Unnecessary Things People Take To #NYSC Camp


Prospective corps members, As a follow up to a previous post – Things To Take To NYSC Camp , NYSC Camp Requirements – here is a list of things you do not need in an NYSC Orientation camp.

1. MATTRESS: The Camp would provide that for everyone, so you don’t have to take any there. It would be excess luggage and in most camps if you meet the ‘wrong’ officials it would be seized.

2. CUTLERY: You might be surprised, but yes, they seize them except spoons. Knives, fork and even metal spoons are seized because it is believed that Otondos use them for negative things……

3. SOPHISTICATED GADGETS: Things like iPads, big tablets, laptops etc… These attract thieves and they are not necessary. In my previous post I said that you could take your PSP, games and novels in case you get bored. In fact for those who have smartphones, BlackBerries, iPhones etc. you do not need others. You should take just that to camp. At least the lesser you carry, the better for you to watch. It reduces the likelihood of it being stolen, misplaced or damaged.

4. BIG/EXCESS LUGGAGE: There is no need to stress yourself in carrying things you won’t need. When you are packing, ensure you check my previous post on what to take. Those are the necessities. Also on your first day, you would have to be moving around with your luggage or where you will be forced to put it on your head. Yes. On your head. God help you if yours is heavy. hmmm this is where OYO (on your own) wakes up. If you get the top bunk, you might not have space to store the said suitcase. Think it’ll attract thieves. The more it looks like you have, the higher the chances you’ll be targeted for theft.

5. PRESSING IRON: It would be seized from you and won’t get it back till camp is over. Also, most camps don’t have sockets in the rooms and some don’t even have electricity in the rooms allocated for corps members.

6. FOOD FLASK: During my time, it was useless to me because I didn’t eat camp food. I fed on almighty mammy food. lol. Actually, when I got to camp, I did buy one but it ended up being useless to me.

7. CAR: Why on earth would you take your car to camp? Are you trying to impress babes (for the guys) or oppress the officials?? It is not necessary. Some very strict camps would send you away or your tires would be deflated. It could be at a risk of being stolen.

8. Boiling ring, mirrors, bottled items, extension boxes. They will all be seized. (don’t ask.)

Are there any items missing from this list? Pls contribute. Remember comments are free. Lol.


SimEx: Fine-tuning Nigeria’s response to potential disease outbreaks

Editor’s Note: This week in Abuja the Federal Ministry of Health (FMOH) alongside the World Health Organisation (WHO), the Nigeria Centre for Disease Control (NCDC) and the National Primary Health Care Development Agency (NPHCDA), launched the EYE Strategy to eliminate Yellow Fever, with Dr. Tedros Adhanom Ghebreyesus, Director General of WHO, present. A few weeks ago in Lagos, the West Africa Health Organisation (WAHO), supported by the NCDC and other partners, carried out the first ever Yellow Fever full scale simulated exercise in Nigeria, and probably the first ever infectious disease outbreak simulated exercise in West Africa, to test the country & the region’s disease response and notification system, and observe where potential gaps might be. The Nigeria Health Watch team attended the exercise and joined a team that went to the Nigerian-Benin border to watch how health officials would respond if someone tried to cross the border with symptoms of yellow fever. 

The Seme border between Nigeria and Republic of Benin is probably one of the most popular land borders in Nigeria. The level of trade and enterprise at this point of entry makes it one of the most commercially busy checkpoints in Western Africa. An unceasing sea of pedestrians go across the border in both directions, with officers in uniform & plain clothes occasionally stopping passers-by to question them for their documents. Goods- consumables, cars and containers – are ferried through the border in quick succession after being cleared by an army of well-fed border officials as well as a group commonly called “agberos” – local touts who hustle at the border. To successfully go through the Nigerian end of the Seme border, you would have to go past a minimum of 7 checkpoints; all of which require a little bit of ‘legal tender’ before you can continue your trip.

