Malaria: Recent Episodes
Oxford University
Malaria is an endemic disease in much of the world, and is a major contributor to child and infant mortality in many countries. Our malaria podcasts describe efforts by NDM clinicians and scientists, in Oxford and around the world, to treat and prevent malaria, including vaccine development, parasitology, and improved treatment for severe malaria, with the aim to lessen the disease burden on some of the world's most vulnerable people.
Lisa White, Professor of Modelling and Epidemiology at our MORU unit in Thailand, tells us how we can use mathematical and economic modelling to better use limited resources to control or eradicate tropical diseases Mathematical modelling, particularly when combined with economical modelling, allows researchers and policy makers to determine the most effective interventions to fight infectious diseases such as malaria. We can use those models to explore ‘what ifs’ scenarios, at country or province level, save more lives and limit costs.
Dr Bob Taylor from MORU (Mahidol Oxford Research Unit) in Bangkok, Thailand, tells us about his research on malaria, and how we can use primaquine to treat vivax malaria and prevent the transmission of falciparum malaria Primaquine can be used both to treat vivax malaria and to prevent the transmission of falciparum malaria from human to mosquito. A shorter and age-based primaquine regimen would reduce the burden of vivax malaria. It would also allow primaquine to be used more widely to block the transmission of falciparum malaria.
115 years of malaria data collected in Africa gives the most detailed picture yet of where efforts to control malaria infection are being won and lost across the continent. The largest data repository of any parasitic disease in the world, it includes 7.8 million blood samples from more than 30,000 locations in 43 countries. The dataset was collected and analysed by KEMRI-Wellcome Trust researchers based in Kenya, and is the result of over 20 years of research funded by Wellcome. The study shows that sub-Saharan Africa has experienced a decline in the prevalence of P. falciparum – a parasite that causes malaria - from 40% prevalence in children aged 2-10 years old between 1900 and 1929 to 24% prevalence in the same age group between 2010 and 2015. This trend has been interrupted by periods of rapidly increasing and decreasing transmission, thought to be the result of several contributing factors. The study reveals that although previous global initiatives have contributed to an unprecedented decline in infection since 2000, reductions have not occurred uniformly throughout the continent, leaving large parts of West and Central Africa with high transmission rates of the disease. The researchers argue that new tools are needed for the low income and high malaria burden areas of Africa, where gains in malaria reduction have stalled. The researchers identify several challenges to malaria control, including emerging insecticide and drug resistance, and inadequate funding plans for replacing long-lasting insecticide-treated nets.
Dr Lorenz von Seidlein from our MORU unit in Bangkok, Thailand, tells us about his research on malaria elimination in the Greater Mekong sub-region Multidrug resistant P. falciparum malaria is now established in parts of Thailand, Laos and Cambodia, causing high treatment failure rates for artemisinin combination therapies, the main falciparum malaria medicines. A further spread from Myanmar to India then sub-Saharan Africa would be a global public health disaster. TME seeks the best ways to eliminate drug-resistant malaria, using both technical solutions and novel ways that engage entire communities. Dr Lorenz von Seidlein coordinates MORU’s Targeted Malaria Elimination (TME) study, which seeks to eliminate artemisinin resistant falciparum malaria by treating entire communities that have significant levels of subclinical malaria parasite infections and transmission with the antimalarial Dihydroartemisinin-piperaquine (DHA-PIP).
Dr Georgina Humphreys coordinates the WorldWide Antimalarial Resistance Network (WWARN) study groups by encouraging partner engagement and managing the data curation and development of publications. WWARN is a network of research that analyses pooled data of numerous clinical trials. The sheer size of those data sets allows study groups to answer questions that couldn't be asked of a normal size clinical trial, such as the efficacy of an anti-malarial drug on malnourished or severely anaemic children. This research helps design policies to maintain the efficacy of current anti-malaria drugs, currently threatened by growing resistance.
Dr Mehul Dhorda heads the Asia Regional Centre of the WorldWide Antimalarial Resistance Network (WWARN). Artemisinin resistance is firmly established in many parts of Southeast Asia and threatens the lives of millions of people. To improve regional intelligence and aid containment efforts, Dr Dhorda promotes the collection of high quality data on malaria drug resistance. His research aims to simplify and harmonise data, securely store results and analyse comparative or collective pooled analyses.
There is a great need for better treatments for malaria and for a preventative malaria vaccine. SPACIAL EPIDEMIOLOGY & VACCINES
Understanding the variation of malaria risk between houses, villages or region, and how malaria is transmitted in and around that variability helps develop better malaria control programmes and use their resources more wisely. Since malaria control tools are becoming less effective with time, progress in vaccine design is essential.
