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The course aims to bolster local partners and managerial and technical capabilities in the management, planning and implementation of malaria control and elimination activities at the different levels of health /malaria service delivery in Myanmar.
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Introduction - That the World Health Organisation (WHO) has certified Sri Lanka as a malaria-free nation is indeed a truly remarkable achievement. Sri Lanka has now completed 3 consecutive years without any case of indigenous malaria, an achievement never seen before, and is now eligible for WHO certification as a malaria- free country. Only the Maldives and Singapore have been declared free of the disease in the region; but both countries have less than a quarter of Sri Lanka’s 21 million population.
Some historical facts – The discovery that malaria is spread by mosquitoes is usually regarded as recent. But actually it is not so. Malaria, or disease resembling malaria, has been noted for more than 4,000 years. Deriving its name from the Italian for "bad air" (mal/aria), the disease has probably had a great influence on human populations and human history. As an example, the construction of the Panama Canal could not be completed until malaria (and yellow fever) was controlled, due to the high morbidity and mortality among the workers. The symptoms of malaria were described in ancient Chinese medical writings. The Indian physician Susruta (6th Century BC) mentions types of fevers, and attributes some to insects like mosquitoes. But, as so often happens, these ancient ideas were ignored and forgotten, and they had to be rediscovered many centuries later.
Following their arrival in the New World in the 17th century, Spanish Jesuit missionaries learned from indigenous Indian tribes of the medicinal properties of the bark of a tree they used for the treatment of fevers. With this bark, the Countess of Chinchón, wife of the Viceroy of Peru, was cured of her fever. The bark from the tree was then called Peruvian bark and the tree was named Cinchona after the countess. The medicine from the bark is now known as quinine, which along with artemisinin (isolated from the plant Artemisia annua, sweet wormwood, a herb employed in Chinese traditional medicine) is anti-malarial. Quinine is one of the most effective anti-malarial drugs available today.
Discovery of the parasite – Alphonse Laveran (1845 -1922), a French army surgeon stationed in Constantine, Algeria, was the first to notice the parasites (protozoa, like amoeba), in the red blood corpuscles of a patient suffering from malaria. This occurred on the 6th of November 1880. He showed that in successive blood smears the parasite grew and changed their shape. With each new brood of parasites in the blood, a fresh bout of ‘ague fever’ began. For his discovery, Laveran was awarded the Nobel Prize in 1907.
The parasite has been named as Plasmodia species. There are four main types –the two common types: Plasmodium vivax and P. falciparum causing respectively benign tertian and the more clinically dangerous malignant tertian; one less common type P.malariae, quartan malaria; and there is also a rare one: P.ovale. Another type P. knowlesi has been seen in a long-tailed macaque monkey. The first documented human infection with P. knowlesi was in 1965. The periodicity of the fever is characteristic of each species. In P.falciparum, P. vivax and P. ovalemalaria, a brood of schizonts mature every 48 hr, so the periodicity of fever is tertian ("tertian malaria"), whereas in P malariae disease, fever occurs every 72 hours ("quartan malaria").
Discovery that mosquitoes transmit malaria parasites – The next person to advance our knowledge of malaria was Ronald Ross (1857 -1932), a British army officer in the Indian Medical Service. Whilst he was on leave from India, he met Sir Patrick Manson (1844 -1922), called the "Father of Tropical Medicine". He appraised Ross about his own findings in filariasis, and the cycle in the mosquito. He advised Ross to be on the look-out for something similar in the parasite of malaria. On his return to India, Ross examined various types of mosquitoes under the microscope. He finally found dark spots (cysts) in the walls of the stomach of the female Anopheles mosquito on August 20th, 1897. These cysts were alive and multiplying. He was the first to demonstrate that malaria parasites could be transmitted from infected patients through mosquitoes. In further work with bird malaria, Ross showed that mosquitoes could transmit malaria parasites from bird to bird. This necessitated a sporogonic cycle (the time interval during which the parasite developed in the mosquito) giving rise to sporozoites. These sporozoites then migrate into the salivary glands. When the infected mosquito takes her next blood meal, they are injected into the human. Thus the problem of malaria transmission was solved. For his discovery, Ross was awarded the Nobel Prize in 1902.
The Vectors of human malaria – The ‘carriers’ of malaria are Anopheles mosquitoes, which can be distinguished from others by the stance they adopt in the resting position. They rest with the mouth part and body in one straight line, making an acute angle with the resting surface. Non-Anopheles mosquitoes hold their bodies parallel to the resting surface. Also, the wings of Anopheles have dark scales which form distinct markings on the upper margin of the wing.
