Symptoms of malaria include fever, headache, and vomiting, and usually appear between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs. In many parts of the world, parasites have developed resistance to a number of malaria medicines.
Key interventions to control malaria include prompt and effective treatment with artemisinin-based combination therapies, the use of insecticidal nets by people at risk, and indoor residual spraying with insecticide to control the vector mosquitoes.
Malaria remains a public health challenge in Viet Nam despite a substantial reduction in the incidence of the disease over the last 20 years. In 2016 there were only 10,446 cases reported to the National Malaria Control Programme (Annual Report NMCP 2016), and 03 deaths were attributed to malaria. Viet Nam was one of the first countries to deploy artemisinin derivatives in its fight against malaria over 20 years ago. Since 2005, Viet Nam has used dihydroartemisinin-piperaquine (DHA-PPQ) as the first-line treatment for falciparum malaria. The spread of artemisinin resistance in Plasmodium falciparum and the subsequent loss of partner antimalarial drugs in the Greater Mekong subregion (GMS)
Drug resistance represents one of the greatest threats to the control and elimination of malaria. Artemisinin resistance is associated with mutations in the Pfkelch gene; initially, multiple independent kelch mutations were observed, but gradually the single dominant artemisinin-resistant P. falciparum C580Y mutant lineage, which has arisen in Western Cambodia, is becoming the dominant resistant malaria parasites and subsequently acquiring resistance to piperaquine.
These findings present policymakers in Viet Nam with a dilemma because the current recommended second-line regimen combines quinine with doxycycline, which is not well tolerated, and so adherence to the required seven-day regimen is poor. Although the combination of DP and mefloquine (Triple ACT) has high efficacy on artemisinin-resistant P. falciparum, it has not been approved and needs to be monitored for side effects. Newer antimalarials such as cipargamin (KAE 609), KAF 156, and artefenomel (OZ 439) are in phase II of development and will likely not reach the market until 2020.
For the prevention of relapse in P.vivax infections, ongoing studies would answer whether the short course regimen of primaquine is as effective as the 14-day regimen and how to manage patients with G6PD deficiency. The long-acting 8-aminoquinoline (Tafenoquine) would be a promising candidate for a radical cure for vivax patients worldwide.
Over one-half of Indonesia’s 270 million people live at risk of infection by the plasmodial parasites that cause acute and threatening malaria attacks. At least several million such attacks are estimated to occur each year in Indonesia, with most of that burden being borne by the impoverished and isolated communities of eastern Indonesia.
Our research studies are to define and develop new antimalaria drugs: Despite the Malaria Control Program, Viet Nam still adheres to the dihydroartemisinin-piperaquine combination because there is no alternative antimalarial drug which is as good, as available, or as affordable as the current one. We initiate research to find out new antimalarial drugs or to re-enforce the armoury to fight against malaria.
As well as clinical studies, our malaria researcher conduct many activities focused on improving patient outcomes, including:
Collaboration with Novartis, GSK, MMV to assess the KAE609, KAF156, Tafenoquine in several clinical trials in Viet Nam
Tracking Resistance to Artemisinin (TRAC): collaboration with Mahidol University and Worldwide Antimalarial Resistance Network (WWARN) funded by DFID UK
Invivo susceptibility of artesunate in the treatment of adult with P. falciparum malaria in Binh Phuoc Province, Viet Nam, in collaboration with WHO