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Wed December 19, 2012
Shots - Health News

How The U.S. Stopped Malaria, One Cartoon At A Time

Originally published on Thu December 20, 2012 12:28 pm

"Her business is robbery and coldblooded murder ... they call her Annie Awful ... She's a thief and a killer. She stops at nothing."

Those lines sound like they're from an old detective movie, but they're actually from a 1943 public health cartoon aimed at preventing malaria. That dangerous dame, Annie Awful, is Anopheles — the family of mosquitoes that transmits the malaria parasite.

The cartoon's creator was the predecessor of the U.S. Centers for Disease Control and Prevention. Today the CDC is the world's top authority on an array of germs and viruses. But its origins are deeply rooted in malaria — and war.

The CDC was founded during World War II as the Office of Malaria Control in War Areas. The agency was charged with eradicating malaria in the South, especially around military bases. It ran mosquito abatement programs and publicity campaigns denouncing the insects, such as the animated film above.

At the same time, the U.S. Army was working hard to eliminate the parasite on military bases and among the troops. They broadcasted anti-malaria jingles on the Armed Forces Radio and distributed cartoons and "pinup calendars" encouraging troops to cover up and use repellent.

Through the groups' combined efforts, the U.S. officially eradicated malaria in 1951. The CDC, though, still remains very involved with malaria research around the globe.

The agency's labs can carry out complicated chemical analysis of insecticide levels on bed nets or decode the molecular structures inside the malaria parasite.

And, CDC has become a resource for scientists in Africa, Southeast Asia and many developing countries, where malaria remains one the most significant health problems.

Last year, the CDC tallied 1,600 domestic malaria cases inside the U.S. All of these were in people who'd picked up the parasite outside of the country.

The low number of domestic cases poses a challenge for health care facilities, which rarely encounter the disease and may have difficulty diagnosing it. With malaria, a rapid diagnosis can be crucial because the disease can kill a person in a matter of days.

So the CDC helps local doctors, hospitals and health departments identify the parasite from pictures of blood. Local health workers can even send images of parasites via email for so-called telediagnosis.

Last year, the CDC fielded 450 inquiries for telediagnosis of suspected parasitic infections. About a third of those cases turned out to be malaria.

Microbiologist Blaine Mathison, one of two scientists who perform telediagnosis at the CDC, says he can even analyze an image of a blood smear straight off his BlackBerry. "I remember once," he says, "I've actually sat at Turner Field at a Braves game and done diagnostics while watching a ballgame."

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Transcript

MELISSA BLOCK, HOST:

From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.

ROBERT SIEGEL, HOST:

And I'm Robert Siegel.

Malaria was officially eradicated in the U.S. more than a half a century ago, but the federal government and the Centers for Disease Control and Prevention continue to pour hundreds of millions of dollars each year into fighting malaria elsewhere in the world.

As part of our series Malaria Pushing Back, NPR's Jason Beaubien visited the CDC's malaria labs in Atlanta to find out how some of that money is being spent.

JASON BEAUBIEN, BYLINE: On the first floor of what otherwise looks like a corporate office tower on the CDC's campus in Atlanta, thousands of mosquitoes are locked inside hot, humid vaults.

PAUL HOWELL: Most of these are considered to be the deadliest animals in the world.

BEAUBIEN: Biologist Paul Howell is in a long, white lab coat in a sterile white laboratory in between the mosquito vaults. Howell is getting ready to feed a cage of the insects from his own arm.

HOWELL: So basically, I just - I put my hand right inside the cage. The females will pretty much instantly start feeding. And, as a matter of fact, they just started biting. I can feel them probing. It's a little sting, but it's not bad.

BEAUBIEN: Female mosquitoes need proteins from blood to make shells for their eggs. Some mosquitoes here are content to sip warm rabbit's blood from a specially adapted glass beaker, but other mosquito species will only feed on people.

