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A Surveillance Infrastructure for Malaria Analytics: Provisioning Data Access and Preservation of Interoperability

CiteULike malaria tags - 16 June 2018 - 8:18am
JMIR Public Health Surveill, Vol. 4, No. 2. (15 Jun 2018), doi:10.2196/10218

Background: According to the World Health Organization, malaria surveillance is weakest in countries and regions with the highest malaria burden. A core obstacle is that the data required to perform malaria surveillance are fragmented in multiple data silos distributed across geographic regions. Furthermore, consistent integrated malaria data sources are few, and a low degree of interoperability exists between them. As a result, it is difficult to identify disease trends and to plan for effective interventions. Objective: We propose the Semantics, Interoperability, and Evolution for Malaria Analytics (SIEMA) platform for use in malaria surveillance based on semantic data federation. Using this approach, it is possible to access distributed data, extend and preserve interoperability between multiple dynamic distributed malaria sources, and facilitate detection of system changes that can interrupt mission-critical global surveillance activities. Methods: We used Semantic Automated Discovery and Integration (SADI) Semantic Web Services to enable data access and improve interoperability, and the graphical user interface-enabled semantic query engine HYDRA to implement the target queries typical of malaria programs. We implemented a custom algorithm to detect changes to community-developed terminologies, data sources, and services that are core to SIEMA. This algorithm reports to a dashboard. Valet SADI is used to mitigate the impact of changes by rebuilding affected services. Results: We developed a prototype surveillance and change management platform from a combination of third-party tools, community-developed terminologies, and custom algorithms. We illustrated a methodology and core infrastructure to facilitate interoperable access to distributed data sources using SADI Semantic Web services. This degree of access makes it possible to implement complex queries needed by our user community with minimal technical skill. We implemented a dashboard that reports on terminology changes that can render the services inactive, jeopardizing system interoperability. Using this information, end users can control and reactively rebuild services to preserve interoperability and minimize service downtime. Conclusions: We introduce a framework suitable for use in malaria surveillance that supports the creation of flexible surveillance queries across distributed data resources. The platform provides interoperable access to target data sources, is domain agnostic, and with updates to core terminological resources is readily transferable to other surveillance activities. A dashboard enables users to review changes to the infrastructure and invoke system updates. The platform significantly extends the range of functionalities offered by malaria information systems, beyond the state-of-the-art.
Sadnan Al Manir, Haël Brenas, Jo Baker, Arash Shaban-Nejad
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The genomics of insecticide resistance: insights from recent studies in African malaria vectors

CiteULike malaria tags - 14 June 2018 - 9:45am
Current Opinion in Insect Science (June 2018), doi:10.1016/j.cois.2018.05.017
Chris Clarkson, Helen Temple, Alistair Miles
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Kinetics of antibody responses to PfRH5-complex antigens in Ghanaian children with Plasmodium falciparum malaria

CiteULike malaria tags - 14 June 2018 - 9:19am
PLOS ONE, Vol. 13, No. 6. (8 June 2018), e0198371, doi:10.1371/journal.pone.0198371

Plasmodium falciparum PfRH5 protein binds Ripr, CyRPA and Pf113 to form a complex that is essential for merozoite invasion of erythrocytes. The inter-genomic conservation of the PfRH5 complex proteins makes them attractive blood stage vaccine candidates. However, little is known about how antibodies to PfRH5, CyRPA and Pf113 are acquired and maintained in naturally exposed populations, and the role of PfRH5 complex proteins in naturally acquired immunity. To provide such data, we studied 206 Ghanaian children between the ages of 1–12 years, who were symptomatic, asymptomatic or aparasitemic and healthy. Plasma levels of antigen-specific IgG and IgG subclasses were measured by ELISA at several time points during acute disease and convalescence. On the day of admission with acute P. falciparum malaria, the prevalence of antibodies to PfRH5-complex proteins was low compared to other merozoite antigens (EBA175, GLURP-R0 and GLURP-R2). At convalescence, the levels of RH5-complex-specific IgG were reduced, with the decay of PfRH5-specific IgG being slower than the decay of IgG specific for CyRPA and Pf113. No correlation between IgG levels and protection against P. falciparum malaria was observed for any of the PfRH5 complex proteins. From this we conclude that specific IgG was induced against proteins from the PfRH5-complex during acute P. falciparum malaria, but the prevalence was low and the IgG levels decayed rapidly after treatment. These data indicate that the levels of IgG specific for PfRH5-complex proteins in natural infections in Ghanaian children were markers of recent exposure only.
Frederica Partey, Filip Castberg, Edem Sarbah, Sarah Silk, Gordon Awandare, Simon Draper, Nicholas Opoku, Margaret Kweku, Michael Ofori, Lars Hviid, Lea Barfod
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An in vitro erythrocyte preference assay reveals that Plasmodium falciparum parasites prefer Type O over Type A erythrocytes

