of-thousands of humans. The battle against this deadly disease has forced scientists to look in unlikely places for a cure. Now, they're even looking in depths of the sea.

"University of Central Florida scientist Debopam Chakrabarti is analyzing more than 2,500 samples from marine organisms collected off deep sea near Florida's coast. Some of them could hold the key to developing drugs to fight malaria". Nothing has been proven yet, but Chakarabarti is optimistic. "One active sample" that he tested, "derived from a marine sponge, contained the compound Nortopsentin. Because of this compound's initial promise" at combating disease, Chakrabarti has "already filed an application for patent protection." With assistance from two graduate students, Chakrabarti has "conducted preliminary testing of more than 2,500 samples from the Harbor Branch collection. They conducted tests to evaluate growth inhibitory properties of these samples for malaria parasite growing inside human red blood cells in culture."

Chakrabarti's approach of looking to marine sources for disease treatment is not new. He follows in the footsteps of modern scientists and ancient medics.

In the meantime, Chakrabarti is concerned how the Gulf of Mexico's oil spill will affect his work. "He's also concerned...that the...oil spill may wipe out species that could hold healing properties for many deadly diseases."

"If we can find two or three good molecules that can be easily synthesized in a lab and that can prevent malaria, I'd be very happy," he said.


Source:
University of Central Florida (2010, June 28). Underwater sponges and worms may hold key to cure for malaria. ScienceDaily. Retrieved June 30, 2010, from http://www.sciencedaily.com­ /releases/2010/06/100628124601.htm

Yellow Fever

“Malaria is one of the most pressing health crises of developing countries: in communities stricken by infection, attendance at work and school drops, and poverty deepens…There is no vaccine for malaria, which sickens almost a quarter of a billion people each year and kills a child every 30 seconds.” Scientists race to change those statistics, exploring various avenues for human vaccination and malaria eradication. Recently, “researchers at The Rockefeller University have genetically transformed the yellow fever vaccine to prime the immune system to fend off the mosquito borne parasites that cause the disease. The researchers found that the modified vaccine, along with a booster, provided mice with immunity to the deadly disease.”

“It has been known since the 1960s that” the sporozoite, one form of the malaria parasite “can wake up the immune system and help to protect against future infection.” Unfortunately, the only known “way to gather sporozoites…is to pluck them one-by-one from the salivary glands of irradiated, malaria-ridden mosquitoes. To provide immunity, the attenuated parasites must then be injected in high doses” or “delivered by the bites of hundreds of mosquitoes”, which is “a labor intensive approach not feasible for large-scale use.”

In an effort to find a better way to achieve the “benefits of sporozoite immunization”, scientists, led by Charles Rice, thought “that fighting infection with infection might be the key. They began experimenting with the attenuated yellow fever strain used in the yellow fever vaccine, known as YF17D, which has been used to successfully vaccinate more than 400 million people since 1937. Previous work in the Rice laboratory and by others had shown that this vaccine strain could be modified to include short sequences from other pathogens, including malaria.”

“Immunization of mice with the YF17D-CSP vaccine led to a measurable jump in immune activity against the malaria protein, but the single shot was not enough to protect the animals from infection with the mouse form of the malaria parasite.” The scientists added a booster shot, and discovered that “vaccination with YF17D-CSP plus the sporozoites protected 100 percent of the animals against infection.”

Sources:
Stoyanov et al. Immunogenicity and protective efficacy of a recombinant yellow fever vaccine against the murine malarial parasite Plasmodium yoelii. Vaccine, 2010; 28 (29): 4644 DOI: 10.1016/j.vaccine.2010.04.071

Rockefeller University (2010, June 11). Yellow fever vaccine modified to fight malaria. ScienceDaily. Retrieved June 13, 2010, from http://www.sciencedaily.com¬ /releases/2010/06/100611222839.htm

Malaria in Venezuela

Miners, in search of gold and diamonds, fear a plague of malaria. “These workers have long caught the disease by venturing into forests where malaria-carrying mosquitoes live. Their strip-mines destroy patches of forest, leaving behind muddy pools and water contaminated with the mercury they use to separate gold from rock.”

“Malaria cases have doubled in Venezuela so far this year as health officials confront an epidemic in a vast southern region where wildcat gold miners are often infected in remote jungle camps.”

Last year, the country reported 10,758 malaria cases. Already this year, 21,601 cases have been recorded. Most patients “were diagnosed in southern Bolivar state, where government officials say there is an epidemic. The statistics, which are updated weekly and circulated among some health officials, cover the period running from the start of the year through May 22.”

“Public health officials attribute the rise in malaria cases in part to a government-led operation this year in which soldiers have evicted thousands of miners from their illegal strip-mines.”

This government initiative displaced miners, who sought refuge in towns. With them, they brought disease and spread malaria into areas that were previously clean.

Dr. Ana Gineth Morales, who heads the Bolivar state Public Health Institute, expected this surge in malaria cases. “It hasn't taken us by surprise," Morales asserts, reassuring interviewers that her agency had been fully prepared. The Public Health Institute is “efficient in diagnosing, detecting." Despite the increase in cases of malaria, few people have died.

But some critics say the malaria situation appears to be out of control.

"We expect malaria cases will keep increasing," said Dr. Angel Granados, of the Bolivar state Medical Association. Granados cites the recent rain and continual movement of miners as contributing causes. “Public health teams haven't been reaching many remote areas including indigenous communities to detect and treat cases,” Granados said.

Granados reminded officials that, earlier this year, one Yekuana Indian community “reported six deaths — including three children and three adults — that came after they suffered high fevers and appeared to be due to malaria. But he said state health officials ruled out malaria saying the deaths were due to other causes and did not include them in their tally.”

Source:
James, Ian. “Malaria epidemic hits southern Venezuela.” Associated Press. 5 June 2010.

Cerebral malaria

“Scientists are making strides against cerebral malaria, a fatal form of malaria in children that can ravage the brain and is extremely difficult to treat.” Cerebral malaria causes inflammation in the brain, which leads to “the obstruction of blood vessels” and results in brain damage. “New research points to platelets -- known for their role in blood clotting -- as playing an important role in the disease, stimulating the immune system and turning on molecules that increase inflammation.”

Scientists at the University of Rochester Medical Center conducted this study as “part of an ongoing effort to better understand the origin and development of cerebral malaria, which predominantly affects children under the age of 10 living in malaria-endemic areas, such as sub-Saharan Africa.”

"Malaria is a complex disease and we need to look at it from every possible angle, focusing on both vaccine research and basic research, as we've done in this study," said Craig Morrell, D.V.M., Ph.D., assistant professor within the Aab Cardiovascular Research Institute at the Medical Center and lead author of the study. "Our findings increase our knowledge of cerebral malaria and suggest that targeting platelets may prove to be a viable intervention strategy."

Malaria is responsible for approximately 1 million deaths each year. 250-500 million people are afflicted with malaria annually, yet malaria is treatable. Efforts to eradicate malaria are being made internationally. “While research efforts are mainly focused on vaccine development, new therapies to treat malaria are needed, as the parasite that causes malaria -- Plasmodium falciparum -- is becoming resistant to current treatments.”

