Tag Archives: malaria

In historic first, WHO greenlights world’s first malaria vaccine

The world just got a new tool against a very deadly disease. The World Health Organization (WHO) said that the only approved vaccine against malaria should be given to African children following a large-scale pilot program. The vaccine (called RTS,S, or Mosquirix), with a 30% to 40% efficacy, is developed by GlaxoSmithKline and will soon be distributed in key areas. 

Image credit: Flickr /USAID.

Over two million doses of Mosquirix have been administrated to children in Ghana, Malawi and Kenya since 2019 as part of a program coordinated by the WHO. The results from the pilot were largely optimistic. The vaccine was found to be cost-effective, safe, and with have negative impact on other vaccines or other measures to prevent malaria.

“This is a historic moment. The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control,” WHO Director-General Tedros Adhanom Ghebreyesus, said in a statement. “Using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year.”

Mosquirix had already been approved by the European Medicines Agency (EMA) in 2015, arguing the benefits outweighed the risks. But the WHO wanted to wait for the results of the pilot program before recommending it for its use. The expectation is that it will be mainly used in sub-Saharan Africa, where the disease is a top killer of children. 

Still, this doesn’t mean the vaccine will be rolled out immediately in Africa. It’s hard to tell at the moment who will offer the money to purchase the necessary doses. Also, it’s a tricky vaccine to administer as it needs four doses in order to be effective – the first three at five, six, and seven months old and then a final booster at around 18 months. Nevertheless, the fact that such a vaccine — imperfect as it may be — exists, was hailed as a game changer. 

“We have long hoped for an effective malaria vaccine and now for the first time ever, we have such a vaccine recommended for widespread use,” Matshidiso Moeti, WHO Regional Director for Africa, said in a statement. “Today’s recommendation offers a glimmer of hope for the continent which shoulders the heaviest burden of the disease.”

A very serious disease

Malaria is caused by a parasite, Plasmodium, that spreads to people through the bites of infected mosquitoes. There are five species that can cause malaria in humans, and two represent the largest threat. Symptoms usually appear 15 days after the mosquito bite and if not treated quickly it can progress to severe illness and even to death. 

In 2019, almost half of the world’s population was at risk of malaria, according to the WHO. Most cases and death happen in sub-Saharan Africa, but South-East Asia, the Americas, and Western Pacific are also at risk. Some groups are at higher risk than others, including infants, children under 5 years of age, pregnant women, and migrants.

There were 229 million cases of malaria in 2019, compared to 228 million in 2018, according to the latest World Malaria report. The African region carried the highest share of the burden, home to 94% of all malaria cases and deaths. Nigeria, Congo, Tanzania, Burkina Faso, and Niger were the countries with the highest number of cases.

Using an insecticide-treated net has proven to be effective to reduce contact between mosquitoes and humans thanks to the physical barrier and the insecticidal effect. At the same time, indoor residual spraying with insecticides can also reduce malaria transmission, spraying the inside of housing structures with an insecticide once a year.

There are also antimalarial medicines that can be used to prevent the disease. For travelers, the use of chemorophylaxis is advised as it suppressed the blood stage of malaria infections. For pregnant women, WHO recommends preventive treatment with sulfadoxine-pyrimethamine at scheduled antenatal visits after the first trimester. 

The first malaria vaccine is finally here: WHO endorsement received

Credit: Flickr, Pixabay.

Scientists have been working on a vaccine against malaria — an infectious disease spread by mosquitoes that infects over 230 million people annually and kills 400,000, most of whom are children — since the 1980s. More than thirty years in the making, the first malaria vaccine has finally passed its Phase III clinical trials in three African countries and the World Health Organization (WHO) now recommends its approval.

A lifesaver for children worldwide

The vaccine, known as RTS,S (trade name Mosquirix), was developed by GlaxoSmithKline. It started its first pilot immunization program in Ghana, Kenya, and Malawi where it was found to prevent approximately 4 in 10 malaria cases, including 3 in 10 cases of life-threatening severe malaria. Furthermore, the vaccine also cut the level of severe anemia—the most common reason kids die from the disease—by 60%.

The Mosquirix vaccine is given in three doses between the ages of 5 months and 17 months, with a fourth dose about 18 months later. The most recently closed clinical trials have shown Mosquirix is 50% effective against severe malaria in the first year. However, the vaccine-granted immunity wanes with time, its efficacy plummeting close to zero by the fourth year.

After these clinical trials, the vaccine coverage was expanded to include more than 800,000 children who have received 2.3 million doses of the vaccine thus far. This program showed that the vaccine was 40% effective in the ‘real world’.

If the vaccine was rolled out extensively in countries with the highest incidence of malaria, 5.4 million cases and 23,000 deaths among children younger than 5 years could be prevented annually, according to a modeling study from 2020.

According to Kate O’Brien, the Director of WHO’s Department of Immunization, Vaccines, and Biologicals, young infants are at the highest risk of severe outcomes, and so having a vaccine that can prevent disease in children and infants would be a groundbreaking new strategy.

“This is a historic moment. The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus in a statement. “Using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year.”

Malaria: a hard nut to crack

Although tremendous advances have been made against malaria over the last two decades thanks to prevention and control measures, such as insecticide-treated bed nets, indoor spraying with insecticides, and the timely use of malaria testing and treatment, progress has stalled or even reversed in some areas. The long-awaited vaccine was the missing puzzle piece that health workers were looking for in their long war against malaria.

Malaria is transmitted through the bite of a mosquito that was infected with the Plasmodium parasite. Symptoms include fever, chills, headache, anemia, convulsions, and sweating. A single bite from a malaria-infected mosquito will cause several bouts of the disease, which means a lot of missed school and progressively poorer health during formative years.

There are over 100 different malaria-causing parasites, but Mosquirix only targets one, which is the most common and deadly in Africa: Plasmodium falciparum.

While the COVID mRNA vaccines were designed in a matter of days and immediately started clinical trials, the malaria vaccine took decades to mature. The huge discrepancy is owed to the malaria parasite’s much more sophisticated nature than the coronavirus. Plasmodium parasites have evolved to evade our immune system, being able to hide in the host’s liver and emerge many times over a period of years. To gain natural immunity, you have to be infected multiple times with the parasite. During some of these infections, you risk death. You could say we’ve been lucky that the pandemic is a coronavirus one and not a Plasmodium one.

“From a scientific perspective, this is a massive breakthrough, from a public health perspective this is a historical feat,” said Dr. Pedro Alonso, the director of the WHO Global Malaria Programme.

“We’ve been looking for a malaria vaccine for over 100 years now, it will save lives and prevent disease in African children.”

Malaria vaccines could prove even better in the future. The Jenner Institute at the University of Oxford developed a vaccine against malaria that was shown to be 77% effective in trials in Africa, earlier this year. 

A lab experiment shows that we could engineer malaria-carrying mosquitoes to kill themselves off

A new paper showcases how genetic engineering can be used to cause populations of malaria-spreading mosquitoes to self-destroy.

Image credits Egor Kamelev.

An international research effort has shown, in the context of a lab experiment, that male mosquitoes engineered to carry a certain strand of DNA can rapidly destroy entire groups of these blood-sucking insects. The main importance of this experiment is that it showcases that gene-drive technology can be used even in harsh environmental conditions, such as those in sub-Saharan Africa.

This “gene drive” sequence is essentially a damaging mutation that could prove to be a powerful tool against the carriers of malaria.

