King Tut's Curse

Celebrities draw attention to the diseases that ail them. This is true even if the celebrity is over three-thousand years old. Several media channels released reports pinning the death of King Tutankhamun, a famous pharaoh who died at a young age, on "a severe bout of malaria combined with a degenerative bone condition" (New York Times).

Results from the recent study of Tut's mummy show that he had several genetic bone disorders and that he was "afflicted with avascular bone necrosis, a condition in which diminished blood supply to the bone leads to serious weakening or destruction of tissue." In an already weakened individual, malaria is often fatal. "The finding led to the team's conclusion that it and malaria were the most probable causes of death" (New York Times).

Malaria was nearly impossible to escape during the time of King Tut. Mosquitoes bred in the Nile Valley, fed off whomever they encountered--royalty or not--and carried malaria. In modern times, approximately one million people die from malaria every year. Most of those who die are children, women, and already ill people. Today, a malaria-stricken individual can be treated for malaria. A variety of drugs combat the malaria parasites that cause illness in humans. Malaria can also be prevented through the use of insecticides, mosquito nets, and preventative medicines.


King Tut may not have been so lucky. While the pharaoh may have been able to hide from mosquitoes behind a bed net (a method of malaria prevention still used today), he did not have extensive medical treatments available to him--a fate that still befalls many today.


250 million cases of malaria are reported annually. Many of the humans who fall ill to malaria do not have the medical resources they need to survive. Over three-thousand years after Tut's death, people still suffer and die from malaria. But now, malaria is treatable and preventable. The problem is getting the necessary medical treatment to those in need.

My suggestion: Let the dead do what they do, and worry instead about the people dying today.


Support Roll Back Malaria and Malaria No More. Treating a bout of malaria costs under $5.00. A $10 bednet can save two lives.

Sources:
New York Times. Wilford, John Noble. "Malaria Most Likely Killed King Tut, Scientists Say." 16 February 2010.

Telegraph. Alleyne, Richard. "King Tut died of malaria and bone condition, says new research." 16 February 2010.

Credit: @followthethread deserves recognition for her alert. She's on my Do Not Bite list.

Photo source: Bjørn Christian Tørrissen (via wikimedia creative commons archives)

Who ya gonna call?

Blood-drinkers be warned: Slayers are on the prowl. Taking a note from a cheesy '80s movie, these hunters have equipped themselves with a backpack-carried weapon and are crawling the sewers collecting the flying fiends who annoy the living.

Mosquito hunters from Emory University have developed an efficient way to monitor adult mosquitoes and the deadly diseases they carry, and they have done it cheaply. "Emory has filed a provisional patent on the Prokopack mosquito aspirator, but the inventors have provided simple instructions for how to make it in the Journal of Medical Entomology."

"This device has broad potential, not only for getting more accurate counts of mosquito populations, but for better understanding mosquito ecology," according to Gonzalo Vazquez-Prokopec. "There is a great need for effective and affordable mosquito sampling methods. Use of the Prokopack can increase the coverage area, and the quality of the data received, especially for blood-fed mosquitoes. Ultimately, it can help us develop better health intervention strategies."

This new invention outperformed standards for resting mosquito surveillance in lab and field tests. The Prokopack has a longer reach than the Center For Disease Control and Prevention Backpack Aspirator (CDC-BP), which enables "it to collect more mosquitoes than the CDC-BP". The Prokopack is also "significantly smaller, lighter, cheaper, and easier to build" than its predecessor.

"Anyone with access to a hardware store, and about $45 to $70, can make the Prokopack, which uses a battery-powered motor to suck up live mosquitoes for analysis."

"The CDC-BP can quickly vacuum up samples of live specimens, which can be analyzed in a lab to determine the source of blood they recently consumed. The drawbacks to the CDC-BP, however, include its heavy weight (26 pounds), its bulk and its price -- about $450 to $750 in the United States."

