Key facts

· Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is preventable and curable.

· In 2016, there were an estimated 216 million cases of malaria in 91 countries, an increase of 5 million cases over 2015.

· Malaria deaths reached 445 000 in 2016, a similar number (446 000) to 2015.

· The WHO African Region carries a disproportionately high share of the global malaria burden. In 2016, the region was home to 90% of malaria cases and 91% of malaria deaths.

· Total funding for malaria control and elimination reached an estimated US$ 2.7 billion in 2016. Contributions from governments of endemic countries amounted to US$ 800 million, representing 31% of funding.

Malaria is caused by Plasmodium parasites. The parasites are spread to people through the bites of infected female Anopheles mosquitoes, called "malaria vectors." There are 5 parasite species that cause malaria in humans, and 2 of these species ? P. falciparum and P. vivax ? pose the greatest threat.

· P. falciparum is the most prevalent malaria parasite o­n the African continent. It is responsible for most malaria-related deaths globally.

· P. vivax is the dominant malaria parasite in most countries outside of sub-Saharan Africa.

Malaria is an acute febrile illness. In a non-immune individual, symptoms usually appear 10?15 days after the infective mosquito bite. The first symptoms - fever, headache, and chills? may be mild and difficult to recognize as malaria. If not treated within 24 hours, P. falciparum malaria can progress to severe illness, often leading to death.

Children with severe malaria frequently develop o­ne or more of the following symptoms: severe anaemia, respiratory distress in relation to metabolic acidosis, or cerebral malaria. In adults, multi-organ involvement is also frequent. In malaria endemic areas, people may develop partial immunity, allowing asymptomatic infections to occur.

Who is at risk?

In 2016, nearly half of the world's population was at risk of malaria. Most malaria cases and deaths occur in sub-Saharan Africa. However, the WHO regions of South-East Asia, Eastern Mediterranean, Western Pacific, and the Americas are also at risk. In 2016, 91 countries and areas had o­ngoing malaria transmission.

Some population groups are at considerably higher risk of contracting malaria, and developing severe disease, than others. These include infants, children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as non-immune migrants, mobile populations and travellers. National malaria control programmes need to take special measures to protect these population groups from malaria infection, taking into consideration their specific circumstances.

Disease burden

According to the latest World Malaria Report, released in November 2017, there were 216 million cases of malaria in 2016, up from 211 million cases in 2015. The estimated number of malaria deaths stood at 445 000 in 2016, a similar number to the previous year (446 000).

The WHO African Region continues to carry a disproportionately high share of the global malaria burden. In 2016, the region was home to 90% of malaria cases and 91% of malaria deaths. Some 15 countries ? all in sub-Saharan Africa, except India ? accounted for 80% of the global malaria burden.

In areas with high transmission of malaria, children under 5 are particularly susceptible to infection, illness and death; more than two thirds (70%) of all malaria deaths occur in this age group. The number of under-5 malaria deaths has declined from 440 000 in 2010 to 285 000 in 2016. However, malaria remains a major killer of children under five years old, taking the life of a child every two minutes.

Transmission

In most cases, malaria is transmitted through the bites of female Anopheles mosquitoes. There are more than 400 different species of Anopheles mosquito; around 30 are malaria vectors of major importance. All of the important vector species bite between dusk and dawn. The intensity of transmission depends o­n factors related to the parasite, the vector, the human host, and the environment.

Anopheles mosquitoes lay their eggs in water, which hatch into larvae, eventually emerging as adult mosquitoes. The female mosquitoes seek a blood meal to nurture their eggs. Each species of Anopheles mosquito has its own preferred aquatic habitat; for example, some prefer small, shallow collections of fresh water, such as puddles and hoof prints, which are abundant during the rainy season in tropical countries.

Transmission is more intense in places where the mosquito lifespan is longer (so that the parasite has time to complete its development inside the mosquito) and where it prefers to bite humans rather than other animals. The long lifespan and strong human-biting habit of the African vector species is the main reason why nearly 90% of the world's malaria cases are in Africa.

Transmission also depends o­n climatic conditions that may affect the number and survival of mosquitoes, such as rainfall patterns, temperature and humidity. In many places, transmission is seasonal, with the peak during and just after the rainy season. Malaria epidemics can occur when climate and other conditions suddenly favour transmission in areas where people have little or no immunity to malaria. They can also occur when people with low immunity move into areas with intense malaria transmission, for instance to find work, or as refugees.

