<![CDATA[ MOSQUITO PUNDIT - MosquitoPundit Blog]]>Mon, 19 Feb 2018 07:54:29 -0800Weebly<![CDATA[Brazil 2018 and the 'Complications of Yellow Fever Vaccination': lessons forgotten from 1938]]>Sun, 18 Feb 2018 07:42:28 GMThttp://mosquitopundit.net/mosquitopundit-blog/brazil-2018-and-the-complications-of-yellow-fever-vaccination-lessons-forgotten-from-1938

In 2017-2018, Brazil has apparently accepted outside advice promoting an expensive mass-vaccination drive against yellow fever, but Brazil went down that path in 1938.  Brazil needs to go back to their own history and experience gained by their own Brazil national Yellow Fever Service.   Brazil was once the world's most successful country - a true leader - in freeing its population from yellow fever... through the eradication of urban infestations of the virus-porting mosquito Aedes aegypt, not by mass vaccinations.

The general public has been given the impression that vaccines are the solutions to all communicable diseases.  In the case of mosquito-borne diseases, notably yellow fever, this assumption is not based on historical experience.  The public health official most knowledgeable of the success of the Brazilian yellow fever eradication campaign, including the mixed results and problems of the 1938 yellow fever mass-vaccination program, Fred Lowe Soper, concluded:

“The use of vaccine in the control of yellow fever should occupy more or less the same place that typhoid fever vaccine has in the control of typhoid fever. No sanitary authority would desire to substitute typhoid vaccine for the supply of pure water and food, so we must not accept the yellow fever vaccine as a substitute for the elimination of Aedes aegypti.  The vaccine provides individual protection for the person who cannot be protected by more general measures.”

Fred Lowe Soper,
‘Complications of Yellow Fever Vaccination,’
Building the Health Bridge, 1970
à MosquitoPundit blog ©2018

<![CDATA[Gonna fish or always cut bait? Malaria versus two kinds of stubbornly non-communicating scientists]]>Thu, 08 Feb 2018 07:42:10 GMThttp://mosquitopundit.net/mosquitopundit-blog/gonna-fish-or-always-cut-bait-malaria-versus-two-kinds-of-stubbornly-non-communicating-scientistsWhat is the current state of anti-malaria via boots-on-the-ground anti-vector/anti-Anopheles gambiae public health for Africa?

Observing now in 2018 the current years marching by with a continued complete lack of freedom from malaria in the lives of everyday Africans, the following 2006 quote from a prominent mosquito researcher is sadly illuminating as to one of the roots of the modern malaria problem:
ontemporary research on genetic control of disease-transmitting insects knows two kinds of scientists: those that work in the laboratory and those known as 'field people'.  Over the last decade, both groups seem to have developed differing research priorities, address fundamentally different aspects within the overall discipline of infectious-disease control, and worse, have developed a scientific 'language' that is no longer understood by the 'other' party. 

This gap widens every day, between the North and the South, between ecologists and molecular biologists, geneticists and behaviourists, etc..."

Bart G.J. Knols, Bridging Laboratory and Field Research for Genetic Control of Disease Vectors, 2006

Note that this lament is all about the lion's share of funding going to laboratory research on 'genetic control', at leisurely paces, in safe and comfortable labs far from endemic malaria regions, to ponder the tiniest intricacies of the mosquito and to develop a plethora of minor works on the details of the parasite, rather than to field research to generate more studies and minor works on the same sorts of things.

The situation today in 2017 in ineffectively fighting malaria is exactly what Nobel Prize laureate malaria researcher Sir Ronald Ross warned about in 1910. 

This heavily-funded malaria research sector has almost nothing - in affinity or funds - to actually help Africans quickly wipe out the specific mosquitoes that carry them before those mosquitoes infect people with these parasites or viruses. 

