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1.
Recurso de Internet en Portugués | LIS - Localizador de Información en Salud | ID: lis-48421

RESUMEN

O efeito de estímulos imunes na manutenção da função neurocognitiva, que pode ser afetada pela infecção por malária, foi o alvo de novo estudo conduzido pelo Laboratório de Pesquisa em Malária do Instituto Oswaldo Cruz (IOC/Fiocruz).


Asunto(s)
Malaria/prevención & control , Disfunción Cognitiva/prevención & control , Malaria/terapia
2.
J Glob Health ; 11: 13008, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34484715

RESUMEN

Backgound: The global community recognizes the urgent need to end preventable child deaths, making it an essential part of the third Sustainable Development Goal. Pneumonia, diarrhoea, and malaria still remain the leading causes of deaths among children under five years, especially in one of the poorest geographic regions of the world - West and Central Africa. This region carries a disproportionately high share of the global burden, both in terms of morbidity and mortality. The study aims to assess levels and trends of the prevalence of these three childhood diseases in West and Central Africa to better inform ongoing and future programmes to improve child survival. Methods: Demographic and Health Surveys and Multiple Indicator Cluster Surveys available from 1995 to 2017 for 23 countries in West and Central Africa were analysed. We estimated the prevalence of diarrhoea, acute respiratory infections (ARI), malaria, and fever as a proxy for malaria, and split the data into three time periods to assess these trends in disease prevalence over time. Further analyses were done to assess the variations by geographic location (urban and rural) and gender (boys and girls). Results: In West and Central Africa, the reduction of the prevalence rates of diarrhoea, acute respiratory infections, malaria, and fever has decelerated over time (1995-2009), and little improvements occurred between 2010 and 2017. The reduction within the region has been uneven and the prevalence rates either increased or stagnated for diarrhoea (nine countries), ARI (four countries), and fever (six countries). The proportion of affected children was high in emergency or fragile settings. Disaggregated analyses of population-based data show persistent gaps between the prevalence of diseases by geographic location and gender, albeit not significant for the latter. Conclusions: Without intensified commitment to reducing the prevalence of pneumonia, malaria, and diarrhoea, many countries will not be able to meet the SDG goal to end preventable child deaths. Evidence-driven programmes that focus on improving equitable access to preventive health care information and services must be fostered, especially in complex emergency settings. This will be an opportunity to strengthen primary health care, including community health programmes, to achieve universal health coverage.


Asunto(s)
Malaria , Infecciones del Sistema Respiratorio , África Central , Niño , Preescolar , Diarrea/epidemiología , Diarrea/prevención & control , Femenino , Salud Global , Humanos , Malaria/epidemiología , Malaria/prevención & control , Masculino , Prevalencia , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/prevención & control
3.
Ig Sanita Pubbl ; 78(4): 564-582, 2021.
Artículo en Italiano | MEDLINE | ID: mdl-34525014

RESUMEN

BACKGROUND: Countries in sub-Saharan Africa remain the most affected by malaria, with nearly 93% of cases and 94% of deaths in 2018 according to the World Health Organization (WHO). According to the WHO, in order to significantly reduce malaria- related incidence and mortality, at least 80% of the population should be covered with insecticide-treated mosquito nets (ITNs). Hence our objective which was on the one hand to determine the rates in terms of possession and use of ITNs in countries located in Sub- Saharan Africa between January 2015 and January 2020, and to determine the impact of the use of ITNs on the probability of being infected with malaria. METHODS: To achieve our goal, we conducted a systematic literature review followed by a meta-analysis. The article search was done in the Scopus, Medline via Ovid, BioRxiv, MedRxiv, Google and Google scholar databases. Data extracted from articles included in the meta-analysis were represented as P-value, Odds Ratio (OR) and 95% confidence interval (CI). RESULTS: We obtained 693 article references published between 2015 and 2020, of which 54 were used in our work. Of these articles, 20 were used to analyze association between ITNs use and the probability of being infected with malaria. We noted an average rate in terms of possession of 75.8%±15.2 and in terms of use of 58.3%±18. This represents a gap of approximately 43.1%±19.2. Many factors was significantly associated with this level of use. These included the wealth quintile, the number of children under 5 in the household, the education level of the head of the household, and the knowledge that sleeping under a mosquito net protects against malaria. Finally, we determined, basis on the meta-analysis, that ITNs use is significantly associated (OR=0.53; 95%CI=[0.45-0.62]) with a decrease in the probability of being infected with malaria. CONCLUSION: The results of this study highlight the huge gap between ITN ownership and use. It is therefore important to increase information and awareness campaigns on the importance of ITNs use against malaria in communities.


