Posts or Comments 19 June 2024

Monthly Archive for "February 2013"

Drug Quality &Research &Vaccine Bill Brieger | 10 Feb 2013

TB setbacks: lessons for malaria control

Tuberculosis is one of the big three receiving Global Fund support, and like HIV and malaria control efforts, the emphasis is on multiple interventions to ensure ultimate success. Compared to the other diseases, TB’s interventions have been mainly limited to immunization and directly observed treatment. Both of these interventions have recently met some major challenges that have also plagued the other big diseases.

Roger Bate and colleagues, who have focused on the problems of fake and substandard malaria drugs have turned their attention to TB. (see ). Their investigation at pharmacies in 19 Asian and African countries found around 9% of TB drugs were substandard/poor quality. The rate of fake medicines was 16% in Africa and 10% in Asia.

Governments in these countries were encouraged to give these issues greater attention including better regulation and collaboration with international policing efforts.

The need for new vaccines is a necessary development to maintain a strong disease control arsenal. For TB, “A new vaccine, modified Vaccinia Ankara virus expressing antigen 85A (MVA85A), was designed to enhance the protective efficacy of BCG.” (as reported in The Lancet )

As the BBC report on this study pointed out, “BCG is only partially effective against the bacterium that causes TB, which is why several international teams are working on new vaccines.” (see BBC at )

While the new vaccine “… was well tolerated and induced modest cell-mediated immune responses. Reasons for the absence of MVA85A efficacy against tuberculosis or M tuberculosis infection in infants need exploration.” Fortunately research on other vaccine candidates is underway.

Continued control and eventual elimination of malaria and TB will require research that is both basic (vaccines) and applied (drug quality) in order to develop, maintain and implement effective strategies. Disease research budgets should not be compromised in the ever changing world of pathogen/parasite evolution.

Vaccine Bill Brieger | 10 Feb 2013

Vaccines – tried and true or tired and blue

The March 2013 issue of Discover Magazine provides a chilling overview of why a standard vaccine against pertussis (whooping cough) is no longer as effective as we hoped. About 20 years ago the US switched from killed whole bacteria vaccine to one that contained five key proteins. The change was necessitated by some severe reactions to the original vaccine.

who-208327-ethiopia-pvirot-sm.jpg [PVirot, WHO Ethiopia 2002.]

It has come to light that the effects of the current pertussis vaccine, given in combination with tetanus and diphtheria immunization (DPT) last only a short time, as little as one year for adults receiving the booster. It seems that the five chosen bacteria proteins may have evolved and that those in the vaccine confer less immunity.

There are efforts to find new adjuvants to enhance efficacy, but what we are witnessing is a constant battle for balance between finding both safe and effective health interventions.

Why should malaria program people be concerned about pertussis? Recent trials of the new RTS,S/AS02D malaria vaccine is that research trials of this new malaria tool were designed to integrate it into existing childhood immunization programs, including DPT. Not only are we concerned about whether the malaria vaccine works, but whether there might be any negative interactions with other concurrent vaccines.

Community members may not easily distinguish all the different diseases in a vaccination program, but the success or failure of any one component may affect their attitudes to the whole package.

In the case of malaria, an effective vaccine that guarantees more protection than those currently under trial, will be important tools in efforts to control the disease. Vaccines may not yet provide the key to elimination. Also as we can see, vaccines that were once effective may loose their edge, much as parasites and vectors may develop resistance to medicines and insecticides. That is why program managers must always ensure adequate resources for a multi-intervention approach.

Malaria in Pregnancy Bill Brieger | 08 Feb 2013

Interventions that work in the fight against malaria in pregnancy


The Malaria in Pregnancy Working Group of the Roll Back Malaria Partnership has compiled a briefing document on the importance and effectiveness of available interventions to protect pregnant women from malaria. Below are some of the highlights. The full document can be accessed at the MCHIP website.