"Learn how to get rid of Anopheles gambiae by actually getting rid of Anopheles gambiae."
Fred Lowe Soper: Anopheles Gambiae in Brazil 1930-1940 
<![CDATA[Chronic Malaria: The Under-diagnosed Endemic]]>Mon, 11 Dec 2017 04:39:15 GMThttp://mosquitopundit.net/mosquitopundit-blog/chronic-malaria-the-under-diagnosed-endemic
Chronic Malaria: The Under-diagnosed Endemic by MalariaPundit à MosquitoPundit Blog ©2017
The inability of current diagnostic tests available in Africa to identify many chronic malaria infections condemns un-counted millions of Africans to suffer with chronic, untreated cases of malaria.  In malaria endemic zones in Africa, the likelihood that malaria is lurking behind almost every other affliction is extremely high, yet many chronic malaria cases are left untreated for months, even over a year.

The confusion that negative blood test results in true cases of chronic malaria is very damaging - sufferers waste months desperately seeking any and all sorts of help for an undiagnosed condition.  The odds of untreated chronic malaria causing incremental organ damage that can affect the person's long-term quality of life and lifespan are much higher in these circumstances.

Doctors are typically able to easily feel an oversized spleen in a basic abdominal examination, a sign of chronic malaria due to the increased stress placed on the spleen to filter malaria parasite-caused destroyed blood cells.  But in an endemic malaria zone, there are going to be a lot of oversized spleens in the general population caused by previous infections - it's typical and  thus doesn't automatically prove an active infection.

One of the symptoms of chronic malaria is dragging, persistent fatigue, but seemingly perversely when sufferers try to sleep, they are stymied, plagued by severe insomnia.  Sufferers who receive a negative malaria diagnostic test put themselves at great risk desperately looking for ways to be able to achieve that deep, healing sleep to overcome the daily debilitating fatigue, not realizing that the insomnia is the body's safety reaction to inadequate oxygen levels in the bloodstream, that is an anemia caused by the destruction of the oxygen-carrying red blood cells.  During normal deep sleep, breathing is very slow so at low blood oxygen levels caused by malaria parasite-destroyed capacity to carry oxygen in the blood,  the body risks not being able to wake up - slipping into asphyxiation.  So, the body to protect itself won't go into that deep sleep state.

After treatment for malaria, vitality returns so quickly it almost feels like a miracle. 

Researchers outside Africa aren't as sensitive to this problem as are doctors on the front lines in Africa, but the front-line doctors in malaria-endemic zones aren't as listened to as much nor is their input and their insights taken as seriously in setting standard malaria treatment protocols.

<![CDATA[The Lexicon of Malaria: 'Eliminate' versus 'Eradicate']]>Mon, 04 Dec 2017 07:13:12 GMThttp://mosquitopundit.net/mosquitopundit-blog/the-lexicon-of-malaria-eliminate-versus-eradicateIn order to understand modern global malaria policy, the public must understand what the terms actually mean in the context of public health and malaria.
‘Elimination’ is defined as reducing malaria by 90% over a 15-year period.  It is a process producing partial results that leaves 10% of the problem to persist.   
"The Global Technical Strategy for Malaria 2016–2030, was adopted by the World Health Assembly in May 2015.  It provides a comprehensive framework to guide countries in their efforts to accelerate progress towards malaria elimination.  The strategy sets the target of reducing global malaria incidence and mortality rates by at least 90% by 2030."

World Health Organization Global Technical Strategy for Malaria 2016-2030
The Philosophy of Defeat
‘Eradication’ means 100% destruction of malaria

“…results of work with both Aedes Aegypti and Anopheles gambiae indicate that it is much easier to evaluate perfect rather than partial results.”
Fred Lowe Soper, 1940
"Number of patients under malaria treatment
in Northeast Brazil 1939-1940

Jan-Jun 1939:    219,604
July-Dec 1939:  326,928
Jan - Jun 1940:    83,098
July  1940:             3,779
Aug  1940:                861
Sept.1940:                400

"By September 1, 1940, there were not enough cases of malaria to justify keeping special employees to treat the few cases that did appear."

