WHO Global Malaria Programme
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Transcript WHO Global Malaria Programme
In viaggio con la malaria
Seminario L'avete fatto a me
Milano, 22 marzo 2014
Franco Pagnoni
[email protected]
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www.who.int/malaria
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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
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1,319
888
3,308
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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
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Risorse per lotta alla malaria
Africa sub-sahariana, 2005-2012
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Le zanzariere impregnate di insetticida a lunga durata
d'azione
Riduzione del 25%
della mortalità per chi
dorme stabilmente
sotto zanzariera
impregnata
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Prevenzione – Disponibilità di zanzariere impregnate di
insetticida a lunga durata d'azione
Africa – 2004-2013
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Prevenzione – Popolazione protetta da zanzariere o
spray intradomiciliare – Africa
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Prevenzione – Protezione della donna in gravidanza
Africa
Gravità ingravescente: 1° gravidanza > 2°
gravidanza > gravidanze successive
Insuffcienza renale acuta
Edema polmonare
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Prevenzione – Protezione della donna in gravidanza
Africa
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Diagnosi di malaria
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Diagnosi di malaria
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Incidenza e mortalità
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Incidenza e mortalità
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Il vaccino antimalaricio - il ciclo del Plasmodio
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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
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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
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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
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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!
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In viaggio... senza la malaria
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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
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Interventi di lotta alla malaria a base comunitaria
-----------The Rapid Access Expansion 2015 project
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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
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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.'
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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
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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)
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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
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Total coverage:
1,286,000 children aged 2-59 months living in
"hard to reach" areas, each year, in 5 countries
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Grazie per l'attenzione
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