Sierra Leone has committed to reducing new malaria infections by 40 percent by 2020, the Programme Manager of Roll Back Malaria said on Tuesday.
This will require concerted actions from government, partners, health staff and communities to ensure uptake of preventive measures and timely treatment for all.
Dr. Smith said Malaria is the cause of over 38% of all hospital consultation, and 17.6% of those admitted die of malaria.
The death rate of malaria for the following years include: 4872 death for 2016; 2288 for 2017; and 1869 for 2018. He said malaria is still the cause of child morbidity and mortality rate in Sierra Leone, where out of every ten children four tested positive of malaria.
He said that the government is therefore strengthening collaboration with the military and private partners, and that they would soon embark on the distribution of treated mosquitoes bed nets nationwide. He noted that the bed net is a very effective intervention in the fight against malaria, but sadly people are not making full use of the bed nets in the northern part of the country.
Malaria remains a public health concern and half of the world population is still at risk getting infected with the disease, and pregnant women and children below five years are the most vulnerable groups,
He noted that since 2000, the world has made historic progress against malaria by saving millions of lives from this preventable and treatable disease which costs a child’s life every two minutes. Malaria is killing more than one million people every year, according to Dr Smith.
The theme for this year’s commemoration is: “Zero Malaria Starts with Me” and the slogan is: “Yu get Wambodi Go Ospitul Wantem.”
Dr. Smith pointed out that Roll Back Malaria Partnership Programme is a global platform for coordinated actions on WMD to focus the attention of policymakers, donors, partners and the public.
Statement of B.F. (Lee) Hall, M.D., Ph.D., and Anthony S. Fauci, M.D., National Institute of Allergy and Infectious Diseases.
Eliminating malaria — one of the world’s oldest and deadliest diseases — remains a critically important public health and biomedical research challenge. Despite remarkable advances in reducing malaria incidence and deaths since 2000, recent progress has become stagnant and has even reversed in some regions.
The World Health Organization(link is external) (WHO) estimates that in 2017 about 219 million cases of malaria occurred worldwide and approximately 435,000 people died of the disease. Unfortunately, malaria cases increased from 2016 to 2017 in the 10 highest-burden countries in Africa, and the number of cases per 1,000 in populations at risk remained at 59 from 2015 to 2017.
Today, the National Institutes of Health recognizes World Malaria Day and commits to a reinvigorated malaria research program. This year’s World Malaria Day theme, “Zero malaria starts with me,” encourages governments, companies, academic institutions, philanthropies, and others to prioritize malaria, mobilize resources, and empower communities affected by malaria to lead and coordinate response activities. The National Institute of Allergy and Infectious Diseases (NIAID), part of NIH, is working toward “zero malaria” with coordinated global research projects to better understand the disease, improve diagnostics, treatments, and mosquito control interventions, and develop safe and effective vaccines.
NIAID works directly with scientists in malaria-endemic regions to build specialized local clinical research capacity. The NIAID-supported International Centers of Excellence for Malaria Research (ICEMR) program has more than 50 field sites in 17 endemic countries dedicated to multidisciplinary research on the complex interactions between the human host, mosquito vectors, and malaria parasites. ICEMR investigators share genomic and epidemiological data for parasites, mosquitoes, and human hosts through public databases such as PlasmoDB(link is external), VectorBase(link is external), and ClinEpiDB(link is external) to assist researchers in developing drugs, vaccines and diagnostics, and in improving public health programs.
ICEMR researchers are studying how the malaria-causing parasite adapts to antimalarial drug pressure and how that translates to the emergence and spread of drug resistance. Resistance to artemisinin drugs, used in most endemic areas, is emerging in Southeast Asia and appears to be spreading west. The ICEMRs are evaluating how asymptomatic malaria infections may contribute to persistent disease transmission and risk. Investigators also are studying how the behavior of malaria-transmitting mosquitoes is changing in response to insecticide use and environmental and ecosystem changes.
Another international research team supported by NIAID created mutated versions of nearly all of the 5,400 Plasmodium falciparum(P. falciparum) parasite genes to determine which of the organism’s genes are essential to growth and survival. The information will help investigators prioritize targets for future antimalarial drug development. One investigational drug being evaluated, DM1157, is a modified form of the antimalarial drug chloroquine. Similar to chloroquine, it interferes with the malaria parasite’s metabolism; however, it inhibits the parasite’s ability to expel the drug, thereby avoiding the drug resistance seen with chloroquine. A Phase 1 clinical trial to evaluate the drug’s safety began in September 2018.
Cerebral malaria — a severe form of illness that can lead to brain damage, long-term neurological deficits, and death — remains a significant problem in sub-Saharan Africa. ICEMR investigators and their collaborators identified brain swelling as a potential contributor to the high mortality rate among children in Malawi with cerebral malaria. A clinical trial is underway to assess whether measures to reduce brain swelling can improve treatment outcomes. ICEMR investigators in India are studying whether the same findings are seen in adults with cerebral malaria, while NIAID researchers are working to develop novel adjunctive cerebral malaria treatments.