Oct.  1940:  0 
Nov. 1940:  0
Dec. 1940:  0

Fred Lowe Soper, Anopheles gambiae in Brazil, 1930-1940
Month-to-month results during the malaria eradication in NE Brazil, 1939-40

Getting rid of malaria - get rid of Anopheles - Fred Soper, 1940
<![CDATA[Peering malarially at the report of Venezuela's 2017 malaria surge]]>Wed, 29 Nov 2017 06:59:51 GMThttp://mosquitopundit.net/mosquitopundit-blog/peering-malarially-at-the-report-of-venezuelas-2017-malaria-surgeA worrisome increase in malaria infections and deaths in Venezuela was reported recently in a Reuters news article by reporter Ramirez published in November 2017. Venezuelans suffer malaria outbreak

The article as written provoked some thoughts from this malaria observer used to the daily struggle to live in malaria-endemic zones.  Key concerns:

“But health activists and doctor groups estimate that around 200 people have died from malaria over the last year nationwide, and fear the illness is starting to afflict populated urban centers.”

First, these numbers are drops in the bucket compared to the annual death toll of malaria in Africa – well over 100,000 deaths per year according to the annual WHO World Malaria Report.  But no one wants Venezuelans to go down that route.  Second, what a curious population of malaria worriers: un-named ‘health activists’ and un-named ‘doctor groups.’  Hope those are African ‘doctor groups’ because when we’ve had to rush for help for treatment for malaria, we seek out African doctors who deal with malaria daily.  It doesn’t fill us with any confidence when the non-African doctor looks blank for a long time, then reaches for a book to look up ‘malaria.’

Further, what kind of ‘job’ is ‘health activist?’  What’s being activated?  Not much is for any serious eradication of malaria by targeted mosquito species eradication to save lives, and that’s a FACT, because the official WHO malaria policy until the year 2030 is about ‘control’ and ‘slow, steady progress’ which is fine for anyone who doesn’t live in a malaria endemic zone. 
(The Philosophy of Defeat) 
After twenty years of idle observations of them, ‘activists’ seem to want funds only for that sort of inconclusive, inconclusive activity; never for rapid, defined beginning and end mosquito eradication drives that free entire regions from malaria for a hundred years, saving lives for generations.

"The mines have a high proportion of young adults, but their kids and pregnant partners are in the cities, and that's a bigger problem: the entire family is at risk of falling ill," said doctor and former health minister Jose Felix Oletta, a government critic.”

Stop. Criticizing any government is another subject, rich and deep. Keep it apart from this subject, which is malaria and that Venezuelans are reportedly getting infected and dying from it in increasing numbers, suggesting a failure of modern anti-malaria programs, assuming the reported statistics are indeed reasonably correct.
But that statement does not properly inform the reading public.  Malaria is not a ‘contagious disease.’

Malaria is caused by a parasite that cannot be passed directly from one human to another by simple proximity.  The parasite is passed by the bite of an infected mosquito.  Only certain species of mosquitoes can carry this parasite, notably Anopheles and especially Anopheles gambiae, so just having any old mosquito around isn’t sufficient to facilitate the disease inside a household.
A person ill with malaria can go home in the city and not infect a single person in the city household, because malaria isn’t contagious. It absolutely requires a period of incubating in a particular species of mosquito before being able to be passed on to humans by the bite of that particular infected mosquito.  If the city household  has Anopheles
mosquitoes inside the house, and then those bite the actively infected person, then those mosquitoes, after the roughly 12-day incubation period can infect other members of the family. If those mosquitoes are not present, then no transmission is possible.
Yes, the live malaria parasite can be spread to people via infected blood transfusions, but that is no sort of casual contact and usually hardly contributes to any meaningful increase in transmission – unless the health officials have completely screwed up screening blood donations.  It’s not impossible, but it’s less likely than a surge in HIV/AIDS, hepatitis or other viral diseases due to a failure in blood screening.
Not stated anywhere in a ‘news’ article about malaria in Venezuela is which type of malaria parasite is being spread. Vivax or falciparum?  Which mosquito species is the culprit in Venezuela?  If one doesn’t first identify the problem correctly, then the solution will be incorrect and inappropriate.
But, since 1901, the malaria mosquito, Anopheles has been called the ‘country mosquito’ for preferring not urban settings, but suburban and rural; its activities and range are rigidly defined by where its larvae can typically survive.

