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Name: Message> IDRC: Malaria Control in a Nutshell > > \ > > Researchers in Peru have discovered a low-cost, eco-friendly > weapon in the fight against malaria: that weapon is COCONUTS. > Coconuts are used to incubate a bacteria which successfully > controls the larva of the malaria-bearing mosquito. > > The Facts about Malaria > > Malaria, one of the most debilitating diseases in the > developing world, is making a comeback. Epidemics are increasing, > despite a decade of control programs in various parts of the > world. Malaria is spread by the bite of a mosquito. It causes > fever, chills, nausea, and muscle painand can lead to severe > complications and death. Its weakening effects sap productivity; > in countries where malaria is endemic, workforce and school > absenteeism is high. Every minute, two children die from the > effects of malaria somewhere in the tropics. Almost half of the > world's population is at risk of catching malaria. About 300 to > 500 million people suffer from the disease each year and more > than one million die of it. Mosquitos are becoming more resistant > to chemical insecticides, such as DDT, that have been used for > decades to control malaria. Moreover, insecticides are expensive > to use and can pose a threat to human health and cause > environmental contamination. > > A Solution: Using coconuts to produce malaria-killing bacteria > > * Bacillus thuringiensis var israelensis H-14 (Bti) is a > bacteria that effectively kills mosquito larvae. It is > commercially available but its cost can be prohibitive for > developing countries. Researchers at the Alexander von > Humboldt Tropical Medicine Institute in Lima, Peru found a > cheap way to produce Bti. It can be grown in coconuts and > then released into ponds where mosquito larvae flourish. > * Bti is environmentally friendly. It is a naturally occurring > bacteria that is harmless to humans and livestock. > * The research team has developed a kit that communities can > use to produceBti in coconuts with minimal instruction. The > coconuts are plentiful and free, growing virtually beside the > ponds infested with mosquito larvae. > > The Coconut Laboratory > > "Out in the field, the coconut can replace the petri dish and the > lab." - Microbiologist and research team leader Palmira > Ventosilla > > How does it work? > > A cotton swab that has been doused with Bti is dropped through a > hole drilled in a coconut. The hole is plugged with a wisp of > cotton and sealed with candle wax. The coconut's hardshell > protects the Bti during incubation while the coconut milk > contains the amino acids and carbohydrates the bacteria must eat > to reproduce. After the coconuts have fermented for two to three > days, they are broken open and thrown into an infested pond. > Along with their regular diet of algae, the mosquito larvae eat > the bacteria. The Bti kills the larvae by destroying the stomach > lining. In tests, the Bti killed nearly all the mosquito larvae > in a pond and stopped breeding for 12 to 45 days. A typical pond > needs two to three coconuts for each treatment. > > How the research was developed: A Chronology > > * 1976. Bti is discovered by Israeli scientists when they > notice a large number of dead mosquito larvae in certain > ponds. On analysis of the pond water, they isolate the Bti > spore. > * Late 1980s. It is noted at several international meetings > that the malaria situation is getting worse. > * 1988. The Peruvian research team tries to multiply the Bti > spore by fermenting it with such locally grown produce as > bananas and pineapples. The idea came from the native > practice of making a fermented drink from the yucca plant. > Coconuts prove to be the best option. > * 1992. Recognizing the need for a renewed attack on malaria, > 102 member states of the World Health Organization adopt a > Global Malaria Control Strategy. The strategy acknowledges > the importance of community partnerships in fighting the > disease. > * 1993. Using coconuts as incubators, three communities in > northern Peru produce Bti to apply to local larvae breeding > grounds. > > > Copyright 1997 \co International Development Research Centre, > Ottawa, Canada\ > > pub@idrc.ca | March 2, 1997 Name: Peter Singfield (via rlt) MessageThe following -- in my opinion -- is an excellent description of what Dengue is about. Lots of answers for those "tricky" questions regarding Dengue Hemoragic Fever. Peter Singfield, Belize
One last announcement -- "Pink Eye" (viral conjunctivitis) is on it's way -- we see it every fall. Read the following -- (Again from Promed)
Date: Sat, 17 Oct 1998 10:13:34 -0500 From: Silvio Vega <silviove@pty.com>
More than 10,000 cases of viral conjunctivitis has been reported in Panama City in the last 3 weeks. -- Silvio Antonio Vega, MD, MSc. Professor of Microbiology Faculty of Medicine PO.BOX. 10878 University of Panama ***************************************************** DENGUE - CANADA (EX BARBADOS) ***************************** A ProMED-mail post <http://www.healthnet.org/programs/promed.html> Date: Sat, 17 Oct 1998 08:51:44 -0700 Source: (Canada CDR, Vol. 24 / No. 10) Via: Dr. James Chin, CDPC mail <jchin@cdpc.com>
Dengue fever is emerging as a public health problem in many countries in the American tropics (e.g., the Caribbean, Mexico, Central America, and northern South America) commonly visited by Canadian tourists. Anecdotal single case reports of dengue in Canadians have been published in the past. However, a better indication of incidence is dengue serology data from the National Arbovirus Laboratory, Laboratory Centre for Disease Control, Ottawa, and the Ontario Provincial Laboratory, Toronto. While dengue is not a reportable disease, the annual number of serologically diagnosed cases (confirmed and suspected) has increased considerably in this decade - 17 vs. 29.5 in the 1980s and 1990s, respectively. The number is expected to rise in coming years. We report here an unusual single source outbreak of dengue in a group of 13 tourists, 11 of whom were Canadian, sharing the same holiday accommodation on the west coast of Barbados during the 2-week period from 21 December 1997 to 4 January 1998. The outbreak is of interest because of the high attack rate over a very short period of time, as well as for the questions it raises concerning risks to tourists of second attacks of dengue, and the associated risk of the serious consequences of dengue hemorrhagic fever (DHF) / dengue shock syndrome (DSS). Discussion: There are four distinct serotypes of dengue virus (DEN 1, DEN 2, DEN 3, and DEN 4). Immunity is serotype specific and lasts for life. However, after a short period of cross-protection of about 6 to 8 months, humans infected with one serotype are fully susceptible to infections with the other serotypes. Moreover, sub-neutralizing levels of heterotypic dengue antibodies place them at risk of developing DHF/DSS through an antibody-dependant enhancement of viral infection. In the Western hemisphere, this phenomenon has been illustrated by the Cuban DHF/DSS epidemic of 1981. In 1977- 1978, a major outbreak of classic dengue caused by DEN 1 virus occurred in Cuba and resulted in infection of 44% of the total population. In 1981, 3 years after the first outbreak, a second outbreak caused by DEN 2 virus was unusually severe. A total number of 116,000 people required hospitalization (1% of the Cuban population) and, of these, 10,312 (including 158 fatal cases) were classified as DHF/DSS. A seroepidemiologic study showed a ratio of DHF/DSS hospitalizations to individuals with secondary infections to be 1/32 among children and 1/80 among adults. Other studies, done in Thailand, have found an incidence of DSS of 0.5% to 20% in children experiencing a secondary dengue infection with any serotype. The greatest risk appeared when the second infection occurred 6 months to 5 years after the primary one. Recently, new data from Cuba are suggesting that DHF/DSS can occur even 16 years after a primary infection. After the 1981 outbreak, strict measures of surveillance and controls eliminated dengue in Cuba for 16 years, until January 1997. Since then, there has been an epidemic of 2,946 serologically confirmed cases of dengue; 205 (including 12 fatal cases) were classified as DHF/DSS. Preliminary studies indicate that 98% of these DHF/DSS cases were due to secondary infection. Of concern is the fact that, apart from one exception, all cases of DHF/DSS were equal to or greater than 17 years of age, suggesting a longer period of antibody- dependant enhancement than previously proposed. This is the first report of a single point outbreak of dengue in Canadian tourists. In this group of 13 tourists, living in a single building for 1 to 2 weeks, the attack rate for classic dengue was 77%. This attack rate is consistent with reports in the literature for dengue epidemics in large populations, but it is noteworthy for such a high attack rate over a relatively short period of exposure. In fact, most of the tourists became sick within a 4-day period, suggesting that a single mosquito may have infected more than one person. _Aedes aegypti_ is known to be a "nervous feeder" and can feed on multiple individuals during the same blood meal. This outbreak points to an increasing health risk for tourists in popular vacation destinations of the Americas. It also points out the need for better education of tourists regarding classic dengue avoidance, and equally importantly a clearer definition of the risks of haemorrhagic dengue in tourists who have had classic dengue in the past and wish to return to dengue endemic regions of the world. The tourist's first line of attack in dengue prevention is the avoidance of the day-biting _Aedes aegypti_ mosquito. Standard insect repellents, long sleeves and trousers, and the use of insecticides in screened accommodations can have an impact. _Ae. aegypti_ breeds in the still clean water of discarded tires, cans, water storage containers, and flower pots, and travels from its site only 100 metres during its life. The removal of such breeding sites in the vicinity of tourist accommodation may reduce the risk of dengue. Breeding sites that can not be removes can be treated with larvicides. At present, there is no effective vaccine against dengue. -- ProMED-mail e-mail: promed@usa.healthnet.org [ProMED-mail has posted numerous requests for information regarding dengue cases, clusters, outbreaks, or epidemics in the Caribbean. Obtaining data has been like pulling teeth, only with great resistance, political and otherwise. These cases imported into Canada are an example of the likely reason few countries are willing to tell the truth, the whole truth, and nothing but the truth. This, of course, is a disservice to humanity and keeps tourists in the dark as to what is really going on in those countries but is economically functional. Or, as Humphrey Bogart ("Casablanca") said, "Well, everybody in Casablanca has problems. Yours may work out." - Mod.CHC] ....................................chc/es -- Send all items for posting to: promed@usa.healthnet.org (NOT to an individual moderator). If you do not give your full name and affiliation, it may not be posted. Send commands to subscribe/unsubscribe, get archives, help, etc. to: majordomo@usa.healthnet.org. For assistance from a human being, send mail to: owner-promed@usa.healthnet.org Name: Peter Singfield (via rlt) MessageFolks: Peter here -- I am presenting this very good article on Malaria in all it's aspects. Suggest you file it. It is coming in two parts. This is part one. This excellent description of malaria is presented by Rotary Against Malaria. The original Url is: http://www.bednet.org/MalPrev.html The following is a good ASCII text rendition. Easier to file for future on hand reference. I may suggest printing it out for further distribution to those that are not so fortunate to be connected to the WWW. Some disclaimers at this time: The booklet is dated 1994. So certain parts referring to statistics of world wide malaria are on the low side. Further, there is no reference to Artemether or the new technology Antigen detection kits. But it is a very good general handbook on malaria!! Something that anyone planing to travel to the tropics should have on hand. Peter Singfield. Xaibe village, Belize ******************************************* Malaria&Prevention Think of this as a sample. EDUCATION IS KEY FOR MALARIA CONTROL. CURRENTLY MANY PLACES DO NOT HAVE BOOKLETS ON THE BASICS OF MALARIA CONTROL. THE EDUCATIONAL COMPONENT OF ROTARY AGAINST MALARIA CAN USE PROVIDING EDUCATIONAL MATERIALS AS A VERY SIMPLE STARTING POINT. MATERIALS ARE AVAILABLE, BUT NOT IN THE RIGHT PLACES, THE RIGHT QUANTITIES, THE RIGHT LANGUAGES. PRINTING COSTS ARE MINIMAL. The ultimate goal is to have adequate malaria control booklets available for each country, for each language, for print and non-print readers alike. The RAM homepage hopes to have educational materials and social marketing materials available for many situations. The following is a booklet on Malaria Prevention for use in Sri Lanka. The authors wrote versions in other languages used in Sri Lanka. The IDEA is that the basic information is made available here, to ADAPT to local circumstances and to TRANSLATE into the local languages.
