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COMBAT dengue: India-EU science alliance takes aim at dengue in global health push
COMBAT dengue: India-EU science alliance takes aim at dengue in global health push

Indian Express

timea day ago

  • Health
  • Indian Express

COMBAT dengue: India-EU science alliance takes aim at dengue in global health push

Dengue fever affects nearly 400 million people annually, with India among the countries most severely impacted. Now, as part of the India-EU partnership under the Horizon Europe program, the COMBAT dengue initiative will soon be launched to tackle the world's most rapidly spreading viral infection. This project brings together top researchers, clinicians, and technologists across both continents. The Swedish Karolinska Institute in Stockholm coordinates the COMBAT research initiative. The acronym stands for 'Advancing Pandemic Preparedness Innovative Multidisciplinary Strategies for COMBATing Severe Dengue'. Dr Ujjwal Neogi, Project Coordinator, Karolinska Institute, told The Indian Express, 'Infectious diseases don't respect borders. The aim is to uncover the underlying mechanisms of severe dengue and reduce the disease burden. This can be done through innovation, precision medicine, and translational research, which will contribute to saving lives, protecting the brain, and strengthening preparedness for future outbreaks.' 'It is not just a response to dengue, but also a critical advancement in global health, integrating fundamental science with clinical and societal applications,' Dr Neogi further said. Scientists involved in the project said that while dengue fever has primarily occurred in tropical and subtropical regions, the risk of contracting the disease is also rising in Europe due to climate change. At present, India bears a significant share of the dengue burden, and as per data from the National Centre for Vector Borne Diseases Control, close to 12 lakh lab-confirmed dengue cases and over 1,650 deaths have been reported since 2019 till March this year. However, experts like Dr Swarup Sarkar of the World Health Organization, who is advising the COMBAT project, said that the dengue problem is compounded by underreporting in India and other South Asian countries. 'Pending vaccine trial results and good clinical protocols, there is a need for biomarkers to identify potential severe cases that would be helpful to reduce adverse outcomes due to dengue,' Dr Sarkar said. Led by Prof Arindam Maitra, National Institute of Biomedical Genomics, Kalyani, West Bengal, clinical samples will be collected from Artemis Hospital and Max Hospital in New Delhi, and Kasturba Medical College Hospital in Mangaluru. Scientists said that these sites, located in regions with high dengue prevalence, are central to generating critical scientific insights that will not only strengthen India's outbreak response capabilities but also contribute to global knowledge alongside cohorts in Guatemala. They also said that the data and findings will support the European Union's efforts to enhance pandemic preparedness against emerging and re-emerging infectious diseases. Scientists said what sets COMBAT apart is its integration of high-end, innovative, and affordable technologies seldom seen in virus research. The project employs brain organoids, miniature, lab-grown human brain-like tissues, to investigate how dengue invades the nervous system. Advanced super-resolution and photonic microscopy allow scientists to visualise the virus in action within living cells, while artificial intelligence sifts through complex patient data to discover biomarkers that could predict severe disease outcomes. The approach is a fusion of virology, physics, engineering, and data science, emblematic of the EU-India strategy to position science at the crossroads of innovation and accessibility, according to scientists. They also noted that COMBAT dengue also comes at a vital moment in India-EU relations, following the renewal of the Science and Technology Cooperation Agreement until 2030. Though dengue is the immediate target, the platform being developed has wider ambitions. The technologies and workflows created under COMBAT – from multi-modal imaging to AI-integrated biological pipelines – are designed to be rapidly adaptable to other pathogens. Anuradha Mascarenhas is a journalist with The Indian Express and is based in Pune. A senior editor, Anuradha writes on health, research developments in the field of science and environment and takes keen interest in covering women's issues. With a career spanning over 25 years, Anuradha has also led teams and often coordinated the edition. ... Read More

Malaria's new frontlines: vaccines, innovation, and the Indian endgame
Malaria's new frontlines: vaccines, innovation, and the Indian endgame

