Malaria : Epidemiology, signs and symptoms

FActs about Malaria

1. Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected mosquitoes.
2. A child dies of malaria every 30 seconds.
3. There were 247 million cases of malaria in 2006, causing nearly one million deaths, mostly among African children.
4. Malaria is preventable and curable.
5. Approximately half of the world's population is at risk of malaria, particularly those living in lower-income countries.
6. Travellers from malaria-free areas to disease "hot spots" are especially vulnerable to the disease.Malaria takes an economic toll - cutting economic growth rates by as much as 1.3% in countries with high disease rates.

Malaria is caused by parasites of the species Plasmodium. The parasites are spread to people through the bites of infected mosquitoes.

There are four types of human malaria:

Plasmodium falciparum
Plasmodium vivax
Plasmodium malariae
Plasmodium ovale.
Plasmodium falciparum and Plasmodium vivax are the most common. Plasmodium falciparum is the most deadly.




Common symptoms of malaria
In the early stages, malaria symptoms are sometimes similar to those of many other infections caused by bacteria, viruses, or parasites. Symptoms may include:
Fever.
Chills.
Headache.
Sweats.
Fatigue.
Nausea and vomiting.
Other common symptoms of malaria include:
Dry (nonproductive) cough.
Muscle and/or back pain.
Enlarged Spleen

Complications of Malaria( Falciparum):
Cerebral malaria
Algid Malaria
ARDS
Convulsion
Coma
Acute Renal Failure
Hypoglycemia
hyperthermia
hyperparasitemia
severe anemia


Symptomatic diagnosis
Using Giemsa-stained blood smears from children in Malawi, one study showed that when clinical predictors (rectal temperature, nailbed pallor, and splenomegaly) were used as treatment indications, rather than using only a history of subjective fevers, a correct diagnosis increased from 21% to 41% of cases and unnecessary treatment for malaria was significantly decreased.

Microscopic examination of blood films
Field tests
In areas where microscopy is not available, or where laboratory staff are not experienced at malaria diagnosis, there are antigen detection tests that require only a drop of blood. Immunochromatographic tests (also called: Malaria Rapid Diagnostic Tests, Antigen-Capture Assay or "Dipsticks") have been developed, distributed and fieldtested. These tests use finger-stick or venous blood, the completed test takes a total of 15–20 minutes, and a laboratory is not needed. The threshold of detection by these rapid diagnostic tests is in the range of 100 parasites/µl of blood compared to 5 by thick film microscopy. The first rapid diagnostic tests were using P. falciparum glutamate dehydrogenase as antigen.[42] PGluDH was soon replaced by P.falciparum lactate dehydrogenase, a 33 kDa oxidoreductase [EC 1.1.1.27]. It is the last enzyme of the glycolytic pathway, essential for ATP generation and one of the most abundant enzymes expressed by P.falciparum. PLDH does not persist in the blood but clears about the same time as the parasites following successful treatment. The lack of antigen persistence after treatment makes the pLDH test useful in predicting treatment failure. In this respect, pLDH is similar to pGluDH. The OptiMAL-IT assay can distinguish between P. falciparum and P. vivax because of antigenic differences between their pLDH isoenzymes. OptiMAL-IT will reliably detect falciparum down to 0.01% parasitemia and non-falciparum down to 0.1%. Paracheck-Pf will detect parasitemias down to 0.002% but will not distinguish between falciparum and non-falciparum malaria. Parasite nucleic acids are detected using polymerase chain reaction. This technique is more accurate than microscopy. However, it is expensive, and requires a specialized laboratory. Moreover, levels of parasitemia are not necessarily correlative with the progression of disease, particularly when the parasite is able to adhere to blood vessel walls. Therefore more sensitive, low-tech diagnosis tools need to be developed in order to detect low levels of parasitaemia in the field. Areas that cannot afford even simple laboratory diagnostic tests often use only a history of subjective fever as the indication to treat for malaria. Using Giemsa-stained blood smears from children in Malawi, one study showed that unnecessary treatment for malaria was significantly decreased when clinical predictors (rectal temperature, nailbed pallor, and splenomegaly) were used as treatment indications, rather than the current national policy of using only a history of subjective fevers (sensitivity increased from 21% to 41%).


