Current status of Malaria in South America

Cristian Desmarchelier, PhD

Fundación Mundo Sanodel Libertador Av 1146 Buenos Aires, Argentina

www.mundosano.org

http://www.neotropico.net/

Malaria in South AmericaNumber of cases per 1000 people per country

South America Africa Asia

Country Per 1000 people Country Per 1000 people Country Per 1000 people

Guyanas 36-22 Uganda 478 Afghanistan 25

Ecuador 4.0 Sao Tome & Prince 394 Myanmar 15

Colombia - Belize 3.7 Liberia 302 Yemen 13

Peru 2.9 Tanzania 290 Papua New Guinea 12

Bolivia 2.3 Burundi 274 Cambodia 5.0

Brazil 2.1 Mozambique 270 India – Bhutan 1.7

Source: SocialWatch.org (WHO)

Latin America: Malaria Status 2000-2007

18 countries free of malaria

6 countries with 50 - 74% reduction of cases5 countries with 75% decrease in cases

• 21 endemic countries• 11 countries in South America (73% cases are P. vivax)•8 countries in Central America and Mexico (94% cases P. vivax)•2 countries Hispaniola (almost 100% P. falciparum)

•REGION•75% cases P. vivax•25% P.falciparum•

Malaria in South AmericaDistribution of vivax - falciparum

falciparum / vivax

falciparum / vivax

Malaria and South American natural productsLessons from the Neotropics

Cinchona sp (Rubiaceae) – “Peruvian bark” or “cascarilla”

Quinine

Malaria and South American natural productsLessons from the Neotropics

Andiroba oil (Carapa guianensis)

Repelent

O

O

O

H

Quassinoids (basic structure)

- Present in Simarouba spp, Quassia spp,and other neotropical species;

- Potent in vitro antimalarial activity in P.falciparum chloroquine-resistant strains;

- Novel mechanism of action: inhibition ofProtein synthesis via ribosome interaction.

Malaria and South American natural productsLessons from the Neotropics

1. 4-nerolidylcatechol (Pothomorphe peltata – “caapeba”)2. Neoselgeolide (Picrolema sprucei – “caferana”)3. Ellipticine (Aspidosperma vargasii – “amarelao”)4. Aspidocarpine (A. desmanthum – “amargoso”)

De Andrade-Neto et al. (2007) In vitro inhibition of Plasmodium falciparum by substances isolated from Amazonian antimalarial plants. Mem Inst Oswaldo Cruz102: 359-365.

Malaria and Artemisia annua production in South AmericaWho is Who

- UNICAMP: Introduction of A. annua production in the State of Sao Paulo; developmentof new varieties for low latitudes; phytotherapic remedies bases on A. annua leaves

- UTPR: Intensive research on fertilisation, density, pesticides, herbicides, etc; phenology;transfer of small scale productive know-how to small farmers in State of Paraná.

- FUNDACION MUNDO SANO: Research on industrial and large scale production;extraction and purification of artemisinin; synthesis of artesunate (2009).

Malaria and Artemisia annua production in South AmericaAgricultural ventures

Tropic of Capricorn

Malaria and ACTBrazil: 1.4 million cases (2006)

For 2007: 457,000 cases P. vivax90,000 cases P. falciparum

Source: Ministerio da Saúde do Brasil

Malaria and ACTBrazil's Public Policy

Suggested treatments for Plasmodium vivax infection:

-Chloroquine-Primaquine

Suggested treatments for Plasmodium falciparum infection:

-Artemether + Lumefantrine (Coartem®)-Quinine + Doxicicline-Primaquine

Source: Ministério da Saúde do Brasil

Malaria and ACTBrazil: The case of Farmanguinhos - DNDi

Source: Ministério da Saúde do Brasil

First ACT developed in Brazil, ASMQ is the first fixed-dose formulation (FACT) of the association of AS and MQ.

Each treatment consists of 300 mg AS plus 1200 mg MQ.

Malaria and PhytotherapicsBrazil: The case of UNICAMP - Farmanguinhos

Source: Ministério da Saúde do Brasil; ICEI Mercosur

Malaria and ACTColombia and Peru Public Policies

Colombia: 0.4 million cases Peru: 0.3 million cases

Suggested treatments for Plasmodium vivax infection:

-Chloroquine + Primaquine

Suggested treatments for Plasmodium falciparum infection:

-Artesunate + Mefloquine-Amodiaquine + Sulfadoxine-Pyrimethamine-Artemether + Lumefantrine (Coartem®)-Quinine

Source: World Malaria Report 2008 (WHO); Peruvian Ministry of Health

Malaria and ACTArgentina: cases of malaria 1980-2008

Source: Dr Tomás Orduna, CEMPRA-MT, Muñiz Hospital, Buenos Aires

341 326

567 535437

774

2000

1521

666

16201529

803

643

758

948

1065

2076

592

339

222

441

215125 124 116

252 212

355

72

0

500

1000

1500

2000

2500

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 0 1 2 3 4 5 6 7 8

THANK YOU VERY MUCH !!!

Fundación Mundo Sanodel Libertador Ave 1146 - Buenos Aires, Argentina

www.mundosano.org