Morrell's team studies “the development and progression of cerebral malaria, with the goal finding new ways to intervene and treat the disease.” Malaria occurs when the specific parasite infects red blood cells. These infected “blood cells activate platelets, which secrete a key protein…whose job it is to protect against foreign intruders -- in this case, the malaria parasite -- by turning on pro-inflammatory cells, known as monocytes. Monocytes contribute to the inflammation in the blood vessels that leads to obstructions in the brain.”

This study has shown scientists that “the role of platelets is more complex than they initially thought. Ongoing research will focus on when to intervene and influence the activity of platelets, as timing has been found to make a marked difference in the outcome. Additionally, scientists at Rochester are collaborating with researchers from Johns Hopkins University to look at drugs that are approved for the treatment of other conditions to see if they might be effective in treating cerebral malaria.”

Sources:
Kalyan Srivastava, David J. Field, Angela Aggrey, Munekazu Yamakuchi, Craig N. Morrell, Pieter H. Reitsma. Platelet Factor 4 Regulation of Monocyte KLF4 in Experimental Cerebral Malaria. PLoS ONE, 2010; 5 (5): e10413 DOI: 10.1371/journal.pone.0010413

University of Rochester Medical Center (2010, June 1). Cerebral malaria: Scientists advance understanding of deadly form of malaria in children. ScienceDaily. Retrieved June 2, 2010, from http://www.sciencedaily.com¬ /releases/2010/06/100601114639.htm

Photo from Davidson College: http://www.davidson.edu/academic/psychology/ramirezsite/neuroscience/psy324/rebergner/malariabrain.jpg

In the midst of global warming

Doomsday reports of malaria epidemics, stirred by global warming, have reared ominously for decades. New studies show that contrary “to a widespread assumption, global warming is unlikely to expand the range of malaria because of malaria control, development and other factors that are at work to corral the disease.”

“Scientists and public policy makers have been concerned that warming temperatures would create conditions that would either push malaria into new areas or make it worse in existing ones.” But a team of scientists, “including two University of Florida researchers, … analyzed a historical contraction of the geographic range and general reduction in the intensity of malaria -- a contraction that occurred over a century during which the globe warmed. They determined that if the future trends are like past ones, the contraction is likely to continue under the most likely warming scenarios.”

"If we continue to fund malaria control, we can certainly be prepared to counteract the risk that warming could expand the global distribution of malaria," one researcher said.

Malaria “control efforts over the past century have shrunk the prevalence of the disease”. "The globe warmed over the past century, but the range of malaria contracted substantially," Researcher Tatem said. "Warming isn't the only factor that affects malaria."

Reduction in malaria prevalence is attributed to mosquito control efforts, better health care, urbanization, and economic development. “The banned pesticide DDT was instrumental in ridding the disease from 24 countries in Southern Europe, the former Soviet Union and elsewhere in the world between 1955 and 1969.” “Researchers debate how the U.S. defeated malaria, but the reduction of mosquito breeding grounds, improved housing and reduced emphasis on agriculture that comes with development -- and the reduced risk of bites that accompanies urbanization -- probably played a role,” according to Researcher Smith.

"Malaria remains a huge public health problem, and the international community has an unprecedented opportunity to relieve this burden with existing interventions," Simon Hay, author of the Nature paper, said. "Any failure in meeting this challenge will be very difficult to attribute to climate change."


Sources:
Peter W. Gething, David L. Smith, Anand P. Patil, Andrew J. Tatem, Robert W. Snow, Simon I. Hay. Climate change and the global malaria recession. Nature, 2010; 465 (7296): 342 DOI: 10.1038/nature09098

University of Florida (2010, May 19). Malaria control to overcome disease’s spread as climate warms. ScienceDaily. Retrieved May 27, 2010, from http://www.sciencedaily.com­ /releases/2010/05/100519143413.htm

Threatening malaria

"Malaria parasites can detect when they are being threatened and change their behaviour to survive, new research has suggested." Changes in behavior may "explain how malaria" resists "drug treatment".

The study, conducted in Edinburgh, provides insight that "could lead to better control of the disease."

"Caused by a parasite called Plasmodium, malaria is spread through the bites of infected mosquitoes and kills around a million people in the world each year. Some of the parasites multiply in the bloodstream and others change into a specialised transmission form, which enables the disease to spread."

The study indicates that "when exposed to low doses of anti-malarial drugs, this delicate balance of replicating and transmitting is upset." Malaria parasites respond to the drugs by attempting to increase "their chances of survival through a safety-in-numbers strategy: they produce fewer transmission forms and concentrate more on replication."

Malaria illness produces symptoms in a cyclical pattern. This pattern corresponds with the reproduction of the parasite. "If drugs push parasites into producing more replicating stages, which cause the symptoms, then this may lead to more serious illness," says Dr. Sarah Reece, from the University of Edinburgh's school of biological sciences. "This study uncovers a new way that parasites are able to resist the effects of drugs. This is also likely to have important implications for human disease control strategies."



Source:

Reece, Sarah. Proceedings of the Royal Society. The Press Association. 19 May 2010. http://www.google.com/hostednews/ukpress/article/ALeqM5h42KsAItyKjo2vyhBDIMEBvAOdNA

Containment cells

When a human hurts another, the solution is often to restrict the aberrant human to a containment cell. The same principle may be applied to malaria parasites to prevent them from killing their human host.

Seeking to "block invasion of healthy red blood cells by malaria", researchers at the Harvard School of Public Health have "succeeded in locking the parasites within infected blood cells, potentially containing the disease."

"The findings reveal an essential step in the biology of the most common and severe malaria parasite, Plasmodium falciparum, and offer a new drug target for fighting one of the world's most common and dangerous infections."

"Working with the malaria parasite...the research team identified a single fast-acting protein …that enables it … to escape from a human red blood cell in preparation for quick invasion of many more healthy blood cells." If the protein is eliminated, then the escape plan is foiled.

Malaria parasites reproduce in red blood cells, producing up to 32 offspring every two days. Then, the parasites "burst out to infect more red blood cells."

"This is the stage where things have to happen very fast for the parasite," said senior author Manoj Duraisingh, HSPH assistant professor of immunology and infectious diseases and senior author of the paper in the May 14 Science. "The parasite doesn't like to spend much time outside the cell. It grows and matures, and immediately following rupture, enters a new cell. It was a surprise that this protein kinase, which we thought would be involved in red blood cell invasion, turns out to be essential for the parasite getting out of the cell."

"When the parasite gets out of the red blood cell, it has a matter of seconds or minutes to get into new red blood cells, or it will be cleared or killed by the human immune system."

Fortunately, this particular protein "is found in the parasite and in plants, but not in humans, which means a drug targeted to that protein may be less toxic for people."


Read more: Harvard School of Public Health (2010, May 14). New twist on potential malaria drug target acts by trapping parasites in cells. ScienceDaily. Retrieved May 16, 2010, from http://www.sciencedaily.com¬ /releases/2010/05/100514171912.htm

Source:
J. D. Dvorin, D. C. Martyn, S. D. Patel, J. S. Grimley, C. R. Collins, C. S. Hopp, A. T. Bright, S. Westenberger, E. Winzeler, M. J. Blackman, D. A. Baker, T. J. Wandless, M. T. Duraisingh. A Plant-Like Kinase in Plasmodium falciparum Regulates Parasite Egress from Erythrocytes. Science, 2010; 328 (5980): 910 DOI: 10.1126/science.1188191

Childhood deaths

"Preventable infectious diseases cause two-thirds of child deaths, according to a new study published by The Lancet." Based on information provided by the World Health Organization (WHO) and UNICEF's Child Health Epidemiology Reference Group (CHERG), the study examined causes of childhood death in 193 countries. "While the number of deaths has declined globally over the last decade, the analysis reveals how millions of children under five die every year from preventable causes."