Human immunity is another important factor, especially among adults in areas of moderate or intense transmission conditions. Partial immunity is developed over years of exposure, and while it never provides complete protection, it does reduce the risk that malaria infection will cause severe disease. For this reason, most malaria deaths in Africa occur in young children, whereas in areas with less transmission and low immunity, all age groups are at risk.

Prevention

Vector control is the main way to prevent and reduce malaria transmission. If coverage of vector control interventions within a specific area is high enough, then a measure of protection will be conferred across the community.

WHO recommends protection for all people at risk of malaria with effective malaria vector control. Two forms of vector control ? insecticide-treated mosquito nets and indoor residual spraying ? are effective in a wide range of circumstances.

Insecticide-treated mosquito nets

Long-lasting insecticidal nets (LLINs) are the preferred form of insecticide-treated mosquito nets (ITNs) for public health programmes. In most settings, WHO recommends LLIN coverage for all people at risk of malaria. The most cost-effective way to achieve this is by providing LLINs free of charge, to ensure equal access for all. In parallel, effective behaviour change communication strategies are required to ensure that all people at risk of malaria sleep under a LLIN every night, and that the net is properly maintained.

Indoor spraying with residual insecticides

Indoor residual spraying (IRS) with insecticides is a powerful way to rapidly reduce malaria transmission. Its potential is realized when at least 80% of houses in targeted areas are sprayed. Indoor spraying is effective for 3?6 months, depending o­n the insecticide formulation used and the type of surface o­n which it is sprayed. In some settings, multiple spray rounds are needed to protect the population for the entire malaria season.

Antimalarial drugs

Antimalarial medicines can also be used to prevent malaria. For travellers, malaria can be prevented through chemoprophylaxis, which suppresses the blood stage of malaria infections, thereby preventing malaria disease. For pregnant women living in moderate-to-high transmission areas, WHO recommends intermittent preventive treatment with sulfadoxine-pyrimethamine, at each scheduled antenatal visit after the first trimester. Similarly, for infants living in high-transmission areas of Africa, 3 doses of intermittent preventive treatment with sulfadoxine-pyrimethamine are recommended, delivered alongside routine vaccinations.

In 2012, WHO recommended Seasonal Malaria Chemoprevention as an additional malaria prevention strategy for areas of the Sahel sub-region of Africa. The strategy involves the administration of monthly courses of amodiaquine plus sulfadoxine-pyrimethamine to all children under 5 years of age during the high transmission season.

Insecticide resistance

Much of the success in controlling malaria is due to vector control. Vector control is highly dependent o­n the use of pyrethroids, which are the o­nly class of insecticides currently recommended for ITNs or LLINs.

In recent years, mosquito resistance to pyrethroids has emerged in many countries. In some areas, resistance to all 4 classes of insecticides used for public health has been detected. Fortunately, this resistance has o­nly rarely been associated with decreased efficacy of LLINs, which continue to provide a substantial level of protection in most settings. Rotational use of different classes of insecticides for IRS is recommended as o­ne approach to manage insecticide resistance.

However, malaria-endemic areas of sub-Saharan Africa and India are causing significant concern due to high levels of malaria transmission and widespread reports of insecticide resistance. The use of 2 different insecticides in a mosquito net offers an opportunity to mitigate the risk of the development and spread of insecticide resistance; developing these new nets is a priority. Several promising products for both IRS and nets are in the pipeline.

Detection of insecticide resistance should be an essential component of all national malaria control efforts to ensure that the most effective vector control methods are being used. The choice of insecticide for IRS should always be informed by recent, local data o­n the susceptibility of target vectors. To ensure a timely and coordinated global response to the threat of insecticide resistance, WHO worked with a wide range of stakeholders to develop the "Global Plan for Insecticide Resistance Management in Malaria Vectors (GPIRM)", which was released in May 2012.

Diagnosis and treatment

Early diagnosis and treatment of malaria reduces disease and prevents deaths. It also contributes to reducing malaria transmission. The best available treatment, particularly for P. falciparum malaria, is artemisinin-based combination therapy (ACT). WHO recommends that all cases of suspected malaria be confirmed using parasite-based diagnostic testing (either microscopy or rapid diagnostic test) before administering treatment. Results of parasitological confirmation can be available in 30 minutes or less. Treatment, solely o­n the basis of symptoms should o­nly be considered when a parasitological diagnosis is not possible. More detailed recommendations are available in the "WHO Guidelines for the treatment of malaria", third edition, published in April 2015.

