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RSTV: IN DEPTH- MALARIA VACCINE

RSTV

Introduction:

Malaria has been one of the world’s deadliest diseases. It kills more than 400,000 people a year worldwide and causes illness in millions of others.Africa is home to 70% of the world’s malaria cases and 90% of deaths.In the past two decades, existing interventions have reduced the malaria burden. And India, too, has made good progress in malaria control. The disease burden has declined by 59 per cent. The success has led to the government in making a commitment to eliminate malaria by 2030. The fight against the disease got another shot in the arm when the world’s first malaria vaccine launched in Malawi this week.

  • Malaria is caused by Plasmodium The parasites are spread to people through the bites of infected female Anopheles mosquitoes, called “malaria vectors.”
  • There are 5 parasite species that cause malaria in humans, and 2 of these species – falciparum and P. vivax – pose the greatest threat.
  • In 2018, falciparum accounted for 99.7% of estimated malaria cases in the WHO African Region 50% of cases in the WHO South-East Asia Region, 71% of cases in the Eastern Mediterranean and 65% in the Western Pacific.
  • vivax is the predominant parasite in the WHO Region of the Americas, representing 75% of malaria cases.
  • Symptoms
    • Malaria is an acute febrile illness. In a non-immune individual, symptoms usually appear 10–15 days after the infective mosquito bite. The first symptoms – fever, headache, and chills – may be mild and difficult to recognize as malaria. If not treated within 24 hours, falciparum malaria can progress to severe illness, often leading to death.
    • Children with severe malaria frequently develop one or more of the following symptoms: severe anaemia, respiratory distress in relation to metabolic acidosis, or cerebral malaria. In adults, multi-organ failure is also frequent. In malaria endemic areas, people may develop partial immunity, allowing asymptomatic infections to occur.
  • Prevention
    • Vector control is the main way to prevent and reduce malaria transmission. If coverage of vector control interventions within a specific area is high enough, then a measure of protection will be conferred across the community.
    • WHO recommends protection for all people at risk of malaria with effective malaria vector control. Two forms of vector control – insecticide-treated mosquito nets and indoor residual spraying – are effective in a wide range of circumstances.

Mosquirix:

  • It is the world’s first vaccine against the deadly Malaria.
  • RTS,S, known by its trade name Mosquirix, uses antibodies to target proteins presented by sporozoites (such as the circumsporozoite protein of falciparum)to enhance the immune system and help prevent the parasite from infecting the liver.
  • Mosquirix is also engineered using a hepatitis B viral protein and a chemical adjuvant to further boost the immune response for enhanced effectiveness.
  • The vaccine offers partial protection from the disease, with clinical trials finding that it prevented approximately 4 in 10 malaria cases, according to WHO.
  • African Nation, Malawi will be undertaking large scale pilot tests for the world’s most advanced experimental malaria vaccine in a bid to prevent the disease. Some 360,000 children a year in three African countries will receive the world’s first malaria vaccine as part of a large-scale pilot project.
  • The vaccine has been recommended by WHO for pilot introduction in selected areas of 3 African countries- Ghana, Kenya and Malawi.

India’s efforts to fight Malaria:

  • India’s progress in fighting malaria is an outcome of concerted efforts to ensure that its malaria programme is country-owned and country-led, even as it is in alignment with globally accepted strategies.
  • Indian government has released a National Strategic Plan (NSP) for malaria elimination for years 2017-2022, targeting eradication by 2030.
  • This marked a shift in focus from malaria “control” to “elimination”. The plan provides a roadmap to achieve the target of ending malaria in 571 districts out of India’s 678 districts by 2022.
  • India has sustained significant decline in malaria cases, halving numbers to 5.1 million in 2018 from 9.6 million the year before. This followed a 24% decline in 2017, according to the World Malaria Report 2018.
  • Since 2000, India has reduced malaria deaths by two-thirds and halved the number of malaria cases.
  • Scaling up a diagnostic testing, treatment and surveillance
  • Ensuring an uninterrupted drug and diagnostics supply chain
  • Training community workers to test all fever cases and provide medicines, and distributing medicated bed-nets for prevention, under its ‘test-treat-track’ in the endemic north-eastern states and Odisha.

World Malaria Report 2019:

  • As per the report, an estimated 228 million malaria cases were reported across the world in 2018, reduced from 251 million cases in 2010 and 231 million cases in 2017.
  • Most of the burden of malaria cases was reported from the African Region (93%), followed by South-East Asia Region (3.4%) and the Eastern Mediterranean Region (2.1%).
  • India and nineteen countries in sub-Saharan Africa were found to have carried 85 percent of the global malaria burden, among which six countries accounted for more than half of the global malaria cases.
  • The countries included Nigeria (25%), the Democratic Republic of the Congo (12%), Uganda (5%) and Côte d’Ivoire, Mozambique and Niger (4% each).
  • Besides, an estimated 405 000 malaria deaths were recorded globally in 2018, reduced from 416000 estimated deaths in 2017 and 585000 deaths in 2010.
  • Children aged below 5 years were found to be most vulnerable to the disease, as they accounted for 67 percent of malaria death globally in 2018. In the region-wise record, the African Region accounted for 94 percent of malaria deaths in 2018.
  • Almost 85 percent of the global malaria deaths in 2018 were restricted to 20 countries from the African Region and India. Nigeria topped the list with 24 percent of global malaria deaths, followed by the Democratic Republic of the Congo with 11 percent of total malaria deaths, United Republic of Tanzania (5%) and Angola, Mozambique and Niger accounting for 4 percent each.
  • Only the African Region and South-East Asia Region showed a reduction in malaria deaths in 2018, in comparison to 2010. The African Region reported the largest absolute reduction in malaria deaths, from 533 000 in 2010 to 380 000 in 2018.
  • India was one of the only two countries to report a reduction in malaria burden in 2018. The other nation was Uganda.
  • India witnessed a 28 percent fall in malaria cases between 2017 and 2018. In the 2016 and 2017 period, India had recorded a 24 percent reduction in malaria cases.
  • Further, only seven out of 28 Indian states and 9 UTs accounted for 90 percent of the estimated malaria cases in 2018. These states included West Bengal, Jharkhand, Chhattisgarh, Odisha, Madhya Pradesh, Uttar Pradesh and Gujarat.
  • All the seven states reported large reductions in malaria cases, from 14.3 million cases in 2010 to 5.7 million cases in 2018. The rates of reductions were mostly slower in the past 3 years than in preceding years in other nations.