Akira Kaneko Project - Malaria elimination on islands
Malaria is a disease related to poverty. Islands provide a natural environment for ecological experiments and a great potential for intervention studies. Cooperating with endemic communities on islands in Vanuatu, Oceania since 1987 and in Lake Victoria, Kenya since 2008, Akira has studied the feasibility and sustainability of malaria elimination with the ultimate aim of proposing a community-directed strategy of sustainable malaria freedom and development towards global malaria eradication.
Human and parasite polymorphism on islands in Lake Victoria: implications for mass drug administration and malaria elimination
Using island models in Lake Victoria, Kenya, we examine the feasibility of malaria elimination in tropical Africa. Today, 11 countries in Africa are embarking upon malaria elimination. Although malaria elimination should be feasible for countries in peripheral Africa with low and unstable malaria transmission, it is unclear how feasible it is to eliminate malaria in tropical Africa, where malaria transmission is hyper-endemic.
Kenya launched its second National Malaria Strategy for the period 2009-2017 with a notably ambitious vision for a “malaria free Kenya”. We believe that the current scaling-up of interventions in the national malaria control programs (ITN, ACT, & RDT) is capable of bringing parasite rates down to lower than 1% in low to moderate transmission settings. However these tools are not sufficient in hyper-endemic settings such as our project site in Lake Victoria, Kenya, where more specific measures are necessary in the attack phase.
Low-density submicroscopic infections, most of which are asymptomatic, represent a major challenge for malaria elimination programs. Interventions that aim to eliminate malaria should ideally include all symptomatic and asymptomatic parasite carriers. While sensitive molecular detection methods are increasingly common in malariometric surveys, logistical difficulties prevent the detection of all parasitemic individuals prior to drug administration. However, this can be circumvented by treating all individuals in mass drug administration (MDA) campaigns, regardless of parasitaemia.
Together with schizontocidal drugs primaquine has been an important but underused partner drug. The main limitation to the use of primaquine is the risk of hemolysis in patients who are glucose 6-phosphate dehydrogenase (G6PD) deficient. Recent review of studies suggests that a lower primaquine dose would be equally effective but safer. These lower doses could be safely deployed together with ACTs without prior testing of G6PD status in Africa to interrupt malaria transmission. Human cytochrome P-450 isoenzyme 2D6 (CYP2D6) may be a key enzyme involved in metabolizing primaquine into redoxactive metabolites that kill gametocytes.
On Aneityum island in Vanuatu, Oceania, we previously demonstrated that malaria can be eliminated on isolated islands with well-adapted short-term MDA and sustained vector control if there is a high degree of community participation (Kaneko A, et al. Lancet 2000). We intend to apply the Aneityum strategy to our study site on islands in Lake Victoria, to examine whether malaria can be eliminated by well-adapted short-term mass drug administration of ACT with a low dose of primaquine and sustained vector control with a high degree of community participation. We specifically aim to examine: 1) the efficacy (against P. falciparum gametocytes) and safety (risk of intravascular hemolysis) of a low dose of primaquine with ACT, in relation to CYP2D6 and G6PD status, respectively, 2) the impacts of MDA on P. falciparum population dynamics, and 3) the roles of community involvement in malaria elimination. We ultimately aim to address the feasibility of malaria elimination in hyper-endemic settings, and to propose a community-directed malaria elimination strategy for tropical Africa.
Akira Kaneko graduated from Hirosaki University School of Medicine, Japan in 1982 (M.D.) and after clinical training got D.T.M.&H. from Mahidol University, Thailand in 1984 As malariologist AK worked in the coastal Asahan, North Sumatra, Indonesia, 1985-1987 (JICA), and on islands in Vanuatu, 1987 - 1994 (WHO). He was Associate Professor in Tokyo Women's Medical University, 1994-2004. Akira Kaneko defended thesis, Malaria on islands in 1999 (PhD) and got docent in 2004 at Karolinska Institutet.