It makes logical sense that malaria spread in Venezuela could be on the uptick in ramshackle mining areas where new pools of stagnant water would be made by the activities of the mining excavations.  Situations like that are quite lawless and brutal to humans working there.

On the other hand, in 1905, the Panama Canal was one long, muddy, tropical rainforest excavation with work camps and grubby towns, providing daily practically unlimited new places for malaria-carrying mosquitoes to hatch out their larvae.  In 1905 Panama was considered the top contender for the most unhealthy place on the entire planet, yet William Gorgas and his mosquito-eradicating teams promptly destroyed both yellow fever and malaria there, making the entire Panama Canal zone – a 77 km corridor of work camps and towns anchored by two cities on each end - free of those diseases – results lasting a century - using simple, cheap, 1905 technology.

Thus, there is no historical basis for asserting that rough, primitive
mining camps can’t be made malaria-free.  The solution for such conditions is well-documented: the application of the Gorgas methods of disease-carrying mosquito destruction.

The problem seems to be perhaps the lack of human cooperation – not permitting access to do this work?

“Others have turned to brewing bark from cinchona trees, which was popular during the colonial era for its antiseptic properties.”

Re-read that statement; left sort of hanging in the air.

“Antiseptic” isn’t the word.   Raising malaria awareness  in the public includes noting the history that cinchona trees are the source of the first, most effective drug treatment against malaria: quinine.

In so-called ‘colonial times’ the bark was harvested and boiled to make a tisane to drink to treat malaria.  This was the standard procedure for hundreds of years until modern laboratories were able to extract and then later copy the essential chemical compounds to be made into pill or liquid form – for uniformity of dosages without all the bark pieces in them.

Fascinatingly, Africa had malaria, but South America had quinine - the cure.  African people benefitted immensely with the discovery of quinine from South American cinchona trees.

The same article reported that WHO is sending over a million doses of malaria treatment drugs… to a continent that has the natural reservoir of anti-malaria quinine.  The drugs WHO is sending one assumes would be WHO’s official guidelines recommended first treatment choice: ACT, Artemisinin combinations, wholly-owned by China.
This would be the same drugs which have been reported twice by the BBC as failing in Asia since 2002 and have been reported as failing in Africa.  The article doesn’t mention how extensively ACT has been distributed in South America over the past twenty years and whether Venezuela is in fact also struggling with experiencing any similar treatment failures as being reported on other continents.  Our experience with ACT in Africa was malaria recrudescence (resurging of the original parasite infection) caused by ACT treatment failure, necessitating re-treatment with other drugs; at least six cases we had personal knowledge of were retreated successfully with… quinine  
(A Fatal Error for Africa?

Since its discovery in China over 50 years ago, Artemisinin and its derivatives have been reported as never been as effective as the malaria-busting derivatives obtained from the South American cinchona trees.

Regardless, a mosquito-borne disease cannot be defeated by drugs for the sickened alone.  Relying on drug treatments for malaria are like the fire department rushing to hose down a burning roof, then rushing to the burning roof on the next house and the next, while ignoring the street bonfire that is billowing out hot embers.  Eradication of malaria-carrying mosquitoes is like smothering the bonfire to stop it from spreading the burning embers.
Unlike the virus of yellow fever which provokes a life-long immunity if survived, malaria is caused by a parasite that has a very complicated life process that requires both insects and humans; two very, very different physical hosts.  For this reason, a reliable vaccine for malaria has been extremely difficult to develop and remains elusive.  It’s not humanitarian to tell people that maybe help is on the way in a couple of years when the annual malaria season fatalities start their relentless climb, as usual.

