Institue of Malariology Parastology and Entomology Quy Nhon

TheAPMENnewsletter aims to provide regular updates on Network activities and news onP.vivaxand elimination efforts in the Asia Pacific region.

After formally joining APMENas a Partner Institution earlier this year, the collaboration between APMEN and Medicines for Malaria Venture (MMV) has deepened, and APMEN is looking forward to strengthening the relationship with this important malaria organization. MMV Executive Vice President of Access & Product Management, Dr George Jagoe, recently offered his views on future regional malaria elimination activities with the APMEN Vivax Working Group.

"The APMEN-MMV relationship started in 2011 at theAPMENIII meeting on the island of Borneo, when malaria experts discussed progress towards elimination of malaria in the Asia-Pacific region. Since then the collaboration has progressed actively, with MMV's participation in both the APMEN Vivax and Surveillance & Response Working Groups" Dr Jagoe said.

Dr Jagoe also said MMV will support the APMEN Vivax Working Group, which generates evidence for the successful control and ultimate elimination of P. vivax through the development and coordination of operational research.

"The synergy between these two organizations is immense. While APMEN's country-owned network provides an interface between malaria programmes and the implementing partners, MMV provides technical expertise in drug innovation, assists with advocacy efforts, and helps build capacity to support the drug components for malaria elimination within the region."

The World Health Organization convened the 68th World Health Assembly (WHA68) in Geneva on 18 - 22 May. During the Assembly, members endorsed the highly anticipated Global Malaria Programme's draft global technical strategy: post 2015, in which WHO Member States will target reducing global malaria morbidity and mortality by 90%, and malaria elimination in 35 countries by the year 2030.

Forty-one countries took the floor during the discussion, including Indonesia which spoke on behalf of the 11 countries of the WHO South-East Asia Region.

APMENPartner Institution Medicines for Malaria Venture (MMV) Director for Access and Delivery Asia & Latin America, Penny Grewal Daumerie, delivered a statement to WH68 describing the dramatic global progress witnessed since 2000:

"...With concerted global effort aimed at increasing access to vector control measures, rapid diagnostic tests and artemisinin combination treatments, deaths from malaria have fallen by 47%. Through innovative public-private partnerships the malaria drug development pipeline has been populated with promising and targeted compounds. Yet insecticide and drug resistance continue to threaten these fragile gains. We need constant vigilance, targeted tools, and swift action to improve access to existing and new interventions, if we are to win this battle."

WHO has released the strategy document for malaria elimination in the Greater Mekong subregion (2015?2030). The document was drafted under the aegis of the Regional Hub for the Emergency Response to Artemisinin Resistance in coordination with countries and regional partners.

Ms Dechen Pemo from the Vector-borne Disease Control Programme in Bhutan received an APMEN2014 Fellowship for her topic, ?Training on Biochemical techniques to Detect Insecticide Resistance Mechanisms and Monitoring in Malaria vectors, Bhutan?.

In April 2015, Ms Pemo traveled to Bangkok, Thailand, to train at the Department of Medical Entomology at Mahidol University, under the guidance of mentor and Head of Department, A/Professor Narumon Komalamisra.

When asked about her fellowship experience, Ms Pemo said the practical learning on biochemical technique was most enjoyable.

Over the course of 8 weeks, Ms Pemo challenged herself to learn as much from her host mentors as possible.

"I was able to perform the practical classes completely, with extra support from my professor here at (Mahidol) University.?

?For testing insecticide, be it bioassay or biochemical technique, rearing of mosquitos is very important. The practicals on biochemical technique were the main challenge for me. But I found it really interesting and satisfying as the course went on," she said.

Ms Pemo added that her personal experience at the Mahidol University Department of Medical Entomology was a positive one.

?(The mentors) were always willingly providing their helping hands in fulfilling the objectives of the fellowship. I would recommend Mahidol University to host trainings if it is related to entomology. The organization and supervisors were very approachable, sincere and open.?

Ms Pemo has returned to

Bhutan

where she will endeavor to impart her learned skills and knowledge on rearing of mosquitoes and bioassay and also biochemical technique to her national malaria program staff.

