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Malaria Vector Control
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Ugandan Study Highlights Best Drug Combinations for Treating Malaria in Africa  - The Lancet
Results of a randomised trial from Uganda in this week’s issue of THE LANCET suggest that the drug combination of amodiaquine and sulfadoxine-pyrimethamine might offer the optimal treatment for malaria in terms of efficacy and cost-effectiveness in this region. The study also shows that the drug combination of chloroquine and sulfadoxine-pyrimethamine—the recommended first-line treatment in Uganda—is far less effective than other drug combinations.

Climate Change and Malaria  - Indur Goklany - with response from Sir David King
Indur Goklany offers some fascinating insights into climate change, malaria, poverty and development. Sir David King, the UK Government's chief scientific adviser gives a predicable response.

The Real Obstacles to Sound Treatment of AIDS in Poor Countries  - Roger Bate & Richard Tren
Writing for the American Enterprise Institute's Health Policy Outlook, Bate and Tren explore some of the reasons for low drug access in poor countries. Despite promises of cheap or free antiretroviral drugs, Bate and Tren argue that access to treatment in poor countries is abysmally low because of a lack of infrastructure, political indifference, excessive bureaucracy and taxes and tariffs.

South Africa's War Against Malaria - Lessons for the Developing World  - Richard Tren & Roger Bate
The Cato Institute published Richard Tren and Roger Bate's analysis of South Africa's recent history with malaria control. They argue that its policy on DDT use and Artemesinin based combination therapy provide excellent examples for other malarial countries.

SA's Leading Malaria Researchers Support DDT Use  -
South Africa’s leading malaria control experts, researchers and doctors support and endorse the use of the insecticide DDT to control malaria. Their statement is released in light of recent claims that DDT is harmful to human health and should be removed from South Africa’s malaria control programme.

South African Malaria Data  - SA Dept of Health
November 2003 - the malaria statistics show that malaria is still well under control in South Africa. A recent epidemic in the Limpopo Province was primarily caused by late spraying and poor case management.

South Africa Malaria Data  - SA Dept of Health
The latest data on malaria cases and deaths from South Africa show that the country's policy of indoor residual spraying with DDT (among other insecticides) and the use of artemesinin based combination therapy is working. KwaZulu Natal, traditionally the province with the worst malaria and the centre of the recent epidemic has only recorded 1 malaria death this year!

South Africa Malaria Statistics  - Dept of Health
The 11th Dept of Health Malaria Update shows the latest number of confirmed cases and deaths from malaria in the three malarial provinces of South Africa.

Saving Lives Today and Tomorrow  - Dr. Roger Bate
This paper analyses trends in drug development using data from the drug industry association, the Pharmaceutical Research and Manufacturers of America (PhRMA). Worryingly, the findings suggest that far fewer AIDS drugs are in development compared to several years ago, and at a time when drug development for other communicable diseases is increasing. There are several probable explanations for this phenomenon, but the least benign is the likelihood that continual pressure group and media attacks on the industry over pricing of drugs in Africa has reduced incentives for development of new AIDS medicines

South African Malaria Update  - SA Dept of Health
The latest malaria update from the Directorate of Communicable Diseases.

Efficacy of the RTS,S/AS02A vaccine against Plasmodium falciparum infection and disease in young African children: randomised controlled trial

Pedro L Alonso, Jahit Sacarlal, John J Aponte, Amanda Leach, Eusebio Macete, Jessica Milman, Inacio Mandomando, Bart Spiessens, Caterina Guinovart, Mateu Espasa, Quique Bassat, Pedro Aide, Opokua Ofori-Anyinam, Margarita M Navia, Sabine Corachan, Marc Ceuppens, Marie-Claude Dubois, Marie-Ange Demoitié, Filip Dubovsky, Clara Menéndez, Nadia Tornieporth, W Ripley Ballou, Ricardo Thompson, Joe Cohen


Lancet 2004; 364: 1411-20


See Comment


Centre de Salut Internacional, Hospital Clínic/IDIBAPS, Universitat de Barcelona, Barcelona, Spain (P L Alonso MD, J J Aponte MD, C Guinovart MD, M Espasa MD, Q Bassat MD, M M Navia PhD, C Menéndez MD); Centro de Investigação em Saúde da Manhiça, Ministerio de Saúde, CP 1929 Maputo, Mozambique (P L Alonso, J Sacarlal MD, J J Aponte, E Macete MD, I Mandomando VetMed, C Guinovart, M Espasa, Q Bassat, P Aide MD, M M Navia, C Menéndez, R Thompson PhD); Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique (J Sacarlal); Instituto Nacional de Saúde and Direcção Nacional de Saúde, Ministerio de Saúde, Maputo, Mozambique (E Macete, I Mandomando, P Aide, R Thompson); GlaxoSmithKline Biologicals, Rixensart, Belgium (A Leach MRCPCH, B Spiessens PhD, O Ofori-Anyinam PhD, S Corachan BSc, M Ceuppens MD, M-C Dubois MSc, M-A Demoitié MSc, N Tornieporth MD, W R Ballou MD, J Cohen PhD); and Malaria Vaccine Initiative, PATH, Rockville, MD, USA (J Milman MPH, F Dubovsky MD)


Correspondence to: Dr Pedro L Alonso, Centre de Salut Internacional, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain palonso@clinic.ub.es

Summary
Introduction
Participants and methods
Results
Discussion

Summary

Background Development of an effective malaria vaccine could greatly contribute to disease control. RTS,S/AS02A is a pre-erythrocytic vaccine candidate based on Plasmodium falciparum circumsporozoite surface antigen. We aimed to assess vaccine efficacy, immunogenicity, and safety in young African children.

Methods We did a double-blind, phase IIb, randomised controlled trial in Mozambique in 2022 children aged 1-4 years. The study included two cohorts of children living in two separate areas which underwent different follow-up schemes. Participants were randomly allocated three doses of either RTS,S/AS02A candidate malaria vaccine or control vaccines. The primary endpoint, determined in cohort 1 (n=1605), was time to first clinical episode of P falciparum malaria (axillary temperature ge37·5ºC and P falciparum asexual parasitaemia >2500 per µL) over a 6-month surveillance period. Efficacy for prevention of new infections was determined in cohort 2 (n=417). Analysis was per protocol.

Findings 115 children in cohort 1 and 50 in cohort 2 did not receive all three doses and were excluded from the per-protocol analysis. Vaccine efficacy for the first clinical episodes was 29·9% (95% CI 11·0-44·8; p=0·004). At the end of the 6-month observation period, prevalence of P falciparum infection was 37% lower in the RTS,S/AS02A group compared with the control group (11·9% vs 18·9%; p=0·0003). Vaccine efficacy for severe malaria was 57·7% (95% CI 16·2-80·6; p=0·019). In cohort 2, vaccine efficacy for extending time to first infection was 45·0% (31·4-55·9; p<0·0001).

Interpretation The RTS,S/AS02A vaccine was safe, well tolerated, and immunogenic. Our results show development of an effective vaccine against malaria is feasible.

Read the paper at: The Lancet (registration necessary, but relatively painless)