Drug treatments simply stop a current infection, but as long as the parasite can survive in local infestations of Anopheles mosquitoes, people can be re-infected by other malaria parasites and fall ill again.  Ignoring the mosquito vector in malaria is always the path to failure through a vicious cycle of infection, treatment, re-infection, treatment/re-infection and ultimately treatment failure. Only eradication of the mosquito carrier in the afflicted locality can provide rapid and long-lasting freedom from these types of diseases.

The goal in anti-malaria efforts is to not need any of these.
<![CDATA[Failure: Malaria reportedly surges in Venezuela: SOS for the Mosquito Eradicators, Gorgas and Soper?]]>Tue, 28 Nov 2017 05:19:18 GMThttp://mosquitopundit.net/mosquitopundit-blog/failure-malaria-reportedly-surges-in-venezuela-sos-for-the-mosquito-eradicators-gorgas-and-soperAt the end of November 2017, media reports via yahoo News that Venezuela is experiencing a surge in malaria cases thanks reportedly to conditions that allow standing water for the mosquito larvae (ramshackle mining operations) .  Medicine is reportedly being  shipped, but treating the sick for malaria is not the way to STOP it.  If the mosquitoes are not decisively confronted, people simply become re-infected - a vicious cycle.  A mosquito-borne disease cannot be stopped unless the vector - the local infestations of the mosquito species responsible- is dealt with - quickly and efficiently. Modern public health policy against malaria does not prioritize this approach, hence the persisting problems with mosquito-borne malaria.

"Sing a song of kerosene
Of barrels deep and wide
Doctors have become so mean
Mosquitoes have to hide!"

Walter Reed, Doctor in Uniform, Wood, 1945

If it worked in decrepit Third-World conditions in pre-modern technology 1901 and over a vast terrain in 1940 in Brazil, then it can work in 2017.  How to defeat malaria is very simple:

1) Isolate the sick so that the specific parasite-carrying mosquitoes cannot bite them and by that become infected with the parasite that causes malaria.

2) Rapidly destroy the local infestations of the malaria-carrying mosquitoes in that locality by locating the pooled/puddled water sources for their larvae and destroying the larvae in those water areas by emptying the pooling water, oiling with a mixture of kerosene and motor oil,  filling water-filled depressions where larvae are found in with dirt, concreting over the area, putting drainage systems in underground pipes.  Malaria-carrying mosquito larvae are going to be found typically within about 100 yards of any human habitation.
Put the boots on and start hunting.   It requires perseverance and diligence, not a PhD.

3) Quarantining actively-infected people from leaving the afflicted area until they are free of the parasite.

"No one foresaw the relative ease with which malaria was eradicated."
Fred Lowe Soper, 1940, Anopheles gambiae in Brazil"

Anopheles gambiae - the country mosquito.
<![CDATA[The domesticated mosquitoes - Aedes and Anopheles]]>Fri, 17 Nov 2017 17:09:59 GMThttp://mosquitopundit.net/mosquitopundit-blog/the-domesticated-mosquitoes-aedes-and-anophelesSince 1901, when the United States Army Chief Sanitation Officer in Havana, Cuba, Major Dr. William Gorgas, restructured his sanitation squads from fighting filth and imaginary 'fomites' to fighting two mosquito species instead, Aedes aegypti and Anopheles gambiae, they quickly discovered these two mosquito species shared one critical characteristic that set them apart from nearly 3,000 other mosquito species in the world, even from their 'cousins' so to speak in their original forest 'reservoirs' of wild mosquitoes: they were so highly attracted to humans it wasn't necessary to search for them.

Even though Aedes and Anopheles look nothing alike, have other different habits and abilities, and that Aedes carries certain viruses, notably  yellow fever, dengue, chikungunya and zika,  while Anopheles carries certain parasites, notably those that cause malaria,  both the flying female adult Aedes and Anopheles mosquitoes quickly install themselves inside and around any occupied human habitations or buildings.  Any empty building that began being occupied by humans would very soon be also occupied with any Aedes and or Anopheles within their flying range.

