MALARIA: WHO launches plan to contain resistance to artemisinin-based combination therapies

A WHO action plan outlines critical steps to ensure the effectiveness of the world’s most powerful treatment for malaria. The World Health Organization (WHO) has released its Global Plan for Artemisinin Resistance Containment (GPARC), which outlines the steps necessary to prevent the spread of artemisinin-resistant parasites and ensure the effectiveness of artemisinin-based combination therapies (ACTs) as the top-line medicine for treating malaria. Artemisinin-resistant parasites were first detected along the Thailand-Cambodia border several years ago; the WHO stresses that the world must now act quickly so that it does not lose the most effective existing treatment for Plasmodium falciparum malaria.
GPARC outlines five steps for preventing and containing artemisinin resistance:
    Stop the spread of resistant parasites.
    Increase monitoring and surveillance for artemisinin resistance.
    Improve access to malaria diagnostic testing and rational treatment with ACTs.
    Invest in artemisinin resistance-related research.
    Motivate action and mobilize resources.

The document is a companion to the Global Report on Antimalarial Drug Efficacy and Drug Resistance: 2000–2010, which provides the extensive evidence on which the GPARC was based.
http://www.macepalearningcommunity.org/newsletter_whoact.htm

MA:ARIA: Resistance - a barrier to malaria elimination

Bill Brieger : 07 Apr 2011

The World Health Organization reminds us today that, “Antimicrobial resistance is not a new problem but one that is becoming more dangerous; urgent and consolidated efforts are needed to avoid regressing to the pre-antibiotic era.” It is not just antibiotics that are in trouble, but other microbial agents including malaria drugs.
In the malaria community we are also worried about insecticide resistance. Growing resistance to DDT was one of the reasons that earlier efforts to eradicate the disease were not globally successful.
WHO explains clearly that human behavior (patients, providers, health service managers and drug manufacturers) plays a big role in developing antimicrobial resistance:
Antimicrobial resistance is facilitated by the inappropriate use of medicines, for example, when taking substandard doses or not finishing a prescribed course of treatment. Low-quality medicines, wrong prescriptions and poor infection control also encourage the development and spread of drug resistance. Lack of government commitment to address these issues, poor surveillance and a diminishing arsenal of tools to diagnose, treat and prevent also hinder the control of drug resistance.
Scientific American this month has two timely articles on antibiotic resistance that also highlight how human behavior exacerbates the problem. Agricultural use of antibiotics is one major problem. Another revolves around infection prevention procedures (or the lack thereof) in hospitals.
The use of combination drug treatments was expected to slow or prevent the emergence of resistance to another class of anti-malaria drugs, but prior and continued use of monotherapy artesunate drugs in Southeast Asia has raised the specter of resistance developing there and spreading throughout the world following the patterns of chloroquine and sulphadoxine-pyrimethamine. The following steps are designed to help:
Treatment only with combination therapies where there is no demonstrable resistance for either component of the combination
Treatment based only on positive results of parasitological tests thus avoiding indiscriminant use of malaria drugs
Regular/frequent drug efficacy testing using WHO protocols
Pharmacovigilence/Surveillance
Donors and National Malaria Control Programs must recognize and fund surveillance activities as one of the central interventions in efforts to eliminate malaria. As this year’s World Health Day theme clearly states: no action today, no cure tomorrow.
http://www.malariafreefuture.org/blog/?p=1188

MALARIA: CAMBODIA/THAILAND: Border row could aid spread of drug-resistant malaria

 Photo: Swiss Radio

PHNOM PENH, 4 February 2011 (IRIN) - Health officials warn that an ongoing border dispute and subsequent military build-up along the Thai-Cambodian frontier could undermine global efforts to contain drug-resistant malaria, citing limited access for surveillance, early diagnosis and treatment.


A fisherman plying his trade on the waters of the Tonle Sap lake, Cambodia.


“I hope the critical importance of a global health emergency takes precedence over a political conflict,” Robert Newman, director of the Global Malaria Programme for the World Health Organization (WHO), told IRIN.
His comments follow a three-day visit to what WHO calls the epicentre of the public health emergency: the former Khmer Rouge stronghold of Pailin on the Thai-Cambodian border.
Health officials are concerned that along this forested and mountainous border the parasite that causes malaria is increasingly becoming resistant to the most effective drug they have for treating it, artemisinin.
They are most concerned that the parasite might become completely resistant to the drug, and that this drug resistant parasite could reach Africa.