Asunto(s)
Mosquiteros Tratados con Insecticida , Insecticidas , Malaria , África del Sur del Sahara/epidemiología , Niño , Humanos , Malaria/epidemiología , Malaria/prevención & control , Control de Mosquitos
4.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 33(4): 373-379, 2021 Aug 20.
Artículo en Chino | MEDLINE | ID: mdl-34505444

RESUMEN

OBJECTIVE: To analyze the epidemiological characteristics and diagnosis of imported malaria before and after malaria elimination in Nanjing City of Jiangsu Province, so as to provide the scientific evidence for formulating the malaria control strategy after malaria elimination. METHODS: Data pertaining to the epidemic situation and individual investigation of malaria in Nanjing City before (from 2012 to 2016) and after malaria elimination (from 2017 to 2020) were captured from the National Notifiable Communicable Disease Reporting System and the Information System for Parasitic Diseases Control and Prevention and were analyzed statistically. RESULTS: A total of 178 malaria cases were reported in Nanjing City from 2012 to 2020, and all were imported cases. There were 99 malaria cases reported before malaria elimination in Nanjing City, including 78 cases with Plasmodium falciparum malaria (78.79%), 5 cases with P. vivax malaria (5.05%), 10 cases with P. ovale malaria (10.10%), 3 cases with P. malariae malaria (3.03%) and 3 cases with mixed infections (3.03%), and 79 malaria cases reported after elimination, including 63 cases with P. falciparum malaria (79.75%), 5 cases with P. vivax malaria (6.33%), 9 cases with P. ovale malaria (11.39%), 2 cases with P. malariae malaria (2.53%). There was no significant difference in the proportion of each type of malaria cases in Nanjing City before and after malaria elimination (χ2 =2.400, P > 0.05). Malaria cases mainly acquired Plasmodium infections in African regions, and no significant difference was seen in the proportion of malaria cases returning to Nanjing City from African countries before and after malaria elimination (χ2 = 0.093, P > 0.05). The number of malaria cases peaked in Nanjing City in January and during the period from May to July before elimination, and there was no apparent seasonal variation in the distribution of malaria cases after elimination. The proportion of malaria cases living in Nanjing City was significantly greater after malaria elimination than before elimination (72.15% vs. 55.56%; χ2 = 5.187, P = 0.023). The proportions of businessmen and international students were both 5.05% before malaria elimination, and increased to 15.19% and 13.92% after elimination, respectively (χ2 = 5.229 and 4.229, both P values < 0.05). The percentage of definitive diagnosis of malaria at initial diagnosis was 18.75% in county-level hospitals before malaria elimination and increased to 61.11% after elimination (χ2 = 6.275, P = 0.012), while the proportion of malaria cases with definitive diagnoses in county-level hospitals was 4.04% before malaria elimination and increased to 13.92% after elimination (χ2 = 5.562, P = 0.018). During the period from 2012 to 2020, the proportion of malaria cases with definitive diagnoses within 1 to 3 days post-admission increased from 27.27% in Nanjing City before malaria elimination to 45.57% after elimination (χ2 = 6.433, P = 0.011). CONCLUSIONS: The epidemic situation of imported malaria remains serious in Nanjing City during the post-elimination stage, and malaria parasite infections predominantly occur in African regions. In addition, there are changes in regional and occupational distributions of malaria cases and the diagnostic capability of malaria increases in county-level hospitals in Nanjing City after malaria elimination. Further improvements in the malaria surveillance system and the diagnostic and treatment capability of malaria in medical institutions at each level are required to consolidate malaria elimination achievements in Nanjing City.


