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ANNOUNCEMENTS:::

TIPS ON MALARIA

  • HOW CAN MOSQUITOES BE CONTROLLED?

    Mosquitoes around the home can be reduced significantly by minimizing the amount of standing water available for mosquito breeding. Residents are urged to reduce standing water around the home in a variety of ways.

  • HOW CAN I PROTECT MYSELF FROM MOSQUITO-BORN DISEASES?

    The best way is to avoid being bitten by mosquitoes.This can be accomplished using personal protecting  while outdoors when mosquitoes are present. Treated bed nets should be used sleeping. Mosquito repellent should be used when outdoor.

  • WHO ARE AT RISK?


    Nearly half of the world’s population is at risk of getting malaria. Pregnant women are particularly at risk of malaria. Children under 5 years are at high risk of malaria.
     

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Operation 2015

The year 2015 will mark a new beginning in sub-Saharan Africa as countries attack an ancient killer of mothers and children in an attempt to bring malaria deaths to near-zero or eliminate the disease.

Based on individual targets and tailor-made solutions, countries are moving from malaria control as they prepare for elimination or already in the process of elimination.

This may well be “Operation 2015” with different approaches and different targets for different players.

One malaria fighting strategy currently receiving a lot of attention is vaccine evelopment, hailed as an approach that can provide the answer to malaria elimination.

In October, 2013 the RTS,S malaria vaccine was again presented to the world as a safe, reliable and worthy new tool against malaria by scientists and developers from PATH Malaria Vaccine Initiative (MVI), GlaxoSmithKline (GSK) and 11 African research centres of the Malaria Clinical Trials Alliance (MCTA).

The presentation was made at the 6th Pan-African conference of the Multilateral nitiative on Malaria (MIM) in Durban, South Africa, where Dr. David Kaslow, Director of PATH-MVI, and Kenyan researcher, Dr. Lucas Otieno, presented the Phase III trial results.

The theme of the MIM conference 'Moving towards malaria elimination: Investing in research and control,' is seen at work in the vast sums of money pumped (by Bill Gates and global partners) into the research and development of the RTS,S and other vaccines.

Calling a spade a spade, scientists have said that although the RTS,S, malaria vaccine is doing well in clinical trials and likely to be licensed by 2015, it is not a certainty. Even if it were, there is still the need for heavy dependence on current tools like  bed nets and indoor residual spraying.

This is the time to be realistic about the task ahead and the solutions available. The results of the clinical trials of the vaccine showed that 18 months after the initial three-dose vaccination series, RTS,S gave a 46 per cent protection among infants.

“The RTS,S vaccine candidate is still under development and additional data from 32 months follow-up and the impact of a fourth 'booster' dose given 18 months after the initial three doses, are expected to become available in 2014,” according to the researchers.

Issues under consideration If the quest to end malaria deaths by 2015 is still on the cards, so also must the reality of how operation 2015 should look like.

Of the many reports carried in the media, not much time is spent to explain that even when the vaccine is approved, insecticidetreated nets (ITNs) and indoor residual spraying (IRS) will continue to be essential means of prevention.

For some reason, news about the joy of having a vaccine for malaria is galloping far ahead of the reality that, in the trial the RTS,S vaccine was administered alongside existing malaria control measures, like insecticide treatedbed nets, which were used by 78 per cent of children and 86 per cent of infants.

The researchers said the potency levels of the vaccine is good news, but admonish that RTS,S will not vanquish malaria by itself. They cautioned therefore that the use of the vaccine must go hand in hand with the existing tools.

Dr. Kaslow has said “The protection offered by RTS,S seems low. The polio vaccine is up to ninety-five per cent effective. “Usually if it's not eighty or ninety per cent, it's not a vaccination.”

Dr. Kaslow and his partners said that while the efficacy levels of the RTS,S fall far below what is preferable, the data must be considered from the broader perspective of public health and the number of lives to be saved.

This view is shared by Dr George Amofah, former Deputy Director-General of the Ghana Health Service (GHS) who has seen how much harm malaria causes on the continent.

Dr Amofah said “The reason we are enthused about RTS,S is that malaria kills and very fast so even if we are able to reduce morbidity and mortality by 40 per cent, you would cut down the number of children dying from the disease because the malaria disease burden is huge and even moderately successful vaccines can have a huge impact.

He said “Technically the health authority would have liked it better if the results were between 70 and 80 per cent protection for the children. Most vaccines are higher than 70 per cent. Yellow fever and measles vaccines are about 90 per cent. And even they need to be boosted because the effect wanes over time. When you add a booster programme it extends the immunity period.”

With the low level of protection, scientists project that the vaccine could prevent nine hundred and forty-one malaria cases per thousand children, and four hundred and forty-four cases per thousand infants.

Like most vaccines, the efficacy of RTS,S declined over time as shown by a previous result from one year follow-up of the Phase 3 trial. It showed that the efficacy of RTS,S was 56% against clinical malaria and 47% against severe malaria for the 5-17 month-old age group and 31% against clinical malaria and 37% against severe malaria in the 6-12 weekold age group.

One thing that needed to be cleared is the age at which infants receive the vaccination under EPI. It is usually 6-14 weeks. On the WHO update on RTS,S, it says 6-14 weeks while the researchers are talking about 6-12 weeks. That seems to have been addressed.

Dr Amofah dispelled the notion that if the malaria vaccine is added to the vaccines for the 6 childhood killer diseases, it might be too much for them to bear.

“It must be noted that all the children receiving the malaria vaccine in the RTS,S study are also receiving the basic vaccines under the expanded programme on immunisation (EPI). And this
is being looked at during the analysis of RTS,S.”

African countries are thinking of adding a few more vaccines to EPI to give children better protection because when you have an efficacious vaccine there's no need to rely on another tool which
depends on the personal action of the individual.”

Getting into gear
Dr. Amofah said“ It may complicate things a bit trying to convince people that this particular vaccine requires bed nets and others. People are used to higher percentage cover from other vaccines.”

“The euphoria that has greeted the discovery of a malaria vaccine could well make it difficult to get people to understand the reality that the vaccine offers half protection against malaria in
children, and only a third protection in infants” he said.

The former GHS Deputy Director-General said what remains is spreading the total message on the RTS,S vaccine to engender the co-operation of the community.

“We cannot say that we now have a reasonably efficacious vaccine against malaria so everything is okay and we are eliminating malaria.”

While the expectation of a vaccine is good for Africa, it is worth remembering that even with its arrival a few good practical measures have to be identified and ensured.

The countries on course for elimination have taken advantage of modern and sophisticated surveillance programmes to control the menace. They have combined high-tech tools, like
GPS mapping and active case detection and personal follow-ups at the home of every individual with confirmed malaria.

If ever there is “Operation 2015,” it must be borne in mind that time is short and all workable solutions have to be well applied now, even if tomorrow promises to bring better options.
 

Editions: 
Eleventh Edition