CiteULike malaria tags - 1 June 2018 - 8:23am
Scientific Reports, Vol. 8, No. 1. (25 May 2018), doi:10.1038/s41598-018-26559-2
Michel Theron, Nadia Cross, Paula Cawkill, Leyla Bustamante, Julian Rayner
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Antibodies to ICAM1-binding PfEMP1-DBLβ are biomarkers of protective immunity to malaria in a cohort of young children from Papua New Guinea

CiteULike malaria tags - 24 May 2018 - 12:16pm
Infection and Immunity (21 May 2018), IAI.00485-17, doi:10.1128/iai.00485-17

Plasmodium falciparum Erythrocyte Membrane Protein 1 (PfEMP1) mediates parasite sequestration to the cerebral microvasculature via binding of DBLβ domains to Intercellular Adhesion Molecule 1 (ICAM1) and is associated with severe cerebral malaria. In a cohort of 187 young children from Papua New Guinea (PNG), we examined baseline antibody levels to the ICAM1-binding PfEMP1 domain, DBLβ3PF11_0521, in comparison to four control antigens including NTS-DBLα and CIDR1 domains from another group A variant and a group B/C variant. Antibody levels for the group A antigens were strongly associated with age and exposure. Antibody responses to DBLβ3PF11_0521 were associated with a 37% reduced risk of high-density clinical malaria in the follow up period (adjusted incidence risk ratio, aIRR = 0.63 [95% CI: 0.45-0.88; p = 0.007]) and a 25% reduction in risk of low-density clinical malaria (aIRR = 0.75 [95% CI: 0.55-1.01; p = 0.06]), whilst there was no such association for other variants. Children who experienced severe malaria also had significantly lower antibody levels to DBLβ3PF11_0521 and the other group A domains than other children. Furthermore, a subset of PNG DBLβ sequences had ICAM1-binding motifs, formed a distinct phylogenetic cluster and were similar to sequences from other endemic areas. PfEMP1 variants associated with these DBLβ were enriched for DC4 and DC13 head-structures implicated in EPCR-binding and severe malaria, suggesting conservation of dual binding specificity. These results provide further support for the development of specific classes of PfEMP1 as vaccine candidates, and as biomarkers for protective immunity against clinical P. falciparum malaria.
Sofonias Tessema, Digjaya Utama, Olga Chesnokov, Anthony Hodder, Clara Lin, Abby Harrison, Jakob Jespersen, Bent Petersen, Livingstone Tavul, Peter Siba, Dominic Kwiatkowski, Thomas Lavstsen, Diana Hansen, Andrew Oleinikov, Ivo Mueller, Alyssa Barry
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Genomes of all known members of a Plasmodium subgenus reveal paths to virulent human malaria

CiteULike malaria tags - 24 May 2018 - 10:48am
Nature Microbiology, Vol. 3, No. 6. (21 May 2018), pp. 687-697, doi:10.1038/s41564-018-0162-2
Thomas Otto, Aude Gilabert, Thomas Crellen, Ulrike Böhme, Céline Arnathau, Mandy Sanders, Samuel Oyola, Alain Okouga, Larson Boundenga, Eric Willaume, Barthélémy Ngoubangoye, Nancy Moukodoum, Christophe Paupy, Patrick Durand, Virginie Rougeron, Benjamin Ollomo, François Renaud, Chris Newbold, Matthew Berriman, Franck Prugnolle
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Comparative study of artemether and quinine in severe Plasmodium falciparum malaria in adults and older children in Cameroon

