Credit: Ed Wray for Nature
As COVID19 swept through the world at a terrifying pace, the public’s mind quickly shifted almost all of its attention to the coronavirus. It probably felt like the virus completely hijacked your life in 2020, and demanded all your attention. However, in the background, teams like the one led by researcher Adi Utarini have been hard at work devising solutions to the diseases that will exist long after our quarantine has ended. In August of 2020, Utarini and her team achieved a decisive victory against Dengue fever, a mosquito-transmitted disease prominent in many regions of the developing world.
Dengue fever is caused by a virus which uses mosquitoes as a vector to infect human hosts. A species of mosquito that commonly transmits this virus is Aedes aegypti, which also spreads other viruses like Zika and chikungunya. About three billion people live in a place with a risk of Dengue, and the disease is unique in that the second infection is often much worse than the first. Normally, a person infected with a virus that they have survived in the past will be able to produce antibodies against the virus that quickly identify and eliminate the invading pathogens—a product of our immune system’s ‘memory.’ Dengue seems to hijack this system, using the immune system against itself so that someone’s second infection with Dengue is often much worse than the first. As a result, an estimated 22,000 people die of severe Dengue every year. Its high transmissibility and severity make it especially dangerous for people in southeast Asia and Latin America, where A. aegypti carrying the Dengue virus are common.
That’s why it was so surprising when, in a recent experiment, Utarini’s team found that their solution to Dengue fever lowered the disease’s prevalence by up to 77% in treated areas. The results were truly shocking, and many epidemiologists are optimistic about the team’s method of eliminating Dengue. “a 77% reduction is really extraordinary”, says Philip McCall, a vector biologist at the Liverpool School of Tropical Medicine, UK. “This does have huge promise.”
Utarini described the results as “a very big relief,” and as the study’s lead scientist in Indonesia, where the study took place, her contributions to the discovery were vital. Adi Utarini is a professor of public health and project leader of Eliminate Dengue Project Yogyakarta at Universitas Gadjah Mada, and her work focuses on using the bacterium Wolbachia to fight Dengue in a trial coordinated by the World Mosquito Program.
Utarini completed her master degree from the Institute of Child Health, London UK and went on to get her PhD from the Department of Public Health and Epidemiology, Umea University, Sweden. After working in public health to research malaria and tuberculosis, she was recruited to work on the Yogyakarta trial in 2013.
In order to fight off the Dengue virus, mosquitoes can be bred that carry Wolbachia, which compete with viruses in the mosquito and slow their ability to reproduce and spread. Wolbachia pose little threat to humans or the environment, and in this study have proven an effective solution to Dengue fever—showing that the Wolbachia-carrying Aedes can be implemented even in urban environments with significant populations.
A major contributor to the trial’s successful implementation has been its connection to the community of Yogyakarta. The team used a wide variety of media to inform citizens about the trial, and its results have been a sign of hope for the community. “Even before the final results, we already had requests from the community asking, ‘When can you do it in my area?’,” says Utarini. “It’s a dream come true.”
Utarini’s work in the trial hasn’t been smooth sailing the whole way. In March of 2020, her husband died of COVID19—a salient reminder of the time we live in, and the importance of what Utarini and other epidemiologists are doing to combat disease. In difficult times, she has turned to her other passions — piano playing and cycling. “Whenever I have unsolved problems, I try to get ideas through that.” Through it all, her contribution to the team has been immense. According to Scott O’Neill, director of the World Mosquito Program in Ho Chi Minh City, Utarini has provided the “glue to hold things together” in their trial.
The 77% reduction in Dengue suggests an optimistic future for the people of Yogyakarta and for the billions of others at risk of the disease. With the conclusion of this trial, the World Mosquito Program is planning to release modified mosquitoes across the entire city. “That’s our obligation,” says Utarini.
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