IPTi still in limbo, doubts remain

Even after several years of intensive, multi-site research on intermittent preventive treatment for infants (IPTi) with sulfadoxine-pryimethamine (SP) we still seem no closer to making IPTi a public health intervention to strengthen our malaria control arsenal. In 2006 WHO’s Global Malaria Program indicated that, “Intermittent preventive treatment in infants (IPTi) is a new promising strategy under WHO evaluation.” Two years later, this evaluation period appears to continue.

img_3667_lowsm.jpgCochrane Reviews has published this month an update on IPT and chemoprophylaxis. The authors conclude that the “long-term deleterious effects, including the possibility that it may interfere with the development of children’s immunity to malaria, are unknown for either regimen. Further trials with long-term follow up are needed.” Interestingly they do quote one study from 2005 that reported: “Intermittent treatment produced a sustained reduction in the risk of clinical malaria extending well beyond the duration of the pharmacological effects of the drugs, excluding a so-called rebound effect and suggesting that such treatment could facilitate development of immunity against Plasmodium falciparum.”

More recently these researchers addressed interventions including IPTi and found evidence, “… that each of these measures may permit attenuated P. falciparum blood-stage infections, which do not cause clinical malaria but can act as an effective blood-stage ‘vaccine’.” This paints a more positive picture than the Cochrane review, though the need for more research looking specifically at immunity would be valuable.

IPT is what the name says – intermittent. It would be given possibly three times a year coinciding with immunization contacts. There would therefore still be opportunities for ‘attenuated infections’ as mentioned above that could actually boost immunity.

It is time that decisions are made concerning IPTi. If more research is needed, malaria partners need to say so and fund it now. If more study is not needed, it is time to roll out another life saving malaria control intervention.

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