Drastic measures

“Our study is the first [that] could show that gene-drive technology works under ecologically challenging conditions,” says Ruth Muller, an entomologist who led the research at PoloGGB, a high-security lab in Terni, Italy. “This is the big breakthrough that we made with our study.”

While this experiment has been a success, that doesn’t mean it’s going to be used any time soon. For that to happen, the authors first need to prove that their edited mosquitoes can work in practice — i.e. that they’re safe to release into the wild. Not only that but local governments and residents will have to give their approval before any of the mosquitoes can be released.

Still, with that being said, malaria remains one of the most concerning diseases on Earth. It infects an estimated 200 million people every year, with an estimated annual death toll of around 400,000. This is despite decades of coordinated effort to contain it.

So the authors decided to use the CRISPR gene-editing technique to make mosquitoes, the carriers of the malaria parasite, to self-destroy. They worked with the Anopheles gambiae species, which is native to sub-Saharan Africa. The gene they modified is known as “doublesex”, and is normally carried by healthy females. The modified variant, however, deforms their mouths and reproductive organs, meaning they can’t bite (and thus spread the parasite) nor lay eggs. This is combined with a gene drive, “effectively a selfish type of genetic element that spreads itself in the mosquito population,” says Tony Nolan of the Liverpool School of Tropical Medicine, who helped develop and test the mosquitoes.

Due to the risks involved in releasing these insects into real ecosystems, the experiments were carried out in small cages in a high-security basement lab in London. The modified mosquitoes showed that they can destroy populations of the unmodified insects here.

In order to test them under more natural conditions, however, the team also built a special high-security lab in Italy, specifically designed to keep the mosquitoes in. Here, dozens of gene-edited mosquitoes were released into very large cages containing hundreds of natural mosquitoes. Temperature, humidity, and the timing of sunrise and sunset mimicked the environment in sub-Saharan Africa. In less than a year, the authors report, the population of un-altered mosquitoes was all but wiped out.

Both of these steps were carried out far from the insects’ natural range as extra insurance in case any of them got out.

Whether such an approach will ever actually be used in real-life settings is still a matter of much debate. Even so, the study showcases one possible approach and strongly suggests that it would also function in the wild. It’s also a testament to how far gene-editing technology has come, that we could potentially have one of the most threatening (to us) species right now effectively destroy itself.

The paper “Gene-drive suppression of mosquito populations in large cages as a bridge between lab and field” has been published in the journal Nature Communications.

A game-changer on the horizon: Researchers develop the world’s most effective malaria vaccine

A vaccine against malaria has proven to be 77% effective in trials in Africa and could be a major breakthrough against the disease, according to its developers from the Jenner Institute at the University of Oxford.

Image credit: Wikipedia Commons

Malaria kills over 400,000 people every year, mostly small children in sub-Saharan Africa; one child dies from the disease every two minutes, according to the World Health Organization (WHO). Although many vaccines have been trialed over the years, none has been sufficiently successful.

A parasitic disease, malaria is transmitted through the bite of female Anopheles mosquitoes. It is both preventable and treatable. The African region was home to 94% of all malaria cases and deaths in 2019, according to the WHO. In recent years, countries have made progress using new tools such as insecticide-treated mosquito nets.

The Oxford vaccine, known as R21, is the first one to meet the WHO goal of 75% efficacy against the mosquito-borne parasite disease. The previously developed Mosquirix vaccine, now being piloted by the WHO in four countries in Africa, was partially effective, preventing 39% of malaria cases among small children in Africa over four years. A 75% efficacy could be a game changer.

“These are very exciting results showing unprecedented efficacy levels from a vaccine that has been well-tolerated in our trial programme,” Halidou Tinto, the trial’s principal investigator, said in a statement. “We look forward to the upcoming Phase III trial to demonstrate large-scale safety and efficacy data for a vaccine that is greatly needed in this region.”

Trialed in 450 children between the ages of five and 17 months in Burkina Faso, the vaccine was found to be safe and showed “high-level efficacy” over 12 months of follow-up. The children were divided into three groups and the higher dose one was 77% less likely to get the disease, the researchers reported in a pre-print study in The Lancet.

There were “no serious adverse events related to the vaccine,” the researchers wrote in the study. Now, together with their commercial partners the Serum Institute of India and drugmaker Novavax, they are recruiting for a Phase III trial to assess the safety and efficacy of the vaccine in 4,800 children, aged from five to 36 months.

Adrian Hill, director of the Jenner Institute, where the Oxford/AstraZeneca Covid vaccine was recently invented, told The Guardian that the vaccine has the potential to cut the death toll from malaria significantly. Even going from the 400,000 annual deaths to “tens of thousands” in the next five years, if the vaccine proves successful.

Hill said the institute will likely apply for emergency approval for the malaria vaccine just as it did for the COVID-19 jab. “Malaria kills a lot more people than Covid in Africa, so you should think about emergency-use authorization for a malaria vaccine,” he said. The institute will first ask regulatory bodies for a scientific opinion on the vaccine.

The researchers said the vaccine will be manufactured on a large scale and low cost. They have already done a deal with the Serum Institute of India, which is involved in manufacturing the Oxford/AstraZeneca Covid-19 vaccine. The Serum Institute promised to deliver 200 million doses a year of the malaria vaccine if it’s licensed.

Cyrus Poonawalla and Mr Adar Poonawalla, Chairman and CEO of the Serum Institute of India said in a statement: “We are highly excited to see these results on a safe and highly effective malaria vaccine. Serum Institute is committed to global disease burden reduction and disease elimination strategies by providing high volume, affordable vaccines.”

Plasmodium vivax.

Novel anti-malaria drug can flush the parasite out of hiding with a single pill

Known as tafenoquine, the new drug was developed by GlaxoSmithKline (GSK). After receiving FDA approval, the drug also has to pass the scrutiny of other national drug regulation agencies before it can see global use.

Plasmodium vivax.

Stained micrograph showing a mature Plasmodium vivax trophozoite (the purple blotch in the middle).
Image credits CDC / Steven Glenn, Laboratory & Consultation Division.

The compound is tailored to fight the recurring form of malaria. This disease, caused by the parasite Plasmodium vivax and estimated to infect over 8 million people each year, is especially tricky to cure as the parasite can hide in the host’s liver and emerge many times over a period of years.

Persistent malaria

The recurring form of the disease is the most commonly encountered type of malaria outside of Sub-Saharan Africa. Children are particularly hard-hit by the disease. A single bite from a malaria-infected mosquito will cause several bouts of the disease, which means a lot of missed school and progressively-poorer health during formative years.

Even worse, infected individuals act as unwilling spreaders of the disease. If the parasite reawakens and passes through to their blood, any mosquito that bites them will spread malaria to other people. This combination of a dormant state and high infectivity make recurring malaria especially hard to eliminate.

Still, with the FDA’s recent approval of tafenoquine, that state of affairs may change. The drug can flush the parasite out of its dormant state in the liver, preventing it from re-infecting its host. Even better, tafenoquine doesn’t interfere with other drugs used to treat the immediate infection caused by the parasite, so both treatments can be taken side-by-side.

We already have a drug on hand to clear the plasmodium out of the liver — it’s called primaquine. However, primaquine treatment needs to be followed for 14 days at a time, while the tafenoquine course only involves taking a single dose.

There’s a legitimate concern in the medical community that many patients with recurring malaria feel better after a few days of primaquine treatment and don’t follow the course to its completion — which isn’t nearly enough to flush out all the parasites.

While the FDA approval of the drug vouches for its effectiveness, the administration warns that the drug comes with side effects you should be aware of.