"With a bit of ingenuity and a few trips to the hardware store," the Emory research team "put together a solution: a plastic container, a wire screen, a plumbing pipe coupler, a battery-powered blower motor and painter extension poles. After some experimentation with these components, the Prokopack was born.

"Collecting more mosquitoes in higher locations can give researchers more insights into their behaviors. Upper foliage, for instance, can yield more mosquitoes resting after feeding on birds. And upper walls and ceilings of homes may harbor more mosquitoes resting after a meal on humans."

Source:
Emory University (2010, January 13). Mosquito hunters invent better, cheaper, DIY disease weapon. ScienceDaily. Retrieved January 13, 2010, from http://www.sciencedaily.com¬ /releases/2010/01/100112152402.htm

Meddling with sex

Your mother may have told you that it's not nice to meddle in the business of others (especially when it's 'nasty business'), but when it comes to mosquitoes, meddling may offer very nice results. Imperial College recently released a report, entitled: "Meddling in mosquitoes' sex lives could stop the spread of malaria", revealing how a particular species of Anopheles gambiae has an easily disrupted sexual process, which when interrupted will prevent that mosquito from breeding.

"The new study focuses on the species of mosquito primarily responsible for the transmission of malaria in Africa, known as Anopheles gambiae. These mosquitoes mate only once in their lifetime, which means that disrupting the reproductive process offers a good way of dramatically reducing populations of them in Africa. When they mate, the male transfers sperm to the female and then afterwards transfers a coagulated mass of proteins and seminal fluids known as a mating plug" (Reeves). Prior to the release of this study, the purpose of this mating plug was misunderstood. Unlike similar substances in other species, the "male mating plug is not a simple barrier to insemination from rival males" (Imperial). Instead it is "essential for ensuring that sperm is correctly retained in the female's sperm storage organ, from where she can fertilise eggs over the course of her lifetime. Without the mating plug, sperm is not stored correctly, and fertilisation cannot occur" (Reeves).

"In Imperial's mosquito labs, the scientists showed it was possible to prevent the formation of the plug in males, and that this stopped them successfully reproducing with females" (Imperial). "In the future", researchers may "develop an inhibitor that prevents the coagulating enzyme doing its job inside male An. gambiae mosquitoes in such a way that can be deployed easily in the field -- for example in the form of a spray as it is done with insecticides". In this way, "we could effectively induce sterility in female mosquitoes in the wild. This could provide a new way of limiting the population of this species of mosquito, and could be one more weapon in the arsenal against malaria" (Reeves).

Sources:
Imperial College London. "Meddling in Mosquitoes' Sex Lives Could Help Stop the Spread of Malaria." ScienceDaily 22 December 2009. 27 December 2009 .
Reeves, Danielle. "Meddling in Mosquitoes' Sex Lives Could Help Stop the Spread of Malaria." Imperial College London. http://www.eurekalert.org/pub_releases/2009-12/icl-mim121609.php

Male infertility

How does male sterility combat malaria? When mosquitoes are sterile, they devastate the entire mosquito population. Called the Sterile Insect Technique (SIT), "the release of sexually sterile male insects to wipe out a pest population" is suggested as a "solution to the problem of malaria in Africa" (BioMed).

Malaria "control in sub-Saharan Africa, where 90 percent of the 300 to 500 million malaria cases and one to three million deaths occur from malaria each year, still depends on only two technologies for vector intervention: indoor residual spraying and insecticide-treated bed nets" (Klassen). Overtime mosquitoes become resistant to pesticides and insect populations bounce back from elimination efforts. According to researcher, Mark Benedict, "In the context of elimination, SIT could play a unique role. As part of an area-wide integrated pest management programme, the SIT may be able to minimize problems due to insecticide resistance to antimalarial drugs" (BioMed).

This technique "involves the generation of 'sterile' male mosquitoes, which are incapable of producing offspring despite being sexually active. Because female mosquitoes only mate once during their lifetimes, a single mating with a sterile male can ensure that she will never breed" This leads to an increasing reduction in the population over time, in contrast to insecticides, which kill a certain fraction of the insect population" (BioMed).

