Tag Archives: malaria

Africa: Major Malaria Vaccine Less Effective Than Hoped

Researchers unveiling critical trial results of a potentially major anti-malaria vaccine are expressing disappointment that the drug’s efficacy levels have proved lower than they had anticipated.

Following on decades of research, the third phase of testing on a vaccine known as RTS,S found that the drug reduced malaria rates among infants (age six to 12 weeks) by about a third, far lower than expected.

The study, funded largely by the Bill & Melinda Gates Foundation, is part of the largest malaria trial ever conducted, taking place in seven African countries. Results were published Friday in the New England Journal of Medicine, a U.S. publication.

While still significant, the results were disappointing in having followed surprisingly positive findings last year, when a similar study suggested that RTS,S was almost twice as effective (47-56 percent) on slightly older children, those five to 17 months old.

If this most recent phase could replicate that level of efficacy among infants, researchers had hoped that RTS,S doses could become incorporated into the standard round of initial vaccinations commonly given to newborns – an approach that has now been proven safe.

“It’s a little frustrating that we’re seeing different levels of protection in different age groups compared to last year and this year,” Andrew Witty, the CEO of GlaxoSmithKline, a major drugs manufacturer and one of the central partners in developing RTS,S, told journalists Friday from London.

“As it turns out, this phase of study was not the final step that I think many people might have hoped. But it’s an important step and takes us further forward towards the goal we’ve been working toward over the past 50 years … this remains the lead and most encouraging candidate vaccine.”

Indeed, the new research constitutes the first time that scientists have found such high efficacy for an anti-malarial vaccine for infants. Witty notes that if the two rounds of study had been reversed, the psychological impact would be far different and the findings would undoubtedly have been widely lauded.

Further, the higher efficacy among the slightly older cohort remains extremely important, given that scientists have found that this age category has greater susceptibility to severe cases of malaria than do infants. While the ease of a single early vaccination would have been the most efficient scenario, researchers say they will now be looking into additional strengthening options, such as giving toddlers a booster later on.

“Two things are very, very encouraging,” Witty says. “One, the trial is successful, despite the fact that it doesn’t achieve quite the high level we would have hoped. Two, the benefit we’ve seen is higher than bed nets, which themselves deliver about 30 percent gain over nothing.”

This last point is an important one, and hints towards the approach that researchers appear to be taking to continue moving forward. Although there are still at least 12 months of additional testing planned ahead of a 2015 projected release date for RTS,S, it now seems clear that the drug will need to play a more limited role among a package of additional interventions.

This will include treated bed nets, which the study reports 86 percent of children under observation were using. Additional research will now look into how to tweak the usage of RTS,S based on age, location and other demographic characteristics.

“In combating malaria, one size does not fit all,” David Kaslow, director of the PATH Malaria Vaccine Initiative, a U.S.-based non-profit that has led the RTS,S research, said Friday from Cape Town, South Africa.

“There is a need for new options for controlling malaria, and we expect that different combinations of tools will be appropriate in different settings in Africa. So, to understand the optimal use for RTS,S, it is critical that we get input from African researchers, because they’re on the frontlines.”

Kaslow notes that the wealth of information coming out of the RTS,S-related studies will also provide “a lasting legacy in Africa for the capacity to develop solutions for malaria and other infectious diseases for years to come.

Today’s global malaria burden falls most dramatically on Africa, where there are thought to be some 175 million cases of the disease. Ever year, around 655,000 people die of malaria, most of them children in sub-Saharan Africa.

Beyond health and wellbeing, such high numbers inevitably have a massive impact on the prospects for both individual and national economic development.

Yet even as the RTS,S studies move towards the projected 2015 release date, questions remain on how to ensure that the drug could feasibly get to the people that need it the most – whether its price can be kept low enough and whether it can be moved to areas that are often difficult to access.

On the first question, Witty says that GlaxoSmithKline has “made a very firm commitment that this vaccine will be priced at the cost of manufacture plus five percent margin, and all of that margin will be reinvested into future malaria research. So this will be a not-for-profit activity for GSK, where we seek to have the lowest possible cost to maximise access for families and children in Africa.”

On the second question, Salim Abdulla, director of the Ifakara Health Institute, an organisation based in Tanzania that is heavily involved in the current studies, says that Africa has a surprisingly positive record on getting drugs into the hands of those who need them.

“The experience so far with vaccination programmes in Africa has showed that this is one intervention that can be scaled up to reach many children,” he told journalists Friday from Cape Town. “This is one of the major reasons we’ve been able to control many types of diseases in rural Africa, even in remote areas.”

Testing will now take place on the longer-term efficacy of RTS,S, including 30 months after a third dose, as well as the impact of an additional booster. Results should be released by the end of 2014.

