New Vaccine Development Establishing Priorities: Volume II, Diseases of Importance in Developing Countries (1986) / Chapter Skim
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Appendix D-10: The Prospects for Immunizing Against Plasmodium spp.
Appendix D-10: The Prospects for Immunizing Against Plasmodium spp.
Pages 275-286
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Malaria caused by Plasmodium falciparum, or "malignant malaria," is fatal in a high proportion of cases if untreated, but responds well to appropriate chemotherapy. Although a variety of drugs are highly effective against malaria parasites, the organisms, especially P
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Individuals reexposed to infected mosquitoes nave repeated episodes of malaria (Miller et al., 1984~. Repeated infections eventually lead to a relative increase in immunity, however, which is made apparent by the profound difference between the clinical manifestations of malaria in young children and in adults.
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Disease Burden Estimates It is difficult to obtain reliable information on the worldwide incidence of malaria. The World Health Organization is the major source of such information.
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Seasonal epidemic and reinfection cases are divided into the four age groups used in the disease burden analysis according to the relative populations of these age groups (see Chapter 4 and Population Reference Bureau, 1984~. Annual deaths in the under 5 years age group are assumed to be about 1 million, in line with an estimate by Gilles (1981~.
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However, these groups are small in number relative to the local population at r isk. Assuming that a vaccine can be developed that induces immunity at an early age, it appears that a malaria vaccine could be introduced into the World Health Organization Expanded Program on Immunization.
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falciparum malaria is now the focus of vaccine development. The first generation vaccine is likely to be limited to this strain; hence, it may only prevent that portion of the disease burden caused by P
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Mefloquine is highly effective as a prophylactic agent, but because resistance to this drug already has occurred in Southeast Asia (SPRTTD, 1985) , its use as a prophylactic agent would certainly accelerate widespread resistance to it.
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An example of the third approach is the experimental use of vaccinia virus as a carrier for Plasmodium knowlesi circumsporozoite protein genes in the immunization of experimental animals (Smith et al., 1984~. Phase one clinical trials of candidate vaccines using the first two approaches with P
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That protracted exposure to the natural disease is required for the development of immunity suggests that the parasite has evolved mechanisms for evading the human immune response. This may be particularly problematic in selecting merozoite antigens as candidate immunogens.
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1985. Expression of Plasmodium falciparum circumsporozoite proteins in Escherichia cold for potential use in a human malaria vaccine.
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