Breakthroughs Blog: Zika

Faces of Innovation—a new GHTC project that features scientists on the front lines of research and development on new global health tools and technologies—profiles Dr. James Mutunga, who we met at the American Society of Tropical Medicine and Hygiene (ASTMH) Annual Conference, who does research on developing and testing new methods of controlling vector-borne diseases as well as pathogen surveillance in arthropod disease vectors at the US Army Medical Research Directorate-Africa in Kisumu, Kenya. My Name: James Mutunga, PhDWhere I work: US Army Medical Research Directorate-Africa in Kisumu, KenyaI’m funded by: US DoDThe views I express here are my own and do not and are not to be construed as official, or as reflecting true views of the Department of the Army or the Department of Defense. My research: I work on surveillance for vectors—that is, arthropod disease vectors. I work in the Entomology lab in Kisumu. Under the surveillance program, we do collection of field samples of mosquitoes, ticks, mites, fleas, any arthropod that we can imagine, sandflies included—we bring them to the lab and we do pathogen testing to detect diseases that they may carry. We also do morphological and molecular identification of these vectors. Eventually, what we create is a heat map of potential pathogens in circulation and the areas they are circulating so we can advise on the areas that are high-risk and therefore give this information to the US Army for deployment purposes, and protection. The vectors we currently mostly target are mosquito vectors. These transmit malaria, dengue, Zika, chikungunya, and many other different diseases. Motivation: A couple of years ago, I worked for a research institution that primarily researches on arthropod vectors called the International Center for Insect Physiology and Ecology, based in Nairobi, Kenya. And from there, my passion for mosquito research transitioned to what I undertook for my masters and my PhD. I undertook my PhD at Virginia Tech here in the US, and I worked on developing new carbamate molecules and testing them for malaria control. So that kind of invoked my passion, given that it is a disease [with] a broad burden [in] the world. That still is the focus of the work that I do, and I enjoy it.Why federal support is critical: The work we do, and the many years that the US government has invested in vector-borne disease research and control, is commendable. We still do not want to relent. We are facing challenges in vector control. We are having problems [with] insecticide resistance, we are having problems of changing vector behavior, and therefore, the investment in terms of financial support for researchers in the US—and all over the world—is more than needed. We are having challenges with the issues of climate change and habitat change—places that never used to have disease transmission are actually now having active indigenous transmission and therefore there is a need to continue investing and ensuring that policies that are being made to support this research.When I’m not in the lab: I spend time with family, friends. I like traveling, doing road trips. I also like charity work.

Faces of Innovation—a new GHTC project that features scientists on the front lines of research and development on new global health tools and technologies—profiles Dr. Mark Kortepeter, who we met at the American Society of Tropical Medicine and Hygiene (ASTMH) Annual Conference, who does research on emerging infectious diseases at the University of Nebraska in Lincoln.My name: Mark Kortepeter, MD, PhD.Where I work: University of Nebraska in LincolnI’m funded by: Assistant Secretary of Preparedness and Response and Centers for Disease Control and Prevention.My research: I’m an infectious disease and public health physician and I work for the University of Nebraska Medical Center. I lead what’s called the special pathogens research network, so this is a network, we have ten centers across the country, that are tied together as a research network for response to outbreaks, especially ones that are related to high consequence pathogens like Ebola. What we realized after the 2014/2016 outbreak [of Ebola], where there were patients coming into the US, was that there were a number of different investigational products that were used to treat the patients. We realized in the end that we really didn’t understand what was beneficial and what wasn’t in terms of the treatment because they were all given as individual investigational products. So the whole goal was to have a network that was tied together so we can learn more if this happens again—whether it’s Ebola or some other disease like Nipa virus or some novel influenza—so at the end of an outbreak, we would actually be able to compile data, be working off the same sheet of music, off the same protocol, to essentially advance science in understanding what works best for patients.If there are novels products that are still investigational, we would track with those—so we have some Ebola countermeasures that we have been working with…as well as if there was something new that popped up and a need to study something in real time, we could do that. In addition, if there is something for which there is no therapy, we also have the ability to follow the natural history of the disease and what clinical interventions also seem to be useful.Motivation: I got into this because I had a travel bug, and I liked the idea of doing work in infectious diseases because there is a travel component with it because you’re dealing with exotic diseases across the world. So that’s what really got me into it. I just found it fascinating working with people of other cultures.Why federal support is critical: It’s important to invest in this because we really don’t know where the next outbreak will come from…It’s possible that something will come out of left field and surprise us. So it’s very important to have some preparedness in mind, such that you can be ready for anything that comes. If you really think about it, we were all caught up with Ebola in 2014/2016, and then suddenly there is Zika virus, or we were surprised when West Nile showed up on the US shores. So we have to have a global mindset, we have to understand what’s going on outside the country as well as what can land on our shores, because we just never know what’s going to happen next. We’re all kind of one global world now in terms of infectious diseases. Infectious diseases have no boundaries or borders.When I’m not in the lab: The thing I’m really excited about right now is that I wrote a book about my experiences dealing with bioweapon defense when I worked at Fort Detrick, Maryland at the US Army laboratory there…It’s called “Inside the Hot Zone: A Solider on the Frontline of Biological Warfare.” It just came out this week. It’s written like a medical thriller, but it’s also very educational, and it gives an insider’s perspective on things like the anthrax attacks, preparation for Ebola outbreaks, dealing with Ebola in the laboratory, things like that. 

