What is Malaria?Unlike most infections that are caused by bacteria and viruses, there is no malaria virus or bacteria that causes the infection. The disease is caused by a parasite that is transmitted by mosquitoes. The symptoms of malaria can be rather extreme even when dealing with mild cases of malaria. Symptoms typically include high fevers, severe anemia and flu-like symptoms that could include chills and shivering. This does not pose much of a threat to healthy individuals, but pregnant women, young children and the aged are at a high risk because of complications that may develop on account of the symptoms. Severe cases of malaria can be a lot more worrying, as children can experience lifelong intellectual disabilities as a result of the infection. How do you get Malaria?Despite the widespread prevalence of malaria across the world (the World Health Organization estimates around 40% of our global population to be at risk), most people are still oblivious to the risk and remain unaware of the answers to some basic questions such as ‘how is malaria transmitted’ and ‘how does malaria spread’. Malaria is transmitted through the bite of an infected Anopheles mosquito. It is only the female mosquito that bites its victims. At present there is no vaccine that offers protection against malaria, but there are other preventive measures that can be taken to minimize the risk of infection. History of MalariaMalaria has in all probability been around for longer than we have, most likely having started out as a disease that affected primates in Africa. Symptoms that are characteristic of malaria have also been described in historical accounts dating as far back as 4,000 years ago. The disease was widespread at its peak, affecting populations across every continent, with the exception of Antarctica. Since the precise cause of infection was identified in the late 1800s infection rates saw a rapid decline, with the disease being eliminated in many parts of the world over the course of the 20th century. The disease remains endemic to developing countries in tropical and subtropical regions however, and the effects of malaria result in an economic cost that is estimated to be in billions of dollars a year. Travelers to such countries are at particular risk of infection because of the absence of any immunity. There are four different types of malaria, the most deadly of them being found in Africa, just south of the Sahara Desert. Although the fatality rate is quite high, malaria medications have been extremely effective in reducing the global incidence of malaria and in bringing down fatalities. Most of the malaria deaths today, occur as a result of poor access to malaria medications and a lack of adequate health care services in some regions. Malaria tests are extremely effective at detecting infection and if identified early the prognosis is very good. Different types of anti-malarial drugs are used to treat the disease, depending on the type of infection. Unfortunately, the parasites responsible have developed drug resistance to some medications resulting in a public health care crisis in some parts of the world. Drug resistance makes it difficult to control the rate of infection, as well as the spread of malaria. The phenomenon of mosquitoes developing resistance to insecticides has only added to the problem. Malaria FactsAn important aspect of any strategy to combat an infection with preventive measures depends on public awareness, as this is an important determinant in the success of any strategy. Although malaria has been largely eradicated from many parts of the world its presence in some of the most populous regions means that it still poses a huge risk to humanity. Over 40% of the world’s population is at the risk of malaria, according to the WHO. There were almost 200 million recorded malaria cases in 2013, with around 584,000 of them resulting in fatalities. Modern malaria medications have been extremely effective, but poor health care services and the lack of access to antimalarial drugs in developing and underdeveloped regions have contributed to the high human cost. Of all the recorded fatalities, 90% are localized within the WHO Africa Region. Children are most often the victims, with most of the victims being children under the age of 5. Access to diagnostic testing and treatments is central to the outcome of any strategy to combat malaria. Early diagnosis and treatment can significantly reduce the spread of disease and would bring about a huge reduction in malaria fatalities. Artemisinin is the main compound in and in recent years 5 Southeast Asian countries have been afflicted with strains of the malaria parasite that demonstrate resistance to the drug. Despite the emerging drug resistance artemisinin still remains effective as a treatment for malaria, when used in combination with drugs that are locally effective. The old adage ‘prevention is better than cure’ couldn’t hold more true than it does in the case of malaria. Preventive measures are extremely effective and insecticidal nets have been found to offer considerable protection against malaria. Such nets can be used by people living in high-risk areas, especially by vulnerable groups like pregnant women and young children. Indoor residual spraying is another effective preventive strategy, but it is most effective when at least 80% of all the houses receive the treatment within the target area. The effects of indoor spraying can last for 3 to 6 months, depending on the insecticide that is used and the area that is being treated. Malaria poses an especially high risk of fatalities to pregnant women because of the possibility of complications like premature delivery, stillbirth, spontaneous