The Hindu

time01-08-2025

  • Health
  • The Hindu

Malaria's new frontlines: vaccines, innovation, and the Indian endgame

In 2023, malaria infected nearly 294 million people and killed close to 6,00,000. Despite early victories in the fight against malaria, global progress has stalled in recent years. The parasites are adapting, becoming resistant to treatments, while mosquitoes are surviving insecticides. It's a shape-shifting enemy—and the old tools are slipping. India has reduced its malaria burden by over 80% between 2015 and 2023—but last year, tribal districts such as Lawngtlai (Mizoram) and Narayanpur (Chhattisgarh) still recorded malaria rates of over 56 and 22 cases per 1,000 people, respectively as per the National Centre for Vector Borne Diseases Control —reminders that the parasite continues to thrive in several pockets long after national averages have improved. While Africa faces mostly Plasmodium falciparum, India also battles the relapse-prone Plasmodium vivax which can lie dormant in the liver and reawaken weeks or, even months later. In Jharkhand, mixed infections account for nearly 20% of cases (NCVBDC), complicating elimination. Even where incidence has dropped, the parasite can persist—lurking in asymptomatic carriers (people with no symptoms) or returning months after infection. The search for smarter, longer-lasting vaccines has never been more urgent. Hope with limits: RTS,S and R21 After decades of setbacks, the first approved malaria vaccine—RTS,S—arrived in 2021. It offered about 55% protection in the first year, but efficacy waned by 18 months, requiring a fourth booster dose. The R21/Matrix-M vaccine, developed by Oxford and the Serum Institute, showed up to 77% efficacy in Phase 3 trials winning World Health Organization (WHO) approval in 2023. Fewer doses, low cost, and Indian production make it especially promising. Still, both vaccines target only one stage of the parasite, leaving reinfection and transmission a lingering threat. Whole-parasite vaccines: a stronger shot on the horizon Instead of targeting a single protein, like in RTS,S and R21, whole-parasite vaccines expose the immune system to the entire malaria parasite—alive, but weakened. The experimental PfSPZ vaccine mimics natural infection using radiation-weakened P. falciparum sporozoite (the parasite's early-stage form) delivered directly into the bloodstream. Early studies showed that 96% of participants developed strong antibodies, with up to 79% protection after the third dose. Building on that foundation, a modified version called PfSPZ-LARC2, developed by Sanaria, may push efficacy even further. The simplicity of a one-dose regimen, despite the intravenous requirement, could make it a strong candidate for targeted use in outbreak zones or among hard-to-reach migrant populations in India. Unlike vaccines that target the parasite's earlier stage, PfRH5 acts during the blood stage, when symptoms appear and the risk of severe illness increases. Since RH5 is a vital protein for red blood cell invasion that the parasite can't easily alter, it offers cross-strain protection—a rare asset in malaria vaccine design. Phase 1a/b and Phase 2b trials in the UK, The Gambia, and Burkina Faso have shown promising outcomes. These vaccines could complement earlier-stage ones and may help boost natural immunity in people who've previously had malaria. Transmission-blocking vaccines While the above vaccines aim to protect individuals, transmission-blocking vaccines (TBVs) target the parasite in the mosquito—halting its spread at the population level. Pfs230D1 induces antibodies that prevent parasite fertilization within the mosquito gut. In Mali, it reduced transmission by 78% in a Phase 2 trial. This strategy is especially relevant to India with a far higher proportion of asymptomatic carriers. 'Our group and others in India are actively working on TBVs to address this reservoir,' said Agam P. Singh, scientist at the National Institute of Immunology, New Delhi. India, too, is entering the TBV space with its own candidates. In July 2025, AdFalciVax was announced by the Indian Council of Medical Research (ICMR), the country's first indigenous dual-stage malaria vaccine. Unlike single-phase vaccines, it combines pre-erythrocytic (PfCSP) and transmission-blocking (Pfs230 and Pfs48/45) antigens to both prevent infection and block mosquito transmission. 