On the Malaria Vaccine

November 7, 2011

A recent WHO report indicates that nearly a third of all countries affected by malaria are on course to eliminate the disease over the next 10 years. Though malaria can lead to complications or even death, it is a preventable and curable illness caused by a parasite that is passed from one human to another through the bite of infected Anopheles mosquitoes. Infected individuals frequently experience high fevers, flu-like symptoms, and anemia; and in 2008 malaria caused between 190 and 311 million clinical episodes and between 708,000 and 1,003,000 deaths. Anti-malarial medications, insecticidal nets, and other control and prevention measures have saved an estimated 1.1 million lives in Africa over the past 10 years, but the availability of an effective vaccine  is vital to halt its spread.

In the 109 countries and territories where the risk of malaria transmission is the greatest, newly developed malaria vaccines could save lives. Reports indicate that there were 225 million cases of malaria and an estimated 781,000 deaths in 2009, but these figures have steadily declined in recent years. Though preventative measures have helped to reduce infection rates, experts note that the development and use of a malaria vaccine could reduce them further. During a major clinical trial,  a recently produced experimental vaccine known as RTS,S halved the risk of children in Africa contracting malaria. Currently children under five years of age account for the majority of the 800,000 people who die each year as a result of malaria. According to the developers of the vaccine, the adverse effects observed during the vaccine trial are comparable to those seen in children receiving other vaccines.

The RTS,S vaccine triggers an immune response which targets the Plasmodium falciparum parasite that causes malaria. This immune response prevents the parasite from maturing and multiplying in the liver of the vaccinated individual. Unlike other previously developed malaria vaccines, this new vaccine has been created to target different forms of the disease and to trigger a range of antibody responses. Though researchers have been working for 40 years to develop an effective malaria vaccine, to date the outcomes have not been entirely successful. Additional research and testing of the RTS,S vaccine is needed, but according to Dr. Mary Hamel of the Centers for Disease Control and Prevention, “these findings show we are on track in the development of a vaccine.”

With further testing and refinement, this vaccine has the potential to save millions of lives each year and eradicate a disease that affects 3.3 million people – half the world’s population. An effective malaria vaccine could reduce malaria-related deaths, 89 percent of which occur in Africa, and could improve the lives of individuals in regions impacted by the diseases.

 

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Flooding in Pakistan

September 1, 2010

Reports indicate that recent flooding in Pakistan has affected the lives of at least 15.4 million people and left a third of the nation – including approximately 7.9 million acres of cultivated land – under water. At least 900,000 homes have been destroyed by surges of water, and a reported six million people do not have access to food, shelter, and potable water. In addition, the United Nations indicates that 1,600 have died and more lives are at risk as the threat of water-borne illness continues to rise.

Floods began in late July following a period of particularly heavy monsoon rains and have continued through August. Many have sought shelter in camps established by aid organizations, but public health experts warn that the crowding associated with displaced persons camps could exacerbate the spread of disease. Scabies, a skin infection caused by mites that burrow and cause pimple-like irritation, is becoming increasingly common in the camps. According to some reports, tens of thousands of infected individuals are among the 600,000 people in relief camps set up in Sindh province. In these tented camps which have been established in army compounds, schools, and public buildings, healthcare providers are struggling to contain outbreaks of acute diarrhea, the precursor to fatal cholera.

According to Mark Ward, acting director of the U.S. Agency for International Development’s office for foreign disaster assistance, “When you are dealing with this much water and that many people it [cholera] is almost unavoidable.” In addition, the World Health Organization (WHO) has reported 204,000 cases of acute diarrhea, 263,300 cases of skin diseases, and 204,600 cases of acute respiratory diseases in flood-affected regions. Thousands of cases of suspected malaria have also been documented and the conditions for mosquito-borne as well as water-borne illness are present.

The delivery of treatment for these fast-spreading communicable diseases has been compounded by the lack of adequate clinical facilities. Reports indicate that 200 health facilities were damaged or destroyed. Vaccination programs have been established in Charsadda and Peshawar regions and more than 100,000 children have received polio shots. Despite these efforts, millions, including 3.5 million children are at risk of contracting disease, and require water, shelter, or emergency care. Radio and text messaging campaigns have also been put in place to distribute information about the importance of hand washing and good hygiene.