Molecular methods
Molecular methods are available in some clinical laboratories and rapid real-time assays (for example, QT-NASBA based on the polymerase chain reaction) are being developed with the hope of being able to deploy them in endemic areas.

Rapid antigen tests
OptiMAL-IT will reliably detect falciparum down to 0.01% parasitemia and non-falciparum down to 0.1%. Paracheck-Pf will detect parasitemias down to 0.002% but will not distinguish between falciparum and non-falciparum malaria. Parasite nucleic acids are detected using polymerase chain reaction. This technique is more accurate than microscopy. However, it is expensive, and requires a specialized laboratory. Moreover, levels of parasitemia are not necessarily correlative with the progression of disease, particularly when the parasite is able to adhere to blood vessel walls. Therefore more sensitive, low-tech diagnosis tools need to be developed in order to detect low levels of parasitaemia in the field.

Tropical diseases in Asia

Malaria
Cholera
Dysentery
Intestinal Worms
Dengue Fever
Yellow Fever
Schistosomiasis
Leprosy
Filariasis
Trypanosomiasis
Hepatitis
Chlamydia Trachomatis

Swine Flu 4 vaccines Declared

The US Food and Drug Administration (FDA) announced today that it has approved 4 vaccines against the 2009 influenza A (H1N1) virus, formerly known as "swine flu." The vaccine lots are expected to be available and distributed within the next 4 weeks.

FDA Commissioner of Food and Drugs Margaret A. Hamburg, MD, said she thought Tuesday's approval was good news for the nation's response to the H1N1 influenza virus. "This vaccine will help protect individuals from serious illness and death from influenza," she said.

The approval comes at a time when the Centers for Disease Control and Prevention (CDC) is reporting that visits to physicians around the country for influenza-like illness are increasing and are higher than expected at this time of year. The vaccines that are currently available against 3 seasonal influenza virus strains will not protect against the 2009 H1N1 virus.

The FDA said that the vaccines, based on early data, effectively elicit an immune response in most healthy adults about 8 to10 days after vaccination. Clinical studies are still underway to produce an optimal dose for children, with results expected in the near future.

Meanwhile, the CDC stresses that influenza is primarily spread through person-to-person contact, by the coughing or sneezing of infected people, and recommends that infected people stay home and limit their contact with others to keep from infecting them.

The newly approved vaccines are being made by CSL Limited, MedImmune LLC, Novartis Vaccines and Diagnostics Limited, and Sanofi Pasteur Inc. All 4 firms reportedly use the same processes to manufacture the H1N1 vaccines. As with the seasonal influenza vaccine, some lots of the H1N1 vaccine will contain the preservative thimerosal and others will not. The FDA has been continuing its efforts toward reducing thimerosal used in vaccines.

The FDA warns that persons with known allergies to chicken eggs or any other substance in the vaccine should probably not be vaccinated, although in the ongoing clinical trials, the vaccines have been well tolerated. The most common adverse effect is soreness at the injection site; other adverse effects can include a mild fever, body aches, and fatigue for a couple of days after vaccination. For the nasal spray delivery system, the most common adverse effects were runny nose, nasal congestion in all ages, sore throats in adults, and fever in children aged 2 to 6 years.

The FDA is working with different organizations regarding adverse event monitoring, information sharing, and an overall analysis during and after the 2009 H1N1 vaccination program, according to the news release. "As with any medical product, unexpected or rare serious adverse events may occur," the FDA notes.

WHO Issues Guidelines for Antiviral Treatment for H1N1 and Other Influenza

WHO Issues Guidelines for Antiviral Treatment for H1N1 and Other Influenza

August 25, 2009 —
The World Health Organization (WHO) has issued guidelines for antiviral treatment for novel influenza A (H1N1) and other influenza. The purpose of the new recommendations, which were posted online August 20, is to provide a basis for advice to clinicians regarding the use of the currently available antivirals for patients presenting with illness caused by influenza virus infection, as well as considerations regarding potential use of these antiviral medications for chemoprophylaxis.