The transmission of infection is not merely mechanical; the parasites must grow in the mosquito before infection of another human can take place. The time interval for this varies with the temperature. Below 60 F (16 C), it does not happen. Above this, at about 90 F (32 C) it is 8 to 10 days; longer (about 25 days) at lower end of the scale. Optimal is 70-80 F (21-27 C).
In Sri Lanka, the most important is Anopheles culicifacies. Other documented vectors are An. subpictus and An. tessellatus.
Clinical features – In P. vivax malaria after an incubation period of 8-17 days, there is a classical fever which has three phases:
Cold stage – Chills and rigors lasting 30 minutes to 2 hours, preceded by headache, nausea, vomiting and backache
Hot stage – Fever 39 to 42 C lasting 30 minutes to 4 hours.
Sweating stage – with this, the temperature falls to normal.
After a fever-free period of about 48 hours, fever recurs on the third day.
With P. falciparum malaria, symptoms are more severe.
The Exo-erythrocytic (hepatic) cycle in man - The life cycle in humans, however, remained incompletely understood and nobody knew where the parasites developed during the first 10 days or so after infection, during which they could not be seen in the blood. This question was not resolved until 1947 when Henry Shortt and Cyril Garnham, working in London, showed that a phase of division in the liver preceded the development of parasites in the blood. In 1948 when I was studying Zoology for the University Entrance, we had not heard of this cycle. In 1949, in the 1st MBBS at the Science Faculty, Thurstan Road – (those days one had to sit this before entering the Medical Faculty, Kynsey Road), Dr. Hilary Crusz lectured to us in Biology. I remember him telling us that we were the first in this country to be lectured to on the hepatic (pre-erythrocyte) cycle of the malarial parasite, Plasmodium vivax. He had just come back from England and I believe, had worked with Prof. Shortt.
There remained, however, one further question; what caused the long prepatent period between infection and the appearance and reappearance of parasites in the blood, seen in some temperate strains of P. vivax? This led to the discovery of a dormant exo-erythrocytic stage, hypnozoites, by Wojciech Krotoski, working with Garnham's team, in 1982.
The Life cycle of Plasmodium – To summarize this in brief: there are 2 cycles, one in the mosquito, and the other in the human.
A. Human - The life cycle in humans begins with the introduction of sporozoites into the blood. They enter the liver cells within 30 minutes to start the exo-erythrocytic phase. Sporozoites multiply and differentiate into merozoites. These merozoites flood out into the blood and invade red blood cells where they initiate a second phase of asexual multiplication (erythrocytic schizogony) resulting in the production of about 8-16 merozoites which invade new red blood cells. As the infection progresses, some young merozoites develop into male and female gametocytes that circulate in the peripheral blood until they are taken up by a female anopheline mosquito when it feeds on humans.
In P.vivax and P.ovale, maturation of liver-stage schizonts may be delayed for as long as 1 to 2 years. These quiescent liver-phase parasites are called hypnozoites.
B. Mosquito – Each of the gametocytes in the RBCs ingested by the female Anopheles mosquito develop further within her gut. The female gametocyte into a female macrogamete, and the male gametocyte into 8 sperm-like male microgametes. After fertilization, the diploid zygote differentiates into a motile ookinete that burrows into the gut wall, where it grows into an oocyst within which are many haploid sporozoites. These are released and migrate to the salivary glands. They complete the cycle when the mosquito takes her next blood meal and injects them into the bloodstream of the human.
(To be continued)
Source: http://www.island.lk/index.php?page_cat ... ign=buffer
Statistics: Posted by admin — Mon Jan 16, 2017 1:51 pm
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Charles J. Woodrow, Nicholas J. White
DOI: http://dx.doi.org/10.1093/femsre/fuw037 34-48 First published online: 8 September 2016
Abstract:
Artemisinins are the most rapidly acting of currently available antimalarial drugs. Artesunate has become the treatment of choice for severe malaria, and artemisinin-based combination therapies (ACTs) are the foundation of modern falciparum malaria treatment globally. Their safety and tolerability profile is excellent. Unfortunately, Plasmodium falciparum infections with mutations in the ‘K13’ gene, with reduced ring-stage susceptibility to artemisinins, and slow parasite clearance in patients treated with ACTs, are now widespread in Southeast Asia. We review clinical efficacy data from the region (2000–2015) that provides strong evidence that the loss of first-line ACTs in western Cambodia, first artesunate-mefloquine and then DHA-piperaquine, can be attributed primarily to K13 mutated parasites. The ring-stage activity of artemisinins is therefore critical for the sustained efficacy of ACTs; once it is lost, rapid selection of partner drug resistance and ACT failure are inevitable consequences. Consensus methods for monitoring artemisinin resistance are now available. Despite increased investment in regional control activities, ACTs are failing across an expanding area of the Greater Mekong subregion. Although multiple K13 mutations have arisen independently, successful multidrug-resistant parasite genotypes are taking over and threaten to spread to India and Africa. Stronger containment efforts and new approaches to sustaining long-term efficacy of antimalarial regimens are needed to prevent a global malaria emergency.
