Dr. Rebecca Duerst, Program Director for Health Care ELCA Synod Malaria Summit March 2014

 True or False on malaria biology, epidemiology, and public health  Scientific advances in malaria work  Time for Q&A

 Q: Malaria is caused by mosquitos  A: False  Explanation: Malaria is caused by parasites in the genus Plasmodium; it is transmitted by female Anopheles mosquitoes

 Q: There are 4 species of Plasmodia known to cause malaria in humans  A: False  The 4 main species causing human malaria are:  Plasmodium falciparum  Plasmodium ovale  Plasmodium vivax  Plasmodium malariae  A 5 th species, Plasmodium knowlesi (“nolls-eye”), is now recognized as an important cause of human disease in Southeast Asia; it is responsible for up to 75% of malaria infections in some areas

 Q: The life cycle of Plasmodium parasites is complex  A: True  a Female Anopheles mosquitoes require a blood meal for egg development. Infected females inject the sporozoite form into a human host. b Sporozoites are carried in the bloodstream to liver cells, where they proliferate asexually and release merozoites. c Merozoites invade red blood cells and reproduce asexually; disease clinically manifests as fever & chills. d Then male and female gametocytes are produced and transmitted back to a mosquito, where they fuse to form oocysts that divide into sporozoites. These migrate to the salivary glands.

 Q: Epidemiology is the branch of medicine dealing with physiology and pathology of the skin  A: False  Epidemiology is the study of distribution and determinants of health-related states / events (including disease), and the application of this study to control diseases and other health problems (WHO)

 Q: Africa carries the majority of the world’s burden of malaria  A: True

 Q: Malaria has no relationship to poverty, HIV&AIDS, climate change, etc.  A: False 

 Q: Despite much progress, malaria is still a major public health concern globally  A: True  2012 estimated malaria cases:  207 million  80% occur in sub-Saharan Africa  2012 estimated malaria deaths:  627,000  90% occur in sub-Saharan Africa, 77% in children under 5 years of age  An estimated 3.3 million deaths were averted between

 Q: Focusing efforts only on net distribution is the best strategy for malaria prevention  A: False  WHO promotes integrated approach (“integrated vector management”) including LLINs, IRS, & environmental management, along with education, prompt diagnosis and effective treatment, surveillance, etc.  03/ /why-ending-malaria-may- be-more-about-backhoes-than-bed-nets 03/ /why-ending-malaria-may- be-more-about-backhoes-than-bed-nets

 Q: Artemisinin (key ingredient in ACT) is still 100% effective throughout the world  A: False  Parasite resistance to artemisinins has been detected in 4 countries in Southeast Asia  Cambodia, Myanmar, Thailand and Viet Nam  In Cambodia, resistance has been found to both components of ACT  Special provisions have been made for DOT with a non-artemisinin-based combination

 Q: Because malaria is such a focus of global health efforts, extensive, accurate data is available  A: False  There is more uncertainty about malaria than any other disease  Malaria surveillance systems detect <10% of estimated cases - Richard Cibulskis, WHO Global Malaria Programme, 2011

New ideas & technological innovations

 Phone camera microscopes  “CellScope” (relatively expensive)  1mm glass ball, cardboard, tape  “Origami” microscope (6 March 2014) 

 “Matibabu” blood scanner (Swahili for “medical center”)  diagnoses-malaria-video.htm diagnoses-malaria-video.htm Brian Gitta, Makerere University, Uganda pitches his idea that uses cell phones and light – not needles and blood samples to test for malaria (USAID).

 PfSPZ (Sanaria) – August, 2013  6 volunteers received 5 IV doses each, over 20 weeks  100% protection, but impractical conditions  RTS,S (GSK) – October, 2013 (18 mo. follow-up)  Protection lasted over 18 months, though waned slightly  Reduced malaria cases in children by nearly half (46%)  Adding a booster dose at 18 months is now being studied  Policy recommendation from WHO is possible in 2015  st-malaria-vaccine-moves-a-step-closer-to-approval st-malaria-vaccine-moves-a-step-closer-to-approval

 AP2-G protein – February, 2014  Master switch that triggers activation of genes that initiate the development of gametocytes (only form infectious to mosquitos)  CAX protein – April, 2013  Transporter that controls calcium level inside cells (Artemisinin interferes with the other Ca +2 transporter)  Parasites die before developing inside mosquito when CAX does not function

 GM mosquitos (?)  Mosquito blood has proteins that punch holes through the parasite’s membrane  Engineer mosquitos that produce in higher amounts  Wolbachia-infected mosquitos  Bacteria naturally occuring in other species of mosquitos  Confers resistance to malaria (and dengue virus)