Courtesy All Africa News

HEALTH: Malaria Deaths “Underestimated”

DAA-7 February 2012

A new attempt to quantify malaria deaths over the past 30 years suggests the death toll, especially among adults, has been greatly underestimated. The figures also show the fragility of the gains made in fighting the disease.

Collecting data on malaria deaths is notoriously tricky; the countries where the disease is most prevalent have the weakest statistics. And even where causes of death were recorded, the researchers found many deaths were simply attributed to “fever” – probably malaria, but possibly not. In addition, a malaria infection is often a contributory cause of death along with other health problems.

However, after some complicated number-crunching, researchers, based at the Institute for Health Metrics in Seattle, believe they have produced the best estimates so far of how many people in the world die of malaria.

The figures, published in the London-based medical journal, The Lancet, some surprises, principally because they are significantly higher than those issued last year by the World Health Organization (WHO) – more than eight times higher in the case of older children and adults in Africa, where most of the deaths occurred. The difference was smaller in the case of children under five, but the researchers said they believed malaria was a more important cause of death in under-fives than the 2011 World Malaria Report estimated, causing 24 percent of child deaths in Africa.

Christopher Murray and his colleagues said they believed the fact that almost half a million extra deaths occurred in adults and older children each year had practical implications. “Traditional teaching in most medical schools argues that acquired immunity [in endemic areas] means that adults have clinical malaria, but are not likely to die from it. Inspection of the basic… data, however, clearly shows a substantial percentage of malaria deaths in individuals aged 15 years and over, even in endemic areas such as sub-Saharan Africa.”

In the light of this they suggest a shift of control strategies to pay more attention to all adults, not just women and children, in the distribution of insecticide-treated bed nets.

The research also tracked malaria deaths through time, from 1980 to 2010. Global malaria deaths almost doubled between 1980 and 2004; child deaths in Africa almost tripled over the same period. The researchers suggest the HIV/AIDS epidemic and resistance to chloroquine as probable causes, along with an increase in population in malaria-endemic areas.

After that the number of deaths started to fall, although they are still not down to 1980 levels. The results of hard-fought campaigns, and the resources provided by the Global Fund to fight AIDS, Tuberculosis and Malaria, do show up in the figures. The authors say “the risk of malaria death in several countries that have scaled up control efforts, such as Zambia, Tanzania, Kenya and Ethiopia, has decreased between 2000 and 2010 figures”.

The reverses of the 1980s and 1990s signal the fragility of the gains in the war against malaria, and the researchers say this underscores the danger posed by the world economic crisis, and the slowdown in health funding. They conclude: “The announcement by the Global Fund [in November] that their next round of funding would be cancelled raises enormous doubts as to whether the gains in malaria mortality reduction can be built on or even sustained.”

Sarah Kline, executive director of Malaria No More UK, told IRIN this fragility of funding, especially from the Global Fund, was a big source of discussion and anxiety for the whole malaria community. “The total funding gap for malaria, from all sources, if we are going to meet our 2015 targets, is around US$3 billion a year, although we did have some positive announcements at Davos about extra funding from the Gates Foundation, and the governments of Saudi Arabia and Japan.”

The funding gap was also addressed by the Liberian President Ellen Johnson Sirleaf when she was elected to head the African Leaders’ Malaria Alliance on 2 February, and urged African countries to step up their own funding for control campaigns and find innovative sources of finance to close the gap.
[Courtesy IRIN]

COTE D’IVOIRE: Unrest disrupts malaria programme

DAKAR, 7 June 2011 (IRIN) – The post-election violence in Côte d’Ivoire delayed by several months a distribution of mosquito nets – a pillar of the country’s strategy to combat malaria, a leading killer of children.

Some communities must wait even longer as hundreds of thousands of nets were looted during the unrest.

This is just one example of how the recent conflict has disrupted health services, which were already fragile after nine years of a north-south split.

“This sets us back in our malaria prevention efforts. We were supposed to have done this distribution in December,” said San Koffi Moïse, head of the national malaria control programme (PNLP). The project – funded by The Global Fund to Fight AIDS, Tuberculosis and Malaria – aims to cover all households across the country, he told IRIN.

Health workers, along with NGOs Population Services International (PSI) and CARE, on 3 June began handing out insecticide-treated nets in the northwest and in one southern department. A team with The Global Fund is currently in Côte d’Ivoire to meet with PNLP officials and aid workers to discuss how to proceed.

“We are evaluating the situation to see in what regions we can do distributions,” San said.

More than 100 containers of mosquito nets were pre-positioned throughout the country prior to the October 2010 presidential election. In western Côte d’Ivoire – one of the regions hardest hit by post-election violence – entire containers were carted off and scores were broken into and emptied.

In Duékoué IRIN saw several empty containers next to the government health services building; most state health workers abandoned their posts during the violence and hospitals and offices were also looted. Mosquito nets like those destined for free distribution were for sale in the Duékoué market.