Antimalarial drug resistance

Resistance to antimalarial medicines is a recurring problem. Resistance of P. falciparum to previous generations of medicines, such as chloroquine and sulfadoxine-pyrimethamine (SP), became widespread in the 1950s and 1960s, undermining malaria control efforts and reversing gains in child survival.

WHO recommends the routine monitoring of antimalarial drug resistance, and supports countries to strengthen their efforts in this important area of work.

An ACT contains both the drug artemisinin and a partner drug. In recent years, parasite resistance to artemisinin has been detected in 5 countries of the Greater Mekong subregion: Cambodia, Lao People?s Democratic Republic, Myanmar, Thailand and Viet Nam. Studies have confirmed that artemisinin resistance has emerged independently in many areas of this subregion.

In 2013, WHO launched the Emergency response to artemisinin resistance (ERAR) in the Greater Mekong Subregion, a high-level plan of attack to contain the spread of drug-resistant parasites and to provide life-saving tools for all populations at risk of malaria. But even as this work was under way, additional pockets of resistance emerged independently in new geographic areas of the subregion. In parallel, there were reports of increased resistance to ACT partner drugs in some settings. A new approach was needed to keep pace with the changing malaria landscape.

Consequently, WHO?s Malaria Policy Advisory Committee in September 2014 recommended adopting the goal of eliminating P. falciparum malaria in this subregion by 2030. WHO launched the Strategy for Malaria Elimination in the Greater Mekong Subregion (2015?2030) at the World Health Assembly in May 2015, which was endorsed by all the countries in the subregion. With technical guidance from WHO, all GMS countries have developed national malaria elimination plans. Together with partners, WHO will provide o­ngoing support for country elimination efforts through the Mekong Malaria Elimination programme, a new initiative that evolved from the ERAR.

Surveillance

Surveillance entails tracking of the disease and programmatic responses, and taking action based o­n the data received. Currently many countries with a high burden of malaria have weak surveillance systems and are not in a position to assess disease distribution and trends, making it difficult to optimize responses and respond to outbreaks.

Effective surveillance is required at all points o­n the path to malaria elimination and the Global Technical Strategy for Malaria 2016-2030 (GTS) recommends that countries transform surveillance into a core intervention. Strong malaria surveillance enables programmes to optimize their operations, by empowering programmes to:

· advocate for investment from domestic and international sources, commensurate with the malaria disease burden in a country or subnational area;

· allocate resources to populations most in need and to interventions that are most effective, in order to achieve the greatest possible public health impact;

· assess regularly whether plans are progressing as expected or whether adjustments in the scale or combination of interventions are required;

· account for the impact of funding received and enable the public, their elected representatives and donors to determine if they are obtaining value for money; and

· evaluate whether programme objectives have been met and learn what works so that more efficient and effective programmes can be designed.

Stronger malaria surveillance systems are urgently needed to enable a timely and effective malaria response in endemic regions, to prevent outbreaks and resurgences, to track progress, and to hold governments and the global malaria community accountable.

Elimination

Malaria elimination is defined as the interruption of local transmission of a specified malaria parasite species in a defined geographical area as a result of deliberate activities. Continued measures are required to prevent re-establishment of transmission. (The certification of malaria elimination in a country will require that local transmission is interrupted for all human malaria parasites.)

Malaria eradication is defined as the permanent reduction to zero of the worldwide incidence of malaria infection caused by human malaria parasites as a result of deliberate activities. Interventions are no longer required o­nce eradication has been achieved.

The rate of progress in a particular country will depend o­n the strength of its national health system, the level of investment in malaria control, and a number of other factors, including: biological determinants, the environment, and the social, demographic, political, and economic realities of a particular country.

In countries with high or moderate rates of malaria transmission, national malaria control programmes aim to maximize the reduction of malaria cases and deaths. As countries approach elimination, enhanced surveillance systems can help ensure that every infection is detected, treated and reported to a national malaria registry. Patients diagnosed with malaria should be treated promptly with effective antimalarial medicines for their own health and to prevent o­nward transmission of the disease in the community. Countries that have achieved at least 3 consecutive years of 0 local cases of malaria are eligible to apply for the WHO certification of malaria elimination. In recent years, 7 countries have been certified by the WHO Director-General as having eliminated malaria: United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), Armenia (2011), Maldives (2015), Sri Lanka (2016) and Kyrgyzstan (2016). The WHO Framework for Malaria Elimination (2017) provides a detailed set of tools and strategies for achieving and maintaining elimination.

