Vaccination for malaria VACCINATION FOR MALARIA: A BRIEF ERVIEW Nimmus N1*, Amaritha P2 1.

Tropical Clinical Center, Djibouti City, Djibouti 2. Tropical Clinical Center, Pune, India

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Correspondence: Dr Nicholas Nimmus. Tropical Clinical Center, Djibouti City, Djibouti Email: nimmus4576@yahoo.com Nimmus N, Amaritha P. Vaccination for malaria: a brief review. Adv Trop Med Pub Health Int. 2013; 3(2): 75 - 77. ABSTRACT Mosquito borne infectious disease is an important group of disease worldwide. Vaccination is available for some tropical mosquito-borne diseases, especially for Japanese encephalitis virus infection and yellow fever. However, there is no available vaccine for malaria at present. In this article, the authors briefly review the issues on vaccination for malaria. Key words: Malaria, vaccination, prevention INTRODUCTION Generally, preventive medicine covers three levels: primary, secondary and tertiary prevention 1. Concerning primary prevention, prevention from starting of the unwanted event, infection in this case, is focused. The primary prevention can be the control of vector, immunization as well as chemophophylaxis. Concerning secondary prevention, early detection and prompt treatment is focused. Identify and treat asymptomatic persons who have already developed risk factors or preclinical infectious disease is in this step. The efficiency of preventive treatments should lead toward the goal of zero infectious cases 2. Concerning tertiary prevention, the control of disability or sequelae, including physical, psychological as well as social items, is focused. Vaccination is available for some tropical mosquito-borne diseases, especially for Japanese encephalitis virus infection and yellow fever. However, there is no available vaccine for malaria at present. In this article, the authors briefly review the issues on vaccination for malaria. CLINICAL ASPECT OF MALARIA Malaria is a mosquito-borne parasitic infection. It can be said that malaria is a very important tropical mosquito-borne infectious disease. Malaria is caused by protozoan parasites of the genus Plasmodium. Four species of Plasmodium, Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale and Plasmodium malariae can produce the human disease in its various forms. . In human, malaria is an important and potentially deadly mosquito-borne disease characterized by cyclical bouts of fever with Advance Tropical Medicine and Public Health International 2013; 3(2): 75 - 77. 75

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muscle stiffness, shaking and sweating in the tropical countries 3 - 4. Despite encouraging trends in dramatically reducing malaria, the rates of disease may be reemerging in many tropical and non-tropical countries as evidence from an increased annual parasite index. Malarial infections are one of the most important mosquito-borne diseases in the world. With an annual incidence of 300-500 million clinically manifest cases and a death toll of 1.1-2.7 million, malaria is still one of the most important communicable diseases 5. Wernsdorfer and Wernsdorfer mentioned that about 40% of the world's population lives in areas where malaria is endemic, as against 80% in 1950 5. Imported malaria in the traveler is now a big concern in traveling medicine. Concerning the imported malarial patients in Japan, about 45% of patients are Plasmodium falciparum and another 45% Plasmodium vivax infections 6. Kano and Kimura said that the former species was likely to be seen in travelers coming back from African countries and the latter was mainly from Asian countries 6. Newman et al mentioned that nearly 1500 malaria cases occur each year in the United States; most were among travelers 7. Symptoms of malaria generally take around six days to appear after infection 8. Wide range of malarial symptoms is described 8. Most symptoms are very vague and nonspecific 8. Generally, malaria can be presented as asymptomatic case or mild symptomatic case, also progress rapidly to coma and death in the nonimmune patient 8. Some patients complain for a headache, fatigue and muscleache 8. High fever is common; however, these symptoms are similar to a viral illness and can be mistaken for flu 8. Some people presented with, chest pain, abdominal pain, joint pains and diarrhea which suggest something other than a viral illness 8. At present, malaria is still the most common infectious cause of mortality and morbidity in many developing countries in the tropic 9. Thousands of fatal cases are reported worldwide every year. EFFORT FOR PRODUCING MALARIAL VACCINE Although there have been many efforts for decades to produce a vaccine to combat this infection, few have been able to meet the challenges posed by the unusual interplay between this virus and its human host. According to the globalization at present, the malaria becomes an emerging infectious problem not only to the tropical but also to the non-tropical countries. Angell and Cetron said that high-risk illnesses in travelers included childhood vaccine-preventable illnesses, hepatitis A and B, tuberculosis, malaria, and typhoid fever 10. In addition, the problem of drug resistant malaria is increase at present. Wernsdorfer and Wernsdorfer noted that drug resistance of malaria was the most formidable obstacle in the fight against the disease since it jeopardized the most elementary objective of malaria control, namely the elimination of mortality and the reduction of suffering from malaria 11. The knowledge on the malaria is, therefore, an interesting topic for general practitioners all over the world. Development of vaccine for malaria is therefore necessary objective for control of malaria. More than 40 years ago, researchers first demonstrated that immunization with irradiated sporozoites could protect against malaria infection, providing the impetus for the development of a malaria vaccine 12. However, today we are still without a highly effective malaria vaccine, despite considerable progress achieved during many years of research and development 12. The number of clinical trials has increased and some malaria antigens have been tested in endemic areas. No potential vaccine has yet shown Advance Tropical Medicine and Public Health International 2013; 3(2): 75 - 77. 76