 Photo: Geoffrey Cain/IRIN : A strong military presence is making surveillance efforts difficult

In January, WHO launched a US$175 million global containment plan, in partnership with Roll Back Malaria.
Worries about drug-resistant malaria reaching Africa “wake me up in the middle of the night,” Newman said.
A failure of current containment efforts had the potential to be “a public health disaster”, he added.
Recent tests had found that in some villages it was taking twice as long for the drug to clear the parasite from an infected patient, and that in some clusters more than one third of those infected were showing resistance to the drug. The drug resistance was first detected in 2009.
“We need to stop it in its tracks,” Newman warned.
Cambodian warning
His comments follow a similar warning on 1 February from Doung Socheat, the director of the National Center for Parasitology, Entomology and Malaria that the containment effort could be hampered by the border dispute.
After noting correlations between rises in the number of malaria cases along both sides of the border as the conflict escalated over the past three years, Socheat said the containment effort could be delayed if conflict flared again.
The situation was too unpredictable to provide a timeframe, he said.
Socheat also said he had no direct access to data on the incidence of malaria among Cambodian soldiers, as the military operates its own health system, which reports to the Ministry of Defence.
Some health data, primarily reports on fatalities and injuries, is reported to the Ministry of Health.

Epicentre
WHO is working closely with the Thai Ministry of Health as well as their Cambodian counterparts, but public health sources in both countries say they are concerned their respective militaries are reluctant to share medical data due to perceived security concerns.
The first phase of the containment project has received $22.5 million from the Bill and Melinda Gates Foundation. It is focused on the area of the border believed to be the epicentre of drug resistant malaria, and first detected in 2009.
This area encompasses Pailin and several districts of Battambang, Pursat and Banteay Meanchay provinces in western Cambodia, as well as districts on the Thai side of the border.
A section of Kampot Province near Cambodia’s Vietnamese border is also included.

Temple
The majority of troops from both countries are believed to be stationed on each side of the disputed ruins of the Preah Vihear temple along the border.
Both sides have, however, placed reinforcements at other sites along the 800km frontier.
In 2008 Cambodia applied to the UN Educational, Scientific and Cultural Organization (UNESCO) to have the temple - to which both countries lay claim - declared a World Heritage Site.
The application was backed by the Thai government at the time, but was sharply opposed by those who said it threatened Thailand's sovereignty.
Since then, strong nationalist sentiment continues, and there have been sporadic exchanges of fire in areas around the disputed site.
According to WHO, about 3.3 billion people - half the world's population - are at risk of malaria. Every year, this leads to about 250 million malaria cases and nearly one million deaths.
http://www.irinnews.org/report.aspx?ReportID=91827

MALARIA: WHO calls for global action on malaria resistance

Eva Aguilar: 13 January 2011

 Flickr/tonrulkens:
Artemisinin was originally isolated for an Asian plant Artemisia annua:

The WHO has launched a worldwide 'call to action' to governments, agencies, researchers and non-governmental organisations over the malaria parasite's growing resistance to the most potent weapon against it — the drug, artemisinin. If recently discovered resistance spreads, said the WHO, the formidable successes of anti-malaria campaigns in recent years will be threatened. Artemisinin lies at the heart of malaria treatment worldwide and has no obvious successor.
"The consequences of widespread resistance to artemisinins would be catastrophic," WHO director-general Margaret Chan told a press conference held after the launch of the 'Global plan for artemisinin resistance containment' yesterday (12 January).
"We need to maintain this medicine. What is at stake it is not just the goals on malaria but, frankly, the whole related Millennium Development Goals", said Robert Newman, director of the WHO Global Malaria Programme.
Resistance to artemisinin was identified in the Plasmodium falciparum parasite on the Cambodia–Thailand border in studies conducted between 2001 and 2009. It is now reported in other areas of the Greater Mekong Subregion and some fear that the resistance will spread to Africa, where most malaria deaths occur.
GPARC calls for increased surveillance of resistance and improved access to diagnostics and treatment with artemisinin combination therapies (ACTs), and for more research on topics ranging from new methods for containing resistance to mathematical modelling of its spread.
"We don't have all the knowledge and tools we need," said Newman, adding that finding a quick way of testing for resistance should be a priority.
"We need a molecular marker for drug resistance that will allow us to know much earlier where this problem may be emerging."
"The research community must be engaged in the development of new classes of antimalarial medicines that would not fall into the same trap of resistance that we have with ACTs," he added.
But it will not be easy to pin down the parasite's genes responsible for resistance, according to Pascal Ringwald, coordinator of the drug resistance and containment unit of the WHO Global Malaria Programme.
"It took 30 years to find the gene related to chloroquine resistance," he told SciDev.Net. "There are thousands of mutant genes in the parasite and the problem is to find which mutation could be related to artemisinin resistance."
"Now we have better molecular tools," he said. "I don't think it's going to take another 30 years, but it is very difficult and also very expensive."
Call for action also aims to bring in new funds to bridge the estimated US$175 million funding gap for the project. So far, the UK's Department for International Development (DFID) has agreed to fund a project to improve surveillance and map the extent of resistance.
http://www.scidev.net/en/news/who-calls-for-global-action-on-malaria-resistance-1.html

