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See Inside April 2006

New Hope For Defeating Rotavirus

Although its name is unfamiliar to many, rotavirus is the leading cause of severe childhood diarrhea worldwide and a frequent killer of young children in developing nations. Now--after 30 years of investigation--vaccines that may well conquer it are ready for market
ORANGUTAN



PERRY VAN DUIJNHOVEN FROM AMONG ORANGUTANS: RED APES AND THE RISE OF HUMAN CULTURE, BY CAREL VAN SCHAIK. THE BELKNAP PRESS OF HARVARD UNIVERSITY PRESS, ¿ 2004 BY THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE

The thought of a murderous virus often conjures images of patients suffering from Ebola virus in Africa, SARS in Asia or hantavirus in the U.S. Yet those evildoers have taken far fewer lives than rotavirus, whose name is virtually unknown. This virus infects nearly all children in their first few years of life. It causes vomiting followed by diarrhea. The diarrhea is often so severe that, if left untreated, it can lead to shock from dehydration and then death. Worldwide, rotavirus kills an estimated 610,000 children every year, accounting for about 5 percent of all deaths among those younger than five years. In the U.S., few children perish from the virus, but as many as 70,000 require hospitalization for it annually, and several million suffer quietly at home.

Scientists, though, are now about to break the grip of this devastating disease. In January--some three decades after investigators first identified the pathogen--researchers reported that two rotavirus vaccines had proved successful in massive clinical trials. The process of developing rotavirus vaccines has been more difficult and complicated than anyone imagined, full of setbacks and surprises. But today both the World Health Organization and the Global Alliance for Vaccines and Immunization consider rotavirus vaccine a top priority, and the final battle to get immunizations to the young children who so desperately need them has begun.

Identifying the Contagion

ROTAVIRUS was first identified as a cause of human disease in 1973 by Ruth Bishop, a young microbiologist working on gastrointestinal diseases at the Royal Children's Hospital in Melbourne, Australia. At the time, investigators were perplexed by diarrhea in children. Although the disorder was common and frequently severe, the causative agent was rarely identified. Searching for clues, Bishop's group looked through an electron microscope at biopsied tissue from the duodenum, or small intestine, of acutely sick children. What they saw astounded them: an infestation of wheel-shaped viruses in the epithelial cells that form the intestinal lining.

Quest for a Vaccine Begins

VACCINES are powerful weapons in the human arsenal against infectious disease and among the most effective interventions in public health. Made from either live or killed microorganisms or from their key proteins, vaccines trick a recipient's immune system into believing it is under attack. In response, the immune system produces antibodies against the vaccine (which poses no biological threat), just as it would against the virus itself. And as in natural immunity, should the disease-causing agent ever invade, the immune system is fully primed, ready to pump out antibodies to immobilize it.

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