Asunto(s)
Epidemias , Malaria Falciparum , Malaria Vivax , Malaria , China/epidemiología , Ciudades , Humanos , Malaria/diagnóstico , Malaria/epidemiología , Malaria/prevención & control
5.
Trials ; 22(1): 613, 2021 Sep 10.
Artículo en Inglés | MEDLINE | ID: mdl-34507602

RESUMEN

BACKGROUND: In cluster randomized trials (CRTs) of interventions against malaria, mosquito movement between households ultimately leads to contamination between intervention and control arms, unless they are separated by wide buffer zones. METHODS: This paper proposes a method for adjusting estimates of intervention effectiveness for contamination and for estimating a contamination range between intervention arms, the distance over which contamination measurably biases the estimate of effectiveness. A sigmoid function is fitted to malaria prevalence or incidence data as a function of the distance of households to the intervention boundary, stratified by intervention status and including a random effect for the clustering. The method is evaluated in a simulation study, corresponding to a range of rural settings with varying intervention effectiveness and contamination range, and applied to a CRT of insecticide treated nets in Ghana. RESULTS: The simulations indicate that the method leads to approximately unbiased estimates of effectiveness. Precision decreases with increasing mosquito movement, but the contamination range is much smaller than the maximum distance traveled by mosquitoes. For the method to provide precise and approximately unbiased estimates, at least 50% of the households should be at distances greater than the estimated contamination range from the discordant intervention arm. CONCLUSIONS: A sigmoid approach provides an appropriate analysis for a CRT in the presence of contamination. Outcome data from boundary zones should not be discarded but used to provide estimates of the contamination range. This gives an alternative to "fried egg" designs, which use large clusters (increasing costs) and exclude buffer zones to avoid bias.


Asunto(s)
Culicidae , Insecticidas , Malaria , Animales , Humanos , Malaria/prevención & control , Control de Mosquitos , Ensayos Clínicos Controlados Aleatorios como Asunto
8.
BMJ Open ; 11(8): e050400, 2021 08 13.
Artículo en Inglés | MEDLINE | ID: mdl-34389579

RESUMEN

INTRODUCTION: In the Greater Mekong Subregion, community health workers, known as malaria volunteers, have played a key role in reducing malaria in the control phase, providing essential malaria services in areas with limited formal healthcare. However, the motivation and social role of malaria volunteers, and testing rates, have declined with decreasing malaria burden and reorientation of malaria programmes from control to elimination. Provision of additional interventions for common health concerns could help sustain the effectiveness of volunteers and maintain malaria testing rates required for malaria elimination accreditation by the WHO. METHODS AND ANALYSIS: The Community-delivered Integrated Malaria Elimination (CIME) volunteer model, integrating interventions for malaria, dengue, tuberculosis, childhood diarrhoea and malaria Rapid Diagnostic Test (RDT)-negative fever, was developed based on global evidence and extensive stakeholder consultations. An open stepped-wedge cluster-randomised controlled trial, randomised at the volunteer level, will be conducted over 6 months to evaluate the effectiveness of the CIME model in Myanmar. One hundred and forty Integrated Community Malaria Volunteers (ICMVs, current model of care) providing malaria services in 140 villages will be retrained as CIME volunteers (intervention). These 140 ICMVs/villages will be grouped into 10 blocks of 14 villages, with blocks transitioned from control (ICMV) to intervention states (CIME), fortnightly, in random order, following a 1-week training and transition period. The primary outcome of the trial is blood examination rate determined by the number of malaria RDTs performed weekly. Difference in rates will be estimated across village intervention and control states using a generalised linear mixed modelling analytical approach with maximum likelihood estimation. ETHICS AND DISSEMINATION: The study was approved by Institutional Review Board, Myanmar Department of Medical Research (Ethics/DMR/2020/111) and Alfred Hospital Ethics Review Committee, Australia (241/20). Findings will be disseminated in peer-review journals, conferences and regional, national and local stakeholder meetings. TRIAL REGISTRATION NUMBER: NCT04695886.


