Malaria RTS,S Vaccine

I recently did some private study on malaria and the development of the RTS,S vaccine which is "the first malaria vaccine candidate to ever reach large-scale Phase III clinical testing"  (http://tinyurl.com/cm6q6zx). You can find about the outline of clinical trials on the 'Clinical Trials' page.

What I found was that although there are currently ways of preventing malaria or treatments that are available once malaria is contracted, a lot of them take time to teach people how to use them and other solutions have to be replaced after a certain time period. For example; I looked at LLIN's and ITN's and the comparison between them. I found that LLIN's (long-lasting insecticide-treated mosquito nets) were of a better standard than ITN's (insecticide-treated mosquito nets) because they last around 3 years opposed to 12-18 months. This means that the distributor (mainly the WHO) does not have to go back to the same place every year but can distribute further afield or spend time funding other projects.

Another solution are antimalarial drugs, but mosquitoes are becoming/have become resistant to certain drugs; as was reported today; "scientists have found new evidence that resistance to the front-line treatments for malaria is increasing" (http://www.bbc.co.uk/news/health-17628172).

IRS (indoor residual spray) is another option but there are issues to do with the component of the spray; DDT (Dichlorodiphenyltrichloroethane) which is thought by many to have environmental impacts and also health impacts, although the WHO disagrees and; "announced that this intervention will once again play a major role in its efforts to fight the disease; Dr Anarfi Asamoa-Baah, WHO Assistant Director-General for HIV/AIDS, TB and Malaria said; DDT presents no health risk when used properly” (http://www.who.int/mediacentre/news/releases/2006/pr50/en/).

Therefore, the newest development in the fight against malaria to prevent the disease that affects millions of people every year is the RTS,S vaccine. It has been under development for 25 years and is the most clinically advanced malaria vaccine there has ever been and there has been a huge amount of investment in the development by a number of huge companies.

Results from the Phase III trials were released in 2009 by the "New England Journal of Medicine". On their website there are a number of interesting tables and graphs to show the effectiveness/efficacy of the vaccine and the methods of trialling it, who they administered it too and the effects that the vaccine had. One table that I found very interesting was to do with 'serious adverse effects' (7th table on the right hand side (http://www.nejm.org/doi/full/10.1056/NEJMoa1102287#t=articleResults)). The results look shocking when you see how many more adverse effects there were in the malaria group than the control drug, but then I noticed that the group that it was administered was double that of the control in both the '6-12 week' and '5-17 month' test groups. This seems to point towards the age groups that this drug will be administered in and leads to the question of safety for the children that it is being tested in; but as the tables data shows (and the other data), it appears to be a very safe vaccine.  

In terms of issues of cost, organisation, transportation to the areas where the vaccine is needed i.e. sub-Saharan Africa and administering the vaccine to the patients; I think that these will all be overcome by the co-operation between GlaxoSmithKline Biologists and organisations such as the WHO but also through the governments of the countries that need the vaccine for their people. The amount of people that will be saved by this vaccine in the future is worth more than the effort that is needed for organisation of producing and distribution of the vaccine itself. 

I would say that the RTS,S vaccine is a very good solution to the issue of malaria control. I think that it would be very effective if used in combination with other alternative malaria controls such as LLIN’s (which I feel would be a lot more successful than ITN’s) and also IRS. I think that GlaxoSmithKline Biologicals and other biological companies should continue their work and strive to develop a second generation malaria vaccine that performs even better than the first generation RTS,S vaccine.

Indian drug-resistant TB

I picked this story up from the New Scientist website (http://tinyurl.com/6oqv3rf) which was about a "strain of tuberculosis that is resistant to all existing TB drugs" which has been "emerged" in Mumbai, India.
Tuberculosis is an infection caused by bacteria that infects the lungs but can also "spread to other parts of the body". Either, the "immune system deals with it, or it fails to kill or contain it. If it is not treated, an active TB infection can be fatal. It can damage the lungs to such an extent that a person cannot breathe properly" (http://tinyurl.com/78j3mds). There have been "12 confirmed cases of which three are dead" said Zarir Udwadia of the Hinduja National Hospital and Medical Research Centre in Mumbai "(head of the team whose diagnoses of four cases has just been published)", (http://tinyurl.com/78j3mds).

"Several medicines are used to treat TB and the treatment usually lasts six months" (http://tinyurl.com/789jpvy). The issue with the strain of TB that has been uncovered is that it is drug-resistant (as indicated in the title...) and this has caused a big worry to Mumbai as it is such a densley populated city and TB is passed on "through inhaling tiny droplets of saliva from the coughs or sneezes of an infected person" (http://tinyurl.com/78j3mds) which is incredibly easy when there are so many people, ("30,000 per square km", http://tinyurl.com/6lpbyco). The worry is that this will result in an epidemic in Mumbai with an incurable disease affecting the majority of the population of the city. "It's estimated that on average, a tuberculosis patient infects 10 to 20 contacts in a year" (http://tinyurl.com/6oqv3rf).

The only way to prevent this strain from continuing to be spread is by "quarantining them in hospitals with isolation facilities till they become non-infectious – which is not practical or possible" (http://tinyurl.com/6oqv3rf) and will become even harder to enforce as there becomes more people affected.

The World Health Organisation (WHO) will be organising a meeting to "decide what steps to take next" (http://tinyurl.com/6oqv3rf). New Scientist also mentions two other cases, one in Italy (2007) and another in Iran (2009) where there were cases of people with "totally drug-resistant (TDR) tuberculosis" and say that the "Indian report is the first since then" (http://tinyurl.com/6oqv3rf).