CiteULike malaria tags - 21 May 2018 - 11:14am
Vol. 59, No. 2. (1999), 151‐156

From June 1993 to June 1994, a study was carried out to compare artemether and quinine for management of severe falciparum malaria in adults and adolescents in Cameroon. Artemether was administered intramuscularly at a dose of 3.6 mg/kg on the first day and 1.6 mg/kg for the following 4 days. Quinine was administered intravenously at a dose of 1.6 mg/kg for the first 4 hours and 8 mg every 8 hours for the next 3 days. The files of 84 of the 95 patients recruited were validated for inclusion in the final study. There were 40 patients in the artemether group and 44 in the quinine group. The two groups were comparable with regard to all factors at the time of inclusion. Findings showed that artemether was more effective than quinine with regard to total clearance of parasitemia, 90 p. 100 clearance, and fever control and that it was as effective with regard to 50 p. 100 clearance and recovery of consciousness. In view of its good performance and of the simplicity of its administration by intramuscular injection, artemether would appear to be an excellent alternative for treatment of severe malaria and cerebral malaria in areas with poor medical facilities.
JJ Fargier, FJ Louis, S Duparc, C Hounsinou, P Ringwald, M Danis
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Comparative clinical trial of four regimens of dihydroartemisinin-mefloquine in multidrug-resistant falciparum malaria

CiteULike malaria tags - 21 May 2018 - 11:13am
Vol. 4, No. 9. (1999), 602‐610

We conducted a randomized, comparative trial at the Bangkok Hospital for Tropical Diseases during 1996‐98 to evaluate the clinical efficacy and tolerability of four combination regimens of dihydroartemisinin‐mefloquine. 207 male patients aged 18‐25 years, weighing 49.3‐55.1 kg were randomized to receive a single oral dose of 300 mg dihydroartemisinin plus one or two doses of mefloquine as follows: regimen I (n = 26): 750 mg mefloquine concurrently, or regimen II (n = 22): 750 mg mefloquine 24 h later, or regimen III (n = 78): 750 and 500 mg mefloquine at 24 and 30 h, or regimen IV (n = 81): 750 and 500 mg mefloquine (at 0 and 24 h). All patients improved clinically within 24 h of initiation of treatment. The initial therapeutic response was rapid and identical in all treatment groups (median PCT vs. FCT: 36 vs. 24, 36 vs. 28, 36 vs. 26, and 34 vs. 26 h, for regimen I, II, III and IV, respectively). All combination regimens generally showed acceptable tolerability profiles. Compliance with follow‐up (42 days) was achieved by 86.5% (179 cases). Recrudescent parasitaemia was significantly higher in patients treated with low‐dose mefloquine combinations (regimens I, II:8/23, 9/16) than in those who received high‐dose mefloquine (regimens III, IV: 2/70, 3/70). No RII or RIII type of response was observed. There were no significant differences in susceptibility to mefloquine between primary and recrudescent isolates. Dose‐adjusted whole blood mefloquine concentrations were significantly higher in high‐dose mefloquine regimens (III and IV). Patients who vomited within the first hour of mefloquine administration had markedly lower whole blood mefloquine concentrations than those who did not vomit.
K Na-Bangchang, P Tippanangkosol, R Ubalee, S Chaovanakawee, S Saenglertsilapachai, J Karbwang
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Artemisinin derivatives for treating uncomplicated malaria

CiteULike malaria tags - 21 May 2018 - 10:51am
Cochrane Database of Systematic Reviews, No. 2. (1999), doi:10.1002/14651858.CD000256

Abstract - Background Artemisinin derivatives are a relatively new group of drugs with antimalarial properties. As resistance to other antimalarial drugs continues to increase, artemisinin drugs may be useful alternatives. Objectives The objective of this review was to assess the effects of artemisinin drugs for treating uncomplicated falciparum malaria. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register, the Cochrane Controlled Trials Register, MEDLINE, EMBASE, Science Citation Index, LILACS, African Index Medicus, conference abstracts, and reference lists of relevant articles. We contacted organisations, researchers in the field, and drug companies. Selection criteria Randomised and quasi‐randomised trials of artemisinin derivatives, alone or in combination with other antimalarials, compared with standard antimalarial treatments, in adults or children with uncomplicated falciparum malaria. Only trials where treatment was given by mouth or suppository were included. Comparisons between different artemisinin derivatives and treatment regimens were also included. Data collection and analysis Eligibility and trial quality were assessed and data were extracted independently by the two reviewers. Main results Forty‐one trials involving over 5000 patients were included. Variation in study design and quality made synthesis of the data problematic. Allocation concealment was adequate in only two trials. Most data were from areas of multidrug resistant falciparum malaria in South‐East Asia. Compared with standard antimalarial treatments, artemisinin drugs showed fast parasite clearance and high cure rates at follow‐up, provided the duration of treatment with artemisinin drugs was adequate. Combination with mefloquine improved sustained parasite clearance and was effective in multidrug resistant areas. When doses were adequate, the combination shortened the duration of treatment. We found no evidence that artemisinin drugs are more harmful than standard treatment drugs over a typical trial period of 28 days. Authors' conclusions The evidence suggests that artemisinin drugs are effective and safe for treating uncomplicated malaria. There is no evidence from randomised trials that one artemisinin derivative is better than the others. In areas where there is mefloquine resistance, combination therapy with an artemisinin derivative appears to improve sustained parasite clearance compared with either drug alone. This review summarizes trials up to 1999. For the reasons in the 'What's new' section, this review will no longer be updated. Plain language summary Artemisinin drugs for treating uncomplicated malaria are better used in combination therapy Artemisinin drugs come originally from a plant that has been used since ancient times in China as a traditional medicine for fever and malaria. These drugs act quickly and few side effects have been reported. Malaria parasites have so far not developed resistance to artemisinin drugs. The review shows that artemisinin drugs clear malaria parasites from the blood more effectively than standard treatment drugs. In areas where malaria parasites are more resistant to existing drugs, such as South‐East Asia, artemisinin drugs are not better at sustained parasite clearance than standard treatment with quinine or mefloquine. Combination treatment using an artemisinin drug together with the longer‐acting antimalarial drug mefloquine improves sustained clearance of parasites, but mefloquine is associated with adverse effects. There are few studies on combination treatment with longer‐acting antimalarial drugs that are safer than mefloquine. There is no evidence from trials that any of the several artemisinin derivatives is better than the others.
H McIntosh, P Olliaro
Categories: malaria news feeds