Vaccines against malaria

RTS,S/AS01 (RTS,S) ? also known as Mosquirix ? is an injectable vaccine that provides partial protection against malaria in young children. The vaccine is being evaluated in sub-Saharan Africa as a complementary malaria control tool that potentially could be added to (and not replace) the core package of WHO-recommended preventive, diagnostic and treatment measures.

In July 2015, the vaccine received a positive opinion by the European Medicines Agency, a stringent medicines regulatory authority. In October 2015, two WHO advisory groups recommended pilot implementation of RTS, S/AS01 in a limited number of African countries. WHO adopted these recommendations and is strongly supportive of the need to proceed with the pilot programme as the next step for the world?s first malaria vaccine.

In November 2016, WHO announced that the RTS,S vaccine would be rolled out in pilot projects in 3 countries in sub-Saharan Africa. Funding has been secured for the initial phase of the programme and vaccinations are due to begin in 2018. These pilot projects could pave the way for wider deployment of the vaccine if safety and effectiveness are considered acceptable.

WHO response

The WHO Global Technical Strategy for Malaria 2016-2030 - adopted by the World Health Assembly in May 2015 ? provides a technical framework for all malaria-endemic countries. It is intended to guide and support regional and country programmes as they work towards malaria control and elimination.

The Strategy sets ambitious but achievable global targets, including:

· Reducing malaria case incidence by at least 90% by 2030.

· Reducing malaria mortality rates by at least 90% by 2030.

· Eliminating malaria in at least 35 countries by 2030.

· Preventing a resurgence of malaria in all countries that are malaria-free.

This Strategy was the result of an extensive consultative process that spanned 2 years and involved the participation of more than 400 technical experts from 70 Member States. It is based o­n 3 key pillars:

· ensuring universal access to malaria prevention, diagnosis and treatment;

· accelerating efforts towards elimination and attainment of malaria-free status; and

· transforming malaria surveillance into a core intervention.

The WHO Global Malaria Programme (GMP) coordinates WHO's global efforts to control and eliminate malaria by:

· setting, communicating and promoting the adoption of evidence-based norms, standards, policies, technical strategies, and guidelines;

· keeping independent score of global progress;

· developing approaches for capacity building, systems strengthening, and surveillance; and

· identifying threats to malaria control and elimination as well as new areas for action.

GMP is supported and advised by the Malaria Policy Advisory Committee (MPAC), a group of 15 global malaria experts appointed following an open nomination process. The MPAC, which meets twice yearly, provides independent advice to WHO to develop policy recommendations for the control and elimination of malaria. The mandate of MPAC is to provide strategic advice and technical input, and extends to all aspects of malaria control and elimination, as part of a transparent, responsive and credible policy setting process.

1. Letter to partners

19 December 2017 ? In his latest bi-annual letter to partners, Dr Pedro Alonso, Director of the Global Malaria Programme, shares information and updates o­n the World Malaria Report 2017, o­n WHO?s work in emergency settings, and o­n elimination efforts in the Greater Mekong. Other topics include a new WHO Malaria Threats Map and the Ashgabat Statement ? a pledge by countries of Central Asia and the Caucuses to keep the European region malaria-free.

2. Greater Mekong countries make inroads in the race towards elimination

7 December 2017 ? In recent years, countries of the Greater Mekong Subregion (GMS) have accelerated their efforts to prevent, diagnose and treat malaria. According to the latest bulletin from WHO, the reported number of malaria cases and deaths in the GMS fell by 74% and 91%, respectively, between 2012 and 2016. Mid-year estimates for 2017 point to a further decline in cases.

29 November 2017 ? After an unprecedented period of success in global malaria control, progress has stalled, according to the latest World malaria report. In 2016, there were an estimated 216 million cases of malaria in 91 countries, an increase of about 5 million cases over 2015. Deaths reached 445 000, a similar number to the previous year. ?Without urgent action, we risk going backwards and missing the global malaria targets for 2020 and beyond,? says Dr Tedros Adhanom Ghebreyesus, Director-General of WHO.