Today we arrive at the border with a mixed team of observers, to see what happens when someone tries to cross into Nigeria with an illness, as part of the Yellow Fever Simulation Exercise that was organized by the West Africa Health Organisation (WAHO), with support from the Nigeria Centre for Disease Control (NCDC), Africa Centre for Disease Control (Africa CDC) and other partners. An actor, Tuoyo, has been inserted at the border, to try and make his way into Nigeria from Benin, while observers and evaluators are watching closely, from a safe distance, taking note of every action.

When Tuoyo, the SimEx actor, collapsed, he was surrounded by a crowd of health officers. Photo credit: Nigeria Health Watch

We are told that, save for a few easily managed road accidents, the Seme Land Border rarely experiences medical emergencies. Therefore, the sight of Tuoyo collapsing under the relentless heat of the March afternoon sun disrupted activities at the border checkpoint. He was immediately given the customary treatment. The crowd surrounded him, raucous voices yelling out different suggestions of resuscitation techniques to be administered, with everybody jostling to see but doing nothing to help. Tuoyo then showed signs of vomiting and this sent the border officials running to make phone calls to their superiors and to the closest ambulance service they could get.

A simulation exercise is an activity that places participants in a made-up situation requiring them to function in the capacity expected of them in a real event. It is conducted to promote preparedness and evaluate an organization’s ability to respond to situations by testing policies, standard operating procedures, and personnel training.  Tuoyo’s part in the exercise involved him mimicking Yellow Fever symptoms enough to convince border health officers that this situation was worthy of notifying the appropriate authorities at once, thereby activating the next stage of emergency response and disease notification.

Yellow fever is an acute viral hemorrhagic disease transmitted by infected mosquitoes. The “yellow” in the name refers to the jaundice that affects some patients. Symptoms include fever, headache, jaundice, muscle pain, nausea, vomiting and fatigue. The virus is endemic in tropical areas of Africa and Central and South America. Large epidemics of yellow fever occur when infected people introduce the virus into heavily populated areas with high mosquito density and where most people have little or no immunity due to lack of vaccination. In these conditions, infected mosquitoes of the Aedes aegypti specie transmit the virus from person to person.

Evaluators and observers observing the actions of the health officers from a distance. Photo credit: Nigeria Health Watch

Accelerated urbanization, deforestation, and population movement in and out of cities and across porous borders – combined with high population density, low population immunity, and limited mosquito control resources — puts Nigeria at imminent risk for widespread and deadly yellow fever outbreaks, especially in urban areas. It was against this backdrop that the simulation exercise was carried out in 10 locations in Lagos State.

The simulation exercise started with an opening ceremony at the Radisson Blu Hotel in Ikeja, Lagos State on March 12th, 2018. In attendance were representatives from the World Health Organisation (WHO), Africa Centres for Disease Control and Prevention (Africa CDC), Centres for Disease Control and Prevention (CDC), Preparedness and Response (P&R), GIZUnited States Agency for International Development (USAID),and Economic Community of West African States (ECOWAS). The participants were greeted with goodwill messages from WHO, World Bank and West Africa Health Organisation (WAHO).

This was followed by an address from Dr. Chikwe Ihekweazu, CEO, Nigeria Centre for Disease Control. He explained that there was an ongoing outbreak of Yellow fever in Angola & Brazil which suggests that we should be on the alert, especially as Nigeria has an extremely low vaccination coverage. He emphasised that the level of preparedness has to be ascertained and tested especially to promote efficient collaboration amongst various players. He also said that in case of an outbreak, response should be in a “command and control” manner. “Conducting a SIMEX in Lagos presents us with the biggest opportunity and the biggest risk,” Ihekweazu said, adding that, “Only states that have experienced big outbreaks like Ebola can appreciate this exercise.”