Amodiaquine for treating malaria

CiteULike malaria tags - 21 May 2018 - 10:51am
Cochrane Database of Systematic Reviews, No. 2. (2003), doi:10.1002/14651858.CD000016

Abstract - Background Using a pilot system we have categorised this review as: Historical question ‐ no update intended. Please see "Published notes" section of the review for more details. Since 2001, the World Health Organization has recommended that antimalarial drug combinations be used for uncomplicated falciparum malaria and that monotherapy should no longer be used. For the most up‐to‐date information on malaria combination treatment, please refer to Sinclair D, Zani B, Donegan S, Olliaro P, Garner P. Artemisinin‐based combination therapy for treating uncomplicated malaria. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD007483. DOI: 10.1002/14651858.CD007483.pub2. Amodiaquine has been widely used to treat malaria. Fatal adverse reactions have been reported in adults taking it for prophylaxis. This has led some authorities to suggest it is withdrawn as a first line treatment for malaria. Objectives To compare amodiaquine with chloroquine or sulfadoxine‐pyrimethamine for treating uncomplicated Plasmodium falciparum malaria. Search methods We searched the Cochrane Infectious Diseases Group specialized trials register (February 2003), The Cochrane Central Register of Controlled Trials ( The Cochrane Library Issue 1, 2003), MEDLINE (1966 to February 2003), EMBASE (1980 to December 2002), LILACS (February 2003). We contacted researchers in the field and pharmaceutical companies. Selection criteria Randomised and quasi‐randomised trials. Data collection and analysis Two reviewers independently extracted data and assessed trial quality. Main results 56 studies included, mostly from Africa. Treatment allocation was adequately concealed in three trials, and unclear or inadequate in the remainder. Amodiaquine was more effective than chloroquine for parasite clearance (day 7, Peto odds ratio 4.42 (95% confidence interval 3.65 to 5.35); day 14, Peto odds ratio 6.44 (95% confidence interval (CI) 5.09 to 8.15). Comparisons with sulfadoxine/pyrimethamine were more mixed, with sulfadoxine/pyrimethamine more effective on day 28 (Peto odds ratio 0.41; 95% CI 0.28 to 0.61). No significant difference for adverse events was observed between amodiaquine and chloroquine and sulfadoxine/pyrimethamine. Reported adverse effects were minor or moderate. No life threatening events were detected. Authors' conclusions There is evidence to support the continued use of amodiaquine to treat uncomplicated malaria, although local drug resistance patterns need to be considered. Monitoring for adverse events should continue. This review summarizes trials up to 2003. For the reasons in the 'What's new' section, this review will no longer be updated. Plain language summary Amodiaquine for treating malaria Using a pilot system we have categorised this review as: Historical question ‐ no update intended. Please see "Published notes" section of the review for more details. Since 2001, the World Health Organization has recommended that antimalarial drug combinations be used for uncomplicated falciparum malaria and that monotherapy should no longer be used.
PL Olliaro, P Mussano
Categories: malaria news feeds