It is estimated that 8.8 million children die annually. Over 5.5 million children die from pneumonia, diarrhea, malaria, and other infectious diseases. These diseases are preventable and treatable, but many victims are unable to reach or afford prophylactics or proper medical care.

"These findings have important implications for national programs," said UNICEF Chief of Health, Dr. Mickey Chopra. "The persistence of diarrhea, pneumonia and malaria, all of which are easily preventable and curable but which nonetheless remain the leading single causes of death worldwide, should spur us to do more to control these diseases."


Read more: Johns Hopkins University Bloomberg School of Public Health (2010, May 12). Infectious diseases caused two-thirds of the nearly 9 million child deaths globally in 2008. ScienceDaily. Retrieved May 12, 2010, from http://www.sciencedaily.com¬ /releases/2010/05/100511201732.htm


Source:
Robert E Black, Simon Cousens, Hope L Johnson, Joy E Lawn, Igor Rudan, Diego G Bassani, Prabhat Jha, Harry Campbell, Christa Fischer Walker, Richard Cibulskis, Thomas Eisele, Li Liu, Colin Mathers, for the Child Health Epidemiology Reference Group of the World Health Organization and UNICEF. Global, regional, and national causes of child mortality in 2008: a systematic analysis. The Lancet, 2010; DOI: 10.1016/S0140-6736(10)60549-1

Safer anti-malarials

In the arms race against malaria, humans wield the biggest weapons, but their cost is great. In recent years, malaria has mutated and adapted to resist the drugs used to combat it. Caused by a parasite and transmitted by mosquitoes, malaria is an infectious disease that kills nearly one million people each year. Humans struggle to prevent malaria transmission and to treat those infected with the deadly disease.

Unfortunately, some of the malaria treatments are potentially deadly as well. "Amodiaquine was introduced as an antimalarial drug, but. . . withdrawn from the market when it became clear that the drug caused serious adverse effects in the form of liver damage and impaired immune system." The drug is still used in the most severe cases of drug-resistant malaria. It saves lives, but endangers them as well.

Endeavoring to create safer drugs, scientists at the University of Gothenburg, Sweden, studied the byproducts of drugs, looking for toxins. "A pharmaceutical in the body is, in the optimal case, broken down into harmless products (metabolites) that leave the body, for example via the urine. Some pharmaceuticals, however, can be converted into toxic products, which may result in serious adverse effects." Proposed by Tove Johansson Mali'n, the scientists uncovered a process that can "simulate the metabolism of pharmaceuticals in the body". In this way they can identify and characterize several potentially toxic products that arise as the metabolites of drugs". With the aid of this methond, Mali'n "has now managed to identify. . . previously unknown metabolites that may have caused, or contributed to, the adverse effects of amodiaquine."

"We hope that the method can simplify the work of identifying potentially toxic metabolites at an early stage, and thus facilitate the development of safe drugs," says Tove Johansson Mali'n.

Tove Johansson Mali'n, Lars Weidolf, Neal Castagnoli, Ulrik Jurva. P450-catalyzed vs. electrochemical oxidation of haloperidol studied by ultra-performance liquid chromatography/electrospray ionization mass spectrometry. Rapid Communications in Mass Spectrometry, 2010; 24 (9): 1231 DOI: 10.1002/rcm.4505
University of Gothenburg (2010, May 9). New method for developing safer drugs. ScienceDaily. Retrieved May 10, 2010, from http://www.sciencedaily.com¬ /releases/2010/05/100509202645.htm

Quiescence

How does a vampire avoid that which kills him? He plays dead.

Plasmodium falciparum, a deadly disease known as malaria, proves just as apt to play dead as a fictive vampire facing the sunlight. Humans had a secret weapon against malaria. "Artemisinin (ART), a substance extracted from a Chinese plant," was "the first-line drug for malaria," since other compounds lost their efficacy from overuse and parasite mutation. Artermisinin-based Combination Therapies (ACT) were "the most effective treatment for malaria, achieving a 95% cure rate."

Then, malaria played dead.

In July 2009, artemisinin-resistant malaria was identified in South East Asia. Scientists, desperate to determine how malaria avoided their once brutal weapon, ran laboratory studies.

Françoise Benoit-Vical and his team at Laboratoire de Chimie de Coordination (CNRS) "sought to isolate ART-resistant strains in an experimental manner. This feat was achieved at the end of 2009 when the scientists managed to obtain a strain of Plasmodium falciparum that was resistant to this compound and some of its derivatives, and the first to be adapted to in vitro culture." In the process, the "researchers also identified and characterized a new mode of parasite resistance. To evade the action of ART, Plasmodium falciparum arrested its development and entered a so-called state of quiescence [temporary inactivity]. It thus functioned at a slow metabolic rate until the drug was eliminated", at which time, it would reawaken and wreak havoc again.

"Malaria still continues to kill nearly a million people each year throughout the world. There is no vaccine against this infectious disease", which is caused by a blood parasite and transmitted by mosquitoes."

This study demonstrated "a novel resistance mechanism" and provides "important tool that will allow a clearer understanding of the mechanisms of resistance to antimalarial drugs". Scientists plan further studies in order to "identify the genes responsible for the acquisition of ART resistance."

Sources:
Physorg.com. "How the parasite responsible…" 5 May 2010. http://www.physorg.com/news192300284.html
Witkowski B, Leličvre J, López Barragán MJ, Laurent V, Su XZ, Berry A, Benoit-Vical F. "Increased tolerance to artemisinin in Plasmodium falciparum is mediated by a quiescence mechanism." Antimicrobial Agents and Chemotherapy. Mai 2010.

Pooling resources

South Africa aims to "speed development of drugs for neglected tropical diseases by freely sharing patented information owned by drug companies and academic institutions." The country "will use a new 'patent pool' to work on new drugs for tuberculosis and malaria, making it the first government to take advantage of the industry-led idea."

After GlaxoSmithKline set up a pool to share patents, in the effort to create an effective malaria vaccine, South Africa saw the possibility to use vast research from various channels to create medications that will change the world.

"The pool contains more than 2,300 patents that are available for use by industry, non-profit groups and academic researchers to develop new medicines for malaria, cholera and more than a dozen other diseases."

"This patent pool is an enormous boost for us to have a significant impact in South Africa," according to Mamphela Ramphele, chairwoman of the South African Technology Innovation Agency. "Her agency will coordinate and nurture drug development among local companies".

The patent pool is a tremendous wealth of information, providing not only "free use of patents, but also know-how and expertise".

"Frankly, expertise and know-how are often some of the more valuable aspects of drug development, and also things that companies don't usually share," says Melinda Moree, chief executive of BIO Ventures for Global Health. "This pool has both of these things (patents and expertise), which I think makes it fairly unusual."

"Moree said other large drug companies are interested in signing up to the pool, but would not name them. The pool contains patents for compounds that have a potential to be developed into drugs."

The pool opens "up the innovation process around drug development for neglected disease." Millions of people suffer every day. "Drug development has lacked. Tens of millions of people are too poor to pay for the drugs". "This is really a step on the part of industry to try a new model around one of the things that has sparked contentious debate around intellectual property," Moree said.'