Panelists at the Yellow Fever SimeEx spoke about the impact that the exercise would have across the ECOWAS region. Photo credit: Nigeria Health Watch

Immediately after the opening ceremony was a press briefing which had a panel consisting of Dr Simon Antara (AFENET), Dr. Carlos Brito of WAHO, Professor Babatunde Salako, Representative of the Minister for Health and CEO of the Nigerian Institute for Medical Research, Professor Stanley Okolo, Director General, WAHO, Dr. Jide Idris, Lagos State Commissioner for Health, Dr. Chikwe Ihekweazu, and Dr. Mary Stevens, Regional Coordinator, WHO Africa. The panelists spoke about the impact this exercise would have across the ECOWAS region.

Dr. Okolo explained that, “This exercise will enable us identify our strengths & weaknesses, as well as gaps to be filled to strengthen our health security system. WAHO remains fully supportive in strengthening member countries’ capacities.” Lagos Commissioner for Health Dr. Jide Idris mentioned that funding the health sector has to be increased because, “If we do not prepare for disease outbreaks, then we have a failed system. This Yellow Fever simulation exercise is therefore a very important activity.”

For the exercise, participants were split into 10 groups, each comprising evaluators, observers and actors, for the 10 selected sites of the simulation exercise. The sites ranged from the Lagos University Teaching Hospital (LUTH), to private clinics in Shomolu LGA, from the Murtala Mohammed International Airport to the Seme Land Border.

Health officers seen wearing face masks and gloves at the Seme Border. Photo credit: Nigeria Health Watch

At the Seme Border, health officers were seen putting on latex gloves and face masks while going about their activities; with some also washing their hands after coming in contact with the casualty. A secondary screening facility where cases like Tuoyo’s could be treated was also available. One noticeable shortcoming was the absence of an ambulance at the border. Emeka Chukwuemeka, an observer from Pro-health International, added that, the secondary screening room was a recent development as there was none available two years ago.“In all, the simulation exercise was able to achieve its objective” Chukwuemeka said, “… as opposed to the table-top exercises that just address theoretical assertions, this exercise has been more revealing.” The Seme-Border simulation ended with Tuoyo being taken to the General Hospital, Badagry, and temporarily suspected of having Yellow Fever.

During the simulation exercise, observers and evaluators identified strong points, lapses, challenges and opportunities that face the first line responders for early detection and quick communication of communicable diseases. Dr. Bathondoli Kabali from the WHO Afro Region, noted that, “All the agents appeared already informed and briefed about the simulation exercise and prepared accordingly with Public Health Emergency Contingency Plan (PHECP) copies in hands.”

This pre-knowledge had some effect on the SimEx. For instance, the observers and evaluators were easily identified at some of the sites of the SimEx, thereby eliciting actions of thorough & proper behaviour, such as checking of body temperatures using infrared thermometers. This, they didn’t do to thousands of passers-by going through the border but focused on just the observers. Also, some of the observed agents possibly exaggerated their services by going beyond what they would usually do or neglected certain routines because they knew that it is only a simulation.

Still, Dr. Ngibo Mubeta Fernandes from the Ministry of Health in Cape Verde, an observer, said, “Nigeria has to be congratulated for taking on a big challenge of putting together such a crucial and challenging exercise…. especially in a region where there is a consistent occurrence of disease outbreaks”. She further stated that the information gotten from this exercise would be “extremely helpful” in other countries in West Africa, especially in evaluating their preparedness towards checkmating public health events that could put their states at risk of an epidemic. Simon Bell, the lead evaluator from WHO, said to the SimEx Coordinators, “Really quite impressive what you have chosen to do here, and the ambition you have displayed. You should be quite pleased at what you have been able to do in this exercise.”