First and foremost, people suffering from enzyme G6PD deficiency should not take the drug, as it can cause severe anemia. The FDA recommends that patients are screened for this deficiency before being given the treatment — but this may be virtually impossible in the poorer areas where malaria is most common. Secondly, there are concerns that higher doses may interact with pre-existing psychiatric conditions.

Despite its potential risks, the drug could help reduce the incidence of Plasmodium vivax malaria on a global level, however.

“The approval of Krintafel [the brand name for tafenoquine], the first new treatment for Plasmodium vivax malaria in over 60 years, is a significant milestone for people living with this type of relapsing malaria,” says Dr Hal Barron, president of research and development at GSK. “Together with our partner, Medicines for Malaria Venture, we believe Krintafel will be an important medicine for patients with malaria and contribute to the ongoing effort to eradicate this disease.”

The next step will be for the drug to be assessed by regulators in countries where this form of malaria is a significant problem.

A newly-found microbe could stop mosquitoes from spreading malaria

Malaria, a life-threatening disease typically found in tropical climates, is transmitted through the bite of a mosquito that was infected with the Plasmodium parasite. Symptoms include fever, chills, headache, anemia, convulsions, and sweating.

In 2018, the World Health Organization (WHO) estimated 228 million cases of the mosquito-borne disease, and that they would lead to 405,000 deaths. The WHO, governments, and researchers have long been working on different approaches to tackle the disease, but progress has stalled in recent years.

But what if we could go to the source and prevent the mosquitoes from being infected? That was the question researchers from Kenya and the UK asked themselves, having found a microbe that protects the mosquitoes and could thus help to control the disease.

The malaria-blocking microbe, called Microsporidia MB, was discovered by the researchers on the shores of Lake Victoria, Kenya. They couldn’t find a single mosquito carrying the microbe and also harboring the malaria parasite there.

The protection given by the microbe was later confirmed by further laboratory analysis. Microsporidias are fungi, or at least closely related to them, and most are parasites. However, this new species may be beneficial to the mosquito.

“The data we have so far suggest it is 100% blockage, it’s a very severe blockage of malaria,” Dr Jeremy Herren, from the International Centre of Insect Physiology and Ecology in Kenya told the BBC. He added: “It will come as a quite a surprise. I think people will find that a real big breakthrough.”

The idea that a mosquito microbe could be stopping the transmission of a disease isn’t exactly new. Wolbachia, a genus of bacteria that naturally occurs in mosquito populations, has shown incredible potential for wiping out dengue and other mosquito-borne infections.

This new research is currently in its early stages. Because Microsporidia MB is passed down the maternal line, once it’s in the mosquito population, it’s unlikely to be going anywhere. The team found that some mosquito populations in some areas they tested already had 9% of individuals infected with the malaria-busting microbe.

Microsporidia MB could be priming the mosquito’s immune system, so it is more able to fight off infections. Or the presence of the microbe in the insect could be having a profound effect on the mosquito’s metabolism, making it inhospitable for the malaria parasite.

The researchers are investigating two main strategies for increasing the number of infected mosquitoes. Microsporidia forms spores that could be released en masse to infect mosquitoes. Or male mosquitoes (which don’t bite) could be infected in the lab and released into the wild to infect the females when they have sex

“It’s a new discovery. We are very excited by its potential for malaria control. It has enormous potential,” Prof Steven Sinkins, from the MRC-University of Glasgow Centre for Virus Research, told the BBC.

The scientists need to understand how the microbe spreads, so they plan to perform more tests in Kenya. However, these approaches are relatively uncontroversial as the species is already found in wild mosquitoes. It also would not kill the mosquitoes, so it would not have an impact on species that rely on them for food.

The research was published in Nature Communications.

Anti-malaria drug being tested for efficacy against COVID-19

Chinese experts, based on the result of clinical trials, have confirmed that chloroquine phosphate, an antimalarial drug, has a certain curative effect on the novel coronavirus disease (COVID-19).

The experts suggested the drug be included in the next version of the treatment guidelines and applied in wider clinical trials as soon as possible, Sun Yanrong, deputy head of the China National Center for Biotechnology Development under the Ministry of Science and Technology (MOST), said at a press conference.

Chloroquine phosphate, which has been used for more than 70 years and is on the World Health Organization’s List of Essential Medicines, the safest and most effective medicines needed in a health system. Chloroquine was discovered in 1934 by Hans Andersag but was initially ignored for a decade because it was considered too toxic for human use. During World War II, United States government-sponsored clinical trials for antimalarial drug development showed unequivocally that chloroquine has a significant therapeutic value as an antimalarial drug.

Aside from preventing and treating malaria, chloroquine is also occasionally used for amebiasis that is occurring outside the intestines, rheumatoid arthritis, and lupus erythematosus.

Chloroquine was selected from tens of thousands of existing drugs after multiple rounds of screening, Sun said. According to her, the drug has been under clinical trials in over 10 hospitals in Beijing, as well as in south China’s Guangdong Province and central China’s Hunan Province, and has shown fairly good efficacy.

In the trials, the groups of patients who had taken the drug have shown better indicators than their parallel groups, in abatement of fever, improvement of CT images of lungs, the percentage of patients who became negative in viral nucleic acid tests and the time they need to do so, she said.

Patients taking the drug also take a shorter time to recover, she added. Sun gave an example of a 54-year-old patient in Beijing, who was admitted to the hospital four days after showing symptoms. After taking the drug for a week, he saw all indicators improve and the nucleic acid turn negative.

Zhong Nanshan, Chinese epidemiologist and pulmonologist who discovered SARS in 2003. 

So far, no obvious serious adverse reactions related to the drug have been found among the over 100 patients enrolled in the clinical trials, she said. The expert team, led by Zhong Nanshan, a renowned respiratory specialist and an academician of the Chinese Academy of Engineering, agreed that chloroquine phosphate can be used to treat more COVID-19 patients, Sun said.

Previous in vitro experiments showed that it can block virus infections by changing the acidity and basicity value inside the cell and interfering receptors of SARS coronavirus. It also shows immune-modulating activity, which may enhance its antiviral effect in vivo and is widely distributed in the whole body, including the lungs, after oral administration.

Chloroquine is also in trials as an antiretroviral for HIV-1/AIDS and is being considered in pre-clinical models as a potential agent against chikungunya and Zika.

UPDATE: New research suggests that remdesivir — broad-spectrum antiviral agent — and chloroquine “are highly effective in the control of 2019-nCoV infection in vitro.” Scientists at the University of Queensland Centre for Clinical Research recently announced that they are close to commencing a clinical trial with chloroquine in Australia by the end of the month.

Malaria-bearing mosquitoes are evolving insecticide-resistant feet

Two major mosquito species that carry malaria are developing resistance to insecticide through their feet. A new study reports on how this impacts the efficiency of anti-mosquito nets, anti-malaria efforts, and a potential way forward.

Image via Pixabay.

Binding proteins in the feet of Anopheles gambiae and Anopheles coluzzii mosquitoes are helping them resist the insecticides embedded in mosquito nests, explains the team at the Liverpool School of Tropical Medicine (LSTM). As these species represent two of the most important malaria vectors in West Africa, it could undo “decades” of progress against the disease.

Net gonna get me

“We have found a completely new insecticide resistance mechanism that we think is contributing to the lower than expected efficacy of bed nets,” explains Dr. Victoria Ingham, first author. “The protein, which is based in the legs, comes into direct contact with the insecticide as the insect lands on the net, making it an excellent potential target for future additives to nets to overcome this potent resistance mechanism.”

