Big Bad Malaria

Malaria is merely a passing blip on the radar screen of most of us in the United States, but worldwide, the disease remains a killer.  Distressingly, many of its victims are children.  The World Health Organizations's  '2010 World Malaria Report' states that malaria causes 2.23% of deaths worldwide, the majority among children in sub-Saharan Africa.  In this week's podcast, Rick and I discuss a potentially serious emergence of resistance to two major strategies currently employed to control the disease as reported in the Lancet: insecticide treated bed netting and combination drug therapy.

Bed netting treated with an insecticide has proven to be one largely effective means to interrupt the cycle of transmission and infection relative to malaria.  The malaria parasite itself, most often Plasmodium falciparum, must hitch a ride inside the salivary glands of a mosquito.  When the mosquito bites someone, the parasite is injected along with the bug's saliva.  Thus merely shielding people from those nasty infected female mosquitos reduces the chances for transmission.  Additionally, the nets are durable and cheap.  Now for the bad news:  this study and others are reporting resistance on the part of the mosquito to the insecticides used in the netting. Score one, female mosquitos.

What about treatment?  Just a few years ago 'combination therapy' was widely deployed based on a medication called 'artemesinin.' Large scale international funding enabled this change in treatment and occurred more or less concomitantly with bednet distribution.  Initially things looked rosy and substantial reductions in both morbidity and mortality were seen, but now drug resistance too is increasingly reported.  Score two, parasite.

This study looked at the population of Dielmo village, Senegal, between January 2007 and December 2010.  Rick lauds the study as very well conducted and rigorous, and judging by the reams of data collected, he's right.  Researchers monitored the inhabitants for fever during the study period and treated them promptly when malaria attacks were discovered.  They collected mosquitos monthly at night and distributed bed nets when they became available.  Unfortunately after an immediate and precipitous drop in cases of malaria after net deployment, they rebounded.  The researchers call for immediate and concerted efforts to define the resistance problem and develop solutions.

Malaria is, of course, something that should concern us all, and not merely for humanitarian reasons.  With increased global travel more of us are exposed to the possibility of contracting malaria, and who knows how global warming will affect distribution of both mosquito and parasite? 

Other topics this week include whether coronary calcium scanning can be used to assess cardiac disease risk in a middle range risk group and a new medication for congestive heart failure, both in the Lancet, and early versus late surgery for hip fracture in Annals of Internal Medicine.  Until next week, y'all live well.

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Malaria Solutions That Are Widely Used Currently
December 7, 2011 at 1:53 pm

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Jetson September 4, 2011 at 2:00 am

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