Artemisinin derivatives for treating severe malaria

CiteULike malaria tags - 21 May 2018 - 10:51am
Cochrane Database of Systematic Reviews, No. 2. (2000), doi:10.1002/14651858.CD000527

Abstract - Background Artemisinin derivatives may have advantages over quinoline drugs for treating severe malaria since they are fast acting and effective against quinine resistant malaria parasites. Objectives The objective of this review was to assess the effects of artemisinin drugs for severe and complicated falciparum malaria in adults and children. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register, Cochrane Controlled Trials Register, MEDLINE, EMBASE, Science Citation Index, LILACS, African Index Medicus, conference abstracts, and reference lists of articles. We contacted organisations, researchers in the field and drug companies. Selection criteria Randomised and pseudo‐randomised trials comparing artemisinin drugs (rectal, intramuscular or intravenous) with standard treatment, or comparisons between artemisinin derivatives in adults or children with severe or complicated falciparum malaria. Data collection and analysis Eligibility, trial quality assessment and data extraction were done independently by two reviewers. Study authors were contacted for additional information. Main results Twenty three trials are included, allocation concealment was adequate in nine. Sixteen trials compared artemisinin drugs with quinine in 2653 patients. Artemisinin drugs were associated with better survival (mortality odds ratio 0.61, 95% confidence interval 0.46 to 0.82, random effects model). In trials where concealment of allocation was adequate (2261 patients), this was barely statistically significant (odds ratio 0.72, 95% CI 0.54 to 0.96, random effects model). In 1939 patients with cerebral malaria, mortality was also lower with artemisinin drugs overall (odds ratio 0.63, 95% CI 0.44 to 0.88, random effects model). The difference was not significant however when only trials reporting adequate concealment of allocation were analysed (odds ratio 0.78, 95% CI 0.55 to 1.10, random effects model) based on 1607 patients. No difference in neurological sequelae was shown. Compared with quinine, artemisinin drugs showed faster parasite clearance from the blood and similar adverse effects. Authors' conclusions The evidence suggests that artemisinin drugs are no worse than quinine in preventing death in severe or complicated malaria. No artemisinin derivative appears to be better than the others. This review summarizes trials up to 1999. For the reasons in the 'What's new' section, this review will no longer be updated. Plain language summary Artemisinin derivatives for treating severe malaria Artemisinin drugs improve survival in severe malaria. Artemisinin drugs come originally from a plant that has been used since ancient times in China as a traditional medicine for fever and malaria. They are fast acting and effective against malaria parasites that have developed resistance to quinine. The review shows that treatment with artemisinin drugs may be better than quinine at preventing death in adults and children with severe and complicated malaria. There is no evidence so far against early treatment with suppositories in rural areas whilst patients are transferred to hospital. Few side effects have been reported with these drugs.
H McIntosh, P Olliaro
Categories: malaria news feeds

Steroids for treating cerebral malaria

CiteULike malaria tags - 21 May 2018 - 10:51am
Cochrane Database of Systematic Reviews, No. 3. (1999), doi:10.1002/14651858.CD000972

Abstract - Background Cerebral malaria is associated with swelling of the brain. Corticosteroid drugs could reduce the harmful effects of this swelling, but they could also suppress host immunity to infection. Objectives To assess the effects of corticosteroid drugs in patients with cerebral malaria on death, life‐threatening complications, and residual disability in survivors. Search methods In March 2008, we searched the Cochrane Infectious Disease Group Specialized Register, CENTRAL ( The Cochrane Library 2008, Issue 1), MEDLINE, EMBASE, LILACS, and m RCT. We also checked reference lists. Selection criteria Randomized controlled trials comparing corticosteroids with no corticosteroids in addition to otherwise identical treatments for patients with cerebral malaria. Data collection and analysis Both authors independently assessed trial eligibility and risk of bias (methodological quality), and extracted data. Outcomes sought included death, death with life‐threatening complications, other complications, and disability. Main results Two trials with 143 participants met the inclusion criteria. There were 30 deaths in the two trials, distributed evenly between the corticosteroid and control groups (risk ratio 0.89; 95% confidence interval 0.48 to 1.68; 143 participants). Clinical complications were reported as the number of events in each trial arm and did not exclude complications occurring in fatalities. This made it difficult to interpret the reports of significantly more episodes of gastrointestinal bleeding and seizures in the corticosteroid group. Neither trial examined disability. Authors' conclusions There is currently no evidence of benefit from corticosteroids, but the small number of participants means it is difficult to exclude an effect on death in either direction. Data on clinical complications are difficult to assess. Plain language summary Corticosteroids for treating cerebral malaria Cerebral malaria is a severe form of the disease that can induce convulsions and coma; about 15% to 50% of patients with cerebral malaria will die, and 5% to 10% of survivors are left disabled as a result of brain damage. In the past decades, health professionals often gave corticosteroids such as dexamethasone and hydrocortisone, as well as antimalarial drugs, to patients with cerebral malaria, with the aim of reducing the effects of swelling and inflammation in the brain. This review assesses the effects of corticosteroid drugs given for cerebral malaria, on death, life‐threatening complications, and residual disability in survivors. The authors included two trials with a total of 143 patients (both adults and children). There were no significant differences in the number of deaths between the corticosteroid and control groups, and data on clinical complications were difficult to assess. Neither trial examined disability.
K Prasad, P Garner
Categories: malaria news feeds