In pregnant women, severe malaria is responsible for high maternal mortality, and uncomplicated malaria results in in high morbidity. Professor Rose McGready works on the treatment and epidemiology of uncomplicated malaria in pregnancy. Pregnant women are particularly vulnerable as pregnancy reduces the immunity to malaria, increasing the susceptibility to malaria infection and the risk of illness, severe anaemia and death. For the unborn child, maternal malaria increases the risk of spontaneous abortion, stillbirth, premature delivery and low birth weight - a leading cause of child mortality.
Over 250 Institutions participate in the effort of sharing data on the efficacy of antimalarial drugs, which involves standardising and re-analysing data. Professor Philippe Guérin is Director of the WorldWide Antimalarial Resistance Network (WWARN). The best lines of defence against malaria are avoidance of mosquito bites and effective drug therapy. WWARN tracks the emergence of antimalarial drug resistance to ensure that anyone affected by malaria receives effective and safe drug treatment.
Artemisinins are very poweful tools in the treatment of malaria, and the emerging loss of their activity has the potential to create a major public health problem. MALARIA TREATMENT
Dr Charlie Woodrow is based at MORU in Bangkok, Thailand, where he coordinates clinical and laboratory studies on resistance to artemisinins. Bringing together diverse datasets of clinical, in vitro and molecular data has helped better understand the emerging resistance, particularly in Myanmar.
Artemisinins are very poweful tools in the treatment of malaria, and the emerging loss of their activity has the potential to create a major public health problem. MALARIA TREATMENT
Dr Charlie Woodrow is based at MORU in Bangkok, Thailand, where he coordinates clinical and laboratory studies on resistance to artemisinins. Bringing together diverse datasets of clinical, in vitro and molecular data has helped better understand the emerging resistance, particularly in Myanmar.
Too high a dose can result in toxicity and side-effects, too low a dose can cause the illness to come back and at worse develop resistance. Professor Joel Tarning is Head of Clinical Pharmacology in our MORU Unit in Bangkok, Thailand. He's working towards drug dose-optimisation using novel pharmacometric modelling approaches. He is particularly interested in antimalarial treatments for children and pregnant women.
Too high a dose can result in toxicity and side-effects, too low a dose can cause the illness to come back and at worse develop resistance. Professor Joel Tarning is Head of Clinical Pharmacology in our MORU Unit in Bangkok, Thailand. He's working towards drug dose-optimisation using novel pharmacometric modelling approaches. He is particularly interested in antimalarial treatments for children and pregnant women.
Between research and humanitarian Professor François Nosten's work concentrates on infectious diseases at the Thai-Burma border. The main focus of his research is on malaria, especially malaria in pregnant women and emerging drug resistance of malaria parasites.
Professor Nick White talks about the future of artemisinin and other drug therapies for malaria. Malaria kills more than half a million people every year. Following a number of groundbreaking clinical trials, Professor Nick White and his Thailand team successfully demonstrated the effectiveness of artemisinin drug therapy for malaria in adults, children and infants. He also pioneered artemisinin combination therapy, the first-line treatment for malaria worldwide.
Professor Nick White talks about the future of artemisinin and other drug therapies for malaria. Malaria kills more than half a million people every year. Following a number of groundbreaking clinical trials, Professor Nick White and his Thailand team successfully demonstrated the effectiveness of artemisinin drug therapy for malaria in adults, children and infants. He also pioneered artemisinin combination therapy, the first-line treatment for malaria worldwide.
Dr Sumi Biswas talks about the development of a vaccine aimed at the mosquito stage of the malaria parasite cycle. Malaria transmission-blocking vaccines aim to induce immunity against the parasites that infect mosquitoes. Such vaccines will prevent malaria transmission on a wider scale, focusing on the community rather than the individual. Dr Sumi Biswas is working on the development of transmission-blocking vaccines to prevent the spread of malaria.
Dr Sumi Biswas talks about the development of a vaccine aimed at the mosquito stage of the malaria parasite cycle. Malaria transmission-blocking vaccines aim to induce immunity against the parasites that infect mosquitoes. Such vaccines will prevent malaria transmission on a wider scale, focusing on the community rather than the individual. Dr Sumi Biswas is working on the development of transmission-blocking vaccines to prevent the spread of malaria.
Dr Simon Draper tells us about his progress in malaria vaccine research. The malaria parasite is a 'master of disguise'. Whilst the development of a vaccine has proved difficult, targeting a pathway for the parasite has led to the neutralisation of all strains of Plasmodium falciparum. Dr Simon Draper's research interests include studies of vaccine-induced malaria immunity and trials of vaccine candidates. Focusing on translational medicine, his group will take their most promising vaccine candidates and manufacture them as clinical grade material; the next step is proof of concept clinical trials in healthy volunteers.
Dr Simon Draper tells us about his progress in malaria vaccine research. The malaria parasite is a 'master of disguise'. Whilst the development of a vaccine has proved difficult, targeting a pathway for the parasite has led to the neutralisation of all strains of Plasmodium falciparum. Dr Simon Draper's research interests include studies of vaccine-induced malaria immunity and trials of vaccine candidates. Focusing on translational medicine, his group will take their most promising vaccine candidates and manufacture them as clinical grade material; the next step is proof of concept clinical trials in healthy volunteers.