The devastating consequences of Plasmodium falciparum malaria in pregnancy (MiP) are well documented; these include higher rates of maternal anemia and low birth weight (LBW) babies in areas of stable malaria transmission. In areas of unstable P. falciparum malaria transmission, pregnant women are at increased risk of severe malaria, death and still birth of the fetus. Approximately 11% of neonatal deaths in malaria endemic African countries are due to low birth weight resulting from P. falciparum infections in pregnancy. However, until recently, there was limited documented evidence of the protective effect of malaria prevention in pregnancy on neonatal mortality.

mip1.jpgA recent meta-analysis of national survey datasets by Eisele et al. (2012) showed exposure to intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine pyrimethamine (SP) and insecticide treated bed nets (ITNs) to be associated with reductions of both neonatal mortality and LBW under routine program conditions. Menéndez et al. (2010) also showed the protective role of IPTp-SP in reducing neonatal mortality under trial conditions. Further, Sicuri et al. (2010) in the context of the Menéndez trial showed IPTp to be highly cost effective in the context of routine antenatal care (ANC) services. These studies highlight the critical importance of continuing IPTp as well as ITN use among pregnant women to prevent the adverse consequences of malaria in pregnancy.

In October 2012, the WHO Malaria Policy Advisory Committee (MPAC) reviewed guidance based on the most recent evidence of the efficacy and effectiveness of IPTp-SP in light of growing SP resistance in children and also potential SP resistance in pregnant women receiving IPTp-SP. Based on the review the MPAC determined that frequent dosing (3 doses or monthly) of IPTp-SP is effective in reducing the consequences of MIP.

WHO concluded that prioritizing IPTp as a key intervention for pregnant women (combined with ITN use and effective case management) should remain a priority across stable malaria transmission countries. The WHO’s recent policy update, confirms the critical importance of increasing the frequency of IPT-SP, in addition to ITN use among pregnant women and effective case management.

IPTp-SP and ITNs continue to have an important and significant effect on reducing neonatal mortality and LBW (low birth weight) and need to be recognized as interventions to reduce newborn mortality. IPTp and ITNs reduce neonatal mortality even in programmatic settings, where use may be less than optimal and where SP resistance may exist.

Although the majority of women attend ANC at least once during pregnancy and often twice, IPTp-SP uptake as well as ITN coverage among pregnant women is alarmingly low across most countries. This is a major missed opportunity, at present.

Key References:

  • Guyatt HL, Snow RW. Malaria in pregnancy as an indirect cause of infant mortality in sub-Saharan Africa. Trans R. Soc Trop Med Hyg 2001; 95: 569-76.
  • Elisa Sicuri, Asucena Bardaji, Tacita Nhampossa, Maria Maixenchs, Ariel Nhacolo, Delino Nhalungo, Pedro L. Alonso, Clara Menéndez. Cost-Effectiveness of Intermittent Preventive Treatment of Malaria in Pregnancy in Southern Mozambique. PLoS ONE; Oct. 2010; Volume 5, Issue 10
  • Clara Menéndez, Azucena Bardaji, Betuel Sigauque, Sergi Sanz, John J. Aponte, Samuel Mabunda, Pedro L. Alonso. Malaria Prevention with IPTp during Pregnancy Reduces Neonatal Mortality. PLoS ONE; Feb 2010; Vol. 5, Issue 2.
  • Thomas P Eisele, David A Larsen, Philip A Anglewicz, Joseph Keating, Josh Yukich, Adam Bennett, Paul Hutchinson, Richard W Steketee. Malaria prevention in pregnancy, birthweight, and neonatal mortality; a meta-analysis of 32 national cross-sectional datasets in Africa. The Lancet. Published online Sept 18, 2012.
  • Anna Maria van Ejik, Jenny Hill, Victor A Alegana, Viola Kirui, Peter W Gething, Feiko O ter Kuile, Robert W Snow. Coverage of malaria protection in pregnant women in sub-Saharan Africa: as synthesis and analysis of national survey data. The Lancet. Vol. 11. March 2011.
  • WHO. October 2012
  • Guyatt HL, Snow RW. Malaria in pregnancy as an indirect cause of infant mortality in sub-Saharan Africa. Trans R. Soc Trop Med Hyg 2001; 95: 569-76.

