Clinical Review

Science, medicine, and the future : malaria

BMJ 1997; 315 doi: http://dx.doi.org/10.1136/bmj.315.7110.730 (Published 20 September 1997) Cite this as: BMJ 1997;315:730
  1. Sanjeev Krishnaa ([email protected])
  1. a Division of Infectious Diseases, Department of Cell and Molecular Sciences, St George's Hospital Medical School, London SW17 0RE

Introduction

Sixteen years ago, when I was a medical student interested in malaria, my professor of medicine asked me what the chances were of developing a malaria vaccine. So far, a successful vaccine is still being sought, but recent advances in the molecular biology of malaria suggest that one may become available soon, along with better diagnostic, preventive, and treatment strategies.

Malaria is a huge and growing problem, especially in Africa: it kills one to two million children each year, causes disease in a further 400 million individuals, and accounts for 25-50% of all hospital admissions. Moreover, mortality associated with cerebral malaria (caused by infection with Plasmodium falciparum) has not improved in the past 30 years.1 P falciparum is now virtually untreatable with chloroquine in most parts of the world, and many strains of P vivax are also resistant. Although quinine is often the antimalarial drug of choice for chloroquine resistant strains, it is poorly tolerated and compliance is therefore low. Newer antimalarials such as mefloquine are both expensive and not always effective. Some parasites are now resistant to most antimalarials. This drug resistance makes choice of chemoprophylaxis for travellers difficult as well.

Possible future developments

New antimalarial drugs developed from “rational” approaches and combination chemotherapies

Alternative routes by which to administer antimalarial drugs in rural settings

Rapid identification of drug resistance in parasites

Adjunctive therapies to improve survival of patients with severe malaria

Interference with transmission of malaria by genetic manipulation of mosquito vectors

In the past 15 years research has expanded considerably from preventive strategies and development of vaccines to include better understanding of the pathophysiology of disease, both clinically and at the cellular and molecular level.2 A recent review of malaria research by the Wellcome Trust highlights some of these achievements and points to important directions for future study. …

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