[ppi] [ppiindia] Ditemukan vaksin mencegah penyakit malaria

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Beberapa tahun terakhir malaria menjadi penyakit
masyarakat lagi di Indonesia.  Padahal dulunya negara
kita sudah dinyatakan bebas, kecuali beberapa tempat
misalnya Irja.

Rupanya penyebab malaria tidak lagi mempan dengan
kinine.  Tapi sayang, vaksin yang ampuh sukar
ditemukan, maklum penyakit ini hanya ada di tempat
tropis, yang penduduknya belum mampu membeli obat
mahal.  Jadi usaha farmasi multinasional enggan
mengadakan riset untuk memperoleh vaksin ampuh.

Untung ada dermawan Bill Gates dan isterinya yang
adalah orang terkaya di dunia saat ini.  Mereka keluar
dana untuk mencari vaksin malaria, seperti mereka
mendanai pemberantasan penyakit masyarakat yang lebih
ganas, yaitu HIV/AIDS.



(The New York Times)

October 15, 2004
Malaria Vaccine Proves Effective
For the first time, researchers say, a vaccine against
malaria has shown that it can save children from
infection or death.

The vaccine, tested on thousands of children in
Mozambique, was hardly perfect: It protected them from
catching the disease only about 30 percent of the time
and prevented it from becoming life-threatening only
about 58 percent of the time.

But because malaria kills more than a million people a
year, 700,000 of them children, even partial
protection would be a public health victory. The
disease, caused by a parasite carried by mosquitoes,
is found in 90 countries, and drug-resistant strains
are spreading.

Dr. Allan Schapira, strategy coordinator for the Roll
Back Malaria campaign at the World Health
Organization, said the trial was "good news, and
definitely of great interest for malaria control."

The director of the Malaria Vaccine Initiative, which
is underwriting tests on 15 experimental vaccines with
money from the Bill and Melinda Gates Foundation, said
the GlaxoSmithKline product tried in Mozambique was
now its leading candidate and had proved that the
concept worked.

"We'd all like to see the numbers be higher,
absolutely," said Dr. Melinda Moree, director of the
initiative. "But these are still very significant

The results - to be published tomorrow in the British
medical journal The Lancet - were comparable to or
better than other methods of preventing infection in
African villages, like distributing mosquito nets and
insecticides, she said.

A malaria expert not connected with the study, Dr.
Dyann Wirth, director of the Harvard Malaria
Initiative, a program at the Harvard School of Public
Health that is also seeking cures, was more cautious.
She said the findings opened "a fruitful area for
further investigation," but needed larger trials. 

Glaxo and the Malaria Vaccine Initiative are planning
such trials. But experts said it would be several
years before the vaccine could be adopted as a
childhood inoculation like those for diphtheria or
measles. It is not yet known how long the vaccine's
protection lasts, whether it is safe for infants and
whether it is compatible with other vaccines.

A trial of the same vaccine among adults in Gambia six
years ago showed that it protected about 35 percent of
them from infection, but that the protection waned
after about two months.

Still, experts noted that children stand to benefit
more from a vaccine. In rural Africa, people can be
infected several times a year. Children who survive to
adulthood become immune. Newborns inherit some
protection from their mothers, but it wears off in a
few months. Young children are the hardest hit, and
many who survive are brain-damaged.

The most recent vaccine test, conducted in two rural
districts in southern Mozambique, where malaria is
endemic during the six-month rainy season, involved
2,022 children ages 1 to 4. Half of them were given
the malaria vaccine; rather than placebos, the other
half got vaccines against hepatitis or bacteria that
cause meningitis.

To ensure that the results were not skewed by other
factors, the control and vaccine groups had roughly
equal numbers of children who slept under mosquito
nets at home and who lived near a clinic. The children
were followed for six months and had home visits with
blood and temperature checks at least once a month.
Those who developed malaria were given immediate
medical attention; the disease can kill in as little
as 48 hours, but it can be cured if it is caught in

To test the vaccine's ability to prevent new
infections, two subgroups of about 180 children each
were given drugs to clear any parasites they might
have had before the trial began. In both subgroups,
most children developed new parasites. But the number
was considerably smaller among those who had received
the vaccine: 123 children in the vaccine group,
compared with 159 in the control group. Over all, 11
vaccinated children developed severe malaria while 26
in the control group did.

Fifteen children died of various causes. None in the
vaccine group died of malaria, while four in the
control group did. Those numbers are too small to have
any statistical meaning.

Mozambique is one of the world's poorest countries,
where 200 out of every 1,000 children die before age
5, said Dr. Regina Rabinovich, director of infectious
diseases for the Gates foundation, so the death rate
across the whole study was lower than normal,
presumably because the children in it got better than
average medical care. 

The trial was conducted by the biologicals division at
Glaxo and the Mozambique Ministry of Health, with
financing from the Malaria Vaccine Initiative, which
was created in 1999 with $50 million from the Gates

Malaria is spreading - possibly, some experts say,
because global warming has encouraged the spread of
mosquitoes. More people die of the disease today than
did 30 years ago.

Beyond death and retardation, there are economic
consequences. For example, families affected by
malaria harvest only 40 percent of the crops of
healthy ones, according to the World Health

A malaria vaccine, one of the holy grails of tropical
medicine, has proved surprisingly elusive. Health
authorities have been fighting malaria since the
Panama Canal was a gleam in Theodore Roosevelt's eye. 

Until the Gates foundation arrived, work on vaccines
for tropical diseases had languished for decades
because they make little profit for drug companies.
(The world spends about $400 billion a year on drugs,
but only about $8 billion on vaccines.) The American
military, which also does malaria research, had
limited amounts of money for it. 

The Glaxo vaccine, known as RTS,S/AS02A, has been in
development and testing for 17 years, said Dr. Joe
Cohen, one of its inventors. It fuses a bit of
hepatitis B virus with a bit of the falciparum strain
of the parasite, which is the most common, and usually
the most deadly, form of malaria. The piece of the
parasite is from the life stage that is injected by
mosquitoes, so antibodies and white blood cells
stimulated by the vaccine attack before the parasite
can settle in the liver and reproduce.

Pieces of the hepatitis virus were added because they
provoke strong immune responses, Dr. Cohen said.
(Another malaria vaccine candidate uses a weakened
version of a smallpox vaccine to do the same.)

The goal, he said, is to create immunity that lasts
longer than natural immunity, which fades in adults
after they move out of malaria areas. 

Dr. Rabinovich of the Gates foundation said future
vaccines might incorporate proteins from other parts
of the parasite's life cycle. 

But she added: "This demonstrates that vaccines have
the potential to prevent millions of child deaths.
That's something to wake your mom up about." 


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