The MBI represents the first time researchers have collaborated in such a global effort against mosquito-borne diseases. Investigators are creating genetic references to the world’s mosquitoes by collecting specimens in the field or using museum specimens, identifying them to species, and finally sequencing “barcodes” that correlate with specific genes. One of the project’s ultimate goals is to equip field personnel with devices that can identify not only the mosquito species, but what kind of pathogen it might be carrying.

Szumlas pointed out that aside from the obvious benefit to public health, this biosurveillance tool could help protect Soldiers deployed overseas. “In the field, the commander has so many things to worry about,” he said. “Infected bugs infecting people is one of those, but it’s probably a lower priority until the red flag goes up. And that’s what the surveillance is all about: To collect mosquitoes, identify what they are, and then see what’s in them. If there is malaria about to be transmitted, the commander of that unit can say to everyone, ‘If you have not been using your repellent, your prophylactics, your netting, you’d better right now, because we’ve got some hot mosquitoes out and around.’”

Ironically, WRAIR’s entomologists, who continue to spend much of their energy trying to repel these insects, are working on better ways of attracting them – not only to participate in biosurveillance efforts, said Szumlas, but also to provide subjects for vector and parasite studies. “A lot of times,” he said, “they have been reared for so many years they’re not a wild type anymore, and they actually react very differently.” To lure mosquitoes, either in the laboratory setting or from within the huge screen tents erected in the field, WRAIR entomologists are evaluating a new generation of traps: some baited with sugar, which mosquitoes seek when they’re not looking for blood, and some with carbon dioxide, the signature attractant in the respiration of all warm-blooded animals.

The Military HIV Research Program

When the United States launched its HIV/AIDS (Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome) research program in the 1980s, the Department of Defense, recognizing the threat the disease posed to end strength and readiness, had already begun developing protective measures – education programs, vaccine development, and innovative anti-viral therapies. In 1986, based on data collected at the Walter Reed Army Medical Center, the military program published evidence of the possibility – which was then a controversial idea – that HIV could be transmitted heterosexually. That same year, the Army also adopted the Walter Reed staging classification system for HIV, the first of its kind. The system provided a framework for diagnosing infected military personnel and evaluating patients’ clinical responses to antiviral treatment.

Based in part on these advances, Congress mandated the formation of a military HIV/AIDS research unit, to be led by the Army. The program that has emerged and evolved over the last quarter-century, centered at WRAIR and known collectively as the U.S. Military HIV Research Program (MHRP), has grown to include research sites in Kenya, Tanzania, Uganda, Mozambique, Nigeria, and Thailand. The director of the MHRP is currently Col. Nelson Michael, M.D., Ph.D., who was deployed to Jordan during the preparation of this publication.

According to Col. Jerome Kim, M.D., deputy director of the MHRP, an early program focus was on protecting the military’s blood supply. “The idea at the time – and it’s still true today,” he said, “was that if you’re injured on the battlefield, you don’t always have the luxury of having banked blood available. Sometimes you just have to put out a call for donations.”

MHRP investigators, building on the early HIV tests pioneered by Dr. Robert Gallo, a co-discoverer of the AIDS virus, developed screening protocols for blood units as well as a total-force HIV screening effort. “At first it was criticized,” Kim said. “People were saying: ‘You’ll have too many falsely diagnosed people, and cause all this stress.’ But the Army’s program was set up to make sure false diagnosis didn’t happen. It was an idea that was way ahead of its time.”

Today this diagnostic group, based at WRAIR, performs all the confirmatory diagnostics for everyone in the Army, anywhere in the world, who tests positive for HIV. In fact, MHRP developed and implemented the most advanced HIV diagnostic algorithm in the United States, which can be used to detect HIV in deployed troops. “They also do what we call viral load testing,” said Kim. “They can tell how much virus there is in people’s blood – and then also provide the service of telling those doctors who is resistant to what drug. So we provide a clinical service as well as diagnostics.”