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign-up now to receive our weekly R&D News Roundup email. A new blood test for Zika that can detect the virus within a few hours has been approved for production and use by the Brazilian Health Regulatory Agency. The test can detect the virus in infected patients in less than four hours, a dramatically shorter turnaround time than current methods which can take anywhere from 15 to 30 days. This test is also highly accurate in people who have contracted other diseases transmitted by the Aedes aegyptis mosquito, whereas existing lab tests have challenges in differentiating between infections. The test will be produced by a Brazilian company, AdvaGen Biotech, and sold at no more than US$10 per test so that it’s available to most labs, according to the lead scientist who developed the tool. An experimental tuberculosis (TB) vaccine has shown nearly 50 percent protection against progression of active TB in clinical trials, researchers reported last week at the 50th Union World Congress on Lung Health in Hyderabad, India. These final findings from a phase 2b trial confirm earlier results first reported in 2018 for the vaccine M72/AS01E, developed by GlaxoSmithKline and the International AIDS Vaccine Initiative, and put the world one step closer to developing a better vaccine against the disease. Currently, the only available TB vaccine is the bacilli Calmette-Guerin vaccine. Developed in 1921, it is fairly effective for infants and young children, but its protection varies widely in adults. Researchers concluded that trial results support further evaluation of the vaccine as a tool for global TB control, including confirming results in larger, longer studies and broader populations. A Lassa fever vaccine candidate that could offer protection in a single injection was selected by the Coalition for Epidemic Preparedness Innovations to be advanced into human clinical trials by the end of the year. This vaccine, which is based on the measles vaccine platform, was the most effective single-injection vaccine candidate against Lassa fever evaluated by scientists at the Institut Pasteur and offered protection two days after immunization. Lassa fever is a hemorrhagic fever endemic to West Africa and infects up to 300,000 people per year, killing between 5,000 and 6,000.

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign-up now to receive our weekly R&D News Roundup email. An experimental drug, remdesivir, was shown to protect monkeys against infection with Nipah virus—an emerging pandemic threat for which there is no approved vaccine or cure. The only current treatment is a still experimental monoclonal antibody that was tested during an outbreak in India last year. Remdesivir is also being tested against the Ebola virus in the current outbreak in the Democratic Republic of Congo and has shown some effectiveness against Lassa fever, MERS coronavirus, and respiratory syncytial virus in other studies. In the new study performed by the National Institute of Allergy and Infectious Diseases (NIAID) and the Centers for Disease Control and Prevention, eight African green monkeys were given lethal doses of Nipah virus. The four monkeys who received intravenous remdesivir within 24 hours of infection and daily infusions for 12 days survived, while the four that did not died within eight days. If remdesivir wins approval, “it will give us an extra treatment that could be used relatively quickly,” said Emmie de Wit, a virologist at NIAID, noting that “the average person who reaches a hospital dies within two days, so it’s hard to protect them once they’re infected.” The next step is to test how long after infection the drug can be given and still cure the animals. Women make up just over half of the 35 million people living with HIV worldwide but are underrepresented in clinical trials of potential HIV treatments, cures, and vaccines. A 2016 study performed by amfAR, the Foundation for AIDS Research, found that women represented a mean of only 11 percent of HIV cure trials, 19 percent of antiretroviral drug trials, and 38 percent of vaccine studies. Despite the well-known differences in how the immune systems of men and women respond to the HIV infection and how women respond to some drug treatments, clinical trials continue to rely heavily on the participation of gay men in particular. Further complicating women’s participation in clinical trials is the US Food and Drug Administration’s (FDA) strict rules for including women of childbearing age, leaving most researchers to opt for the easy way out and just enroll men, collecting data from women only after the drug is on the market. As scientists continue to pursue cures for HIV in light of reports of the second patient cured of the infection, researchers must reckon with the longstanding obstacle of the lack of women in clinical trials. The FDA has authorized the first diagnostic test to detect Zika antibodies in human blood to be marketed in the United States. The diagnostic, known as ZIKV Detect 2.0 IgM Capture ELISA, detects the proteins produced by the body’s immune system when it tests for the Zika virus in blood. Though 18 other active tests to detect Zika exist, they have only been allowed under emergency use. This newly approved diagnostic test will only be usable by those with clinical signs and symptoms of Zika or on those who have traveled to regions with active Zika transmissions. FDA Acting Commissioner Ned Sharples noted that the marketing authorization of this Zika diagnostic demonstrates “FDA’s work to protect the public health in emergency response situations.”