The team found higher than average levels of the binding protein SAP2 in the insecticide-resistant species of Anopheline mosquitoes. These levels elevated further elevated levels following contact with pyrethroids, the class of insecticides used in bed nets. However, when the genes encoding this protein are partially silenced, the insects lost their resistance to pyrethroids.

As insecticide resistance grows across mosquito populations, the team explains, new insecticide-treated bed nets containing the synergist piperonyl butoxide (PBO) and pyrethroids are being introduced. Such netting targets one of the most effective and widespread resistance mechanisms mosquitoes posses, but they are always evolving new ones. The authors hope that their discovery could help point to other potentially dangerous adaptations by mosquitoes.

“Long-lasting insecticide treated bed nets remain one of the key interventions in malaria control,” explains Professor Hilary Ranson, the paper’s senior author.

“It is vital that we understand and mitigate for resistance within mosquito populations in order to ensure that the dramatic reductions in disease rates in previous decades are not reversed.”

The paper “A sensory appendage protein protects malaria vectors from pyrethroids” has been published in the journal Nature.

Malaria eradication by 2050 is ambitious but achievable

Every two minutes, a kid under age 5 dies of malaria, one of the oldest and deadliest diseases known to mankind. But malaria could be eradicated within a generation, a landmark report says.

According to 41 malariologists, biomedical scientists, economists, and public health policy experts, a future free of malaria — one of the world’s oldest and deadliest diseases — can be achieved as early as 2050. This statement contradicted last month’s WHO-led malaria review that concluded eradication cannot be achieved any time soon and urged the WHO not to shy away from this “goal of epic proportions”. The Lancet Commission analyzed new epidemiological and financial data and concluded that eradication is possible.

Malaria is a life-threatening disease caused by Plasmodium parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. People with malaria often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications and die. 

Malaria infected about 219 million people in 2017 and killed around 435,000 of them — the vast majority babies and children in the poorest parts of Africa. Due to ongoing transmission, half the world’s population is still at risk of contracting malaria. These figures are little changed from 2016, but global case numbers had previously fallen steadily from 239 million in 2010 to 214 million in 2015, and deaths from 607,000 to around 500,000 from 2010 to 2013.

Since 2000, the number of countries with malaria has fallen from 106 to 86, cases have fallen by 36%, and the death rate has fallen by 60%. This is mainly due to the widespread use of bed nets treated with insecticide and better drugs for treating people who are infected.

Martin Edlund, head of Malaria No More, said the world should do everything possible to eradicate the disease: “If we double down on ending malaria now, the world will reap massive social, humanitarian and economic benefits and save millions of people from needlessly dying from mosquito bites.”

“For too long, malaria eradication has been a distant dream, but now we have evidence that malaria can and should be eradicated by 2050,” said Sir Richard Feachem, one of the report authors. “This report shows that eradication is possible within a generation.”

So, what will it take? The report estimates that based on current trends, the world will be “largely free of malaria” by 2050. To reach eradication by 2050, current technologies need to be used more effectively and new ways of tackling the disease needs to be developed. This could include the “game-changing” gene-drive technologies that could make mosquitoes infertile or make them resistant to the parasite.

King Mswati III of Eswatini (formerly Swaziland) and chair of the African Leaders Malaria Alliance said: “Malaria eradication within a generation is ambitious, achievable and necessary. The struggle has been constant to keep up with the malaria mosquito and the parasite, both of which are evolving to evade the effect of malaria interventions. We must make sure that innovation is prioritized.”

How much is this going to cost? The report estimates that around $4.3bn is spent on malaria annually. With $2 billion more in annual funding and strong partnerships to develop and deploy the correct tools, including new vaccines, we would be able to rid the world of malaria by 2050. Business as usual would mean many lives lost and the constant struggle against the malaria parasite and the evolving resistance to drugs.

“Eradicating malaria has been one of the ultimate public health goals for a century, it is also proving to be one the greatest challenges,” said Dr Tedros Ghebreyesus, the director general of the World Health Organization. “But we will not achieve eradication within this time frame with the currently available tools and approaches – most of which were developed in the past century or even earlier.”

Malaria eradication possible, but not with current tools

Malaria is a disease of the most vulnerable: the very young and the poor. Every year, there are about 219 million cases of the disease, and more than 400,000 deaths every year. We can put and end to it.

The key to eradicating malaria is stepped up research and development of new tools to battle the disease, claims a World Health Organization (WHO) expert group that spent the last 3 years studying the trends and future projections for the factors and determinants that underpin malaria. The group, called the Strategic Advisory Group on Malaria Eradication (SAGme), published a 20-page executive summary of their report including a set of recommendations, ahead of a WHO-hosted malaria forum in Geneva on Sep 9.

Malaria infections and deaths have held steady since 2015, but there isn’t enough progress against the disease to achieve the 2030 goal set out in the latest WHO malaria strategy — cutting cases and deaths by 90%.

When the group looked at funding, they found that less than 1% of the support for health research targets tools to fight malaria. The group estimates that scaling up current interventions could prevent 2 billion more malaria cases and 4 million deaths by 2030, but only if they reach 90% of the population in countries that make up 95% of the global burden.

This could actually save money in the long run. The researchers calculated that the cost of the scale-up would be $34 billion and that the economic gain would be about $283 billion in total gross domestic product — putting the benefit-to-cost ratio above 8:1.

SAGme experts say it is theoretically possible to wipe out malaria, but not with the current control methods being used. Most tools used to battle the disease were developed in the past century or earlier. Promising new efforts are being developed, and the world’s first vaccine against malaria—RTS, S/AS01—has been deployed in Ghana, Malawi, and Kenya.

“An effective vaccine is something we desperately need if we’re ever going to get malaria under control and we just don’t have it,” said Professor Alister Craig, dean of biological sciences at the Liverpool School of Tropical Medicine. GSK and the Bill & Melinda Gates Foundation supported the development of the RTS, S/AS01 vaccine at a cost of ~$700 million. The effort culminated in 2015, when a study of about 15,000 subjects found that giving four doses of RTSS over 18 months cuts the number of malaria episodes that young children experienced by 36%.

SAGme also pointed to an urgent need to step up research and development and strengthen the pipeline, noting that a research agenda published in 2017 serves as a starting point.

A major challenge in many countries is access to health services. For example, only one in five pregnant women in moderate- to high-transmission parts of Africa can get drugs to protect themselves from malaria. Only half of those at risk for malaria on the continent sleep under insecticide-treated bed nets, and only 3% are protected by indoor insecticide spraying.

Expansion of the universal healthcare coverage and strengthening of health services are crucial so more people can access malaria prevention, diagnostics, and treatments. Better data on malaria transmission is also needed and better tools to control mosquitoes and protect and treat people in malarial regions.

Multidrug-resistant malaria spreading across Southeast Asia

Malaria carrying mosquitoes have caused the extinction of more than two dozen bird species in Hawaii. Should they be destroyed using irreversible gene editing before other birds meet the same fate? Credit: Wikimedia Commons

Malaria carrying mosquitoes have caused the extinction of more than two dozen bird species in Hawaii. Should they be destroyed using irreversible gene editing before other birds meet the same fate? Credit: Wikimedia Commons

Malaria is a serious and possibly fatal disease, caused by a parasite that typically infects a certain type of mosquito. The parasite that causes malaria is Plasmodium.

There are five types: Plasmodium falciparum, Plasmodium malariae, Plasmodium vivax, Plasmodium ovale, and Plasmodium knowlesi. But P. falciparum is the most worrisome.

