eradication of malaria so why did the campaign fail? 1) insecticides (ddt) –environmental damage!
TRANSCRIPT
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Eradication of Malaria
• So why did the campaign fail?
• 1) Insecticides (DDT)– Environmental damage!
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Pesticide Resistance
• Rapid Reproduction
• Selection
DDT
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DDT
Pesticide Resistance
• Rapid Reproduction
• Selection
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Eradication of Malaria
• 2) Plasmodium– Wide use of chloroquine has led to drug
resistant strains!
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Eradication of Malaria
• 3) Social/Political Reasons– Emerging nations in Africa were trying to be
free from external (Western European nations) domination; much of the monetary resources stopped flowing in!
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• Genetic resistance to Plasmodium
• 2 examples
There are some general genotypes that are resistant to malaria
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Duffy Blood Group
• Noticed in military groups in Vietnam.
• African Americans had less severe cases or no cases of malaria!
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Genetic Resistance• Plasmodium vivax
• Duffy blood groups– Proteins on cell surface– 3 alleles
• A Dominant
• B Dominant
• y recessive
A =
B =
y = no proteins
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Genetic Resistance• Plasmodium vivax
• Duffy blood groups– Proteins on cell surface– 3 alleles
• A Dominant
• B Dominant
• y recessive
A =
B =
y = no proteins
AB yyAA BB Ay
By
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Genetic Resistance
• yy genotype has advantage– P. vivax malaria resistance– Only advantageous if P. vivax malaria
endemic
• 40% people of W. African decent
• 0.1% people of non-African decent
• P. vivax keeps the allele common in Africa.
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Genetic Resistance
• Sickle celled anemia• Codominant trait (Allele “A” and “B”)
– AA have sickle celled anemia– AB have both types of cells
• Sickle cells don’t support species of Plasmodium well.
• Resistance to infection
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Genetic Resistance
• AA selected against – Sickle celled anemia
• AB selected for– Both sickle and normal cells
• BB selected against– Normal cells
• If malaria not endemic, what alleles will be selected for? Against?
• Allele for sickle cells maintained in the population even though strongly disadvantageous to have both alleles.
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Genetic Resistance
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Sickle Celled Anemia
• In the US, 10% of African Americans have this allele!
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Other forms of Resistance to Malaria
• Babies get antibodies from their moms breast milk; they are protected until weaned.
• Once weaned becomes susceptible again!
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• What you need to have malaria spread within a population!
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Epidemiological Models
Infected People
MosquitoesUninfected
People
contact contact
Habitat
Climate
Food
Source of Plasmodium
Source of New Hosts
Habitat
Behavior
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Breaking the Chain
Infected People
MosquitoesUninfected
People
contact contact
Habitat
Climate
Food
Source of Plasmodium
Source of New Hosts
Habitat
Behavior
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Eliminating Mosquitoes
• Mosquito Life Cycle
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Eliminating Mosquitoes
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Eliminating Mosquitoes
• Destroy habitat
• Insecticides
• Biological control
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Eliminating Mosquitoes
• Destroy habitat
• Insecticides
• Biological control
• Why don’t these methods work?
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Pesticide Resistance
• Rapid Reproduction
• Natural selection
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Getting rid of the source of Plasmodium
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Getting rid of the source of Plasmodium
• Drug treatment
• Transgenic mosquitoes
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Getting rid of the source of Plasmodium
• Drug treatment
• Transgenic mosquitoes
• Why don’t these work?
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Getting rid of the source of Plasmodium
• Drug treatment
• Transgenic mosquitoes
• Why don’t these work?
– Availability of drugs• Money
• Medical staff
– Recrudescense
– Drug resistance
– Reservoir hosts?
– Transgenic mosquitoes not a reality
– Expensive
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How can we protect the uninfected population?
• Vaccines
• Prophylactic drugs
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How can we protect the uninfected population?
• Vaccines
• Prophylactic drugs
• Why don’t these work?
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How can we protect the uninfected population?
• Vaccines
• Prophylactic drugs
• Why don’t these work?– Vaccines unsuccessful– Prophylactic drugs expensive– Prophylactic drugs unpleasant
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How can we prevent contact between people and mosquitoes?
• Insecticides
• Mosquito nets
• Long clothing
• Behavior
• Avoid mosquito habitat
• Screens on houses
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How can we prevent contact between people and mosquitoes?
• Insecticides• Mosquito nets• Long clothing• Behavior• Avoid mosquito
habitat• Screens on houses
• Why don’t these work?
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How can we prevent contact between people and mosquitoes?
• Insecticides• Mosquito nets• Long clothing• Behavior• Avoid mosquito
habitat• Screens on houses
• Why don’t these work?– Money
– Availability of materials
– Human behavior difficult to change
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• "Everything about malaria is so molded by local conditions that it becomes a thousand epidemiological puzzles." Hackett (1937)
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Roll Back Malaria (RBM) Strategy• Early diagnosis and prompt treatment
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Roll Back Malaria (RBM) Strategy• Early diagnosis and prompt treatment • Prevention
– insecticide-treated materials– vector control measures
• indoor spraying• larvicide • environmental management
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Roll Back Malaria (RBM) Strategy• Early diagnosis and prompt treatment • Prevention
– insecticide-treated materials– vector control measures
• indoor spraying• larvicide • environmental management
• Prevention of malaria in pregnancy
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Roll Back Malaria (RBM) Strategy• Early diagnosis and prompt treatment • Prevention
– insecticide-treated materials– vector control measures
• indoor spraying• larvicide • environmental management
• Prevention of malaria in pregnancy
• Monitoring for epidemics – Rapid response
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Roll Back Malaria (RBM) Strategy• Early diagnosis and prompt treatment • Prevention
– insecticide-treated materials– vector control measures
• indoor spraying• larvicide • environmental management
• Prevention of malaria in pregnancy • Monitoring for epidemics
– Rapid response
• New methods and tools
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Roll Back Malaria (RBM) Strategy• Early diagnosis and prompt treatment • Prevention
– insecticide-treated materials– vector control measures
• indoor spraying• larvicide • environmental management
• Prevention of malaria in pregnancy • Monitoring for epidemics
– Rapid response• New methods and tools
• Improvement in existing tools through research and development
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Roll Back Malaria (RBM) Strategy• Early diagnosis and prompt treatment • Prevention
– insecticide-treated materials– vector control measures
• indoor spraying• larvicide • environmental management
• Prevention of malaria in pregnancy • Monitoring for epidemics
– Rapid response• New methods and tools• Improvement in existing tools through research and development
• Coordinated action through establishing partnerships that utilize an optimal mix of measures adapted to local situations.