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

Chemical paths

Frequent use and misuse of antimalarials [drugs that fight malaria] can lead to malaria parasites that are resistant to existing treatments. For this reason, there "is an urgent need for new drugs to combat malaria". "Researchers report that they have discovered -- and now know how to exploit -- an unusual chemical reaction mechanism that allows malaria parasites and many disease-causing bacteria to survive."

The same research team from the University of Illinois, led by Eric Oldfield, developed an inhibitor of a pivotal chemical reaction. This inhibitor may fight malaria [and other bacterial and parasitic diseases] in a manner that is different from the traditional medicines. The situation is dire, according to Oldfield. "The parasites that cause malaria also have become resistant to quinine, chloroquine and now, artemisinin, three common treatments for the disease."

"The new study focuses on an essential chemical pathway that occurs in malaria parasites and in most bacteria but not in humans or other animals, making it an ideal drug target." An enzyme, known as IspH, promotes the assembly of a "class of compounds, called isoprenoids, which are essential to life" and prove to be necessary to the bacteria and parasites that cause disease.

"Isoprenoids are the largest class of compounds on the planet," Oldfield said. "There are over 60,000 of them. Cholesterol is an isoprenoid. The orange beta-carotene in carrots is an isoprenoid. And bacterial cell walls are made using isoprenoids." After a decade of research, scientists believe that they understand the structure and function of IspH and hope that it will "allow them to find a way to... shut down production of isoprenoids in the disease-causing bugs," thereby reducing their numbers.

"We're really at the initial, key stage, which is understanding structure and function and getting clues for inhibitors -- drug leads," he said. "But there are a finite number of proteins unique to bacteria and malaria parasites that can be targeted for the development of new drugs. And everyone agrees that this enzyme, IspH, is a tremendous target."

Further research:
Eric Oldfield et al. Bioorganometallic mechanism of action, and inhibition, of IspH. Proceedings of the National Academy of Sciences, Feb 15, 2010. http://www.news.illinois.edu/WebsandThumbs/Oldfield,Eric/0215pnas.200911087.pdf
The National Institute of General Medical Sciences at the National Institutes of Health funded this research.


Source:
University of Illinois at Urbana-Champaign (2010, February 16). New weapon to fight disease-causing bacteria, malaria developed. ScienceDaily. Retrieved February 16, 2010, from http://www.sciencedaily.com¬ /releases/2010/02/100215173944.htm

Photo source:
http://insciences.org/article_album_file.php?article_id=8350&articlemedia_id=1069

Substandard Medicines

"A high percentage of medicines circulating on national markets", in ten Sub-Saharan African countries, "are of substandard quality and thus may contribute to the growth of drug-resistant strains of Plasmodium falciparum, the most virulent form of malaria." First results of the "large-scale study of key antimalarial medicines" were released for Madagascar, Senegal, and Uganda by the Promoting the Quality of Medicines (PQM) Program, a USAID-funded program.

"Within Madagascar, Senegal and Uganda, the study" focused "on artemisinin-based combination therapy (ACT) products, currently the WHO's recommended form of first-line treatment for uncomplicated malaria, and sulfadoxine-pyrimethamine (SP) products, often used for preventative treatment of malaria during pregnancy." Researchers collected samples from "public and regulated private sectors" and from "informal markets, as many patients obtain their medicines from these sources."

"Substandard and counterfeit versions of antimalarial medicines are highly problematic throughout Africa, Asia and Latin America because of the direct threat they pose to the lives of individual patients as well as their contribution to the development of drug-resistant strains of these diseases." The "study found that approximately 44 percent of sampled medicines from Senegal, 30 percent of samples from Madagascar, and 26 percent of samples from Uganda that underwent full quality control laboratory testing failed such testing and were thus substandard."

"Substandard" medicines are classified as "those that do not meet the quality specifications set for them, primarily because they do not contain the correct amount of the active ingredient(s), do not dissolve properly in the body or include unacceptable levels of potentially harmful impurities." According to the released results, "[n]o samples in the full study completely lacked the active ingredient(s). The results also showed that, as a general rule, when a brand passed or failed in one country, it would also pass or fail in other countries. This indicates that the problem of quality is created at the source, rather than during passage through the distribution chain."

Substandard medicines were not limited to informal markets, and their point of sale varied by country. "In Madagascar, for instance, poor quality medicines appear to be widespread across regions and not limited to any particular type of distributor [public, private, or informal]. In Uganda, samples fared much better in the public sector than in the country's private sector. Despite overall failure rates, this was one of the bright spots the study revealed; in Uganda's public sector, all ACT and SP samples passed quality tests."

The purpose of this study was reveal "the prevalence of substandard antimalarials in Sub-Saharan Africa, which are believed to contribute to antimicrobial resistance of Plasmodium falciparum. Already, Plasmodium falciparum has become resistant to traditional" treatments "such as chloroquine, and more recently to SP products. The sustainability of treatment success depends to a large extent on preventing Plasmodium falciparum's exposure to incomplete doses of these medicines to minimize the possibility of the emergence of drug resistance."

Source:
US Pharmacopeia (2010, February 10). One-third of antimalarial medicines sampled in three African nations found to be substandard. http://vocuspr.vocus.com/vocuspr30/Newsroom/ViewAttachment.aspx?SiteName=USPharm&Entity=PRAsset&AttachmentType=F&EntityID=108111&AttachmentID=f2e22216-44a5-41a2-a9bc-464b7a98e3bf

Pregnant women at risk

Pregnancy, for most women, means planning for a safe and healthy baby, but in malaria-endemic regions, fear of mortality outweighs hope. At "least 125.2 million women" who are at risk of contracting malaria "become pregnant each year".

Malaria during pregnancy creates disaster, causing "miscarriages, preterm births," low-birth-rate, and death. "About 10,000 women and 200,000 babies die annually because of malaria" during pregnancy. "Most malaria deaths are caused by Plasmodium falciparum, which thrives in tropical and sub-tropical regions", but "the most widespread type of malaria is P. vivax malaria, which also occurs in temperate regions." Estimates on the burden of malaria were previously only available for Africa", but now include lesser-realized endemic regions.