The first symptoms of malaria – fever, headache, and chills – usually appear 10–15 days after the bite of an infected mosquito. Left untreated, P. falciparum malaria can progress to severe illness and death. Although it has been eliminated in developed countries, malaria is still prevalent in multiple areas around the world. Worldwide, 3.2 billion people (about half the world’s population) are at risk of contracting malaria. Every 2 minutes, a child dies of malaria. And each year, more than 200 million new cases of the disease are reported.

New studies recently in The Lancet Infectious Diseases warns that malaria could “become a potential global health emergency”. An aggressive strain of drug-resistant malaria that originated in Cambodia has rapidly spread into neighboring countries, causing high rates of treatment failure to first-line treatment and complicating efforts to eliminate the disease.

One study found that the KEL1/PLA1 strain of P. falciparum now accounts for over 80% of the malaria parasites in northeastern Thailand and Vietnam. Researchers also found that the strain acquired novel genetic mutations that have allowed it to become resistant to dihydroartemisinin-piperaquine, a form of artemisinin-based combination therapy (ACT) that has been the first-line treatment for malaria in Cambodia for over a decade now and more recently adopted by Thailand and Vietnam as the treatment of choice.

The other study found that the average failure rate for dihydroartemisinin-piperaquine treatment in Cambodia, Vietnam, and Thailand is now 50%, suggesting a new first-line option is needed to fight the mosquito-borne disease in those countries.

An earlier study in The Lancet reported that KEL1/PLA1 parasites first appeared in western Cambodia in 2008, shortly after dihydroartemisinin-piperaquine was introduced. By 2013 KEL1/PLA1 parasites had migrated to northern Cambodia and Laos. By 2015 and 2016, the parasites were identified in Thailand and Vietnam. Resistance to the treatment was first reported in Cambodia in 2013.

To determine the extent of the spread of the KEL1/PLA1 parasites and the type of genetic mutations that have driven the spread, Professor Olivo Miotto, PhD, of the Wellcome Sanger Institute and University of Oxford and a team of researchers analyzed whole-genome sequencing data from P. falciparum samples collected from malaria patients in Cambodia, Laos, northeastern Thailand, and Vietnam from 2008 through 2017. The data came from the MalariaGEN P. falciparum community project, which provides researchers with sequencing data on samples from 28 countries.

From a data set of 1,673 whole-genome sequences, the team found that 1,615 had KEL1/PLA1 status, and that the prevalence of the co-lineage—a combination of an artemisinin-resistant lineage that carries mutations to the kelch13 gene and a piperaquine-resistant lineage that carries amplifications of the plasmepsin 2 and 3 genes—increased steadily over the 10-year study period. Before 2009, KEL1/PLA1 was only in western Cambodia, but by 2016-2018 it accounted for more than 50% of samples in all the countries except for Laos. More than 80% of the most recent samples in northeastern Thailand and Vietnam were KEL1/PLA1.

The data suggests that multiple KEL1/PLA1 subgroups were able to spread rapidly across borders in separate transmission waves, following the acquisition of one of several mutually exclusive mutations. The spread of KEL1/PLA1 is having a negative impact on malaria treatment in the region.

The authors of the study suggested that given the high rates of treatment failure, dihydroartemisinin-piperaquine “should no longer be used for the treatment of P. falciparum malaria in the eastern Greater Mekong subregion.” Cambodia has switched to another artemisinin-based combination therapy (ACT), artesunate-mefloquine.

“Our study provides a clear picture of how malaria that is resistant to the first-line treatment is spreading, and demonstrates the importance of using genetics to detect patterns of resistance in each area. Active genomic surveillance is now vital to inform national malaria control programmes, to help reduce the risk of a major global outbreak,” Professor Dominic Kwiatkowski, a senior author on the paper from the Wellcome Sanger Institute and the Big Data Institute at University of Oxford, said.

The potential spread of ACT-resistant malaria to Africa is particularly alarming since 90% of malaria-associated deaths occur on the continent.

Decline of iconic London sparrow might be caused by malaria

Noisy but admired by many, the sparrows used to be a regular sight in London’s gardens, but their number has dropped 71% since 1995. Now, a new study suggests that avian malaria might have a part to play in the decline.

Credit: Nmahieu (Flickr)

 

The “sudden and unexplained decline of the iconic birds” inspired a team from Zoological Society of London, the Royal Society for the Protection of Birds, the British Trust for Ornithology and the University of Liverpool to investigate what was going on.

Up to 74% of the city’s house sparrows were carrying avian malaria, according to their research. That’s more than any other bird population in Northern Europe. While it is a strain that only affects birds, it is still cause for alarm.

“Parasite infections are known to cause wildlife declines elsewhere and our study indicates that this may be happening with the house sparrow in London. We tested for a number of parasites, but only Plasmodium relictum, the parasite that causes avian malaria, was associated with reducing bird numbers,” said Daria Daram, lead author.

Researchers searched for parasites for three years by taking blood and fecal samples from sparrows in different areas, ranging from Enfield in north London to Sutton in the south and Fulham in the west. They were centered around a single breeding colony and spaced at least four kilometers apart.

In some areas, 100% of birds were infected with the avian malaria parasite and, when the birds were counted, many juvenile sparrows did not survive the winter. The disease is spread when mosquitoes bite birds and feed on their blood. It can lead to infections that can be fatal to the birds. At the very least, it is adding more pressure on sparrows, making it harder for them to survive.

The research follows other studies that have ruled out domestic cats as a cause of falling sparrow numbers, while casting doubt on whether sparrowhawks are responsible. Some experts also suggested that, because sparrows fail to move very far, populations may be becoming inbred.

“Exactly how the infection may be affecting the birds is unknown. Maybe warmer temperatures are increasing mosquito numbers, or the parasite has become more virulent,” said Will Peach, head of Research Delivery at the Royal Society for the Protection of Birds.

With a changing climate, researchers expect that avian malaria will become more widespread across Northern Europe, thanks to higher temperatures and wetter weather, both of which affect mosquito reproduction. This could be linked to the change with the sparrows, they said.

“It has been hypothesized that Plasmodium prevalence will increase across Northern Europe due to climate warming, and that climate change will influence avian malaria infection rates through increased parasite and vector abundance and altered mosquito distributions,” the study reads.

The study was published in Royal Society Open Science.

Mosquito.

Climate change poised to expose millions to malaria, new study reports

Warmer climates will likely mean more malaria in more areas of the world, a new study suggests.

Mosquito.

Image via Pixabay.

At lower temperatures, the malaria parasite (Plasmodium) develops faster in mosquitoes than previous research indicated, based on a study done by a team at Penn State and the University of Exeter. Their results suggest that even slight climate shifts could increase the malaria risk for hundreds of thousands to millions of people, both locals and travelers, in areas where the disease currently isn’t present.

Morelaria

“The rate of malaria transmission to humans is strongly determined by the time it takes for the parasites to develop in the mosquito,” said Matthew Thomas, professor and Huck scholar in ecological entomology, Penn State, and the paper’s corresponding author.

“The quicker the parasites develop, the greater the chance that the mosquito will survive long enough for the parasites to complete their development and be transmitted to humans.”

The team explains that previous work suggested that malaria parasites simply can’t develop fast enough in cool climates to be able to infect people — in essence, they took longer to mature than the host mosquito’s lifespan. However, that research was carried out almost a century ago using a Russian species of mosquito.

“Our results challenge this long-standing model in malaria biology,” says Thomas.