NIAID also supports the development of various investigational malaria vaccines. The Institute has conducted and supported multiple early-stage clinical trials of PfSPZ, a candidate malaria vaccine made of weakened immature malaria parasites. It is designed to prevent malaria infection and is now being evaluated in multiple clinical trials in malaria endemic regions, including in infants and children. Another candidate vaccine based on a recombinant protein is currently in a Phase 1 clinical trial.
NIAID researchers also are working on a vaccine designed to block transmission of the malaria parasite from infected humans to mosquitoes. Although a transmission-blocking vaccine would not prevent malaria infection, by limiting further spread it could reduce new malaria infections over time. Results from a clinical trial in Mali indicate that the investigational vaccine, when formulated with an immunity-boosting adjuvant, shows promise. Plans are underway to evaluate the efficacy of the vaccine in a Phase 2 clinical trial in Mali.
NIAID scientists recently developed a monoclonal antibody from a person vaccinated with PfSPZ that potentially could be used for seasonal control and elimination efforts as well as by tourists, health care workers, and military personnel to prevent malaria infection. A trial evaluating the antibody’s safety and efficacy against a controlled human malaria infection (human challenge study) is planned for early 2020. NIAID experts also are collaborating with Malian scientists to discover additional broadly protective monoclonal antibodies.
Although recent data indicate that malaria control efforts may have stalled, numerous historical examples indicate that with enough commitment and ingenuity malaria elimination can be achieved, even after significant setbacks. NIAID-supported investigators, researchers and their collaborators are accelerating progress toward malaria elimination every day. On this World Malaria Day, we reaffirm our commitment to advancing the best research to reach our goal of “zero malaria.”
Lee Hall, M.D., Ph.D., is chief of the Parasitology and International Programs Branch in the NIAID Division of Microbiology and Infectious Diseases. Anthony S. Fauci, M.D., is Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health in Bethesda, Maryland.
The National Institute of Allergy and Infectious Diseases (NIAID) in the United States is supporting the development of products to control mosquitoes without the limitations of traditional chemical pesticides.
On August 20, 1897, the British scientist Sir Ronald Ross dissected a female Anophelesmosquito in his lab in Secunderabad, India, and observed microscopic malaria parasites in the insect’s gut. He went on to prove the role of mosquitoes in transmitting malaria parasites to humans, thus solving one of the great medical mysteries of the day. His landmark discovery is commemorated each August 20 as World Mosquito Day. As Ross wrote in a poem about his feat, “With tears and toiling breath, I find thy cunning seeds, O million-murdering Death.”
Indeed, mosquitoes are the deadliest animals on the planet, transmitting not only malaria parasites but also Zika, West Nile, dengue, and chikungunya viruses as well as other pathogens and bringing death and misery to millions every year. The most common mosquito-control techniques have traditionally involved chemical pesticides that target and kill adult mosquitoes. However, this approach has drawbacks; chemical pesticides may target more than mosquitoes, they may also be toxic to honeybees and other beneficial insects, and may harm fish, aquatic animals, and other wildlife. Additionally, mosquito populations have developed resistance to chemical pesticides over time. These concerns necessitate the development of alternative approaches for mosquito control.
As mosquitoes continue to threaten human health, NIAID is fighting back by supporting basic, translational, and clinical research on non-conventional mosquito-control methods. Through research awards to scientists at universities and small companies, NIAID supports the development of products to control mosquitoes without the limitations of traditional chemical pesticides.
For example, with NIAID support, ISCA Technologies(link is external) (Riverside, California) is working to develop safer larvicides. One of ISCA’s newest products, SPLAT Bac, controls mosquito populations with no risk to humans or other animals. SPLAT Bac consists of the bacteria Bacillus thuringiensis israelensis, which is toxic only to mosquito larvae, encapsulated in a proprietary waxy substance. This wax matrix contains pheromones (molecules secreted by mosquitoes) that attract female mosquitoes. When SPLAT Bac is applied to a body of water, female mosquitoes are drawn to the area to lay their eggs. After the eggs hatch, the bacteria in SPLAT Bac kill the larvae, halting the next generation of mosquitoes.
MosquitoMate(link is external) (Lexington, Kentucky) used NIAID support to develop a way to decrease mosquito populations by infecting male mosquitoes with Wolbachiabacteria. Male mosquitoes do not bite, and when Wolbachia-infected males mate with wild female mosquitoes they effectively sterilize them and thwart the development of their offspring. The male-infecting technology has been developed for two species of mosquito—Aedes aegypti and Ae. albopictus—that can spread dengue, Zika, and other viruses. Wolbachia-infected males reduce mosquito populations without chemicals or genetic modification.