Statistics: Posted by admin — Mon Jan 16, 2017 1:35 pm
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Jan. 10: Sahotra Sarkar has helped protect rainforests in Indonesia, primates and birds in Equatorial Guinea, and salamanders in Texas over a 28-year career straddling biology and philosophy. Now, he appears willing to support an idea to wipe out a couple of species.
Sarkar, professor of philosophy at the University of Texas, Austin, says India needs to debate whether it wants to cautiously adopt a radical new gene-editing technology that he says could be used to selectively eliminate the species of mosquitoes that spread dengue or malaria.
The technology, called CRISPR/Cas9, allows unprecedented precision-editing of genomes and could be used - in a drive against mosquitoes - to introduce a gene that makes all mosquitoes male, thus preventing reproduction and triggering an extinction of their populations.
"It is possible, in principle, to use CRISPR/Cas9 to wipe out mosquitoes. Imagine eliminating dengue-spreading mosquitoes from Calcutta," said Sarkar, who delivered a talk today at Presidency University's bicentennial celebrations. "A rough calculation suggests that you would need to release about 10,000 such gene-edited mosquitoes at about six locations across the city and, over a period of two or three years, we could expect them to be eliminated," he said.
But he warned that the technology has controversial applications and needs to be regulated. "This technology has a good side and it has a troubling side," he told Metro on the sidelines of the conference. "We need wide-ranging public discussions on this."
Sarkar, who completed school in Darjeeling before moving to the US for university studies, has over the years worked with landowners and state officials in Texas to protect salamanders, proposed strategies to protect plants, primates and birds in abandoned cocoa plantations in Equatorial Guinea, and designed plans to protect patches of rainforests in Indonesia.
Sarkar doesn't see any paradox between his conservation efforts and his cautious enthusiasm to discuss the elimination of disease-carrying mosquitoes. His call for a discussion on the merits and risks of CRISPR/Cas9 in India comes against the backdrop of a similar discourse among scientific academies in the US, UK and China, advocating a go-slow strategy that permits regulated research but no field applications yet.
Sarkar said Indian science and policy-making circles would soon need to launch a similar discourse, pointing out that India's Tata Trusts had given the University of San Diego $70 million to use genetic technology to target malaria-causing mosquito populations, among other goals.
India already has scientists and medical experts discussing the implications of CRISPR/Cas9 technology, said Dorairajan Balasubramanian, a senior biologist and former director of the Centre for Cellular and Molecular Biology, Hyderabad, who was among Sarkar's audience at the Presidency lecture.
"Such technology raises ethical issues," Balasubramanian said. "What if someone wants to use this technology to eliminate monkeys?"
Monkeys are a major menace on farms in parts of northern India and, Sarkar concedes, suggestions to apply CRISPR/Cas9 for the extinction of anything other than mosquitoes would be problematic.
Source:
https://www.telegraphindia.com/1170111/ ... HzKL1N9601
Statistics: Posted by admin — Mon Jan 16, 2017 1:29 pm
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Statistics: Posted by admin — Sat Jan 07, 2017 1:11 pm
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The celebration of the 20th Founding anniversary of ACTMalaria was culminated with a Gala Night which is very memorable, overwhelming and gives everybody nostalgic feels especially to those that has been in the network since the beginning. The Gala started with parade of colors assisted by the member countries delegation representative. Ecumenical prayer was lead by Dr Chea Nguon (Cambodia), Dr M.M Aktaruzzaman (Bangladesh) and Ms Cecil Hugo and Ms Joy Lico from ACTMalaria Foundation Inc. Dr Mario Baquilod (ACTMalaria CCD) then officially welcomed everybody with his message citing how the network conceived a long time ago and how it was develop through times with the advocate to strengthen the forces in the field. Messages then was given from the past coordination country directors of ACTMalaria and partners that has been with the network in supporting financially, technically and morally.