"The researchers estimated the sizes of populations at risk of malaria in 2007 by combining maps of the global limits of P. vivax and P. falciparum transmission with data on population densities. They used data from various sources to calculate the annual number of pregnancies (the sum of live births, induced abortions, miscarriages and still births) in each country. They calculated the annual number of pregnancies at risk of malaria in each country by multiplying the number of pregnancies in the entire country by the fraction of the population living within the spatial limits of malaria transmission in that country."

"This study contributes to the global understanding of the risk of malaria in pregnancy. In 2007, 54.7 million pregnancies occurred in areas with stable P. falciparum malaria and a further 70.5 million in areas with exceptionally low malaria transmission or with P. vivax only. This marks the first time species specific risks have been estimated globally for malaria in pregnancy."


Source:
Dellicour S, Tatem AJ, Guerra CA, Snow RW, ter Kuile FO. Quantifying the Number of Pregnancies at Risk of Malaria in 2007: A Demographic Study. PLoS Medicine, 2010; 7 (1): e1000221 DOI: 10.1371/journal.pmed.1000221

Lethal Weapon

"Mankind may finally have a weapon to fight two of the world's deadliest diseases." A new vaccine may prove to be a "lethal weapon against malaria" and cholera. Each year approximately a million people die from malaria and cholera sickens hundreds of thousands. Currently, "no FDA approved vaccine to prevent malaria, a mosquito-borne illness" exists. "Only one vaccine to fight cholera, a diarrheal illness that is common in developing countries and can be fatal" is on the market. "The lone vaccine is too expensive to prevent outbreaks in developing countries after floods, and children lose immunity within three years of getting the current vaccine."

Recently, a "University of Central Florida biomedical researcher has developed what promises to be the first low-cost dual vaccine against malaria and cholera."

Led by Henry Daniell, the "team genetically engineered tobacco and lettuce plants to produce the vaccine. Researchers gave mice freeze-dried plant cells (orally or by injection) containing the vaccine. They then challenged the mice with either the cholera toxin or malarial parasite…Untreated rodents contracted diseases quickly, but the mice who received the plant-grown vaccines showed long-lasting immunity for more than 300 days (equivalent to 50 human years)."

In addition to this vaccine, Daniell's lab has "created vaccines against anthrax and black plague that generated a congratulatory call from the top U.S. homeland security official and was featured on the Discovery Channel."

But, why lettuce? "Producing vaccines in plants is less expensive than traditional methods because it requires less labor and technology," Daniell said.

"We're talking about producing mass quantities for pennies on the dollar," he said. "And distribution to mass populations would be easy because it could be made into a simple pill, like a vitamin, which many people routinely take now. There is no need for expensive purification, cold storage, transportation or sterile delivery via injections."

"For Daniell, his research is more than his day job. His passion to find vaccines for the world's top 10 diseases as defined by the World Health Organization comes from growing up in India. He watched many of his childhood friends contract malaria, cholera and other diseases."

"I'm not done yet," he claims. "I still have more diseases to attack."

Source:
University of Central Florida (2010, January 27). New vaccine could be lethal weapon against malaria, cholera. ScienceDaily. Retrieved February 3, 2010, from http://www.sciencedaily.com¬ /releases/2010/01/100126101421.htm

Haiti in the wake of disaster

"Tuesday's earthquake could decimate what fragile medical care exists" in Haiti "and spawn a 'perfect storm' in a country already struggling to fight rare tropical and infectious diseases, health experts" warn. The Red Cross has estimated that "3 million people -- one-third of Haiti's population -- were affected by the quake", which was measured at a magnitude of 7.0 and "ripped apart buildings, shearing huge slabs of concrete off structures in the poorest country in the Western Hemisphere" (Park). The homeless are "clustering in public places without food, clean water or sanitation. It's the perfect environment for the spread of communicable disease." Photo by Pinheiro.

The earthquake has thwarted medical efforts in a place that already struggles to stave off infectious diseases. "Even before the earthquake, the country has been the subject of intense public health efforts, as nearly half the causes of deaths have been attributed to HIV/AIDS, respiratory infections, meningitis and diarrheal diseases, according to the World Health Organization." "Hundreds of thousands of people are sleeping in tents, or filling public squares waiting for some kind of help. There is no water, food or sanitation. Many of the survivors have broken arms and legs" (Kenny). "The earthquake decimated Haiti's capital just days ago[, but] it's an eternity in terms of getting medical care to the injured" (Pearson). Now, "if left untreated, minor injuries or fractures can become life-threatening because they're left open to bacterial infections such as tetanus".

Even the uninjured face severe medical risks.

"The disaster cut power, electricity and other utilities." Without clean drinking water, endemic diseases are hard to resist. "What you have is the perfect storm of infection. What you have is a breakdown. It is already a fragile infrastructure with high rates of infectious and neglected tropical disease. Now there are potential breakdowns in sanitation, clean water, housing and subsequent crowding. That's a terrible mix," says Dr Peter Hotez, head of the department of microbiology at George Washington University. "The potential new mass of displaced persons could create crowded, unsanitary conditions that facilitate the spread of contagious respiratory infections."

Cholera, typhoid fever, and other diarrheal diseases threaten the people. "Bacterial and mosquito-borne diseases such as dengue and malaria" are also major risk factors to the injured and uninjured alike.

Dirty water, broken drainage, and a tattered terrain create natural reservoirs where disease can breed. Malaria, an infectious disease that kills approximate one million people each year and is carried by mosquitoes, is expected to intensify in the aftermath of the quake. Malaria is already endemic in this region, and in the midst of this chaos, it will be difficult to avoid.