Evaluators and observers at the Seme border, during the debriefing of health officers. Photo credit: Nigeria Health Watch

In addition, Mrs Tomisin Tawose, the Lagos State Business Manager for InStrat Global Health Solutions (InStrat GHS), pointed out that the exercise was a good platform to aggregate the ecosystem of Public Health, to assess Nigeria’s emergency preparedness & response, in the event of a potential outbreak. InStrat GHS was a member of the Technical Working Group for this exercise, possibly because of its extensive work in data management and communication in the area of disease notification. InStrat GHS has been able to come up with a communication system, named the Tup (EWORS), capable of bridging the gap present in the communication channels in disease notification. EWORS utilizes satellite technology to ensure timely and qualitative communication of information about red flag diseases.

This event had the necessary ingredients of foresight, proper planning and the collective input of all stakeholders in the Health sector. We hope that partners left the exercise with a better understanding of the importance of team work in maintaining a healthy nation. According to Mrs. Olubunmi Ojo, of the NCDC, who was part of the simulation exercise organising technical working group, “Every citizen is a surveillance officer and we all have a role to play in safe-guarding the nation from diseases.”

Dr. Ike Anya of EpiAfric, who worked with Mrs Ojo and Dr. Lokossou of WAHO as lead coordinators of the exercise expressed gratitude at the opportunity to help design and deliver the exercise. He said, “I hope that the capacity building and learning that all those involved in planning and delivering the exercise have gained will help embed a culture of regular testing and exercising across the West African region, thus strengthening our preparedness and response mechanisms.”

NYSC Camp: Things To Take To Camp

Where are the Men in the Family Planning Discourse? – #NaijaMen4FP


From inception, family planning interventions and responsibility for the uptake of family planning commodities has pre-dominantly been targeted at women. This seems logical, as women are the end users of most family planning commodities. Yet, men are often the primary decision makers that have an influence on when (or whether) women access family planning services or commodities. So, what would happen if family planning interventions and discussions targeted men just as much as they did women?  How would this affect uptake of family planning services and commodities? More importantly, how would it help Nigeria reach a modern contraceptive rate of 27% among all women by 2020, as the government has pledged?

At the just concluded 2nd THISDAY Healthcare Policy Dialogue, the Nigeria Health Watch press team spoke with Dr. Joe Abah, Country Director, DAI Global. Speaking on the role of men in family planning, he said,

“We live in a patriarchal society where all advice is targeted at women, and men take no responsibility… Men have a vital role in family planning because they have the responsibility to care about the health of their spouses… Men need to first see it as their responsibility… The fact that one party is the one bearing the physical responsibility doesn’t take away the responsibility from the other party to make sure she is in a fit state.”

The first Nigeria Health Watch Forum for 2018 is themed, “The Elephant in the Room – Men as Change Agents in the Family Planning Discourse”. The Forum, a town hall style breakfast meeting, will have four speakers address the role of men in helping Nigeria meet its FP2020 Commitments from their different perspectives.

This will be followed by two panel discussions focusing on the following critical questions:

  • How do we accelerate action to meet Nigeria’s FP 2020 Commitments?
  • How do we engage men to support their partners in seeking FP Services?
  • How do we get men to take responsibility for FP without depending on women?

The speakers and panelists come from a wide range of health care services and specialties, from general practice to community practice. Their work spans from clinical practice, teaching, policy making to management of health services.

Dr. Diene Keita, the UNFPA Country Representative brings a wide breadth of experience having worked across many countries on family planning initiatives. Effiom Nyong Effiom, Country Director for Marie Stopes International Organization Nigeria (MSION), has over 20 years of experience in commercial and social enterprise and expertise in using private sector business models to deliver social benefits.

Dr. Ejike Oji, Chairman, Association for the Advancement of Family Planning, is an experienced doctor with a demonstrated history of working in the health wellness and fitness industry. He has experience in the areas of Non-profit Organizations, Life Coaching, Epidemiology, and Program Evaluation. Dr Adebimpe Adebiyi, Director of Family Health at the Federal Ministry of Health, is currently responsible for initiating policy formulation, monitoring and evaluation of the implementation of health policies on Reproductive, Maternal, Newborn, Child and Adolescent Health as well as Elderly care, Nutrition and Health Promotion.