In the past, some pharmaceutical companies received criticism for "fiercely backing patents that blocked cheaper competitors, even in the poorest countries, where brand-name medicines were unaffordable." GlaxoSmithKline and some other companies responded by "selling AIDS drugs in certain areas without a profit and offering licenses to generic makers." Companies and countries are now joining together with the common goal of disease eradication at all costs.


Source:
Steenhuysen, Julie. "S. Africa taps patent pool for neglected diseases." Reuters. 5 May 2010.

Malaria in Ethiopia

In 2005, US President George W. Bush instituted the President's Malaria Initiative (PMI) to "fight malaria in the region most affected by the disease. The President committed. . . $1.2 billion in malaria funding to this Initiative with the goal of reducing malaria-related deaths by 50 percent in 15 focus countries", including Ethiopia.

Five years later the PMI is still going strong. On the 26th of April 2010, "[t]housands of Long-Lasting Insecticidal Nets, or mosquito bed-nettings, were handed out by a U.S. Army Civil Affairs team to the people" in malaria-endemic regions of Ethiopia.

"We are distributing 35,000 nets to a population of approximately 93,000 people," said Lieutenant Daniel Deckard, commander of the Civil Affairs team, Combined Joint Task Force-Horn of Africa. "That's approximately two nets per household," he said.

The distributed nets are treated with insecticides to repel and kill mosquitoes in addition to serving as a physical barrier between humans and flying insects. Insecticide treated nets are estimated to be twice as effective as standard nets and may reduce malaria transmission by up to seventy percent (when used correctly). Participants in the PMI not only distribute nets, they are also "properly installing the nets in optimal locations within homes and are giving directions and other vital information to homeowners about proper use to minimize possible hazards and maximize protection" against malaria.

Malaria "is one of the leading causes of the deaths of pregnant women and children under five years of age in Africa. . .Malaria is a blood-borne infection caused by parasites and transmitted to people by the bite of female Anopheles mosquitoes, which are active from dusk to dawn, according to the PMI website. Malaria usually begins as a flu-like illness with fever and chills. Mild to moderate anemia is also common because the malaria parasite infects and destroys red blood cells."

Untreated, malaria may cause severe anemia, organ failure, coma, and death.

Based on the annual reports (reporting began in 2006), malaria relief efforts are producing results. For example:
* Zambia has seen a 10% decrease in malaria cases
* In Rwanda, child mortality rate has dropped from 168 deaths/1,000 to 119 deaths/1,000
* Infant mortality rate in Tanzania has also dropped

The initiative expects to see similar or better improvements in Ethiopia.


Sources:
Barnett, Robert. "Fighting Malaria in Ethiopia". The Ethiopian Review. 4 May 2010. http://www.ethiopianreview.com/articles/32007

PMI: Saving Lives in Africa. http://www.fightingmalaria.gov/

Hope for Haiti

Spraying DDT in 1958 as part of The United States' National Malaria Eradication Program

The source article for this post should be considered an editorial, and it expresses the opinions of Henry I Miller.

Is there a hope for Haiti?

"On top of the almost unimaginable devastation caused by January's earthquake in Haiti, the nation is bracing for the ravages of the rainy season." Torrential downpours already flood homes and turn "tent cities into muddy misery. Ominously, the number of cases of malaria, which is spread by the bite of mosquitoes and which was endemic in Haiti even before the earthquake, is increasing."

Aid groups plan to distribute over three million bed nets in order to minimize the number of malaria cases. However, this "ultra-low-tech" solution stands as "only modestly effective intervention". "What is really needed is the chemical DDT, an old, cheap and safe tool to control the vector -- the Anopheles mosquito -- that spreads the disease."

"Malaria is a scourge of humanity, particularly for the inhabitants of poor tropical countries." Over forty percent of the world's population lives at-risk for contracting malaria. 350 to 500 million cases of malaria occur worldwide each year. It is "a crushing economic burden on malaria-endemic countries" and impedes economic growth.

Once contracted, malaria is treatable. "A drug called chloroquine is a useful preventive but many strains of the malaria parasite in Haiti have developed resistance to it." Artemisinin-combination medicines "are safe and exhibit potent, rapid antimalarial activity", but resistance to these drugs is also rising. It is clear "that in the absence of a vaccine", "elimination of the mosquitoes that spread the disease is the key to preventing epidemics."

"Unfortunately, flawed public policy limits the available options."

Humans, armed with the weapon of DDT, are capable of destroying the deadly mosquito population; however, "on the basis of data on toxicity to fish and migrating birds" the U.S. Environmental Protection Agency (EPA) banned "virtually all uses of the pesticide DDT" in 1972. Subsequently, DDT was banned for "agricultural use worldwide under the 2001 Stockholm Convention on Persistent Organic Pollutants, which stigmatized the chemical and effectively constituted a prohibition."

"Although DDT is a (modestly) toxic substance, there is a vast difference between applying large amounts of it in the environment -- as farmers did before it was banned -- and using it carefully and sparingly to fight mosquitoes and other disease-carrying insects."

DDT is an effective pesticide because it is long lasting, and it works by poisoning and repelling mosquitoes. Treatment of mosquito breeding grounds prevents malaria transmission by reducing the insect population. Spraying DDT in homes and on door frames repels adult mosquitoes and prevents malaria transmission within the home. Because of its dual effectiveness, it is logical to assume that DDT will help prevent malaria even if mosquitoes develop resistance to it…a resistance that is yet to manifest.

"Since the banning of DDT, insect-borne diseases such as malaria and dengue have been on the rise. In fact, the huge toll of diseases spread by mosquitoes caused some public health officials to rethink DDT's use…In 2006, after some 50 million preventable deaths, the U.N.'s World Health Organization reversed course and endorsed the use of DDT to kill and repel malaria-causing mosquitoes."

"Poor tropical countries like Haiti where malaria is endemic desperately need cheap, effective control of mosquitoes. Instead of continuing the politically correct stigmatization of DDT, United Nations agencies and NGOs such as the Red Cross should be rushing supplies of it to Haiti."

Henry I. Miller, a physician and molecular biologist, is a fellow at Stanford University's Hoover Institution. He was an official at the NIH and FDA.

Read more: http://www.miamiherald.com/2010/05/03/v-fullstory/1610610/ddt-can-stymie-malaria-carrying.html#ixzz0mvfg9aS4

Source:
Miller, Henry I. "DDT can stymie malaria-carrying mosquitoes in Haiti." Miami Herald. 3 May 2010.

Never too young or too small

Determined to help prevent needless deaths from malaria, middle school students in Westfield, Massachusetts set a lofty fundraising goal of $5,000. They raised money to purchase mosquito nets through the Nothing but Nets program, which sends mosquito nets to families in Africa. After learning that experts estimate that "one child dies every 30 seconds from malaria", this group of 93 students diligently campaigned to save lives.

Their fund-raising project succeeded in meeting and surpassing their goal. The seventh-grade students "raised more than $18,000 for the cause". For their efforts, the director of Nothing but Nets, Adrianna Logalbo, "presented the students with the first ever Notable Net Raisers Award". Mozzie the Mosquito, the project mascot, joined Logalbo in praising the fund-raising effort.

"Logalbo said that with the assistance of North Middle School the project has sent more than 3 million mosquito nets to families in Africa. She said the project was started four years ago and has raised over $30 million."

