Infectious disease – the problem around which Brig. Gen. George M. Sternberg organized his Army Medical School 120 years ago, and that sent Maj. Walter Reed into the swamps of Cuba to prove where yellow fever came from – has always been one of the Army’s most important concerns.

During the War for American Independence, when smallpox – the disease Gen. George Washington called his “most dangerous foe” – killed more men than musket fire, the disease reduced the troop strength of Washington’s Continental Army by more than half. In 1777, Washington secretly ordered the inoculation of his entire Army through variolation – the purposeful infection of subjects in a controlled, quarantined environment. The commander in chief’s decision is now regarded as a decisive factor in winning American independence.

For more than a century, however, diseases continued to be deadlier to soldiers than combat. Fully two-thirds of the 620,000 soldiers who died during the Civil War were killed by diseases, including dysentery, typhoid fever, malaria, yellow fever, tuberculosis, smallpox, and pneumonia. In the Spanish-American War, a monthlong conflict in which fewer than 400 U.S. forces were killed in combat, more than 2,500 soldiers were killed by diseases; by the time it was over, fewer than one-quarter of the U.S. soldiers who had gone ashore in Cuba remained fit for service, and the entire contingent was evacuated to a makeshift quarantine camp on the eastern tip of Long Island.

Better military medicine – and deadlier weapons – ensured that battle deaths outnumbered those of disease in the ensuing world wars, though infectious diseases still wiped out millions of combatants. In the latter half of the 20th century, as American soldiers were dispatched to places as varied as Korea, Vietnam, Iraq, Somalia, Haiti, Sudan, and East Timor, they were exposed to endemic pathogens – bacteria, viruses, and parasites – they’d never before encountered.

At the Walter Reed Army Institute of Research (WRAIR), infectious disease continues to be recognized as one of the greatest threats to the strength and readiness of the Army, both in the field and in the garrison. Since its earliest beginnings, its researchers have been focused on preventing naturally occurring diseases through evaluation, control, and treatment; in 2005, this work was placed under the authority of WRAIR’s Center for Infectious Disease Research (CIDR), which encompasses a worldwide network of laboratories and field sites. The center’s work focuses on enteric diseases; wound infections; bacterial and viral diseases, including multidrug-resistant organisms; vector control for malaria and other vector-borne infections; drug and vaccine development for malaria; drug development for leishmaniasis; and research into vaccines and treatments for HIV/AIDS.

The work of the CIDR is carried out through several branches, including:

 

Bacterial Diseases

The work of the Bacterial Diseases Branch focuses broadly on the various ways bacterial infections can affect Soldiers. Several programs are devoted to product development and vaccines for enteric pathogens, while other groups – including several being established at WRAIR’s new Richard G. Lugar Center for Public Health Research in Tblisi, Republic of Georgia – are actively tracking emerging bacterial infections and agents around the world.

In its Department of Wound Infections under the command of Lt. Col. Eric Wagar, the branch’s researchers work to engineer and evaluate complementary strategies for the prevention, diagnosis, and treatment of wound infections. The focus is primarily on the ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species) and the increasing problem of multidrug-resistant bacteria that colonize battle wounds. According to the branch’s acting director, Dr. Edwin Oaks, this department is in the early developmental stages. “They’re doing basic research and animal model development,” he said, “looking at different ways to evaluate therapeutics for wound infection. These are very complicated systems, because they involve multi-agent infections.” One study, for example, is evaluating the ability of cell-penetrating nanoparticles to deliver anti-inflammatory proteins into mammalian cells. “You can just see, the way they are progressing,” he said, “that they’re going to be developing products probably in the not-too-distant future for wound infection.”