Malaria and its Prevention ========================== Ranjan Ramasamy Ph.D. Professor and Head, Department of Life Sciences, IFS, Kandy Manthri S. Ramasamy Ph.D. Member and Programme Leader-Vector Biology, Departmentof Life Sciences, IFS, Kalldy Anula WUesundere M.D., M.RC.P. Consultant Physician, Sri Jayawardhanapura Hospital, Kotte Ajita WUesundere M.RC.O.G. Consultant Obstetrician and Gynaecologist, Gampalla Hospital, Gampaha -------------------------------------------------------------------- Institute of Fundamental Studies Hantana Road Kandy Sri Lanka S 1994 Institute of Fundamental Studies Hantana Road Kandy Sri Lanka Edited and designed by Champa Fernando Typeset at the IFS by Champa FernaDdo ISBN 955-26-0024-3 Cover by D.S.Jayaweera Printed in Sri Lanka by Karunaratne and Sons Limited 647 Kularatne Mawatha Colombo 10 The opinions expressed in this book are those of the authors. Funds for printing this publication have been provided by the French Embassy in Sri Lanka. --------------------------------------------------------------------
Contents FOREWORD 1. HISTORY OF MALARIA 1.1 Malaria in the World 1.2 Malaria in Sri Lanka 1.3 The Anti-Malaria Campaign 2. LIFE CYCLE OF THE MALARIA PARASITE 2.1 Liver Stages 2.2 Asexual Stages in the Blood 2.3 The Sexual Stages 3. LIFE CYCLE OF THE MOSQUITO VECTOR 4. CLINICAL FEATURES AND TREATMENT OF MALARIA 4.1 Clinical Features of Malaria 4.2 Diagnosis 4.3 Treatment for Adults Clinical Complications of Malaria Chemoprophylaxis Consulting a Medical Practitioner 5. MALARIA IN PREGNANCY 5.1 Placenta in Pregnancy 5.2 Effects on the Mother 5.3 Foetal Complications 5.4 Treatment 6. PREVENTION OF MALARIA 6.1 Individual Precautions 6.2 Prevention of Malaria at the Community Level 6.3 A Malaria Vaccine 7. OUTLOOK AND CONCLUSIONS FOREWORD The idea of publishing this book emerged during a discussion that took place among Mrs. Champa Fernando (Editor, IFS) Mme. Genevieve Berreby (Cultural, Scientific and Technical Cooperation Counsellor of the French Embassy), and Prof. Ranjan Ramasamy (Head, Department of Life Sciences, IFS) at the Institute of Fundamental Studies (IFS) last year. The malaria research group at the IFS recognized the need to educate the public on malaria and how to prevent it, as a contribution to the overall malaria-control programme in the island. The IFS malaria group and the physicians who have been collaborating with them have used their knowledge to explain in this book in simple terms what everyone in Sri Lanka needs to know about malaria. I am grateful to Mme. Berreby for her sustained interest in this book and to the French Embassy for funding its publication. I sincerely hope that the objectives of the authors in writing this book will be realized. C.B. Dissanayqke Director Institute of Fundamental Studies Kandy 1994
HISTORY OF MALARIA 1.1 Malaria in the World Malaria has probably been associated with man since very early in his evolution. It is believed that malaria parasites that infect man evolved from similar parasites found in other mammals, birds, and reptiles. Malaria was widespread in Africa, Asia, and Europe during the Middle Ages and was introduced into the Americas by European settlers and their African slaves. Malaria was prevalent at this time even in the Northern European countries that experience very cold and long winters. The origin of the name malaria stems from the association between the disease and the bad air of swamps, a relationship that was noticed during Roman times in Italy. Because of its long association with human populations, malaria has influenced the evolution of certain genetic characteristics in man. Examples are seen in the case of sickle-cell anaemia (a fatal disease caused by the presence of an altered or mutant form of the gene for haemoglobin), other mutant forms of haemoglobin, and certain alleles of antigens found on the surface of white blood cells. These gene types have been selectively retained in West African populations because the presence of such genes to some extent protect individuals against malaria. The global incidence of malaria is presently estimated to be more than 300 million cases per year, about half of which are caused by the parasite Plasmodium falciparum and the balance by three other species that infect man, namely P. vivax, P. malariae, and P. ovale. Malaria is responsible for at least one million deaths annually according to the World Health Organization. Many of these occur among very young children in African countries south of the Sahara Desert. In these countries medical treatment is not readily available in rural areas and complications of malaria such as cerebral malaria, which can be fatal, are relatively common. The history of modern research into malaria can be said to have begun in 1880 with the discovery by the Frenchman Alphonse Laveran, while working in Algeria, that malaria was caused by a single-celled organism. The parasite was shown to be located inside red blood cells. The next landmark was the demonstration in 1897 by the Scotsman Ronald Ross, when he was working in India, that mosquitoes transmitted the disease while taking a blood meal. More recently, the development in 1976 by William Trager and Jim Jensen, while working in the United States of America, of a method for growing P. falciparum outside the body has greatly facilitated research on malaria. At present malaria is widespread in the tropics, but has been eradicated from Australia, Europe, and North America . Eradication of malaria from areas where it was formerly present can be attributed largely to the elimination of breeding sites of the mosquito vector (e.g., by draining of swamps and use of insecticides), improved public hygiene and education of the public on malaria, the development of anti-malarial drugs, and also to the lower rates and seasonal malaria transmission in temperate countries. Many malaria-endemic countries have launched malaria control and eradication programmes, but these have not generally been successful except in well-organized island states such as Singapore. The World Health Organization reports that many presently malaria-free countries might be at risk if an increase in vector numbers takes place as a result of favourable environmental changes. Such a situation might be created by climatic changes that accompany the increase in carbon dioxide concentration in the atmosphere. (Hey -- shades of America's burning of 60 million tons of coal per day to feed it's electricity habit -- could not resist -- Peter) Travellers to malaria-endemic countries have been known to return to Europe and North America with malaria, which sometimes goes undiagnosed and therefore becomes fatal. There is also the risk of infected mosquitoes being carried in airplanes into malaria-free tropical countries and initiating an outbreak of malaria. Increased international travel and the movement of populations because of civil strife or famine also tend to spread malaria across national frontiers. 1.2 Malaria in Sri Lanka Malaria has been a problem in Sri Lanka since ancient times. Symptoms of malaria-like fever and the use of ayurvedic preparations for its treatment have been recorded in ancient Sinhala and Tamil literature. It is reasonable to think that malaria epidemics contributed, at least partly, to the decline of the ancient kingdoms of Anuradhapura and Polonnaruwa. Epidemics of malaria have occurred this century in 1906, 1914, 1919, 1923, 1928-1929, 1934-1935, 1939-1940, 1945-1946, 1967-1969, and 1986-1988. The most serious of these was between October 1934 and April 1935 when 1.5 million people contracted the disease and 80,000 died. In the 1986-1988 epidemic, the significant feature was the dramatic increase in P. falciparum malaria. The most recent data from the Anti-Malaria Campaign shows that in 1991 there were 400,263 cases of malaria in Sri Lanka (excluding the North), of which 76,541 were caused by P. falciparum and 323,722 by P. vivax infections. Nineteen deaths were directly attributed to malaria in 1991. Sri Lanka is divided into three climatic zones based on rainfall. The dry zone receives < 2,000 mm of rain every year, mainly from the northeast monsoon (October-January). The wet zone receives > 2,500 mm of rain from the southwest monsoon (May-July) as well as from the northeast monsoon. An intermediate zone with mixed properties lies between the dry and wet zones. Malaria has traditionally been endemic in the dry and intermediate zones. In more recent times, new agricultural settlements, increasing population density, and environmental degradation have resulted in the spread of malaria to many areas in the wet zone. Occasional malaria outbreaks owing to local transmission have occurred in the suburbs of Colombo (Ragama) and Kandy (Waratenne). Only the high hill country appears to be entirely free of malaria transmission. An increase in internal travel tends to favour the spread of malaria within the country. Hence, it is not uncommon to find patients in Colombo or Nuwara Eliya hospitals who have contracted malaria during pilgrimage to Anuradhapura or Kataragama. Rainfall is a critical factor in determining the occurrence of malaria epidemics. Less than normal rainfall in the wet zone results in the drying up of rivers and formation of pools in river beds. These are favourite breeding sites of mosquitoes of the genus Anopheles that transmit malaria. Excessive rain in the dry zone, which results in the formation of large numbers of surface pools, also favours increased malaria transmission. 