4. New interactive mapping tool launched

7 November 2017 ?

A new interactive map showing malaria vector resistance, P. falciparum gene deletions, and antimalarial efficacy and resistance has been released. Such information is critical to inform appropriate malaria prevention, diagnosis and treatment strategies and to guide the development of new tools. WHO is seeking user feedback o­n this early release version available in English, French and Spanish.

5. Report of the latest meeting of the Malaria Policy Advisory Committee

3 November 2017 ? The Malaria Policy Advisory Committee (MPAC), which brings together some of the world?s foremost experts o­n the disease, provides essential guidance to WHO for the development of global policy recommendations o­n malaria. Read the report of the latest MPAC meeting as well as a special series of interviews with the 5 women currently serving as members o­n the Committee.

6. Integrated campaign tackles malaria and polio in north-eastern Nigeria

       31 October 2017 ? In Nigeria?s Borno State, malaria is currently the leading cause of death and claims more lives than all other diseases combined. Children under the age of 5 are particularly vulnerable. WHO recently launched a special campaign in this state aimed at rapidly reducing the malaria burden among young children and, at the same time, protecting them against polio.

7. Malaria Policy Advisory Committee meeting report (October 2017)

On 17-19 October 2017, the WHO Malaria Policy Advisory Committee (MPAC) convened to review updates and progress, and provide guidance with respect to specific thematic areas of work carried out by the Global Malaria Programme.

The meeting included 10 sessions focused o­n 18 topics: (1) the outcomes from an evidence review group (ERG) o­n low density infections; (2) the outcomes from an ERG o­n the deployment of piperonyl butoxide plus pyrethroids nets; (3) an update o­n malaria elimination in the Greater Mekong Subregion; (4) the outcomes from the drug efficacy and response technical expert group (TEG); (5) a response plan o­n pfhrp2 gene deletions; (6) an update o­n RTS,S pilot implementation; (7) an update o­n the malaria vaccine advisory committee; (8) an update o­n the vector control advisory group; (9) the outcomes of the ERG o­n comparative effectiveness of vector control tools; (10) a proposed ERG o­n border malaria; (11) an introduction to the WHO Research & Development Observatory; (12) a presentation o­n universal access to malaria core interventions ; (13) the results from the rapid access expansion programme o­n integrated community case management of malaria; (14)  a demonstration of the o­nline mapping tool for insecticide resistance, antimalarial resistance and hrp2/3 deletion data; (15) the outcomes of the ERG o­n malaria in pregnancy outside of Africa; (16) an update o­n the establishment of the malaria elimination oversight committee (MEOC) and malaria elimination certification panel (MECP); (17) a proposed ERG o­n malaria mortality estimates; and (18) a review of the revised recommendations for achieving and maintaining universal coverage with long-lasting insecticidal nets in malaria control.

8. Global vector control response 2017?2030

Overview

            The

Global vector control response 2017?2030 (GVCR) provides a new strategy to strengthen vector control worldwide through increased capacity, improved surveillance, better coordination and integrated action across sectors and diseases.

In May 2017, the World Health Assembly adopted resolution WHA 70.16, which calls o­n Member States to develop or adapt national vector control strategies and operational plans to align with this strategy.

Resolution WHA70.16: An integrated approach for the control of vector-borne diseases

            Priority activities set out in the GVCR fall within 4 pillars that are underpinned by 2 foundational elements:

Pillars of action

· Strengthen inter- and intra-sectoral action and collaboration

· Engage and mobilize communities

· Enhance vector surveillance, and monitoring and evaluation of interventions

· Scale up and integrate tools and approaches

Foundation

· Enhance vector control capacity and capability

· Increase basic and applied research, and innovation

            Successful implementation of the GVCR will require strong country leadership, advocacy, resource mobilization and partner coordination, along with regulatory, policy and normative support.

            The GVCR was developed through a fast-tracked and broadly consultative process co-led by the WHO Global Malaria Programme (GMP), WHO Department of Control of Neglected Tropical Diseases (NTD), and the Special Programme for Research and Training in Tropical Diseases (TDR). It is currently available in final format in English. Draft versions in 5 other languages are currently being updated and finalized.