Doctors "worry that the major, long-term health initiatives to treat preventable diseases" like malaria and dengue "could be upended" by this disaster. "Any interruptions in fighting these preventable diseases has disastrous consequences", claims Hotez. "This is going to a big setback for public health control measures, and you will see the impact of this earthquake at least for months and possibly for years." Kaplan, who formed the Cap Haitien Health Network to tackle preventable diseases such as diarrhea, malaria and malnutrition agrees, "That's another tragedy of the earthquake."

"When the rubble is cleared and the bodies are buried," Haiti will still face the threat of devastating disease as it always has. But by that time, medical supplies and money will be expended on the newly injured, clinics and hospitals will need to rebuild, and the landscape will need to be reshaped in order to prevent water buildup, which fuels the spread of infectious diseases.

Despite it all, Kaplan has hope. He hopes that "this situation may lead to improvements, because it's bringing lots of attention and help to the area." "There's that silver lining," he said.

Want to help the relief & malaria prevention effort in Haiti? Support the Red Cross.
Send a $10 Donation by Texting 'Haiti' to 90999
You may also call 1-800-REDCROSS to make a donation over the phone.
Please DO NOT send donations for Haiti relief efforts to Infectious Bite. Donations to support the Infectious Bite malaria awareness campaign are always welcome.

Sources:
Kenny, Sean. Common Dreams. "Haiti's earthquake survivors face massive risk."
Park, Madison. CNN.com. "Haiti's earthquake could trigger 'Perfect Storm'." 13 January 2010.
Pearson, Carol. VOA News. "In Haiti, Wounds, Infectious Diseases are top concern." 15 January 2010.
Pinheiro, Roosewelt. Agência Brasil. [PHOTO]

Alarm amid medicine shortage

Kenya's rainy season is the most dangerous for contracting malaria, a deadly disease carried by mosquitoes, and children are the most susceptible. "A shortage of malaria drugs for children has hit hospitals as fears of an outbreak of the disease loom following heavy rains in various parts of the country."

"The Kenya Medical Supplies Agency said stocks of the drugs were running low, but were in the process of being procured and could be delivered by the beginning of February." The Chief executive, John Munyu, is hopeful that the crisis will be avoided because deliveries are continuing. He indicated that "adult malarial drugs are already being supplied after a reported shortage in parts of the country."

The minister of medical services, Anyang' Nyong'o, claims that "the shortage of drugs was caused by inadequate funding by the Treasury." The "budget for Health ministries was laughable when compared to that for the Ministry of Education", he says. This is not the first shortage that Kenya has suffered in recent years. Antibiotics used to treat cholera "were nearly exhausted due to last year's outbreak".

Still, Nyong'o is confident that disaster will be avoided. He says, "I do not envisage any crisis because the government is already adding stocks to what is already there in the health facilities. That is mere replenishment."

Ogo, Kenneth. "Children's malaria drugs run out." Daily Nation. 7 January 2010.

Eco-epidemiology

Small bands of males chased game through the savannahs. Females dug along the forest edges for roots, and searched the bushes for edible berries. Humans lived in isolated groups, which constantly moved in search of better subsistence. Then around ten thousand years ago, human settlements sprouted in the plains. Flocks grazed in pastures and humans tended their fields. This social transition "from hunting to agriculture brought permanent settlements, domestication of animals, and changes in diet. It also brought new infectious diseases, in what scientists call an 'epidemiologic transition'" (University).

"Another of these" epidemiologic "transitions came with the Industrial Revolution. Infectious diseases decreased in many places while cancer, allergies and birth defects shot up" (University). Changes to the environment, including shifts in the variety and type of species in a location, cause the emergence of new diseases or the resurgence of old diseases that were once rare.

"Now, it seems, another epidemiologic transition is upon us. A host of new infectious diseases -- like West Nile Virus -- have appeared. And infectious diseases thought to be in decline -- like malaria -- have reasserted themselves and spread" (University). Humans across the globe are falling victim to malaria, an ancient infectious disease, which was once considered to be limited to isolated tropical regions.

According to Pongsiri, a scientist conducting research on the resurgence of infectious disease, the studies "show that emergence or reemergence of many diseases is related to loss of biodiversity." She asserts that this disturbing trend is "not just case-study specific". "Something is happening at a global scale" (University). For example, it is now known that malaria rises and spreads from deforestation. The clearing of forests results in changes to the watershed, including the creation of reservoirs where malaria-carrying mosquitoes can breed. Elevation in regional temperature due to pollution or deforestation can increase the potential habitat of the mosquitoes, causing the disease to spread.

"It is new to think about biodiversity -- and therefore, species and land conservation -- as integral to public health. Until recently, almost no epidemiologists, nor medical schools, were framing questions of human infectious disease prevention in terms of, say, habitat structure, promoting genetic diversity in non-human species, or protecting animal predators as ecosystem regulators. Human diseases, goes the conventional thinking, are best understood and treated by looking at humans."

"Now there is the beginning of a movement to bring epidemiology and ecology together," says Pongsiri.

More info: http://www.sciencedaily.com/releases/2009/12/091203132157.htm

Source:
University of Vermont. "Biodiversity Loss Can Increase Infectious Diseases in Humans." ScienceDaily 3 December 2009. 5 December 2009 .

World AIDS Day

"Malaria and HIV are two of the most devastating global health problems of our time. Together they cause more than 4 million deaths a year" (WHO). On this World AIDS Day, Infectious Bite looks at the relationship between malaria and HIV (the virus that causes AIDS), and discusses new research to treat co-infected (simultaneously infected with both diseases) individuals.

"Our current understanding of the human immune response to malaria and HIV leads us to expect that either infection might influence the clinical course of the other." Ordinarily, "infections are associated with at least a transient increase in HIV viral load" (measure of severity) and it is logical to assume that malaria accelerates "HIV disease progression." On the other side, "immune deficiency caused by HIV infection should, in theory, reduce the immune response to malaria parasitemia and therefore increase the frequency of clinical attacks of malaria" (Whitworth).