While funding for humanitarian aid has been limited to date, the UN and other international organizations continue their efforts to garner support. Assuring that food, water, shelter, and medical treatment are available for those who need them is the primary concern of aid organizations currently working in Pakistan. By delivering effective medical treatment in a timely fashion while also working to prevent the spread of diseases, outbreaks can be contained.

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On Malaria Worldwide

May 3, 2010

Nearly half the world’s population – roughly 3.3 billion people – are at risk of contracting malaria. Though individuals in Latin America, the Middle East, and Europe are among those most often affected by the disease, the Centers for Disease Control and Prevention reports that 98 percent of global malaria deaths occur in 35 countries – 30 of them in sub-Saharan Africa and five in Asia. Every year there are nearly 250 million cases and an average of one million deaths due to malaria. Reports show that in 2008, an estimated 863,000 people died from malaria infection, indicating some improvement in diagnosis and treatment outcomes. Transmission is possible to any individual, however some groups are at an increased risk. These include young children who have not yet developed full immunity, pregnant women whose immunity has been decreased by pregnancy, international travelers who lack immunity, and  individuals with HIV/AIDS or others with compromised immune systems.

Malaria is a preventable and curable acute febrile illness caused by the bite of Anopheles mosquitoes which have been infected with Plasmodium parasites. The long lifespan of the Anopheles species found in Africa contributes to the disease’s prevalence in the region, and experts note that more than 85 percent of the world’s malaria deaths occur in Africa. Symptoms are usually seen seven days after the infective mosquito bite, and include fever, headache, chills, and vomiting. If diagnosed quickly, malaria can be treated using artemisinin-based combination therapy (ACT), however if treatment is not initiated, malaria can progress and lead to severe anemia, respiratory distress, or death.

In countries where malaria is endemic, access to diagnostic tools and medications may be limited. Less than 15 percent of these individuals are able to begin treatment within 24 hours of the onset of fever, which is when treatment must be started. Malaria diagnosis relies on either microscopy or rapid test procedures to allow healthcare providers to quickly determine if patients have the disease and require treatment. The Malaria Product Testing Evaluation Programme recently completed an assessment of 29 rapid diagnostic tests and found that 16 of them met the minimum performance criteria set by the WHO. According to Robert Newman, the director of the WHO’s Global Malaria Programme, using rapid tests allows healthcare providers to “test people who cannot access diagnosis based on microscopy in remote, rural areas where the majority of malaria occurs” and thus improves treatment outcomes.

In addition to improved testing, global efforts are underway to control malaria by eliminating the mosquitoes that transmit the disease. During the past decade, the distribution of treated bed nets has increased rapidly in 11 African nations, helping to reduce infection rates. Reports indicate that in 2008, 31 percent of African homes had insecticide-treated nets (ITNs), compared with 17 percent in 2006. Through the use of ITNs, as well as spraying of homes with insecticide chemicals, 10 African nations reduced the number of cases of malaria by at least 50 percent between 2000 and 2008.

Though there is no vaccine for malaria, more effective prevention measures, diagnostic tests, and medications can help to improve treatment outcomes for those affected. Government agencies, including the World Bank, and other groups, such as Roll Back Malaria global partnership, have made efforts to increase global awareness about malaria. By utilizing social media and online tools it has been possible to improve the effectiveness of outreach and fundraising for efforts which may help to eradicate malaria worldwide.

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On Neglected Tropical Diseases

January 11, 2010

Malaria, HIV/AIDS, and tuberculosis are often considered the most pressing disease-related threats to individuals in the developing world and the quest to eradicate them receives a large portion of government and private funding. However, a group of conditions known collectively as neglected tropical diseases (NTDs) have a more widespread and devastating effect on the lives of people in many regions of sub-Saharan Africa, Southeast Asia, and Latin America. These regions account for up to 90 percent of the disease burden for this group of 13 parasitic and bacterial conditions. Reports from the Global Network for Neglected Tropical Diseases indicate that these parasitic and bacterial infections affect over 1.4 billion people, most of whom survive on less than US$1.25 per day. While NTDs may not necessarily kill those infected, they can lead to malnutrition, anemia, a range of disabilities (most often blindness), stunted growth, and greater susceptibility to other illnesses.

Neglected Tropical Diseases

Clockwise from top left: An egg of the roundworm, which causes Ascariasis; a man with Lymphatic Filariasis being examined by a physician; the whipworm, which causes Trichuriasis; and a child receiving antibiotic treatment for Trachoma.