“We don’t know the motive for the looting but it appears the thefts were organized, not just simple acts of vandalism,” PSI representative Rambeloson Lalah told IRIN. “In Toulepleu [near the border with Liberia], entire containers were taken away.”

When things began to heat up before the election, NGOs insured the nets against “political violence”, so they expect to replenish stocks so as to cover the entire country as planned.

Vouchers 

The rains have started in much of the country, and with that comes malaria. Ivoirians told IRIN they received vouchers for the nets months ago and are still waiting.

“The people really need mosquito nets right now,” said Miagnet Fatou, nutrition expert at the main hospital in the western town of Danané. “It’s mango season and malaria is hitting hard.” Mango season corresponds with the rains so people commonly associate mango season with the disease.

Miagnet said most of the malnutrition she sees in Danané is linked to malaria.

“People received vouchers a long time ago but they are still waiting… Now they’re seeing nets for sale in the market; they’re not sure what to think.” She said nets sell for up to 1,000 CFA francs (US$2.23) in the market – unaffordable for most families.

“I use mosquito nets to protect my children,” said 32-year-old mother of four Affissatou Diakité in the main city Abidjan. “I got a voucher about six months ago… but then the crisis stopped the process.”

But even as distribution gets under way, there is uncertainty over the number needed in many areas, as tens of thousands of people throughout Côte d’Ivoire have yet to return home after fleeing violence, said Kouyaté Karim, departmental health director in the centre-north city of Bouaké.

“And some people have told me they’ve lost their vouchers. I’m not saying we’ll have to make a new count from scratch, but this is something we have to be aware of as we proceed.”

He added: “The conflict has brought considerable disorder to the health system and it will take time to get back on track.”

While mosquito nets are not a panacea, their use has repeatedly been shown to reduce severe disease and mortality due to malaria in endemic regions, according to the World Health Organization (WHO). Bednet distribution is one part of Côte d’Ivoire’s control strategy, along with prevention measures for pregnant women and ensuring access to malaria drugs.

During 2006-09 PNLP distributed about 2.1 million treated bednets, according to a government report on progress on the millennium development goals. But that is about 10 percent of the number of people at risk, according to WHO’s 2010 World Malaria Report.

[Courtesy of IRIN]

 


MYANMAR: Malarial drug resistance “hotspots” identified

Health experts had barely finished one project to contain anti-malarial drug resistance along the Thai-Cambodia border when their attention was drawn to Myanmar, where early warning signs suggest a waning influence of the anti-malarial drug Artemisinin.
Malaria is a leading cause of morbidity and mortality in Myanmar and a leading cause of deaths in children under five, says the UN World Health Organization (WHO).

Resistance to the previous standard treatment for malaria, chloroquine, was first reported in the 1950s along the Thai-Cambodia border. By the 1980s it had spread to sub-Saharan Africa, which has the world’s highest rate of malaria mortality.

Evidence of resistance emerged from Southeast Asia once again in 2007, this time to Artemisinin, one component of the combination therapies used worldwide to control malaria. Donors, starting with the Bill & Melinda Gates Foundation, pumped US$22 million into the border from 2009.

Charles Delacollette, coordinator of the Bangkok-based Mekong Malaria Programme with WHO, said while those huge multi-country efforts have worked to bring down reports of malaria infections, “what we are seeing along the Thai-Myanmar border seems equally serious … to what we had at the Thai-Cambodian one”.

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Central African Republic: Conflict hits Healthcare

After decades of political violence, displacement and insecurity caused by clashes between rebel groups and government forces, as well as armed bandits, thousands of people in Central African Republic (CAR) are vulnerable to disease and have little access to health services, aid agencies say.

According to the UN Office for the Coordination of Humanitarian Affairs(OCHA), many health centres in the north and southeast of CAR are either looted or not operational because medical workers are often compelled to leave the area. Since 2008, the government has spent only 1.5 percent of GDP on public health, hence its dependency on some 19 medical NGOs to provide drugs and medical equipment and improve the skills of health workers.

Malaria remains the leading cause of morbidity, accounting for 13.8 percent of deaths. There are resurgent meningitis outbreaks as well as other communicable diseases such as wild poliovirus, measles and yellow fever but the principal afflictions are water-borne, skin and respiratory diseases.

The Consolidated Appeal report 2011 states that only 30.5 percent of the population (28 percent in urban and 32 percent in rural areas) have access to safe drinking water , while the Food and Agriculture Organization (FAO) says that with rural agricultural production abandoned in many areas due to insecurity, farmers do not have access to productive capital, having lost seeds, tools and harvests when forced to flee. Sixty-seven percent of the population live on less than US$1 and thousands are food-insecure or living on aids agencies.

According to the UN Children’s Fund, 16 percent of children under-five are acutely malnourished, while 6.6 percent are severely acutely malnourished, but there are only 25 therapeutic feeding centres and 60 outpatient facilities, covering one-third of the cases that would have to be managed.

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