He has organized multidisciplinary malaria research ventures between Sweden, Japan, UK and USA since 1995 with partners from Vanuatu, PNG, Malawi, Kenya, Ghana, Cambodia, Madagascar and Zanzibar.
Akira Kaneko has been Professor of Global health, Karolinska Institutet since 2011 and holds Island Malaria Group at MTC. He is also affiliated to Osaka City University Graduate School of Medicine and Nagasaki University Institute of Tropical Medicine, Japan.
Akira Kaneko has been academic coordinator to Japan since 2011.
Akira Kaneko Publications
Malaria resurgence after significant reduction by mass drug administration on Ngodhe Island, Kenya.
Kagaya W, Gitaka J, Chan CW, Kongere J, Md Idris Z, Deng C, Kaneko A
Sci Rep 2019 Dec;9(1):19060
Naturally acquired antibody response to Plasmodium falciparum describes heterogeneity in transmission on islands in Lake Victoria.
Idris ZM, Chan CW, Kongere J, Hall T, Logedi J, Gitaka J, Drakeley C, Kaneko A
Sci Rep 2017 Aug;7(1):9123
High and Heterogeneous Prevalence of Asymptomatic and Sub-microscopic Malaria Infections on Islands in Lake Victoria, Kenya.
Idris ZM, Chan CW, Kongere J, Gitaka J, Logedi J, Omar A, Obonyo C, Machini BK, Isozumi R, Teramoto I, Kimura M, Kaneko A
Sci Rep 2016 Nov;6():36958
Characteristic age distribution of Plasmodium vivax infections after malaria elimination on Aneityum Island, Vanuatu.
Kaneko A, Chaves LF, Taleo G, Kalkoa M, Isozumi R, Wickremasinghe R, Perlmann H, Takeo S, Tsuboi T, Tachibana S, Kimura M, Björkman A, Troye-Blomberg M, Tanabe K, Drakeley C
Infect Immun 2014 Jan;82(1):243-52
Impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar.
Bhattarai A, Ali AS, Kachur SP, Mårtensson A, Abbas AK, Khatib R, Al-Mafazy AW, Ramsan M, Rotllant G, Gerstenmaier JF, Molteni F, Abdulla S, Montgomery SM, Kaneko A, Björkman A
PLoS Med 2007 Nov;4(11):e309
Stable SNPs in malaria antigen genes in isolated populations.
Tanabe K, Sakihama N, Kaneko A
Science 2004 Jan;303(5657):493
Mosaic organization and heterogeneity in frequency of allelic recombination of the Plasmodium vivax merozoite surface protein-1 locus.
Putaporntip C, Jongwutiwes S, Sakihama N, Ferreira MU, Kho WG, Kaneko A, Kanbara H, Hattori T, Tanabe K
Proc Natl Acad Sci U S A 2002 Dec;99(25):16348-53
Malaria eradication on islands.
Kaneko A, Taleo G, Kalkoa M, Yamar S, Kobayakawa T, Björkman A
Lancet 2000 Nov;356(9241):1560-4
High and variable frequencies of CYP2C19 mutations: medical consequences of poor drug metabolism in Vanuatu and other Pacific islands.
Kaneko A, Lum JK, Yaviong L, Takahashi N, Ishizaki T, Bertilsson L, Kobayakawa T, Björkman A
Pharmacogenetics 1999 Oct;9(5):581-90
Plasmodium falciparum accompanied the human expansion out of Africa.
Tanabe K, Mita T, Jombart T, Eriksson A, Horibe S, Palacpac N, Ranford-Cartwright L, Sawai H, Sakihama N, Ohmae H, Nakamura M, Ferreira MU, Escalante AA, Prugnolle F, Björkman A, Färnert A, Kaneko A, Horii T, Manica A, Kishino H, Balloux F
Curr Biol 2010 Jul;20(14):1283-9