6th MIM Pan-African Malaria Conference

"Moving towards malaria elimination: Investing in research and control"

6 - 11 October 2013 at The International Convention Centre, Durban, South Africa

Name: MUPENZI MUMBERE   
Host institution: GSK Vaccines, Wavre, Belgium
Email: mumbere.x.mupenzi@gsk.com, mupjahman80@yahoo.fr

1.   Objectives of attending this conference

As a fellow researcher involved in the GSK Vaccines studies on a malaria candidate vaccine, my objectives to attend this conference are:

• Hear and learn on the updates of malaria research in its various aspects: epidemiology, parasitology, entomology, biology, research on drugs and vaccines, strategies for control and elimination, etc.
• Seek networking opportunities with other scientists and stakeholders.

2.   Agenda of the conference

The conference was stretched on 5 days plus one day for preliminary sessions. Below the detailed agenda:

I. PLEANARY SESSIONS

 II. SYMPOSIA

3.   Did attendance to this conference meet the needs you originally described? Please explain your answer in either way:

This conference met the needs I originally described. I was able to attend different sessions where researchers from all over the world presented the results of their work on various topics pertaining to all of aspects of malaria, its main causal agent (Plasmodium falciparum), vectors, prophylactic and curative tools and strategies under development. During breaks I could also have talks with scientists and I made fruitful exchanges with some of them on many topics: discussions on relevant points in sessions that retained my interest, possibilities for future partnerships.

4.   Please highlight what was the most important/useful information you learnt during the conference

The session that most gained my attention was the presentation from Dr Alan Magill from the Bill and Melinda Gate Foundation: “Accelerating to Zero: Strategies for Realizing Malaria Elimination and Eventual Eradication”. Below the highlights:

NEW CONCEPTS AND STRATEGIES TO ELIMINATE MALARIA

Malaria control progress in the last decade:

• Case incidence rates decreased by 17%
• Mortality rates decreased by 26% and 33% in the WHO African Region
• 274 million fewer cases  and 1.1 million fewer malaria deaths
• But it still kills about 660 000 people every year, essentially young African children

Unprecedented advances:

• Historic investment
• Scale Up in delivery of effective new interventions: LLINs, IRS, RDTs, ACTs.
• Targeted interventions for highest risk populations: IPTp, IPTi, SMC.
• Promising pipeline of diagnostics, vaccines, delivery strategies and innovative vector control tools.
• Africans active and engaged
• Resurgence of malaria where control measures have been implemented successfully and falter due to different reasons: lack of political will, shift in country priorities, lack of resources, etc.

Why do we need to accelerate to zero (infections of malaria)?

“Any goal short of eradicating malaria is accepting malaria; it’s making peace with malaria.” Melinda Gates

• We need to accelerate to zero because elimination is the only way to get rid of the foe (Plasmodium falciparum).

The concepts of elimination:

• Target the Human Reservoir Parasites: malaria eradication is to extirpate the roots of the infection (the parasite) in given population so that the mosquitoes will find none to transmit.
• Clinical cure: resolution of symptoms and prevention of severe disease and death. Clinical cure with an ACT only targets asexual stage parasites. Mature sexual stage 5 of P. falciparum gametocytes in peripheral blood are not affected by ACTs.
• Complete Cure: resolution of symptoms and prevention of severe disease and death + complete parasitological cure. Clinical cure with an ACT for asexual stage parasites + single dose primaquine for sexual stage 5 P. falciparum gametocytes.
• Complete parasitological cure: previous malaria elimination efforts did not target gametocytes, the transmission reservoir for P. falciparuman or vivax. Primaquine is the only available drug for stage 5 of P. falciparum while it kills all gametocytes of P. vivax, it remains the only drug that can kill its hypnozoites.
• Incomplete prevention: ITN and IRS. The gap: times and places where LLINs and IRS will not prevent transmission (early evening and early morning, outside the house + human behaviors), species shift(An. arabiensis becomes a significant vector when An. gambiae and An. funestus decline) etc
• Complete Prevention: incomplete prevention + the gap(An ecologically and evolutionary correct perspective in preventing transmission with vector based interventions)
• T3 (Test , Treat, and Track): universal coverage, every suspected malaria case is tested with a quality diagnostic, every confirmed case is treated with a quality assured ACT, every treated case is tracked through timely and accurate surveillance systems.
• Combined Interventions

Accelerate to zero: new strategies focused on:

• Dry season interventions : target the numerical, genetic, and species bottlenecks; reduced larval habitat, reduced or zero adult mosquitoes, etc
• Health center centric to Community based involvement: universal coverage by LLINs, mass screening and treatment
• Complete cure of the symptomatic plus targeted parasite elimination
• Microepidemiology: universal to targeted interventions: tailored to high/low transmission settings
• Mobility: sources and sinks. Regional approaches that minimise reintroduction.

The successful and sustainable approach to saving lives is through eradication. Eradication will require new concepts, new tools, and new strategies

5.   What ideas/recommendations did you bring back?

1) The T3 (Test, treat and track) approach in order to have malaria under control for eventual elimination: Every suspected case should be tested with the available rapid diagnostic test; every confirmed case should receive appropriate treatment; and measures should be implemented for epidemiological surveillance of malaria.

2) To improve mortality in severe malaria, different components of the treatment can be targeted, including:

•  Antimalarial treatment: in large trials, parenteral artesunate reduced severe malaria mortality by 22•5% in Africa and 34•7% in Asia compared with quinine and this large reduction in mortality was not at the expense of an increase in neurological sequelae.
• Treatment of concomitant diseases:  parenteral antimicrobials should be given to all children with suspected severe malaria in areas of moderate or high transmission, because of the high incidence of concomitant invasive bacterial disease in these settings.
• Supportive treatments and nursing care: fluid therapy in both adult and paediatric cases should be restricted. A large study of fluid bolus therapy in African children with compensated shock showed in the subgroup with P. falciparum malaria, that mortality in the bolus groups was 51% higher.

6.   How will you incorporate them in your research or training activities?

• I was shocked to see that epidemiologic data on malaria for the Democratic Republic of Congo, my home country, were not available and it was said to have one the poorest surveillance system of the malaria endemic countries. My target is to evaluate the surveillance system as it is now in order to propose ways and means to improve it so that the Democratic Republic of Congo could align with the global endeavours to fight malaria.
• The idea in the management of severe malaria will be incorporated in training activities to the physicians treating malaria so that patients are treated at the best available standard.

7.   How could others benefit from the conference?

Others could benefit from the conference if the conference organizers could disseminate a full report that presents the highlights of the presentations and recommendations; but also if all relevant findings could be translated into policies in the field of malaria.

8.   Would you recommend other grantees attend this conference?

Yes I would definitely recommend other grantees to attend this conference because it offers all what a researcher needs in terms of knowledge and networking.