HOWELL: They prefer to feed on humans rather than anything else. So we have to maintain them on live human blood.

BEAUBIEN: Inside this high-security, immaculately clean wing of the building, Howell and other scientists tend 53 colonies of mosquitoes. Some are used for experiments at the CDC, others are shipped to researchers around the globe. Howell says one of the things the CDC is studying right now is growing resistance to insecticides among mosquitoes in malaria hotspots.

HOWELL: We have one that's particularly nasty from Benin that's resistant to at least four different types of insecticide that are commonly used. So...

BEAUBIEN: Malaria remains one the most significant health problems in the developing world. The World Health Organization estimates that there are more than 200 million cases of the disease annually, causing hundreds of thousands of deaths. And it's the leading killer of kids under the age of five in Africa.

The CDC was founded during World War II as the Office of Malaria Control in War Areas. The agency was charged with eradicating malaria in the Southern United States. It ran mosquito abatement programs and publicity campaigns like this one, denouncing the insect.

(SOUNDBITE OF A MALARIA PUBLICITY CAMPAIGN)

UNIDENTIFIED MAN: She's a robber and a killer. She murders millions of people each year. It's time people got wise to the anopheles mosquito.

BEAUBIEN: This animated film from 1943 was produced with the South Carolina Health Department. It starred a dangerous dame called Annie Awful, a deadly biting anopheles mosquito.

(SOUNDBITE OF A MALARIA PUBLICITY CAMPAIGN)

UNIDENTIFIED MAN: They won't stay healthy long with Anne around. She's got what it takes to make them sick.

BEAUBIEN: Malaria was officially eradicated from the U.S. in 1951, yet last year, the CDC still tallied 1,600 domestic malaria cases. All of these were among people who'd picked up the parasite outside of the U.S. The low number of domestic cases now actually poses a challenge for health care facilities.

BLAINE MATHISON: Because malaria is not endemic in the U.S., there's not a lot of expertise for identifying it.

BEAUBIEN: Blaine Mathison, a microbiologist with the CDC, is part of a two-man, on-call parasite team.

MATHISON: This is one that came to us yesterday from the Missouri State Health Department. So they sent images of a blood film, and then you can see the parasites in the blood film. And we can actually identify the parasite just by looking at the images alone.

BEAUBIEN: Mathison and his colleague fielded 450 inquiries last year from local doctors, hospitals and health departments. About a third of those turned out to be malaria, but they're also asked to identify other parasites.

MATHISON: The amoebas, the worms, arthropods are of public health importance. We can identify ticks and lice, hookworms, tapeworms, pinworms.

BEAUBIEN: With malaria, a rapid diagnosis can be crucial because the disease can kill a person in a matter of days. So the CDC offers what's called telediagnosis around the clock. Blaine says he can analyze an image of a blood smear straight off his Blackberry.

MATHISON: I remember once I've actually sat at Turner Field at a Braves game and done diagnostics while watching a ball game.

BEAUBIEN: Upstairs, the CDC labs have far more expensive and far more sophisticated equipment than BlackBerries. They can do complicated chemical analysis of insecticide levels on bed nets or break down the molecular structure of malaria parasites.

The CDC labs have become a resource for scientists in Africa and other parts of the developing world. Paul Newton, a malaria researcher based in Laos, says counterfeit malaria drugs are a major problem in his part of the world, and he relies on the CDC's labs to analyze drug samples that he's picked up all across Southeast Asia.

PAUL NEWTON: It's pretty labor-intensive. And there aren't very many labs in the world that can do this sort of work.

BEAUBIEN: Newton says the CDC analysis helped trace a large shipment of fake malaria drugs back to a manufacturer in China. So even though malaria now resides almost exclusively outside the U.S. borders, the disease remains a significant and historic part of the CDC's work. Jason Beaubien, NPR News.

SIEGEL: And you can watch a video about malaria and the role of counterfeit pharmaceuticals at npr.org.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.

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