NIAID also supported the development of an autocidal gravid ovitrap (AGO) by SpringStar, Inc(link is external). (Woodinville, Washington), a device that was initially designed by scientists at the Centers for Disease Control and Prevention. SpringStar’s AGO is a black bucket fitted with a capture chamber and grass-infused water that lures egg-laden female mosquitoes. The females enter the trap through the top screen that is large enough for them to pass through, but small enough to keep birds, squirrels, and other animals out. The mosquitoes try to reach the water to lay their eggs but are blocked by a finer-meshed screen. As they tire, the mosquitoes alight on a replaceable glue board inside the trap and are prevented from laying eggs. This trap is designed to reduce the populations of Aedes aegypti and Ae. albopictus mosquitoes.
Editor’s note: According to the World Health Organization (WHO), nearly half of the world’s population is at risk of malaria. In 2015, there were roughly 212 million malaria cases and an estimated 429 000 malaria deaths. Increased prevention and control measures have led to a 29% reduction in malaria mortality rates globally since 2010.
A female Aedes albopictus mosquito. This species can transmit dengue, chikungunya, yellow fever and the Zika virus. Photo credit: USDA-ARS
National Institute of Allergy and Infectious Diseases (NIAID) scientists are developing promising dengue virus vaccine candidates, with the goal of creating a vaccine that is protective against all four dengue virus serotypes.
Preclinical and early phase clinical testing has been encouraging, warranting their further development for use as live attenuated vaccine candidates.
Typically spread through mosquitos, dengue virus infection can lead to dengue hemorrhagic fever and, in severe cases, death.
In recent years dengue fever (DF) has become a major international health problem affecting tropical and sub-tropical regions around the world – especially urban and peri-urban areas. The geographic distribution of dengue, the frequency of epidemic cycles, and the number of cases of dengue have increased sharply during the last two decades. In addition, the frequency of a potentially lethal complication of dengue, called dengue haemorrhagic fever (DHF) has begun to occur on a regular basis in countries where only dengue occurred previously.
Dengue fever is caused by four distinct but closely related dengue viruses called serotypes (DEN-1, DEN-2, DEN-3, and DEN-4) and transmitted to humans through the bites of infected mosquitos (Aedes aegypti is the primary vector).
Dengue fever is a severe flu-like illness that affects infants, young children and adults, but rarely causes death. Symptoms vary according to age. Infants and young children may be asymptomatic or have undifferentiated fever and rash, whereas older children or adults are more likely to have a more severe set of symptoms including high fever that starts quickly, sometimes with two peaks, and/or severe headache, pain behind the eyes, muscle and joint pains, nausea and vomiting and rash. Infection with dengue confers immunity to infection with the same dengue serotype, but aside from short-lived protection does not prevent infection with other serotypes.
DHF is a life threatening complication of dengue characterized by high fever lasting 2-7 days, haemorrhagic phenomena (including vascular leakage of plasma), low numbers of platelets and sometimes circulatory failure. The condition of some patients progresses to shock. This is known as dengue shock syndrome (DSS), which could be rapidly fatal if appropriate volume replacement therapy is not administered promptly. Without proper treatment, DHF case fatality rates can exceed 20%. With modern intensive supportive therapy, it can be reduced to less than 1%.
While the mechanisms that cause DHF are not completely understood, it is widely accepted that antibodies from previous dengue infections can predispose some individuals to develop DHF when infected by a second dengue serotype. Thus the co-circulation of several different dengue serotypes in a geographical area favours the occurrence of DHF in that area.
NIH-funded study observes virus-induced placental damage in monkeys.
A female Aedes mosquito.NIAID
Zika virus infection appears to affect oxygen delivery to the fetuses of pregnant monkeys, according to a small study funded by the National Institutes of Health. Researchers also observed a high degree of inflammation in the placenta and lining of the uterus, which can harm the fetal immune system and increase a newborn’s susceptibility to additional infections. Their study is published online in Nature Communications.
Zika virus infection among pregnant women can lead to developmental problems in fetuses and newborns.
In the current study, researchers led by Daniel Streblow, Ph.D., of the Vaccine & Gene Therapy Institute at Oregon National Primate Research Center, used non-invasive imaging to evaluate how persistent Zika infection affects pregnancy in five rhesus macaques.
The team found that the virus induces high levels of inflammation in the blood vessels of the uterus and damages placental villi, the branch-like growths that help transfer oxygen and nutrients from maternal blood to the fetus. The researchers suggest that this damage may disrupt oxygen transport to the fetus, which can restrict its growth and lead to stillbirth, among other conditions.
The team observed evidence of fetal brain abnormalities in two of the five animals, but the researchers did not see any obvious signs of microcephaly. This finding, they reason, is consistent with previous studies that establish microcephaly as only one of a spectrum of Zika-induced complications. The authors call for additional studies to improve knowledge of how Zika virus causes infection during pregnancy.
About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): NICHD conducts and supports research in the United States and throughout the world on fetal, infant and child development; maternal, child and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit NICHD’s website.
About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.