Malaria infections during pregnancy are known to cause poor maternal and fetal outcomes and in Africa are thought to cause as many as 50,000 maternal deaths and 200,000 stillbirths each year. Tools such as bed nets and intermittent therapy have been inadequate, but immunizing women before pregnancy looks promising as a new strategy, researchers reported yesterday in The Lancet Infectious Diseases.

Researchers from the National Institutes of Health and their partners in Mali tested the strategy using PfSPZ, an investigational attenuated vaccine based on Plasmodium falciparum sporozoites made by Sanaria, based in Rockville, Maryland. Earlier clinical trials in Africa had found that the vaccine was safe and effective. 

In Mali, researchers enrolled 300 women who planned on getting pregnant in the coming year. Participants were categorized into three groups. Two received either a low or high dose of the vaccine, and the third got a normal-saline placebo vaccine. 

Participants received three doses, each a month apart. Investigators monitored the women for two malaria seasons over nearly 2 years. The team also tracked women who were pregnant over that period and followed-up on the health of the newborns through the first birthday.

Durable protection across 2 years

The vaccine was safe for both women and their babies. In the first year of the trial, 55 women became pregnant within 6 weeks of the third vaccine dose. Vaccine efficacy was 65% in those who received the lower dose and 86% in participants who got the higher dose. Of 155 women who became pregnant in both study years, efficacy was 57% for the lower dose and 49% for the higher dose.

In the next steps, the group will examine the safety of the PfSPZ vaccine during pregnancy and do a larger study on its preconception use.

In a related editorial in the same issue, Stephanie Yanow, PhD, and Daniel Ferrer Vinals, PhD, a cell biologist and chemical biologist, respectively, at the University of Alberta, wrote that the vaccine showed durable protection over 2 years without boosting, unlike other malaria vaccines. They said the preconception trial builds a good framework for assessing the vaccine in pregnant women, who are often excluded from trials.

Compared to last year at this time, global cholera cases have declined 31%, but deaths are 34% higher, the World Health Organization (WHO) said today in its latest update, which includes data received in July.

For July, 17 countries reported nearly 52,000 cases, along with 223 deaths. Four WHO regions reported cases, with the Eastern Mediterranean region hit hardest, followed by the African region. 

Since late July, Nepal has reported new cholera clusters from several districts. 

Cholera vaccine shortage persists

The WHO said the response to the outbreaks is still hampered by a shortage of oral cholera vaccine, with 105 million doses requested by 18 countries since January 2023, nearly double the 55 million doses produced over that period.

The WHO said the global risk is still very high and is considered a grade 3 emergency. It added that transmission dynamics are increasingly complex, reflecting factors that cross county borders, such as population mobility, natural disasters, and climate change.

The New York State Department of Health (NYSDH) is telling healthcare providers to discontinue the use of ciprofloxacin in people who've had contact with patients diagnosed as having bacterial meningitis.

Ciprofloxacin is among the antibiotics that have been recommended for post-exposure prophylaxis (PEP) to prevent illness in contacts of people with invasive meningococcal disease, a rare but severe infection caused by Neisseria meningitidis. But in a health advisory notification yesterday, department officials said they've been finding an increase in ciprofloxacin-resistant strains of N meningitidis over the past 18 months.

"Providers should instead use rifampin or ceftriaxone, as they remain a first-line treatment option," State Health Commissioner James McDonald, MD, MPH. said in a press release. "Importantly, the treatment recommendations have not changed—it's vital to begin antibiotic treatment promptly when invasive meningococcal disease is suspected."

Resistance levels close to CDC threshold 

According to the notification, 4 of 20 N meningitidis isolates (20%) collected from invasive meningococcal disease patients in New York but outside of New York City in 2023 were resistant to ciprofloxacin. In New York City, 6 (17%) of 35 isolates collected from patients from July 23, 2023, to July 22, 2024, were resistant. The Centers for Disease Control and Prevention recommends discontinuing ciprofloxacin PEP when at least 2 patients and 20% of patients in a local catchment area have resistant strains.

The NYSDH said azithromycin may also be used as an alternative option for PEP.

Invasive meningococcal disease can cause swelling of the brain, bloodstream infections, and joint infections, and is fatal in 10% to 15% of cases. Roughly 30 cases occur each year in New York state.