Chloroquine or amodiaquine combined with sulfadoxine‐pyrimethamine for treating uncomplicated malaria

CiteULike malaria tags - 21 May 2018 - 10:51am
Cochrane Database of Systematic Reviews, No. 4. (2005), doi:10.1002/14651858.CD000386.pub2

Abstract - Background Chloroquine (CQ), amodiaquine (AQ), and sulfadoxine‐pyrimethamine (SP) are inexpensive drugs, but treatment failure is a problem. Combination therapy may reduce treatment failure. CQ or AQ plus SP are affordable options of combination treatment, but there is debate about their effectiveness. Objectives To assess the combination of CQ or AQ plus SP compared with SP alone for first‐line treatment of uncomplicated falciparum malaria. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register (April 2005), CENTRAL ( The Cochrane Library Issue 2, 2005), MEDLINE (1966 to April 2005), EMBASE (1974 to April 2005), LILACS (1982 to April 2005), Science Citation Index (1981 to April 2005), African Index Medicus (1993 to 1998), and reference lists. We also contacted researchers at relevant organizations and a pharmaceutical company. Selection criteria Randomized controlled trials in adults or children with uncomplicated Plasmodium falciparum malaria were eligible for inclusion. The main outcomes of interest were total and clinical failure at day 28 follow up and serious adverse events. Data collection and analysis Two people independently applied the inclusion criteria. One author extracted data and another checked them independently. We used risk ratio (RR) and 95% confidence intervals (CI). Main results Twelve trials (2107 participants) met the inclusion criteria. A meta‐analysis of five AQ trials (461 participants) showed a statistically significant reduction in total failure at day 28 with the combination therapy (RR 0.64, 95% CI 0.46 to 0.91), and meta‐analysis of three trials (384 participants) showed a significant reduction in clinical failure at day 28 (RR 0.23, 95% CI 0.11 to 0.49). The statistical significance in the total failure analysis was sensitive to losses to follow up. Data from two CQ trials showed no advantage for total failure with combination therapy at day 28. There was no evidence from the included trials of serious adverse events. Authors' conclusions The evidence base is not strong enough to support firm conclusions. The available evidence suggests that AQ plus SP can achieve less treatment failure than SP, but this might depend on existing levels of parasite resistance to the individual drugs. Addendum, 2008: The World Health Organization (in 2006) recommended that monotherapy should not be used for treating malaria. Therefore the authors do not intend to update this review. Plain language summary Chloroquine or amodiaquine combined with sulfadoxine‐pyrimethamine for treating uncomplicated malaria Using amodiaquine and sulfadoxine‐pyrimethamine together to treat uncomplicated malaria instead of sulfadoxine‐pyrimethamine alone may reduce treatment failure; adding chloroquine to sulfadoxine‐pyrimethamine may not be beneficial Chloroquine, amodiaquine, and sulfadoxine‐pyrimethamine are relatively inexpensive drugs to treat malaria. Treatment failure is a problem when these drugs are used alone because malaria parasites have become resistant to them. Based on evidence from randomized controlled trials, a combination of amodiaquine plus sulfadoxine‐pyrimethamine may reduce treatment failure in some locations. It appears less likely that chloroquine plus sulfadoxine‐pyrimethamine will have a treatment benefit over sulfadoxine‐pyrimethamine alone.
H McIntosh, KL Jones
Categories: malaria news feeds

Drugs for preventing malaria in pregnant women in endemic areas: any drug regimen versus placebo or no treatment

CiteULike malaria tags - 21 May 2018 - 10:51am
Cochrane Database of Systematic Reviews, No. 10. (2014), doi:10.1002/14651858.CD000169.pub3