Donate to Nothing But Nets

Source:
LaBorde, Ted. "Westfield students raise money to fight malaria…" The Republican. 2 May 2010. http://www.masslive.com/news/index.ssf/2010/05/westfield_students_raise_money.html

Banishing malaria

"On Hispaniola, home to the nations of Haiti and the Dominican Republic, malaria is caused by a single mosquito-borne parasite, Plasmodium falciparum" (Joseph). Hispaniola remains as "the last island in the Caribbean where the disease occurs regularly." Researchers from Tulane University claim that "success in eliminating malaria from Hispaniola would demonstrate that it is possible to defeat malaria in other regions of the world where it remains a dire threat. There is also evidence in Haiti that the parasite is becoming resistant to chloroquine, an inexpensive treatment for the disease. Eliminating malaria now would save these impoverished nations from having to resort to more expensive drug therapies."

In order to banish malaria from Hispanola, the countries must adopt more intensive mosquito-control methods. Every suspected malaria case should be diagnosed properly and treated.

"Success will require the 'unwavering political will' of both governments on the island, and will 'set a precedent for health diplomacy'"(Tulane).


Sources:

Joseph Keating, Donald J Krogstad, Thomas P Eisele. Malaria elimination on Hispaniola. The Lancet Infectious Diseases, 2010; 10 (5): 291-293 DOI: 10.1016/S1473-3099(10)70075-X

Tulane University (2010, April 28). Researchers call for eliminating malaria in Haiti and the Dominican Republic. ScienceDaily. Retrieved April 30, 2010, from http://www.sciencedaily.com­ /releases/2010/04/100428121457.htm

New species of human malaria

Over two-hundred species of malaria exist, but few infect humans. "Plasmodium falciparum and Plasmodium vivax are the most common. Plasmodium falciparum is the most deadly" (WHO). While investigating the fourth type of human malaria, Plasmodium ovale, scientists "confirmed that the parasite is actually two similar but distinct species which do not reproduce with each other" (London).

"Researchers from the London School of Hygiene & Tropical Medicine, the Hospital for Tropical Diseases and Mahidol University, Bangkok collaborated last year in order to share their research after noticing that the single parasite Plasmodium ovale, though visible through a microscope, was not detected by forensic DNA tests designed to identify the species."

According to lead researcher, Dr. Colin Sutherland, it "was a great surprise to find that, not only are these two species completely distinct from each other by every test we carried out, they actually occur in people living side by side" in the same towns. "We hope to continue our work so we can unravel the mysterious differences between these two newly recognized human pathogens," he says (Sutherland).

Sources:
London School of Hygiene & Tropical Medicine (2010, April 19). New species of human malaria recognized. ScienceDaily. Retrieved April 27, 2010, from http://www.sciencedaily.com¬ /releases/2010/04/100419150951.htm

Sutherland et al. Two Nonrecombining Sympatric Forms of the Human Malaria Parasite Plasmodium ovale Occur Globally. The Journal of Infectious Diseases, 2010; 201 (10): 1544 DOI: 10.1086/652240

WHO. "Malaria fact sheet." http://www.who.int/mediacentre/factsheets/fs094/en/

World Malaria Day

25 April 2010 is World Malaria Day

A parasite poisons hundreds of millions of people. The ancient illness kills nearly a million humans each year. Yet, this infectious disease is treatable and preventable.

Fragile mosquitoes flit through the tropical breezes. Poised on delicate feet, the insect prepares to feed. With a thwack, a slap of a hand, the mosquito melts into a smear of blood. Malaria has been defeated, at least in that instant.

Transmitted by mosquitoes, the malaria parasite may be deadly to humans, but many vectors for control exist. Prevention measures like pesticide spraying, reservoir draining, and insect-repellent bed-net distribution prevent the breeding and biting of mosquitoes. Fewer mosquitoes mean fewer vehicles in which malaria may travel.

Doctors around the globe strive for a vaccine that will prevent malaria infection, but a perfected vaccine has yet to be developed. Still, medicine plays a pivotal part in preventing malaria deaths. Traditional medicines like Artemisinin, Quinine, and Chloroquine are still used to treat the disease, but drug-resistant malaria has evolved in many parts of the world. New combination therapies are implemented to fight the illness, but the situation resembles an arms race. Medics and malaria struggle to keep the upper-hand, and we see an escalation in the strength of weapons needed to fight the deadly disease.

"Malaria defeated the international community many years ago. We cannot allow this to happen again," said Margaret Chan, director-general of the World Health Organization. Many so-called developed countries have expelled malaria from their territories, yet the disease is still endemic in much of the world. Malaria is a global problem, and it affects the global community. The mosquitoes that transmit the disease do not heed political boundaries or economic status. If one country suffers from rampant malaria, then the world risks the global spread of disease.

Eradicating malaria is not a simple task, but it can be done. The parasite changes, mutates, and evolves to ensure its survival, but humans can outwit this evolution. Concentrated effort to prevent and treat malaria drastically reduces the number of ill and diminishes the number of deaths in a region. And, it isn't just trained medical professionals who can help fight malaria on a global scale. One of the biggest efforts to combat malaria comes from mosquito-net distribution.

Bed-nets prevent malaria-infested mosquitoes from biting people while they sleep. Insecticide treated nets are the most effective, but even a standard net is better than no protection. Donations to support the distribution of mosquito nets are collected on a global scale. Please visit Malaria No More or Nothing But Nets to contribute to a net-distribution program.

Other ways you can help:
* Donate
Malaria is an economic drain on the countries and communities where the disease is endemic. Donations are needed to provide medical treatment and to support preventative measures in places where malaria is most prevalent. Please only donate to reputable organizations. Infectious Bite suggests Malaria No More, the CDC Foundation, and Nothing But Nets.

* Help
Volunteer in anyway that you can. Medical personnel are always needed in endemic regions, but non-medical volunteers are also needed. Volunteers distribute mosquito nets, disrupt and destroy mosquito breeding grounds, and educate at-risk individuals about proper use of insecticides and other preventative measures.

* Start
Start an awareness project of your own. Compared to activism for many other causes, anti-malaria offensives are still developing to find novel ways to fight the disease. Media publications reveal the signs of "an evolving 'malaria activism' (akin to AIDS activism)" (Public). "Probably no other disease in human history has been associated with social and political activism to the extent that the HIV epidemic has" (AIDS Activism). "Such activism played a huge role in reducing the costs of anti-retroviral drugs in developing countries" (PLoS). Outspoken individuals are needed to raise awareness in their communities. Small actions are indispensable to the global effort of malaria awareness.



World Malaria Day "is a day for recognizing the global effort to provide effective control of malaria." Instituted by the World Health Assembly in May 2007, World Malaria Day seeks to engage everyone at moving toward the goal of eliminating the global problem of malaria (WHO).

"Approximately half of the world's population is at risk of malaria, particularly those living in lower-income countries. It infects more than 500 million people per year and kills [approximately] 1 million. The burden of malaria is heaviest in sub-Saharan Africa but the disease also afflicts Asia, Latin America, the Middle East and even parts of Europe" (WHO).

World Malaria Day is an opportunity:
*for countries in the affected regions to learn from each the experiences of others and support each global efforts;
*for new donors to join a global partnership against malaria;
*for research and academic institutions to flag their scientific advances to both experts and general public; and
*for international partners, companies and foundations to showcase their efforts and reflect on how to scale up what has worked

Join us, and join the world as we fight to bring an end to malaria illness and deaths. Together we can bite malaria back.


