25 January 2007
U.S. Navy, Egyptian Scientists Fight Global Illness, Infection
Mild resistance to anti-viral drug found in Egyptian avian flu victims
This is the first in a series of articles on U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
Washington – As pathogens, both ancient and emerging, move from country to country, carried by and shared among insects, animals and people to spread illness and death, a small group of U.S. and Egyptian scientists is building a medical line of defense throughout the Middle East, North Africa and Southwest Asia, against diseases that range from malaria and fevers to HIV/AIDS and avian influenza.
In a triangular, 1.2-hectare compound in eastern Cairo, in the shadow of the 1,500-bed Abbassia Fever Hospital – the Middle East’s oldest and largest – a team of Navy and Army scientists, U.S. civilian employees, Egyptian scientists and technicians, and contractors staffs the 60-year-old U.S. Naval Medical Research Unit No. 3 (NAMRU-3).
Their direct mission is to support U.S. military personnel in that region by studying viruses, enteric (intestinal) diseases and disease vectors (carriers) like ticks and mosquitoes, and through disease surveillance, which means monitoring the most important infectious disease threats in the region.
The scientist also engage in an activity not in the official NAMRU mission statement: they make sure they are good neighbors, passing along the benefits of science and medical research to the citizens of nearby countries.
“The idea is that public health work is good diplomacy,” said NAMRU-3 Commanding Officer Captain Bruce Boynton, a doctor, in a recent USINFO interview in Cairo, “and not just in the sense that we represent the United States. [Diseases studied at NAMRU-3] are of interest to public health leaders, and doing good things for people brings countries and people together.”
NAMRU-3 is part of the Naval Medical Research and Development Command in Maryland, whose other overseas research laboratories include NAMRU-2 in Jakarta, Indonesia; a detachment in Manila, Philippines; and the Naval Medical Research Institute Detachment in Lima, Peru.
GOOD NEIGHBORS
The scientists at NAMRU-3 work closely with the Egyptian Ministry of Health and Population (MOHP), the World Health Organization (WHO), the U.S. Agency for International Development, the U.S. National Institutes of Health, the Centers for Disease Control and Prevention (CDC) and many nongovernmental organizations.
At NAMRU-3, the Virology Research Department is a regional influenza reference laboratory for WHO’s Eastern Mediterranean Regional Office, where NAMRU-3 scientists confirm the identity of flu viruses isolated by national laboratories, develop and distribute virus reference reagents (substances used in a chemical reaction to detect and measure other substances), prepare training materials, organize workshops, offer extended laboratory training, collaborate on special surveillance studies and conduct research to improve methods of flu virus surveillance.
NAMRU-3 technicians analyze and study the genetic composition of viruses to identify specific types of viruses, a process important to the development of vaccines and therapies. They also examine the genetic material of influenza viruses, including the highly pathogenic H5N1 strain of avian influenza, and share the data with the scientific community so scientists around the world can benefit from the information.
For example, in Egypt on January 18, H5N1 viruses were found to have a genetic mutation that was linked in laboratory testing with moderate resistance to the anti-viral drug oseltamivir (TamiFlu®). These were found in two people with H5N1 infections, according to a WHO statement.
Both patients – a 16-year-old girl and her 26-year-old uncle who lived in the same house in Gharbiyah province north of Cairo – had been treated with oseltamivir for two days before the clinical samples were taken. Despite the efforts of health workers, the girl died December 25, 2006, her uncle December 28, 2006. Of the 267 H5N1 cases reported worldwide since 2003, 18 have occurred in Egypt.
Egypt's monitoring and rapid virological analysis conducted at the Central Public Health Laboratory in Cairo initially allowed the H5N1diagnoses to be made. Confirmatory testing and genetic sequencing were done at NAMRU-3 and two WHO collaborating centers in the United States (at CDC) and the United Kingdom.
According to WHO, there is no indication that oseltamivir resistance is widespread in Egypt or elsewhere.
TRAINING THE TRAINERS
“One of the major things we do as a regional reference laboratory when it comes to influenza or avian influenza,” said U.S. Navy Lieutenant Commander Marshall Monteville, head of the NAMRU-3 Viral and Zoonotic Diseases Research Program, “is give [scientists and technicians] in the region training [in influenza diagnostics] here at NAMRU-3, then we send a field team to train them in their own laboratories ... and we visit them once in a while to make sure they’re doing okay.”
Such thorough training is in the interest of quality assurance, he added.
“We want to make sure they’re doing things correctly in their laboratories. When they send people to us for training, we’re usually training the trainers, so we want to make sure the trainers are going back and teaching their people appropriately,” Monteville said. “Also, they’re collaborators of ours, so it’s good business.”
More information about NAMRU-3 is available at the Naval Medical Research Center Web site.