abortions and maternal anemia. All too often, such complications claim the lives of both mother and child. The disease often creates more than a health care crisis, as those who are worst affected are families living in poverty and regions with low quality health care. Days of lost productivity, lingering health issues and medical expenses can take a huge toll on finances, crippling those who already live in poverty. The risk of malaria is higher for travelers who live in areas where malaria is not common. While most local populations have some kinds of immunity, visitors have no such natural protection. An even greater risk however faces immigrants who live in malaria free regions and return to visit their home countries where malaria is endemic. This group is vulnerable because of assumed immunity, when in reality their levels of immunity to the parasite are waning or may even be completely absent. An interesting, albeit disturbing, phenomenon has been noted in recent years, with a zoonotic variant of malaria surfacing in certain parts of South East Asia. The parasite that normally only affected monkeys in the region is called Plasmodium knowlesi. Although eerily reminiscent of Bram Stoker’s vampires, mosquitoes are generally more active at night and tend to feed off their victims’ blood after sundown. This holds true for almost all of the important vector species at least. Although there is no malaria vaccine available to patients at present, there has been research into vaccines for the various strains of malaria, with one against P. falciparum being the most advanced. There have been large clinical trials conducted across various countries and the vaccine now awaits approval. If the results are found to be successful, this vaccine should be available to patients by the end of 2015. Interestingly, there were 63 outbreaks of ‘locally transmitted mosquito borne malaria’ in the US between 1957 and 2011. In such cases, local mosquitoes become transmitters after feeding on individuals who are carriers of the parasite, having picked it up from an endemic area. These mosquitoes then proceed to spread the infection by biting and consequentially transmitting the infection to local residents. Malaria has been devastating the human population for millennia and mankind has long struggled to find ways to combat and survive infection. The Chinese recommended the use of the Qinghaosu plant, while South Americans recommended the Cinchona tree. What’s worth noting is that the two primary components in malaria drugs- artemisinin and quinine are both derivatives of these plants. The Centers for Disease Control and Prevention (CDC) is probably one of the best-known governmental agencies that combat infectious diseases and possible outbreaks. What most people don’t know is that the CDC was originally formed to fight Malaria, replacing the Office of Malaria Control in War Areas, which was a WWII era agency that was setup to address the malaria crisis that plagued US forces in the Pacific and Africa. Rome was often plagued with outbreaks of Malaria and some historians even believe that the disease may have played some role in the sacking of Rome. The very name for the disease comes from Italian, with the words ‘mal’ meaning bad and ‘aria’ meaning air. Romans associated the disease with fumes from the swamps, as there was no way to identify the parasite back then. The connection was only logical to them, as the disease was likely most prominent in such swampy areas, where mosquitoes would thrive. Historians suggest that the disease may have been introduced to North America by English settlers with the establishment of the Jamestown colony in Virginia in 1607. They suggest that this would have been the starting point for the spread of the infection, which rapidly spread across the continent taking quite a toll. The disease was also a large contributor to wartime losses during the Civil War. Although malaria is most threatening today in impoverished populations it has been an indiscriminate killer in the past, claiming some high profile victims, with a list of casualties including Emperors and Popes! Malaria is believed to have been responsible for the deaths of Alexander the Great, St. Augustine, Pope Gregory V, Pope Sixtus V and Roman Emperor Charles V. More recent victims include the likes of Rebka Chenashu, an Ethiopian bronze medalist who was just 17 when she fell victim to malaria in 2003. Actor Amrish Puri also lost his life because of malaria related complications and passed away because of a blood clot in the brain, whilst being treated for the disease. In what may have seemed like a page out of a sci-fi book a century ago, Brazil became the first nation to use genetically modified mosquitoes to combat and contain its problem with mosquito borne diseases like malaria and dengue. The strategy is implemented by releasing genetically modified sterile male mosquitoes that proceed to mate with wild females. This works to reduce the population drastically as female mosquitoes typically mate just once. Researchers at the London School of Hygiene and Tropical Medicine quite literally turn themselves into sacrificial lambs at the altar of medical science. They allow mosquitoes to feed off them for two days in a week in a bid to better understand the disease and develop better techniques to combat infection. References:1. http://data.unicef.org/child-health/malaria2. http://www.cdc.gov/malaria/malaria_worldwide/impact.html3. http://www.unicef.org/health/index_malaria.html4. Snow RW, Trape JF, Marsh K. The past, present and future of childhood malaria mortality in Africa. Trends Parasitol. 2001 Dec;17(12):593-7. Review. PubMed PMID: 11756044.