Several alumni who are now holding key positions in their respective countries were invited in the event. Among of them were Dr Than Win (TTT, 2005) and Dr Wichai Satimai (MMFO 1997). They reminisce how the training equipped them in managing people and enabled him to handle different designation in the programme. Dr Wichai emphasized the knowledge and experiences shared during the training with the other participants that taught him to handle same potential cases and able to help solve the problem. Now that the collaborative network has reached its twentieth year, he urged everybody to move farther even fr the challenges ahead, every post should hold their position and put the trainings gained in good use for the development of the human resources. Dr Zhang Zaixing (WR Representative and Dr Sunil Mehra (Director of HPI) also gave their messages. Dr Sunil Mehra remembered those that has been in the network from the beginning. He mentioned the late Sylvia Meek of Malaria Consortium who supported even in the early years of ACTMalaria. He bowed on those that has been with the collaboration and look up for those new generation that could lead more innovations in the future.
A keynote speech was given by Dr Gerardo Bayugo, the Undersecretary of Health of the Department of Health-Philippines. He cited the importance of capacity building for malaria health service providers and program implementers. That these capacity building initiatives paved the way to the progress in malaria control and elimination of the program not only in the Philippines but also those that of the member countries of the network. He thanked the network, the Global Fund, Pilipinas Shell Foundation and WHO for all the unwavering support all those years from the establishment to sustaining capabilities of the malaria workforce across the country and the region. Were it not of the support received, the road to elimination would have been harder and much more challenging. He propelled everybody to work harder towards the common goals and help the respective countries and its people be free from the burden of malaria.
The awarding of plaques to the past CCDs of the ACTMalaria
Statistics: Posted by jufel — Fri Dec 16, 2016 2:54 am
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17 November 2016 | GENEVA - The world’s first malaria vaccine will be rolled out in pilot projects in sub-Saharan Africa, WHO confirmed today. Funding is now secured for the initial phase of the programme and vaccinations are due to begin in 2018.
The vaccine, known as RTS,S, acts against P. falciparum, the most deadly malaria parasite globally, and the most prevalent in Africa. Advanced clinical trials have shown RTS,S to provide partial protection against malaria in young children.
“The pilot deployment of this first-generation vaccine marks a milestone in the fight against malaria,” said Dr Pedro Alonso, Director of the WHO Global Malaria Programme. “These pilot projects will provide the evidence we need from real-life settings to make informed decisions on whether to deploy the vaccine on a wide scale.”
Vaccine financing and development
The Global Fund to Fight AIDS, Tuberculosis and Malaria today approved US$ 15 million for the malaria vaccine pilots, assuring full funding for the first phase of the programme. Earlier this year, Gavi, the Vaccine Alliance and UNITAID announced commitments of up to US$ 27.5 million and US$ 9.6 million, respectively, for the first 4 years of the vaccine programme.
RTS,S was developed through a partnership between GlaxoSmithKline and the PATH Malaria Vaccine Initiative (MVI), with support from the Bill & Melinda Gates Foundation and from a network of African research centres.
“WHO recognizes and commends the leadership and support of all funding agencies and partners who have made this achievement possible,” said Dr Jean-Marie Okwo-Bele, Director of the WHO Department of Immunization, Vaccines and Biologicals.
Vaccine programme recommended by two WHO advisory bodies
In October 2015, two independent WHO advisory groups comprised of the world’s foremost experts on vaccines and malaria – the Strategic Advisory Group of Experts (SAGE) on Immunization and the Malaria Policy Advisory Committee (MPAC) – recommended pilot implementation of the RTS,S vaccine in 3 to 5 settings in sub-Saharan Africa. These recommendations followed a July 2015 announcement that the European Medicines Agency (EMA) had issued a positive scientific opinion of the RTS,S vaccine.
WHO officially adopted the SAGE-MPAC recommendations in January 2016 and has since worked to mobilize financial support for the pilots and to finalize the programme design. The pilot programme will evaluate the feasibility of delivering the required 4 doses of RTS,S; the impact of RTS,S on lives saved; and the safety of the vaccine in the context of routine use.* It will also assess the extent to which the vaccine’s protective effect demonstrated in children aged 5–17 months old in the Phase 3 trial can be replicated in real-life settings.
Country selection
RTS,S is the first malaria vaccine to successfully complete pivotal Phase 3 testing. The Phase 3 trial enrolled more than 15,000 infants and young children in 7 countries in sub-Saharan Africa. Countries that participated in the Phase 3 clinical trials will be prioritized for inclusion in the WHO pilot programme. Consultations are ongoing and the names of the 3 selected countries will be announced in the coming weeks.
