A chemical shield against malaria

A study led by a Spanish science shows that the administration of two drugs already available in Africa reduced by one third cases of the disease in children



Until 1964, the World Health Organization (WHO) not declared eradicated malaria in Spain. Perhaps it is this that explains the efforts of Spanish scientists in the fight against the disease that causes more deaths of African children, about 800,000 a year.

The Lancet today again echoing a Spanish achievement in the battle against malaria. The researcher of the Center for International Health Research of Barcelona (CRESIB) Clara Menendez directs a study showing that intermittent administration of an inexpensive preventive treatment reduced by 30% of malaria cases in children under one year, most susceptible to severe forms of the disease. And it does, well, without causing serious side effects.

Every year nearly 800,000 African children from malaria

Menendez is the wife of Pedro Alonso, científicopremio Prince of Asturias International Cooperation 2008 that tested what could become the first effective vaccine against malaria, which has shown a reduction of up to 60% of the risk of malaria for under - five years.

Today in The Lancet reports the results of six clinical trials three in Ghana and the rest in Tanzania, Mozambique and Gabon which evaluated the administration of intermittent preventive treatment (IPT) in 3958 compared with 3972 infants who are given a placebo. The children, who had up to 12 months old, received treatment regardless of whether they had been infected.

The chosen combination of drugs (sulfadoxine and pyrimethamine) is not unknown in Africa. These two drugs very baratosalrededor of 30 cents per dose, and its use to treat malaria in pregnant women even allowed.
Making vaccination

However, not always the availability of a drug makes it easy to mass administration. For this reason, the team opted to use Menendez a program that has proven effective for decades, the WHO Immunization, which systematically vaccine to children of diseases for which there is such a possibility. "We wonder what would have to devise a new program where we could benefit from a successful one," he said at a news conference yesterday Professor, School of Hygiene and Tropical Medicine, David Schellenberg. The British center is one of 20 participating in the Consortium, comprising more than 20 institutions in Africa, Europe and USA, as well as WHO and UNICEF.

The drugs tested are inexpensive and have caused side effects

Menendez's work is part of the this group, as defined Pedro Alonso, is "a new mode of international cooperation to move the politicians the need to establish measures for malaria control.

Today is certainly an important day in the fight against malaria. CRESIB addition to the work of another assay Consortium shows that apart from the combination sulfadoxine-pyrimethamine, other medications administered preemptively reduce the incidence of the disease in vulnerable populations. Thus, the study conducted by researcher Daniel Chandramohan, the aforementioned center of London, confirms the effectiveness of mefloquine. A very good news if you consider that in certain parts of Africa the parasite that causes malaria is resistant to sulfadoxine and pyrimethamine.

Despite the success, Pedro Alonso warned yesterday that this formula is far from a panacea. Nor will the vaccine, whose trials are already in phase III, the last prior to their authorization. In the fight against malaria, say the experts, the multiple attack will be essential.
"This approach saves money for governments"

Clara Menendez. CRESIB Researcher and author of the study

The researcher Clara Menéndez is very clear that in the battle against malaria, be addressed several fronts simultaneously. This fight is dedicated multifocal at the Center for International Health Research of Barcelona (CRESIB).

One of the main concerns about the preventive administration of antimalarial drugs is the risk of side effects. How secure is the proposed solution?

This aspect has been studied better than in most drugs, even in the smallest detail. And not only were evaluated side effects of drugs themselves but also their interactions with children receiving these vaccines, and that the program has been jointly administered drugs and immunizations. What we concluded is that, as administered, no serious effects. Reported only two cases of Stevens-Johnson syndrome [a rare autoimmune disease that affects the skin] that, with hindsight, have not been confirmed.

The cost of drugs is a primary concern in countries as poor as those who have participated in the trial ...

Yes, but we have shown that the combination of sulfadoxine-pyrimethamine is not only cost effective because it is worth paying the quarter euro each dose costing the benefits to be gained, but also saves money for the system health, the decline in hospital admissions that achieved it.

In another Lancet study adverse results are obtained with the combination you propose as effective. Why?

This second test is also part of our work, and the results it offers are completely expected, as the area where we have made, northern Tanzania, an area I know very well, presents a pathogen with resistance to these drugs nearby 99%. But the positive of the latter work is that we have seen that there is an alternative to mefloquine, which is effective for this variety.

Another recent study showed that placing nets on doors and windows reduced the transmission of malaria. Should we combine several strategies until you get the vaccine?

You can not use a single method. The mosquito nets will have a major role. Keep in mind that the vaccine will not have a 100% effective, so it must be combined with all other available strategy which, incidentally, are many.