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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/

Drug-resistant malaria

"In a dusty village near the Thai-Cambodia border, 24-year-old Oeur Samoeun sits on a dark green hammock recovering from a strain of malaria that has resisted the most powerful drugs available. . . Ravaged by days of fever and chills, he is considered lucky: the parasite has left his body. But for many others, the potentially deadly disease never quite disappears."

Pailin province, where Samoeun lives, is the unwitting nursery of drug-resistant malaria. It "is the epicenter of strains of malaria that have baffled healthcare experts worldwide, raising fears a dangerous new form of malaria could already be spreading across the globe."

Last year, a study published by the New England Journal of Medicine "showed that conventional malaria-fighting treatments derived from artemisinin took almost twice as long to clear the parasites that cause the disease in patients in Pailin and others in northwestern Thailand, suggesting the drugs were losing potency in the area." USAID, a U.S. development agency, agrees that traditional arteminsinin-based therapies are "now taking two to three times longer to kill malaria parasites along the Thai-Cambodian border than elsewhere."

Three drug-resistant malaria parasites have emerged from this province over the past five decades. "Thanks to prolonged civil conflict, dense jungles and movement of mass migrants in the gem mines in the 1980s and 90s, the strains multiplied and dispersed through Myanmar, India and two eventually reached Africa."

"Few can say why it is a hotbed for drug-resistant malaria", but experts point to "a combination of sociological factors and a complicated history spanning the Khmer Rouge era when 1.7 million people, nearly a quarter of Cambodia's population, perished from execution, overwork or torture during their 1975-79 rule."

Insurgents clung to Pailin, and it was "one of their last holdouts" before their defeat in the late 1990s. During the era of the Khmer Rouge, people resided in Pailin illegally. When they contracted malaria, they bought medication through black markets and self-medicated.

Self-medication was the only way to curb the rising number of malaria cases, so Cambodia made the decision to make anti-malarial drugs available over the counter. "The strategy carried risks. Easy access reduced the number of cases but also led to incorrect dosages and substandard or counterfeit medicine". Instead of eradicating the malaria parasites, over-the-counter treatments made the parasitic population stronger against widely used medications.

Without adequate drugs to combat the disease, drug-resistant malaria parasites threaten the world. Preventative measures, such as the use of bed-nets to avoid mosquito bites, may be our best defense against malaria. Donate a bed net through Nothing But Nets.

Source:
Win, Thin Lei. Reuters. "Cambodia drug-resistant malaria stirs health fears." 6 March 2010.

Malaria enters the US

"Nearly a dozen cases of Malaria has been confirmed here in the United States. All of the cases were acquired in Haiti after the January 12th, 2010 earthquake" (Gibbons). "Seven emergency responders, three Haitian residents now in the United States and one American traveler are known to have caught malaria in Haiti after the Jan. 12 earthquake, United States health officials said Thursday. Malaria is endemic throughout Haiti, so Haitians now living outdoors and relief workers are 'at substantial risk for the disease,' the Centers for Disease Control and Prevention said" (McNeil).

"Haiti already had a problem with malaria, which is spread by mosquitoes that will have more places to breed in the cities and towns wrecked by the giant quake" (Reuters). Displaced people living in temporary shelters our outdoors are at substantial risk of contracting malaria. Health workers who flooded to Haiti after the earthquake to offer aid are also at risk. "U.S. health officials advise people travelling to Haiti should take medications to prevent malaria" (UPI).

"Six out of eight patients, including seven emergency responders, had been advised to take drugs to prevent malaria but had not done so, the PAHO experts said." Three of the cases that the CDC cited "occurred among Haitian residents traveling to the United States and one case involved a U.S. resident who was visiting Haiti. All are expected to recover fully" (Reuters).

Individuals in Haiti are still at risk. "Each year, Haiti reports about 30,000 confirmed cases of malaria to the Pan American Health Organization, but the CDC estimates as many as 200,000 may occur each year. According to the CDC, malaria transmission peaks after the two rainy seasons -- November to January and again during May to June" (Reuters). The peak season is still months away, but anti-malarial medications are already needed to treat those who are infected and reduce the number of possible cases.

"There is no vaccine against the parasite that causes the illness[,] and it quickly evolves resistance against drugs"; however some drugs are known to treat and reduce malaria illness (Reuters).

The CDC indicates that "anyone traveling to Haiti should take drugs to help prevent infection" (Reuters).


Sources:
Gibbons, Sabrina. WSB News. "Malaria from Haiti Now in US." 4 March 2010.

McNeil, Donald G Jr. The New York Times. "U.S. Warns of Malaria Risk in Haiti". 4 March 2010.

Reuters. "Travelers from Haiti bringing Malaria to the US." 4 March 2010.

UPI. "Malaria Drugs for those going to Haiti." 4 March 2010.

Climate and behavioral change

In recent years, "malaria has been spreading into highland areas of East Africa, Indonesia, Afghanistan, and elsewhere" it was previously unknown. High elevations, low temperature, and temperate rainy seasons prevented malaria from entering these regions before. Now, the deadly disease is contracted locally in these previously malaria-safe environments. Malaria "is on the rise in some parts of the world" partly due to climate change. Other "factors such as migration and land-use changes are likely also at play."