A complementary control tool
The RTS,S vaccine is proposed as a tool to complement the existing package of WHO-recommended malaria preventive, diagnostic and treatment measures and will be used in combination with the current interventions. Other tools include: long-lasting insecticidal bed-nets, spraying inside walls of dwellings with insecticides, preventive treatment for infants and during pregnancy, prompt diagnostic testing, and treatment of confirmed cases with effective anti-malarial medicines.
Deployment of these tools has already dramatically lowered malaria disease burden in many African settings. Between 2000 and 2015, the rate of new malaria cases in sub-Saharan Africa fell by 42% and malaria mortality rates fell by 66%. However, this region continues to account for approximately 90% of global malaria cases and deaths.
As RTS,S is only partially effective, it will be essential that any vaccinated patients with a fever be tested for malaria, and that all those with a confirmed malaria diagnosis are treated with high quality, effective anti-malarial medicines.
Partner quotes:
Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance:
“These pilots are critical to determine whether this vaccine can be rolled out more broadly, adding an important new tool to the proven interventions we already have in the fight against malaria. The Global Fund's commitment marks the beginning of a historic partnership between Gavi, the Global Fund and UNITAID, bringing together three of the world's biggest health financing institutions to tackle one of the leading killers of children."
Mark Dybul, Executive Director of the Global Fund:
“The new vaccine is a potentially valuable new tool in the fight against malaria. With the pilots funded, we are eager to see how this vaccine works in combination with insecticide-treated nets and indoor spraying.”
Lelio Marmora, Executive Director of UNITAID:
"Ending malaria, a disease that kills a disproportionate number of children, is going to require a high degree of ingenuity and boldness. We must seize the opportunity to pilot a vaccine that could strengthen the means at our disposal to combat this deadly disease."
Note to the editors:
There were 2 target age groups in the Phase 3 RTS,S trials:
Infants who received the malaria vaccine together with other routine childhood vaccines at 6, 10 and 14 weeks of age.
Older children who received their first dose of the malaria vaccine between 5 and 17 months of age.
Among children in the older age group, there was a risk of febrile seizures within 7 days after any of the vaccine doses. Among infants, this risk was only apparent after the fourth dose. There were no long-lasting consequences due to any of the febrile seizures.
Among children in the older age group, an increase in the number of cases of meningitis and cerebral malaria was found in the group receiving the malaria vaccine compared to the control group. The significance of these findings in relation to the vaccination is unclear. An excess of meningitis and cerebral malaria was not seen in infants aged 6–12 weeks.
For more information please contact:
Saira Stewart
Technical officer, WHO
Mobile: +41 79 500 6538
Email: [email protected]
Christian Lindmeier
Communications Officer, WHO
Mobile: +41 79 500 6552
Email: [email protected]
Statistics: Posted by jufel — Fri Dec 16, 2016 1:45 am
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The World Malaria Report 2016 summarizes information received from malaria-endemic countries and other sources, and updates the analyses presented in the 2015 report.
The World Malaria Report is WHO’s flagship malaria publication, released each year in December. It assesses global and regional malaria trends, highlights progress towards global targets, and describes opportunities and challenges in controlling and eliminating the disease. Most of the data presented in this report is for 2015.
Click below to download the file.
Statistics: Posted by jufel — Thu Dec 15, 2016 3:45 pm
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Severity and mortality of malaria was high at the hard to reach area of Tachleik District, Eastern Shan State, Myanmar on 1999. There was a low literacy rate, poor health knowledge, low socioeconomic status, low accessibility to health center and quality drugs. Villagers find it hard and difficult to assess sickness even in the health centers. So, they consult to the person who is older, respected, more knowledgeable when they got any discomforts. Therefore, traditional healers, teachers, preachers, community health workers and the person who have experience with medicine were forced and to informal drug providers. Although they have no skill and no training for the malaria diagnosis and treatment, they treat the villagers as nearest Primary Drug Providers (PDPs). The villagers cannot assess the correct diagnosis and appropriate treatment.
The pioneers train (21) PDPs for malaria diagnosis, appropriate treatment and personal protective measures were taught to them. The trainers convey the Malaria Health Education with tools, ITNs, RDT and ACT to the hard to reach community through PDPs. The severity and morbidity is very much few now. This is a pilot project for community based malaria control programme. Now, there are 13,000 village malaria volunteers already. Community Based Malaria control programme is deemed to be one of the way in eliminating the disease malaria.
Statistics: Posted by jufel — Thu Dec 15, 2016 1:41 pm
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