Upload
neva
View
47
Download
0
Tags:
Embed Size (px)
DESCRIPTION
In viaggio con la malaria. Seminario L'avete fatto a me Milano, 22 marzo 2014. Franco Pagnoni [email protected]. www.who.int/malaria. Approximately 3.3 billion at risk of malaria and 1.2 billion at high risk. Popolazioni a rischio malarico. Total population. Population at any risk. - PowerPoint PPT Presentation
Citation preview
11
In viaggio con la malaria
Franco [email protected]
Seminario L'avete fatto a meMilano, 22 marzo 2014
22
www.who.int/malaria
33
Popolazioni a rischio malarico
Approximately 3.3 billion at risk of malaria and 1.2 billion at high risk
Total population
Africa 774 647 586 76%Americas 895 137 61 7%
Eastern Mediterranean 540 295 66 12%Europe 887 22 2 0%South-East Asia 1,721 1,319 457 27%Western Pacific 1,763 888 54 3%
World 6,581
3,308
1,226
19%
Population at any risk
Population at high risk
High risk (%)
44
Il mondo ridisegnato dalla malaria
Dorling D Worldmapper. PLoS Med 4 (1), 2007
55
Risorse per lotta alla malariaAfrica sub-sahariana, 2005-2012
66
Le zanzariere impregnate di insetticida a lunga durata d'azione
Riduzione del 25% della mortalità per chi dorme stabilmente sotto zanzariera impregnata
77
Prevenzione – Disponibilità di zanzariere impregnate di insetticida a lunga durata d'azione
Africa – 2004-2013
88
99
Prevenzione – Popolazione protetta da zanzariere o spray intradomiciliare – Africa
1010
Prevenzione – Protezione della donna in gravidanza Africa
Gravità ingravescente: 1° gravidanza > 2° gravidanza > gravidanze successiveInsuffcienza renale acutaEdema polmonare
1111
Prevenzione – Protezione della donna in gravidanza Africa
1212
Diagnosi di malaria
1313
Diagnosi di malaria
1414
Incidenza e mortalità
1515
Incidenza e mortalità
1616 16
Il vaccino antimalaricio - il ciclo del Plasmodio
1717
Prevent infection
Reduce clinical diseaseseverity
Interrupttransmission
Target stage Clinical effect
PRE-ERYTHROCYTIC(RTS,S)
BLOOD STAGE
SEXUAL STAGE
I punti di azione dei diversi vaccini antimalarici
1818 18
Pre-erythrocytic Vaccines
<50
~100,000,000,000
<5
Antibodies
Antibodies
Effector T cells
Antibodies
Pf Pv CSPTRAPLSA1 LSA3
CELTOS
MSP1AMA1MSP3
GLURP, SERA, SR11.1, P27, MSP2, EBA175, PvDBP, Rh
Pvs25/Pfs25
AgAPN1Pfs230
Pfs48/45
191919
Many Blood stage vaccines are under evaluation
<50
~100,000,000,000
<5
Antibodies
Antibodies
Effector T cells
Antibodies
Pf Pv CSPTRAPLSA1 LSA3
CELTOS
MSP1AMA1MSP3
GLURP, SERA, SR11.1, P27, MSP2, EBA175, PvDBP, Rh
Pvs25/Pfs25
AgAPN1Pfs230
Pfs48/45
202020
Sexual stage/mosquito antigen vaccines are conceptually attractive for interrupting transmission
<50
~100,000,000,000
<5
Antibodies
Antibodies
Effector T cells
Antibodies
Pf Pv CSPTRAPLSA1 LSA3
CELTOS
MSP1AMA1MSP3
GLURP, SERA, SR11.1, P27, MSP2, EBA175, PvDBP, Rh
Pvs25/Pfs25
AgAPN1Pfs230
Pfs48/45
2121
Take home messages
There is no licensed or available malaria vaccine One candidate RTS,S/AS01 is the most advanced, and the first
WHO recommendations on use are expected in 2015 Even higher efficacy vaccines are desired and we have 2030 goals
for highly effective clinical disease prevention and elimination vaccines
Non-vaccine control ↓deaths by 25% to estimated 660,000 over last decade. Emerging drug and insecticide resistance threaten malaria control. New tools are needed.
Malaria Vaccine R&D is a very active and exciting area!
2222
In viaggio... senza la malaria
2323
In viaggio... senza la malaria
http://www.iamat.org/disease_details.cfm?id=140&gclid=CPSIxtPPmb0CFWfLtAod1AsAIg
http://www.who.int/ith/en/
http://www.who.int/topics/malaria/en/
2424
Interventi di lotta alla malaria a base comunitaria
------------The Rapid Access Expansion 2015 project
2525
Razionale
Impacto facility-based interventions
alone fail to impact on child mortality
Equityo iCCM example of a strategy
to achieve equitable results o HF services are less likely
to be accessed by the pooro Opportunity costs > direct
costs
2626
New findings on disparities
Many regions have reduced disparities in under-five mortality between the poorest and the richest except Sub-Saharan Africa and South Asia
Under-five mortality rate has declined among even the poorest in all regions Source: UNICEF analysis based on Pedersen, J., et al., Levels and Trends in
Inequity and Child Mortality: Evidence from DHS and MICS surveys', working paper, unpublished, 2013.'
2727
C'è una notevole sovrapposizione sintomatologica tra malaria e polmonite
I test diagnostici (RDT), se negativi, consentono di escludere la malaria
Malaria, polmonite e diarrea sono le cause più frequenti di mortalità post-neonatale
UN Child Mortality Report 2010
Razionale per un approccio integrato a malaria, polmonite e diarrea
2828
RAcE 2015 - Key elements
Award
Grant awarded by CIDA in April 2012, CAD 74.5 million
5 year program in 5 countries: Malawi, Mozambique, DRC, Niger, Nigeria (2 states)
Selection criteria: high disease burden, enabling policy, commitment by MoH, potential for scale-up;
Implemented through NGOs; 2M/country/yr – 3 M/yr in NIgeria (1.5M/state)
Objectives
1. Increase access to correct diagnosis, treatment and referrals for malaria, pneumonia and diarrhea at the community level
2. Stimulate policy review and regulatory update on disease case management at the community level (WHO comparative advantage)
2929
Malawi: 4 districts, 190,359 children; Consortium of 4 NGOs led by SAVE; start April 2013
Mozambique: 4 provinces, 308,000 children; SAVE+MC; April2013
DRC: 7 Health Zones in Tanganika district, 150,000 children; IRC; September 2013
Niger: 4 districts, 230,833 children; World Vision; July 2013
Nigeria: Niger state, 6 LGAs, 162,000 children; Malaria ConsortiumAbia state: 6 LGAs, 245,000 children: Society for Family HealthNovember 2013
3030
Total coverage: 1,286,000 children aged 2-59 months living in
"hard to reach" areas, each year, in 5 countries
3131
Grazie per l'attenzione