1.3 The Anti-Malaria Campaign The Anti-Malaria Campaign (AMC) of the Ministry of Health coordinates all main malaria-control activities in the island. Early efforts to control malaria in Sri Lanka were essentially directed towards controlling the larval stages of the vector mosquitoes. They consisted of removing breeding sites by measures such as draining marshy land and constructing and maintaining drains, biological control by introducing larvivorous fish in water bodies and wells, and chemical control by applying oil to water bodies. When DDT (dichlorodiphenyl trichloroethane) became available, a systematic campaign to spray DDT inside houses was started by the colonial government. This effort was remarkably successful in bringing down the incidence of malaria in the country. As a result, in 1958, it was considered possible to eliminate malaria from the island and a formal malaria-eradication programme was started. In 1963, only seven cases of malaria of local origin were reported in the country and DDT spraying was stopped or reduced in many areas. This success was short-lived. By 1964-1965 malaria had resurfaced and an epidemic followed in 1967-1969. DDT spraying was quickly resumed but failed to make the previous dramatic impact on malaria incidence, although it did bring the epidemic under control. Two ominous developments occurred in the 1970s. The first was the increasing resistance of the vector mosquito to DDT. The other was the increasing prevalence of P. falciparum, a parasite considered more dangerous from the clinical point of view. As a result, in 1977, a new insecticide called malathion was introduced and an intensive programme aimed at controlling rather than eradicating malaria commenced. A significant development in the administration of the AMC was the devolution of many of its responsibilities to the provincial ministries of health in 1991.
LIFE CYCLE OF THE MALARIA PARASlTE 2.1 Liver Stages Malarial infection of man occurs when infected female mosquitoes of theAnopheles species inject droplets of saliva, containing sporozoite stages of the parasite, while taking a blood meal (Figure 3). The sporozoites circulate in the blood for a few minutes and are then rapidly taken up by the liver cells. The sporozoites develop into schizonts within the liver cells and each schizont then uncdergoes multiple division to form numerous merozoites. Merozoites are released into the blood when the infected liver cell ruptures. The emergence of P. falciparum merozoites in the blood after sporozoite inoculation takes 7 to 10 days. The corresponding period for P. vivax is about 10 days. P. vivax can remain dormant in the liver in a form known as a hypnozoite for several months. This may be an adaptation of the parasite to survive winters during which time mosquitoes are absent. The tendency for P. vivax malaria to relapse after several weeks or months is due to the dormant liver stages. 2.2 Asexual Stages in the Blood Merozoites released by the liver invade red blood cells. This is achieved by specific interactions between molecules on the merozoite surface and the red blood cell membrane. P. vivax merozoites prefer younger red blood cells. Parasites within red cells can be seen by staining a blood film on a glass slide with Giemsa stain and viewing the slide under a microscope. Newly invaded parasites give a ring-like appearance after staining with Giemsa and are termed ring stages. Further development of the parasites has been well characterized in P. falcipamm, which is the only human malaria parasite that has been cultured in vitro. The ring-stage parasite grows within the red cell, feeding on haemoglobin as a source of protein and other nutrients absorbed from the blood. In 15 to 18 hours it develops into a trophozoite which grows further and undergoes nuclear and cytoplasmic fission to form numerous merozoites. Approximately 48 hours after invasion in the case of both P. falciparum and P. vivax, the red cell ruptures releasing 10 to 20 merozoites into the bloodstream. The merozoites then continue the asexual blood stage cycle in the blood. Antibodies in the blood can bind to merozoites and block the invasion of red cells. This is one mechanism by which the immune response in man protects against malaria. The asexual blood stages of the parasite stimulate white blood cells to release several protein molecules termed interleukins and interferons. These proteins have a role in the normal immune response against pathogenic organisms. In malaria, however, these proteins produced in excess cause damage to host tissues and are partly responsible for the fever of malaria. Interleukins and interferons can affect different tissues and organs and this may be responsible for the multiple effects of malaria. In the case of P. falciparum, infected red blood cells containing trophozoites and schizonts adhere to the walls of blood capillaries and thereby block the normal flow of blood. Cerebral malaria, which can be fatal, is believed to be caused by the blockage of capillaries in the brain owing to enhanced adhesion of parasitized red blood cells brought about by specific proteins released by malaria-stimulated white blood cells. 2.3 The Sexual Stages Occasionally, and particularly late in the infection, parasites within red cells differentiate into male and female gametocytes -the sexual stages of the parasite. Gametocytes do not undergo further development in blood, but do so only when ingested by anAnopheles mosquito in a blood meal. Within the mosquito gut, the gametocytes differentiate into male and female gametes. The lower temperature, pH, and molecules produced by the mosquito play a role in this process. Fertilization produces a zygote and then a motile ookinete within the gut. The ookinete passes through the single cell layer of the mosquito midgut and comes to rest on the outside surface of the gut. Here it develops into an oocyst which contains several hundred slender parasites termed sporozoites. This process takes 7 to 14 days. When an oocyst is mature, the sporozoites are released into the body cavity of the mosquito, from where they find their way to the salivary glands. The sporozoites are guided by specific recognition molecules in the salivary glands. The sporozoites are then able to continue the infection cycle when the mosquito next takes a blood meal from a person.
LIFE CYCLE OF THE MOSQUITO VECTOR The female mosquito needs to ingest a meal of blood to produce a batch of eggs. This blood meal is obtained by piercing the skin of a vertebrate host, which may be either man or another animal, with a specialized mouthpart termed the proboscis of the female mosquito. The mouthpart of the male mosquito is not adapted for blood feeding, and males usually feed on plants. In between their blood meals, female mosquitoes also feed on plant sap and plant nectar. The vectors of human malaria areAnopheles mosquitoes which can be distinguished from other mosquitoes by the stance they adopt in the resting position. Adult Anopheles rest with the piercing mouthpart, head, and the rest of the body in one straight line, thus making an acute angle with the resting surface while non-Anopheles mosquitoes do not hold all parts of their bodies in a straight line (Figure 4). The wings of Anopheles vectors are characterized by the presence of dark scales which form distinct markings on the upper margin of the wing. Many species of Anopheles mosquitoes are present in Sri Lanka, but only a few have been shown to be vectors of human malaria. Anopheles culicifacies is considered to be the most important vector of P. falciparum and P. vivax in the country. An. subpictus and An. tessellatus are some of the other well-documented vectors. An. anmllans breeds well in irrigation canals and has emerged as an important vector in certain parts of the new Mahaweli settlements. It is of negligible importance as a malaria vector elsewhere in the country. The life cycle of anAnopheles mosquito is closely associated with the presence of collections of fresh water. The femaleAnopheles mosquito lays a batch of about 100 to 150 eggs on the surface of water. Each egg is laid singly, and usually at night. The egg hatches in two days and a larva emerges. The larvae of the Anopheles mosquito lie parallel to the water surface and can therefore be easily distinguished from non-anopheline larvae which orientate themselves at an angle to the water surface. The larval stage lasts 7 to 8 days during which time it feeds on smaller organisms and organic matter present in the water, grows steadily, and moults three times. The fully grown fourth instar larva moults into a pupa. The pupal stage does not feed and an adult mosquito emerges in 1 to 2 days. The adult emerging from the pupal case, spreads its legs and wings before flying away. The female takes her first meal of blood 2 to 3 days after emergence. Female mosquitoes may rest indoors (endophilic) or outdoors (exophilic) before and after blood feeding on man (anthropophilic) or other vertebrates (zoophilic). Blood feeding by malaria vectors takes place usually at night and in the early hours of the morning. A batch of eggs is laid 2 to 3 days after feeding on blood, and during its life time, a female mosquito will lay several batches of eggs. The life span of the adult is dependant on environmental conditions such as temperature and humidity. Mosquitoes are known to have a flight range of up to about 5 km and usually 1 to 2 km. Hence, insecticides are usually sprayed in an area with a radius of a few kilometres around known mosquito breeding sites. However, mosquitoes can be dispersed over much longer distances in windy conditions.
