eradication of malaria so why did the campaign fail? 1) insecticides (ddt) –environmental damage!
TRANSCRIPT
Eradication of Malaria
• So why did the campaign fail?
• 1) Insecticides (DDT)– Environmental damage!
Pesticide Resistance
• Rapid Reproduction
• Selection
DDT
DDT
Pesticide Resistance
• Rapid Reproduction
• Selection
Eradication of Malaria
• 2) Plasmodium– Wide use of chloroquine has led to drug
resistant strains!
Eradication of Malaria
• 3) Social/Political Reasons– Emerging nations in Africa were trying to be
free from external (Western European nations) domination; much of the monetary resources stopped flowing in!
• Genetic resistance to Plasmodium
• 2 examples
There are some general genotypes that are resistant to malaria
Duffy Blood Group
• Noticed in military groups in Vietnam.
• African Americans had less severe cases or no cases of malaria!
Genetic Resistance• Plasmodium vivax
• Duffy blood groups– Proteins on cell surface– 3 alleles
• A Dominant
• B Dominant
• y recessive
A =
B =
y = no proteins
Genetic Resistance• Plasmodium vivax
• Duffy blood groups– Proteins on cell surface– 3 alleles
• A Dominant
• B Dominant
• y recessive
A =
B =
y = no proteins
AB yyAA BB Ay
By
Genetic Resistance
• yy genotype has advantage– P. vivax malaria resistance– Only advantageous if P. vivax malaria
endemic
• 40% people of W. African decent
• 0.1% people of non-African decent
• P. vivax keeps the allele common in Africa.
Genetic Resistance
• Sickle celled anemia• Codominant trait (Allele “A” and “B”)
– AA have sickle celled anemia– AB have both types of cells
• Sickle cells don’t support species of Plasmodium well.
• Resistance to infection
Genetic Resistance
• AA selected against – Sickle celled anemia
• AB selected for– Both sickle and normal cells
• BB selected against– Normal cells
• If malaria not endemic, what alleles will be selected for? Against?
• Allele for sickle cells maintained in the population even though strongly disadvantageous to have both alleles.
Genetic Resistance
Sickle Celled Anemia
• In the US, 10% of African Americans have this allele!
Other forms of Resistance to Malaria
• Babies get antibodies from their moms breast milk; they are protected until weaned.
• Once weaned becomes susceptible again!
• What you need to have malaria spread within a population!
Epidemiological Models
Infected People
MosquitoesUninfected
People
contact contact
Habitat
Climate
Food
Source of Plasmodium
Source of New Hosts
Habitat
Behavior
Breaking the Chain
Infected People
MosquitoesUninfected
People
contact contact
Habitat
Climate
Food
Source of Plasmodium
Source of New Hosts
Habitat
Behavior
Eliminating Mosquitoes
• Mosquito Life Cycle
Eliminating Mosquitoes
Eliminating Mosquitoes
• Destroy habitat
• Insecticides
• Biological control
Eliminating Mosquitoes
• Destroy habitat
• Insecticides
• Biological control
• Why don’t these methods work?
Pesticide Resistance
• Rapid Reproduction
• Natural selection
Getting rid of the source of Plasmodium
Getting rid of the source of Plasmodium
• Drug treatment
• Transgenic mosquitoes
Getting rid of the source of Plasmodium
• Drug treatment
• Transgenic mosquitoes
• Why don’t these work?
Getting rid of the source of Plasmodium
• Drug treatment
• Transgenic mosquitoes
• Why don’t these work?
– Availability of drugs• Money
• Medical staff
– Recrudescense
– Drug resistance
– Reservoir hosts?
– Transgenic mosquitoes not a reality
– Expensive
How can we protect the uninfected population?
• Vaccines
• Prophylactic drugs
How can we protect the uninfected population?
• Vaccines
• Prophylactic drugs
• Why don’t these work?
How can we protect the uninfected population?
• Vaccines
• Prophylactic drugs
• Why don’t these work?– Vaccines unsuccessful– Prophylactic drugs expensive– Prophylactic drugs unpleasant
How can we prevent contact between people and mosquitoes?
• Insecticides
• Mosquito nets
• Long clothing
• Behavior
• Avoid mosquito habitat
• Screens on houses
How can we prevent contact between people and mosquitoes?
• Insecticides• Mosquito nets• Long clothing• Behavior• Avoid mosquito
habitat• Screens on houses
• Why don’t these work?
How can we prevent contact between people and mosquitoes?
• Insecticides• Mosquito nets• Long clothing• Behavior• Avoid mosquito
habitat• Screens on houses
• Why don’t these work?– Money
– Availability of materials
– Human behavior difficult to change
• "Everything about malaria is so molded by local conditions that it becomes a thousand epidemiological puzzles." Hackett (1937)
Roll Back Malaria (RBM) Strategy• Early diagnosis and prompt treatment
Roll Back Malaria (RBM) Strategy• Early diagnosis and prompt treatment • Prevention
– insecticide-treated materials– vector control measures
• indoor spraying• larvicide • environmental management
Roll Back Malaria (RBM) Strategy• Early diagnosis and prompt treatment • Prevention
– insecticide-treated materials– vector control measures
• indoor spraying• larvicide • environmental management
• Prevention of malaria in pregnancy
Roll Back Malaria (RBM) Strategy• Early diagnosis and prompt treatment • Prevention
– insecticide-treated materials– vector control measures
• indoor spraying• larvicide • environmental management
• Prevention of malaria in pregnancy
• Monitoring for epidemics – Rapid response
Roll Back Malaria (RBM) Strategy• Early diagnosis and prompt treatment • Prevention
– insecticide-treated materials– vector control measures
• indoor spraying• larvicide • environmental management
• Prevention of malaria in pregnancy • Monitoring for epidemics
– Rapid response
• New methods and tools
Roll Back Malaria (RBM) Strategy• Early diagnosis and prompt treatment • Prevention
– insecticide-treated materials– vector control measures
• indoor spraying• larvicide • environmental management
• Prevention of malaria in pregnancy • Monitoring for epidemics
– Rapid response• New methods and tools
• Improvement in existing tools through research and development
Roll Back Malaria (RBM) Strategy• Early diagnosis and prompt treatment • Prevention
– insecticide-treated materials– vector control measures
• indoor spraying• larvicide • environmental management
• Prevention of malaria in pregnancy • Monitoring for epidemics
– Rapid response• New methods and tools• Improvement in existing tools through research and development
• Coordinated action through establishing partnerships that utilize an optimal mix of measures adapted to local situations.