Eliminating Disease 隔绝疾病

Professor Scott O’Neill
Founder & Head of the Eliminate Dengue Program

In the drier and temperate regions of Australia, many people may not regard mosquito-borne diseases as a serious issue, but they are a silent and prevalent killer for those who are closer to the equator.

The World Health Organisation (WHO) has ranked dengue fever as the most critical mosquito-borne viral disease in the world and the most rapidly spreading – with a 30-fold increase in global incidence over the past 50 years. Each year an estimated 390 million dengue infections occur around the world. Of these, 500,000 develop into dengue haemorrhagic fever, a more severe form of the disease, and dengue results in up to 25,000 deaths annually worldwide.

The statistics are alarming with over 2.5 billion people (more than 30% of the world’s population in over 100 countries at risk of infection). The most significant recent epidemics have occurred in South-east Asia, the Americas and the Western Pacific.

Deadly Dengue And More
For years, countries and governments have attempted to mitigate against the disease as well as more recent mosquito-borne disease threats such as Chikungunya and Zika. These measures have been largely ineffective. The Eliminate Dengue Program (EDP), a not-for-profit international collaboration led from Monash University in Australia – part of the Institute of Vector-Borne Disease – has an innovative solution to the transmission of such diseases.

The programme is headed by scientist, Professor Scott O’Neill and brings together scientific collaborators from around the world with a range of skills and experience including Wolbachia mosquito biology and ecology, dengue epidemiology and control, and public health education and promotion.

“In each country we work in, we partner with local people – local research institutes, governments, regulatory authorities, private enterprise and community members,” explains O’Neill, a biologist, who started this research more than 20 years ago.

What propelled O’Neill’s interest in the field study was to create a project and movement for a social purpose, instead of solely for scientific experimentation. After working in this field in Australia and the USA for several years, O’Neill’s team had a breakthrough with the Wolbachia innovation. The scientific team managed to transfer Wolbachia (commonly found in many insects such as the fruit fly) into the Aedes Agypti mosquito after more than 10 years.

Wolbachia is safe for humans, animals and the environment. It is found in many insects associated with human food and is widely consumed by humans; and it does not infect humans or other vertebrates. What the Eliminate Dengue Program innovation has done, is enable the Aedes agypti mosquito to block the transmission of disease. The EDP method uses Wolbachia, a naturally occurring bacteria, to reduce mosquito’s ability to transmit harmful human viruses such as Dengue, Chikungunya, and Zika. (Wolbachia has also been known to block the transmission of Yellow Fever and West Nile viruses.)

Expansion to Eliminate
Now, the EDP project has shown that its method of dengue control is feasible, thanks to initial field trials which have shown that the Wolbachia continues to block disease transmission. So far, the disease has been blocked for up to five years in communities where Wolbachia mosquitoes have been released. The team expects this to continue on an ongoing basis. Mathematical modelling by independent experts shows that the disease will continue to be blocked for 30 years.

“We are now further developing the method for low-cost, large-scale application across urban areas in countries affected by dengue.”

The programme is currently deploying its method in Australia, Vietnam, Indonesia, Brazil and Colombia with plans to expand into other top 20 countries affected by mosquito-borne diseases.

Within the next six years, the project aims to reduce the burden of the disease by 90%. As well as continuing to carry out large scale field releases in several countries, the team is planning large randomised trials in at least one city, Yogyakarta (Indonesia) until 2018-2019.

“We work with local universities, researchers, government agencies and communities in the countries we’re present in.” O’Neill and his team include close to 400 people working on the Eliminate Dengue project, with some 60 people based in the Monash University headquarter in Melbourne.

Unlike commercialised drugs administered to patients after an infection, EDP focuses on providing sustainable protection from disease. Application (release of mosquitoes with Wolbachia) is only done once over a short period (2-3 months) with no need for repetition.

“Our method is quite novel. People think you have to kill mosquitoes, but we have a different focus.”

A core part of the EDP method and innovation is the way the team involves communities. Key for O’Neill is “authentic engagement before, during and after mosquito releases”. The teams and partners engage with local communities and share details of what is involved, and share results as releases progress. They involve the media. Their focus is on accessible and transparent communication and a respectful and inclusive approach.

“Our field trials in five countries in over 30 sites have shown no reported adverse events; and good disease blocking,” says O’Neill. “In Indonesia we are conducting a large scale release and an impact study across Yogyakarta through to 2019.”

This type of new approach requires forward and bold thinking,” explains O’Neill.

While still recognised as a new method, funding for all science based interventions continues to be a challenge. Eliminate Dengue is a non-profit organisation that is looking to increase its philanthropic and government support base globally.

“We believe governments would prefer our method because it is safe, and takes financial pressure off their health systems, especially in countries where they are low on resources,” explains O’Neill.

The work is possible because of the vision of great philanthropists such as Bill and Melinda Gates, The Tahija family, the Gillespie family, the Wellcome Trust and governments including the Australian, UK and Brazilian governments and USAID. In order to expand the life changing work, the scientific team are looking for more partners and supporters.

