Wmd.ppt

WORLD MALARIA DAY

(25th April, 2013)

Md. Kabiul Akhter Ali

VBD ConsultantMalda

World Malaria Day - April 25

Malaria remains a killer disease with nearly 1 million people losing their lives every year. Eighty five per cent of deaths are children under 5 years of age.

Most malaria cases occur in Africa but it nevertheless remains a global problem also affecting countries in large parts of Asia and Latin America.

Importance of

World Malaria Day World Malaria Day was established in May

2007 by the 60th session of the World Health Assembly, the decision-making body of the World Health Organization (WHO). The day was established to provide education and understanding of malaria and disseminate information on  malaria-control strategies, including community-based activities for malaria prevention and treatment in endemic areas.

Past World Malaria Day Themes•2008: Malaria – a disease without borders

•2009: Counting malaria out

•2010: Counting malaria out

•2011: Achieving progress and impact

•2012: Sustain Gains,Save Lives: Invest in Malaria

INVEST IN THE FUTURE : DEFEAT MALARIA

World Malaria Day Theme, 2013

Malaria – Early History

The symptoms of malaria were described in ancient Chinese medical writings. In 2700 BC, several characteristic symptoms of what would later be named malaria were described in the Nei Ching,

Hippocrates and Malaria

Hippocrates, a physician born in ancient Greece, today regarded as the "Father of Medicine", was the first to describe the manifestations of the disease, and relate them to the time of year and to where the patients lived.

Malaria

Name is derived from Italian Mal’ aria or bad air Malaria continues to be most

important cause of fever and morbidity in the Tropical world

Malaria has been eradicated from Europe, Most of North America, USA South America Korea and Japan,

Malaria-endemic Areas 2000

MALARIA AND THE WORLD

Why it is important in Medicine

Malaria remains the world's most devastating human parasitic infection. Malaria affects over 40% of the world's population. WHO, estimates that there are 350 - 500 million cases of malaria worldwide, of which 270 - 400 million are Falciparum malaria, the most severe form of the disease.

Malaria Kills more people than AIDS

Malaria kills in one year what AIDS kills in 15 years. For every death due to HIV/AIDS there are about 50 deaths due to malaria. To add to the problem is the increasing drug resistance to the established drug.

History – Events on Malaria

1880 - Charles Louis Alphose Lavern discovered malarial parasite in wet mount

1883 - Methylene blue stain - Marchafava 1891 - Polychrome stain- Romanowsky 1898 - Roland Ross - Life cycle of

parasite transmission, wins Nobel Prize in 1902

1948 - Site of Exoerythrocytic development in Liver by Shortt and Garnham

Major Developments in 20th Century

1955 - WHO starts world wide malaria eradication programme using DDT

1970 – Mosquitos develop resistance to DDT Programme fails

1976 – Trager and Jensen in vitro cultivation of parasite

Charles Louis Alphonse Laveran,

Charles Louis Alphonse Laveran, a French army surgeon stationed in Constantine, Algeria, was the first to notice parasites in the blood of a patient suffering from malaria. This occurred on the 6th of November 1880. For his discovery, Laveran was awarded the Nobel Prize in 1907.

Ronald Ross In August 20th, 1897,

Ronald Ross, a British officer in the Indian Medical Service, was the first to demonstrate that malaria parasites could be transmitted from infected patients to mosquitoes For his discovery, Ross was awarded the Nobel Prize in 1902.

Nobel Prizes in Malaria The discovery of this

parasite in mosquitoes earned the British scientist Ronald Ross the Nobel Prize in Physiology or Medicine in 1902. In 1907, Alphonse Lavern received the Nobel prize for his findings that the parasite was present in human blood.

Parasites Cause of Malaria

Malaria is caused by an infection by one of four single celled Plasmodia species, they

are: falciparum, vivax, malariae, and ovale. The

most dangerous of the four is:

P.falciparum

Newer species of Mosquito

A fifth species, Plasmodium knowlesi, causes malaria in humans.

Malaria the disease

9-14 day incubation period

Fever, chills, headache, back and joint pain

Gastrointestinal symptoms (nausea, vomiting, etc.)