CLINICAL FEATURES AND TREATMENT OF MALARIA 4.1 Clinical Features of Malaria P. vivax Malaria The typical P. vivax malaria fever is seen in people of non-endemic areas who have recently visited malaria-endemic locations. After an incubation period of between 8 and 17 days, the classical fever of malaria is seen, which peaks every 48 hours. A typical attack of malaria has three distinctive phases: 1. The cold stage - this stage is preceded by headache, nausea and vomiting, and backache and is followed by chills and rigors lasting 30 minutes to 2 hours. 2. The hot stage-during this stage, the fever rises rapidly to around 39^* to 42^*C. This stage lasts for 30 minutes to 4 hours and is often accompanied by a throbbing headache. 3. The sweating stage-profuse sweating follows the hot stage and the temperature falls rapidly to normal. The primary attack of fever is followed by a fever-free period of about 48 hours during which the patient feels well and may even engage in normal work. The fever then recurs on the third day. P. falciparum Malaria Features such as headache, myalgia, vomiting, and backache are more marked in P. falcipa7um infections than in P. vivax malaria. The fever is intermittent and only lasts for a few hours each day. However, the fever may be irregular and higher temperatures may be observed. The cold, hot, and sweating stages are less clearly defined from each other than in P. vivax infections. 4.2 Diagnosis Examination of Blood Films Clinical diagnosis of malaria is confirmed by examining thick and thin blood films made on glass slides under a microscope. The blood films are first stained with Giemsa or Leishman's stain to show the parasites clearly. A thick blood film is necessary when parasitaemia is low. A thin blood film is useful for distinguishing between P. vivax and P. falciparum infections, since it shows the small differences in the structure of blood-stage forms of the two species more clearly. For example, P. vivax-infected red blood cells are usually enlarged with fine, stained dots (Schuffner's dots). P. falciparum-infected cells are not enlarged and lack visible Schuffner's dots. The mature asexual stages of P. falciparum are usually not seen in peripheral blood owing to sequestration in capillaries unlike in P. vivax. Microscopic examination of blood films is the most commonly used diagnostic technique for malaria everywhere in the world. QBC (Quantitative Buffy Coat Method) This method increases the level of accuracy and positivity (i.e., the sensitivity of detecting parasites in blood). This test is based on the centrifugal stratification of red cells parasitized with Plasmodium species. A QBC microhaemocrit tube coated with acridine orange stain is used. In this method, the parasitized cells take up the acridine orange and appear as bright red specs of light against the nonfluorescing red cells. Detection of Malaria Parasites by DNA Probes This is done by reacting a small DNA sequence of the requiree Plasmodium species with the blood of a patient suspected o having malaria. The DNA "probe" specifically binds to malaria parasite DNA in the blood and the binding is made visible by, color reaction or by tagging the DNA probe with a radioactive label. An initial negative result by any of the above methods does no exclude a diagnosis of malaria, especially if the patient is alread on anti-malarial therapy. The ideal time to examine blood for the malaria parasite is when the patient has developed a temperature. Physical examination of the patient may also help in the diagnosis of malaria. The patient may be febrile, anaemic, and mildly jaundiced. The liver and spleen are usually enlarged. 4.3 Treatment for Adults (aged 15 years or older) Uncomplicated Attack of P. vivax Malaria Chloroquine: 600 mg (4 tablets on day 1). 600 mg (4 tablets on day 2). 300 mg (2 tablets on day 3). Primaquine: 15 mg (2 tablets of 7.5 mg each) every day. Primaquine is given for one week for patients returning to endemic areas, and for two weeks for patients returning to non-endemic areas. Chloroquine should be given after meals to minimize vomiting. The dosage given to children is of course lower than what is described here and depends on body weight. Uncomplicated Attack of P. falciparium Malaria Chloroquine: 600 mg on day 1. 600 mg on day 2. 300 mg on day 3. Primaquine: 45 mg as a single dose. Treatment of Chloroquine-resistant Strains of P. falciparium This is diagnosed by the clinician if there is persistent fever and asexual parasitemia after completing a full course of chloroquine. Unfortunately, chloroquine resistance is very common in countries of Southeast Asia, Africa, and Latin America, and is increasingly making its appearance in Sri Lanka. One of the following treatments may be used for adults: Quinine: 600 mg 8 hourly for 1 week. Fansidar: 3 tablets (each containing 500 mg sulfadoxine and 25 mg pyrimethamine in a single dose). Tetracycline: 500 mg every 6 hours for one week. 4.4 Clinical Complications of Malaria Complications of P. falciparium malaria occur particularly in non-immune patients who remain untreated for more than one week after the onset of fever. The most serious complication is cerebral malaria which is associated with the occurrence of deep coma and generalized convulsions. The other complications are severe liver failure, circulatory collapse, hypoglycaemia, severe anaemia, hyperpyrexia, acute pulmonary oedema, and acute renal failure. 4.5 Chemoprophylaxis In Chloroquine-sensitive Areas: Chloroquine 300 mg (2 tablets) should be taken by adults the night before entering an endemic area. As long as the person stays in the area, 300 mg of the drug should be taken once a week. Also, 300 mg of chloroquine should be taken weekly for 4 weeks afte leaving the endemic area. Children require smaller doses of the drug. In Chloroquine-resistant Areas: Several possible regimes for adults (children require smalle doses) are given below: 1. Chloroquine 300 mg weekly and proguanil 200 mg daily 2. Fansidar 1 tablet weekly. 3. Chloroquine 300 mg weekly and maloprim (dapsone and pyrimethamine) 1 tablet weekly. 4. Mefloquine 250 mg weekly for 1 month followed by 125 mg weekly during the second month. 4.6 Consulting a Medical Practitioner In all cases of suspected malaria, a medical practitioner should be consulted as early as possible. Anti-malarial drugs should not be taken indiscriminately and without a medical practitioner' prescription. Widespread use of such drugs in inadequate dose and duration helps to spread drug resistance in parasites within the country. As there are few effective drugs available for treating malaria, the spread of resistance to such drugs can cause very serious problems. A medical practitioner will also be able to best determine the appropriate drug regime and its suitability for each patient. For example, primaquine is not administered to malaria patients with an inherited deficiency of the enzyme glucose-6-phosphate dehydrogenase. Leaving malaria untreated can lead to severe illness and death in the case of P. falciparum malaria.
MALARIA IN PREGNANCY
Continued in part two --- Name: Peter Singfield (via rlt) MessageX-Sender: snkm@wgs1.btl.net (Unverified) Mime-Version: 1.0 To: hondo1@peak.org From: Peter Singfield <snkm@btl.net> Subject: Malaria&Prevention (2/2) Date: Sun, 4 Oct 1998 12:35:36 -0600 Sender: owner-hondo1@peak.org Precedence: bulk Second Part -- Malaria&Pevention MALARIA IN PREGNANCY Malaria has pronounced effects on the pregnant mother and the unborn baby. As immunity to malaria is reduced during pregnancy, pregnant women are more prone to develop malaria than nonpregnant women. Malaria affects pregnant women of all ages and has similar effects on them regardless of the number of children they have borne previously. 5.1 Placenta in Pregnancy ln pregnant women, the placenta is the site of the heaviest infection of malaria. In severe infections of malaria, almost every cell in the placenta is infected with the parasite. A highly parasitized placenta appears unusually dark in colour, soft, and friable in consistency. Owing to heavy parasitization of the placenta, the foetus receives less than the required levels of nutrition. This results in low birth weight babies and sometimes foetal death. Rarely, a baby is born with congenital malaria where the baby has become infected from the blood of the mother. The placenta acts as a storehouse for the parasites and the infection lurks for long periods even when the peripheral blood is free of parasites. These hidden parasites in the placenta can give rise to recurrent attacks of malaria, which are sometimes a feature in pregnant women. 5.2 Effects on the Mother Anaemia due to red cell lysis is the commonest complication affecting the mother. Recurrent infections of malaria combined with malnutrition and hookworm infections can produce serious anaemia in the mother. In severely anaemic women, heart failure is sometimes seen. This can lead to their death at the time of labour. Cerebral malaria is rarely seen in pregnancy and when it does occur it is manifested by fits. It is important that cerebral malaria in pregnant women is differentiated from eclampsia which is characterized by high blood pressure and fits. 5.3 Foetal Complications Low birth weight is frequently seen in babies when the mothers have had malaria. If a mother had malaria during pregnancy, she has twice the chance of producing a low birth weight baby when compared to a mother who did not have malaria. Premature babies are commonly born to malaria-infected mothers and the resultant prematurity can contribute to neonatal deaths. Congenital abnormalities have been observed at a slightly higher rate among babies born to malarial mothers. Congenital malaria is rarely observed. Congenital malaria is due to the malarial parasite crossing from the maternal blood via the placenta to the foetus. Foetal death is sometimes seen at the height of the fever in the mother. Death of the foetus could also occur owing to massive parasitization of the placenta affecting its nutrition and also due to congenital malaria. 5.4 Treatment Malaria has to be treated whatever the stage of pregnancy. Many mothers are reluctant to take anti-malarial drugs, fearing that such drugs may cause abortion or deformities in the baby. This fear is largely due to the fact that "quack doctors"give large doses of anti-malarial drugs in the hope of inducing an abortion in unwanted pregnancies. The standard treatment involves taking 4 tablets of chloroquine on the first day (600 mg), 4 tablets on the second day (600 mg), and 2 tablets on the third day (300 mg). Primaquine is best avoided in pregnancy. Chloroquine is given intravenously to women who cannot tolerate the oral tablets. When there is resistance to chloroquine, quinine is used. Quinine in therapeutic doses is not harmful to the mother or the baby. Chloroquine prophylaxis of two tablets per week should be given to pregnant mothers living in endemic areas. Many mothers avoid prophylactic treatment owing to fear of the effect it may have on the unborn child and ignorance of its benefits. All pregnant mothers living in endemic areas must be encouraged to take malaria prophylaxis throughout pregnancy and combine this with adequate measures to protect themselves against mosquito bites. In the Northcentral Province of Sri Lanka and in other malaria-endemic areas of the world, malaria has been confirmed to be a major cause of maternal and foetal morbidity and mortality.
