In viaggio con la malaria
Seminario L'avete fatto a me
Milano, 22 marzo 2014
Franco Pagnoni
[email protected]
1
www.who.int/malaria
2
Popolazioni a rischio malarico
Approximately 3.3 billion at risk of malaria and
1.2 billion at high risk
Africa
Americas
Eastern Mediterranean
Europe
South-East Asia
Western Pacific
Total
populatio
n
774
895
540
887
1,721
1,763
World
6,581
Populatio
n at any
risk
647
137
295
22
1,319
888
3,308
3
Population
at high
risk
586
61
66
2
457
54
1,226
High risk
(%)
76%
7%
12%
0%
27%
3%
19%
Il mondo ridisegnato dalla malaria
Dorling D Worldmapper. PLoS Med 4 (1), 2007
4
Risorse per lotta alla malaria
Africa sub-sahariana, 2005-2012
5
Le zanzariere impregnate di insetticida a lunga durata
d'azione
Riduzione del 25%
della mortalità per chi
dorme stabilmente
sotto zanzariera
impregnata
6
Prevenzione – Disponibilità di zanzariere impregnate di
insetticida a lunga durata d'azione
Africa – 2004-2013
7
8
Prevenzione – Popolazione protetta da zanzariere o
spray intradomiciliare – Africa
9
Prevenzione – Protezione della donna in gravidanza
Africa
 Gravità ingravescente: 1° gravidanza > 2°
gravidanza > gravidanze successive
 Insuffcienza renale acuta
 Edema polmonare
10
Prevenzione – Protezione della donna in gravidanza
Africa
11
Diagnosi di malaria
12
Diagnosi di malaria
13
Incidenza e mortalità
14
Incidenza e mortalità
15
Il vaccino antimalaricio - il ciclo del Plasmodio
16
16
I punti di azione dei diversi vaccini antimalarici
Target stage
Clinical effect
Prevent
infection
Reduce
clinical
disease
severity
PRE-ERYTHROCYTIC
(RTS,S)
BLOOD STAGE
Interrupt
transmission
17
SEXUAL STAGE
Pre-erythrocytic Vaccines
Antibodies
Pvs25
/Pfs25
AgAPN1
Pfs230
Pfs48/45
<50
<5
Antibodies
Pf Pv CSP
TRAP
LSA1
LSA3
CELTOS
Effector
T cells
~100,000,000,000
Antibodies
18 18
MSP1
AMA1
MSP3
GLURP, SERA,
SR11.1, P27, MSP2,
EBA175, PvDBP, Rh
Many Blood stage vaccines are under evaluation
Antibodies
Pvs25
/Pfs25
AgAPN1
Pfs230
Pfs48/45
<50
<5
Antibodies
Pf Pv CSP
TRAP
LSA1
LSA3
CELTOS
Effector
T cells
~100,000,000,000
Antibodies
19
MSP1
AMA1
MSP3
GLURP, SERA,
SR11.1, P27, MSP2,
EBA175, PvDBP, Rh
Sexual stage/mosquito antigen vaccines are conceptually
attractive for interrupting transmission
Antibodies
Pvs25
/Pfs25
AgAPN1
Pfs230
Pfs48/45
<50
<5
Antibodies
Pf Pv CSP
TRAP
LSA1
LSA3
CELTOS
Effector
T cells
~100,000,000,000
Antibodies
20
MSP1
AMA1
MSP3
GLURP, SERA,
SR11.1, P27, MSP2,
EBA175, PvDBP, Rh
Take home messages
 There is no licensed or available malaria vaccine
 One candidate RTS,S/AS01 is the most advanced, and the first WHO
recommendations on use are expected in 2015
 Even higher efficacy vaccines are desired and we have 2030 goals
for highly effective clinical disease prevention and elimination
vaccines
 Non-vaccine control ↓deaths by 25% to estimated 660,000 over last
decade. Emerging drug and insecticide resistance threaten malaria
control. New tools are needed.
 Malaria Vaccine R&D is a very active and exciting area!
21
In viaggio... senza la malaria
22
In viaggio... senza la malaria
http://www.who.int/ith/en/
http://www.who.int/topics/malaria/en/
http://www.iamat.org/disease_details.cfm?id=14
0&gclid=CPSIxtPPmb0CFWfLtAod1AsAIg
23
Interventi di lotta alla malaria a base comunitaria
-----------The Rapid Access Expansion 2015 project
24
Razionale
 Impact
o
facility-based interventions
alone fail to impact on child
mortality
 Equity
iCCM example of a strategy
to achieve equitable results
o HF services are less likely
to be accessed by the poor
o Opportunity costs > direct
costs
o
25
New findings on disparities
 Many regions have
reduced disparities in
under-five mortality
between the poorest
and the richest except
Sub-Saharan Africa
and South Asia
 Under-five mortality
rate has declined
among even the
poorest in all regions
Source: UNICEF analysis based on Pedersen, J., et al., Levels and Trends in
Inequity and Child Mortality: Evidence from DHS and MICS surveys', working
paper, unpublished, 2013.'
26
Razionale per un approccio integrato a malaria, polmonite e
diarrea
 Malaria,
polmonite e
diarrea sono le
cause più
frequenti di
mortalità postneonatale
 C'è una notevole
sovrapposizione
sintomatologica
tra malaria e
polmonite
 I test diagnostici
(RDT), se negativi,
UN Child Mortality
consentono di
Report 2010
escludere la
malaria
27
RAcE 2015 - Key elements
Award
Objectives
 Grant awarded by CIDA in
1. Increase access to correct
diagnosis, treatment and
referrals for malaria,
pneumonia and diarrhea at
the community level
April 2012, CAD 74.5 million
 5 year program in 5 countries:
Malawi, Mozambique, DRC,
Niger, Nigeria (2 states)
2. Stimulate policy review and
regulatory update on disease
case management at the
community level (WHO
comparative advantage)
 Selection criteria: high disease
burden, enabling policy,
commitment by MoH, potential
for scale-up;
 Implemented through NGOs;
2M/country/yr – 3 M/yr in
NIgeria (1.5M/state)
28
Malawi: 4 districts, 190,359 children;
Consortium of 4 NGOs led by SAVE; start April 2013
DRC: 7 Health Zones in Tanganika district,
150,000 children; IRC; September 2013
Niger: 4 districts, 230,833 children; World
Vision; July 2013
Nigeria: Niger state, 6 LGAs, 162,000
children; Malaria Consortium
Abia state: 6 LGAs, 245,000 children:
Society for Family Health
November 2013
Mozambique: 4
provinces, 308,000
children; SAVE+MC;
April2013
29
Total coverage:
1,286,000 children aged 2-59 months living in
"hard to reach" areas, each year, in 5 countries
30
Grazie per l'attenzione
31