"We assessed...conclusions from both sides and found that evidence for a role of climate in the dynamics is robust," write study authors Luis Fernando Chaves from Emory University and Constantianus Koenraadt of Wageningen University in the Netherlands. "However, we also argue that over-emphasizing a role for climate is misleading for setting a research agenda, even one which attempts to understand climate change impacts on emerging malaria patterns."

"Malaria, a parasitic disease spread to humans by mosquitoes, is common in warm climates of Africa, South America and South Asia." Development and survival of the mosquito and parasite depend on warm temperatures; therefore, "the disease has been spreading to the highlands, and many studies link the spread to global warming. But that conclusion is far from unanimous. Other studies have found no evidence of warming in highland regions, thus ruling out climate change as a driver for highland malaria."

Most studies, which conclude that climate change plays a significant role in highland malaria, tend to be statistically strong. Clearly, climate change does impact the range of malaria endemic regions; however, it may not be the only contributing factor. "What is needed, the researchers say, is a research approach that combines climate with other possible factors."

"Even if trends in temperature are very small, organisms can amplify such small changes and that could cause an increase parasite transmission," a researcher said. "More biological data will improve our overall understanding of malaria and will allow scientists to propose more general and accurate models on the impacts of climate change on malaria transmission."

Some factors contributing to the spread of malaria may be migration and agriculture. People "migrating from lowlands may be introducing the malaria parasite into highland regions. Changes in farming practices may also play a role. Irrigation associated with more intensive farming may be creating more places for mosquitoes to breed."

"The spread of malaria in highlands is of great concern to those who work to contain the disease. But understanding the many factors that influence the spread of highland malaria could help with efforts to control the disease worldwide."

Source:
University of Chicago Press Journals (2010, March 4). Climate change one factor in malaria spread. ScienceDaily. Retrieved March 4, 2010, from http://www.sciencedaily.com­ /releases/2010/03/100303162906.htm

Anti-malarial treats cancer

"Can a drug that has been used to treat malaria for years possibly be used to treat breast cancer before it becomes invasive? That's what researchers at George Mason University's Center for Applied Proteomics and Molecular Medicine (CAPMM) and Inova Breast Care Institute (IBCI) are trying to prove." We already know that artemisinin may target and kill cancer cells in breast-cancer patients, but now it appears that chloroquine, a drug commonly administered to treat malaria, may also treat cancer.

In a three-year clinical trial, researchers "will test the effectiveness of the anti-malarial drug chloroquine in treating 90 women with ductal carcinoma in situ (DCIS), a type of breast cancer in which the cancer cells start in the milk ducts but have not yet become invasive and spread in the breast. Once the cancer cells start to spread in the breast and throughout the body, the condition is considered invasive and can often be fatal."

Breast cancer is the most common form of cancer in women (American Cancer Society). In 2009, 254,650 patients were diagnosed. This treatment will "prevent breast cancer cells from becoming deadly by killing pre-invasive cancer cells". A novel therapy that uses chloroquine, which has been used to treat malaria in the past, may prevent deaths from breast cancer in the near future.

Source:
George Mason University (2010, March 2). Trial launched to test new treatment for pre-invasive breast cancer. ScienceDaily. Retrieved March 3, 2010, from http://www.sciencedaily.com¬ /releases/2010/03/100302123120.htm

Battling malaria

"Scientists battling malaria have earned a major victory", according to a Nature Genetics study. "Combating malaria resistance is nothing short of an arms race," says author and pediatrics professor, Dr. Philip Awadalla, from the Universite de Montreal. "As the malaria pathogen evolves, researchers must evolve with it to find ways to counter the disease."

Every year approximately 250 million people contract malaria. "Malaria is transmitted when people are bitten by infected mosquitoes. According to the World Health Organization, malaria symptoms include fever, headaches, vomiting and appear within 10 to 15 days after an infected mosquito bite." If left "untreated, malaria can be life-threatening" and may kill "an estimated five million people yearly." At the current level of malaria treatment one million people die annually, and most of those who die are young children.

The team at Universite de Montreal is deciphering the deadly parasite in an effort to eradicate the disease. This "international group of researchers has used genomics [study of organisms' genomes] to decode the blueprint of Plasmodium falciparum -- a strain of malaria most resistant to drugs that causes the most deaths around the world. The discovery may lead to advanced pharmaceuticals to fight the disease and prevent drug resistance".


"The team decoded 200 malaria samples from Asia, Africa, Central America, South America and Papua New Guinea. Their goal was to identify how Plasmodium falciparum strains were becoming resistant to the eight anti-malaria drugs currently available." The team noted how there is "substantial genetic differences in malaria around the world. What has occurred is a combination of genetic drift, where genes segregated over space and time from differential environments, immune pressures and exposures to drugs."

Research discovered that "Plasmodium falciparum recombined fastest in Africa...New clues garnered by this study...will allow pharmaceutical companies to create treatments that target the evolving malaria genome."

Sources:

Mu et al. Plasmodium falciparum genome-wide scans for positive selection, recombination hot spots and resistance to antimalarial drugs. Nature Genetics, 2010; DOI: 10.1038/ng.528

University of Montreal (2010, February 18). Genomic warfare to counter malaria drug resistance. ScienceDaily. Retrieved February 20, 2010, from http://www.sciencedaily.com¬ /releases/2010/02/100216140146.htm