India has a significant burden of typhoid, especially in young children. And, this disease is becoming more and more widespread along the length and breadth of the country. To help the entire country stay prevented against this disease, and effectively treat those that are already infected with it, it is essential that we first understand how the pathogen transmits the disease, how the disease progresses, how an individual responds to it, and how an effective treatment can be formulated to encounter the disease. In order to understand all of this, researchers have proposed Clinical Human Infection Model (CHIM) studies, in which healthy participants will be infected with a weakened strain of the pathogen in a controlled setting so that every detail about the disease can be learnt, in order to be able to develop appropriate vaccines.
Why CHIM?
There is already a rotavirus vaccine that has been tested in other countries, and shows 90% efficacy. Now you may ask why we simply cannot use this vaccine, instead of putting our fellow citizens at risk. The reason here is that while the vaccine shows 90% efficacy in other countries, it shows only 50% results in India. Similarly, oral vaccinations for other diseases like cholera and polio have shown good results in other countries, but low efficacy in India. This is why we cannot depend on other populations for testing and vaccines, when we clearly know that Indians have a different genetic makeup, socio-economic backgrounds, and nutritional demands. This is why researchers have come up with the CHIM proposal, which can prove to be a faster way to develop vaccines after studying about the disease in human models. And, this can prove to be the best solution for typhoid, as typhoid strains can only be present in humans, and cannot be artificially developed or cultured in labs.
How can CHIM be conducted?
Now one problem here is that India has an ethical obligation where clinical trials cannot be conducted on humans. This is why typhoid strains that were developed in India, were tested in the Oxford University in UK. Why it is important to conduct the same on humans is firstly because typhoid affects only humans, and secondly because animals and humans have different physiologies. Thus, it has been decided to test typhoid pathogens on humans, starting with only a few people, say five, which can then be conducted on a larger number of people if the studies go well. However, even though only five people are selected, it is important to have the volunteers and their family members informed thoroughly about the disease and any kinds of risks involved. Although the entire study will be done in a controlled setting under the supervision of experts, after which the volunteers will be examined for an entire year, there could be rare chances of side effects like mild fever or nausea. Also, volunteers will be isolated from the community for a defined period of infectivity of the pathogen, in order to avoid transmission of the disease to the community.
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