Malaria stages of the disease

Malaria intensifies

Symptoms intensify Irregular high fever Anxiety, delirium and

other mental problems

Sweating, increased pulse rate, severe exhaustion

Enlarged spleen and liver

Malaria the disease

Malaria A Major Health problem of Tropical

countries

Pernicious Malaria

Is a life threatening complication in acute falciparum malaria

It is due to heavy parasitization Manifest with 1 Cerebral malaria – it presents with

hyperpyrexia, coma and paralysis. Brain is congested

2 Algid malaria – presents with clammy skin leading to peripheral circulatory failure.

Complication in Malaria

Pulmonary edema (fluid buildup in the lungs) or acute respiratory distress syndrome (ARDS), which may occur even after the parasite counts have decreased in response to treatment

Abnormalities in blood coagulation and thrombocytopenia (decrease in blood platelets)

Cardiovascular collapse and shock

Black water Fever

It is a manifestation of infection with P.falciparum occuring in persons who have been previously infected and have had been inadequate dose of quinine

It is characterized by intravascular hemolysis fever, and Haemoglobunuria

Cardiovascular collapse and shock Abnormalities in blood coagulation and

thrombocytopenia (decrease in blood platelets)

Other Complications In Malaria

Acute kidney failure Hyperparasitemia, where more than

5% of the red blood cells are infected by malaria parasites

Metabolic acidosis (excessive acidity in the blood and tissue fluids), often in association with hypoglycemia

World Health Organization Recommends

In endemic areas, the World Health Organization recommends that treatment be started within 24 hours after the first symptoms appear. Treatment of patients with uncomplicated malaria can be conducted on an ambulatory basis (without hospitalization) but patients with severe malaria should be hospitalized if possible.

Doctortvrao’s ‘e’ learning series

What is Presumptive Treatment?

Presumption - In an area with high transmission of malaria, it should be presumed that ALL cases of fever are due to malaria.

Treatment - First loading dose of Chloroquine should be administered immediately after collecting the blood specimen, even without waiting for its report.

If the fever is indeed malaria, this treatment alleviates symptoms early, may be well before the test result is available.

If it is malaria, Chloroquine also prevents the spread of malaria by destroying the gametocytes of P. vivax (the more common malaria).

If it is not malaria, nothing is lost, for Chloroquine at this dose is safe and has no adverse effects!

Radical treatment

Radical treatment is administration of Primaquin to all confirmed cases of malaria.

In P. vivax malaria, 2 weeks' therapy with Primaquin completely cures the infection in the host by its tissue schizonticidal activity and thereby prevents relapses.

In P. falciparum malaria, a single dose of primaquine destroys the gametocytes, thereby prevents the spread of the infection into the mosquito.

Use of Primaquine

Primaquine is active against the dormant parasite liver forms (hypnozoites) and prevents relapses. Primaquine should not be taken by pregnant women or by people who are deficient in G6PD (glucose-6-phosphate dehydrogenase). Patients should not take primaquine until a screening test has excluded G6PD deficiency.

Resistance to Chloroquine - 1960

Resistance to Chloroquine - 1970

Resistance to Chloroquine - 1980

Resistance to Chloroquine - 2000

Anti-malarials Resistance – 1998 (excluding CQ)

SP, Mefloquine, Halofantrine, Quinine

SP

Mefloquine

SP, Mefloquine

Reports of Chloroquine Resistance in P.vivax

19891990

1995

1995

19911995

Future Ambitions

The malaria vaccine community aims to license—by 2015—a first-generation vaccine that has 50 percent efficacy against severe disease and death, with protection lasting at least one year without the need for boosting. They also aim to license—by 2025—a second-generation malaria vaccine that has a protective efficacy of at least 80 percent against clinical disease and with protection lasting for many years without a booster.

Goals to achieve : Control Malaria Sustaining malaria control efforts is an investment in

development. Continued investment in malaria control now will propel malaria-endemic countries along the path to achieving the 2015 Millennium Development Goals, especially those relating to improving child survival and maternal health, eradicating extreme poverty and expanding access to education.

Just by scaling up efforts to prevent malaria, including universal coverage of mosquito nets, WHO estimates that three million African children can be saved by 2015, while many more lives can be saved through a combination of proven and innovative malaria control tools including access to effective prevention, accurate diagnosis and prompt, reliable anti-malaria treatment

Successful malaria control has a dramatic impact on the health, productivity and well-being of people living in malaria risk areas.

Thanks