According to UNICEF, "HIV infection increases the incidence and severity of clinical malaria. In non-pregnant adults, HIV infection has been found to roughly double the risk of malaria parasitemia and clinical malaria...Although the effect of malaria on HIV has not been so well documented, some recent research is now adding to the growing body of evidence. Acute malaria infection increases viral load, and one study found that this increased viral load was reversed by effective malaria treatment. This malaria-associated increase in viral load could lead to increased transmission of HIV and more rapid disease progression, with substantial public health implications" (UNICEF).

Treatment of malaria is also complicated by HIV. "Artemisinin combination therapy has become the standard of care for uncomplicated malaria in most of Africa. However, there is limited data on the safety and tolerability of these drugs, especially in young children and patients co-infected with HIV" (Shereen). Recently, a "controlled trial was conducted" in Uganda consisting of "HIV-infected and uninfected children aged 4-22)." Participants were randomly designated to receive treatments of artemether-lumefantrine (AL) or dihydroartemisinin-piperaquine (DP). Both therapies were deemed "safe and well tolerated for the treatment of uncomplicated malaria in young HIV-infected and uninfected children" (Shereen).

In conclusion, co-infection of HIV and malaria fuels the spread of both diseases. HIV increases the severity of the episode and the patient susceptibility to malaria infection. Malaria increases the viral load of HIV, thereby elevating the risk of spreading HIV. "Co-infection might...have facilitated the geographic expansion of malaria in areas where HIV prevalence is high. Hence, transient and repeated increases in HIV viral load resulting from recurrent co-infection with malaria may be an important factor in promoting the spread of HIV in sub-Saharan Africa" (Abu). The connection between HIV and malaria also corresponds to the treatment of both diseases. Artemether-lumefantrine and dihydroartemisinin-piperaquine are safe for the treatment of malaria in HIV-infected children. It is also believed that the effective treatment of malaria within HIV-infected individuals may reverse the increased viral load of co-infected individuals.

SOURCES:
Abu-Raddad, Laith J. Et. Al. "Dual Infection with HIV and Malaria Fuels the Spread of Both Diseases in Sub-Saharan Africa". Science 8 December 2006.

Shereen, Katrak Anne. Et al. Malaria Journal 2009, 8:272
UNICEF. "Malaria and HIV/AIDS." http://www.unicef.org/health/files/UNICEFTechnicalNote6MalariaandHIV.doc

Whitworth, James. HIV InSite Knowledge Base Chapter. May 2006. http://hivinsite.ucsf.edu/InSite?page=kb-05-04-04

WHO. http://apps.who.int/malaria/malariandhivaids.html

Monkey malaria

"Researchers in Malaysia have identified...an emerging new form of malaria infection" that is a "potentially deadly" strain of the disease (ScienceDaily). "Malaria kills more than a million people each year. It is caused by malaria parasites, which are injected into the bloodstream by infected mosquitoes" (Daneshvar).

"Recently, researchers at the University Malaysia Sarawak...showed that P. knowlesi, a malaria parasite previously thought to mainly infect only monkeys - in particular long-tailed and pig-tailed macaques found in the rainforests of Southeast Asia - was widespread amongst humans in Malaysia." After several similar reports, P. knowlesi has been deemed "the fifth cause of malaria in humans" (ScienceDaily).

P. knowlesi malaria is particularly dangerous because it "can easily be confused with P. malariae", a more benign form of malaria (ScienceDaily). Under the microscope, the two strains appear nearly identical, but the strains are very different in severity and deadliness. "One of the most significant findings of the study is that Plasmodium knowlesi was found to have the ability to reproduce every 24 hours in the blood -- meaning infection was potentially deadly. This, according to the researchers, meant early diagnosis and treatment were crucial" (Kounteya).

A universally low platelet count is another curious characteristic of this strain of parasite. "In other human forms of malaria, this would only be expected in less than eight out of ten cases." But, "all of the P. knowlesi patients - including those with uncomplicated malaria - had a low blood platelet count...The researchers believe the low blood platelet count could be used as a potential feature for diagnosis of P. knowlesi infections." (ScienceDaily).

"Recently, there have been cases of European travellers to Malaysia and an American traveller to the Philippines being admitted into hospital with knowlesi malaria following their return home" (ScienceDaily). This deadly strain of malaria may potentially spread across the globe and infect millions if it is not adequately treated and controlled.

Sources:
Daneshvar C, et al. Clinical and laboratory features of human Plasmodium knowlesi infections. Clin Infect Dis. 2009;49(6):852-60.

Kounteya Sinha. The Times of India. "Monkey malaria spreads to humans in South-east Asia". 11 September 2009.

ScienceDaily. In Humans. Retrieved September 13, 2009, from http://www.sciencedaily.com­ /releases/2009/09/090909103004.htm

Schweinsaffe im Tierpark Berlin (photo)

Genetically-engineered malaria vaccine

Scientists have created a "weakened strain of the malaria parasite" that "will be used as a live vaccine against the disease." This type of vaccine "has proven successful in eradicating smallpox and controlling diseases such as flu and polio" (Walter). It has already been advantageous in animal studies, and it is hoped that it will prove successful when it enters human trials (slated for early next year).

Professor Alan Cowman, head of the Walter and Eliza Hall Institute's Infection and Immunity division, said that "in developing the vaccine the research team...deleted two key genes in the Plasmodium falciparum parasite - which causes the form of malaria most deadly to humans" (Walter). "The deletions did not affect the parasites throughout most of the life cycle," but "by removing the genes the malaria parasite is halted during its liver infection phase, preventing it from spreading to the blood stream where it can cause severe disease and death" (Cowman; Walter). The photo to the left shows the parasitic cells during the liver stage (WT is normal).

The fact that the deletion of the genes "did not result in any observable defect during blood-stage replication...indicated that gene deletions did not affect the sexual stages of the parasite" (Cowman). "Although two genes have been deleted the parasite is still alive and able to stimulate the body's protective immune system to recognize and destroy incoming mosquito-transmitted deadly parasites" (Walter).