On the basis of a review of data collected with previously circulating strains, and treatment of human H5N1 influenza virus infections, the new guidelines expand on recommendations published in May 2009, titled ʺClinical management of human infection with new influenza A (H1N1) virus: Initial guidance." These new guidelines do not change recommendations in the WHO rapid advice guidelines on pharmacological management of humans infected with highly pathogenic avian influenza A (H5N1) virus.

"In April 2009, the [WHO] received reports of sustained person to person infections with [H1N1] virus in Mexico and the United States," write Edgar Bautista, from Médico Neumólogo Intensivista, Jefe de UCI-INER in Mexico, and colleagues. "Subsequent international spread led WHO to declare on 11 June 2009 that the first influenza pandemic in 41 years had occurred. This 2009 pandemic H1N1 influenza virus has now spread worldwide, with confirmed cases of pandemic H1N1 virus infection reported in more than 100 countries in all 6 WHO regions[, which] has led to the need to add to the existing guidance on the use of antivirals."

The new recommendations highlight oseltamivir and zanamivir, which are neuraminidase inhibitors, and amantadine and rimantadine, which are M2 inhibitors. Suggestions are also provided regarding the use of some other potential pharmacological treatments, such as ribavirin, interferons, immunoglobulins, and corticosteroids.

Management of patients with pandemic influenza (H1N1) 2009 virus infection is the primary focus of the statement, although it also includes guidance regarding the use of the antivirals for treatment of other seasonal influenza virus strains, as well as for infections resulting from novel influenza A virus strains.

The guidelines urge country and local public health authorities to issue local recommendations for clinicians periodically, based on epidemiological and antiviral susceptibility data on the locally circulating influenza strains. As the prevalence and severity of the current pandemic evolves, WHO anticipates that additional data will be forthcoming that may require revision of the current recommendations. WHO therefore plans to review the guidance no later than September 2009 to determine whether modifications to the recommendations are needed.

Recommendations for Antiviral Treatment of H1N1

For patients with confirmed or strongly suspected infection with influenza pandemic (H1N1) 2009, when antiviral medications for influenza are available, specific recommendations regarding use of antivirals for treatment of pandemic (H1N1) 2009 influenza virus infection are as follows:

•Oseltamivir should be prescribed, and treatment started as soon as possible, for patients with severe or progressive clinical illness (strong recommendation, low-quality evidence). Depending on clinical response, higher doses of up to 150 mg twice daily and longer duration of treatment may be indicated. This recommendation is intended for all patient groups, including pregnant women, neonates, and children younger than 5 years of age.
•Zanamivir is indicated for patients with severe or progressive clinical illness when oseltamivir is not available or not possible to use, or when the virus is resistant to oseltamivir but known or likely to be susceptible to zanamivir (strong recommendation, very low quality evidence).
•Antiviral treatment is not required in patients not in at-risk groups who have uncomplicated illness caused by confirmed or strongly suspected influenza virus infection (weak recommendation, low-quality evidence). Patients considered to be at risk are infants and children younger than 5 years of age; adults older than 65 years of age; nursing home residents; pregnant women; patients with chronic comorbid disease including cardiovascular, respiratory, or liver disease and diabetes; and immunosuppressed patients because of malignancy, HIV infection, or other diseases.
•Oseltamivir or zanamivir treatment should be started as soon as possible after the onset of illness in patients in at-risk groups who have uncomplicated illness caused by influenza virus infection (strong recommendation, very low quality evidence).
Recommendations for Chemoprophylaxis of H1N1

Specific recommendations regarding the use of antivirals for chemoprophylaxis of pandemic (H1N1) 2009 influenza virus infection are as follows:

•When risk for human-to-human transmission of influenza is high or low, and the probability of complications of infection is high, either because of the influenza strain or because of the baseline risk of the exposed group, use of oseltamivir or zanamivir may be considered as postexposure chemoprophylaxis for the affected community or group, for individuals in at-risk groups, or for healthcare workers (weak recommendation, moderate-quality evidence).
•Individuals in at-risk groups or healthcare personnel need not be offered antiviral chemoprophylaxis if the likelihood of complications of infection is low. This recommendation should be applied independent of risk for human-to-human transmission (weak recommendation, low-quality evidence).
For treatment of mild to moderate uncomplicated clinical presentation of infection with multiple cocirculating influenza A subtypes or viruses with different antiviral susceptibilities, patients in at-risk groups should be treated with zanamivir or oseltamivir plus M2 inhibitor (noting that amantadine should not be used in pregnant women). Otherwise-healthy patients with this presentation need not be treated.

