Navy Captain Spearheads Malaria Breakthrough For 15 years, Navy Capt. Judith Epstein has toiled at the Naval Medical Research Center to develop a malaria vaccine. As a Harvard-trained pediatrician, she hoped to develop an immunization that would protect deploying troops and possibly prevent the deaths of 660,000 people each year, including one child every minute. On Aug. 8, in an article published in the journal Science, the world learned that Epstein and her colleagues are closing in on that goal. Epstein and other researchers from NMRC, the Walter Reed Army Institute of Research, the National Institutes of Health and Sanaria Inc. of Bethesda, Md., conducted a study in which they injected 40 subjects with a vaccine developed from a weakened strain of the deadliest form of malaria, Plasmodium vivax. They then let malaria-ridden mosquitoes feast on human subjects and sat back and watched. Malaria symptoms — high fever, sweats, chills and aches — take about 10 days to develop after a person is infected. In this study, though, no one became ill. Not on Day 10, Day 11 or later. By Day 14, Epstein felt she was witnessing history. “I just had this feeling like, ‘Oh my God. They are not getting sick. I’m right in the middle of a scientific breakthrough,’ ” she said. The Navy and Army have worked to develop malaria preventives and treatments for decades. In the 1970s, the Navy discovered the basic foundation for the current vaccine: By irradiating mosquitoes, scientists could weaken the Plasmodium vivax. When the weakened strain was transferred to patients, it gave them immunity. But there were issues with the delivery system, according to Epstein. “It wasn’t ideal. In order to get the protection, the patients had to get a thousand mosquito bites, about 200 each day for a series of days,” she said. In 2002, her predecessor as director of the Navy’s malaria program, retired Navy Capt. Stephen Hoffman, founded Sanaria Inc., to develop and manufacture a vaccine that didn’t need mosquitoes to make it work. NMRC worked with Hoffman to test that product in 2009 and 2010. It yielded mixed results. Delivered the common way most vaccines are given, through an injection into the skin or under the skin, all but two of the 40 patients developed malaria. On an airplane after that study, Epstein came up with the idea to deliver the PfSPZ vaccine intravenously — something that had been done before with monkeys. “Mosquitoes bite you. They inject the parasite directly into the bloodstream. We had to give it IV,” she said. It worked with stunning success: 100 percent protection. The experiment was the first for the NIH’s National Institute of Allergy and Infectious Diseases’ Vaccine Research Center. NIH researchers are thrilled to fund and support the project. “We are encouraged by this important step forward,” said Dr. Anthony Fauci, NIAID’s director. According to Fauci and Epstein, a commercial version of the vaccine is still at least four years off. More studies need to be done on larger groups and to address dosing and delivery issues. Trials are scheduled by other investigators for Tanzania and Mali. Those trials will take the vaccine to the heart of the malaria epidemic. Epstein, who celebrated her success with a much-needed vacation, said she’s excited about the future. “This is a multi prong effort, but the Navy has been involved from the beginning ... it’s been the highlight of my career,” she said. Profile: Capt. Judith Epstein Before she spent her days watching large, malaria-infested mosquitoes bite patients at the Naval Medical Research Center, Capt. Judith Epstein was a pediatrician. And a Harvard scholar. And a professional ballet dancer. Epstein spent more than a decade dancing en pointe. After hanging up her ballet slippers in the early 1980s, she attended Columbia University and, later, Harvard Medical School, graduating in 1990. She went into pediatrics, specializing in infectious disease. In 1998, she joined the Navy to study malaria at the Naval Medical Research Center, focusing mainly on developing a whole-parasite malaria vaccine. “It’s a threat not only to our troops ... but to children. I am a pediatrician, and I joined the Navy to work on malaria vaccines. I thought it was the best place for me to go,” she said. Besides her position as director of the NMRC’s malaria program, she’s a member of the faculty of the Uniformed Services University of the Health Sciences and an attending physician at Walter Reed National Military Medical Center. And she’s vice-chairwoman of the board of Youth Art for Healing, a nonprofit that brings youth-created art into hospitals and medical clinics. As an investigator on the recent vaccine study published in the journal Science, Epstein has now witnessed the promise of nearly 15 years of effort. “As researchers, you get so used to failure. So when it worked, my husband said I was just in a trance, I was so excited,” she said. By Patricia Kime Navy Times August 26, 2013
Posted on: Tue, 20 Aug 2013 08:37:17 +0000
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