Abstract - Background Pregnancy increases the risk of malaria and this is associated with poor health outcomes for both the mother and the infant, especially during the first or second pregnancy. To reduce these effects, the World Health Organization recommends that pregnant women living in malaria endemic areas sleep under insecticide‐treated bednets, are treated for malaria illness and anaemia, and receive chemoprevention with an effective antimalarial drug during the second and third trimesters. Objectives To assess the effects of malaria chemoprevention given to pregnant women living in malaria endemic areas on substantive maternal and infant health outcomes. We also summarised the effects of intermittent preventive treatment with sulfadoxine‐pyrimethamine (SP) alone, and preventive regimens for Plasmodium vivax. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, and reference lists up to 1 June 2014. Selection criteria Randomized controlled trials (RCTs) and quasi‐RCTs of any antimalarial drug regimen for preventing malaria in pregnant women living in malaria‐endemic areas compared to placebo or no intervention. In the mother, we sought outcomes that included mortality, severe anaemia, and severe malaria; anaemia, haemoglobin values, and malaria episodes; indicators of malaria infection, and adverse events. In the baby, we sought foetal loss, perinatal, neonatal and infant mortality; preterm birth and birthweight measures; and indicators of malaria infection. We included regimens that were known to be effective against the malaria parasite at the time but may no longer be used because of parasite drug resistance. Data collection and analysis Two review authors applied inclusion criteria, assessed risk of bias and extracted data. Dichotomous outcomes were compared using risk ratios (RR), and continuous outcomes using mean differences (MD); both are presented with 95% confidence intervals (CI). We assessed the quality of evidence using the GRADE approach. Main results Seventeen trials enrolling 14,481 pregnant women met our inclusion criteria. These trials were conducted between 1957 and 2008, in Nigeria (three trials), The Gambia (three trials), Kenya (three trials), Mozambique (two trials), Uganda (two trials), Cameroon (one trial), Burkina Faso (one trial), and Thailand (two trials). Six different antimalarials were evaluated against placebo or no intervention; chloroquine (given weekly), pyrimethamine (weekly or monthly), proguanil (daily), pyrimethamine‐dapsone (weekly or fortnightly), and mefloquine (weekly), or intermittent preventive therapy with SP (given twice, three times or monthly). Trials recruited women in their first or second pregnancy (eight trials); only multigravid women (one trial); or all women (eight trials). Only six trials had adequate allocation concealment. For women in their first or second pregnancy, malaria chemoprevention reduces the risk of moderate to severe anaemia by around 40% (RR 0.60, 95% CI 0.47 to 0.75; three trials, 2503 participants, high quality evidence ), and the risk of any anaemia by around 17% (RR 0.83, 95% CI 0.74 to 0.93; five trials,, 3662 participants, high quality evidence ). Malaria chemoprevention reduces the risk of antenatal parasitaemia by around 61% (RR 0.39, 95% CI 0.26 to 0.58; seven trials, 3663 participants, high quality evidence ), and two trials reported a reduction in febrile illness ( low quality evidence ). There were only 16 maternal deaths and these trials were underpowered to detect an effect on maternal mortality ( very low quality evidence ). For infants of women in their first and second pregnancies, malaria chemoprevention probably increases mean birthweight by around 93 g (MD 92.72 g, 95% CI 62.05 to 123.39; nine trials, 3936 participants, moderate quality evidence ), reduces low birthweight by around 27% (RR 0.73, 95% CI 0.61 to 0.87; eight trials, 3619 participants, moderate quality evidence ), and reduces placental parasitaemia by around 46% (RR 0.54, 95% CI 0.43 to 0.69; seven trials, 2830 participants, high quality evidence ). Fewer trials evaluated spontaneous abortions, still births, perinatal deaths, or neonatal deaths, and these analyses were underpowered to detect clinically important differences. In multigravid women, chemoprevention has similar effects on antenatal parasitaemia (RR 0.38, 95% CI 0.28 to 0.50; three trials, 977 participants, high quality evidence )but there are too few trials to evaluate effects on other outcomes. In trials giving chemoprevention to all pregnant women irrespective of parity, the average effects of chemoprevention measured in all women indicated it may prevent severe anaemia (defined by authors, but at least < 8 g/L: RR 0.19, 95% CI 0.05 to 0.75; two trials, 1327 participants, low quality evidence), but consistent benefits have not been shown for other outcomes. In an analysis confined only to intermittent preventive therapy with SP, the estimates of effect and the quality of the evidence were similar. A summary of a single trial in Thailand of prophylaxis against P. vivax showed chloroquine prevented vivax infection (RR 0.01, 95% CI 0.00 to 0.20; one trial, 942 participants). Authors' conclusions Routine chemoprevention to prevent malaria and its consequences has been extensively tested in RCTs, with clinically important benefits on anaemia and parasitaemia in the mother, and on birthweight in infants. Plain language summary The effect of taking antimalarial drugs routinely to prevent malaria in pregnancy Pregnancy increases the risk of malaria and this is associated with poor health outcomes for both the mother and the infant, especially during the first or second pregnancy. For this reason, women are encouraged to try and prevent malaria infection during pregnancy by sleeping under mosquito bed‐nets, and by taking drugs effective against malaria throughout pregnancy as chemoprevention. This Cochrane Review looked at all drug regimens compared to placebo. The review authors sought to summarise and quantify the overall effects of chemoprevention. Seventeen trials were included, all conducted between 1957 and 2008, and all but two in countries of Africa. For women in their first or second pregnancy, malaria chemoprevention prevents moderate to severe anaemia ( high quality evidence ); and prevents malaria parasites being detected in the blood ( high quality evidence ). It may also prevent malaria illness. We don't know if it prevents maternal deaths, as this would require very large studies to detect an effect. In their infants, malaria chemoprevention improves the average birthweight ( moderate quality evidence ), and reduces the number of low birthweight infants ( moderate quality evidence ). We are not sure if chemoprevention reduces mortality of babies in the first week, month and year, as again studies would need to be very large to show these effects.
D Radeva‐Petrova, K Kayentao, FO ter Kuile, D Sinclair, P Garner
Categories: malaria news feeds