When the clinical presentation of infection with multiple cocirculating influenza A subtypes or viruses with different antiviral susceptibilities is severe or progressive, all patients should be treated with oseltamivir plus M2 inhibitor, or zanamivir.

For treatment of mild to moderate uncomplicated clinical presentation of infection with sporadic zoonotic influenza A viruses including H5N1, the at-risk population should be treated with oseltamivir or zanamivir, and the otherwise-healthy population with oseltamivir. All patients, regardless of risk status, with severe or progressive presentation of infection with sporadic zoonotic influenza A viruses including H5N1 should be treated with oseltamivir plus an M2 inhibitor.

((News From MEDSCAPE NEWS))

Swine Flu : Who Are at Risk

Which groups are at greatest risk?

Some people are more at risk than others of serious illness if they catch swine flu. They will need to start taking antivirals as soon as they are confirmed with the illness. On occasion, doctors may advise some high risk patients to take antivirals before they have symptoms if someone close to them has swine flu.

The risk profile of the virus is still being studied but it is already known that certain groups of people are particularly vulnerable. These include:

• Patients who have had drug treatment for asthma in the past three years
• Pregnant women
• People aged 65 years and older
• Children under five years old
• People with chronic lung disease
• People with chronic heart disease
• People with chronic kidney disease
• People with chronic liver disease
• People with chronic neurological disease
• People with immunosuppression (whether caused by disease or treatment)
• People with diabetes mellitus

Why are healthy people over 65 and children not a priority for the swine flu vaccine?

Healthy people aged over 65 appear to have some natural immunity to the swine flu virus. And while children are disproportionately affected by swine flu, the vast majority make a full recovery - therefore the experts do not advise that children (other than those in at-risk groups) should be vaccinated initially.

Swine Flu :How to Protect yourself

preventive measures for Swine flu—

1. The first preventive measure is to avoid contact with the pigs (swine). If you have pigs in your area then please inform the local municipal office so that he can take care of those pigs by keeping them isolated.

2. Swine flu is communicable disease, so use the face masks to protect from the swine flu antigens.

3. Cover your nose and mouth when coughing or sneezing, using tissue when possible. Dispose this tissue by using only once.

4. Avoid visiting the crowded places like theaters and prayer halls. This can be the spreading ground for Swine flu

5. Maintain good hygiene. Wash your hands frequently with soap and water to reduce the spread of virus. It would be better if you use alcohol sanitizers or Dettol for washing hands.

6. Take a special care of children because they easily get infected with the Swine flu. It is okay if you don’t send them to school for few days. Many schools have even announced holidays.

7. Avoid eating outside food because it may be contaminated and may make you infected with the virus.

8. Don’t use the public urinals because many people spit there, which could lead to the spreading of the disease.

9. Drink the boiled water.

Swine Flu Alert : India And Nepal

Swine Flu Now In South Asia

Current Pandemic Level : 6

The WHO has raised the Influenza Pandemic Alert to the highest level which is 6. Already India has seen over 40 confirmed cases of Swine Flu and the threat of a full blown epidemic in India is very real. The best we citizens can do is keep ourselves informed about the happenings and the steps we can take to prevent the spread of the flu. With most of the affected people fitting the profile of a person with internet access, we believe the internet is the first place that people would come looking for information like symptoms, who to contact etc. Swine Flu India is an attempt to bring all the necessary information in one place. India cannot afford to fall sick. Keep yourself and others informed.

Some Vital Stats

Total Confirmed Cases in India		959**
Total Deaths in India		10**
Total Confirmed Cases Worldwide		162380*
Total Deaths Worldwide		1154*
Last Updated Date and Time		11/08/2009 19:26 IST
Sources : *WHO **MoHFW		Nepal = 20 cases Reported