"Similar vaccines" have "been tested in mice and offered 100 per cent protection against malaria infection." Cowman "said it was hoped the vaccine would produce similar results in humans" (Walter). Whenever working with an attenuated [definition: weakened] strain of a disease, mutation is always a concern. Some people fear that the parasite will mutate to a viable form, thereby infecting individuals through the vaccine. "Professor Cowman said it was unlikely the weakened parasites used in the vaccine would regain their potency as the genes had been deleted from the genome and could not be recreated by the parasite" (Walter).

The fact that two essential genes have been deleted "make it extremely unlikely that the attenuated parasite vaccine could restore its capacity to multiply and lead to disease." The scientists believe that their "genetically attenuated parasite approach provides a safe and reproducible way of developing a whole organism malaria vaccine," which has the unique ability of being nearly 100% effective (Walter).


Sources:
Cowman, Alan F. et al. "Preerythrocytic, live-attenuated Plasmodium falciparum vaccine candidates by design." 10 June 2009.

Walter and Eliza Hall Institute (2009, August 24). First Genetically-engineered Malaria Vaccine To Enter Human Trials. ScienceDaily.

Ethiopia's epic battle against the Waba and malaria

Wäba: a mosquito that is carrying malaria (Amharic).

Does it strike you as strange that a language would have a specific term for a malaria-carrying mosquito? In a country that has seen 9 million cases of malaria per year, a distinction between malaria-infested mosquitoes and unaffected mosquitoes is necessary (UNICEF). Ethiopia is hit hard by malaria, but with tremendous dedication, the country is making advances against the disease.

"Historically, a malaria epidemic hits Ethiopia every five to eight years. The last one, in 2003-and four, caught the country unaware. Millions contracted the disease. Nobody knows how many died." Now, "Ethiopia is gearing up for an epic battle with malaria, possibly later this year. The stakes are high, with international aid agencies betting millions of dollars that the Horn of Africa's largest country can wipe out a disease that kills at least a million Africans every year" (Heinlein).

"Malaria is seasonal in Ethiopia coming after the beginning of the rainy season. September and October are usually the months that see the highest number of cases. Will there be more than usual this year? The head of USAID's malaria programme in Ethiopia, Richard Reithinger, says only time will tell, but if it is an epidemic year then some 10 million cases could be expected" (Chinnock). "Aid agencies have spent hundreds of millions of dollars trying to prevent the next outbreak" and "30,000 health extension workers" have been deployed to combat malaria by eradicating mosquitoes and educating the public (Heinlein). "Hospitals are also being put on alert and, meanwhile, the country continues with its ambitious programme to distribute 20 million insecticide-treated bednets" (Chinnock). "In a country with a doctor shortage and a mostly rural population...bednets for all, and an army of village-level health workers are the cornerstones of the strategy to beat the disease" (Heinlein).

The strategy of maintaining village health personnel and distributing anti-mosquito bednets is working for Ethiopia. "In 2005, the Ethiopian government unveiled an ambitious strategy, with donor support, to deliver two mosquito nets to every family at risk. By January 2008, 20.5 million bed nets had been delivered and a third of at-risk children were sleeping in safety... Within three years of the start of the program, cases of malaria, and death rates, had been halved" (Coghlan). With continued support, Ethiopia might just be able to make malaria a disease of the past.

Sources:
Chinnock, Paul. "Ethiopia will expand malaria control efforts." TropIKA.net. 23 Mar 2009.
Coghlan, Nora. "SMART Aid helps Ethiopia halve malaria deaths in two years." ONE International. 12 June 2009.
Heinlein, Peter. Addis Ababa. "Ethiopia Prepares for Battle with Malaria." VOA News. 20 March 2009.
UNICEF Ethiopia. http://www.unicef.org/ethiopia/malaria.html

Malaria in Cambodia

Researchers recently announced that a strain of malaria parasite in Cambodia has become resistant to "arteminisnin-based drugs". This development "could put millions of lives at risk" (Resistance). "Artemisinin-based combination therapies are the recommended first-line treatments of falciparum malaria in all countries with endemic disease. There are recent concerns that the efficacy of such therapies has declined on the Thai-Cambodian border, historically a site of emerging antimalarial-drug resistance" (Dondorp).

"Choloroquine and sulfadoxine-pyrimethamine resistance in P.falciparum emerged in the late 1950s and 1960s on the Thai-Cambodian border and spread across Asia and then Africa, contributing to millions of deaths from malaria. "Since the first reports of chloroquine-resistant falciparum malaria in southeast Asia and South America...drug-resistant malaria has posed a major problem in malaria control. By the late 1980s, resistance to sulfadoxine-pyrimethamine and to mefloquine was also prevalent on the Thai-Cambodian and Thai-Myanmar (Thai-Burmese) borders, rendering them established multidrug-resistant (MDR) areas" (Wongsrichanalai).

"Artemisinins have been available as monotherapies in western Cambodia for more than 30 years, in a variety of forms and doses, whereas in most countries...they have been a relatively recent introduction." An "extended period of often-suboptimal use, and the genetic background of parasites from this region, might have contributed to the emergence and subsequent spread of these new artemisinin-resistant parasites in western Cambodia." "In contrast, artemisinin derivatives have been used almost exclusively in combination with mefloquine on the Thai-Burmese border, where parasitologic responses to artemisinins remain good, even after 15 years of intensive use" (Dondorp).

The recent study compared patients from Cambodia with those from Thailand. "Researchers (Wellcome Trust-Mahidol University Oxford Tropical Medicine Research Program) discovered that on average "patients in Thailand were clear of malaria parasites within 48 hours" but Cambodian patients averaged 84 hours" (Resistance). "These markedly different parasitologic responses were not explained by differences in age" and "adverse events were mild and did not differ significantly between the two treatment groups" (Dondorp). Dr Arjen Dondorp declared, "Our study suggests that malaria parasites in Cambodia are less susceptible to artemisinin than those in Thailand". Currently, artemisinin is used to "clear the parasites at an early stage, preventing them further maturing and reproducing" (Resistance). Since its introduction, "artemisinin-based combination therapies has reduced the morbidity and mortality associated with malaria" (Dondorp).