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sufficient and lasting efficacy to justify its inclusion in a public health program 13. The main problem is expected malarial vaccine is the parasite vaccine which has never been successful due to the complexity of immune response as well as cross linkage between host and parasite. Several new vaccines have entered Phase I/II trials recently, new adjuvants have been developed for human use and new approaches, such as DNA vaccines and structural modification of antigens to circumvent some of the strategies the parasite uses to avoid the immune response, are being applied 14. REFERENCES 1. Fitzgerald MA. Primary, Secondary, and Tertiary Prevention: Important in Certification and Practice. Available at http://www.fhea.com/CertificationCols/level_prevention.htm 2. Le Mire J, Arnulf L, Guibert P. Malaria: control strategies, chemoprophylaxis, diagnosis, and treatment. Clin Occup Environ Med. 2004; 4: 143 - 65. 3. Chareonviriyaphap T, Bangs MJ, Ratanatham S. Status of malaria in Thailand. Southeast. Asian J Trop Med Public Health. 2001; 31: 225 - 37. 4. Phillips RS. Current status of malaria and potential for control. Clin Microbiol 2001; 14: 208 26. 5. Wernsdorfer G, Wernsdorfer WH. Malaria at the turn from the 2nd to the 3rd millenium. Wien Klin Wochenschr. 2003; 115 Suppl 3: 2 - 9. 6. Kano S, Kimura M. Trends in malaria cases in Japan. Acta Trop. 2004; 89: 271 8. 7. Newman RD, Parise ME, Barber AM, Steketee RW. Malaria-related deaths among U.S. travelers, 1963-2001. Ann Intern Med. 2004; 141: 547 - 55. 8. Suyaphun A, Wiwanitkit V, Suwansaksri J, Nithiuthai S, Sritar S, Suksirisampant W, Fongsungnern A. Malaria among hilltribe communities in northern Thailand: a review of clinical manifestations. Southeast Asian J Trop Med Public Health. 2002; 33 Suppl 3: 14-5. 9. Hien TT, VinhChau NV, Vinh NN, Hung NT, Phung MQ, Toan LM, Mai PP, Dung NT, HoaiTam DT, Arnold K. Management of multiple drug-resistant malaria in Viet Nam. Ann Acad Med Singapore. 1997; 26: 659 - 63. 10. Angell SY, Cetron MS. Health disparities among travelers visiting friends and relatives abroad. Ann. Intern. Med. 2005; 142: 67 - 72. 11. Wernsdorfer G, Wernsdorfer WH. Malaria at the turn from the 2nd to the 3rd millenium. Wien. Klin. Wochenschr. 2003; 115 Suppl 3: 2 - 9. 12. Epstein JE, Giersing B, Mullen G, Moorthy V, Richie TL. Malaria vaccines: are we getting closer? Curr Opin Mol Ther. 2007; 9: 12 - 24. 13. Rogier C, Orlandi-Pradines E, Fusai T, Pradines B, Briolant S, Almeras L. Malaria vaccines: prospects and reality. Med Mal Infect. 2006; 36: 414 - 22. 14. Engers HD, Godal T. Malaria vaccine development: current status. Parasitol Today. 1998; 14: 56 - 64.

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