Asunto(s)
Malaria , Niño , Agentes Comunitarios de Salud , Análisis Costo-Beneficio , Humanos , Malaria/prevención & control , Mianmar , Ensayos Clínicos Controlados Aleatorios como Asunto , Voluntarios
11.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 33(3): 262-266, 2021 Jun 22.
Artículo en Chino | MEDLINE | ID: mdl-34286527

RESUMEN

OBJECTIVE: To analyze the epidemiological features and diagnosis of imported malaria cases in Zhejiang Province from 2017 to 2020, so as to provide the scientific evidence for the management of imported malaria in the province. METHODS: The data of malaria cases reported in Zhejiang Province were captured from the Information Management System for Parasitic Disease Control of China Information System for Disease Control and Prevention from 2017 to 2020, and the temporal, spatial and human distribution, and initial and definitive diagnosis of imported malaria cases were descriptively analyzed. RESULTS: A total of 593 malaria cases were reported in Zhejiang Province from 2017 to 2020, and all were overseas imported cases, including 532 men and 61 women, with a mean age of 41 years. There were 93.93% of the malaria cases from African countries, and the malaria parasites infecting these cases included Plasmodium falciparum, P. vivax, P. ovale, P. malariae and mixed infections, with P. falciparum as the predominant species (76.73%, 455/593). All malaria cases received totally correct initial diagnoses in county- and city-level centers for disease control and prevention (CDC) and entry-exit inspection and quarantine sectors, and the proportion of malaria cases with confirmation at the day of initial diagnosis was 41.48% (207/499) in medical institutions and 66.18% (45/68) in CDC (χ2 = 14.779, P < 0.001). In addition, the median interval [M (QR)] of malaria cases was 1 (2) d from onset to initial diagnosis and 1 (2) d from initial diagnosis to confirmation in Zhejiang Province from 2017 to 2020, and the median interval [M (QR)] of severe malaria cases was significantly longer than that of non-severe cases [2 (3) d vs. 1 (2) d; Z = -3.002, P < 0.05]. CONCLUSIONS: Zhejiang Province faces great challenges of malaria control, and post-elimination surveillance of malaria still requires to be reinforced. Meanwhile, the awareness of seeking medical services requires to be improved among returners from malaria-endemic regions and the diagnostic capability of malaria requires to be improved among medical professionals.


Asunto(s)
Malaria Vivax , Malaria , Adulto , África , China/epidemiología , Ciudades , Femenino , Humanos , Malaria/diagnóstico , Malaria/epidemiología , Malaria/prevención & control , Masculino
12.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 33(3): 308-310, 2021 Jan 13.
Artículo en Chino | MEDLINE | ID: mdl-34286536

RESUMEN

OBJECTIVE: To increase the awareness of malaria prevention and control among people going abroad and returners, so as to prevent the local retransmission of oversea imported malaria. METHODS: Health education interventions for malaria control were given to people going abroad and returners in communities, and the changes of malaria prevention and control knowledge and medical-seeking behaviors were observed among the target populations. RESULTS: There were 367 people going abroad and oversea returners from malaria-endemic areas in Zhangjiagang City from July 2018 to December 2019, and 18 imported malaria cases were found. Following the implementation of community health education, the awareness of malaria prevention and control knowledge increased significantly from 35.09% to 93.08% among the target populations (χ2 = 78.130, P < 0.01), and the proportions of carrying anti-malarial drugs and administration of anti-malarial drugs for emergency treatment increased from 12.14% and 11.46% to 26.79% and 26.79% (χ2 = 8.793 and 9.834, P < 0.05), respectively. In addition, the mean duration from malaria onset to the definitive diagnosis reduced from (5.86 ± 4.45) days to (3.11 ± 1.28) days (U = 64.000, P < 0.05). CONCLUSIONS: Community health education based on the precision community administration is an effective approach for malaria control in current era.


Asunto(s)
Malaria , China/epidemiología , Ciudades , Educación en Salud , Humanos , Malaria/tratamiento farmacológico , Malaria/epidemiología , Malaria/prevención & control
13.
Nat Commun ; 12(1): 4388, 2021 07 19.
Artículo en Inglés | MEDLINE | ID: mdl-34282149

RESUMEN

Mosquito-borne diseases, such as dengue and malaria, pose significant global health burdens. Unfortunately, current control methods based on insecticides and environmental maintenance have fallen short of eliminating the disease burden. Scalable, deployable, genetic-based solutions are sought to reduce the transmission risk of these diseases. Pathogen-blocking Wolbachia bacteria, or genome engineering-based mosquito control strategies including gene drives have been developed to address these problems, both requiring the release of modified mosquitoes into the environment. Here, we review the latest developments, notable similarities, and critical distinctions between these promising technologies and discuss their future applications for mosquito-borne disease control.


