280 likes | 493 Views
Conquering Malaria. Joel G. Breman, MD, DTPH Fogarty International Center National Institutes of Health Improving Population Health Workshop Instituto Nacional de Salud Publica (INSP) Cuernavaca, Mexico 21 – 22 June 2003. Conquering Malaria. Burden Ecology and manifestations Successes
E N D
Conquering Malaria Joel G. Breman, MD, DTPH Fogarty International Center National Institutes of Health Improving Population Health Workshop Instituto Nacional de Salud Publica (INSP) Cuernavaca, Mexico 21 – 22 June 2003
Conquering Malaria • Burden • Ecology and manifestations • Successes • Control • Research and training
The Global Burden of Malaria • 1.5 – 2.7 million deaths annually • Over 1 billion clinical episodes • 300 – 500 million people infected • Every 10 - 30 seconds a child dies of malaria
Malaria Ecology EXTRINSIC Control and prevention measures Social, behavioral, economic and political factors Human Intrinsic and Extrinsic Factors INTRINSIC Parasite Mosquito Environmental conditions
Malaria’s Toll: Major Intrinsic Components Plasmodium falciparum Anopheles gambiae
Hypoglycemia Anemia Acute febrile illness Severe illness Death Respiratory distress Cerebral malaria Infected Mosquito Anemia Chronic effects Impaired growth and development Neurologic/ cognitive Malnutrition Infected Human Developmental Low birth weight Infantmortality Fetus Pregnancy Acute illness Maternal Impaired productivity Anemia Malaria Ecology and BurdenClinical Manifestations
Successes: Vector Control • 1899-1914, multiple demonstrations of control by reduction of Anopheline larvae and adults • 1899, Sierra Leone (antilarval); Cuba (large-scale); Malaysia (antilarval) • 1904-1914, Panama Canal Zone; control by larviciding, large-scale environmental modification • 1927, elimination of A. albimanus in Barbados (first area-wide success with invading species)
Successes: Vector Control (2) • 1935-1939, use of pyrethrum spraying in South Africa, Netherlands and India • 1939-1957 • 1939-1940, Elimination of A. gambiae from Brazil and upper Nile, Egypt, 1942-1945 • 1946-1957, Interruption of transmission by anti-mosquito measures in Cyprus, Sandinia, Guyana, Venezuela and Greece; indoor residual spraying with DDT, a new major strategy
Successes: Personal Protection (3) • 1987-2003 • Multiple projects and programs using insecticide-impregnated bed nets demonstrating overall mortality reduction and decrease in several malaria indices
Vector Control • Drainage and filling: urban* • Chemical and biological larvicides* • Indoor residual insecticide spraying* • Outdoor residual insecticide spraying *costly and effective
Personal protection (2) • Insecticide–impregnated materials: nets, curtains, clothing* • House screening • House location • Repellents • Fumigants * Cost-effective for low-income countries
Antiplasmodial (3) • Patient management: early diagnosis, treatment, referral, education • Chemoprophylaxis • Intermittent treatment (pregnancy)* • Radical therapy for relapses (P. vivax, P. ovale) * cost effective
Social Action (4) • Mobilization of individual, family, community • Health education Management Effectiveness • Health systems: access, use, quality • Leadership: policies, strategies, tactics • Surveillance of infection and disease • Monitoring and evaluation of programs
Research, Training, and Support Needs According to Understanding of Diseases andEfficacy of Control Methods High High Training Efficacy of Control Methods Research Needs Low Low Some Moderate High Research Support Needs
Research, Training, and Support Needs According to Understanding of Diseases andEfficacy of Control Methods High High Training Efficacy of Control Methods Malaria Dengue HIV/AIDSTuberculosisEbola/Marburg InfluenzaCancersAlzheimer’s SmallpoxGuinea wormPoliomyelitisH. influenzae type BMeaslesTetanus Research Needs Low Low Some Moderate High Research Support Needs
Research Agenda • Pathogenesis • Drug development • Immunology and vaccine development • Diagnostics • Entomology • Recent genetic breakthroughs
Conquering Malaria For More Information MIM http://mim.nih.gov RBM http://www.who.int DCPP http://www.fic.nih.gov/dcpp/ Joel Breman jbreman@nih.gov