Antimalarial Drug Evaluations: Namru-2 And Indonesian Partnership

Meningkatnya insiden malaria di beberapa daerah tertentu terutama di Indonesia Bagian Timur disebabkan antara lain : P. falciparum telah resisten terhadap beberapa obat antimalaria, ditemukannya P. vivax resisten klorokuin, dan belum tersedianya vaksin yang efektif. Sehubungan dengan hal tersebut, dilakukanlah evaluasi obat antimalaria yang perlu dipertimbangkan dalam peningkatan pelaksanaan program. Obat antimalaria meflokuin, halofantrin dan beberapa derivat qinghaosu (artesunat dan artemeter) telah diuji coba klinik di Indonesia, dan memberikan efikasi yang cukup baik walaupun perlu dipertimbangkan kemungkinan efek samping dan resistensi atau rekrudesensi yang mungkin terjadi serta harganya yang relatif masih mahal. Obat antimalaria baru yang direncanakan akan diuji coba klinik adalah azithromycin, derivat primaquine WR 238605, atovaquone dan derivat qinghaosu lain. Dasar pengembangan pengobatan malaria adalah sebagai berikut: Meningkatkan atau memperbaiki efikasi pengobatan malaria tanpa komplikasi yaitu dengan mengembangkan kombinasi atau regimen obat antimalaria yang tersedia di Indonesia (klorokuin dan tetrasiklin/doksisiklin) atau dengan mempersiapkan obat antimalaria baru (derivat qinghaosu, atovaquone, azithromycin dan WR 238605).Mencari obat antimalaria baru alternatif yang efektif sebagai obat penyelamat untuk pengobatan malaria dengan komplikasi. Dengan melakukan evaluasi obat antimalaria ini, akan didapat data efikasi dan keamanan yang dapat membantu Departemen Kesehatan untuk menentukan obat pilihan di Indonesia. Selain itu juga dapat ikut membantu menanggulangi masalah malaria di dunia

Epidemic Malaria Among Transmigrants in Irian Jaya

Malaria merupakan masalah kesehatan yang penting untuk masyarakat transmigrasi di daerah endemisitas malaria tinggi seperti Irian Jaya. Di Arso, epidemi malaria timbul setelah dua sampai enam bulan sesudah tibanya transmigran baru. Dalam tiga bulan angka parasitemia bisa mencapai 70% dan hampir 10% dari transmigran mendapat malaria berat yang membutuhkan rujukan ke rumah sakit dalam enam bulan p< rtama. Usaha penanggulangan malaria di daerah seperti Arso menghadapi berbagai tantangan dan hambatan karena tingginya derajat resistensi parasit terhadap klorokuin, fasilitas dan kemampuan untuk diagnostik yang terbatas, sulitnya pengendalian vektor (An. punctulatus group) dan tidak adanya strategi untuk menghilangkan sumber infeksi yang asimptomatik. Berbagai USAha yang dapat mengurangi risiko epidemi malaria di daerah transmigrasi Irian Jaya ialah antara lain pemberian profilaksis selama tiga bulan (selain klorokuin perlu dipertimbangkan pemberian primakuin bagi transmigran yang tidak hamil dan tidak menderita defisiensi G-6-PD), peningkatan fasilitas diagnostik dan pengobatan/termasuk rujukan untuk kasus malaria berat), pemakaian kelambu; penemuan kasus aktif untuk menghilangkan gametocytemia yang asimptomatik (selama enam bulan) serta penyuluhan dan partisipasi masyarakat dalam pemberantasan malaria (termasuk pembinaan kader kesehatan). Untuk melaksanakan kegiatan tersebut di atas perlu disediakan tenaga dan sumber dana yang khusus

Opportunities For Evaluating Malaria Vaccines In Indonesia

Di Indonesia, khususnya di Irian Jaya dan daerah malaria tinggi lainnya terdapat kesempatan yang sangat baik untuk mengevaluasi vaksin malaria. Hal ini antara lain disebabkan tersedianya data epidemiologi termasuk insidens, risiko malaria yang tinggi dan merata pada berbagai kelompok umur, jenis kelamin dan pekerjaan, adanya kelompok masyarakat yang sesuai untuk penelitian (transmigran dan angkatan bersenjata), lokasi desa yang memungkinkan randomisasi serta tersedianya fasilitas laboratorium di dekat daerah penelitian. Pemberantasan malaria dengan vaksinasi diharapkan akan menjadi fokus dari penelitian kesehatan menjelang akhir abad ke-20. Indonesia yang terdiri dari berbagai pulau memungkinkan konsolidasi pemberantasan malaria secara bertahap. Pengalaman yang diperoleh dengan pemberantasan malaria di suatu pulau akan sangat bermanfaat untuk menghadapi masalah yang lebih berat yakni malaria di daratan luas seperti Afrika atau daratan Asia Tenggara

Protection of Rhesus Monkeys by a DNA Prime/Poxvirus Boost Malaria Vaccine Depends on Optimal DNA Priming and Inclusion of Blood Stage Antigens