Links to visit:
World Malaria Day: http://www.worldmalariaday.org
Roll Back Malaria: http://www.rollbackmalaria.org/worldmalariaday/
WHO: http://www.who.int/mediacentre/events/annual/malaria/en/index.html

Sources:
AIDS Activism. http://www.albany.edu/sph/AIDS/activists.html

PLoS. "Time for a Third Wave of Malaria Activism." http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000188

Public Library of Science. "It's Time for a 'Third Wave' of Malaria Activism to Tackle Drug Shortages." ScienceDaily 23 November 2009. 24 November 2009 .

Roll Back Malaria. "Key Facts, Figures, & Strategies." http://www.rollbackmalaria.org/gmap/GMAP_Advocacy-ENG-web.pdf

Yarney, G. "Roll Back Malaria." http://www.plosmedicine.org/article/findArticle.action?author=Yamey&title=Roll%20Back%20Malaria:%20A%20failing%20global%20health%20campaign.

Malaria in Angola

Located on the West African coast, Luanda is Angola's chief seaport and capital. For years, Angola has waged war against malaria by providing medical treatment, distributing medicine and mosquito nets, and reconstructing the capital city. Social housing built to replace slums has reduced the urban risk of contracting malaria. Better health facilities prevent the ill from dying, and mosquito nets reduce the likelihood of mosquito bites, which may transmit malaria.

"Angola's health systems were severely damaged during the civil war," [ending in 2002] after which "only about 30 percent of the population had access to government health facilities. Malaria accounts for an estimated 35 percent of mortality in children less than five years old, 25 percent of maternal mortality, and 60 percent of hospital admissions for children under age five" (USAID).

Luanda reports that "the number of malaria cases dropped from four million to three million in recent years". "Speaking on the celebrations of the malaria world day [on 25 April], Filomeno Fortes [Ministry of Health] stated that the number of deaths also decreased from 20,000 to 9,000 as a result of the anti-malaria campaigns, namely through sensitization actions, distribution of mosquito nets, the anti-larvae combat and the initiative of the US president."

"Angola is one of three first-round target countries benefiting from the U.S. President's Malaria Initiative (PMI), a five-year $1.2 billion initiative led by the U.S. Agency for International Development (USAID). . . PMI's long-term goal is to cut malaria deaths by 50 percent in 15 African countries by providing lifesaving services, supplies, and medicines to 85 percent of those most vulnerable to malaria -- children under five years of age and pregnant women" (USAID).

Fortes hopes to equip every health unit in the country with COARTEM, anti-malaria tablets, by the end of the year.

"Dr Fortes revealed that the government will launch on April 25 an anti-larvae program with the aim to boost the campaign against the disease" (AngolaPress)

Source:
AngolaPress. "Malaria cases dropped. . ." 18 April 2010.
USAID. Country Profile: Angola. May 2008. http://www.usaid.gov/press/factsheets/2006/CP_Angola_6-06.pdf

Stayin' Alive

Malaria No More (MNM) chooses Jason Castro, American Idol season seven finalist, as the "Stayin' Alive" Ambassador. "The Stayin’ Alive campaign is the new grassroots movement that MNM has started to get American students involved in fighting malaria through dances and similar events to raise awareness about the disease."
Castro became involved with Malaria No More during Idol Gives Back, American Idol's Charity program. He "learned about the thousands of children that die daily from this dreaded disease."

Castro is excited to join Malaria No More's efforts to educate students and encourage their involvement. He says, "I was personally surprised to learn that malaria continues to be an epidemic in parts of the world, so I’m thrilled to do whatever I can to raise awareness of the continuing fight against this disease."

"It is estimated to be up to a half a billion cases of malaria annually with about 1 million deaths, particularly among young children. People contract malaria through the bite of an infected female Anopheles mosquito."

For more information on the "Stayin' Alive" campaign, visit Malaria No More

Source:
Examiner.com 15 April 2010. http://www.examiner.com/x-7707-Infectious-Disease-Examiner~y2010m4d14-Former-American-Idol-Jason-Castro-joins-fight-against-malaria

A brush with death

"U.S. Marine Corps veteran Frederick 'Fritz' Payne" witnessed a great deal of death while flying his fighter plane "over the Pacific during World War II". "Although his plane took a beating during combat missions -- returning to base with numerous bullet holes — Payne said he only had one really close brush with death."

"It was when I got malaria," he said.

At high altitudes, pilots must wear oxygen masks; without the constant flow of oxygen they risk death. "When you get malaria, you naturally get sick," he said.

"When I got sick I vomited in my oxygen mask, and it cut off my oxygen."

"The next thing I knew, I was going around in circles," he said.

As the plane spiraled out of control, Payne lost consciousness.

"When I came to, I was at about 8,000 feet and the plane was going down," he said. Still groggy from the black-out, Payne managed to pull his plane from its downward plummet. The fighter pilot survived, but he remembers malaria as a deadly enemy.

Source:
Goolsby, Denise. "Ace fought enemy, malaria over the Pacific." The Desert Sun. 14 April 2010.

World Health Day

This year the WHO's (World Health Organization) World Health Day focuses on urban health, campaigning in 1000 cities and collecting personal stories from 1000 individuals involved in urban health. Infectious Bite encourages you to read more about World Health Day 2010 and urban health and to get involved in your city's campaign for Global Health.

In 1960, the focus of the World Health Day initiative was "Malaria eradication -- a world challenge". For Infectious Bite, World Health Day 2010 marks the fifty-year anniversary of the malaria eradication challenge posed by the World Health Organization.



This Was Then:
According to The Hindu's (India's National Newspaper) publication from 7 April 1960, in "over ninety countries anti-malarial operations are in progress. In many countries a remarkable decrease in the incidence of this enervating disease, which in past ages has caused the collapse of kingdoms, has been registered. But the World Health Organisation has recorded the fact that 'there are still fifty-six countries where no effort has yet been made to subdue in malaria monster'. In India much progress has been made and large areas freed of this menace. . . .(Mosquitoes, however, still continue to flourish: Madras, for instance, had an unusually large number of them last cool season and they still seem to be with us)."

This Is Now:
Global efforts toward malaria eradication are underway, but each year lives are still lost. Estimates report that 800,000-1 million deaths occur each year due to malaria. According to the 2009 World Malaria Report, "tremendous increase in funding for malaria control is resulting in the rapid scale up of today's control tools. This, in turn, is having a profound effect on health -- especially the health of children in sub-Saharan Africa. In a nutshell, development aid for health is working" (7). The report also calls for continued action. "We can save millions of lives over the coming years by scaling up the malaria control tools that we already have available. However, we know that the malaria parasite is a formidable opponent, and that if we are to ultimately eradicate malaria, we need new tools. The unprecedented recent spending on the research and development of these tools, including a vaccine against malaria, is a critical component of the long-term strategy against malaria" (7).