The team worked with Anopheles stephensi and Anopheles gambiae, the two most important malaria-carrying mosquitoes in the world. They kept malaria-infected mosquitoes of these species in the lab under a range of temperatures (16 to 20 degrees Celsius /  60 to 68 degrees Fahrenheit) to see how the parasite would develop. They also kept a control group of mosquitoes at 27 degrees Celsius / 80 degrees Fahrenheit, the temperature at which malaria transmission is known to be highest.

Daily temperatures were varied by 10 degrees Celsius — 5 degrees above and below the daily mean — to simulate natural conditions such as day-night shifts or other events.

Based on the traditional model, Plasmodium is estimated to take 56 days to fully develop at temperatures just above 18 degrees Celsius / 64 degrees Fahrenheit, which is considered the minimum threshold for its development. However, the current study shows that Plasmodium needs as few as 31 days to develop in Anopheles stephensi. At this lower end of its developmental range, variations in temperature also help promote faster development for the parasite. They fully developed in as few as 27 days at 18 degrees Celsius under realistic variable temperature conditions.

“Our work shows that even small increases in temperature could dramatically increase malaria infections in humans because the parasites develop much faster at these lower temperatures than has been previously estimated,” said Jessica Waite, senior scientist, Penn State.

“Parasite development rate further increases when temperatures fluctuate naturally, from cooler at night to warmer in the day.”

Waite says the findings suggest that millions of people living in the higher elevations of Africa and in South America could be exposed to malaria as climate change ever so slightly increases mean temperatures in these areas.

“As temperatures increase with climate change, infectious mosquitoes in areas surrounding mountains, for example, may be able to transmit the parasite higher up the mountains than they have in the past,” she said. “Our results suggest that small rises in temperature could lead to greater increases in transmission risk than previously thought.”

The paper “Exploring the lower thermal limits for development of the human malaria parasite, Plasmodium falciparum” has been published in the journal Biology Letters.

Genetically modified fungus wipes out 99% of malaria-carrying mosquitoes

Credit: Aedes Albopictus.

Although progress in combating malaria has been phenomenal, the mosquito-borne infectious disease is now on the rise in the most affected countries in Africa. Worldwide, about 220 million people are infected each year by a dangerous parasite that is transmitted to humans through the bites of infected mosquitoes. Naturally, scientists looking to eradicate malaria are finding that stopping its vector — the mosquitoes — is the most effective course of action. In a new study, researchers genetically modified a fungus to produce a spider toxin. Within 45 days, the fungus had killed 99% of mosquitoes capable of carrying malaria without affecting other insects.

The study was conducted inside a “mosquitosphere” — a 6,500-sq-ft (600-square-meter) dummy village in Burkina Faso, complete with plants, water and food sources, homes. The entire fake village was encapsulated in a double layer of mosquito netting in order to prevent any creatures from escaping the habitat.

Researchers at the University of Maryland in the USA and the IRSS research institute in Burkina Faso released 1,500 mosquitoes inside the village, whose numbers quickly soared thanks to the perfect breeding conditions and lack of predators. But then the research team introduced the enhanced fungus, genetically engineered with instructions that produce a toxin found in the venom of a funnel-webs spider native to Australia.

The fungal spores were mixed with sesame oil and wiped on black cotton sheets. When the insects landed on the sheets, they immediately became exposed to the deadly fungus  Within 45 days, there were only 13 mosquitoes left, the authors reported in the journal Science.

No other insects, such as bees, were infected by the fungus. Only certain species of mosquitoes of the Anopheles genus — and only females of those species — can transmit malaria. Malaria is caused by a unicellular parasite called a Plasmodium, which undergoes a series of infection steps before arriving at the mosquito’s salivary gland, from which it ultimately spreads to bitten humans.

“Deployment of transgenic Metarhiziumagainst mosquitoes could (subject to appropriate registration) be rapid, with products that could synergistically integrate with existing chemical control strategies to avert insecticide resistance,” the authors concluded.

These findings suggest that his approach may be effective in controlling the spread of malaria. However, releasing gene-edited creatures into the wild might have unintended consequences, which is why the method needs to be seriously vetted in order to ensure bio-safety. The authors also emphasize that this technology isn’t meant to wipe out mosquitoes but rather to control them and the spread of disease.

Previously, researchers have devised other tricks meant to curb the spread of malaria, including CRISPR gene edits that make mosquitoes less likely to get infected by parasites that cause malaria in humans and even drugs that could make human blood toxic to mosquitoes.

Algeria and Argentina are now malaria-free

Malaria is a mosquito-borne disease caused by Plasmodium parasites. In 2017 an estimated 219 million cases of malaria occurred worldwide and 435,000 people died, mostly children in the African Region.

The World Health Organization (WHO) announced this week that Algeria and Argentina have achieved certification of malaria-free status, meaning both have interrupted local transmission for at least 3 consecutive years.

Algeria, where the disease was first discovered in humans in 1880 by the French physician Dr. Charles Louis Alphonse Laveran, is only the second country in its African region to reach malaria-free status. The first was Mauritius, which was certified in 1973. Algeria reported its last indigenous malaria cases in 2013.

“Algeria has shown the rest of Africa that malaria can be beaten through country leadership, bold action, sound investment and science. The rest of the continent can learn from this experience,” said Dr. Matshidiso Moeti, WHO’s Regional Director for Africa.

Argentina is the second country in the Americas region to be certified in 45 years after Paraguay in 2018. Argentina reported its last local malaria cases in 2010. Malaria elimination was made a goal in Argentina in the 1970s. Elimination was achieved by training health workers to spray homes with insecticides, diagnosing the disease through microscopy, and effectively responding to cases in the community.

The WHO grants malaria-free certification when a country has proven that the chain indigenous transmission has been interrupted for at least the previous 3 consecutive years. Countries should also show evidence that the surveillance systems in place can rapidly detect and respond to any malaria cases and have effective programs to prevent resurgences and re-establishment.

In a WHO statement, Director-General Dr Tedros Adhanom Ghebreyesus said the two countries eliminated malaria due to the unwavering commitment and perseverance of their people and leaders. “Their success serves as a model for other countries working to end this disease once and for all.”

In recent years, 9 countries have been certified by the WHO Director-General as having eliminated malaria: United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), Armenia (2011), Maldives (2015), Sri Lanka (2016), Kyrgyzstan (2016), Paraguay (2018) and Uzbekistan (2018).

World’s first malaria vaccine launched in a pilot program

Malaria remains one of the world’s leading killers, claiming the life of one child every two minutes. Most of these deaths are in Africa, where more than 250,000 children die from the disease every year. Children under 5 are at greatest risk of its life-threatening complications. Worldwide, malaria kills 435,000 people a year, mostly kids.

This week, a pilot program to immunize babies in Malawi with the RTS,S vaccine was launched to evaluate it the vaccine can jump-start stalled progress in the battle against the disease.

Thirty years in the making, RTS,S is the first, and to date the only, vaccine that has demonstrated it can significantly reduce malaria in children. In clinical trials, the vaccine was found to prevent approximately 4 in 10 malaria cases, including 3 in 10 cases of life-threatening severe malaria. The vaccine also cut the level of severe anemia—the most common reason kids die from the disease—by 60%.