This characteristic earned these two mosquito species the appellation of 'domesticated' mosquitoes.  This, from the Latin that is the root for 'domicile' - bringing into the home - normally in terms of animals or plants to be trained, adapted for human use and benefit, but in the case of these two species of mosquito, unwanted guests.

Fred Soper reported numerous studies that found even if a home had animals inside it, (common practice in many rural communities to 'domicile' their animals overnight to protect them from predators and thieves) these mosquitoes usually ignored those, highly preferring to bite only people.

This people-preferring characteristic shared by Aedes and Anopheles plus their ability to carry certain dangerous diseases makes them the two most dangerous mosquitoes in the world to humans.  But it turned out to be a critical flaw that could be highly exploited by eradicators tasked with quickly destroying infestations of these mosquitoes.  Fumigation inside homes would kill both Aedes and Anopheles flying adults.  Aedes larvae would be found within a few steps of the infested buildings, Anopheles larvae could be found within the same zone plus usually less than two hundred yards of the infested buildings.

"Havana was freed from yellow fever within ninety days."
Major Dr. William Gorgas, 1901

"No one anticipated the relative ease and rapidity with which gambiae might be eradicated."
Fred Lowe Soper, 1940

<![CDATA[Africa and  Malaria - promises not kept, yet the life-saving solution has been known since 1901]]>Sun, 05 Nov 2017 08:20:41 GMThttp://mosquitopundit.net/mosquitopundit-blog/africa-and-malaria-promises-not-kept-yet-the-life-saving-solution-has-been-known-since-1901Don't cry Argentina; mosquito-borne diseases were eradicated in the Americas a century ago.  What can be said about Africa?

"Don’t cry Africa,
God has kept all safe who are innocent and good.
Don’t be beaten low by any despair;
As for health - the life of your children –
Trying everything new,
but nothing improved your lives at all.
The truth was not taught
And promises not kept.

As for victory,
Those are not the answers they promised to be
The miracles of 1901 were meant for you,
Waiting this century, but yet still there like new.
But today’s solutions are not what they claim to be;
Those are just corrupting fortunes for others, leaving aching pain for
all our hearts.

Knowing well the scent of hospital wards;
those vigils praying that the treatments would save our dearest loves.
Your husbands' and wives' union should not be parted
in dark nights of drips and fever charts.
but what has changed?

Don’t cry for failed programs, those will be judged by God Himself.
There’s a promise: the discoveries of men who cared a century ago
were meant for you;
They told all who would listen:
They were headed for Africa,
to make sweet the days and lives of all,
Laughter and joy replacing weeping.

Don’t cry Africa,
take the truth
it is for you.
Don’t listen to those who know nothing about your lives and loves
who say to wait and wait, to accept all losses as the lot of life.
The means to victory is within your grasp."

        Rapid response and rapid results in Mosquito-borne Diseases

1) Destroy mosquitoes by quickly destroying their larvae, finding and permanently removing  all of their larvae habitat near human beings.

2) Protect the infectious and actively ill persons from being bitten by any mosquitoes that can carry the disease.

3) Quarantine to stop any possible infected persons from carrying away  live parasites or live viruses out of the disease area, a waiting period defined by the specific infectious periods of the disease organism.

    Mosquito science is much easier to learn than rocket science.

