Tracking and Treating Malaria
with the London School of Hygiene and Tropical Medicine
Malaria is a life- threatening disease spread to humans by some types of mosquitoes. It is mostly found in tropical countries and is preventable and curable. The infection is caused by a single-celled parasite of the genus plasmodium and cannot spread from human to human. Symptoms of malaria can vary, with some people suffering mild symptoms including fever, chills and headache and some suffering much more severe symptoms such as seizures and difficulty breathing. Ultimately, malaria can be fatal.
In 2022, according to the World Health Organization, there were 249 million cases of malaria globally, and 608,000 malaria deaths in 85 countries. The African Region carries a disproportionately high share of the global malaria burden and in 2022, was home to 94% of malaria cases and 95% of malaria deaths. Malaria is a particular risk to children under five years, pregnant women, travelers and people with HIV or AIDS. In 2022, children under five accounted for about 80% of all malaria deaths in the African Region.
Targeting P. vivax
There are five Plasmodium parasite species that cause malaria in humans and two of these species, P. falciparum and P. vivax pose the greatest threat. The deadliest malaria parasite is the P. falciparum however, P. vivax is the dominant malaria parasite in most countries outside of sub-Saharan Africa. Within sub-Saharan Africa, most P. vivax cases are found in the Horn of Africa notably Ethiopia, Madagascar, and Mauritania, and the field activities of this project focus on Ethiopia and Madagascar.
Total malaria elimination requires the elimination of all malaria species. Although there has been tremendous progress in the development of new interventions for particular strains of malaria, the goal of malaria elimination cannot be considered achievable unless there is comparable innovation for interventions specifically targeting these particularly deadly parasites.
Scientists at the Institut Pasteur have partnered with the London School of Hygiene and Tropical Medicine to develop new strategies for controlling the P. vivax parasite. P. vivax malaria is resilient to elimination efforts due to its ability to form dormant liver stages (hypnozoites). These hypnozoites cannot be detected and can reactivate weeks to months after initial infection, causing relapse infection. Blood- stage parasites arising from relapses can cause illness and allow onwards transmission from humans to mosquitos, thus increasing circulation in the population.
In collaboration with partners from The Walter and Elisa Hall Institute in Australia, Institut Pasteur and the London School of Hygiene and Tropical Medicine have developed a diagnostic test to measure antibodies to a selection of P. vivax antigens that identifies individuals who have been recently infected, and thus likely to carry hypnozoites. These individuals can be targeted for treatment with primaquine to clear hypnozoites and prevent relapse infection. This combination of a novel diagnostic test and primaquine treatment provides a new intervention for malaria control and elimination.
The overall objective of this project is to implement a cluster-randomised trial in Ethiopia and Madagascar to demonstrate the effectiveness of a new anti- malaria intervention based on this P. vivax test and treatment model. In parallel, the Institut Pasteur and the London School of Hygiene and Tropical Medicine are working with Institut Pasteur de Madagascar, the Armauer Hansen Research Institute, FIND, University of Galway and the Warsaw University of Technology to innovate mobile technologies for efficient implementation and develop machine learning approaches for population- level malaria surveillance.
Working towards malaria elimination
Early diagnosis and treatment of malaria can dramatically reduce disease, prevent deaths and reduce transmission in areas that are highly susceptible to infection. Developing effective testing is a key step in taking us closer to malaria elimination.
Malaria elimination is defined by the WHO as ‘the interruption of local transmission of a specified malaria parasite species in a defined geographical area as a result of deliberate activities.’
In 2022, 34 countries reported fewer than 1000 indigenous cases of the diseases, an increase of 21 countries since 2000. This project between the Institut Pasteur and the London School of Hygiene and Tropical Medicine is in line with the goals of the WHO’s Global technical strategy of malaria for 2016-2030 which seeks to reduce malaria case incidence and malaria mortality rates by at least 90% by 2030. It would see us come a long way since Pasteurian Alphonse Laveran won the Nobel Prize for the discovery of the protozoan responsible for malaria in 1880.
Key Programme Objectives
The programme has four key objectives, focusing on the impact of the research, the sustainability of the programme and the continued effectiveness within the local communities.
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Perform clinical trials to assess efficacy of testing and treatment.
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Assess acceptance of testing and treatment programme among local communities and health systems.
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Develop mobile health technologies to facilitate programme implementation.
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Develop machine learning approaches for population- level malaria surveillance.
Programme Directors
This programme is jointly coordinated by representatives from the Institut Pasteur and the London School of Hygiene and Tropical Medicine.
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Dr Michael White, Director of Research Institut Pasteur
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Professor Chris Drakeley, Professor of Infection and Immunity Infection Biology, London School of Hygiene and Tropical Medicine
Overall project impact is assured by the Institut Pasteur and the London School of Hygiene and Tropical Medicine, with key actions and input by all partners including Institut Pasteur de Madagascar, MEDEA, the Armauer Hansen Research Institute, FIND, the University of Galway and the Warsaw University of Technology
How can you help?
By making a gift to Pasteur Foundation- UK, you will be supporting our PF- UK Impact Grant programme. PF-UK Impact Grant's support projects like this one that see scientists at the Institut Pasteur and a UK institution joining forces and research expertise to tackle global public health challenges together.
If you would like to explore setting up your own PF-UK Impact Grant, or would like to learn more about this specific project, please get in touch with our Head of Development, Sarah Bridge.
sarah.bridge@pasteurfoundation.uk
Thank you!
We are delighted that this programme is already fully funded thanks to the generous support of UK and European funders.
Funded by the European Union. Views and opinions expressed are, however, those of the author(s) only and do not necessarily reflect those of the European Union or HADEA. Neither the European Union nor the granting authority can be held responsible for them.
Images from the field
Below you can find some photographs the team have shared with us from visits to the field in Ethopia and Madagascar. You can learn more and get updates from this specific project here:
