Child With Malaria : Malaria Prevention and Malarial Vaccine

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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MALARIA IN CHILDREN -AN OVERVIEW

Prevention of Malaria

Related topics

Introduction

Clinical Features

Complicated Falciparum Malaria Signs Diagnosis and Management

Falciparum Malaria General Measures and Treatment

Dr. M.R.Lokeshwar
Past-President, Indian Academy of Pediatrics (1998)
President-Pediatric Association of SAARC Countries (PAS) (1999)

Malaria is an epidemic disease in certain parts of the world and also endemic at number of places. It is a significant public health problem. Age old saying "Prevention is better than cure" is absolutely true for this disease as the morbidity and mortality can be brought down by stringent preventive measures which include -

Prevention of malaria :

Malaria is an epidemic disease in certain parts of the world and also endemic at number of places. It is a significant public health problem. Age old saying "Prevention is better than cure" is absolutely true for this disease as the morbidity and mortality can be brought down by stringent preventive measures which include -

Measures to prevent mosquito bites :
use of bed net (preferably treated with mosquito repellent like Permethrin), wire gauze screen for windows and doors, use of mosquito repellants like citronella oil, neem oil, creams like Dimethyl phthalate (DMP), DEET, use of coils (active ingredient is generally synthetic pyrethroid) or use of mats.
Mosquito control measures
- Insecticide sprays like DDT, BHC, aldrin etc. or Genophosphorus components, malathion, chlorthion and fumigants like SO₂ and methylbromide. to kill the mosquitos
- Antilarval measures like use of larvivorous fishes.
- Removal of breeding places by proper drainage system. Covering of stored water, spraying of oil.
Chemoprophylaxis and use of vaccines :
Chemoprophylaxis is recommended only for pregnant women, non-immune travelers and in children below the age of 4 years. Drugs used for this purpose are :
- Proguanil - 3 mg/kg daily orally but not preferred as parasites are by and large resistant.
- Chloroquine - 5 mg. base/kg/wt (max 300 mg) daily and is drug of choice in non-resistant cases.
However side effects need monitoring and for resistant cases Pyrimethamine + dapsone or sulphadoxine + primethamine, doxycycline and mefloquine may be used. Travellers from non-endemic area who want to visit should be asked to start at least 1 week before the journey and should be continued at least 4-6 weeks after leaving the endemic area.

Malarial vaccine :
Despite massive investment towards development of material vaccine, a safe, effective and long lasting vaccine is still a dream. The various vaccine tried are :

Liver stage vaccine or sporozoite stage vaccine -
- Circumsporozoite surface protein (CS protein) which covers the sporozoites. However it is found to be unprotective.
- Cytotoxic lymphocyte fragment vaccine.
- Sporozyte surface protein II (SSP-II) : This is another major sporozoite protein and antibodies against the peptide strongly inhibit hepatocyte invasion of sporozoite.
- Liver stage antigen I : begin tried
Blood stage vaccines :
Though this vaccine will be incapable of preventing infection, they will be definitely successful in reducing parasite load or transmission of infection.
- Merozoite surface antigen - (MSA) I & II are polypeptide in the merozoite membrane and found to be highly immunogenic.
- Ringed erythrocyte surface antigen and erythrocyte binding antigen- They are again merozoite proteins. Antibodies against this antigen can inhibit invasion of erythrocytes.
- Though it will be a long time before the malaria vaccine becomes a reality, ideal malarial vaccine should be discovered which should not only reduce morbidity and morality but be also cheap and stable.

Conclusion :
Successful management of malaria in children requires high index of suspicion in clinical diagnosis, prompt & early initiation of the treatment and anticipation & management of various complications with proper supportive care. However, the most important issue is the control of malaria through vector control and enviornmental sanitation.Malarial vaccine is the hope for the future.

Also See Article On "MALARIA" For More Information
See Expertise Views For Questions On"Malaria"

Last created on 23-02-2001
Last updated on 15-05-2007

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