Advocacy Bill Brieger | 07 Feb 2013

AFCON 2013 UAM Media Event: Ghanaian Media challenged to make Malaria a niche Issue

By Emmanuel Fiagbey, VOICES Program, Ghana

nigeria-mali-2013.jpgWhen 60 journalists from 7 Television stations, 10 print media establishments and 12 radio stations gathered at the Novotel Hotel in Accra on this day, the clarion call was that, even though civil wars, border disputes, political rivalries and disputes, hunger, poverty and armed robberies etc. are critical issues attracting the attention of the media, Malaria must not be forgotten otherwise the lives of children, pregnant women and the workforce at large would be kept perpetually at risk.

In her address to the media practitioners representing the Ghana Media Malaria Advocacy Network and 15 representatives from the Ghana Football Association, the Private Sector and NGOs at this event, DR. Constance Bart-Plange, Manager of the National Malaria Control Program stated that progress so far made by Ghana in managing Malaria – almost 87% national household ownership of nets; 90% of mothers knowing the mosquito as the true cause of malaria; and national adoption of ACTs for treating the disease need to be protected.

She therefore appealed to the media to remain responsible in their reportage and promotion of all interventions being applied in the country. She called on the private sector companies in the UAM partnership to step up their workplace malaria-safe programs and always endeavour to feed the media with appropriate information on their contributions to the fight against the disease. Dr. Bart-Plange further emphasized that engaging the media, the Private Sector and the Football Association in promoting malaria advocacy tells the full story of the disease as a social and development issue that concerns all sectors of society. “It is a healthy malaria-free people who must play, watch and cheer football, the game we all love and so, we must all be part of this fight,” she reiterated.

afcon-1a.jpgAn official of the National Malaria Control Program, Ms. Vivian Aubyn on her part reminded the media and the private sector partners of the objectives of the Ghana 2008-2015 Malaria Control Strategy and the various policies such as the New Drug Policy and the Integrated Malaria Vector Management Policy. She pleaded with the media and private sector partners to ensure their programs and activities always conform to the prescriptions of the national strategy and the existing policies.
Mr. Fred Crentsil, Vice President of the Ghana Football Association in his contribution reminded Ghanaians that “there is no excuse for a footballer to fail to perform at his or her maximum best because of a malaria attack when we all know that sleeping under insecticide treated nets effectively prevents this disease.”

In his delivery, Mr. Emmanuel Fiagbey, Country Director of the Johns Hopkins University Center for Communication Programs VOICES project called on the media to continue to strategically employ the art of news making to promote public debate and leadership decision making on important issues concerning malaria through direct news items, editorials, features, rejoinders, live interviews and documentaries. In this way, he stressed, the media will remain a powerful mechanism for mobilizing public opinion on emerging issues on Malaria and attracting appropriate responses from local and national leadership as well as the donor community. He urged members of the Ghana Media Malaria Advocacy Network and all other journalists to sustain their watchdog role of exposing abuses and misdeeds by miscreants in the health and allied professions, the pharmaceutical industry, politicians, senior civil servants, NGOs, etc in managing resources meant for malaria control.

afcon-5a.jpgIn launching the colourful AFCON 2013 GOAL Malaria Magazine at the event, Prof. Isabella Quakyi, Former Dean of the School of Public Health of the University of Ghana and Member of the Ghana Health Service Council, who chaired the event, described the GOAL as a self teacher on Malaria prevention and treatment which should engage the attention of everyone during the AFCON 2013 tournament and after. The GOAL Magazine, she explained, “is simply telling all readers, if you love football then you must have the passion to fight malaria.” Prof. Quakyi called on all organizations and individuals to support the continued publication and distribution of this special magazine.

The Ghana AFCON 2013 Media Malaria advocacy event was organized by the Johns Hopkins University Center for Communication Programs Voices for a Malaria-free Future project in collaboration with the National Malaria Control Program, the Ghana Football Association and the Ghana Media Malaria Advocacy Network.