Considerable "research and development on the suppression of mosquitoes with the sterile insect technique (SIT) was conducted from the mid-1950s to the mid-1970s"; however, "nearly all of the scientists who pioneered this approach have retired and several of the greatest have died." The resurgence of this idea is due in part to "new technologies" that are "available to support area-wide integrated pest management (AW-IPM) programmes" (Klassen).

If implemented in Africa, the sterile insect technique when combined with other measures could effectively eliminate the malaria-carrying mosquito population in Africa.

For an overview of the history of malaria and the SIT project, please read the study's introduction in the malaria journal: http://www.malariajournal.com/content/8/S2/I1

Sources:
BioMed Central. "Are Sterile Mosquitoes the Answer to Malaria Elimination?." ScienceDaily 17 November 2009. 18 November 2009 .
Klassen, Wauldemar. "Introduction: development of the sterile insect technique for African malaria vectors". Homestead, Florida. 16 November 2009.

Malaria & Climate Change

Update on climate change as it relates to malaria (4 March 2010)

Every year approximately one million people die from malaria, and most of those are children. 350-500 million people are infected annually. This blood parasite is spread through the bite of infested mosquitoes and most frequently occurs within tropical regions. However, "malaria is an extremely climate-sensitive" disease that cannot be contained to the tropics (Patz). Medical researchers warn about the global threat of malaria in the future due primarily to climate change.

Climate change threatens to expand the mosquito's habitats, thereby spreading the disease. A joint study by the State University of New York and the Kenya Medical Research Institute showed that changes "in temperature can affect the development and survival of malaria parasites and the mosquitoes that carry them...Rainfall also influences the availability of mosquito habitats and the size of mosquito populations, the research found" (Barclay). A study conducted by Brown University researchers revealed that "an epidemic in Ethiopia was attributed to higher temperatures, rainfall and relative humidity than in previous years" (Brown).

A research team at University of Michigan (lead by M Pascual) has "documented a warming trend in the East African highlands from 1950 to 2002, concomitant with increases in malaria incidence. Moreover, their findings confirm the importance of the well recognized nonlinear and threshold responses of malaria (a biological system) to the effect of regional temperature change...For example, showing that the biological response of mosquito populations to warming can be more than an order of magnitude larger than the measured change in temperature represents a stunning finding, critical in advancing risk assessment of climate change impacts" (Patz).

[UNEP projected malaria distribution]

Outside of Africa, malaria is moving to higher altitudes and colder regions within endemic areas. "Malaria cases have been reported on the Bolivian high plateau," (Pabon). These individuals contracted the disease locally, meaning that malaria-carrying mosquitoes are now present in a region where they were previously unknown.

The US and UK are also under threat by malaria. Outbreaks of malaria within the US are not unknown, and may continue to increase as climates change. Florida and Louisiana are particularly susceptible to the disease. Across the pond, the UK reported 1370 cases of malaria in 2008. Six deaths were officially blamed on malaria (HPA). "A high likelihood of a major heat wave" may lead "to as many as 10,000 deaths, hitting the UK by 2012" warns the government (Prince). In coming years "the UK is to be hit by regular malaria outbreaks, fatal heat waves and contaminated drinking water within five years because of global warming, the Government has warned the NHS [National Health Service]" (Prince).

"The best climate conditions for malaria are a long rainy season that is warm and wet, followed by a dry season that is not too hot, followed by a hot and wet short rainy season," (Barclay). Pure global warming is not the primary culprit, instead a general shift in climate across regions is feared. Malaria is a devastating disease that infiltrates all areas of life. Epidemics destroy the health, economy, and cultural fabric of regions where malaria is prevalent.