Mefloquine for preventing malaria in non‐immune adult travellers

CiteULike malaria tags - 21 May 2018 - 10:51am
Cochrane Database of Systematic Reviews, No. 1. (2008), doi:10.1002/14651858.CD000138.pub2

Reason for withdrawal from publication The Editor withdrew this review as of Issue 1, 2008. This review has been updated and replaced following the publication of a new review: Jacquerioz FA, Croft AM Jacquerioz FA, Croft AM. Drugs for preventing malaria in travellers. Cochrane Database of Systematic Reviews 2009 , Issue 4 . Art. No.: CD006491. DOI: 10.1002/14651858.CD006491.pub2 .
AM Croft, P Garner
Categories: malaria news feeds

Vaccines for preventing malaria

CiteULike malaria tags - 21 May 2018 - 10:51am
Cochrane Database of Systematic Reviews, No. 4. (2006), doi:10.1002/14651858.CD000129.pub2

Reason for withdrawal from publication This review has been superseded by three reviews that have been published as: 
 Graves P, Gelband H. Vaccines for preventing malaria (SPf66). Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD005966. DOI: 10.1002/14651858.CD005966. Graves P, Gelband H. Vaccines for preventing malaria (blood‐stage). Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD006199. DOI: 10.1002/14651858.CD006199. Graves P, Gelband H. Vaccines for preventing malaria (pre‐erythrocytic). Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD006198. DOI: 10.1002/14651858.CD006198. Vaccines for preventing malaria (SPf66) published in Issue 2, 2006; Vaccines for preventing malaria (blood‐stage); and Vaccines for preventing malaria (pre‐erythrocytic) published in Issue 4, 2006.
PM Graves, H Gelband
Categories: malaria news feeds

Amodiaquine for treating malaria

CiteULike malaria tags - 21 May 2018 - 9:33am
Cochrane Database of Systematic Reviews, No. 2. (2003), doi:10.1002/14651858.CD000016
PL Olliaro, P Mussano
Categories: malaria news feeds

Artemisinin derivatives for treating severe malaria

CiteULike malaria tags - 21 May 2018 - 9:33am
Cochrane Database of Systematic Reviews, No. 2. (2000), doi:10.1002/14651858.CD000527
H McIntosh, P Olliaro
Categories: malaria news feeds

RTS,S/AS01 malaria vaccine mismatch observed among Plasmodium falciparum isolates from southern and central Africa and globally

CiteULike malaria tags - 10 May 2018 - 12:44pm
Scientific Reports, Vol. 8, No. 1. (26 April 2018), doi:10.1038/s41598-018-24585-8
Julia Pringle, Giovanna Carpi, Jacob Almagro-Garcia, Sha Zhu, Tamaki Kobayashi, Modest Mulenga, Thierry Bobanga, Mike Chaponda, William Moss, Douglas Norris
Categories: malaria news feeds

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