由于澳大利亚位于干燥和温带地区,毒蚊传染病的严重性没太突出,但对居于靠近赤道的人们来说,它是沉默残酷的杀手。

世界卫生组织(WHO)将登革热(或称骨痛热症)列为全球最严重的蚊虫病毒性疾病,而且病症迅速蔓延-过去50年中全球发病率增加30倍,每年计有3.9亿人惨遭感染登革热。

其中50万人趋向恶化,转为登革热骨痛溢血热症,导致全世界每年多达2万5000人死亡。另外,逾25亿人(超过100国家,30%以上的世界人口处于感染危机中),而情势严峻的区域为东南亚,美洲和西太平洋。

了解更多致命登革热
众国家和政府多年来力图减轻疾病的致命性及蚊子传播疾病的威胁,如基孔肯亚和寨卡病毒,但许多措施效用有限。消除登革热计划(EDP)是一项非营利性国际合作项目,来自澳大利亚的蒙纳士大学(Monash University)-“媒介传播疾病研究所”属下的一部分,为传播类疾病提供创新的解决方案。

Scott O’Neill教授作为这项计划的主导者,他与世界各地科研合作者分享研讨一系列技能和经验:包括沃尔巴克氏菌体(Wolbachia)蚊子生物学和生态学,登革热传播病学和控制,还有公共卫生教育和促进。

“身为每个国家的合作伙伴,我们与当地人、本土研究机构、政府、监管当局,私营企业和社区成员积极互动工作。”同时是生物学家的O’Neill解释,他是在20多年前开始这项研究。

至于推动他对实地研究的兴趣来自开创一个计划和互动的社会目标,而并非仅是用于科学实验。在澳大利亚和美国领域工作多年后,O’Neill的团队在沃尔巴克氏体科研成果方面取得突破,研究团队设法将沃尔巴克氏菌体(常见于昆虫,果蝇)转移到埃及伊蚊(Aedes aegypti),这项研究跨越10年。

而沃尔巴克氏菌体对人体,动物和环境是安全的,通常在与人类食物相关的昆虫中发现,并且被人类广泛使用,对于人类或其他脊椎动物不会造成感染。至于消除登革热计划能消解伊蚊并阻止疾病的传播,那是因为EDP利用天然沃尔巴克氏菌体,降低蚊子传播有害病毒例如登革热,基孔肯亚和寨卡的能力。(沃尔巴克氏菌体也证实阻断黄热病(Yellow Fever)和西尼罗病毒(West Nile viruses)的传播。)

扩大消除规模
目前EDP的计划成果显示,控制登革热的方式具备可行性,由最初的现场试验,沃尔巴克氏菌体有效阻止疾病传播。现今,在已经释放带有沃尔巴克氏菌体蚊子的地区,疾病被封锁长达5年,并且团队期望将持续下去,根据独立专家的数学建模测算,疾病将会被隔断30年。

“我们正在进一步开发更低成本及大规模的应用方式,协助受登革热影响的国家与城市。”现此项计划正在澳大利亚、越南、印尼,巴西和哥伦比亚进行部署,并扩展到其他受毒蚊传播疾病影响的前20个国家。”

该计划目标是在6年内把疾病的负担率减少90%。除了在几个国家继续进行大规模现场释放外,团队小组策划在至少一个城市,即是2018至2019年期间,在印尼的日惹(Yogyakarta)进行大规模随机试验。

“我们与当地大学、研究人员,政府机构和所在国家的社区合作。”O’Neill和他的团队包括近400人参与消灭登革热计划项目,约有60人来自总部设于墨尔本的蒙纳士大学。

EDP更侧重于可持续的疾病防护,这与感染后提供患者药物商业化做法不同。而应用程序(释放沃尔巴克氏菌体蚊子),只在2-3个月短期进行一次,不会重复。“这是新颖的方式,人们认为必须灭蚊,但我们的焦点不一样。”

至于EDP的方式和创新的核心部分是团队参与社区的做法。O’Neill的关键是:蚊子释放之前、期间和之后的真正参与。团队和合作伙伴与当地社区互动,参考所涉及的内容、并分享成果发布进度,其中涉及媒体,重点是获得透明沟通,还有互相尊重和包容。

“我们在5个国家,30多个地点进行现场试验,显示无不良现象报告,且成功隔断疾病传播。在印尼日惹区,直至2019年为止,正在进行大规模发布和分析研究,这类型创新方式需前瞻性和大胆思考。”O’Neill说。

即使这项创新方案受到认同,但资金仍然是干预科学基础措施的一项挑战。而消除登革热是一个非营利组织,旨在推动全球慈善群体和政府支持。

“我们认为政府会更喜欢这个方式,因为安全并减轻公共卫生系统的财务压力,特别是在资源匮乏的国家。”

许多慈善捐献证实这项工作的可行性,包括闻名的慈善资金会:比尔及梅林达·盖茨基金会(Bill & Melinda Gates),Tahija家族,Gillespie家族,维康信托(Wellcome Trust),还有澳大利亚、英国和巴西政府,包括美国国际开发署(USAID)都一致愿景。而为了扩大这项改变生活的意义工作,科学团队正在寻找更多的合作伙伴和支持者。

AN ITCHY FACT:
There are over 3000 species of mosquitoes in the world and only two (Aedes aegypti and Aedes albopictus) are responsible for transmitting dengue, chikungunya and Zika.) The O’Neill team’s innovation is focussed on the Aedes aegypti mosquito.

全世界有超过3000种类的蚊子,却只有埃及伊蚊(Aedesaegypti)和黑斑蚊(Aedes albopictus)这两种类会传播登革热、基孔肯亚和寨卡病毒。O’Neill团队新方式集中在消灭埃及伊蚊。

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