'AdFalciVax has completed preclinical testing,' said Subhash Singh, who leads the programme at ICMR-RMRC Bhubaneswar. In mice, it triggered strong immune responses lasting over four months—roughly equivalent to a decade in humans—and remained stable at room temperature for nine months, potentially aiding rural deployment. Progress is also visible beyond P. falciparum. A first-in-human trial in Thailand showed that the P. vivax TBV Pvs230D1M reduced mosquito transmission by up to 96%, another ray of light for India's mixed-species numbers. India, too, is not far behind. 'A similar research program for P. vivax is underway, in collaboration with AdFalciVax co-inventors Sanghamitra Pati and Sushil Singh,' said Dr. Singh. Boosting immune power Strengthening the immune response itself is another active front. A recent protein-based vaccine combined a ferritin nanoparticle with CpG—a type of adjuvant, or immune booster already used in hepatitis B vaccines—and cut liver-stage parasite burden by 95% in mice. AdFalciVax showed over 90% protection in mice even with alum, a mild and widely used adjuvant. 'We saw protection on a par with more inflammatory adjuvants such as MPLA (a stronger adjuvant),' said Dr. Singh. 'Whether this holds in humans remains to be seen.' Scientists are also testing newer vaccine platforms such as mRNA, which allow vaccines to be made faster and tweaked more easily than protein-based ones. In 2025, researchers at CureVac and the U.S. National Institute of Health (NIH) encoded the Pfs25 antigen—targeting the parasite's sexual stage—into an mRNA-lipid nanoparticle. They observed complete transmission blockage in mice, with antibodies lasting over six months from just two doses. However, not all mRNA-based vaccine efforts are moving ahead smoothly. In early 2025, BioNTech's Phase I/IIa trial for its blood-stage mRNA vaccine candidate BNT165e was placed on clinical hold by the U.S. Food and Drug Administration (FDA). While the company did not disclose the reason, it noted that discussions with regulators are ongoing. The pause highlights the hurdles of translating mRNA platforms into malaria vaccines. 'mRNA and nanoparticle platforms can certainly be explored—alone or in combination,' said Pawan Malhotra, emeritus scientist at the International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi. 'But it's hard to predict what will work. Plasmodium is complex, unlike bacteria or viruses.' Augmenting existing vaccines, blocking immune evasions Beyond boosting the strength of the immune response, scientists are also exploring how to improve its aim—modifying malaria antigens to help the body recognise the parasite more efficiently. A new experimental vaccine links PfCSP—a surface protein from the malaria parasite—to MIP3α, a molecule that acts like a flare to draw in immune cells. In mice, it triggered stronger antibody and T cell responses than standard mRNA vaccines, reducing liver-stage infection by up to 88%. It hasn't yet been tested in humans, but it shows how tweaking the immune response could push malaria vaccines past current limits. Beyond vaccines, researchers are exploring how malaria hides from our immune system. P. falciparum uses RIFIN proteins to bind to immune 'off switches' like the LILRB1 receptor, shutting down immune cells. It's a tactic that helps the parasite hide in plain sight. A new study describes an experimental, engineered antibody, D1D2.v-IgG, designed to block this interaction. Built from a segment of the LILRB1 receptor, the antibody binds to RIFIN 110 times more strongly than the natural version—outcompeting the parasite at its own game. By blocking this interference, it freed the body's LILRB1 to function normally, restoring immune attack in lab tests. Though still untested in animals, the approach could one day support new malaria therapies or enhance vaccine responses. Gene drives and vector suppression While engineered antibodies attack the parasite, CRISPR-based gene drives go after its vector. These tools insert fertility-disrupting genes into mosquitoes. In a landmark study, this approach wiped out entire Anopheles gambiae colonies within a