Diagnostic testing

Early and accurate diagnosis of malaria is essential for both rapid and effective disease management and malaria surveillance. High-quality malaria diagnosis is important in all settings as misdiagnosis can result in significant morbidity and mortality. WHO recommends prompt malaria diagnosis either by microscopy or malaria rapid diagnostic test (RDT) in all patients with suspected malaria before treatment is administered. Diagnostic testing improves the overall management of patients with febrile illnesses, and may also help to reduce the emergence and spread of drug resistance by reserving antimalarials for those who actually have the disease.

9. Overview of diagnostic testing

Malaria diagnostic testing improves the quality of care for all patients with febrile illnesses. It is the first step in the WHO-recommended T3: Test. Treat. Track approach to malaria treatment.

Microscopy: Microscopy remains the mainstay of malaria diagnosis in most large health clinics and hospitals but the quality of microscopy-based diagnosis is frequently inadequate.

Rapid diagnostic tests: Malaria rapid diagnostic tests have the potential to significantly improve management of malaria infections, especially in remote areas with limited access to good quality microscopy services.

Nucleic acid amplification-based diagnostics: Nucleic acid amplification tests can detect low density malaria infections. WHO recommends that their use be considered o­nly for epidemiological research and surveys mapping submicroscopic infections.

Guidance o­n the evaluation, procurement, use and evaluation of malaria RDTs

This site provides information and guidance to malaria control programmes and health services, test kit manufacturers as well as organizations and individuals considering the use of RDTs.

10. Changes to the WHO-FIND Malaria RDT Lot Testing Programme

29 November 2017-This information note replaces the earlier note o­n the malaria RDT lot testing programme issued o­n 6 November 2017. The pilot implementation of decentralized malaria RDT lot testing has been postponed due to insufficient financial resources. The current model of lot testing will continue with some modifications described below.

For the last 9 years, FIND and WHO have coordinated an independent global quality assessment programme for malaria rapid diagnostic test (RDT) lots. The programme was funded initially by the Bill and Melinda Gates Foundation and the Global Fund to Fight AIDS, Tuberculosis and Malaria, and over the last 5 years, has been supported by UNITAID and USAID/JSI. The programme is designed to assess lot-to-lot variations in RDT performance in order to ensure that o­nly malaria RDT lots that meet performance standards are used in endemic countries. Since 2011, lot testing has been mandatory for all Global Fund grant recipients and has been adopted by all other major RDT procurers. From 2007 through 2016, the WHO-FIND global lot testing programme tested more than 5000 RDT lots (representing over 900 million RDTs) destined for more than 70 endemic countries. The testing has been conducted free of charge for health ministries, malaria control programmes, RDT procurers, implementing organizations and RDT manufacturers, using reference laboratories in Cambodia (Institut Pasteur [IPC]) and the Philippines (Research Institute for Tropical Medicine [RITM]).

Malaria RDT Lot Testing: modification of procedures

Effective 5 December 2017, the Foundation for Innovative New Diagnostics (FIND) and the Institute Pasteur (IPC) will no longer be involved in the coordination or conduct of the international malaria RDT lot testing scheme. However, the Research Institute for Tropical Medicine (RITM) will continue to operate as the lot testing laboratory serving the global community and WHO will coordinate lot testing activities. The standard WHO-FIND lot testing protocols will be followed with minor revisions.

11. Global Technical Strategy for Malaria 2016-2030

The WHO Global Technical Strategy for Malaria 2016-2030 was adopted by the World Health Assembly in May 2015. The document was developed through an inclusive process under the guidance of a Steering Committee composed of leading malaria technical experts, scientists and country representatives. Oversight was provided by the Malaria Policy Advisory Committee. During the strategy development process, WHO consulted all affected countries through a series of 7 regional consultations. In July-August 2014, WHO held a public web consultation, during which members of the global health community, including nongovernmental organizations in official relations with WHO, had an opportunity to comment o­n the draft. The document was developed in close alignment with the Roll Back Malaria Partnership?s Action and Investment to defeat Malaria 2016-2030 ? for a malaria-free world to ensure shared goals and complementarity. WHO is now working o­n developing regional implementation plans to roll out the technical strategy.

12. Responding to antimalarial drug resistance

11 May 2017- Resistance to antimalarial medicines is a threat to global efforts to control and eliminate malaria. Improved access to effective malaria treatments has been a key contributing factor to the significant reduction in the malaria burden in recent years. Protecting the efficacy of the recommended malaria treatments is a top priority for malaria endemic countries and the global malaria community.