We can make adjustments in our lives to prevent climate change; however, we also need to attack malaria to prevent its spread. Help Infectious Bite stop malaria in its tracks by supporting our cause or by donating to one of the many reputable agencies that provide mosquito nets and medicine to people threatened by malaria. Together we can Bite Malaria Back.

Sources:
Barclay, Eliza. " Climate Change Fueling Malaria in Kenya, Experts Say..." National Geographic. 9 January 2008.

Brown University. "Climate Change and Malaria". http://www.brown.edu/Research/EnvStudies_Theses/full9900/creid/climate_change_and_malaria.htm

Pabon, Cristina. Malaria spreading on Bolivian High Plains. SciDevNet.

Patz, Jonathan A. Sarah H Olson. "Malaria risk and temperature…" PNAS.

Prince, Rosa. "Malaria Warning as UK becomes warmer." Telegraph.co.uk. 12 Feb 2008.

UNEP: Map (http://maps.grida.no/go/graphic/climate_change_and_malaria_scenario_for_2050)

Popcorn parasite

Who would have thought that infecting "mosquitoes with a bacterial parasite could help prevent the spread" of blood parasites like malaria and lymphatic filariasis? If you guessed that it might, then you are either clever or very well-informed. For the rest of us, it is an exciting idea that may aid in "the control of...mosquito-borne parasites" (Wellcome).

Researchers have infected mosquitoes with a strain of Wolbachia, which is a bacterial parasite that infects insects and other arthropod species (Werren). The strain known as wMelPop, and nicknamed 'popcorn', can halve the lifespan of infected mosquitoes. "Mosquito-borne parasites such as the filarial nematode or the malaria parasite require an incubation period between ingestion and transmission, so only older mosquitoes" are "infective. Skewing the mosquito population towards younger individuals reduces the number of infectious insects." In the case of lymphatic filariasis, a parasitic worm that is transmitted by mosquitoes, wMelPop has also been shown to encourage "the mosquito's immune system to attack" the parasite that it hosts (Wellcome).

The 'Popcorn' strain may reduce the number of mosquitoes and the likelihood that they will transmit a parasite that is deadly to humans. Researchers are "currently looking at whether infecting other species of mosquito, such as Anopheles gambiae - the mosquito responsible for the majority of malaria infections - with wMelPop will have a similar effect and help inhibit malaria transmission as well as filariasis transmission."


Sources:

Kambris Z et al. Immune activation by life-shortening Wolbachia and reduced filarial competence in mosquitoes. Science 2009.

Wellcome Trust (2009, October 2). Parasite Bacteria May Help Fight Spread Of Mosquito-borne Diseases. ScienceDaily. Retrieved October 4, 2009, from http://www.sciencedaily.com­ /releases/2009/10/091001163601.htm

Werren, J.H.; Guo, L; Windsor, D. W. (1995). "Distribution of Wolbachia in neotropical arthropods". Proc. R. Soc. London Ser. B 262: 147–204.

Malaria in Tibet

Rarely a soul considers the risk of malaria while gazing upon the snow-covered Himalayas. Why should one bother? Tibet's high-altitude and cold-weather eliminate malaria-transmitting mosquitoes in most regions. For this reason, many travel books and web sites declare that "there is no risk of malaria in Tibet" (NaTHNaC). Unfortunately, this is absolutely untrue.



"Malaria is endemic in Linzhi Prefecture in the Tibet Autonomous Region (TAR), but the vector [definition: agent] for malaria transmission" was not identified until recently. It is now believed that the mosquito, "Anopheles pseudowillmori[,] is the predominant malaria vector" in the region (Song). Preventative treatment "is recommended...for travel along the valley of the Zangbo river in the extreme southeast" of Tibet (MD). "Anti-malaria medication is recommended for low-lying subtropical areas", particularly "during the rainy season" (Dorje 49).

