Assessment of therapeutic responses to gametocytocidal drugs in Plasmodium falciparum malaria.

Indirect clinical measures assessing anti-malarial drug transmission-blocking activity in falciparum malaria include measurement of the duration of gametocytaemia, the rate of gametocyte clearance or the area under the gametocytaemia-time curve (AUC). These may provide useful comparative information, but they underestimate dose-response relationships for transmission-blocking activity. Following 8-aminoquinoline administration P. falciparum gametocytes are sterilized within hours, whereas clearance from blood takes days. Gametocytaemia AUC and clearance times are determined predominantly by the more numerous female gametocytes, which are generally less drug sensitive than the minority male gametocytes, whereas transmission-blocking activity and thus infectivity is determined by the more sensitive male forms. In choosing doses of transmission-blocking drugs there is no substitute yet for mosquito-feeding studies

SPATIO-TEMPORAL ANALYSIS OF MALARIA INCIDENCE ALONG HLAINGBWE TOWNSHIP IN MYANMAR AND THA SONG YANG DISTRICT IN THAILAND

Background: Malaria stays a serious public health problem in many countries of the world. The border regions are difficult to control for the malaria elimination due to the importation or reintroduction of malaria. A key to address such problem is reinforcing of surveillance activities with rapid identification.  The objective of the study was to describe the malaria incidence rate and analyze the space and time distribution of malaria incidence rate in the high endemic border areas between Myanmar andThailand, the Hlaingbwe Township and Tha Song Yang District.  Methodology: Daily malaria data were collected, using a passive surveillance system, from patients visiting local health facilities in both Tha Song Yang and Hlaingbwe regions. ArcMap software version 10.4.1 was used to describe the disease mapping of malaria incidence rate in both regions. Results: Compared to their counterparts, male gender had higher malaria incidence rates in both Tha Song Yang and Hlaingbwe regions. Non-Thai people had higher incidence rate than Thai in Tha Song Yang district. The higher incidence rates had seasonal pattern and the pattern was similar in both regions. The areas with a higher incidence rate could be seen in both inner side and along Thai- Myanmar border (upper and lower parts) in Tha Song Yang area. But in Hlaingbwe Township, the higher incidence rate occurred only in the inner and upper parts except for Me La Yaw and Tar Le areas which are situated along the Thai-Myanmar border. Along the border, the higher incidence rates were connected to the adjacent area in upper and lower parts between these two regions. Conclusion: The descriptive statistics and presented map in this study gave the health policy makers an important overview of malaria situation in this regions in order to intervene high risk areas more effectively, and distribute the resources in a useful manner

Access to primaquine in the last mile: challenges at the service delivery points in pre-elimination era, Myanmar

Abstract Background Alongside monitoring of the disease burden, the successful move towards malaria elimination relies on the readiness of the health care delivery system. However, there is a lack of evidence in the gap of existing National Guidelines and access to low dose primaquine in real practice under varying degrees of antimalarial resistance in the pre-elimination phase in Myanmar. Therefore, this study addressed the essential information from the service delivery points (SDPs) of public and private sectors on the availability and the use of primaquine in both supply and demand side. Concomitantly, the study aimed to underscore challenges in health system infrastructure to promote the sustained flow in rolling out primaquine in line with National Guidelines for malaria elimination. Methods A cross-sectional study conducted from September 2017 to February 2018 included six townships of three states/regions. The team used an observation checklist for documenting primaquine supplies at SDPs. Semi-structured interviews, key informant, and in-depth interviews focused both public and private sectors including staff from the Vector-Borne Diseases Control (VBDC) teams in each state/region and rural health centers (n = 25), those from the non-governmental organizations (NGOs), general practitioners and drug sellers (n = 11), and recently infected malaria patients (n = 11). Triangulation of quantitative and qualitative data provided meaningful interpretations. Results Public sector staff reported an adequate stock of primaquine, but it was unavailable at the general practitioners’ clinics without any connection to NGOs and also at the unlicensed drug shops. Health care providers of the public sector experienced challenges in poor compliance of malaria patients to primaquine treatment in conjunction with an artemisinin-based combination therapy, loss-to-follow-ups especially in conflict areas, and delays in timely substitution of new batches of primaquine. Respondents from the private sector demanded for the refresher training course on updated antimalarial treatment guidelines. Conclusion Monitoring compliance and safety of primaquine treatment was found as a barrier especially among mobile migrant workers and those who were in conflict areas. An alternative strategy by the NMCP could enable to prevent the underutilization of primaquine in vivax malaria to reach the malaria elimination targets

Controlled Human Infection Studies: Proposals for guidance on how to design, develop and produce a challenge strain

There is an increasing need to establish quality principles for designing, developing and manufacturing challenge agents as currently these agents are classified differently by various jurisdictions. Indeed, considerations for challenge agent manufacturing vary between countries due to differences in regulatory oversight, the categorization of the challenge agent and incorporation into medicinal/vaccine development processes. To this end, a whitepaper on the guidance has been produced and disseminated for consultation to researchers, regulatory experts and regulatory or advisory bodies. This document is intended to discuss fundamental principles of selection, characterization, manufacture, quality control and storage of challenge agents for international reference. In the development phase, CMC documentation is needed for a candidate challenge agent, while standard operating procedure documentation is needed to monitor and control the manufacturing process, followed by use of qualified methods to test critical steps in the manufacturing process, or the final product itself. These activities are complementary: GMP rules, which intervene only at the time of the routine manufacturing of batches, do not contribute to the proper development and qualification of the candidate product. Some considerations regarding suitability of premises for challenge manufacturing was discussed in the presentation dedicated to "routine manufacturing"