Find the parasite

Malaria thrives on misinformation. It always has. Even the word malaria is a misnomer. It’s Italian for “bad air,” because the Romans attributed the seasonal sickness — that killed at least four popes and probably the poet Dante — to noxious fumes coming off the swamps.

It wasn’t until 1897 that Dr. Ronald Ross confirmed the mosquito as the vector that spreads the disease.

Misinformation is one of the big reasons malaria continues to kill a child at the rate of nearly one every 60 seconds. Solving the information challenge is going to be key if we’re going to end this disease, and no piece of information is more vital than knowing who is carrying the parasite and who isn’t.

The hidden malaria challenge

While there are more than 200 million malaria cases every year — people who are getting sick from the disease — it’s estimated that there are five times as many people carrying the parasite in their bloodstream at any given moment, a ticking time bomb of illness and infection.

That amounts to more than 1 billion people, one out of every seven people on the planet, who are potentially infected with the malaria parasite — jeopardizing their health, hampering their productivity and making them an active threat to their families and communities. And most of them have no idea they’re carrying the potentially deadly disease.

The insight that sick patients showing up at clinics are only the tip of the malaria iceberg underpins new strategies for eradicating the disease. Simply put: You can’t beat an enemy if you can’t find it. So any attempt to eradicate malaria must start with developing the diagnostic capabilities to find and free the roughly 1 billion people living with the parasite in their bloodstream and stopping them from transmitting.

It may sound like a daunting task, until you consider how far we’ve come in recent years — and how fast.

The diagnostic revolution

Until 2010, there was no practical way to get a timely, accurate diagnosis for malaria.

If you had a fever and wanted to be tested for malaria, you had to travel a long distance, sometimes tens of miles on foot, to find a hospital or clinic equipped with an expensive microscope and a trained lab technician. You had to take a blood slide, then wait several hours for the result, hoping that the lab technician read it right.

It was impractical, and people simply didn’t do it.

The word for “malaria” and “fever” is the same in many African languages. It’s easy to understand why. In the absence of practical diagnostics, doctors simply treated every fever as if it was malaria and hoped for the best.

Then came the breakthrough: the rapid diagnostic test, a simple $0.50 finger-prick blood test that can tell you in a matter of minutes with better than 99 percent accuracy if your fever is in fact malaria.

RDT has revolutionized the malaria fight, enabling lightly trained community health workers operating on the fringes of the health system to test patients for malaria. Negative results are as important as positive ones, as they direct doctors to consider other top killers, such as pneumonia and upper respiratory infection. There are now more than 200 million RDTs distributed across Africa each year.

Next generation tests

Today, we need to revolutionize diagnosis yet again, this time with focus on identifying asymptomatic cases and guiding treatment.

Current RDTs have a sensitivity of 200 parasites per microliter of blood — sufficient for identifying all symptomatic cases. However, finding low levels of the parasite in asymptomatic patients is like an elaborate game of hide-and-seek. To do it, we need a new generation of simple, portable, inexpensive diagnostic tests that are 10 times more sensitive, detecting malaria at levels as low as 20 parasites per microliter or even lower.

Fortunately, through innovative public-private partnerships led by groups like the Medicines for Malaria Venture and Seattle-based PATH, we’re well on our way to developing next-generation diagnostic tests. (Read more about Alere’s quest for new diagnostics here.)

Other next-generation diagnostics may help to solve some of the treatment challenges that stand in the way of elimination. Efforts to tackle the dominant strain of malaria in Asia and South America — known as “p. vivax” — are hamstrung by the fact that some people have an adverse reaction to the drug recommended for completely clearing the parasite, due to a common inherited trait known as G6PD enzyme deficiency.

The development of diagnostics to identify individuals with G6PD deficiency would ensure better use of current drugs and potential new single-dose treatments, such as tafenoquine, currently in development by GlaxoSmithKline and MMV.

Armed with new diagnostics, we’ll be in a position to take the fight to the parasite. Instead of passively waiting for sick people to show up at clinics, they will enable us to go on the offense: actively testing and treating entire communities to find and root out malaria, while ensuring the type of treatment provided to patients will be safe and effective.

Which sets up the next of our challenges. Check back next week to read about another big innovation in the malaria fight: developing a radical cure!

This article is part of a new series entitled Solve for M: 5 Key Challenges to Ending Malaria, hosted by Devex in partnership Malaria No More and the Bill & Melinda Gates Foundation.

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