Asunto(s)
Insecticidas , Control de Mosquitos/métodos , Técnicas de Amplificación de Ácido Nucleico/métodos , Enfermedades Transmitidas por Vectores/genética , Animales , Animales Modificados Genéticamente , Sistemas CRISPR-Cas , Femenino , Humanos , Malaria/prevención & control , Malaria/transmisión , Masculino , Mosquitos Vectores , Control Biológico de Vectores , Wolbachia/genética
14.
Front Cell Infect Microbiol ; 11: 633905, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34307185

RESUMEN

Malaria, one of the most serious parasitic diseases, kills thousands of people every year, especially in Africa. São Tomé and Príncipe are known to have stable transmission of malaria. Indoor residual spraying (IRS) of insecticides and long-lasting insecticidal nets (LLIN) are considered as an effective malaria control interventions in these places. The resistance status of Anopheles gambiae s.s. from Agua Grande, Caue, and Lemba of São Tomé and Príncipe to insecticides, such as dichlorodiphenyltrichloroethane (DDT) (4.0%), deltamethrin (0.05%), permethrin (0.75%), fenitrothion (1.0%), and malathion (5.0%), were tested according to the WHO standard protocol. DNA extraction, species identification, as well as kdr and ace-1R genotyping were done with the surviving and dead mosquitoes post testing. They showed resistance to cypermethrin with mortality rates ranging from 89.06% to 89.66%. Mosquitoes collected from Agua Grande, Caue, and Lemba displayed resistance to DDT and fenitrothion with mortality rates higher than 90%. No other species were detected in these study localities other than Anopheles gambiae s.s. The frequency of L1014F was high in the three investigated sites, which was detected for the first time in São Tomé and Príncipe. No ace-1R mutation was detected in all investigated sites. The high frequency of L1014F showed that kdr L1014F mutation might be related to insecticide resistance to Anopheles gambiae s.s. populations from São Tomé and Príncipe. Insecticide resistance status is alarming and, therefore, future malaria vector management should be seriously considered by the government of São Tomé and Príncipe.


Asunto(s)
Anopheles , Malaria , África , Animales , Anopheles/genética , Humanos , Malaria/prevención & control , Mosquitos Vectores/genética , Mutación , Santo Tomé y Príncipe
15.
BMJ Open ; 11(7): e045900, 2021 07 07.
Artículo en Inglés | MEDLINE | ID: mdl-34233975

RESUMEN

INTRODUCTION: In the Greater Mekong Subregion, adults are at highest risk for malaria. The most relevant disease vectors bite during daytime and outdoors which makes forest work a high-risk activity for malaria. The absence of effective vector control strategies and limited periods of exposure during forest visits suggest that chemoprophylaxis could be an appropriate strategy to protect forest goers against malaria. METHODS AND ANALYSIS: The protocol describes an open-label randomised controlled trial of artemether-lumefantrine (AL) versus multivitamin as prophylaxis against malaria among forest goers aged 16-65 years in rural northeast Cambodia. The primary objective is to compare the efficacy of the artemisinin combination therapy AL versus a multivitamin preparation as defined by the 28-day PCR parasite positivity rate and incidence of confirmed clinical malaria of any species. The sample size is 2200 patient-episodes of duration 1 month in each arm. The duration of follow-up and prophylaxis for each participant is 1, 2 or 3 consecutive 28-day periods, followed by a further 28 days of post-exposure prophylaxis, depending on whether they continue to visit the forest. Analysis will be done both by intention to treat and per protocol. ETHICS AND DISSEMINATION: All participants will provide written, informed consent. Ethical approval was obtained from the Oxford Tropical Research Ethics Committee and the Cambodia National Ethics Committee for Health Research. Results will be disseminated by peer-reviewed open access publication together with open data. TRIAL REGISTRATION NUMBER: NCT04041973; Pre-result.