?The knowledge which I have gained here throughAPMENfellowship will contribute immensely to achieving the goal of my Country (Bhutan), ?Elimination of Malaria by 2020?. Such programs not only enhance my knowledge in the professional field, I can also make the related topics inclusive in the training programs to entomological staff back in my country.?

Upcoming Events

June
14 ? 19	Science of Eradication Core Module, Harvard Business School, Boston, USA
20 ? 22	Science of Eradication Advanced Module, Harvard Business School, Boston, USA
29 ? 1 July	Beating Malaria 2015, London, United Kingdom
July
9 - 10	APLMA Senior Officials Meeting, Manila, Philippines Senior Officials meet to finalize the Leaders' Malaria Elimination Roadmap
25 - 26	Malaria Gordon Research Seminar, ?Translating Malaria Research to the Field?, Girona, Spain
26-31	Malaria Gordon Research Conference, ?Translating Malaria Research to the Field?, Girona, Spain
August
24	RSTMH International Conference on Parasitology Philadelphia, United States
September
6 - 10	9th European Congress on Tropical Medicine and International Health (ECTMIH), Basel, Switzerland
22 ? 2 Oct	Science of Eradication: Malaria, University of S�o Paulo, Brazil
25	RSTMH Disease elimination and policy-making 1-day symposium, London, UK
25- 27	UN Summit for Adoption of Post-2015 Development Agenda
October
1-2	Malaria in Melbourne (MIM) 2015, Monash University, Melbourne, Australia
25 - 29	American Society of Tropical Medicine and Hygiene 64th annual meeting, Philadelphia, USA

In September-October 2015, theUniversity of S�o Paulo, along with the Barcelona Institute for Global Health (ISGlobal), Swiss Tropical and Public Health Institute and Harvard School of Public Health, will host an international course "Science of Eradication: Malaria". This well-known academic consortium have been organizing the leadership development course on this topic over the past four years.

Nominations are now open for the "Malaria Heroes: 2015 Social Media Awards"! These awards will recognize the individuals who use Twitter and Facebook most effectively to promote and showcase the fight to #DefeatMalaria !

During the 68th World Health Assembly (WHA68) in Geneva, Director of WHO Communications Dr Christy Feig, hosted a live video blog, interviewing several health experts in attendance. Director of the Global Malaria Programme, Dr Pedro Alonso, discussed the recently accepted Global Technical Strategy for malaria (2016-2030) on day 4 of WHA68, and you can watch his interview here (from 17:00- 24:00).

The third Surveillance and Response Working Group meeting was held May 11-12, 2015 in Phuket, Thailand. Forty participants attended the meeting, representing 11 of the APMEN countries, three APMEN Partner Institutions, in addition to WHO Global Malaria Programme, ERAR and SEARO and other partners and donors. The objectives of the meeting were twofold: 1) to work together on a minimum set of indicators for elimination and prevention of reintroduction; and 2) to encourage countries to plan for changing from control programs to elimination programs and to understand the changes in activities and indicators that are required.

From the 19-22 May, leading researchers in P.vivax gathered in Bali for the 5th International Conference on Plasmodium vivax research (ICRPV5). This conference is usually held every four years but with the increasing interest in P. vivax and awareness of the threat it poses to elimination efforts the conveners have decided to offer this forum every year.

Members of the VxWG are acutely aware that more research is needed if we are to achieve the goal of regional elimination by the 2030 target. This year?s event was held in Indonesia which proved to be a great opportunity to showcase the work of the many members of the VxWG and as well as the hard work of the APMEN grant recipients.

Presentations and posters from the APMENVxWG members and APMEN small research grant recipients are listed below, and available on the APMEN website here.

