dr. rebecca duerst, program director for health care elca synod malaria summit 20-22 march 2014
TRANSCRIPT
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THE SCIENCE OF MALARIA: BIOLOGY, EPIDEMIOLOGY & PUBLIC HEALTH
Dr. Rebecca Duerst, Program Director for Health Care
ELCA Synod Malaria Summit20-22 March 2014
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Outline
True or False on malaria biology, epidemiology, and public health
Scientific advances in malaria work Time for Q&A
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True or False?Biology, Question 1 Q: Malaria is caused
by mosquitos A: False Explanation: Malaria is
caused by parasites in the genus Plasmodium; it is transmitted by female Anopheles mosquitoes
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True or False?Biology, Question 2 Q: There are 4 species of Plasmodia known to cause
malaria in humans A: False The 4 main species causing
human malaria are: Plasmodium falciparum Plasmodium ovale Plasmodium vivax Plasmodium malariae
A 5th species, Plasmodium knowlesi (“nolls-eye”), is now recognized as an important cause of human disease in Southeast Asia; it is responsible for up to 75% of malaria infections in some areas
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True or False?Biology, Question 3 Q: The life cycle of Plasmodium parasites is
complex A: True http://www.cdc.gov/malaria/about/biology
a Female Anopheles mosquitoes require a blood meal for egg development. Infected females inject the sporozoite form into a human host. b Sporozoites are carried in the bloodstream to liver cells, where they proliferate asexually and release merozoites. c Merozoites invade red blood cells and reproduce asexually; disease clinically manifests as fever & chills. d Then male and female gametocytes are produced and transmitted back to a mosquito, where they fuse to form oocysts that divide into sporozoites. These migrate to the salivary glands.
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True or False?Epidemiology, Question 1 Q: Epidemiology is the branch of
medicine dealing with physiology and pathology of the skin
A: False Epidemiology is the study of distribution
and determinants of health-related states / events (including disease), and the application of this study to control diseases and other health problems (WHO)
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True or False?Epidemiology, Question 2 Q: Africa carries the majority of the world’s burden of
malaria A: True
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True or False?Epidemiology, Question 3 Q: Malaria has no relationship to poverty, HIV&AIDS,
climate change, etc. A: False www.gapminder.org
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True or False?Public Health, Question 1 Q: Despite much progress, malaria is still a major
public health concern globally A: True 2012 estimated malaria cases:
207 million 80% occur in sub-Saharan Africa
2012 estimated malaria deaths: 627,000 90% occur in sub-Saharan Africa, 77% in children under
5 years of age An estimated 3.3 million deaths were averted
between 2000-2012
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True or False?Public Health, Question 2 Q: Focusing efforts only on net
distribution is the best strategy for malaria prevention
A: False WHO promotes integrated approach
(“integrated vector management”) including LLINs, IRS, & environmental management, along with education, prompt diagnosis and effective treatment, surveillance, etc.
http://www.npr.org/blogs/health/2014/01/03/257627285/why-ending-malaria-may-be-more-about-backhoes-than-bed-nets
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True or False?Public Health, Question 3 Q: Artemisinin (key ingredient in ACT) is
still 100% effective throughout the world A: False Parasite resistance to artemisinins has
been detected in 4 countries in Southeast Asia Cambodia, Myanmar, Thailand and Viet Nam
In Cambodia, resistance has been found to both components of ACT Special provisions have been made for DOT
with a non-artemisinin-based combination
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True or False?Final Question Q: Because malaria is such a focus of global health efforts,
extensive, accurate data is available A: False There is more uncertainty about malaria than any other
disease Malaria surveillance systems detect <10% of estimated
cases - Richard Cibulskis, WHO Global Malaria Programme, 2011
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SCIENTIFIC ADVANCES IN MALARIA RESEARCH
New ideas & technological innovations
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Testing & Diagnosis:Detection methods Phone camera microscopes
“CellScope” (relatively expensive) 1mm glass ball, cardboard, tape
“Origami” microscope (6 March 2014) http://youtu.be/pBjIYB5Yk2I
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Testing & Diagnosis:Detection methods “Matibabu” blood scanner (Swahili for “medical
center”) http://
news.discovery.com/tech/videos/phone-app-diagnoses-malaria-video.htm
Brian Gitta, Makerere University, Uganda pitches his idea that uses cell phones and light – not needles and blood samples to test for malaria (USAID).
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Malaria vaccinePrime candidates PfSPZ (Sanaria) – August, 2013
6 volunteers received 5 IV doses each, over 20 weeks 100% protection, but impractical conditions
RTS,S (GSK) – October, 2013 (18 mo. follow-up) Protection lasted over 18 months, though waned
slightly Reduced malaria cases in children by nearly half (46%) Adding a booster dose at 18 months is now being studied Policy recommendation from WHO is possible in 2015
http://www.npr.org/blogs/health/2013/10/08/230356317/first-malaria-vaccine-moves-a-step-closer-to-approval
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DrugsNew targets? AP2-G protein – February, 2014
Master switch that triggers activation of genes that initiate the development of gametocytes (only form infectious to mosquitos)
CAX protein – April, 2013 Transporter that controls calcium
level inside cells (Artemisinin interferes with the other Ca+2 transporter)
Parasites die before developing inside mosquito when CAX does not function
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MosquitosAltering the vector GM mosquitos (?)
Mosquito blood has proteins that punch holes through the parasite’s membrane
Engineer mosquitos that produce in higher amounts
Wolbachia-infected mosquitos Bacteria naturally occuring in
other species of mosquitos Confers resistance to malaria
(and dengue virus)
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Thank you!