Asunto(s)
Antimaláricos , Malaria Falciparum , Malaria , Adulto , Antimaláricos/uso terapéutico , Arteméter/uso terapéutico , Combinación Arteméter y Lumefantrina/uso terapéutico , Cambodia , Bosques , Humanos , Malaria/tratamiento farmacológico , Malaria/prevención & control , Malaria Falciparum/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
16.
Artículo en Inglés | MEDLINE | ID: mdl-34199088

RESUMEN

Malaria parasites are transmitted to humans by infectious female Anopheles mosquitoes. Chemical-insecticide-based mosquito control has been successful in reducing the burden of malaria. However, the emergence of insecticide resistance in malaria vectors and concerns about the effect of the chemicals on the environment, human health, and non-target organisms present a need for new or alternative vector control intervention tools. Biocontrol methods using aquatic invertebrate predators have emerged as a potential alternative and additional tool to control mosquito populations. Ecological control specifically makes use of species insights for improving the physical habitat conditions of competitors and predators of vectors. A first step towards this is to gain knowledge on the predation potential of several typically present macroinvertebrates. Hence, this study aimed at (1) examining the influence of the predation of hemipterans on the number of emerging adult mosquitoes and (2) detecting Anopheles mosquito DNA in the gut of those predators. The prey and predators were collected from a range of water bodies located in the Gilgel Gibe watershed, southwest Ethiopia. A semi-field study was carried out using mesocosms which were constructed using plastic containers mimicking the natural aquatic habitat of immature Anopheles mosquitoes. Adult mosquitoes that emerged from the mesocosms were collected using a mechanical aspirator. At the end of the experiment, predators were withdrawn from the mesocosms and identified to genus level. Polymerase Chain Reaction (PCR) was employed to identify sibling species of Anopheles gambiae s.l. and to detect Anopheles mosquito DNA in the gut of the predators. Data were analysed using R software. Giant water bugs (belostomatids) were the most aggressive predators of Anopheles larvae, followed by backswimmers (notonectids) and water boatmen (corixids). All female Anopheles gambiae s.l. emerged from the mesocosms were identified as Anopheles arabiensis. Anopheles arabiensis DNA was detected in the gut content of hemipteran specimens analysed from the three families. The number of the adult mosquitoes emerging from the mesocosms was affected by the presence of predators. The findings of this study provide evidence of the potential use of aquatic macroinvertebrate predators as biocontrol agents against immature Anopheles mosquitoes and their potential to be considered as a component of integrated vector management for insecticide resistance and the combined restoration of aquatic ecosystems via smart ecological engineering.


Asunto(s)
Anopheles , Insecticidas , Malaria , Animales , Ecosistema , Etiopía , Femenino , Humanos , Larva , Malaria/prevención & control , Control de Mosquitos , Mosquitos Vectores , Conducta Predatoria
17.
Nature ; 595(7866): 289-294, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34194041

RESUMEN

The global decline in malaria has stalled1, emphasizing the need for vaccines that induce durable sterilizing immunity. Here we optimized regimens for chemoprophylaxis vaccination (CVac), for which aseptic, purified, cryopreserved, infectious Plasmodium falciparum sporozoites (PfSPZ) were inoculated under prophylactic cover with pyrimethamine (PYR) (Sanaria PfSPZ-CVac(PYR)) or chloroquine (CQ) (PfSPZ-CVac(CQ))-which kill liver-stage and blood-stage parasites, respectively-and we assessed vaccine efficacy against homologous (that is, the same strain as the vaccine) and heterologous (a different strain) controlled human malaria infection (CHMI) three months after immunization ( https://clinicaltrials.gov/ , NCT02511054 and NCT03083847). We report that a fourfold increase in the dose of PfSPZ-CVac(PYR) from 5.12 × 104 to 2 × 105 PfSPZs transformed a minimal vaccine efficacy (low dose, two out of nine (22.2%) participants protected against homologous CHMI), to a high-level vaccine efficacy with seven out of eight (87.5%) individuals protected against homologous and seven out of nine (77.8%) protected against heterologous CHMI. Increased protection was associated with Vδ2 γδ T cell and antibody responses. At the higher dose, PfSPZ-CVac(CQ) protected six out of six (100%) participants against heterologous CHMI three months after immunization. All homologous (four out of four) and heterologous (eight out of eight) infectivity control participants showed parasitaemia. PfSPZ-CVac(CQ) and PfSPZ-CVac(PYR) induced a durable, sterile vaccine efficacy against a heterologous South American strain of P. falciparum, which has a genome and predicted CD8 T cell immunome that differs more strongly from the African vaccine strain than other analysed African P. falciparum strains.