year—with no resistance detected. But evolution rarely plays along. In the wild, mosquitoes might adapt, ecosystems could shift, and once released, gene drives can't be recalled. The idea of eradicating a species raises thorny ethical and ecological questions. So, researchers are exploring subtler strategies. One 2025 study edited a single letter in the FREP1 gene, blocking the malaria parasite from developing inside the mosquito. With a gene drive, this parasite-blocking trait spread to over 90% of lab mosquitoes in ten generations—without harming their fertility or survival. But the parasite remains under pressure to evolve around the block, and infected mosquitoes still live long enough to potentially transmit malaria if the trait doesn't saturate the population. Another team took a different route—engineering mosquitoes to die sooner only when infected. By disabling an immune gene, they created a self-limiting feedback loop: the more malaria spreads, the more it kills its own carriers. Because this strategy doesn't attack the parasite directly, it reduces the pressure for resistance. It's an elegant inversion—using the parasite's success against itself to shrink transmission, without eradicating the vector or requiring perfect coverage. The Indian lens: challenges and the path ahead The nation aims malaria elimination by 2030. It's an ambitious plan—but one that hinges on precision and persistence. Tribal and forested districts in Chattisgarh, Jharkhand and parts of the Northeast are the last strongholds of malaria—often remote areas with limited healthcare access. Even in places where infections seem to be minimal, adults and older children often act as asymptomatic reservoirs, quietly sustaining transmission. The dual-species landscape in India further complicates elimination efforts. 'P. cynomolgi—a monkey malaria species—is the best model for P. vivax research,' said Dr. Malhotra. 'We were developing it 20 years ago with the Central Drug Research Institute (CDRI), but strict monkey access laws and lack of scientific foresight stalled it.' Despite these challenges in vivax research, efforts to develop a vaccine are gaining ground. Both Dr. Subhash Singh at ICMR and Dr. Agam P. Singh at NII confirm that P. vivax vaccine candidates are under active development. But even the most innovative science needs systems to carry it forward. 'We need a COVID-style push,' said Dr. Malhotra. 'Industry and academia must collaborate with proper funding. We've developed potent therapeutic antibodies against liver-stage parasites and now need partnerships to move them forward. A lone scientist in a lab can't do it all.' The science is advancing—but it needs infrastructure and political will to match. Dr. Singh echoes the sentiment. 'We are now concentrating on translating AdFalciVax's promising preclinical results into trials. Successful deployment however, will require good results over multiple stages of trials as well as regulatory approvals, likely taking at least 7–8 years.' In addition, strong coordination between regulators, industry, and researchers is needed. ICMR has already floated an Expression of Interest seeking industrial partners to co-develop the vaccine. 'Challenges that need to be addressed include producing GMP-grade components, developing immune biomarkers, and benchmarking efficacy against RTS,S and R21,' added Dr. Singh. 'We definitely need vaccines, antibodies, new drugs—for both P. falciparum and P. vivax,' said Dr. Malhotra. 'But that's not enough. Doctors need training, resistance must be tracked, and vector control has to keep pace.' It must be a full-spectrum battle—from the molecular level to the community clinic. India's malaria story is no longer one of uniform burden—it's a fight against hidden reservoirs, remote geographies, and a parasite that won't quit. With next-gen vaccines, homegrown innovation, and growing scientific momentum, the country stands at a critical juncture. Elimination by 2030 is not just a goal—it's a test of whether science, policy, and public health can unite to defeat an ancient foe. The tools are here. Now, we must use them—decisively and everywhere the parasite still survives. (Anirban Mukhopadhyay is a geneticist by training and science communicator from Delhi.

