Two open day programmes have taken place at local health facilities in April, aimed at giving feedback on recently concluded and on-going work.  These events also gave the opportunity to sensitise the community about the upcoming Bill & Melinda Gates-funded Inactivated Polio Vaccine Trial (IPV), scheduled to start in June 2013. The IPV trial will take place in three locations in The Gambia: Fajikunda Health Centre, Sukuta Health Centre and the Jammeh Foundation for Peace Hospital.  An open day programme is scheduled to take place at the Jammeh Foundation hospital in the near future.
Fajikunda Open Day

The Government of The Gambia, The MRC and senior members of Fajikunda and surrounding communities came together on 10th April to thank the many parents and children who have taken part in MRC studies at Fajikunda Health Centre over recent years.  These studies aim to improve children"s health and save lives, not only in The Gambia but also across the developing world, and would not have been possible without the cooperation of the Ministry of Health, the children and their families.

TB vaccine trial (presented by Dr Muyiwa Owolabi): The BCG vaccine helps to protect small babies from TB but it does not protect older children and adults effectively. This study demonstrated that the new trial vaccine was safe when given to children. It also showed that the vaccine stimulated the body to fight TB infection. Given the promising results, it is hoped that the trial in Fajikunda will eventually lead to a new TB vaccine which will prevent people of all ages from falling sick due to TB.

Pneumococcal protein vaccine trial (presented by Dr Aderonke Odutola): A study of a new vaccine to protect against meningitis and pneumonia is coming to an end at Fajikunda. Again, although there are existing vaccines, better vaccines are needed to afford children improved protection. This vaccine was shown to be safe in small babies and the investigators will soon know how well it worked in other ways.

Looking forward: polio vaccine (IPV) (presented by Dr Ed Clarke): Although there are only a few hundred cases of polio in the world each year, this disease remains a high priority for eradication.

The vaccine in the trial will be given as an injection, and will be used with the existing polio drops in the future. It is hoped that this combination will give children better protection against polio. The injected polio vaccine is already used in some parts of the world such as South Africa, and is known to be quite safe.

Looking forward: pneumonia vaccine studies (presented by Dr Olubokola Idoko): Later in the year, the Vaccinology team is planning to start a trial of a new preparation of the pneumococcal conjugate vaccine (PCV13) that is already in use. This new preparation will contain several doses in a vial, reducing storage costs and making the vaccine more affordable for more African countries. Children aged 2-3 months will be recruited for this trial at Fajikunda.
Commenting on Fajikunda"s key role in studies for better health in The Gambia and the developing world, Professor Beate Kampmann (Theme Leader – Vaccinology, MRC) said "Over the last few years, Fajikunda has become a very important partner to underpin our research for better vaccines in The Gambia and the wider global communities.  We have built a very strong relationship with the community and our trials have achieved the highest retention rates we could wish for.  This is very important for the completeness of our data but also for our funders, who trust when we tell them that Fajikunda is a site that always delivers. We look forward to the next study on polio starting soon and to build on this excellent track record."
MRC & Sukuta: Celebrating 10 years of Working Together for Better Health

MRC, the Ministry of Health and the Sukuta community came together on 17th April to celebrate ten years of successful collaboration at the Sukuta Health Centre. The Open Day event was attended by the Speaker of the National Assembly, Hon Abdoulie Bojang, who spoke eloquently (in Mandinka) about the partnership between MRC and the Ministry of Health. Dr Adama Demba (Director of Health Services) delivered an address on behalf of the Minister of Health & Social Welfare. Homage was paid to Ms Sally Savage who recently retired after many years as the Principal Nursing Officer at Sukuta Health Centre. "Aunty Sally" was acknowledged by all for the dedicated support she has given to the MRC's work over the years.

Recent and ongoing work: Studies at Sukuta over the years have included work on the measles vaccine schedule (Hilton Whittle); the trial of a new TB vaccine (MVA 85A - Martin Ota) and studies on how BCG vaccination influences the immune system (Sarah Burl).

Current work includes a trial of Vitamin A (presented by Dr Suzanna McDonald).  The World Health Organization is sponsoring this study, investigating the role of Vitamin A in enhancing the protection of the newborn against early infections. Preliminary findings show that Vitamin A is well tolerated in newborns, with the full results expected in the coming year.

Beyond infants: The European Vaccine Initiative, in conjunction with MRC researchers, has successfully conducted malaria vaccine studies in adults, children and infants at Sukuta; the findings are paving ways for similar studies in other parts of Africa in the search for an effective vaccine to combat the disease (presented by Dr Muhammed Afolabi).

Looking forward: The Bill and Melinda Gates funded IPV trial investigating a new strategy of giving polio vaccines to children of 9 months is due to start in June (presented by Dr Ed Clarke).

Why Sukuta? Vaccines have been a success story in the developing world for a number of decades. However, as the number of vaccines administered increases, there is a growing need to understand how they affect the child"s health; how vaccines interact with each other and the best approach to administering them.  Sukuta Health Centre has been a focal point for this research for over ten years, and from humble beginnings it has become an internationally respected site for clinical studies.

"Studies involving newborns and infants are best carried out where the children are born and where they are being immunised." said MRC Unit Director Professor Tumani Corrah.  "Distance is an important consideration: you look for a very productive health centre in terms of the number of deliveries and service to the community that is as close to the MRC"s laboratories as possible – and Sukuta clearly fits the bill."

A ten year partnership: The Infant Immunology work at Sukuta was set up by Dr Arnaud Marchant (now based at the Universite libre de Bruxelles) in 2002, guided by Professor Hilton Whittle and others (although the MRC's collaboration with Sukuta dates back more than half a century). The first infant immunology study at Sukuta was focused on cytomegalovirus infection (CMV). Many of the studies that came subsequently were built on some of the principals established by this early work. Commenting on the choice of Sukuta as a field site, Dr Marchant said "Sukuta was chosen because it was a stable community; this stability is critical for the follow-up of the children. The Sukuta Health Centre also provided a strong basis because it was well organized by a highly motivated and dynamic team: we were made to feel very welcome by the staff."

Pioneers of Sukuta include Marianne van der Sande (now based at RIVM, The Netherlands); Marianne was key to setting up the cohort and the site. David Miles played an important part in continuing the CMV work. And, as Dr Arnaud Marchant remarked "None of this would have been possible without the contribution of a highly dedicated, skilled field work team."

Partnership: Studies conducted at Sukuta Health Centre have contributed to global policy changes, such as the addition of a measles booster dose to the childhood vaccine schedule. Such achievements could not have been realised without the partnership of the Ministry of Health and the cooperation of the people of Sukuta over many years.