Therapeutic efficacy studies results and treatment policy change

            Therapeutic efficacy studies (TES) are the main reference from which national malaria control programmes determine their national treatment policy. To ensure the efficacy of treatments implemented through national policies, WHO recommends that:

· National malaria control programme should adopt antimalarial medicines with a parasitological cure rate of more than 95%. Medicines should then be monitored at least o­nce every 24 months at established sentinel sites;

· Regions for which there is evidence of resistance should consider adding more sentinel sites to facilitate early detection of new resistance foci.

A change in the national malaria treatment policy should be initiated if the total treatment failure rate is equal to 10% or greater, as assessed through monitoring of therapeutic efficacy.

· WHO-recommended treatment for malaria

Changing the treatment policy for Plasmodium falciparum

            Nearly all malaria endemic countries recommend artemisinin-based combination therapies (ACTs) for the treatment of uncomplicated P. falciparum. Therapeutic efficacy results help determine:

· the proportion of patients with confirmed presence of parasites in the blood o­n day 3 (currently the main indicator to identify suspected artemisinin resistance in P. falciparum);

· the proportion of treatment failure by day 28 or 42.

Recommended steps for making treatment policy decisions in response to TES findings

Changing the treatment policy for Plasmodium vivax

Most countries endemic for vivax malaria recommend chloroquine or ACT for the treatment of uncomplicated P. vivax. Most also include primaquine to eliminate latent liver stage infections and prevent relapse (a method known as radical cure), as it improves the activity of chloroquine against chloroquine-resistant blood stage parasites.

A change in treatment policy to an ACT is recommended if efficacy studies for chloroquine find a total treatment failure rate equal to 10% or greater. To date P. vivax resistance to an ACT has not been detected.

Preventing and containing antimalarial drug resistance

Several factors influence the emergence and spread of drug resistant malaria parasites, including the number of parasites exposed to a drug, the drug concentration to which the parasites are exposed, and the simultaneous presence of other antimalarials in the blood to which the parasite is not resistant.

In areas where the recommended antimalarial treatments remain fully efficacious, correct medicine use must be promoted, with special attention to expanding diagnostic testing, quality-assured treatment, and good patient adherence to the prescribed treatment. Further extending basic malaria interventions, including vector control, will reduce the number of parasites exposed to a drug and the risk of resistance.

Use of oral artemisinin-based monotherapy (oAMT) is considered a contributing factor to the development and spread of resistance to artemisinins. WHO has urged regulatory authorities in malaria-endemic countries to take measures to halt the production and marketing of oAMT, and promote access to quality-assured ACTs for the treatment of falciparum malaria.

Countries where resistance to artemisinins or to ACT partner drugs is reported need to intensify malaria control in order to reduce the burden of the disease, and delay or prevent the spread of resistance. Prevention and containment activities need to build o­n, expand and accelerate o­ngoing national efforts to control and eliminate malaria. In areas of low transmission where antimalarial drug resistance is present, countries should target rapid elimination of falciparum malaria to limit the risk of spread and minimize the impact of resistance in the region.

13. Immunization, Vaccines and Biologicals

WHO?s Initiative for Vaccine Research (IVR) facilitates vaccine research and development (R&D) against pathogens with significant disease and economic burden, with a particular focus o­n low and middle income countries. Our activities span the following areas:

· facilitation of early stage R&D in disease areas with no available vaccines or sub-optimal vaccines,

· research to optimize public health impact where existing vaccines are underutilized,

· research to aid introduction decision-making and post-licensure assessments of risk/benefit

· research to improve monitoring and evaluation of vaccines in use in immunization programmes.

IVR activities align with the strategic objective 6 of the Global Vaccine Action Plan ?Country, regional and global research and development innovations maximize the benefits of immunization?, and with the fifth goal of the Decade of Vaccines ?Develop and introduce new and improved vaccines and technologies?.

Other news »

---

• Malaria vaccines: Advances and future directions (06/28/2024)
• World Mosquito Day 2023 - Theme, Importance, & Slogans (08/18/2023)
• 'You get goosebumps from the data': hopes rise for new malaria vaccine (07/30/2022)
• Malaria in 2022: Increasing challenges, cautious optimism (06/30/2022)
• Ivermectin administration to livestock has greatest impact in West Africa (05/27/2019)