Tibet is home to the "Falciparum type of malaria," which is considered to be the most dangerous and most deadly strain of malaria. "Various combinations of drugs are being used such as Quinine, Tetracycline or Halofantrine. If falciparum type of malaria is definitely diagnosed, it is wise to get a good hospital as treatment can be complex and the illness very serious" (Dorje 58). Clearly, "protection against mosquitoes and drug prophylaxis against malaria are essential" when traveling to certain areas of Tibet, and all travelers should be aware of the risk of infection (51).

Sources:

Dorje, Gyurme. Tibet handbook: with Bhutan.

Galuzzi, Luca. Photo.

MD Travel Health. "Tibet". 28 August 2009.

NaTHNaC. "China (Tibet)." 28 August 2009.

Song, Wu. Et al. Malaria Journal 2009. "Anopheles pseudowillmori is the predominant malaria vector in Motuo County, Tibet Autonomous Region." 16 March 2009.

World Mosquito Day

The 20th of August is World Mosquito Day. What are you doing to stop malaria?

World Mosquito Day was introduced in "an effort to remind the public about the continuing threat of malaria and other diseases transmitted by mosquitoes" (Mirsky). "Each year, approximately 350 to 500 million people are infected with malaria, killing 1 to 3 million people, mostly young children in Sub-Saharan Africa. Only female Anopheles mosquitoes that had previously bitten a person infected malaria will transmit the disease. Currently there is no vaccine that can provide high level of protection, and malaria parasites have evolved to resist many antimalarial drugs" (NowPublic).

Unfortunately, "it's not a day to celebrate" instead, it's "an awareness day. Ronald Ross of the Liverpool School of Tropical Medicine originated World Mosquito Day in 1897. He's the guy who figured out that mosquitoes carried the malaria parasite. He got one of the first Nobel Prizes for it in 1902" (Mirsky). By the way, he was also knighted in 1911. "Sir Ronald Ross was a British physician born in Almora, India. He had the breakthrough discovery during the dissection of a specific species of mosquito, the Anopheles, previously fed on a malaria patient. Malaria parasite was found on the mosquito and on its salivary glands" (NowPublic).

"112 years later, the fight against malaria is still on" (NowPublic). On this World Mosquito Day, motivate yourself to mention malaria and it's global threat to your peers, acquaintances, or that woman who swats at mosquito while she's waiting for the bus. Together, we can Bite Malaria Back.

Sources:
Mirsky, Steve. "Bite Back on World Mosquito Day." Scientific American. 19 August 2009.
NowPublic. "World Mosquito Day on August 20: Fight against Malaria" 19 August 2009.
Photograph by Hugh Sturrock

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 Mexico

Mexico is successfully combating the malaria infection and "has made substantial" advances "in decreasing its malaria burden," according to the Center for Disease Control (CDC). There has been no reported death in Mexico attributed to malaria since 1982.

"The risk of Malaria in Mexico low" (Traveldoctor). Infections caused by the most severe form of malaria (P. falciparum) account for less than 1% of cases. Furthermore, the number of reported cases has also dropped significantly in that time. "Between 1985 and 2003, the numbers of reported cases decreased by 97%, to 3,819 cases in 2003" (CDC).

The climate of Mexico yields itself to the spread and breeding of malaria; however, the country has nearly eradicated the disease in many regions. "17 of the country's 32 states have not reported any case of malaria during the past 4 years, and are in the process of being certified as having eliminated malaria" (CDC).

Mexico attributes its success to a strategy of "intensive surveillance". "In such areas, patients and their families are treated repeatedly with antimalarial drugs; breeding sites for mosquito larvae are destroyed or treated; and pyrethroid insecticides are sprayed as needed, inside houses and outdoors" (CDC). Mexico is also taking measures to safeguard the ecosystems, by "introducing new strategies to prevent malaria outbreaks -- without the help of DDT" (IDRC).

Mexico's success inspires other countries in the region to make moves to eradicate malaria within their borders.

Sources:
CDC: Centers for Disease Control and Prevention. "Malaria Nobel Prizes". 26 January 2005.
IDRC Archive. "Controlling Malaria in Mexico Using Alternatives to DDT". 14 September 2001.
TravelDoctor. "Mexico". 13 July 2009.

