Cases of malaria are on the rise and the US is not ready to deal with it because the supply of drugs left to treat the disease is expired, an expert has warned.
Currently, severe cases of the life-threatening mosquito-borne disease are treated with IV form of quinidine gluconate.
However, the Centers of Disease of Control and Prevention’s remaining supply of the drug in IV form expired earlier this year, according to Dr Mark Travassos, an assistant professor of pediatrics at the University of Maryland School Medicine (UMSOM).
He says there are oral doses of quinidine available but they cannot reduce or slow down parasite replication in the blood as rapidly as the IV form can.
While there is a non-FDA approved drug that can be used, it can take up to a day to reach hospitals, Dr Travassos says.
An expert from the University of Maryland School Medicine has warned that the CDC’s remaining supply of the IV form of quinidine gluconate to treat malaria expired in April 2019 (file image)
Malaria is a disease caused by a parasite that is transmitted from the bite of a mosquito to humans.
Symptoms are flu-like and include fever, chills, headache, muscle aches, fatigue, nausea and vomiting.
Plasmodium falciparum is the parasite that causes malaria’s severe form, affecting the liver, the cerebrum and the cardiovascular system.
In 1951, malaria was considered eliminated in the US, but there are still about 1,500 cases diagnosed each year, according to the CDC.
As temperatures rise, mosquito populations worldwide are growing, as is the prevalence of insects carrying the deadly disease.
Alongside these increases, people are traveling from country to country more, increasing the risks that someone returns to the US from abroad.
Of the 1,500 cases confirmed in 2015 in the US, 259 – about six percent – were serious and needed IV treatment.
‘Severe malaria patients can have brain involvement or repeated vomiting and may not tolerate oral medication, placing them at high risk for complications,’ explained Dr Travassos.
There were 219 million cases of malaria worldwide in 2017, up from 216 million in 2016.
In 2017, 435,000 people died from malaria globally, down from 445,000 estimated deaths in 2016.
According to the CDC, malaria cases have rising steadily over the past 40 years.
The US Food and Drug Administration (FDA) approved IV quinidine to treat severe malaria in 1991, and it is still the only FDA-approved treatment.
But, as of April 2019, the US’s remaining quinidine supply expired, meaning there is currently no available treatment.
Dr Travassos, a malaria expert in UMSOM’s Malaria Research Program, says oral treatments are available in the US, but they are not as effective in treating serious cases.
‘Severe malaria is a medical emergency that requires immediate treatment with IV medication to reduce the risk of death,’ he said.
Currently, physicians are treating severe patients on a case-by-case basis with an IV form of artesunate, a drug not approved by the FDA.
Doctors must request the drug from the CDC, which then sends it to the closest of 10 US airports to the facility where the malaria patient is being treated.
Delivery takes an average of eight hours but could take as long as 24 hours.
In his commentary, Dr Travassos recommended that the CDC find pharmaceutical companies that could manufacture an IV form of artesunate – and send an expedited approval application to the FDA.
This would reduce the approval time from two-and-half-years to as little as six months.
Additionally, he recommended that hospitals should immediately test patients who’ve recently traveled to areas known for high rates of malaria for the disease.
‘As we become more connected globally in the US, it is important to understand the risks and concerns of diseases like malaria,’ said UMSOM Dean Dr E. Albert Reece.
‘At the University of Maryland School of Medicine, our scientists and physician-scientists are studying the best treatments and approaches for managing and treating the most complex and challenging diseases.’