Asunto(s)
Anticuerpos Neutralizantes/inmunología , Hígado/inmunología , Hígado/parasitología , Vacunas contra la Malaria/inmunología , Plasmodium falciparum/efectos de los fármacos , Plasmodium falciparum/inmunología , Vacunas Atenuadas/inmunología , Adulto , Animales , Formación de Anticuerpos/inmunología , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Estadios del Ciclo de Vida/inmunología , Malaria/sangre , Malaria/inmunología , Malaria/parasitología , Malaria/prevención & control , Vacunas contra la Malaria/administración & dosificación , Vacunas contra la Malaria/efectos adversos , Vacunas contra la Malaria/química , Masculino , Persona de Mediana Edad , Plasmodium falciparum/crecimiento & desarrollo , Linfocitos T/citología , Linfocitos T/inmunología , Linfocitos T/metabolismo , Factores de Tiempo , Vacunación/efectos adversos , Vacunas Atenuadas/administración & dosificación , Vacunas Atenuadas/efectos adversos , Vacunas Atenuadas/química
19.
Lancet Glob Health ; 9(9): e1325-e1331, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34216565

RESUMEN

From 2004 to 2019, insecticide-treated bednets (ITNs) have been the most effective tool for reducing malaria morbidity and mortality in sub-Saharan Africa. Recently, however, the decline in malaria cases and deaths has stalled. Some suggest that this inertia is due to increasing resistance in malaria vectors to the pyrethroid insecticides used for treating ITNs. However, there is presently little evidence to reach this conclusion and we therefore recommend that a broader perspective to evaluate ITN effectiveness in terms of access to nets, use of nets, bioefficacy, and durability should be taken. We argue that a single focus on insecticide resistance misses the bigger picture. To improve the effects of ITNs, net coverage should increase by increasing funding for programmes, adopting improved strategies for increasing ITN uptake, and enhancing the longevity of the active ingredients and the physical integrity of nets, while simultaneously accelerating the development and evaluation of novel vector control tools.


Asunto(s)
Mosquiteros Tratados con Insecticida , Malaria/prevención & control , Control de Mosquitos/métodos , Humanos , Resistencia a los Insecticidas , Ensayos Clínicos Controlados Aleatorios como Asunto
20.
BMJ Open ; 11(7): e044715, 2021 07 13.
Artículo en Inglés | MEDLINE | ID: mdl-34257091

RESUMEN

BACKGROUND: As infectious diseases approach global elimination targets, spatial targeting is increasingly important to identify community hotspots of transmission and effectively target interventions. We aimed to synthesise relevant evidence to define best practice approaches and identify policy and research gaps. OBJECTIVE: To systematically appraise evidence for the effectiveness of spatially targeted community public health interventions for HIV, tuberculosis (TB), leprosy and malaria. DESIGN: Systematic review. DATA SOURCES: We searched Medline, Embase, Global Health, Web of Science and Cochrane Database of Systematic Reviews between 1 January 1993 and 22 March 2021. STUDY SELECTION: The studies had to include HIV or TB or leprosy or malaria and spatial hotspot definition, and community interventions. DATA EXTRACTION AND SYNTHESIS: A data extraction tool was used. For each study, we summarised approaches to identifying hotpots, intervention design and effectiveness of the intervention. RESULTS: Ten studies, including one cluster randomised trial and nine with alternative designs (before-after, comparator area), satisfied our inclusion criteria. Spatially targeted interventions for HIV (one USA study), TB (three USA) and leprosy (two Brazil, one Federated States of Micronesia) each used household location and disease density to define hotspots followed by community-based screening. Malaria studies (one each from India, Indonesia and Kenya) used household location and disease density for hotspot identification followed by complex interventions typically combining community screening, larviciding of stagnant water bodies, indoor residual spraying and mass drug administration. Evidence of effect was mixed. CONCLUSIONS: Studies investigating spatially targeted interventions were few in number, and mostly underpowered or otherwise limited methodologically, affecting interpretation of intervention impact. Applying advanced epidemiological methodologies supporting more robust hotspot identification and larger or more intensive interventions would strengthen the evidence-base for this increasingly important approach. PROSPERO REGISTRATION NUMBER: CRD42019130133.


Asunto(s)
Infecciones por VIH , Lepra , Malaria , Tuberculosis , Brasil , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Humanos , India , Indonesia , Kenia , Lepra/epidemiología , Lepra/prevención & control , Malaria/epidemiología , Malaria/prevención & control
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