MalariaPundit ©2017

<![CDATA[Epochal Discoveries: Conquest of Mosquito-borne diseases]]>Wed, 04 Oct 2017 06:44:48 GMThttp://mosquitopundit.net/mosquitopundit-blog/epochal-discoveries-conquest-of-mosquito-borne-diseases
The story of the conquest of yellow fever à MosquitoPundit 2017
Read the fascinating story of how a handful of U.S. Army doctors, working at great personal risk in the most infamous epicenter of yellow fever in the Caribbean, and at great professional risk against prevailing conventions and assumptions, solved the mystery of the conveyance of yellow fever.  This discovery was immediately used to improve the quality of life in the New World - North, Central and South America, saving millions of lives over the past 100 years.  Africa waits.
Convergence in Cuba 1900

<![CDATA[The lexicon of malaria: What is ACT?  What do recrudescence and ETF mean?]]>Fri, 29 Sep 2017 18:39:37 GMThttp://mosquitopundit.net/mosquitopundit-blog/the-lexicon-of-malaria-what-is-act-what-do-recrudescence-and-etf-meanWith increasing frequency of reports making the news from numerous southeast Asian countries warning of problems with ACT,  the average  reader unfamiliar with the lexicon of malaria may be perplexed.  To clarify: ACT stands for Artemisinin-Combination-Therapy.

What does that mean?  The drug Artemisinin, which after decades of research in China was found to only partially clear the live malaria parasite cell forms called gametocytes from the human body.  To improve its effectiveness, Artemisinin has been combined with other drugs, notably Lumefantrine or Piperaquine, thus the name Artemisinin Combination Therapy (ACT).  Artemisinin and any formulations of it, such as Artemether, Artesunate and Dihydroartemisinin, are wholly-owned by the government of China and can only be produced under license from China.

Regarding malaria, recrudescence means a relapse.  The patient falls ill again with, not a new infection, but with a re-surging of the original infection after the treatment phase has passed.  In the case of malaria, this means a failure of the drug treatment because the malaria parasites (the cell forms in humans called gametocytes) were not completely killed off and cleared from the patient’s blood and internal organs.  ETF means ‘Early Treatment Failure.’

Over a decade ago, permutations of ACT such as (Artemether/Lumefantrine) or (Dihydroartemisinin/Piperaquine), under numerous brand names owned or licensed by China have been promoted to doctors by international public health authorities (notably WHO) to be the first choice of treatment for malaria cases.  Because of this action, ACT combinations have been the most widely distributed anti-malarial drugs in countries in southeast Asia.  One well-known ACT in Africa is sold under the brand, Coartem.   According to its insert instructions, "it is not suitable for preventing malaria nor for severe malaria infections."

Why all these terms together, ACT, recrudescence and ETF? The BBC reported in 2015 and again in 2017 about increasing occurrences of malaria treatment failure, reaching 60% in some countries in Asia, where according to the BBC article, ACT (Artemisinin/Piperaquine) had been promoted as the primary choice of treatment, with Artemisinin failing before Piperaquine.  A search about the history of Artemisinin details the problems with it over the years. 

By all measures, Africa is by far the worst-afflicted continent in the world for severe and re-occurring malaria infections, but despite the plain warning in the Coartem ACT instructions that Artemether/Lumefantrine is "not suitable for preventing malaria nor for treating severe malaria," it has been recommended by WHO for years as the primary choice of treatment in Africa countries.

Note: The BBC stated two years ago in 2015 that the rapidly-rising failure rate associated with ACT in S.E. Asia has potential worrisome implications for using ACT in malaria endemic regions in Africa where severe and re-occurring malaria infections are the highest in the world.  The BBC however has yet to update their 2015 and 2017 reporting with the numerous published medical studies that had been available in 2015 coming out of Africa documenting ACT treatment failure in Nigeria, Mali, Congo and Kenya with alarmed appeals by African doctors to re-assess the appropriateness of the recommendations to use ACT in Africa to treat malaria.

There is another term for the malaria lexicon that will be increasingly invoked: 'quiescence' that is, 'hibernation' or 'dormancy' - an ability no one knew until recently that the malaria parasite possessed the capability to do.  The BBC suggests a 'super bug' but studies are showing it's had this ability all along.

"The parasite encapsulates itself against the aggressive peroxide artesunate and reawakens at the end of the treatment. 

“The same effect is called quiescence by a French research team."

(B. Witkowski et al., Antimicrob Agents Chemother. Doi:10.1128/AAC.01636-09).
A Fatal Error for Africa?
  September 2017