Hyderabad sees rise in viral, vector-borne cases as monsoon sets in
Hyderabad sees rise in viral, vector-borne cases as monsoon sets in

New Indian Express

time08-07-2025

  • Health
  • New Indian Express

Hyderabad sees rise in viral, vector-borne cases as monsoon sets in

HYDERABAD: With the advancement of the monsoon season, the city is witnessing a gradual rise in viral fevers and vector-borne diseases (VBDs) such as dengue and chikungunya, along with water-borne illnesses like typhoid being reported since June. Both private and government hospitals in the city have recorded an increase in cases of viral fever and VBDs since June. Doctors have also reported Covid-19 cases over the past two months. According to the National Centre for Vector Borne Diseases Control (NCVBDC), the state recorded 267 cases of dengue, 83 of chikungunya from January to March, and 53 cases of malaria from January to April this year. However, the Health department has not yet released any official data regarding VBDs or viral fever. Tribal areas in the state are reportedly more affected by these seasonal illnesses. Patients come with symptoms such as high-grade fever, cold, cough, nausea, body aches, and joint pain. As these symptoms overlap across several seasonal illnesses, timely medical intervention is essential to avoid serious health complications, doctors stated. In the city, the number of patients visiting the Outpatient (OP) department at Government Fever Hospital has surged since June, with at least 400–500 cases reported daily, most of them viral fever. Dr Rajendra Prasad, Superintendent of Fever hospital, told TNIE, 'We are seeing over 400 OP cases since June. However, there has been no acute spike in any particular disease, including dengue and chikungunya, as of now. All inpatient and outpatient cases are currently stable. We anticipate a spike in July.' City doctors noted that many of the fever cases are being confirmed as dengue upon further investigation. In several instances, patients are asymptomatic, with the infection only being detected through diagnostic tests, resulting in a longer recovery period.

Odisha's malaria woes spill over with 63.6% rise in cases in 2024
Odisha's malaria woes spill over with 63.6% rise in cases in 2024

New Indian Express

time05-05-2025

  • Health
  • New Indian Express

Odisha's malaria woes spill over with 63.6% rise in cases in 2024

BHUBANESWAR: Odisha's much-celebrated success in reducing malaria by 80 per cent (pc) in 2018 appears to be fading away with the state witnessing an alarming 63.6 pc rise in malaria cases in 2024 as compared to the previous year, and topping the incidence chart in the country. According to National Centre for Vector Borne Diseases Control (NCVBDC) data, the state reported 68,693 malaria cases, including the highest 50,501 P falciparum, and eight deaths last year. Around 41,973 cases and four deaths were recorded in 2023. It fuelled the country's malaria tally by contributing around 26.7 pc of the total 2.57 lakh cases. The state was followed by Jharkhand (42,352), Chhattisgarh (33,023) West Bengal (21,802), Maharashtra (21,078), Mizoram (16,899) and Uttar Pradesh (13,477). Officials said 78 pc cases were from five districts - Kalahandi, Rayagada, Kandhamal, Koraput and Malkangiri. The districts are among 21 high prevalent areas where targeted interventions are being made under the state's flagship initiative Durgama Anchalare Malaria Nirakaran (DAMaN) to achieve malaria elimination by 2030. The resurgence of the disease coupled with a spike in asymptomatic cases has prompted the Centre to raise serious concern over the effectiveness and reporting mechanisms of DAMaN. What has sent the alarm bells ringing is under-reporting of asymptomatic cases by the state. In an official communication (accessed by TNIE) to the Odisha government, the NCVBDC has questioned why a significant portion of malaria cases detected through mass screening exercises under the DAMaN programme and in tribal residential schools are not being reported in the national surveillance system M4. The M4 format is used to record fortnightly case information from a sub-centre, PHC, district or state, and is part of the health management information system.

Looking back to the strength of a people's movement against filariasis
Looking back to the strength of a people's movement against filariasis