A 4-dose schedule is required, with the first dose given as soon as possible after five months of age, doses two and three given at monthly intervals after that, and the fourth dose given 15–18 months after the third dose. In the Phase 3 trial, the vaccine was generally well tolerated, with adverse reactions comparable to those of other childhood vaccines. The European Medicines Agency (EMA) carried out a scientific assessment of RTS,S and concluded that the vaccine has an acceptable safety profile in a scientific opinion issued in July 2015. The vaccine is a complementary malaria control tool – to be added to the core package of WHO-recommended measures for malaria prevention, including the routine use of insecticide-treated bed nets, indoor spraying with insecticides, and the timely use of malaria testing and treatment.

In a World Health Organization (WHO) statement, WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said tremendous gains against malaria have been made over the past 15 years with the use of bed nets and other measures, but progress has stalled or even reversed in some areas.

“We need new solutions to get the malaria response back on track, and this vaccine gives us a promising tool to get there,” he said. “The malaria vaccine has the potential to save tens of thousands of children’s lives.”

Along with Malawi, pilot programs to make the RTS,S  available along with other routine childhood vaccine are also slated for selected areas of Ghana and Kenya. The WHO’s Strategic Advisory Group of Experts (SAGE) has been working on vaccination recommendations, and its Malaria Policy Advisory Committee has been addressing issues related to public health use of the vaccine.

Aside from the WHO and the three countries’ health ministries, other groups collaborating on the pilot program include PATH, a nonprofit health group based in Seattle. And GSK is donating up to 10 million vaccine doses. Three global health groups are financing the program at a cost of nearly $50 million: Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis, and Malaria; and Unitaid.

The pilot program’s goal is to reach 360,000 children each year in the three countries. Health ministries will guide where the vaccine will be given, focusing on areas with moderate-to-high transmission. The WHO will use the results from the pilot program to guide its policy recommendations on the wider use of the RTS,S vaccine. Specifically, it will be looking at its impact on child deaths, uptake in target populations, whether parents bring their children in for all four doses, and vaccine safety with routine use.

Kate O’Brien, MD, MPH, Director of WHO’s Department of Immunization, Vaccines, and Biologicals, said young infants are at the highest risk of severe outcomes, and so having a vaccine that can prevent disease in children and infants would be a groundbreaking new strategy.

Anopheles Gambiae.

We can eradicate malaria — but we need to use new tricks

Malaria can be eradicated completely, according to new research. The study goes on to analyze why previous efforts fell short of this goal and takes a look at what new strategies could help continue our fight against this terrible parasite.

Anopheles Gambiae.

A feeding female Anopheles gambiae mosquito. A. gambiae is a known malaria vector.
Image credits CDC / James Gathany.

The early years of this new millennium were fraught with malaria. Several outbreaks of unprecedented size moved the world as a whole to take action. By 2015 the disease’s spreading rate was halved, and such efforts ground to a standstill. Countries like Zanzibar continued to deal with the disease — however, it was never completely wiped out.

A new study led by Professor Anders Björkman at the Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet takes a look at why our efforts fell short in the past — some key issues being changes in mosquito behavior and natural selection of the parasites making them more drug resistant.

Malari-no

“But after [2015], the decline tailed off,” says Professor Björkman who has been running the Karolinska Institutet’s eponymous malaria project for 18 years. “Except for in Zanzibar, where the action taken for its 1.4 million citizens has led to approximately a 96 per cent decline in the incidence of malaria.”

“We’ve optimised these measures with the Zanzibar Malaria Control Programme and can now explain why malaria has not yet been fully eliminated.”

The world-wide anti-malaria offensive was carried largely by the development of new drugs, and the widespread distribution of anti-mosquito sprays and insecticide-infused nets. While definitely successful, such measures are lackluster today at best.

Björkman’s team has been monitoring roughly 100,000 residents from two districts in Zanzibar since 2002. Their study shows that malaria-carrying species of mosquitoes now predominantly bite people outdoors instead of indoors, as used to be the case. The insects also seem to have developed a resistance, or at least a tolerance, to modern pesticides. Finally, Plasmodium, the protozoan parasite that causes malaria, has been undergoing a process of forced natural selection at the hands of our medicine. The current form of Plasmodium is much more difficult to detect and treat but spreads with the same virulence as before.

“Both the mosquitoes and the parasites have found ways to avoid control measures,” says Professor Björkman. “We now need to develop new strategies to overcome this if we’re to attain the goal of eliminating the disease from Zanzibar, an endeavour that can prove a model for the entire continent.”

There’s a lot at stake, too. One of the findings that surprised the team most (and not in a good way) was the sheer decline in child mortality experienced in Zanzibar. Malaria control measures, they note, led to a 70% drop in overall child mortality rates. It’s an immense percentage, given that the highest estimation of malaria-related child deaths in Africa previous to this study was of only 20%. Sub-Saharan Africa currently has the highest rate of newborn deaths in the world (34 deaths per 1,000 live births in 2011) and the highest rate of date for children under five (1 in 9 children) according to the United States Agency for International Development.

This tidbit suggests that malaria has a much more dramatic and chronic effect on general infant health than we dared assume. The disease overtaxes a baby’s immune system, spreading it too thinly to defend against other pathogens. Professor Björkman considers malaria to still be “the greatest obstacle to a healthy childhood in Africa” because of this.

“If you ask African women today, their greatest concern is usually that malaria doesn’t affect their pregnancy and their babies. The global community must continue the fight for improved strategies and control measures. If this happens, I think we’ll be able to reach the goal of ultimate elimination.”

Zanzibar was chosen for this study as the country has made huge efforts to put global anti-malaria initiatives in place, and actively works to control the disease to this day. The researchers hope that their findings can guide anti-malaria strategies throughout Africa.

The paper “From high to low malaria transmission in Zanzibar – challenges and opportunities to achieve elimination” has been published in the journal BMC Medicine.

After millions of tests, researchers find the most promising compounds against malaria

Researchers have isolated the most promising compounds for dealing with malaria.

Elizabeth Winzeler, PhD (right), and her malaria research team at UC San Diego School of Medicine (UCSD). Image credits: UCSD.

There have been 219 million malaria cases in 2017, and the number is on the rise, according to the World Health Organization. The disease has killed over 400,000 people last year alone, and prevention and treatment methods remain difficult to implement at a large scale.

“It’s difficult for many people to consistently sleep under mosquito nets or take a daily pill,” says Elizabeth Winzeler, PhD, professor of pharmacology and drug discovery at University of California San Diego School of Medicine. “We’ve developed many other options for things like birth control. Why not malaria? The malaria research community has always been particularly collaborative and willing to share data and resources, and that makes me optimistic that we’ll soon get there too.”

Most malaria drugs focus on treating the symptoms of the disease once it has infected the body. Not only is this not doing all that much to prevent the infection spread, but the parasite is also starting to develop drug resistance to several treatments.

“In many ways, the search for new malaria drugs has been a search for something akin to aspirin — it makes you feel better but doesn’t necessarily go after the root of problem,” Winzeler adds.

[panel style=”panel-danger” title=”Plasmodium” footer=””]Malaria is caused by a single-celled parasite called Plasmodium, which is neither a virus nor a bacteria. Plasmodium multiplies in red blood cells of humans as well as in the mosquito intestine and is spread by the Cules and Anopheles mosquitoes.[/panel]

Extracting sporozoites of the malaria parasite from mosquitoes in Elizabeth Winzeler’s lab. Image credits: UCSD.

In a study recently published in Science, Winzeler and colleagues took a different approach: they spent two years extracting various strains of malaria parasites and systematically exposed them to over 500,000 chemical compounds to see what works best against them. After millions of tests, they selected the 631 most promising ones.