Spread of Malaria

Undoubtedly, mosquito bites are the most common way that malaria is spread. Specifically, the female anopheles mosquito is most often the culprit of infection. There are approximately sixty varieties of this mosquito.

How mosquitoes spread malaria:
When an infected individual is bitten by a mosquito, the insect ingests the gametocytes (reproductive forms of the parasite) with the blood. These gametocytes continue in the sexual phase of their cycle. Soon sporozoites (cells that infect new hosts) develop and fill the salivary glands of the mosquito. When the mosquito bites the next person, it injects the sporozoites into the human blood stream along with its saliva.

Most mosquito bites occur between 17:00 (5PM) and 07:00.

Other ways malaria is spread:
Mosquito bites are not the only way that malaria is spread. Other common methods of infection include:

1. Blood transfusions
2. Congenital infection
3. Blood-instrument transmission

Infection through Blood Transfusions:
Infection through blood transfusions is a common problem in areas where malaria is rampant. Even when an individual no longer feels sick from malaria, he/she can still transmit the disease via blood transfusion. Infectious periods differ by malaria strain, but for all strains the malaria may remain in the bloodstream for a number of years.

The duration of time malaria remains infectious by strain:
P. falciparum: 1-3 years
P. vivax: 3-4 years
P. malariae: 15+ years (duration may be for life)

Infections through blood transfusions occur when the blood is not stored properly for a long enough period of time. Most infections occur when blood is stored less than five days. It is rare for blood that has been stored over two weeks to transmit the disease. Frozen plasma is not considered infectious.

Blood can be tested for the infectiousness through the indirect fluorescent antibody test or Enzyme-linked immunosorbent assay (ELISA). Visual examination of the blood manually cannot deliver conclusive results.

Another method to reduce the spread of malaria through blood transfusion is to administer chloroquine to the transfusion recipients. Chloroquine is used to prevent malaria from Plasmodium vivax, ovale and malariae.

Congenital Infection:
"80% of deaths due to malaria in Africa occur in pregnant women and children below 5 years. In Africa, perinatal mortality due to malaria is at about 1500/day" (Malaria Site). Physiological changes within the pregnant woman increases the severity of malaria symptoms. Morbidity may be caused by anemia, high fever, pulmonary edema, puerperal sepsis, and hemorrhage.

The infection may be spread from the mother to the child during pregnancy; however this occurs in less than 5% of malaria cases. Congenital malaria is most common in the first pregnancy. Generally, the placenta protects the child from the infection. However, it is possible for transmission to occur prenatally. Babies who contract the disease congenitally are born with symptoms of malaria. Also, infants born to a mother with malaria may be premature, underweight, or stillborn. Malaria and pregnancy are

Blood-instrument transmission:
Instruments that come in contact with blood (including surgical instruments and needles) may transmit the disease. Much like HIV, malaria can be spread through any contact with the blood of an infected individual. Needles (particularly those used in relation to recreational drugs) may transmit malaria if they are shared. At times, malaria was transmitted unintentionally by medical personnel seeking to inoculate against infectious diseases. Medical personal no longer uses the same needles for multiple individuals, so this risk has decreased dramatically. Intravenous drug users can still transmit the disease if needles are shared between individuals.

Note: People have been intentionally infected with malaria (via needles) as a treatment for syphilis because it produced prolonged high-fevers.

Malaria is a disease that can be treated and in some cases prevented. For information how you can help support malaria research and treatment programs, please visit: The Roll Back Malaria Partnership. Infectious bite is not currently accepting money. All donations should be directed through the individual programs.

Sources:
The Malaria Site. 6 July 2009.
Roll Back Malaria Partnership. 30 June 2009.
World Health Organization: Malaria. 26 June 2009.
Center for Disease Control: Malaria. 26 June 2009.