The Hindu

time22-04-2025

  • Health
  • The Hindu

Looking back to the strength of a people's movement against filariasis

The World Health Organization has sought to eliminate filariasis, globally, by 2030, a decade later than its original target of 2020. While India's target year is now 2027, this deadline has been arrived at after several revisions: the National Health Policy had originally set the goalpost for 2015. Filariasis, clearly, has been difficult disease to eradicate. While pioneering experiments by vector specialists over the years have helped India reduce its disease burden, consistent efforts are needed to eliminate the disease, reports have acknowledged. 'Filariasis is the common term for a group of diseases caused by parasitic nematodes belonging to the superfamily Filarioidea. Adult worms of these parasites live in the lymphatic system, cutaneous tissues or body cavity of the humans and are transmitted through vectors', explains a documents from the National Centre for Vector Borne Diseases Control. Filariasis caused by nematodes that live in the human lymph system is called Lymphatic Filariasis (LF). The burden of lymphatic filariasis is massive in India, with as many as 670 million persons at risk for the disease, according to a report published in the Indian Journal of Medical Research in 2022. While the disease has been around for decades in India, there still exist many misconceptions about it, says S. Sabesan, former director of the Indian Council of Medical Research -- Vector Control Research Centre, Puducherry. Kerala's story with filariasis Kerala was instrumental in spotlighting filariasis in India. In 1984-85, a group of filariasis affected persons in Alappuzha formed an association, and its president contested the general election that year, aiming to attract the attention of politicians and bureaucrats. It bore fruit. A Member of Parliament from Kerala S. Krishna Kumar, became the deputy minister in the Union Health Ministry. He called for action against filariasis in Kerala, which set the ball rolling, recalls Dr. Sabesan. Kerala's culture of associations helped to further the project of eliminating filariasis, he says. All associations were amassed under the umbrella of the Filariasis control movement or 'Filco' movement. The project targeted removing floating vegetation where mosquitoes that cause the disease breed. The mosquitoes lay eggs on leaves and the larvae absorb oxygen from the air sacs in the roots of the plants. Understanding the breeding pattern of the mosquitoes helped remove the floating vegetation, which was then placed as manure in coconut groves. To control mosquitoes the State Health Department also targeted Kerala's large resource of ponds and water bodies to develop aquaculture, using fish from dams. The fish would feed on the larvae, curtailing mosquito breeding. Interdepartmental support Support also came from Kerala's Agriculture Department which saw the potential of improving livelihoods in rural areas. Shramdhan workers cleaned temple tanks, canals and water bodies, and NABARD pitched in with financial support to remove the plants, and establish aquaculture. In two years, inland fisheries had been developed. To add value to the removed water vegetation, hemp was cultivated. This improved the quality of fertilisers that coconut groves received. Ultimately, the Health Department roped in the Education Department to raise an army of schoolchildren who could spread awareness to help improve adherence to treatment of the disease. The Health Department also used the knowledge of how village residents checked the feet of eligible young women to check if they harboured the disease before offering a marriage proposal. The Department made a young woman with lymphatic oedema, in whose family many women had been rejected owing to the disease, their mascot. The young woman recovered from filariasis after treatment and this boosted people's confidence. Her story was made into a short film, Yudham (war) and exhibited, giving further fillip to treating the disease. Alongside, the Department trained Filco workers to detect the disease and bring in patients for treatment. Free clinics were opened to offer treatment. The next step was checking for hidden disease, which involved mass drug administration. Soon, the number of cases fell drastically indicating that the disease was in the elimination stage. A win, and a mass strategy The success of the experiment was shared at the WHO's meeting in 1996 in Kuala Lampur and the World Health Assembly decided on a strategy of administering a single dose of diethylcarbamazine citrate (DEC). In India, the annual single dose mass therapy was introduced in 2002, but the nation-wide the scheme did not help in eliminating the disease, for want of follow-up care. In 2006, the Union Health Ministry introduced the drug Albandazole that can have an effect on adult worms of the parasite. But there was a lack of compliance, even though the drugs were distributed. The Health Ministry found that despite distributing the drug there, was no reduction in the number of cases. Meanwhile in Kerala another development took place. The salt story Through a project, salt-infused with a low dose of the drug DEC was introduced in Kerala. This project was launched with the support of the salt corporation in Thoothukudi in Tamil Nadu. Within a year, the number of filariasis cases fell significantly. The project's success was expanded in Tamil Nadu's Kanyakumari district in 2003. By 2020, the Indian Council of Medical Research launched DEC salt in Andaman and Nicobar and successfully eliminated another variety of filariasis. This salt therapy could be used as an adjunct therapy across the country Dr. Sabesan has said in the white paper he has published on the subject: Not only is it odourless, but it also doesn't change the colour of food and is safe for pregnant women and children as well. For the success to be sustained it is imperative that we achieve the target of elimination, he says. 'Tamil Nadu is doing well. But filariasis is found in Karnataka, Andhra Pradesh, Bihar and Uttar Pradesh as well. There are areas where filariasis is a challenge. If uncontrolled, filariasis will be reintroduced, as the vector is already present in the atmosphere. The low density carriers will build up gradually. So it is necessary to continue surveillance even after elimination is declared. Vector entomologists must focus on the mosquitoes and the vector,' he emphasises.

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