working towards malaria elimination in the southwest pacific · world malaria report, 2015. at a...
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Assoc. Prof. Harin KarunajeewaRAM conference, Sydney 2017
Working towards malaria elimination in the Southwest Pacific
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Our research has driven policy change throughout the Southwest Pacific
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Vanuatu
Papua New Guinea (PNG)
Solomon Islands
WEHI malaria field work in Southwest Pacific
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Malaria Research at WEHI: What do we do?
• Parasite biology• Immunology• Vaccine discovery and development• New drug discovery and development• Epidemiology and transmission• Optimizing existing interventions for goal of
malaria elimination
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Incidence
37%
Total reduction in malaria incidence worldwide 2000-
2015
Mortality
60%
Total estimated reduction in
annual number of deaths 2000-2015
Cases averted
1.2 billion
Total estimated number of cases averted between
2000-2015
Lives saved
6 million
Total estimated number of deaths averted between
2000-2015
World Malaria Report, 2015
At a global scale, recent progress in malaria control has been an unprecedented success:
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Incidence
37%
Worldwide
World Malaria Report, 2015
Incidence
90%
Solomon Islands
Incidence
95%
Vanuatu
In the Southwest Pacific, improvements in malaria control have even outpaced global progress:
Incidence
50%
PNG
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Intervention Cases averted
1. Insecticide treated bed-nets 69%
2. Improved malaria drug treatment (ACTs) 21%
3. Indoor residual spraying 10%
World Malaria Report, 2015 (data from Africa)
3 major interventions contribute to this success:
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1969 1972 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005 2008 2011
Cas
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pop
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Year
Global Fund Round 7grant
Global Fund Round 2grant
National Independence
ACTs introduced
Solomon Islands is aiming for nationwide malaria elimination by 2030
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Plasmodium vivax has become the dominant parasite species in Southwest Pacific
P. vivax – 46% of all malaria species & 75% of ongoing transmission in the Solomon Islands.
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P. vivax is much harder to eliminate through conventional malaria control measures
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Fact:
In Southwest Pacific, 4 out of every 5 episodes of P.vivax are due to hypnozoite relapse.
Robinson et al. PLoS Medicine 2015
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The problem of treating Vivax malaria
• Drugs for treating malaria infection in the bloodstream do not kill sleeping forms (hypnozoites) in the liver
• Only one type of drug, primaquine, can kill hypnozoites
• For vivax malaria, killing all parasites in the body necessitates using at least 2 different drugs
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Malaria attack rates in Allied Forces taking Atabrineprophylaxis during and after the Guadalcanal
campaign (1942)
• During active deployment:
1700/1000 person years
• After evacuation to a non-malarious area:
3700/1000 person years
• 5 of every 6 cases of malaria in Allied Forces during WW2 were due to Vivax
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A roadblock to elimination: Currently recommended drug treatment fails to kill P. vivax hypnozoites
• Difficult to kill because it lies dormant in the liver as hypnozoitesand only one drug class is effective against it.
• WHO recommendation – Combination of artemether-lumefantrine (AL) and primaquine (PQ) for 14 days.
• Pilot study in Vanuatu suggests that AL+PQ may not be the most effective combination therapy.
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How can we improve effectiveness of P.vivaxtreatment in Southwest Pacific?
1. Understand why current cure rates are so poor:– Is a drug interaction between the two drugs currently recommended to
kill both blood and liver stage parasites (hypnozoites) compromising the effectiveness of the liver stage drug (primaquine)?
– Are local human genetic factors limiting effectiveness?2. Refining drug dosage and evaluating alternative drugs and drug
combinations (e.g. the new drug tafenoquine)3. Improved targeting of drug interventions
– Better strategies to identify who to treat: including asymptomatic carriers
– Better strategies to identify who not to treat: those likely to experience toxic side-effects or not respond to treatment
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Num
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Solomon Islands is aiming for nationwide malaria elimination by 2030
Cases/1000 pop
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Inoculation Severe disease
Mild disease Death
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Thank you Rotary Clubs for your continued support
Dr Charles Kellaway• Director, Walter and Eliza Hall Institute (1923-1944)• Member, Rotary Club of Melbourne (1932-1944)• Director of Scientific Policy, Wellcome Research
Laboratories (1944-1952)