The panellists are: Dr. Laz Ude Eze, Family Planning Advocate, National Champion for Health; Sa’adatu Hashim, Amira, FOMWAN Kano State Branch; Florida Uzoaru, Founder, Slide Safe; and Rev. Isaac G. Gbaero, Senior Pastor, First Baptist Church, Sabongari, Zaria, Vice-Chairman, Zaria Interfaith for Safe Motherhood/NURHI.

The Health Watch Forum will be moderated by Dr Ifeanyi Nsofor, Director of Policy and Advocacy, Nigeria Health Watch, and CEO, EpiAfric.

Our objective is simple; “To ignite change in the family planning sector by inspiring action through advocacy and innovation”.  We need to ask the tough questions because it is no longer sufficient for the Nigerian government to make declarations, they need to be held to account for outcomes.

For those who have registered to attend the event, we at Nigeria Health Watch would like you to keep three things in mind as you attend: Please download your ticket, ensure that you come early, and come with your questions, ready to learn and network with others working to make the health sector better.

There will be robust conversations both during the health forum and online throughout the day. If you are unable to attend the event, you can watch the event via livestream on our Facebook Page. You can also follow the conversation on Twitter, follow the hashtag #NaijaMen4FP. If you don’t yet, follow Nigeria Health Watch on Twitter @nighealthwatch, as we will live tweet the event.

Join us on April 18th as we explore the critical role that men play in igniting change in Nigeria’s family planning arena. Come hear the voices of #NaijaMen4FP.

Fight against malaria gets two new weapons

(Credit: Getty Images)

Two new strategies show promise in battling malaria, a disease that kills more than 400,000 people each year, mostly children ages five and under in sub-Saharan Africa.

Both new strategies involve making Anopheles mosquitoes more resistant to malaria parasites, which live in the insects and infect humans when female mosquitoes feed on human blood.

Building mosquito resistance to the parasite would reduce the need for repeated, continuous use of other malaria control measures, such as insecticides and bed nets.

One team of researchers from the Johns Hopkins Bloomberg School of Public Health’s Malaria Research Institute discovered a strain of bacteria that can spread rapidly and persist long-term among malaria-carrying mosquitoes. They genetically modified the bacterial strain in a way that strongly suppresses development of malaria parasites, making mosquitoes much less likely to transmit parasites to humans.

A second team of researchers used a genetic modification to boost the immune system of malaria-carrying mosquitoes. The genetic change not only suppresses malaria parasites in the insects but also spreads quickly in a test population by changing mosquitoes’ mating preferences.

If the teams’ initial promising results continue to pan out, altered bacteria and mosquitoes eventually could be released into populations of wild mosquitoes. There, they would spread the genetic changes and eventually reduce malaria transmission to humans.

Odd microbes

In the first study, the discovery of the new mosquito-infecting bacterial strain was a chance event.

“We were working with a different bacterium when a researcher on the project happened to find evidence of a bacterial colony in our mosquitoes’ ovaries,” says senior author Marcelo Jacobs-Lorena, a professor of molecular microbiology and immunology. “That was unusual—normally we find bacteria only in the mosquito gut.”

His team soon characterized these odd microbes as a strain of Serratia bacteria, and dubbed them Serratia AS1.

Researchers have been developing genetically engineered bacteria that can infect mosquito populations and kill the malaria parasites the mosquitoes harbor, without harming the mosquitoes themselves. Getting such bacteria to spread efficiently has been a key challenge, but experiments revealed Serratia AS1 is almost perfect for the task. Unlike other mosquito-infecting bacteria, Serratia AS1 turned out to be easily transmitted from males to females during mating and from female mosquitoes to their offspring.

