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Malaria

Abstract

Malaria is caused in humans by five species of single-celled eukaryotic Plasmodium parasites (mainly Plasmodium falciparum and Plasmodium vivax) that are transmitted by the bite of Anopheles spp. mosquitoes. Malaria remains one of the most serious infectious diseases; it threatens nearly half of the world's population and led to hundreds of thousands of deaths in 2015, predominantly among children in Africa. Malaria is managed through a combination of vector control approaches (such as insecticide spraying and the use of insecticide-treated bed nets) and drugs for both treatment and prevention. The widespread use of artemisinin-based combination therapies has contributed to substantial declines in the number of malaria-related deaths; however, the emergence of drug resistance threatens to reverse this progress. Advances in our understanding of the underlying molecular basis of pathogenesis have fuelled the development of new diagnostics, drugs and insecticides. Several new combination therapies are in clinical development that have efficacy against drug-resistant parasites and the potential to be used in single-dose regimens to improve compliance. This ambitious programme to eliminate malaria also includes new approaches that could yield malaria vaccines or novel vector control strategies. However, despite these achievements, a well-coordinated global effort on multiple fronts is needed if malaria elimination is to be achieved.

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Figure 1: The Plasmodium spp. life cycle.
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Figure 2: A map of malaria-endemic regions.
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Figure 3: Parasite entry into and replication within red blood cells.
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Figure 4: Microscopic images of parasite-infected red blood cells.
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Figure 5: The global pipeline for malaria vector control.
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Figure 6: The global pipeline for malaria vaccines.
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Figure 7: The global pipeline for antimalarial drugs showing current product profiles.
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Figure 8: The chemical structures of novel non-artemisinin-based compounds that are in clinical development.
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Acknowledgements

The authors thank R. Bryant, A. Hill, S. Rees and S. L. Hoffman for their help with the content of Figure 4 and Figure 6, and S. Duparc for critical reading of the clinical sections of the manuscript.

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Contributions

Introduction (M.A.P., J.N.B. and W.C.V.V.); Epidemiology (M.A.P. and W.C.V.V.); Mechanisms/pathophysiology (M.A.P.); Diagnosis, screening and prevention (M.A.P., J.N.B., R.H.v.H. and T.N.C.W.); Management (J.N.B., R.H.v.H. and T.N.C.W.); Quality of life (C.M.); Outlook (R.H.v.H. and T.N.C.W.); Overview of Primer (M.A.P.).

Corresponding author

Correspondence to Margaret A. Phillips.

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Competing interests

T.N.C.W. is a non-executive director of Kymab in the United Kingdom. Kymab has programmes in malaria that are funded by the Bill & Melinda Gates Foundation. All other authors declare no competing interests.

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Phillips, M., Burrows, J., Manyando, C. et al. Malaria. Nat Rev Dis Primers 3, 17050 (2017). https://doi.org/10.1038/nrdp.2017.50

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