Individuals affected by NTDs live primarily in tropical and subtropical climates, and many experience more than one infection or parasite at a given time. According to the World Health Organization (WHO), the majority of individuals affected by NTDs live in remote and rural areas, urban slums, or areas experiencing conflict situations. Seventy percent of infections occur in low- or lower-middle income areas, and are frequently caused by unsafe water and poor housing and sanitation conditions. Further, NTDs contribute to a cycle of poverty in which children are likely to become infected due to their poor living conditions, and once infected they may experience delays in cognitive development inhibiting their ability to escape their impoverished conditions.

The seven most common NTDs are: Ascariasis, Hookworm, Lymphatic Filariasis, Onchocerciasis, Scistosomiasis, Trachoma, and Trichuriasis. These diseases, many of which are caused by parasitic intestinal worms known as helminthes, have the most devastating impact on those who contract them. For example, Ascariasis, resulting from roundworm infestation, affects 800 million people; and trichuriasis, resulting from whipworm, affects 600 million. Helminths rob children of nutrients and can lead to stunted growth, iron-deficiency anemia, and protein malnutrition. They are at an increased risk of contracting parasitic worms, as are the elderly and pregnant women. Over 40 million pregnant women are infected with hookworms, parasitic worms that attach to the small intestine and suck blood from their host, increasing vulnerability to malaria and additional blood loss during labor.

Based on Disability-Adjusted Life Years (DALYs), which refer to the years of healthy life lost to disability or premature death, NTDs are a greater health burden than tuberculosis or malaria, and approach the level of burden of HIV/AIDS. In addition, NTDs are the cause of approximately 534,000 deaths worldwide each year. Through programs to distribute medications, the WHO, pharmaceutical companies, government agencies, and international aid organizations hope to ensure fewer lives are lost. Coordinated efforts have allowed for the rapid deployment of inexpensive diagnostic tools, medications, and treatments, many of which can be administered by trained non-medical staff including teachers and community health workers. Medications are often distributed in “rapid-impact packages,” reducing costs and putting less strain on already weakened healthcare systems in the areas where NTDs are most prevalent. These packages also offer the opportunity to bundle life-saving drug treatments with other interventions such as antimalarial bed nets or nutritional supplements.

Through these and other similar efforts, it has been possible to reduce the occurrence of a number of conditions in many parts of the world. The number of cases of guinea worm disease, also known as dracunculiasis, has fallen from 3.5 million in the 1980s to just 4,619 in 2008, and the WHO has declared eradication in Nigeria and Uganda. Many other conditions are now found only in remote villages and are nearing total eradication through education programs, medication distribution, and improved sanitation.

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A Killer in the Developing World

August 17, 2009

HIV/AIDS and malaria are major health concerns worldwide, however the World Health Organization (WHO) reports across much of Asia and Africa secretory diarrhea – which accounts for 1.6 million deaths annually – is an even greater threat. Each day in India, diarrhea-related diseases kill 1,250 people, only slightly fewer than the H1N1 virus has killed globally to date (1,500), according to the WHO. Caused by E.coli, cholera, and other bacteria, viruses, or parasites, diarrhea affects individuals more often in areas that lack safe water and appropriate sanitation. In individuals with secretory diarrhea, infectious agents cause too much water to enter the bowel and be evacuated from the body, leading to excessive dehydration and eventually death if appropriate treatment is not received.

Diarrhea in the Developing World
In nations of the developing world, including Bangladesh, India, Mali, and Pakistan, aid organizations and government agencies have begun distributing zinc supplements to villagers as a treatment for diarrhea. Data from recent studies documented in the August 2009 issue of the Journal of Leukocyte Biology suggest that zinc may help to activate the T-cells needed to destroy viruses and bacteria, including those that cause diarrhea. Time Magazine reports that in tablet or liquid form, zinc can be used in combination with oral-rehydration therapy (ORT). While it is not entirely clear how zinc helps halt diarrhea, Oliver Fontaine, a diarrhea specialist for the WHO, explains that a single course of zinc treatment can stave off diarrhea for three months.

Unlike zinc, which often produces an immediate improvement in an individual’s health, the glucose present in ORT (a solution of sugars and salts) slows the evacuation of fluids allowing for the absorption of electrolytes in the intestines, and halting the progression of dehydration to a chronic state. Because of the delay in the improvement of symptoms with ORT, “Mothers don’t see ORT as real treatment,” according to Eric Swedberg, senior director of health and nutrition at Save the Children U.S. Though ORT is an effective treatment for diarrhea, only about 35 percent of families in diarrhea-stricken countries utilize the method.