PREVENTION OF MALARIA When persons from non-malaria endemic countries visit Sri Lanka, they are often advised to take drugs such as chloroquine to prevent malaria. However, such prophylactic treatment is expensive and not considered necessary for Sri Lankans living in non-malaria endemic areas of the country (e.g., Central Colombo or Nuwara Eliya). It may be advisable under certain conditions for persons travelling to endemic regions from Colombo or other non-endemic areas to take a prophylactic medicine for malaria. There are however a number of simple measures that on the one hand individuals can take and that on the other, can be taken at a community level to reduce the incidence of malaria. 6.1 Individual Precautions The use of chloroquine or other drugs as a prophylactic is probably the most certain way to avoid contracting malaria in Sri Lanka. However, apart from the cost, the use of these drugs over a long period of time may have undesirable side effects on the health of users. The regime for prophylactic medicines for malaria is described elsewhere (Chapter 4) and is best undertaken under a medical practitioner's supervision. Many of the other measures involve reducing the chance of contact with potentially infectious mosquitoes. Insect repellents are chemicals that one may rub or spray on the exposed parts of the body. They repel mosquitoes. Covering as much of the body as possible with clothing has much the same effect. However, this is difficult to practise in a warm tropical climate. In any case, when this method is adopted, as many people know, mosquitoes can quite easily bite through thin clothing. Another option for reducing contact with mosquitoes is to sleep under a bed net. Anopheline mosquitoes that carry malaria generally prefer to bite in the evening and at night. Hence, bed nets are particularly effective in malarial areas for reducing the risk of infection. They also provide a peaceful night's sleep. Shutting windows in the late afternoon helps to reduce the numbers of anopheline and other mosquitoes present in the house at night. This is because the mosquitoes often rest outdoors and are attracted to human dwellings in the evening when darkness begins to fall. Of course spaces between walls and roof and ventilation holes also provide entry to mosquitoes. The better solution, often employed in mosquito-infested regions of America and Australia, is to have mesh windows and doors and to cover all ventilation holes in the house with a fine mesh. The use of sufficiently fine and well-maintained mesh prevents the entry of mosquitoes to the house while maintaining the ventilation so necessary in tropical climates. Mosquito-proofing houses in this manner is surprisingly inexpensive. It also has the advantage of preventing flies and mosquitoes carrying other pathogens from entering the house, thus making the home not only safer but a more comfortable place to live in. Another form of insect control quite commonly used in Sri Lanka is the burning of mosquito coils that contain an insecticide which is released with the fumes. However, the long-term effects on human health of the use of insecticides in this manner are difficult to evaluate. Also, leaves of certain plants are burnt to repel mosquitoes. Regular spraying of insecticides on walls and ceilings of houses is similarly effective in controlling mosquitoes. 6.2 Prevention of Malaria at the Community Level The regular spraying of malathion by the AMC is probably the most important factor controlling malaria at the community level. Rapid access to medical treatment in most parts of the country and the ready availability of anti-malarial drugs such as chloroquine are other factors that contribute to reducing the disease and deaths resulting from it. Insecticide is sprayed on the ceiling and inside walls of houses and sometimes on the outside walls as a suspension in water. The insecticide settles on the walls and remains stably bound and active for several weeks. During this period, mosquitoes that rest on the wall (e.g., after feeding) are killed. The AMC sprays dwellings in malaria-endemic areas at regular intervals, usually every three months. To control epidemics the AMC undertakes more intensive spraying and also sprays breeding sites in the surrounding environment. When an insecticide is used over a long period of time, mosquitoes develop resistance to it and this has happened with DDT. For environmental and health reasons it is preferable to minimize the spraying of insecticides and to look for other safer methods of mosquito control. A considerable impact on mosquito populations can be achieved by reducing available breeding grounds. Draining swampy areas, clearing blocked drains, filling unused pits, and ensuring the free flow of small streams and rivers can reduce the stagnant water that provides breeding sites for anopheline and other mosquitoes. Water tanks in houses, empty tin cans, old tyres, and discarded coconut shells are also known to provide breeding sites for mosquitoes and this can easily be controlled at a community level. Pools that form after heavy rains can be minimized by appropriate landscaping. Certain fishes feed readily on mosquito larvae and have been introduced into irrigation tanks and other water bodies for this purpose. Fish of the genus Gambusia have been shown to be useful in controlling anopheline and other larvae in submerged rice fields. Their value, under the conditions of paddy cultivation employed in Sri Lanka, remains to be determined. Some bacteria produce proteins that are toxic to insects Bacillus thuringiensis produces proteins that are toxic to adults and larvae. The B. thuringiensis toxin is commercially available and is being used as a larvicide in pilot studies. Although readily biodegradable in the environment, the bacterial toxins are also toxic to other insects. The use of bed nets, if widespread, can reduce malaria transmission within a community. Nets that have been treated with insecticides are particularly effective, since they kill precisely those anopheline mosquitoes seeking a human blood meal, and the effect of the insecticide is quite long lasting. Several new irrigation systems have become operational in Sri Lanka within the last decade. Because of their location in the dry zone, they can cause potentially dangerous increases in vector populations. Close attention to the management and maintenance of irrigation systems and liaison between entomologists and irrigation engineers are therefore necessary to control malaria in communities living in the vicinity of these systems. It is also clear that a multiple, integrated approach to vector control is likely to be more effective than the single use of any one of the approaches described above. Efforts are underway by the AMC to introduce integrated vector control at a pilot level in Sri Lanka. 6.3 A Malaria Vaccine Many scientists throughout the world are engaged in research directed towards developing a vaccine against malaria. As was the case with smallpox, an effective vaccine can lead to the eradication of malaria. Preliminary vaccine trials based on chemically synthesized peptides and proteins produced by recombinant DNA technology have already been performed on human volunteers. These trials have shown varying degrees of protection against malaria. However, most scientists agree that it will be several years before a malaria vaccine becomes available for general use. (This has not "panned" out -- Peter) OUTLOOK AND CONCLUSIONS Malaria is a major public health hazard in Sri Lanka. Increasing resistance of the parasite to chloroquine and the vector mosquito to commonly used insecticides, an expansion in vector breeding sites owing to environmental changes, an increasing and mobile population, and continuing civil unrest are likely to contribute to an increase in malaria incidence and possible epidemics in the future. Similar problems arise from other mosquito-transmitted diseases in the country such as lymphatic filariasis (transmitted by Culex quinquefasciatus), Dengue (transmitted byAedes aegypti andAe. albopictus), and Japanese encephalitis (transmitted mainly by Culex tritaeniorhynchus). Hence there is an urgent need to adopt measures throughout the country to control mosquitoes. This would involve other strategies in addition to spraying residual insecticides such as better management of the environment and mosquito-proofing houses. T he mass media and schools can be utilized more effectively to educate the public on the need for preventive measures. Community development efforts at the village and local government level need to pay more attention to disease control and prevention. Changes in mosquito vector populations in new irrigation schemes need to be carefully monitored and control measures taken where necessary. More scientists should also be encouraged to carry out research into diverse aspects of malaria and mosquitoes. If greater attention is paid to and more resources are provided for controlling malaria, there is no reason why this disease cannot be eradicated from an island such as Sri Lanka.