Showing Progress [Quoted from the 2009 World Malaria Report]

*International funding commitments for malaria control have increased from around US$0.3billion in 2003 to US$1.7 billion in 2009 due largely to the emergence of the Global Fund and greater commitments of the US President's Malaria Initiative, the World Bank and other agencies

*An increased percentage of African households (31%) are estimated to own at least one insecticide-treated net

*Use of artemisinin-based combination therapies (ACTs) has increased. . . but remains very low in most African countries . . . well-below the WHA target of 80%

* More than one-third of the 108 malarious countries (9 African countries and 29 outside of Africa) documented reductions in malaria cases of > 50% in 2008 compared to 2000

*Ten countries are implementing nationwide elimination programmes of which six entered the elimination phase in 2009

Donations to the Global Fund sponsor malaria relief efforts. Since its creation, the Global Fund estimates that 5 million lives have been saved from Malaria, TB, and AIDS. Read more about the Global Fund.

Malaria is an ancient disease. It will not disappear easily, but in recent years, the world is making progress toward complete malaria eradication. With your help, your donations, and your awareness initiatives malaria may be eradicated in your lifetime. On this World Health Day, bite malaria back.


Sources:
2009 World Malaria Report. http://whqlibdoc.who.int/publications/2009/9789241563901_eng.pdf
The Hindu. "World Health Day (7 April 1960)".
http://www.thehindu.com/2010/04/07/stories/2010040754551401.htm

Drugmakers work together

Two drugmakers, Crucell NV and GlaxoSmithKline PLC, "will work together on a new malaria vaccine composed of two drugs", which they previously were developing separately.

According to Crucell, "malaria kills about 900,000 people a year, making it one of the deadliest diseases in the world."

The companies worked together "to research a Crucell vaccine in preclinical studies, and want to begin testing their combined vaccine on humans. They said the preclinical research shows the drugs may work better together than they do separately."

"The experimental vaccine combines a GlaxoSmithKline vaccine", called RTS,S/AS, with a developing vaccine by Crucell, which "involves placing a section of genetic material from a virus or parasite into larger 'vehicle' particle similar to the virus that causes the common cold. Crucell says that creates immunity to the disease, and works better against severe infectious diseases than older methods of vaccine creation".

Source:
Associated Press. "Crucell and Glaxo will combine malaria vaccines." Via Forbes. http://www.forbes.com/feeds/ap/2010/04/06/business-health-care-us-crucell-glaxosmithkline_7490454.html

Funding

To battle three killer diseases--AIDS, Tuberculosis, and Malaria--the United Nations created the Global Fund in 2002 and now hopes to expand it into a Global Health Fund.

Since its creation, the Global Fund has seen spectacular accomplishments, making the fund "arguably the most successful innovation in foreign assistance of the past decade. As a result of Global Fund programmes, an estimated 2.5 million people are on antiretroviral Aids therapy. No fewer than 8 million people have been cured of TB. And more than 100 million long-lasting insecticide-treated bed nets have been distributed in the fight against malaria. In total, studies suggest that Global Fund programmes have saved 5 million lives."

Operational procedures allow the Global Fund to be successful. "Disease-specific committees, called the Country Co-ordination Mechanism (CCM), are constituted in each developing country. Each CCM is chaired by the national government, but incorporates input from non-government organisations to formulate national-scale, disease-specific plans for submission to the Global Fund. Once the Global Fund receives these plans, they are sent to a Technical Review Panel (TRP) to check that the plans are scientifically sound and feasible. If the TRP approves, the plan is sent to the board of the Global Fund, which then votes to approve financing."

Challenges facing the Global Fund include lack of continuous financing and the potential to broaden the Global Fund's mandate. Since 2002, the Global Fund has approved around $19bn in total funding. . .Unfortunately, the Global Fund is already in a state of fiscal crisis. It needs around $6bn per year in the next three years to cover expansion of programmes for the three diseases, but it has only around $3bn per year from donor countries. Unless this is corrected, millions of people will die unnecessarily."

Financial crisis hinders the Global Fund from reaching its new goal, which is to improve basic health and reduce "child and maternal mortality. Expanding the Global Fund's mandate to include financing for training and deployment of community health workers, construction and operation of local health facilities, and other components of primary health systems could ensure the development of these local systems."

"Many countries – including France, Japan, Norway, the United Kingdom, and the United States – have recently recognised the need to move beyond the financing of control of Aids, TB, and malaria to financing improvements in primary health systems more generally. But they seem to view the issue of health-system financing as an either/or choice: scale up control of Aids, TB, and malaria, or scale up financing of primary health systems. The truth, of course, is that both are needed, and both are affordable".

Read More: "Funding a Global Health Fund."

Source:
Sachs, Jeffrey. "Funding a Global Health Fund." Guardian.co.uk. http://www.guardian.co.uk/commentisfree/2010/mar/25/global-health-fund-funding-tb-aids

War of the parasites

Malaria, a disease that reportedly causes "more than 1 million deaths annually", is caused by a mosquito-borne parasite. But, another blood parasite--this one carried by ticks--may provide malaria resistance.

Like malaria, Babesia parasites "infect a wide variety of mammalian hosts". Of the human "population infected with Babesia microti, 25% of adults and 50% of children remain asymptomatic" (without noticeable symptoms). "A new study suggests that monkeys chronically infected with babesiosis, a tick-borne parasite, are able to suppress malaria infection when exposed to a simian malaria parasite." Other coinfection studies in rodents indicate cross-protection. Researchers conclude that "ongoing infection with B. microti parasites leads to suppression of malaria infection" and may provide a way to combat malaria.

Source:
American Society for Microbiology (2010, March 24). Infection with tickborne parasite may suppress malaria. Retrieved March 25, 2010.

Flying vaccinators

Everyone hates mosquitoes, right? But, what if a mosquito bite vaccinated you against malaria, a deadly disease that infects approximately 250 million people each year? "New research published in Insect Molecular Biology reveals that mosquito genetic engineering may turn the transmitter into a natural 'flying vaccinator', providing a new strategy for biological control over the disease."

The study, led by Shigeto Yoshida from Jichi Medical University, "targets the saliva gland of the Anopheles stephensi mosquitoes, the main vectors of human malaria."

"For the past decade it has been theorized that genetic engineering of the mosquito could create a 'flying vaccinator,' raising hopes for their use as a new strategy for malaria control. However so far research has been limited to a study of the insect's gut and the 'flying vaccinator' theory was not developed."

Mosquito bites offer a free and easy way to administer a vaccine. Continued "exposure to bites" is expected to produce "high levels of protective immunity, through natural boosting, for a life time. So the insect shifts from being a pest to being beneficial," according to Yoshida.

"While 'flying vaccinator' theory may now be scientifically possible the question of ethics hangs over the application of the research. A natural and uncontrolled method of delivering vaccines, without dealing with dosage and consent, alongside public acceptance to the release of 'vaccinating' mosquitoes, provide barriers to this method of disease control."

Is this idea too dangerous to be beneficial, or is it just radical enough to help eliminate malaria? The world has yet to decide.

Source:
Wiley-Blackwell (2010, March 19). 'Flying vaccinator': Can genetically engineered mosquitoes provide a new strategy against malaria?. ScienceDaily. Retrieved March 21, 2010, from http://www.sciencedaily.com­ /releases/2010/03/100318192658.htm

Significant progress

Drug "resistance is most alarming" in parts of "Africa where HIV rates are high and people are extremely vulnerable to infections" (Boseley). But, one of the infectious diseases that terrorizes this region is on the retreat, according to recent findings. "A new report from the Roll Back Malaria (RBM) Partnership confirms that current investment in malaria control is saving lives and providing far-reaching benefits for countries. But it warns that without sustained and predictable funding, the significant" progress could be reversed (Roll Back Malaria).