� Qi Gao, Medical College of Soochow University/Jiangsu Institute of Parasitic Diseases - Genetic diversity and population structure of Plasmodium vivax in Central China

� Lenny Ekawati, Eijkman-Oxford Clinical Research Unit - Diagnosis and Treatment Seeking Behaviours in Vivax Malaria in Three Districts, Indonesia

� Zhou Shuisen, National Institute of Parasitic Diseases -Target malaria elimination intervention in China using spatial-temporal distribution analysis

� Fe Esperanza Espino, Research Institute for Tropical Medicine - Comparison of three screening test kits for G6PD enzyme deficiency: implication for its use in remote and resource-poor areas

� Rintis Noviyanti, Eijkman Institute for Molecular Biology - Microsatellite analyses reveal contracting population structure of P.vivax and P.falciparum in four endemic malaria regions in Indonesia

� Preethi Udagama, University of Colombo - Diversity of Plasmodium vivax parasite population during malaria elimination efforts in Sri Lanka: Risks for resurgence

� Ari W. Satyagraha, Eijkman Institute for Molecular Biology - Epidemiology of G6PD deficency

� Tashi Tobgay, University of Medical Sciences of Bhutan (UMSB) -Performance and User acceptance of the Bhutan Febrile and Malaria Information System (BFMIS)

� Tim William, Queen Elizabeth Hospital, Malaysia - Artesunate-melfoquine versus chloroquine in patients with acute uncomplicated P.vivax malaria: an open label randomised controlled trial in Sabah, Malaysia

Matthew Grigg, Infectious Disease Society Sabah, Malaysia - Menzies School of Health Research - Disease burden from P.vivax and P.knowlesi malaria in children in Sabah, Malaysia

� Kevin Baird, The Eijkman-Oxford Clinical Research Unit - The primaquine/G6PD deficiency/Plasmodium vivax relapse dilemma

� Dennis Shanks, Army Malaria Institute - Key Challenges in Plasmodium vivax Diagnosis

� Qin Cheng, Australian Army Malaria Institute - Sub-microscopic (SM) P.vivax infections: prevalence and determining factors

� Kamala Ley-Thriemer, Menzies School of Health Research ? Comparing artemether-lumefantrine and chloroquine with and without primaquine for treatment of uncomplicated vivax malaria in Ethiopia: A randomised clinical trial

Benedikt Ley, Menzies School of Health Research - Observational study on the safety of the national malaria treatment guidelines in the Chittagong Hill Tracts, Bangladesh

A large number of P. vivax genotyping abstracts were submitted to the ICRPV5 conference spurring the decision to hold a molecular workshop. Dr Sarah Auburn (Menzies School of Health Research, Australia), Prof Carol Sibley (University of Washington, US) and Dr Alyssa Barry (Walter and Eliza Hall Institute of Medical Research, Australia) were invited to co-chair the workshop. The main objective was to stimulate discussion amongst members of the vivax community on their experiences and challenges in four molecular topics: population genetics, characterization of recurrent infections, vaccine candidates and drug resistance surveillance. Read more about the ICRPV5 molecular workshop here.

TheAPMENVxWG would also like to acknowledge the work of those VxWG members and friends involved in organising the meeting Kevin Baird, Rintis Noviyanti, Lenny Ekawati, Ari Satyagraha, Carol Sibley, Didier Menard, Jimee Hwang, Ric Price, Ivo Mueller and Jetsumon Prachumsri.

The Jakarta Postpublished a special supplement on June 8 detailing the "joint all-out efforts" to elimiate malaria from the Mimika Regency in West Papua. The feature article described the successful partnerships between the Mimika Health Office, Community Development Institutes, mining and exploration company PT Freeport Indonesia, and other stakeholders to make Mimika malaria-free by 2026 - four years earlier than the government?s target of 2030.

Abstract (excerpt): Robust and responsive surveillance systems are critical for malaria elimination. The ideal information system that supports malaria elimination includes: rapid and complete case reporting, incorporation of related data, such as census or health survey information, central data storage and management, automated and expert data analysis, and customized outputs and feedback that lead to timely and targeted responses.Read the full article in AJTMH here.

Abstract (excerpt): Effective program management is essential for successful elimination of malaria. In this perspective article, evidence surrounding malaria program management is reviewed by management science and malaria experts through a literature search of published and unpublished gray documents and key informant interviews. Program management in a malaria elimination setting differs from that in a malaria control setting in a number of ways, although knowledge and understanding of these distinctions are lacking. Several core features of successful health program management are critical to achieve elimination, including effective leadership and supervision at all levels, sustained political and financial commitment, reliable supply and control of physical resources, effective management of data and information, appropriate incentives, and consistent accountability.Read the full article in AJTMH here.