*** References from this document *** [orig] http://www.bednet.org/MalPrev.html
That's all folks --
Peter Name: Peter Singfield (via rlt) MessageX-Sender: snkm@wgs1.btl.net Mime-Version: 1.0 To: hondo1@peak.org From: Peter Singfield <snkm@btl.net> Subject: Eliminating Mosquitoes Date: Fri, 16 Oct 1998 12:23:19 -0600 Sender: owner-hondo1@peak.org Precedence: bulk My my -- I am certainly running into some interesting things to share with you folks these days. Remember last year we discussed what to do to lower mosquito populations. Well here is some new "high" tech stuff from jolly England. Maybe some brave heart out there can try it?? And let the rest of know how it works. Peter
From the Laboratories of Dayfield Technology Ltd. P.O. Box 195 Eastleigh Hampshire UK SO53 1ZL Ph:0181-659-9502 Fax (0)7070-712180 www.litestar.com/dayfield e-mail: dayfield@interalpha.co.uk
Malaria and other diseases caused by parasites and viruses transmitted by the transfer of infected blood are on the increase. Anopheles mosquitoes, which transmit the Malaria parasite, are migrating across borders and many more countries are now at risk. The CULICINE mosquito, one of the lethal sisters, inhabits similar areas and carries other diseases including Yellow Fever, dengue, nephritis, etc. Highly toxic insecticides, used for years to control mosquitoes, pollute the area and are harmful to humans, animals and fish. The Insecticides become less effective as the mosquito develops immunity to the chemical, but the insecticides remain, dangerous to the environment. DDT and petroleum-oil based insecticide systems substitute one hazard for another. Water and wet lands are polluted, drinking water contaminated and benevolent animals and insects destroyed. In terms of human and animal life and damage to environment and property the cost of intensive use of chemicals and insecticides has been massive. Drugs introduced as a defence for humans against Malaria now provide no immunity. The malaria parasite has evolved a resistance to each new drug produced. There is now no safe & effective anti-malaria pill.. SURFQIL works, naturally. Twenty years of research by the principal chemists of DAYFIELD TECHNOLOGY LTD has produced this non-toxic physical mono-molecular system to control the mosquito. WE ARE THE LEADERS IN THIS FIELD. AVOID IMMITATORS SURFQIL- IS SAFE and COMMUNITY FRIENDLY APPROVED by the British Government Health & Safety Executive for Commercial and Domestic use, and APPROVED by British DTI for export without restriction, SURFQIL invites participation by whole communities in the safe eradication of mosquitoes. SURFQIL spreads rapidly over any continuous water surface from any convenient location. To reduce application costs SURFQIL can be delivered on local sites as part of a >community prevention program= by simple >drip= systems. A molecule of SURFQIL can be represented schematically as having a long water-repellent (hydrophobic) tail attached to a more compact water-attracting (hydrophilic) head. This asymmetry causes the molecules on a water surface to form a sheet of molecules with hydrophobic tails in the air and hydrophilic heads under water in a monomolecular (Monolayer film.) The mosquito larvae or pupae rise to the surface of the water with a bubble of air in the respiratory system (trumpet) and break through the surface to breathe. SURFQIL monolayer on the water surface is transferred into the siphon/trumpet, or snorkel of the insect and the heads (hydrophilic) introduce water molecules onto the hydrophobic plastron surface by attraction of the hydrophobic >tails. This action wets the plastron and reduces the air content of the syphon. SURFQIL, a strong wetting agent allows water to penetrate the interstices of the respiratory system. The air sac is displaced by water and the insect drowns. The wings and legs of any surviving adult mosquitoes are wetted by SURFQIL and they are trapped and drowned. The larvae or pupae of the mosquito die by drowning, not by chemical insecticide or poison. The dead insects remain an uncontaminated food source in the natural chain. SURFQIL targets the MOSQUITO LARVAE AND PUPAE with minimal effect on other insects, fish, humans or animals using the same source of water. THE MOSQUITO HAS EVOLVED OVER MILLIONS OF YEARS SURFQIL simply changes the breeding environment to prevent the mosquito larvae and pupae developing into an adult. A long evolutionary period, perhaps a few HUNDRED THOUSAND years, would be necessary for the insect to adapt to the effect of SURFQIL in its environment. A FRIEND OF THE ENVIRONMENT SURFQIL IS NOT A DRUG OR AN INSECTICIDE but a synthetically produced 'MONOLAYER.' SURFQIL will naturally bio-degrade and leave no toxic residue to the next generation. SURFQIL can be used alone, as a 'barrier' around selected communities or combined with existing systems. APPLICATION SURFQIL deploys rapidly and un-aided over the surface of the water. Depth of water is immaterial. The calculated amount of SURFQIL necessary for treatment will quickly cover the target area to a depth of one molecule (much less than a human hair) providing immediate protection by preventing the mosquito larva, or pupa from reaching oxygen at the surface. SURFQIL is the ECONOMIC ANSWER and COST EFFECTIVE when compared with other mosquito remedies. TWO LITRES, (Half a gallon) of SURFQIL will control one hectare (2.4 acres) of relatively unpolluted water. An Overdose of SURFQIL simply forms a small bank or reserve of SURFQIL ready to spread rapidly to an unprotected area. A Continuous OVER-DOSE of SURFQIL is NOT recommended. ONE DROP of SURFQIL will treat a surface area of ONE SQUARE METRE / YARD. Add 20% for protection on polluted water, stagnant pools, cesspits, drains, truck tyres, etc TARGET AREAS SHOULD BE CHARTED AND MONITORED AS PART OF A COMMUNITY SCHEME. This will demonstrate to the community that protection is possible and encourage continuing protection against a return of the mosquito. THE PERIOD OF EFFECTIVE PROTECTION depends on variable factors including winds strength and temperature. In general a second application should follow within ten to fourteen days, followed by gradually increasing gaps as treatment effectively reduces active mosquitoes. This PROGRESSIVE TREATMENT will effectively eliminate the mosquito from the treated area. Natural predators of the mosquito will compete more aggressively for survivors within the treated territorial area. This can be confirmed by observation. Dead larvae/pupae remain part of the food chain. TESTING WITH LAYTEST OIL Test with LAYTEST oil to ensure that the SURFQIL monolayer is intact. LAYTEST is applied in single drops in different parts of the target area. If it remains as a small compact confined blob on the surface the SURFQIL monolayer is intact. If the drop of LAYTEST spreads and disappears then the layer of SURFQIL has bio-degraded and should be replenished. FOR PRICING, INFO AND DELIVERY - CONTACT DAYFIELD TECHNOLOGY LTD A FIELD TEST SAMPLE AND LAB DEMONSTRATION KIT, INCLUDING A SHORT VIDEO, ARE AVAILABLE AT Sterling £20.oo (US$35.oo). including delivery. Substantial discounts on bulk orders are available to Government and Charity Organisations, and to CREDIBLE COMPANIES entering a DISTRIBUTION or FRANCHISE agreement with DAYFIELD TECHNOLOGY LIMITED. (Also registered in Florida, Dayfield Technology Inc.) Name: Peter Singfield (via rlt) MessageFolks -- The continuing saga of AIDs in third world. The alternative view -- by an African woman no less!! As I hinted in the first article -- "may as well promise them the moon" -- other medical practitioners of third world are making the same point. Josephine does an excellent job in the following response. By the way, these are cross postings from the E-drug mail list -- a list where I have also made a few notorious postings in the past -- regarding the subject of making third world people believe that they must be dependent on only modern world medication. An economic contradiction of terms. Especially in light of modern American, FDA approved medications, highly over priced, and this probably due to their certification costs. One last word -- E-drug is usually a very boring mail list. Made up mostly of 3'rd world medical "wanna-bees" who are continually promoting the American medical system in hopes that someone in the US will read their postings and give them a better paying job. I like to think that it was my earlier postings refuting this seemingly invincible position of world medical domination by American FDA approved pharmaceuticals that has opened this list to responses such as we now will read, from Josephine. I'm two busy this turn of the wheel to jump into what is looking to be an interesting Bru-ha-ha. But I have a feeling Josephine can handle the situation quite well by herself. Josephine misunderstands one point though -- the $800 per "month" is the "reduced" price. Peter ************************************************************** From: "J. Maundu" Date: Fri, 16 Oct 1998 14:33:42 -0400 (EDT) Subject: E-DRUG: Re: Access to AIDS treatment in Honduras E-drug: Re: Access to AIDS treatment in Honduras - ---------------------------------------------------------- A very personal view The situation that Richard Stern found in Honduras though tragic is one that occurs many times in developing countries. A few things bother me. Stern describes how he gave a Spanish magazine to Maria Elena, a woman on her death bed informing her about the availability of antiretroviral drugs in obviously developed countries only. A little further on, we read about Merck providing medications but as usual they have to give a little back by enrolling in a study. The dilemna of AIDS devastation in developing countries and the problem and cost of paying for medication let alone AIDS medication is once again brought to light. Two things that I would like to point out 1. How ethical is it to show/tell or give information on antiretroviral drugs to patients who have virtually no hope of every getting the medication? Should we even put our efforts into providing the medication? 800 dollars for one treatment course (which I think is a month) is to say the least out of the question in many developing countries. Stern mentions that some drug companies are willing to sell this at a discount to countries. Which companies? Only Glaxo announced they would discount their product earlier this year and the logistics of how those drugs will be distributed is still being worked out. Furthermore it appears that the only time that HIV/AIDS patients get antiretroviral medication is when they are enrolled in a study. We are abusing thousands of desperate souls in these attempts to understand this century's scourge. 2. Some considerable effort is being put into supplying "essential" drugs for HIV but what we do not see is efforts and research that would assist communities, families and health care workers in coping with HIV. In many developing countries, the extended family is often the source of social support and care..how can we use this to encourage families to take care of their HIV infected members instead of casting them out of the family unit. From where I sit.. I would like to see us develop more coping strategies rather than put so much effort in providing extremely expensive medication that we probably cannot sustain and despite which patients will eventually die. How about quality of care, The dying process.. many of these patients will die in an institution instead of in their family? What and who takes care of their dependants like in Maria Elena case. Developed countries have various resources to be able to provide both medication and support.. but do we in developing countries? Therefore our (developing country) strategies for combatting HIV/AIDS need to be markedly different from those in developed countries.