However, with the new emergence of resistant malaria parasites, the number of malaria related deaths is expected to rise. "Measures for containment are now urgently needed to limit the spread of these parasites from western Cambodia and to prevent a major threat to current plans for eliminating malaria"(Dondorp). "Sixty percent of Cambodia's landscape poses a malarial risk. One million Cambodians are infected with malaria each year" (Wongsrichanalai). "Malaria remains one of the primary causes of mortality in Cambodia... Sustained efforts through local and national malaria control will be necessary to contain Cambodia's malaria epidemic" (Wongsrichanalai).

Image from Donorp. Graph from comparative study between Cambodia and Thailand, and how well the drugs treat malaria.


Sources:
Dondorp AM, Nosten F, Yi P, et al. Artemisinin resistance in Plasmodium falciparum malaria. N Engl J Med 2009;361:455-467.
Population Reference Bureau. "Fewer Malaria Cases in Cambodia."
"Resistance to Malaria Drug Reported in Cambodia." US World News. 29 July 2009.
Wongsrichanalai C, Pickard AL, et al. Epidemiology of drug-resistant malaria. 2002 Apr.

Malaria in Bolivia

Travel websites warn tourists to "consider taking medication for malaria prophylaxis (cholorquine, doxycycline, or mefloquine)," particularly in the areas "surrounding Santa Cruz," where "yellow fever and malaria are two common mosquito-borne diseases" (MDTravel). The CDC indicates that "areas of Bolivia with Malaria" include "all areas <2,500 m" in the regions of "Beni, Chuquisaca, Cochabamba, La Paz, Pando, Santa Cruz, and Tarija." However, the CDC also warns that Chloroquine, commonly used to prevent and treat malaria, "is NOT an effective anti-malaria drug in Bolivia and should not be taken to prevent malaria in this region" (CDC). In reality, "none of the currently available prophylactic medications is 100% effective. If travel to malarious areas is unavoidable, insect protection measures must be strictly followed at all times" (MDTravel).

Furthermore, areas above 2,500 meters are not absent of the disease. "Malaria cases have been reported on the Bolivian high plateau, confirming scientists' predictions that mosquitoes have adapted to a colder climate." These cases "were found in Oruro, western Bolivia, around 3,710 metres above sea level". Researchers have "demonstrated that some anopheles mosquitoes" (the ones that carry malaria) "have adapted to living at altitudes between 2,520 and 3,590 metres--conditions very different from their usual environment: warm, tropical and subtropical regions below 2,600 metres." Some researchers postulate that "a new subspecies has emerged." Scientists have noticed that the tails "have become shorter" and the "mosquito can live in dirty water rather than the clean water it inhabits at lower levels. It can survive" nighttime temperatures "as low as eight degrees Celsius" (Pabon) This can be terrifying news for the residents of these high-altitude regions since many do not have access to adequate health care to combat malaria.

One case study, examines the village of Tuntunani, which is "situated at an elevation of 2,300 meters." This community "experienced its first malaria outbreak in 1998". "An investigation two years later indicated that the epidemic resulted from introduced transmission...58% of the people had been ill for three weeks or longer" as a result. "This outbreak demonstrates the vulnerability of highland populations with poor access to health care to introduced malaria" (Rutar 15).

It seems that malaria is spreading in a country where its effects are already devastating. "Malaria affects over 3.5 million people in Bolivia each year. The Amazon basin regions of Beni and Pando have the country's highest infection rates. In these regions, migratory worker populations, such as castaneros" (Brazil nut farmers) "run a high risk of malaria infection"
When these harvesters "are sick with malaria, the family income drops since workers do not earn their wages and family members stay home to care for them." Estimates indicate that "at least 15,000 families from rural areas depend on this market for survival" (USAID). USAid led a pilot study among the community of Brazil nut harvesters and found that one-third of the farmers tested positive for malaria.

Pregnant women in Bolivia are also at high risk for the disease. Malaria affects pregnant women and children drastically. The anemia and fever from malaria can cause birth defects and death. Furthermore, there is no approved treatment or avoidance measures for pregnant women to take in Bolivia. Many of the prophylactic medications that work against the Bolivian strain of malaria can cause birth defects or miscarriages during the first trimester. At this time, most women find that they can only use mosquito repellent and mosquito nets to avoid contracting malaria during pregnancy.

Map of regions in Bolivia where malaria is endemic

Sources:

CDC.gov/travel/destinations/bolivia.aspx
Pabon, Cristina. Malaria spreading on Bolivian High Plains. SciDevNet.
Rutar, Tina. Eduardo J Baldomar Salgueiro, James H Maguire. "Introduced Plasmodium Vivas Malaria in a Bolivian Community at an Elevation of 2,300 Meters."
TravelMD. Bolivia.
USAID Reducing Malaria in Migrant Populations

Malaria in Ghana

New Release: 24 July 2009 reports prevalence of fake drugs in Ghana

Despite increased prevention efforts, Ghana is struggling to control endemic Malaria. Major roadblocks include economic deterioration, reduced effectiveness of indoor spraying & bed nets, and the importation of fake drugs to treat malaria.

In early July, US President Obama visited Ghana and "reaffirmed the United States' commitment to fighting malaria and other pressing global health needs" (Malaria Policy, President). For Ghana, the fight against malaria is one of medical and economic concern. "One infected person can indirectly infect 100 others that is how efficient the malaria mosquito is" (Afiriyie). Malaria is detrimental to the population of Ghana and the economic standing of the country. All are effected by the "debilitating effects of malaria on adult victims...In addition to time and money spent on preventing and treating malaria, it causes considerable pain and weakness among its victims. This can reduce peoples' working abilities. The adverse impact of the disease on household production and gross domestic product can be substantial. Malaria therefore is not only a public health problem but also a developmental problem." Apart "from the negative effect of lost productivity on the major sectors of the economy, malaria has negative effects on the growth of tourism, investments and trade especially in endemic regions" (Asante 8).