‘Coloring’ parasite genes shows malaria’s weak spot

The scientists modified Serratia AS1 by adding genes for five potent antimalarial proteins. Powered by the proteins, the bacteria strongly inhibited parasite development in colonized mosquitoes, reducing levels of an early stage of the parasite by more than 90 percent. Experiments also showed that the modified Serratia AS1 bacteria do not have a significant effect on lifespan or fertility of the mosquitoes themselves.

“So far all indications are that these anti-malarial proteins are universally effective against malaria parasites, and the Serratia AS1 bacteria that carry them can go into any malaria-carrying mosquito species,” Jacobs-Lorena says.

Changing mosquito mating preference

In the second study, a team led by George Dimopoulos, also a professor of molecular microbiology and immunology, made small modifications to the DNA of malaria-transmitting Anopheles mosquitoes to boost the activity of their immune genes. The enhanced immunity made the mosquitoes more resistant to infection by malaria parasites, and thus less likely to transmit the parasites to humans.

That result was expected. What was not expected was the unusually high efficiency with which the modified mosquitoes spread their genetic modification to later generations in a mixed population of modified and unmodified, wild-type mosquitoes.

Investigating this surprising result, Dimopoulos and colleagues found that boosting the mosquitoes’ immune genes also altered the mix of bacterial species in the mosquito intestine and reproductive organs. This change in the insect “microbiota” in turn led to a change in mating preferences: Modified male mosquitoes began to prefer unmodified, wild-type females, while wild-type males began to prefer modified females.

New drug could be back-up in fight against malaria

“We believe that, by changing the microbiota, we’re changing the scent of modified mosquitoes—which in turn alters mating preference,” Dimopoulos says. “It’s the perfect change in mating preference in this case, because it maximizes the chances of producing genetically modified offspring when mosquitoes compete for mates.”

Dimopoulos’s modified mosquito population has now been living in a colony in his laboratory for more than seven years, and has retained its high level of resistance to malaria for all that time without any apparent adverse side effects.

The two research groups describe their findings in the journal Science.

The National Institute of Allergy and Infectious Diseases and Bloomberg Philanthropies provided funding for both studies. The Chinese Academy of Sciences and the National Nature Science Foundation of China also funded the Jacobs-Lorena research.

Source: Johns Hopkins University

Malaria parasite packs bags to travel from host to host

(Credit: jev55/Flickr)

The parasite that causes malaria has not one, but two, specialized proteins that protect its messenger RNA—genetic material that encodes for proteins—until the parasite takes up residence in a new mosquito or a human host, researchers report.

A new study describes the two proteins and reveals an additional role that one may play to facilitate RNA-based interactions between the parasite, its mosquito vector, and its human host.

“Understanding the malaria parasite and how it interacts with its host may provide insights that could help prevent the spread of this often-fatal disease,” says Scott Lindner, an assistant professor of biochemistry and molecular biology at Penn State and senior author of the study, which appears in the journal mSphere.

Always ready to move

“The malaria parasite has a complex life cycle that includes phases in the mosquito vector, the human liver, and in human blood. Moreover, the parasite has no idea when it’s going to be transmitted from a mosquito to a human host and back, so it always needs to be ready to be transmitted,” Lindner says.

“It prepares for this by making and packaging up the mRNAs that it will eventually need for making proteins inside its new host or a new mosquito,” he explains.

During this process, called translational repression, special proteins bind to mRNAs and prevent them from being translated into protein. One protein binds to the mRNA’s poly(A) tail—a repeated string of As or adenosine molecules added to the end of most mRNA strands. This helps to form a silenced complex of proteins and RNA that is poised for action after the parasite is transmitted to the host.

Most single-celled organisms have one type of this poly(A)-binding protein, while multi-cellular organisms have two. In this study, the researchers characterize two types of poly(A)-binding proteins in the single-celled Plasmodium parasite, both of which contribute to translational regulation.