Review of Mass Drug Administration for Malaria and Its Operational Challenges

Abstract (excerpt): Mass drug administration (MDA) was a component of many malaria programs during the eradication era, but later was seldomly deployed due to concerns regarding efficacy and feasibility, and fear of accelerating drug resistance. Recently, however, there has been renewed interest in the role of MDA as an elimination tool. Following a 2013 Cochrane Review that focused on the quantitative effects of malaria MDA, this study conducted a systematic, qualitative review of published, unpublished, and gray literature documenting past MDA experiences. Read the full article inAJTMH here.

Abstract (excerpt): As countries move toward malaria elimination, imported infections become increasingly significant as they often represent the majority of cases, can sustain transmission, cause resurgences, and lead to mortality. Here we review and critique current methods to prevent malaria importation in countries pursuing elimination and explore methods applied in other transmission settings and to other diseases that could be transferred to support malaria elimination. Read the full article in AJTMH here.

A Repeat Random Survey of the Prevalence of Falsified and Substandard Antimalarials in the Lao PDR: A Change for the Better

Abstract (excerpt): In 2003, a stratified random sample survey was conducted in the Lao People's Democratic Republic (

Laos

) to study the availability and quality of antimalarials in the private sector. In 2012, this survey was repeated to allow a statistically valid analysis of change through time. The counterfeit detection device 3 (CD-3) was used to assess packaging quality in the field. Read the full paper in AJTMH here.

Spatio-temporal analysis of malaria vectors in national malaria surveillance sites in China

Abstract: To reveal the spatio-temporal distribution of malaria vectors in the national malaria surveillance sites from 2005 to 2010 and provide reference for the current National Malaria Elimination Programme (NMEP) in China. Conclusion: This study first described the spatio-temporal distribution of malaria vectors based on the nationwide surveillance during 2005?2010, which served as a baseline for the ongoing national malaria elimination program. Read the full paper in Parasites and Vectors here.

High Rates of Asymptomatic, Sub-microscopic Plasmodium vivax Infection and Disappearing Plasmodium falciparum Malaria in an Area of Low Transmission in Solomon Islands

Conclusions: P. vivax infection remains endemic in Ngella, with the majority of cases afebrile and below the detection limit of LM. P. falciparum has nearly disappeared, but the risk of re-introductions and outbreaks due to travel to nearby islands with higher malaria endemicity remains. View the pdf from PLOS NTDS here.

Malaria control in Nepal 1963-2012: challenges on the path towards elimination

The magnitudes of declines found in malaria indicators are in line with those reported from similar studies in neighbouring countries: Bhutan, India and China [39,69-71]. Although attempt is made to include completely reported malaria indicator data, the findings of this study should be interpreted with a caution as it is entirely dependent on retrospective surveillance data. These results may represent actual time trends in malaria incidence at health facilities which may not represent trends of true malaria incidence at the population level [14]. However, this study provides important information about past milestones, the present malaria situation and challenges on the path towards malaria elimination in Nepal. Read the text from the Malaria Journal article here.

Dr Rose Nani Mudin, Head of Health Ministry?s Vector-Borne Disease, who presented at the APMENVII meeting in Vietnam in March, has featured in the Borneo Post online, describing the latest findings of zoonotic malaria in patients in Sabah, Sarawak and Kelantan, while overall, the number of malaria cases in the country had dropped dramatically due to various efforts and steps taken by the ministry to monitor and control the spread of the disease. Read the article here.

The Guardian - Malaria: can we eradicate one of the world's deadliest diseases?

Author Anna Leach writes on the social momentum required to to eradicate malaria, and the people and plans needed to sustain the progress being made. Leach interviews Malaria No More CEO, Martin Edlund, and Charles Nelson, chief executive of the Malaria Consortium. Read the full article here.

Sri Lanka

, Long a Hotbed of Malaria, Is Eliminating Indigenous Cases Through Diligence, Education

This article from the Global Press Institute details life-saving stories from

Sri Lanka

, the country on the very cusp of malaria elimination, and praises the political stewardship of the state-sponsored Anti Malaria Campaign. The message is clear - Sri Lanka is vigilant in every aspect of their malaria elimination campaign, and are destined to be an example for all countries. Read the article here.