Every year, "huge sums of money" are "spent on malaria" treatment "even though the disease could be prevented," with the establishment of well-funded programs (Joy). Some methods of malaria control include bed-nets (mosquito nets that drape the beds to prevent mosquito bites during the night) and indoor spraying. Unfortunately, there is some indication that "Indoor Residual Spraying will never eliminate malaria in Ghana". "Hayford Siaw, Executive Director of Volunteer Partnerships for West Africa (VPWA) has expressed concern" over the investments in bed-nets and indoor spraying, saying that "The indoor residual spraying is no more effective than the bed nets, about 25% effective". Effectiveness of indoor treatment is reduced by a "genetic pre-disposition of some malaria mosquitoes" to "only bite outdoors" (Afiriyie). Still, the bed nets and indoor spraying do reduce the number of malaria cases and should not be abandoned. Other methods of eradication should be used in tandem with indoor treatments in order to effectively eliminate malaria in the region.

Ghana is working to establish and maintain programs that will diminish the mosquito population that carries malaria. "Zoomlion, a waste management company that works to improve sanitation throughout the country and fight malaria," maintains "a total of 420 'spraying gangs'" that "periodically spray mosquito breeding sites in order to stop the spread of malaria." This agency "aims to educate communities on sanitation issues and to engage young people in the cause. Their efforts have greatly improved waste issues in the region." (Malaria Policy, Ghana).

The sanitation progress is a step in reducing the "more than 3 million cases of malaria" that "are reported every year in Ghana, more than 900,000 of those cases are young children" (USAID). "45 per cent of child mortality rate recorded nationwide" in 2008 "was caused by malaria" (Joy).

International programs and various governments have stepped up to provide support for Ghana's anti-malaria campaign. It is reported that in December of 2008, China provided "medical assistance to some health practitioners in the country" of Ghana, in order to support their education about anti-malaria practices (Ghana News). In 2006 & 2007, Cuba also donated to Ghana in order to help fund the country's eradication program. Other nations have continuously provided their support to Ghana.

But, news journals have recently revealed that some anti-malarial drugs entering Ghana are fake. "Quantities of a prescription medication used throughout the world for treating malaria have been identified as lacking any active ingredient and presumably counterfeit. These are being removed from the market in Ghana, where they were discovered recently and confirmed as fake last Friday" (Pierson).

The drug (sold as Novartis Coartem{R}) lacked the ingredients necessary to effectively treat malaria. "This drug is an artemisinin-based combination therapy" and it is "recommended by the World Health Organization (WHO) for treating "uncomplicated" malaria" (Pierson).

"It has been estimated that up to 15% of all sold drugs are fake, and in parts of Africa this figure exceeds 50% , which paints a grim picture of health delivery in Ghana and elsewhere in Africa. China is emerging as a source country of counterfeit drugs. India and other Asian countries are" also "emerging as sources"(Ghanian).

"A major barrier in combating malaria throughout much of the developing world is the widespread presence of counterfeit and adulterated drugs, which undermines the public health. Not only do these drugs fail to deliver the appropriate treatment to individual patients--putting their lives at risk, but they contribute to the growth of drug-resistant strains of malaria, one of the greatest challenges to malaria control today" (Pierson).


"The FDB [Food & Drug Board] knows more than anyone that the drug counterfeit business is a multi-million dollar business globally, which is gaining roots in Ghana, the emerging gateway to everything...The production of substandard and fake drugs is a vast and under-reported problem, particularly affecting poorer countries. It is an important cause of unnecessary morbidity, mortality, and loss of public confidence in medicines and health structures" (Ghanian).

"Mr. Anthony Ofori, Brong Ahafo Regional Co-coordinator of Malaria Control," requests "effective collaboration between non-governmental organisations (NGOs), corporate bodies and the health authorities in the campaign against malaria in the country" (Joy). Malaria is endemic throughout the entire country (See map). Ghana is in dire need of positive international assistance in the war against malaria.

Note About Malaria:
"Malaria is integrally tied to maternal and child health in Africa." Each year pregnant women and children suffer and die from the infectious parasite. "Effective malaria control programs" are "vital to helping health systems adequately care for mothers and children," (Malaria Policy, President). "The effect of malaria on people of all ages is quite immense. It is however very serious among pregnant women and children because they have less immunity" (Asante 7).

A Note about Donations:
If you would like to donate to the cause, please visit the Malaria No More site.
At this time, Infectious Bite is not accepting donations. Please donate directly to a reputable agency.

Sources:
Afiriyie, Constance. Volunteer Partnerships for West Africa. "Indoor Residual Spraying will never eliminate malaria in Ghana."

Asante, Felix Ankomah. Kwadwo Asenso-Okyere. Economic Burden of Malaria in Ghana.

Ghanian Journal, The. "Let's do away with fake drugs". 24 July 2009.

Ghana News Agency (via fmprc.gov). China donates anti-malaria drugs to Ghana.

Joy Online. Ghana needs effective collaboration in malaria campaign.

Malaria Policy Center: President Obama Visits Ghana and Reaffirms U.S. Commitment to Fight Malaria.

Malaria Policy Center: Ghana fights malaria by improving sanitation.

Pierson, Francine. US Pharmacopeia. "Counterfeit Antimalarial Drug Discovered in Ghana with Aid of USP Drug Quality and Information Program". 22 July 2009.

USAID Press Release. USAID Administrator Tours Ghana Malaria Control Center.

Malaria in China

China has seen a resurgence of Malaria in recent years. "China reported about 24 million malaria cases in the 1970s, the number of cases declined to several hundred thousand by the late 1990s. However, the disease recently has "re-emerged" in China's central and southern provinces, possibly as a result of insufficient prevention work" (Global).

China suffers from Falciparum malaria which "is the most deadly among the four main types of human malaria. Although great success has been achieved since the launch of the National Malaria Control Programme in 1955, malaria remains a serious public health problem in China" (Lin). "Falciparum malaria was endemic in two provinces of China during 2004–05" (Lin). "The 'level one' areas have an annual malaria incidence of more than one case per 10,000 people, while the 'level two' regions have an annual incidence of less than one per 10,000 people" (Global).