Dr Arturo Reyes-Sandoval tells us about his research on a vaccine against Plasmodium vivax. Plasmodium vivax, one of the four malaria parasites that affect humans, is difficult to eradicate due to its ability to lay dormant in the liver for long periods of time. This parasite is found in Africa, Asia, Latin America and the Western Pacific. 40 percent of the world's population is exposed to the disease that is responsible for around 130 to 350 million clinical cases every year. Dr Arturo Reyes-Sandoval aims to develop a novel malaria vaccine against Plasmodium vivax.
Dr Arturo Reyes-Sandoval tells us about his research on a vaccine against Plasmodium vivax. Plasmodium vivax, one of the four malaria parasites that affect humans, is difficult to eradicate due to its ability to lay dormant in the liver for long periods of time. This parasite is found in Africa, Asia, Latin America and the Western Pacific. 40 percent of the world's population is exposed to the disease that is responsible for around 130 to 350 million clinical cases every year. Dr Arturo Reyes-Sandoval aims to develop a novel malaria vaccine against Plasmodium vivax.
Professor Arjen Dondorp tells us about his work on severe malaria and the development of new therapies. Current malaria therapies using artesunate aim to kill malaria parasites before they mature. Such medications have high success rates but need to be developed further. Based in Bangkok, Thailand, Professor Arjen Dondorp works on the pathophysiology and treatments of severe malaria, antimalarial drug resistance, and improvements in intensive care practice within developing countries.
Professor Arjen Dondorp tells us about his work on severe malaria and the development of new therapies. Current malaria therapies using artesunate aim to kill malaria parasites before they mature. Such medications have high success rates but need to be developed further. Based in Bangkok, Thailand, Professor Arjen Dondorp works on the pathophysiology and treatments of severe malaria, antimalarial drug resistance, and improvements in intensive care practice within developing countries.
Professor Kevin Marsh tells us about his research on Tropical Medicine in Kenya. Professor Kevin Marsh has a broad research interest in child health in the tropics, with a particular focus on the immune epidemiology of malaria. Malaria remains a major world health problem, particularly among children in Africa. Based in Kenya, Professor Marsh is working on preventing and curing malaria in Africa. Professor Marsh is director of the KEMRI Wellcome Programme in Kenya; he also coordinates the malaria immunology group within the programme.
Professor Kevin Marsh tells us about his research on Tropical Medicine in Kenya. Professor Kevin Marsh has a broad research interest in child health in the tropics, with a particular focus on the immune epidemiology of malaria. Malaria remains a major world health problem, particularly among children in Africa. Based in Kenya, Professor Marsh is working on preventing and curing malaria in Africa. Professor Marsh is director of the KEMRI Wellcome Programme in Kenya; he also coordinates the malaria immunology group within the programme.
Dr Climent Casals-Pascual tells us how new tools can help us diagnose and manage malaria more effectively. In tropical countries, poor diagnosis of malaria often results in sub-optimal treatments. Clinical symptoms of severe malaria are similar to those of other diseases like pneumonia and meningitis. Dr Climent Casals-Pascual is researching the diagnosis and clinical management of severe malaria in tropical populations. Integrating proteomic, genomic and clinical data will help us explain differences in clinical outcome in severe malaria, helping to decrease morbidity and mortality in affected areas.
Dr Climent Casals-Pascual tells us how new tools can help us diagnose and manage malaria more effectively. In tropical countries, poor diagnosis of malaria often results in sub-optimal treatments. Clinical symptoms of severe malaria are similar to those of other diseases like pneumonia and meningitis. Dr Climent Casals-Pascual is researching the diagnosis and clinical management of severe malaria in tropical populations. Integrating proteomic, genomic and clinical data will help us explain differences in clinical outcome in severe malaria, helping to decrease morbidity and mortality in affected areas.
Professor Adrian Hill talks about recent developments of vaccines against malaria. Around half of the world's population is at risk of contracting malaria. After studying malaria susceptibility in African children for many years, Professor Adrian Hill is now developing a vaccine against malaria by inducing cellular immune responses (T lymphocytes), instead of taking the more common research approach of stimulating antibodies. Prophylactic vaccines developed in Oxford are now showing great promise in clinical trials.
Professor Adrian Hill talks about recent developments of vaccines against malaria. Around half of the world's population is at risk of contracting malaria. After studying malaria susceptibility in African children for many years, Professor Adrian Hill is now developing a vaccine against malaria by inducing cellular immune responses (T lymphocytes), instead of taking the more common research approach of stimulating antibodies. Prophylactic vaccines developed in Oxford are now showing great promise in clinical trials.