By offering zinc in combination with ORT, government-run programs in Ethiopia and Tanzania hope to increase the number of people surviving diarrheal outbreaks. Additionally, efforts are being made in Mali to add zinc to the country’s list of essential drugs, a step towards improving the distribution of the tablets. To halt the recent outbreaks of diarrhea in Nepal that have led to 235 deaths to date, the Office of the Prime Minister has begun coordinating efforts to construct a toilet in each household, provide sources of potable water, and improve waste disposal systems. In addition, the Nepali government has mobilized 298 personnel to aid in providing treatment in the area through 89 health camps.

To support these and other similar efforts, funding for the provision of the potentially life-saving drugs, and awareness of their effectiveness must be increased. In 2007, only four percent of all U.S. funding for research of epidemics in the developing world was devoted to finding solutions to decreasing the number of diarrhea-related deaths. Support from organizations like the Bill and Melinda Gates Foundation have provided some support, but additional funding is still needed not only to ensure that zinc tablets are more widely distributed, but also to assist in efforts to improve the quality of available water and waste treatment measures.

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WHO on Water Treatment and Safe StorageOn Diarrhea and Tuberculosis in IndiaTime Magazine on Zinc to Treat DiarrheaDiarrheal Deaths in NepalOn Zinc Fighting Infection


Innovative, Low-Cost Medical and Diagnostic Tests

August 3, 2009

In the developing world, the availability of many medical technologies is limited by cost, durability, and ease-of-use. This is especially true of expensive diagnostic devices, which  are critical for detecting diseases that are endemic in developing countries. However, researchers are working to develop low-cost, user-friendly alternatives that could improve the ability of healthcare providers to diagnose a range of conditions.

Innovative New Diagnostic Tests Can Save Lives at a Lower Cost

Harvard researchers have developed an alternative microfluidic device that replaces standard silicon, glass, or plastic substrates with treated paper. Fluids flow through the microchannels in the paper device in the same way that they would in a standard chip. Researchers have used the device to test for glucose and protein in urine, but hope to adapt it for the possibility of testing blood samples for HIV/AIDS, dengue fever, or hepatitis. While a traditional microfluidic device costs between $10 and $1,000USD, the materials to create the paper devices, known as microPADS, cost only three cents. The design of the microPAD device allows for several tests to be conducted simultaneously, furthering the cost and resource savings.

To help better diagnose infectious diseases such as malaria and tuberculosis, researchers have developed a microscope that attaches to any cellular telephone with a camera feature. The device, known as a CellScope, is able to illuminate pathogens in a sample treated with fluorescent molecular “tags.” It is estimated that the production of first CellScopes will cost roughly $1,000 each, but with further developments the price could drop to just a few hundred dollars, including the cell phone. Not only can an individual use the microscope to view the pathogens, but they can also send an image to a healthcare facility for assistance making an appropriate diagnostic determination.

Efforts have also been made by scientists at the Burnet Institute to improve HIV-testing procedures. A prototype monitoring test has been designed for use in remote settings. The new test, which uses a finger-prick blood sample, allows individuals to determine their CD4+ T-cell count within 30 minutes. The CD4+ T-cells are critical for healthy immune system function and their levels are a deciding factor with regard to starting anti-retroviral therapy. Standard CD4 tests are often not available in the developing world due to their cost, the need for specialized equipment and trained personnel, and the long wait period to obtain test results.

Though these diagnostic technologies offer improvements in the developing world, as The Wall Street Journal reports, acceptance may be slower in the United States. Some researchers have found success when applying African healthcare models to rural areas of the U.S., and results using low-cost technologies originally conceived for use in the developing world may follow this trend. The use of innovative low-cost testing methods may also assist with telemedicine initiatives, as they allow healthcare providers to conduct necessary tests and provide better diagnostic information to consultants. Through discussion among global health experts – as allowed by telemedicine initiatives like iCons in Medicine – innovative diagnostic tools and other cost-saving measures may become more popular, and help to provide improved care worldwide.

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IEEE spectrum – Inside Technology – Discover Magazine on the microPAD and the CellScopeBurnet Institute CD4+ T-cell Test