Map provided by Travax

"Imported malaria was reported in 26 non-endemic provinces. Annual incidence of falciparum malaria was mapped at county level in the two endemic provinces of China: Yunnan and Hainan. The sex ratio (male vs. female) for the number of cases in Yunnan was 1.6 in the children of 0–15 years and it reached 5.7 in the adults over 15 years of age" (Lin).

The recent resurgence of malaria in China has prompted "China's Ministry of Health" to draft a "plan to eliminate malaria from the country by 2015" (Xinhuanet). "Central and local governments will provide funding for the malaria control programs, an unnamed official from the health ministry's disease control department said." "The plan aims to reduce malaria incidence to less than one case per 10,000 people in high-burden regions and to no cases in low-burden regions between 2010 and 2015" (Global).

Sources:
Global Health Reporting. "Malaria | China Develops Nationwide Malaria Eradication Plan". 10 April 2009.

Lin, Hualiang. Liang Lu, Linwei Tian, Shuisen Zhou, Haixia Wu, Yan Bi, Suzanne C Ho, Qiyong Liu. Spatial and temporal distribution of falciparum malaria in China.

Xinhuanet. "China lays out plans to quell malaria" http://news.xinhuanet.com/english/2009-04/10/content_11163891.htm 10 April 2009.

Malaria in Malawi

"Malaria is one of Malawi's most serious heath problems" (CDC). The most common malaria found in Malawi is the Plasmodium falciparum, which is "also the most lethal malaria parasite".

The entire population of Malawi is at risk for Malaria, and the highest concern is for children and pregnant women, who are victims of the most severe cases. "In 2001, malaria accounted for 22% of all hospital admissions, 26% of all outpatient visits, and 28% of all hospital deaths. Not all people go to hospitals when sick or having a baby and many die at home, and thus the true numbers are likely much higher" (CDC).

National programs have been established in Malawi to combat malaria. Malawi's National Malaria Control Programme (NMCP) and The National Malaria Technical Committee seek to reduce the cases of malaria in Malawi by using the Roll-back malaria strategy[Website: Roll Back Malaria]. First-line treatment includes the antimalarial drug, sulfadoxine-pyrimethamine, administered as both a medicine and prevention. Insecticide mosquito nets are distributed in Malawi, but their use and spread is limited due to lack of funds. Consquently, 40% of all deaths in this region are considered to be related to malaria (USAID).

Advances Against Malaria | Reduction of Hospitalized Cases in Cambodia

Cambodian news sources are reporting a "50 percent drop in total malaria cases reported by public facilities between 2003 and last year, with officials crediting the success to village-based treatment" (Phnom).

"In 2008, 132,620 malaria patients were treated by village-based malaria volunteers, which has remarkably reduced the malaria death rate," according to the doctor of the National Centre for Parasitology, Entomology and Malaria Control.

Source:
LEAKHANA, KHUON AND CHRISTOPHER SHAY. The Phnom Penh Post. "Malaria cases at hospitals...". 24 June 2009.

Advances Against Malaria | Combination Treatment

New studies conducted with children in Burkino Faso have shown that "in combination with newer malaria drugs, methylene blue prevents the malaria pathogen in infected persons from being re-ingested by mosquitoes and then transmitted to others and is thus twice as effective as the standard therapy" (University).

Methylene blue is one of the oldest synthetic treatments of malaria. In 1891, Paul Ehrlich identified its success at treating the disease (Schirmer). The chemical fell out of favor because of its cosmetic side-effects: whites of the eyes acquire a blue tint (image) and urine turns green.

Methylene blue is relatively cheap to produce and may see a resurgence in use since "combination therapies are twice as effective against gametocytes as the standard therapy" (University).

Sources:
Schirmer H, Coulibaly B, Stich A, et al. (2003). "Methylene blue as an antimalarial agent--past and future". Redox Rep 8: 272–276. doi:10.1179/135100003225002899

University Hospital Heidelberg. "Spread Of Malaria Parasites Curbed With Combination Of Methylene Blue And New Malaria Drugs." ScienceDaily 26 May 2009. 24 June 2009

Malaria Symptoms

Malaria "can lead to impaired function of the brain or spinal cord, seizures, or loss of consciousness." Infection with certain parasites cause severe symptoms and can be fatal.

Common symptoms of malaria:

• Fever
• Chills
• Headaches
• Fatigue
• Sweating
• Nausea
• Vomiting

Symptoms of malaria often cycle or fluctuate. "The cyclic pattern of malaria symptoms is due to the life cycle of malaria parasites as they develop, reproduce, and are released from the red blood cells and liver cells in the human body. This cycle of symptoms is also one of the major indicators that you are infected with malaria."

Malaria has a variable incubation time (the period of time between initial infection and the illness). Symptoms can appear as early as 7 days after infection. "Occasionally, the time between exposure and signs of illness may be as long as 8 to 10 months".

Source:
WebMD. "Malaria." Retrieved on 24 June 2009.

Malaria Statistics

Sobering statistics:

• 300-500 million malaria infections each year
• More than 1 million deaths each year related to malaria
• Nearly 40% of the world's population lives in affected regions.
• Malaria causes 1 in 5 of all childhood deaths in Africa
• African children have between 1.6 and 5.4 episodes of malarial fever each year.

Malaria Cases
2006 Estimates

Sources:
Global Health Facts. "Malaria Cases". Retreived 24 June 2009.

Seattle Biomedical Research Institute (SBRI). "Diseases: Malaria". Retreatived 24 June 2009.

Introduction to Malaria

Malaria is a mosquito-borne disease caused by a parasite. People with malaria often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications and die. Each year 350-500 million cases of malaria occur worldwide, and over one million people die, most of them young children in Africa south of the Sahara. (Source: Centers for Disease Control. Malaria)