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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2016  |  Volume : 27  |  Issue : 5  |  Page : 1071-1072
Malaria vaccine: Good news for African nephrologists


Nephrology Unit, Avicenne Military Hospital, Marrakech, Morocco

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Date of Web Publication22-Sep-2016
 

How to cite this article:
Asserraji M, Belarbi M, Zemraoui N. Malaria vaccine: Good news for African nephrologists. Saudi J Kidney Dis Transpl 2016;27:1071-2

How to cite this URL:
Asserraji M, Belarbi M, Zemraoui N. Malaria vaccine: Good news for African nephrologists. Saudi J Kidney Dis Transpl [serial online] 2016 [cited 2019 Nov 12];27:1071-2. Available from: http://www.sjkdt.org/text.asp?2016/27/5/1071/190909
To the Editor,

The public health challenge:

Malaria is a major public health problem in many countries around the world. According to the World Health Organization, 3.3 billion people in 97 countries and territories are at risk of being infected with malaria and developing disease. One hundred and ninety-eight million cases of malaria occurred globally in 2013 (range between 124 and 283 million), and the disease is responsible of 584,000 deaths (uncertainty range 367,000-755,000). [1]

Ninety percent of all malaria deaths occur in Africa where the disease burden is the heaviest. In African exposed regions, children aged <5 years, account for 78% of all deaths. Sub-Saharan African regions (particularly in Nigeria and the Democratic Republic of the Congo) represent the poorest and most vulnerable communities [Figure 1]. Reducing the heavy effects on public health in developing countries of malaria is one of the 21 st century's most important aim. [1],[2]
Figure 1: Countries with ongoing transmission of malaria, 2013.

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Four Plasmodium (P) species are responsible for the human infection, Plasmodium vivax, Plasmodium falciparum, Plasmodium Malariae, and Plasmodium oval. P. vivax is the most cosmopolitan of the human malaria with public health burden regarded as benign. Responsible for more than 90% of the world's malaria mortality, P. falciparum remains the most important threat to public health worldwide. [3] Common clinical presentations of infection with all four plasmodia species are periodic paroxysm, chills, sweating, body aches, headache, nausea, general weakness, and prostration. Acute renal failure (ARF), considered as severe life-threatening complication, occurs mostly with P. falciparum infection. [1],[2],[3]

Renal dysfunction is mainly associated with infections by two malaria parasites such as P. malariae and P. falciparum. The former is responsible of quartan malarial nephropathy (QMN), an immune complex-mediated glomerular disease, leading to nephrotic syndrome that occurs predominantly in children. While, the renal presentation in case of P. falciparum varies widely, ranging from asymptomatic, mild fluid and electrolyte disorders, transient and mild glomerulonephritis (GN), and abnormal urinary sediments to malaria ARF (MARF). Renal involvement in P. vivax malaria has been reported mostly from Indian subcontinent. [4]

Histopathologic observations show, in QMN, features of immune-complex-mediated mesangiocapillary GN, focal and segmental glomerulosclerosis, immunofluorescence (IF) studies show immune complex deposits containing immunoglobulin (Ig) M, IgG, C3, rarely IgA, and malarial antigens in mesangial and subendothelial areas. The pathology in MARF shows no or poor basement membrane with ischemic acute tubular necrosis, hemoglobin and cellular casts, interstitial infiltration, and edema. IF studies show finely granular IgG3, IgM, and C3 in the mesangial area. [4]

Precise mechanism of renal failure in falciparum malaria is not clearly known. Several hypotheses including mechanical obstruction by infected red blood cells, immune-mediated glomerular pathology, fluid loss due to multiple mechanisms, and alterations in the renal microcirculation.

Malarial ARF can occur alone or associated with shock and multiorgan failure and sepsis. [5]

The malaria vaccine aim to provide specific and durable protection against P. falciparum for patients, especially for children. The complexities of the parasite life cycle and host immune response frustrated this goal. Efforts have focused on the preerythrocytic stage of infection. In the RTS,S vaccine, epitopes from the parasite circumsporozoite protein have been modified to activate immune response and prevent hepatocyte infection, and thereby limits progression to red blood cells and clinical malaria. The action of other vaccine candidates like the P. falciparum sporozoite, a preparation of irradiated whole P. falciparum sporozoites given intravenously, is at starting step of development.

The final results of a phase 3 trial of the RTS,S/AS01 vaccine conducted in seven countries in Africa are reported in a Lancet paper published online.

Protection provided by the vaccine looks to be modest in both extent and duration. However, because the vaccine would be used with others classical complementary interventions such as indoor residual spraying with insecticides and insecticidal bed nets as preferred preventive strategies, this protection could prove to be very important. [6]

This combination of preventives measures, including malaria vaccine, will probably reduce the severe life-threatening complication of the disease and thereby the renal involvement especially the ARF.

After considering the evidence on vaccine efficacy and adverse events, RTS,S will possibly be licensed late in 2015. [6]

Regarding the serious health problem in countries across Africa, Asia, and South America, a large use of RTS,S is expected. This year 2015 is a turning point in malaria prevention.

Conflict of interest: None declared.

 
   References Top

1.
World Health Organization (WHO). World Malaria Report; 2014. Available from: http://www.who.int/malaria/publications/world_malaria_report_2014/en/. [Last accessed on 2015 Aug 5].  Back to cited text no. 1
    
2.
World Health Organization (WHO). Malaria: Policy Guidance - List of Publications by Year. Geneva: WHO; 2014. Available from: http://www.who.int/malaria/publications/policy/en/. [Last accessed on 2014 Nov 16].  Back to cited text no. 2
    
3.
Snow RW. Global malaria eradication and the importance of Plasmodium falciparum epidemiology in Africa. BMC Med 2015;13:23.  Back to cited text no. 3
[PUBMED]    
4.
Elsheikha HM, Sheashaa HA. Epidemiology, pathophysiology, management and outcome of renal dysfunction associated with plasmodia infection. Parasitol Res 2007;101:1183-90.  Back to cited text no. 4
[PUBMED]    
5.
Das BS. Renal failure in malaria. J Vector Borne Dis 2008;45:83-97.  Back to cited text no. 5
    
6.
Vaccines: a step change in malaria prevention? Lancet 2015;385:1591.  Back to cited text no. 6
    

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Correspondence Address:
Dr. Mohammed Asserraji
Nephrology Unit, Avicenne Military Hospital, Marrakech
Morocco
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DOI: 10.4103/1319-2442.190909

PMID: 27752027

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