World Malaria Day brings hopes - and sighs

23 Apr 2012
Authors:
Claire Panosian Dunavan

This guest contribution by Dr. Claire Panosian Dunavan originally ran in southern California newspapers on 22 April 2012.

This Wednesday - April 25 - marks World Malaria Day. I've been interested in malaria since childhood. For one thing, my dad battled it during World War II. In my mind's eye, I can still see his final "souvenir" on our bathroom shelf: an amber bottle of out-dated quinine.

Years later, I pictured the scene of my father's infection for a piece in Scientific American. Here's the opening.

"Guadalcanal, November 1942. Another night of war. Above ground, the air buzzed with enemy ordnance. In foxholes, weary men in boots, fatigues, and steel helmets shifted restlessly, counting the hours until dawn.

" If a soldier wanted to stay in one piece, a hole in the ground was the best place to spend the night. But refuge had its price: disease-bearing mosquitoes. For proof, one need only visit the hospital field tent.

"There, by flickering electric lanterns, medics tended patients whose blood swarmed with the delicate rings, crescents and clusters we know as malaria."

For many WWII combatants, malaria was scarily real. A decade later, memories faded. For one thing, by then, malaria transmission had virtually ceased on U.S. and European soil.

In the tropics, however, malaria continued to sicken and kill despite major blows by DDT and a drug called chloroquine. Then natural selection went to work. Slowly but surely, mosquitoes resisted DDT, and falciparum parasites - the deadliest kind in humans - started scoffing at chloroquine.

Casualties climbed, especially in subSaharan Africa. In the 1990s, malaria caused 30 percent of all deaths in African children. Its' worldwide toll topped 10 million.

Today we have better weapons, most notably insecticide-treated bed nets and combination treatments containing "artemisinin" (a plant-derived compound first used in ancient China). But for how long?

Not long ago, I broached this question with Dr. Patrick Kachur, head of CDC's Malaria Branch. Kachur leads a team of nearly 100 malaria professionals in 20-plus countries. When he and I first met in 2002, he was helping to introduce new therapies in Africa.

In our recent conversation, he listed victories of the last few years: widespread endorsement of artemisinin cocktails by African governments, the distribution of bednets by the millions, a promising experimental vaccine.

Then came the bad news.

Artemisinin-resistant parasites - once a distant cloud on the horizon - are now present in Southeast Asia, often hiding in migrants and refugees. Once the drug-defiant strains reach Africa (only a matter of time, according to Kachur and others), their impact could be huge.

Counterfeit anti-malarials are another modern-day blight. Do you find it inconceivable that someone would make ersatz pills for a possibly fatal infection? Think again.

A study published in 2011 described multiple lots of anti-malarials with fraudulent ingredients. All packets were purchased in Africa or Asia; all were artfully designed to deceive. Pollen analysis pinpointed southern China as the likely site of manufacture. Now Interpol is on the case.

Dr. Claire Panosian Dunavan is an infectious diseases specialist and a professor of medicine at the David Geffen School of Medicine at UCLA. She can be reached at drclaired@earthlink.net.

Image credit: Flickr: oknovokght