Their aim is to tackle malaria at an early stage, before the infection sets out through the body. Essentially, when the female mosquito feeds on an infected person, both male and female forms of the parasite are ingested along with human blood. The male and female forms of the parasite meet and mate in the mosquito’s gut and are passed to another human who is bitten by the same mosquito. However, before the parasite starts to multiply in the bloodstream and make people sick, it infects the liver — this is where researchers want to strike.

As you’d expect, testing all of these compounds took a long time — a really long time.

“In a good week, we’d be able to test 20,000 compounds,” Winzeler said, “but of course many of the mosquitoes we received would be dried out, frozen or covered in fungus.”

It was a painstaking work, but after all of this, researchers successfully identified the promising compounds. Even better, they decided to not patent any of these compounds. Instead, they’re making it available to all interested groups for further research.

“It’s our hope that, since we’re not patenting these compounds, many other researchers around the world will take this information and use it in their own labs and countries to drive antimalarial drug development forward,” Winzeler said.

In the meantime, Winzeler and colleagues will continue to study these compounds themselves. This is still very far from being a final drug or vaccine, but it is the most comprehensive study of its kind to date, and researchers hope that it can lay the foundation for new, efficient ways of dealing with malaria.

Dogs successfully diagnose malaria in children

Dogs have showcased their amazing sniffing abilities once again — this time, by identifying malaria cases on the spot and aiding or potentially replacing more expensive and time-consuming tests.

Freya, a Springer Spaniel, is among the dogs who have been trained to sniff out the scent of malaria. Freya’s highly sensitive nose could help provide the first non-invasive test for malaria. Sniffer dogs could potentially be deployed at ports of entry to identify passengers carrying malaria to prevent the spread of the disease across borders and to ensure people receive timely antimalarial treatment. Image credits: Medical Detection Dogs.

The fight against malaria took massive strides from 2000 to 2015, when fatalities were reduced by more than 60 percent, saving almost 7 million lives and preventing more than 1 billion malaria cases. But things have somewhat stagnated.

This is where man’s best friend steps in.

There are several tests for malaria, generally consisting of a blood test. Now, researchers have shown that a simple dog sniff could work equally well, simplifying things and offering a low-cost alternative. It’s also the first non-invasive diagnosis available for malaria.

“People with malaria parasites generate distinct odors on their skin and our study found dogs, which have an incredibly sensitive sense of smell, can be trained to detect these odors even when it’s just on an article of clothing worn by an infected person,” said Steven Lindsay, a public health entomologist at in the Department of Biosciences at Durham University in the United Kingdom and the lead investigator on the study.

The test worked by having dogs sniff children’s’ socks, and was generally effective, though not flawless. Overall, 175 sock samples were from 30 malaria-positive children and 145 from uninfected children (as verified with conventional tests). The dogs were successful in identifying 70% of the malaria-infected samples and 90% of the samples without malaria parasites.

Lindsay also adds that the dogs’ accuracy rate was slightly lowered because some children were carrying different types of malaria parasites. The accuracy rate could also be improved if the dogs are trained with fresh samples, instead of samples which were frozen over the duration of the training course (as was the case now).

Overall, with a bit more finessed training, the dogs could ultimately reach a level comparable to existing medical tests.

“While our findings are at an early stage, in principle we have shown that dogs could be trained to detect malaria infected people by their odour with a credible degree of accuracy,” says Professor Steve Lindsay, lead author. “This could provide a non-invasive way of screening for the disease at ports of entry in a similar way to how sniffer dogs are routinely used to detect fruit and vegetables or drugs at airports.”

“This could help prevent the spread of malaria to countries that have been declared malaria free and also ensure that people, many of whom might be unaware that they are infected with the malaria parasite, receive antimalarial drug treatment for the disease.”

Even if the dogs are a bit less accurate than medical tests, Lindsay said detection dogs could be used for narrowing the focus of clinical testing and treatment efforts. Detection dogs would operate best at ports of entry into countries which eliminated malaria or are close to elimination, as a sort of safety barrier. In the fight against malaria, we need all the help we can get.

Malaria is still one of the most dangerous diseases in the world. According to the World Malaria Report 2016, there were 212 million cases of malaria globally in 2015 and 429,000 malaria deaths. These figures have remained somewhat constant in the past few years.

The findings will be presented at the 67th American Society of Tropical Medicine and Hygiene (ASTMH) Annual Meeting. The research was funded by the Bill & Melinda Gates Foundation.

Archaeologists discover Roman-age burial site of “vampire-child”

Archaeologists working in Italy have discovered an unusual burial site — a rock has been inserted into the mouth of the buried person, a practice believed to prevent people from rising from the dead. To make matters even more bizarre, the buried person appears to be a child of approximately 10 years.

“I’ve never seen anything like it. It’s extremely eerie and weird,” said David Soren, a Regents’ Professor in the University of Arizona (UA) School of Anthropology and Department of Religious Studies and Classics. “Locally, they’re calling it the ‘Vampire of Lugnano.'”

A rock was inserted into the mouth of a 10-year-old to keep the deceased child from rising from the grave and spreading malaria, researchers believe. Credit: David Pickel / Stanford University.

Vampires and werewolves may produce successful movies, but in ancient times, people took their mythological monsters very seriously. In several cultures (particularly across Europe), people resorted to so-called vampire burials, which believed to prevent the deceased from rising in the form of a vampire or to prevent an “actual” vampire from returning. These weren’t common by any means, but archaeologists have discovered several examples. Among the practices people resorted to, stuffing a rock into the person’s mouth seems to be the most common. This was also the case at the new discovery.

The discovery was made at La Necropoli dei Bambini, or the Cemetery of the Babies, a fifth-century Roman cemetery for children. The necropolis is notable for dating from a period when a massive malaria outbreak swept the area, killing particularly vulnerable people such as children. The skeletal remains, uncovered by archaeologists from the University of Arizona and Stanford University, along with archaeologists from Italy, belong to such a child, who was probably killed by malaria. Excavation director David Pickel says that this discovery offers a unique insight not only into the outbreak itself — but how the people reacted to it.

“Given the age of this child and its unique deposition, with the stone placed within his or her mouth, it represents, at the moment, an anomaly within an already abnormal cemetery,” Pickel said. “This just further highlights how unique the infant — or now, rather, child — cemetery at Lugnano is.”

The resident people at the time were quite superstitious — we know this because, alongside the graves of children, archaeologists often discovered things like raven talons, toad bones, bronze cauldrons filled with ash and the remains of puppies which appear to be sacrificed.

Previously, the team had also found a 3-year-old girl with stones weighing down her hands and feet, another practice meant to prevent her from rising as an undead. In this case, it seems that people were afraid some children would turn undead and continue spreading the plague.

“We know that the Romans were very much concerned with this and would even go to the extent of employing witchcraft to keep the evil — whatever is contaminating the body — from coming out,” Soren said.

“This is a very unusual mortuary treatment that you see in various forms in different cultures, especially in the Roman world, that could indicate there was a fear that this person might come back from the dead and try to spread disease to the living,” added bioarcheologist Jordan Wilson, a UA doctoral student in anthropology who analyzed the skeletal remains.

For now, researchers are set to carry DNA tests on this new find. Next summer, the archaeologists will return to the site and finish excavations and learn more about this dark time of history.

“It’s a very human thing to have complicated feelings about the dead and wonder if that’s really the end,” Wilson said. “Anytime you can look at burials, they’re significant because they provide a window into ancient minds. We have a saying in bioarchaeology: ‘The dead don’t bury themselves.’ We can tell a lot about people’s beliefs and hopes and by the way they treat the dead.”