MALARIA: drug resistance

Reuters) - The World Health Organization, governments and nonprofit groups are saving lives by distributing drugs to developing countries, but they are not paying enough attention to the dangers of drug-resistant bugs, according to a report released on Tuesday.
Many such drug distribution programs may be driving drug resistance and endangering the lives they are meant to save, according to the report from the Center for Global Development.
"Drug resistance is a natural occurrence, but careless practices in drug supply and use are hastening it unnecessarily," the Center's Rachel Nugent, who led the group writing the report, said in a statement.
Millions of children in the developing world die every year from drug-resistant strains of malaria, tuberculosis, AIDS and other diseases, the report found.
Since 2006 donors have spent more than $1.5 billion on specialized drugs to treat resistant bacteria and viruses, and this could worsen, the report cautions.
So-called "superbugs" such as methicillin-resistant Staphylococcus aureas, or MRSA, now cause more than 50 percent of staph infections in U.S. hospitals.
Bacteria and viruses begin to evolve resistance to drugs almost as soon as they first encounter them. If drug treatment leaves even one microbe alive, it will reproduce and whatever genetic attributes helped it survive will be multiplied in the next generation.
Last week, experts told a Congressional panel that U.S. regulators need to provide a clear path for drug companies to develop new antibiotics and should consider offering financial incentives.
The Center's report looks for even broader action, urging WHO to lead others, including pharmaceutical companies, governments, philanthropies that buy and distribute medicines, hospitals, healthcare providers, pharmacies and patients.
The report finds clear links between increased drug availability and resistance. For instance, in countries with the highest use of antibiotics, 75 to 90 percent of Streptococcus pneumoniae strains are drug-resistant, it found.
Poor quality drugs, counterfeit drugs, incomplete use of drugs and other factors all contribute to the problem, the report found. And this problem will worsen as drug access programs succeed, it cautions.
"The number of people being treated for HIV/AIDS, for example, increased 10-fold between 2002 and 2007; there was an 8-fold rise in deliveries of (drugs) for malaria treatment between 2005 and 2006, and the Stop TB Partnership's Global Drug Facility has expanded access to drugs for TB patients, offering nearly 14 million patient treatments in 93 countries since 2001," the report reads.
"While increased access to necessary drugs is clearly desirable, it brings challenges in preserving the efficacy of these drugs and ensuring they are used appropriately."
For instance, in 2008, an estimated 440,000 cases of multi-drug resistant tuberculosis emerged.
The Center for Global Development, an independent, nonprofit group, specializes in research on global poverty and inequality.
http://www.reuters.com/article/idUSTRE65E0NL20100615

MALARIA: Malaria's Drug Miracle in Danger

Along the border between Thailand and Cambodia, Plasmodium falciparum, the most dangerous of malaria parasites, is showing unmistakable signs of becoming resistant to artemisinin derivatives, the group of powerful drugs that—as part of so-called artemisinin-based combination therapies—have become the cornerstone of malaria treatment worldwide. For the moment, the drugs still work in the area; they just take more time to do the job. But that is alarming enough, scientists say. If resistance gets worse and starts spreading out from here, the results could be catastrophic. There are few other drugs in the pipeline, and those that are closest to the market may not work against the resistant strain
http://www.sciencemag.org/cgi/content/summary/328/5980/844