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TUESDAY, SEPTEMBER 7, 2010


PHOTOS FROM U.S. ARMY Left, millions of mosquitoes are bred at the Walter Reed Army Institute of Research. After feeding on humans, the insects secrete blood at the bottom of a carton. A volunteer’s arm is exposed to a swarm of mosquitoes. Volunteers endure hungry mosquitoes to take a bite out of malaria malaria continued from E1


ical tool in the global war against malaria. Some trials have tested medicines to treat patients; oth- ers test vaccines to prevent peo- ple from getting the disease. Bol- ton’s was aimed simply at show- ing that researchers could infect people with Plasmodium vivax, one of the five strains of the ma- laria parasite. “The goal is to show that we can reliably establish malaria in- fection in healthy individuals,” says Col. Chris Ockenhouse, di- rector of Walter Reed’s malaria vaccine program. “By doing this, we have a tool to test drugs and vaccines.” Malaria, whose symptoms in- clude a cycle of severe chills and fever, is a stubborn killer respon- sible for the deaths of nearly 1 million people each year, most of them babies in sub-Saharan Afri- ca. In the United States, federal officials reported 1,300 malaria cases in 2008, with two deaths. But for U.S. travelers to parts of Africa, South America, Asia and


the Caribbean — including mem- bers of the military deployed to tropical zones — malaria remains a persistent threat. While several medications


have been found to treat malaria and prevent its recurrence, there is still no effective vaccine.


16,000 babies That’s why so much is riding on


a massive trial underway in Afri- ca. A prospective vaccine called RTS,S was developed in Belgium by GlaxoSmithKline and initially tested on a small number of vol- unteers in a Walter Reed project in 1997. Today, with the help of $451 million from the Bill and Melinda Gates Foundation, RTS,S is midway through what re- searchers describe as the largest and most promising trial in ma- laria-vaccine history, involving 16,000 babies at 11 sites in seven African countries. The participants are between 5


and 17 months old; some of them get the vaccine, which is aimed at the Plasmodium falciparum strain of the parasite, and others


get placebos. Researchers plan to follow the babies through 2012. Walter Reed is running two of the test sites, both in Kenya. The Gates foundation has put


$1.4 billion into anti-malaria projects in the past decade, pay- ing for everything from drug de- velopment to such low-tech measures as mosquito netting for rural villages. As a result, some African nations have seen malar- ia rates drop by half. But at the same time, the parasite’s resis- tance to some drugs is growing, while new outbreaks are under- way in Venezuela and parts of Southeast Asia. “We’re hoping [the RTS,S vac- cine] will be the catalyst for other foundations and governments to start pouring resources into the fight,” said Ashley Birkett, pre- clinical research and develop- ment director at the Path Malaria Vaccine Initiative, a venture es- tablished by Gates that has helped shepherd RTS,S through its development. “We need to show that we can be successful and really give credibility to de-


veloping a malaria vaccine.” In earlier trials, RTS,S has been shown to protect just more than half the people who receive it. Bir- kett said the eventual goal is 85 percent protection.


A taste of blood


The long road to this point be- gan more than a decade ago at the Walter Reed insectary, a sort of mosquito hothouse where mil- lions of mosquitoes are bred deep inside a building at the institute’s Silver Spring campus. Once through a security checkpoint, visitors and workers pass through seven pressure-sealed doors be- fore reaching a sealed chamber. There, technician Mike Porter was checking racks of mosquito larvae on a recent afternoon, making sure they had enough sugar water for nourishment. “I do get bit,” said Porter, a re- cent college graduate who hopes to make malaria his career. “But not by the infected ones.” One of Porter’s jobs is to sep-


arate the adult males from the females — because it’s the females that bite humans and transmit the malaria parasite. “After a while, you can tell the


difference,” Porter said. “Females have larger abdomens, males have fluffier antennae.” Once separated, the females


get a taste of blood containing the malaria parasite. After they bite the human volunteers, the insects are dissected to make sure they were carrying the parasite. Then the volunteers are off to the Resi-


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include a team of Army research- ers brewing batches of high-tech bug repellent and a study of mo- lecular structures on Plasmodi- um that might help scientists knock out this stubborn parasite. “It’s an amazing organism,”


“I only had it four times. But imagine living in a community where everyone is infected


every season.” — Patrick Duffy, chief of the malaria immunology laboratory at the National Institute for Allergy and Infectious Diseases


dence Inn for two weeks, spend- ing nights and weekends in their hotel rooms with medical staff just down the hall and heading to work as usual until they get sick and need to be treated. More than 950 volunteers, mostly civilians, have taken part in the human challenge model over the past 17 years, Ocken- house said. He said other aspects of Walter Reed’s malaria program


said Patrick Duffy, chief of the malaria immunology laboratory at the National Institute for Al- lergy and Infectious Diseases. “It can swim. It can glide on a sur- face. It can enter a cell and pass out the other side. And it does this because it’s constantly changing.” Duffy himself contracted ma- laria repeatedly while doing field work in Kenya and Tanzania. It left him with fever and stomach cramps, and made him sleepless for up to three days at a time. “I only had it four times,” Duffy said. “But imagine living in com- munity where everyone is infec- ted every season.” Duffy was rein- fected by separate mosquito bites, but if an infection is not treated properly right away, the parasite can return weeks or months later. “It’s a debilitating and deadly disease,” he said, “but it doesn’t have the constituency in the de- veloped world that other diseases have.” Walter Reed begins the next round of malaria clinical trials this fall, Ockenhouse said: “We’re always looking for volunteers.” (To learn about volunteering, go to armyclinicaltrials.com.) health-science@washpost.com


Niiler is a freelance journalist based in Washington.


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