“We knew from our lab’s previous work that Plasmodium had a type of poly(A)-binding protein that functions outside of the nucleus of the cell,” says Allen Minns, research technician at Penn State and first author of the paper.

“This protein binds and protects the poly(A) tail at one end of an mRNA strand. In this study, we used biochemical approaches to further characterize this protein, and found that it also has a specialized job receiving mRNAs. It forms chains without the presence of RNA, which potentially allows large assemblies of the protein to quickly protect the entire length of the poly(A) tail.”

The researchers also identified and characterized a second type of poly(A)-binding protein that functions inside the nucleus of the parasite during the blood stages of its life cycle.

In multi-cellular organisms, this second poly(A)-binding protein usually performs a quality control check before mRNA exits the nucleus, confirming that the mRNA is constructed properly. These quality control proteins then pass on the mRNA strand to other proteins outside of the nucleus, which direct translational repression to translate or package the mRNA for later use.

Inside vs. outside

In addition to an important role in translational regulation inside of the cell, the researchers also discovered that the non-nuclear poly(A)-binding protein may play a surprising role outside of the cell.

Fight against malaria gets two new weapons

“When the parasite takes the form of a sporozoite in the mosquito, we actually don’t see the vast majority of the non-nuclear poly(A)-binding protein inside the cell where we expected it to be—where it would interact with mRNAs produced by the parasite,” says Lindner.

“Instead, the protein accumulates at the surface of the sporozoite and is shed when the parasite moves,” he says. “We don’t see this happening in other life stages of the parasite, and this is now the third RNA-binding protein found to be on the surface of the sporozoite. The parasite is putting these RNA-binding proteins out there on its surface for a reason; the new and exciting question is why.”

The researchers speculate that the poly(A)-binding proteins on the sporozoite surface allow the parasite to interact with RNA from sources outside of the parasite and could thus provide an opportunity for the parasite to interact with the mosquito or the host through their RNA.

“This study suggests that the parasite’s interaction with outside RNA is probably much more pervasive than we thought it was,” says Lindner. “It is possible that this kind of interaction could eventually provide a new target for intervention strategies, but the first step is understanding why the malaria parasite has these poly(A)-binding proteins on the sporozoite surface.”

Enzyme discovery could offer new malaria drugs

In addition to Lindner and Minns, the research team includes Penn State graduate students Kevin Hart and Suriyasri Subramanian, and Susan Hafenstein, associate professor of biochemistry and molecular biology at Penn State University Park and associate professor medicine and of microbiology and immunology at the Penn State College of Medicine.

The National Institutes of Health and the Huck Institutes of the Life Sciences supported the work.

Source: Penn State

Malaria can be deadly because of these proteins

Khmer families get their temperature taken during an intense malaria screening which is part of a World Health Organization (WHO) on a Malaria Containment project along the Thai-Cambodian border in Andong Thma village in Pailin province. (Credit: Getty Images)

The most severe strains of malaria infection are associated with a small group of proteins, according to a new study.

The finding could be a step toward a vaccine against the deadliest forms of the disease.

“The great burden of mortality for malaria is in children under five.”

Not all cases of malaria are the same. There are thousands of different strains—some parasites cause only mild symptoms, while other more severe forms can cause disease and death.

And not all people are the same. Some infected people show no obvious symptoms, while others succumb to a severe and, ultimately, fatal disease. This second group often includes young children who have not yet had a chance to develop a strong immune response to the parasite.

“The great burden of mortality for malaria is in children under five,” says Michael Duffy, a malaria researcher with the School of BioSciences and the Bio21 Institute at the University of Melbourne.

Why are children high risk?

The World Health Organization reported 429,000 malaria deaths in 2015, of which 70 percent were children under the age of 5. Why are children at such high risk of death? And why do some die while others survive?

“We asked ourselves—is it something about the humans or the parasites that results in this difference?” Duffy says. “We think it’s an interplay of both.