Malaria in Zimbabwe

Zimbabwe has received a bleak prognosis for 2009 regarding malaria and cholera cases. Cholera continues to surge at epidemic levels, high numbers of malaria cases are also expected. "Malaria may be worse in Zimbabwe in 2009" than it has been in previous years. "That's because efforts to control cholera may be diverting attention away from programs to prevent malaria. The warning comes from the Rollback Malaria Campaign" (DeCapua).

"It's not just the rainy season that's helping to spread" the diseases, "but also a weakened healthcare system and poor water and sanitation". The Rollback Malaria Campaign adds that "there's been much less indoor residual spraying against mosquitoes", "and current heavy rains will help increase the mosquito population." Treatment "kits to help manage severe malaria cases are not reaching those in need due to distribution problems and that there's a shortage of healthcare workers due to Zimbabwe's economic crisis" (DeCapua).

According to recent statistics, fewer than 7% of young children sleep under any kind of mosquito net. Since mosquitoes are most active at night, the use of a net is paramount in avoiding bites from the mosquitoes that may carry malaria.
For more statistics please visit the Zimbabwe country profile.

Bureaucratic bottlenecks have limited the program's effectiveness in Zimbabwe, but other challenges are even more difficult to overcome. "Problems with flow of global fund within country resulted the loss of part of funding" and there is a constant shortage of personnel (RBM Campaign).

However, there is good news for Zimbabwe. Malaria-related deaths fell between 2001 and 2007 largely because of malaria treatment programs.

The number of deaths is expected to rise in 2009 due to the projected increase in numbers of cases.

[Photo provided by the RBM Campaign]

Currently, "malaria is found in all areas of Zimbabwe except the city of Harare" (Uyaphi). According to the MD Travel Health Website, "Prophylaxis with Lariam, Malarone, or doxycycline" Malaria treatment "is recommended for all areas, except the cities of Harare and Bulawayo".


Malaria prevention in Zimbabwe is dependent of funds raised outside of the country. If you would like to donate to the RBM Campaign, please visit their donation page.

Garlic as a Mosquito Repellent

Malaria, a blood-born parasite carried by mosquitoes, is a serious threat to tropical populations. Very little can be done by many rural villagers to prevent malaria, except for the use of mosquito repellents. As it turns out, garlic is a very good mosquito repellent used in Mexico, India, and other places under the threat of malaria.

"Garlic, taken internally or on the skin, is a fairly effective mosquito repellent" (Franz 218). "Many studies have been done on this subject. It has never been scientifically shown that eating garlic will repel mosquitoes. Spraying garlic on foliage does keep mosquitoes from the sprayed area however" (Mosquito). "For an unforgettable lotion, mix a handful of crushed garlic in half a cup of oil...Let this soak for a week to 10 days and then strain. Add several drops of penny-royal oil...crushed eucalyptus leaves...and parsley to reduce the garlic odor" (Franz 218).

"A mosquito's sense of smell is about 10,000 times better than yours and they are able to locate humans because they detect the carbon dioxide given off by us" (Mosquito). Garlic repellents emit a strong odor that discourage the mosquito from biting. Furthermore, "since mosquitoes are soft-bodied insects the garlic juice can be very toxic to them in increased concentrations". However, it requires "a very powerful variety which is much more potent than the garlic found in grocery stores (in fact, the lab people refer to it as "super garlic"). Garlic has a natural sulfur which repels insects, including mosquitoes, ticks and fleas" (Garlic).

Further research may develop a way to effectively produce a garlic that naturally repels and terminates mosquitoes in areas of the world where malaria proliferates.

Sources:
Franz, Carl, Lorena Havens & Steve Rogers. The People's Guide to Mexico.

Garlic Mosquito Barrier. http://www.dirtworks.net/Mosquito-Barrier.html. 26 June 2009.

Mosquito Barrier: Facts and Frequently Asked Questions. http://www.mosquitobarrier.com/facts.html. 26 June 2009.