Conquering MalariaJoel G. Breman, MD, DTPHFogarty International CenterNational Institutes of Health

Improving Population Health WorkshopInstituto Nacional de Salud Publica (INSP)

Cuernavaca, Mexico21 22 June 2003

Conquering MalariaBurdenEcology and manifestationsSuccessesControlResearch and training

Burden

The Global Burden of Malaria1.5 2.7 million deaths annuallyOver 1 billion clinical episodes300 500 million people infectedEvery 10 - 30 seconds a child dies of malaria

Ecology and Manifestations

Malaria Ecology Intrinsic and Extrinsic Factors

Controland prevention measuresHumanParasiteMosquitoSocial, behavioral, economic and political factorsEnvironmental conditionsEXTRINSICINTRINSIC

Malarias Toll: Major Intrinsic ComponentsPlasmodium falciparumAnopheles gambiae

Malaria Ecology and BurdenClinical Manifestations

MARA/ARMA Model of Malaria Transmission, 2003

Successes

1899-1914, multiple demonstrations of control by reduction of Anopheline larvae and adults1899, Sierra Leone (antilarval); Cuba (large-scale); Malaysia (antilarval)1904-1914, Panama Canal Zone; control by larviciding, large-scale environmental modification1927, elimination of A. albimanus in Barbados (first area-wide success with invading species)Successes: Vector Control

Successes: Vector Control (2)1935-1939, use of pyrethrum spraying in South Africa, Netherlands and India1939-19571939-1940, Elimination of A. gambiae from Brazil and upper Nile, Egypt, 1942-19451946-1957, Interruption of transmission by anti-mosquito measures in Cyprus, Sandinia, Guyana, Venezuela and Greece; indoor residual spraying with DDT, a new major strategy

Successes: Personal Protection (3)1987-2003Multiple projects and programs using insecticide-impregnated bed nets demonstrating overall mortality reduction and decrease in several malaria indices

Control

Vector ControlDrainage and filling: urban*Chemical and biological larvicides*Indoor residual insecticide spraying*Outdoor residual insecticide spraying

*costly and effective

Personal protection (2)Insecticideimpregnated materials:nets, curtains, clothing*House screeningHouse locationRepellentsFumigants

* Cost-effective for low-income countries

Antiplasmodial (3)Patient management: early diagnosis, treatment, referral, educationChemoprophylaxisIntermittent treatment (pregnancy)*Radical therapy for relapses (P. vivax, P. ovale)

* cost effective

Social Action (4)Mobilization of individual, family, community Health education

Management EffectivenessHealth systems: access, use, qualityLeadership: policies, strategies, tacticsSurveillance of infection and diseaseMonitoring and evaluation of programs

Research and Training

Research, Training, and Support Needs According to Understanding of Diseases and Efficacy of Control MethodsResearch NeedsEfficacy of Control MethodsHighHighTrainingSomeHighModerateResearch Support NeedsLowLow

Research, Training, and Support Needs According to Understanding of Diseases and Efficacy of Control MethodsResearch NeedsEfficacy of Control MethodsHighHighTrainingSomeHighModerateResearch Support NeedsLowLowSmallpox Guinea worm Poliomyelitis H. influenzae type B Measles TetanusMalaria Dengue HIV/AIDS Tuberculosis Ebola/Marburg Influenza Cancers Alzheimers

Research AgendaPathogenesis

Drug development

Immunology and vaccine development

Diagnostics

Entomology

Recent genetic breakthroughs

Conquering Malaria

For More InformationMIMhttp://mim.nih.govRBMhttp://www.who.intDCPPhttp://www.fic.nih.gov/dcpp/Joel Bremanjbreman@nih.gov

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