Josephine T. Maundu, RPh
"African women are the hope of Africa" Name: Peter Singfield (via rlt) MessageOk Folks -- a few people have asked me about this Malaria Vaccine. Just let me say -- "Don't Hold Your Breath"!! First -- a vaccine is a method of introducing a gentler version of a disease so the body will have developed immune system response for when the big brother comes around. You can only vaccinate against diseases that stimulate an immune system memory. For instance. Once you catch all four version of dengue -- you will never catch any dengue again. Or, in Yellow Fever, vaccination imparts permanent immunity. The above two example are virus infections. We normally assume vaccination to protect against virus infections. Malaria is a protozoal infection and invokes a different immune system response. In malaria, you do achieve immunity after you have survived a "bought" with the disease -- for less than one year though. That is why in an "endemic" area people are not catching malaria over and over again -- continuously -- but more like once every 6 months to one year. So "pricking" the human immune system (with a vaccination) against malaria can do no better than getting and surviving the disease. This at its best!! This would come in handy in military campaigns however. And we could just have a "vaccination" every four months (which is about what would be required). But point of fact, after years of attempts -- there is no successful vaccination for malaria!! And in point of fact -- they have not been able to develop a vaccine to date that is effective in the bodies defense role against any protozoan infection. Suc as Chagas, ameba -- you know -- a long list. And after many years of trials, the malaria vaccination dream was declared a dud -- just last year!! So that is where the matter lays presently. Now let's look through this article and pick out some bottom lines --
>WASHINGTON (Reuters) - A new type of vaccine that is cheaper and >easier to produce than traditional vaccines may some day be used >to protect people from diseases such as malaria, researchers said >on Thursday. The real news here is about developing a better way to manufacture vaccines. Hey, that's great!! >The new type of vaccine uses a virus' DNA to build up the body's >immunity and scientists tested it on humans for the first time in >a study published in the journal Science. Yes -- that is very cute -- and will make great advances in traditional areas of vaccination. Especially in 3'rd world -- by making storage easier and cost lower. >The researchers injected 20 human volunteers with a DNA vaccine >for malaria. After six weeks, their blood showed a build-up of >cytotoxic T lymphocytes, killer cells that fight infections, said >Stephen Hoffman, director of the Malaria Program at the Naval >Medical Research Institute. >The study tested the vaccine to see if it would elicit some type >of immune response in humans, not for protection against malaria, >which kills some 1.5 million to 2.7 million people annually. >Based on success so far, protection tests should start sometime >next summer, Hoffman said. Here is the "twister". This is the old malaria vaccine that did not work (because malaria is one of those diseases that does not "co-operate") in the previous malaria vaccine trials a few years ago. It was a total dud!! I have the report (HUGE!!) at hand. You notice they say "not for protection of malaria". They were making an experiment on using the existing (failed) malaria vaccine as an immune system enhancer -- which is not a bad idea at all!! But in no way can be construed as being a successful malaria vaccine!! It was not, is not, and never will be!! >The new type of vaccine prompts cells in the body to use the >foreign DNA information to produce a neutralized strain of the >virus, enabling the body to recognize and fight an infectious >strain of the virus if it invades, Hoffman said. Notice -- virus -- not protozoa!! No connection with malaria!! Which is protozoal!! >The World Health Organization estimates there are 300 million to >500 million cases of malaria each year, more than 90 percent of >them in Arica. Mosquitoes with parasites in their bellies pass >the disease on to humans through bites. OK -- the rest of this is just "boiler plate"!! God -- what the press gets up to during slow times!! Hope I have clarified this matter as well as demonstrating how to read "American" news. This is a fine example of snow-jobbing and double talk. Call it modern American Techno-Spam. In this article there is actually no direct connection between new vaccine "technology" and a new vaccine to control malaria. It is all smoke and mirrors -- you are just led to assume -- So don't hold your breath!!
Peter Singfield in Belize
Name: Peter Singfield (via rlt) MessageHi list -- Just filled an order for Don Rocks and he has a number of questions in the letter he sent me. Wil answer them to the list. Dengue fever is presently in Honduras and Mexico. Not yet in Belize. Dengue is basically a very virulent flue of short lasting duration. Normally, three days. Do not take any medications for Dengue. Not even aspirin!! Complete bed rest is strictly indicated for at least one day -- though preferably three. Drink water -- not juices, soft drinks etc -- as much as you need but not more -- there is no problem with dehydration problem in Dengue fever. Here is the medicines I proscribe to help pass a Dengue fever attack. The most important point in getting through a Dengue fever is total relaxation. People become very distressed when having Dengue. Especially when fever reaches above 106 Deg F.!! This "distress" aggravates the condition making the disease intensify. Here is what I recommend. 30 milligrams of codeine along with ten milligrams of Valium. Take this every six hours as needed. You will relax and feel no pain. Basically, the normal patient is knocked right out with this prescription -- especially during a dengue attack. And that is the best way to get through it -- on your back sleeping!! Normally, 24 hrs. of the above medication is enough. From that point on the worst is over. Keep on relaxing. Usually, after the second day apatite returns and you can get back to feeling normal -- though very week. This soon passes. Do not take any antibiotics!! Or any aspirin. tyonal etc.!! Malaria: Here in Belize we presently have an endemic situation. Everyone has it!! That is P. vivax -- the more benign version. Also, the more common version for Honduras as well. Symptoms: Aching joints and bones. Slight headache, no apatite, upset stomach. Most people do not believe they have malaria. They just feel rough or "bad". It is very important to treat the disease at this stage. Before it becomes systemic to the liver. when you know malaria is endemic in an area, and you experience any of the above "minor" symptoms, get to your local pathology lab or malaria center for a test. If positive for malaria -- start treatment immediately!! You have two options for treatment with P. Vivax. Choloquine for 3 days followed by primaquine for two weeks. Artenam: Oneloading dose of 300 mg. (6 tablets) followed by four days of 100mg. per day (two tablets). The important point is to make sure P. vivax does not get into your liver!! Artenam does an excellent job of stopping this from occurring. With no adverse side effects!! P.Falciprum: Presently Honduras is experiencing 1 out of 4 cases infected with the much more deadly P. Falciparum Malaria. One is highly recommended to use Artenam for this. Much of the P. Falciparum is drug resistant to Chloroquine. Summation -- You have plenty of warning (up to one week) to take treatment. With the proper medicine it is "cleared" from your body in less than 6 hours. It is a relative non-event compared to Dengue fever. Without diagnosis and proper treatment it becomes a potential life long curse (P. Vivax) or deadly (P. Falciparum). If diagnosis by lab tests are not available -- one is strongly advised to take the treatment after experiencing symptoms in areas where it is well know that malaria is endemic. Definitions. A malaria epidemic is where, all of the sudden, malaria fever is experienced by many people for a fixed (say 30 days) period of time. And endemic situation -- such as we have here in Belize at present -- is where malaria is there all the time and everyone is catching it. It has been endemic here since June!! There is one big difference between malaria and dengue. Dengue is a virus infection that your body acquires permanent immunity to after an attack. Unfortunalty, there are four serotypes -- so you can only catch Dengue four times. Malaria is a protozoan infection. You can catch it every week anew for the rest of your life when living in "endemic" areas. Don asks about parasites. Forgot to remind you all. We have a number of deadly or seriously inconveniencing parasitical infections -- worms. One excellent medicine, of British origin, not (of Course!!) FDA approved. Called Ketrax -- the active ingredient is Levamisole Hydrochloride. It is effective in all intestinal worm infections. No adverse side effects. I usually recommend that people vacationing in the tropics dose themselves with Ketrax when they get back home. I stock Ketrax and Artenam. Both come in "blister" packs and have a shelf live of greater than two years. They also come with complete instructions on how much to take and when. Also dosages for children of all ages. Both are safe in pregnancy. For a single adult treatment: Ketrax ------------ $ 5.00 Artenam ----------- $30.00
I know it is not cool to talk money or business on a list. But I believe that it is important that everyone living in these tropical areas understand where the medicine is and at what price. I have supplied a fair number of people on this list to date with no complaints. Contact me for detailed information. I advise you stock up on medicine -- not wait for when you need it -- that is to late!! As for the medicine required for Dengue -- Valium and Codeine -- any drug store should have in stock. I strongly advise keeping that on hand as well. There are a number of other tropical afflictions that can be a problem. Amebic infection and other protozoal intestinal "curses". At present we are clear of these. When the time comes -- send me a note -- there are some very effective medications available for these as well -- again -- not FDA approved. The only problem with non FDA approved medications are that you will not be able to buy them in the US or even in Honduras. If the demand is there, I will stock and distribute those as well. As for the extremely lethal by very rare, tropical diseases -- virulent Leptospirosis, lieshmaniasis, hanta virus -- to name a few -- I have very specialized medicines. In those cases you are advised to reach me here in Northern Belize. >From Honduras -- Taca to Belize City. Taxi or bus from there to Corozal District and Xaibe Village (2.5 miles from Corozal). >From the US -- fly to Cancun then bus or fly to Chetumal -- then Taxi to Xaibe. Or, direct to Belize City and as above.
In closing: I have never -- in 18 years -- seen malaria so endemic as at present!! Treated two tourists, both with P. Vivax malaria, today. They got here just two weeks ago!! At this moment -- I don't know of a single Expat living here that has not got malaria since June at least once -- some are on there second "course". Malaria is not a killer disease -- is simple to cure -- just be properly prepared.