(Pk) malaria. This is a multi-stage vaccine that includes two pre-erythrocytic antigens, PkCSP and PkSSP2(TRAP), and two erythrocytic antigens, PkAMA-1 and PkMSP-1(42kD). The present study reports three further experiments where we investigate the effects of DNA dose, timing, and formulation. We also compare vaccines utilizing only the pre-erythrocytic antigens with the four antigen vaccine.In three experiments, rhesus monkeys were immunized with malaria vaccines using DNA plasmid injections followed by boosting with poxvirus vaccine. A variety of parameters were tested, including formulation of DNA on poly-lactic co-glycolide (PLG) particles, varying the number of DNA injections and the amount of DNA, varying the interval between the last DNA injection to the poxvirus boost from 7 to 21 weeks, and using vaccines with from one to four malaria antigens. Monkeys were challenged with Pk sporozoites given iv 2 to 4 weeks after the poxvirus injection, and parasitemia was measured by daily Giemsa stained blood films. Immune responses in venous blood samples taken after each vaccine injection were measured by ELIspot production of interferon-γ, and by ELISA.1) the number of DNA injections, the formulation of the DNA plasmids, and the interval between the last DNA injection and the poxvirus injection are critical to vaccine efficacy. However, the total dose used for DNA priming is not as important; 2) the blood stage antigens PkAMA-1 and PkMSP-1 were able to protect against high parasitemias as part of a genetic vaccine where antigen folding is not well defined; 3) immunization with PkSSP2 DNA inhibited immune responses to PkCSP DNA even when vaccinations were given into separate legs; and 4) in a counter-intuitive result, higher interferon-γ ELIspot responses to the PkCSP antigen correlated with earlier appearance of parasites in the blood, despite the fact that PkCSP vaccines had a protective effect

The impact of Loa loa microfilaraemia on research subject retention during a whole sporozoite malaria vaccine trial in Equatorial Guinea

Loa loa microfilariae were found on thick blood smears (TBSs) from 8 of 300 (2.7%) residents of Bioko Island, Equatorial Guinea, during a Plasmodium falciparum sporozoite malaria vaccine clinical trial. Only one subject was found to have microfilaraemia on his first exam; parasites were not discovered in the other seven until subsequent TBSs were performed, at times many weeks into the study. All infected individuals were asymptomatic, and were offered treatment with diethylcarbamazine, per national guidelines. L. loa microfilaraemia complicated the enrolment or continued participation of these eight trial subjects, and only one was able to complete all study procedures. If ruling out loiasis is deemed to be important during clinical trials, tests that are more sensitive than TBSs should be performed

Malaria in a cohort of Javanese migrants to Indonesian Papua

The epidemiology of infection by Plasmodium falciparum and P. vivax was investigated among Javanese migrants to an endemic region of Papua, Indonesia. A cohort of 243 migrants from Java was followed for malaria in a new settlement village in the endemic Armopa area of north–eastern Papua, beginning on the day each migrant arrived in the village. The subjects were monitored during home visits (three/week) and by the twice-monthly production of bloodsmears that were checked for malarial parasites. At the end of 33 months, 159 (65%) of the subjects remained under follow-up. The prevalence of parasitaemia in the village declined from 16% among those already living there when the study began in August 1996, to 5% when the study finished in June 1999. Over this period, 596 infections by P. falciparum and 723 by P. vivax occurred in the cohort, 22 and 27 of the subjects each experiencing at least six infections by P. falciparum and P. vivax, respectively. The incidence of malarial infection was higher during the first and second years post-migration (3.2 and 2.7 infections/person-year) than during the third (1.2 infections/person-year). Although the geometric mean parasite counts for P. falciparum increased over time (1209, 1478, and 1830 parasites/ml in the first, second and third years, respectively), the corresponding values for P. vivax (497, 535 and 490 parasites/ml ) showed no such trend. Only one of the nine subjects who developed severe malaria (requiring intravenous quinine therapy) was a child, giving an odds ratio for a case of severe malaria being in an adult of 6.1 (P=0.08)

Pola Penyakit Transmigran Jawa dan Transmigran Lokal di Daerah Hiperendemis Malaria Armopasp2, Kecamatan Bonggo, Kabupaten Jayapura, Papua, Tahun 1996-1999

POLA PENYAKIT TRANSMIGRAN JAWA DAN TRANSMIGRAN LOKAL DI DAERAH HIPERENDEMIS MALARIA ARMOPASP2, KECAMATAN BONGGO, KABUPATEN JAYAPURA, PAPUA , TAHUN 1996-199

Confirmed SARS-CoV-2 infection in Scottish neonates 2020-2022: a national, population-based cohort study

Objectives: To examine neonates in Scotland aged 0–27 days with SARS-CoV-2 infection confirmed by viral testing; the risk of confirmed neonatal infection by maternal and infant characteristics; and hospital admissions associated with confirmed neonatal infections. Design: Population-based cohort study. Setting and population: All live births in Scotland, 1 March 2020–31 January 2022. Results: There were 141 neonates with confirmed SARS-CoV-2 infection over the study period, giving an overall infection rate of 153 per 100 000 live births (141/92 009, 0.15%). Among infants born to women with confirmed infection around the time of birth, the confirmed neonatal infection rate was 1812 per 100 000 live births (15/828, 1.8%). Two-thirds (92/141, 65.2%) of neonates with confirmed infection had an associated admission to neonatal or (more commonly) paediatric care. Six of these babies (6/92, 6.5%) were admitted to neonatal and/or paediatric intensive care; however, none of these six had COVID-19 recorded as their main diagnosis. There were no neonatal deaths among babies with confirmed infection. Implications and relevance: Confirmed neonatal SARS-CoV-2 infection was uncommon over the first 23 months of the pandemic in Scotland. Secular trends in the neonatal confirmed infection rate broadly followed those seen in the general population, although at a lower level. Maternal confirmed infection at birth was associated with an increased risk of neonatal confirmed infection. Two-thirds of neonates with confirmed infection had an associated admission to hospital, with resulting implications for the baby, family and services, although their outcomes were generally good. Ascertainment of confirmed infection depends on the extent of testing, and this is likely to have varied over time and between groups: the extent of unconfirmed infection is inevitably unknown