“What we think is that the immunologically naïve—that is, people who have never previously been exposed—get infected with these parasites and those parasites that cause severe disease dominate in these early infections. Either you become immune or you die.”

Duffy believes the key to combating the public health challenge is to focus on those people who are most susceptible to severe strains—young children—and focus on those malaria strains that are most likely to cause death.

But how can you tell a deadly strain from a more benign one?

Different malaria strains

Researchers developed a fingerprinting technique to uniquely identify different strains of malaria in a population based on the genes (called var genes) that code for the surface protein PfEMP1. This protein plays a key role in the parasite’s ability to evade our immune systems.

Each parasite contains around 60 versions of the var gene and when in the bloodstream of a host, these genes are expressed one at a time, each time building a new surface protein.

“We won’t eradicate malaria, but we may be able to protect children when they are most vulnerable to death or serious morbidity…”

“So you develop immunity to one protein and you start to kill off the parasites expressing it,” Duffy says. “And then it spontaneously switches to another protein to which you have no immunity.”

A few years ago, researchers discovered there is probably a particular set of PfEMP1 proteins that cause severe disease.

“Once you are immune to them, you are immune to severe disease, but you can still be infected with uncomplicated malaria, or be asymptomatic,” Duffy says.

To test this, researchers used new sequencing and fingerprinting technologies to sample parasites isolated from the blood of 44 adults in a location where malaria is endemic in the state of Papua in Indonesia. Twenty-three people had severe malaria.

Researchers then assembled 4,662 pieces of var genes that were being expressed in these parasites and compared the genes expressed in severe cases against those expressed in mild cases.

They used advanced statistical processing to show that a tiny subset of the thousands of var genes that were present were being expressed at a higher rate in patients with severe malaria than in those with uncomplicated strains.

Other groups have tested patients in India and Africa for known var genes and have found similarly found an association between the expression of certain genes and severe malaria.

However, this test on the Papuan community was the first time the association could be made with all the genes that were present, not just those that were already known about.

“This is the first time anyone has taken the genes that are expressed, sequenced everything that’s there and tried to assemble them, to work out what’s present and what’s different between severe and uncomplicated cases,” Duffy says.

Malaria parasite packs bags to travel from host to host

Incredibly, all the proteins associated with severe malaria in India and Africa were also upregulated (had a heightened response) in the severe cases in Papua, suggesting that this small group of deadly proteins is highly conserved around the world.

Looking forward

With their comprehensive screening technology, the research team also found many severe-malaria-associated proteins that hadn’t been identified elsewhere.

Researchers are now looking to test children in malaria-endemic regions of Africa—the group by far the most at risk from death—to see if the new deadly proteins they found in Papua are also present there.

“We also want to look for serological responses—whether people have antibodies to these proteins in their blood,” Duffy says.

“Are kids with severe infections missing antibodies to these proteins? Do those who don’t get severe infections have them?” A positive result could lead to a solution to the malaria vaccine puzzle.

A broadly effective vaccine remains elusive largely because malaria is so diverse and each parasite is constantly changing its attack strategy, finding a valid target for a vaccine is hard.

“But now we are starting to understand that, of the thousands of versions of the PfEMP1 protein that are out there, only a handful, maybe 20 or 30, are causing the most severe cases of malaria. And so, we might be able to target vaccines to just these severe versions.

“We won’t eradicate malaria, but we may be able to protect children when they are most vulnerable to death or serious morbidity from malaria, and thus greatly reduce the burden of the disease.”

Fight against malaria gets two new weapons

The findings appear in PLOS Biology. Other researchers are from the University of Melbourne; Oxford University; the Walter and Eliza Hall Institute of Medical Research; the Eijkman Institute for Molecular Biology in Jakarta, Indonesia; the Timika Malaria Research Program; Papuan Health and Community Development Foundation, Indonesia; the Peter McCallum Cancer Centre; and Charles Darwin University.

Source: University of Melbourne

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