Peter Singfield XAIBE Village Corozal District Belize Central America Tel/FAX 011-501-4-35213 E_Mail snkm@btl.net http://www.wireworm.com/snkm/index.htm Name: Peter Singfield (via rlt) MessageE-drug: Access to AIDS treatment in Honduras - ---------------------------------------------------------- AIDS TAKING GRIM TOLL IN POVERTY STRICKEN HONDURAS AS PATIENTS TRY TO ORGANIZE Article by By Richard Stern e-mail: rastern@sol.racsa.co.cr A recent visit to Honduras has revealed hospital wards filled with people dying from AIDS-related opportunistic infections when medical supplies run out. Hondurans with AIDS have virtually no hope of receiving anti-retroviral (ARV) medications. At the state run "Hospital del Thorax" in Tegucigalpa, I visited a 26 bed AIDS unit where patients lack medications that could combat their opportunistic infections. Maria Elena, who appears to weigh less than 80 pounds, lay in the women's ward and said she gets no medication at all. She said she has stopped eating and doesn't care any more what happens to her, adding "this is a mortal illness and I have to accept Gods will." Her three children will become orphans as her common law husband died three years ago. When I gave Maria Elena a copy of POZ magazine in Spanish, she indicated it was the first time she had heard of anti-retroviral medications. The so-called "cocktail" of retroviral medications consists of a combination of three medications that have a significant impact on the damaged immune systems of most patients with AIDS, enabling them to return to a relatively productive and normal lifestyle. About 20 percent of patients do not tolerate the new medications well, and other experimental combinations are now being tried with this group. The cost of a triple therapy cocktail would be about $800 per month if purchased individually, although pharmaceutical companies provide significant discounts when governments buy large quantities of the drugs. In Europe and North America, it is estimated that 90 percent of AIDS patients have access to these medication through a variety of public and private insurance plans. Maria Elena´s attending physician, infectologist Milton Gonzales, indicated that he has run out of the medication to treat opportunistic illnesses such as severe diarrhea and cryptococcus. "Its only July and we have used up all of the medication that was to have been for the entire year, " he said. When a neurological illness is suspected, he and his team have to guess the diagnosis because there is no neurological testing available and no neurologist on staff. Gonzales indicated that he has little hope that the Health Ministry will supply the necessary medications and would like to receive donations from the international community. No one is quite sure exactly why Honduras, with just 17 percent Central America´s population, has over half of the 20,000 reported cases of AIDS in the region. Honduras, with 5.4 million people has more than 11,000 officially diagnosed cases. Costa Rica, with 3.4 million people has 1,400 cases, and Nicaragua with 4 million has just over 300, according to official figures. One theory is that the epidemic began with prostitutes serving the US military community based in Comayagua and spread rapidly as a result of lack of prevention strategies and extreme promiscuity. The epidemic is about 85 percent heterosexual in Honduras. One Doctor estimated that 35 percent of country's 20,000 or more prostitutes are HIV+ and that, ironically, clients pay extra to have sex without a condom. Additional factors contributing to the spread of AIDS include extreme poverty, lack of access to health clinics and lack of knowledge about methods of prevention. Women, abandoned by their husbands and heading impoverished households are vulnerable to the sexual whims of their often promiscuous male partners. Per capita yearly income in Honduras is under $1,500 per year. On the hillsides that tower over downtown Tegucigalpa the tenements of clay and brick appear deceptively scenic from the city below until one gets close and sees that they are really makeshift hovels built over unpaved streets without sewer systems or running water. Women descend to the polluted river that runs through town to wash clothes. These tenements teem with children and although AIDS is rampant, tuberculosis,dengue fever and cholera may pose even greater threats. Two Non-governmental organizations funded by the Dutch government in Honduras are now beginning to focus more attention on the problem of access to medications and rampant discrimination against people who live with AIDS. "Solidaridad and Vida," (Solidarity and Life) directed by a young physician named Enoch Padilla, provides medical services to several hundred patients each month in Tegucigalpa. Padilla recognizes the need for the patients themselves to begin to organize, but pointed out that the death of several of the more activist patients during the past year dealt a severe setback to the group. Some of Padilla´s patients are in a study conducted by the pharmaceutical company Merck, Sharp and Dohme, and they have access to ARVs as well as viral load testing. Padilla tries to help patients find sources to obtain medications for opportunistic infections and has been quite successful in obtaining donated medications from international sources. While Tegucigalpa nurses its wounded in a temperate pleasant climate, San Pedro Sula, 150 miles to the North is a sweltering city of half a million people carved out of the surrounding jungle. Average daily high temperatures are in the mid 90's.
In San Pedro Sula, the "Fraternidad San Pedrana de Lucha Contra el SIDA" (San Pedro Brotherhood against AIDS) has five years of work in the community, and is also funded by the Dutch. There is an established Association of People Living with AIDS and there are about 50 members in the group. However, of the 50, only about five are currently receiving ARVs. Carlos Lopez is the Director of Fraternidad and Alan Dunaway is President of the Association of AIDS patients. Dunaway, his wife Rosa and daughter Emilia all have AIDS. The San Pedrana patient Association has been allowed to participate in the government´s National AIDS commission and also are lobbing legislators for the approval of a bill to curb discrimination against people with AIDS. However, the bill has been "in discussion" for four years and has yet to be approved. According to Carlos Lopez, "many of the congressman are owners of or benefit from the large cheap labor factory market known as "maquila." Says Lopez: "they have no interest in supporting this bill because they don´t want have to pay sick days or face other problems. Maximizing profits is their main consideration and fair employment practices are not conducive to more profits." Also in San Pedro Sula I spoke to Guillermo a 30 year old ex-transvestite sex worker who is now the janitor at San Pedro Sula´s gay community organization known as "Comunidad Gay San Pedrana." Guillermo has had bouts of AIDS related infections for several years but has survived. He knew about ARV medications, and expressed frustration at their impossibly high cost. Guillermo gets one meal a day a the gay community center and sleeps in a $25 a month rented room that has no electricity. He says his family in Tegucigalpa is wealthy but will have nothing to do with him. He left Tegucigalpa in 1996, to try to work in the factories of San Pedro Sula, but illnesses made this impossible. However, he is pleased that he has received support and work in the gay center, and has not had to return to prostitution. He is open about his HIV+ status with the young gays he sees at the center. "But some of them just don´t pay attention," he says. They don´t think it will happen to them." Jonathon Castro, AIDS educator in the gay/lesbian Association in Tegucigalpa called "Collectiva Violeta" told me about his friend Rafael who died at the age of 20 on the sidewalk near the downtown area. "They asked him to leave the hospital because they said they couldn't treat his infections anyway. So he just went outside and found a place to lie down and died." Full blown AIDS in persons as young as 18-22 is quite common in Honduras, as apparently many very young adolescents are quite sexually active. Casa Alianza is the Central American branch of New York city´s Covenant House and operates a center for homeless children in Tegucigalpa. Several thousand receive medical and residential services each year. Alvaro Conte, Casa Alianza Director, told me that a study done last year revealed that 3 percent of these children are HIV+. Subject to constant sexual abuse, these young AIDS patients also have no access to ARV medications, although Casa Alianza tries to educate them about prevention strategies. But many of these children must perform sexual acts just to be able to eat. It is estimated that only about 60 of an estimated 5,000 People who live with AIDS in Honduras have access to the triple therapy combination, perhaps 25 who can pay for them with their own means and the rest who are in studies run by the pharmaceutical companies. The hopelessness of the situation of most people with AIDS seems tragic when one considers that AIDS has now become a relatively treatable illness. In Costa Rica, more than 360 AIDS patients are now receiving ARV medications as a result of a Supreme Court decision handed down last September. Guillermo Murillo, President of the Costa Rican Association of People with AIDS called the Honduran situation "an unnecessary tragedy" and called on international organizations such as UNAIDS to "seek a solution to enable our brothers and sisters in Honduras to survive." ORGANIZATIONS WORKING WITH AIDS IN HONDURAS Medicos Sin Fronteras Dr Germaine Hanquet Apartado Postal 3669 Tegucigalpa, Honduras Tel: 504-231-1012 e-mail: msfch@sdnhon.org.hn Prisma Jose Ramon Ramos Apartado 459 Tegucigalpa, Honduras Tel: 504-232-8342 e-mail: prisma@sdnhon.org.hn Dr. Jorge Alberto Fernandez Consulting Specialist in AIDS Ministry of Health Apartado 3966 Tegucigalpa Tel: 504-237-4343 Fax: 504-238-3270 Collectivo Violeta Apartado 4053 Tegucigalpa, Honduras Tel: 504-237-6398 e-mail: alfredo@optinet.hn Solidaridad y Vida Dr. Enoch Padilla Apartado 2492 Tegucigalpa, Honduras Tel: 504-223-8972 Fax: 504-239-1204 Fraternidad San Pedrana de Lucha Contra el SIDA Dr. Carlos Lopez Ferrera Apartado 3566 San Pedro Sula Tel: 504-553-1281 Fax: 504-552-8797 e-mai: fraternidad@mayaneth.hn Comunidad Gay San Pedrana Dereck Raickov Apartado 4317 San Pedro Sula Honduras Tel: 504-550-6868 Casa Alianza Alvaro Conte 504-237-3623 Name: Stan Marrder MessageWelcome to the Medical Care Threads. |
Courtesy Stanley Marrder