"Most of us by now have got the message that malaria control is working. The report says that an estimated 384,000 children's lives were saved in 12 countries, such as Ethiopia, Rwanda and Zambia, between 2000 and 2009 through distribution of mosquito nets and other preventive measures. A steady and impressive increase in funding for malaria prevention has brought this about, from $100 million to $1.5 billion over that time period" (Boseley).

Richard Cibulskis of the WHO's global malaria program, warns that "If we are not vigilant about the level of funding going to malaria, the progress we have seen will be quickly reversed". According to the Global Malaria Action Plan [plan to eradicate malaria], "$6 billion a year is needed to ensure universal coverage of malaria control measures".

The money collected for malaria relief "goes mostly to the smaller countries…where the impact is measurably greater" than it would be in a larger country. Recent efforts have reduced the number of malaria deaths, but diligent effort to prevent malaria infection and eradicate the disease is still needed by the global community.

Boseley, Sarah. "Drug resistant tuberculosis…" The Guardian. http://www.guardian.co.uk/society/sarah-boseley-global-health/2010/mar/18/tuberculosis-malaria-prevention. 18 March 2010.
Roll Back Malaria. "Roll back malaria report…" http://www.rollbackmalaria.org/globaladvocacy/pr2010-03-18.html

Duffy negative

"In a paradigm changing discovery," malaria illness "has been identified in a population historically thought to be resistant to the disease." The Duffy blood group protein, located on the surface of red blood cells, acts as a receptor for the malaria parasite and facilitates malaria illness in humans. Duffy-negative population groups (people who do not have the Duffy antigen) were considered resistant to malaria because their blood cells lacked the receptor through which malaria invades.

However, "according to researchers from Case Western Reserve University School of Medicine, Pasteur Institute, and the Madagascar Ministry of Health", Duffy-negative individuals may experience illness from malaria. "In a study of more than 600 individuals from eight communities covering the main malaria transmission areas of Madagascar, the researchers found that 10 percent of people experiencing clinical malaria were Duffy-negative and infected with P. vivax."

"Since the early 1920s, it has been widely accepted that people of African ancestry are resistant to P. vivax blood-stage infection and clinical malaria. The Duffy-negative blood group, one of the more than 30 blood types, is predominant in most African ethnic groups" (Case). "Duffy-negative people usually have relatively recent ancestors from historically malaria prone regions. The highest concentration of Duffy-negative people in the world is in West Africa, where more than 95% of people are missing the protein on their red blood cells. Reflecting their African ancestry, 68% of African-Americans are also Duffy-negative" (23andme).

Malaria parasites are changing. Mutations allow the parasite population to become resistant to commonly-used drugs, develop in areas of high altitude, and now may enable them to cause illness in Duffy-negative people.

People with "this blood type, can have P. vivax living dormant in their liver cells where it does not make people sick." What "distinguished Duffy-negatives from all others was that the malaria parasite was unable to cross the threshold from liver cells to blood cells." However, during this study the team documented "photographic evidence of the parasite's presence within red blood cells of many Duffy-negative people experiencing malarial illness."

"The study confirms that P. vivax is not dependent on the Duffy antigen for establishing blood-stage infection and disease in Madagascar. Evolution of new parasite strains, infiltrating a new group of people who are Duffy-negative, seems to be occurring within a population of people from different ethnic backgrounds," says Peter A. Zimmerman, Ph.D., the study's senior author and Professor of International Health, Genetics and Biology in the Center for Global Health and Diseases at Case Western Reserve University School of Medicine. "These findings will have a major impact on efforts to eliminate malaria worldwide, particularly in large regions of Duffy-negative west, central and southern Africa."

"In Madagascar, malaria is endemic to more than three-quarters of the island. With almost one million clinical cases reported each year, this disease is a major public health problem" (Case).

Sources:
23andMe. "Malaria resistance." https://www.23andme.com/health/Malaria-Resistance-Duffy-Antigen/howitworks/ [Image]

Case Western Reserve University. "Duffy-Negative Blood Types No Longer Protected from P. Vivax Malaria." ScienceDaily 15 March 2010. 16 March 2010 .

Horuk et al. (1993) . “A receptor for the malarial parasite Plasmodium vivax: the erythrocyte chemokine receptor.” Science 261(5125):1182-4.

Kasehagen et al. (2007) . “Reduced Plasmodium vivax erythrocyte infection in PNG Duffy-negative heterozygotes.” PLoS ONE 2(3):e336.

Michon et al. (2001) . “Duffy-null promoter heterozygosity reduces DARC expression and abrogates adhesion of the P. vivax ligand required for blood-stage infection.” FEBS Lett 495(1-2):111-4.

Protective barrier

Malaria is a parasite that affects many organisms, yet mosquitoes can carry the disease without it triggering an immune response. How?

"Scientists. . . have found that when the mosquito takes a blood meal, that act triggers two enzymes to form a network of crisscrossing proteins around the ingested blood. The formation of this protein barrier, the researchers found, is part of the normal digestive process that allows so-called "healthy" or commensal gut bacteria to grow without activating mosquito immune responses."

"But there is a downside: The barrier also prevents the mosquito's immune defense system from clearing any disease-causing agents that may have slipped into the blood meal, such as the Plasmodium malaria parasite, which in turn can be passed on to humans." However, scientists believe that disrupting "the protein barrier. . . can trigger mosquito immune defenses to intervene and protect the insect from infection." It is possible that the mosquito's immune defenses will combat and eliminate malaria parasites before they are passed on to humans. Researchers are investigating a vaccine that "would generate antibodies" in humans which, "after a mosquito feeds on" the vaccinated human, "could disrupt the barrier, reduce parasite survival in the mosquito and prevent malaria transmission."

Source:

NIH/National Institute of Allergy and Infectious Diseases (2010, March 14). Barrier in mosquito midgut protects invading pathogens. ScienceDaily. Retrieved March 14, 2010, from http://www.sciencedaily.com¬ /releases/2010/03/100311175043.htm

Improving malaria treatment

"WHO (World Health Organization) is releasing the first ever guidance on procuring safe and efficient anti-malarial medicines. The guidelines will help countries select and obtain effective, good quality medicines and save lives by improving the way patients are diagnosed and treated" (WHO).

New guidelines recommend "the use of diagnostic tests and a new artemisinin-based combination therapy". Robert Newman, "director of the WHO global malaria" program, said "It is time to move away from the idea that everyone with a fever is suspected to have malaria" (Bernama).

Tests to determine whether or not malaria is the febrile culprit are necessary to prevent further drug-resistant malaria from developing. However, reliable tests are expensive and unavailable in rural villages, where they are most needed. "The WHO. . . recommended the rural health clinics, where microscopes are often unavailable, use Rapid Diagnostic Tests because they are easy for community health workers to handle" (Bernama).

"Each year there are 250 million cases of malaria and 860,000 deaths as a result. Approximately 85 percent of the deaths are children" (Bernama).

Malaria treatment guidelines: http://www.who.int/malaria/publications/atoz/9789241547925/en/index.html

Bernama. "WHO releases new malaria treatment guidelines." 10 March 2010. http://www.bernama.com/bernama/v5/newsworld.php?id=481148

WHO. "Improving malaria diagnosis and treatment." 09 March 2010. http://www.who.int/en/