- A participant who drank a diarrhea-inducing smoothie shared what it was like spending 11 days in an inpatient vaccine trial.
- Jake Eberts, 26, said he'd do it again, for both the money, and the humanitarian cause.
- Shigella bacteria kills hundreds of thousands of people every year, and there is no vaccine for it yet.
On April 5, Jake Eberts drank a shot glass's worth of cloudy, salty liquid that he knew was infused with diarrhea-producing shigella bacteria. He also knew that bacteria would — in all likelihood — give him an excruciating case of dysentery. And it did.
Eberts was recently part of an 11-day inpatient vaccine trial at the University of Maryland, where he was one of 16 young, healthy adult participants who were given a drinkable shigella shot, which they all swallowed, knowing it would likely make them violently ill.
It was all part of a tightly-controlled process to test the new vaccine by "challenging" volunteers with a pathogen — some vaccinated, and some not — and seeing how they fared.
Even though Eberts said what followed were "the worst eight hours of my life," he says he'd do it all over again, provided that he was paid (he earned more than $7,000 in this trial) and he knew the research was being done for a good cause.
"I don't wanna make myself out to be Mother Theresa here — would not have done this for free — it's a big ask to ask someone to get dysentery," Eberts told Insider on the eve of his dismissal from the dysentery ward.
"The entire time I was like, 'wow, this is an awful disease.' And I just got really emotional, probably also because I was just delirious, about the thought of small children in the developing world dealing with this."
Why scientists need to test this vaccine on people like Eberts
Every year, hundreds of thousands of children and elderly adults around the world die after contracting shigella. There is no approved vaccine against the bacteria, which is the second leading cause of diarrhea death globally. (The number 1 diarrhea killer is rotavirus, but there are multiple vaccines against it.)
People around the world get shigella the same way Eberts did: after sticking the bacteria in their mouth. Often, people are exposed by drinking contaminated water, eating food that has been prepared or handled by someone with dirty hands, or through coming into direct contact with an infected person's poop.
Scientists at the Institut Pasteur in France have been developing a vaccine against shigella for several years. It was tested initially in Israel, and is now being tried out in several dozen consenting, healthy adults in Maryland, including Eberts, and also among young kids in Kenya, who may come in contact with the bacteria in their day to day lives (they are not given shigella shot glasses).
If the current Phase 2 trials show the vaccine is both well-tolerated and effective at preventing severe disease, it could be tested in a large-scale, real-world trial in hundreds to thousands of kids around the globe, a final regulatory move before the vaccine could be put on clinic shelves worldwide.
Dr. Wilbur Chen, who is running the trial at the University of Maryland, is hoping for 70% protection. If the vaccine doesn't demonstrate at least 50% protection against severe disease in his trial, "then I think then we will have a vaccine that really fails, unfortunately," Chen said. "It's kind of a high bar."
'Never in my life have I felt so exhausted'
Eberts had a hunch that he was in the unlucky non-vaccine placebo group, given that he didn't react in any noticeable way to his two injections. He also ended up with one of the worst cases of dysentery during this trial.
"If I did get the vaccine, that is really bad news for the vaccine," he said.
His illness started about 40 hours after he drank the shigella, when he woke up to cramps and some chills, feeling like he had a "stomach bug." His symptoms quickly progressed into fever, diarrhea, and bloody stool.
"I truly felt like I could not move," Eberts said, saying getting up to go to the bathroom or get his vitals checked required a "herculean effort."
"Every movement in the bathroom, to get up to wash my hands or to grab a paper towel, I would lie back down on the ground and just sit there for five minutes," he said.
Nurses began prescribing him copious liters of rehydration solution, which he described as "sad Gatorade," a salty-sweet water meant designed to keep him functioning, but without any yummy flavor or bright coloring.
He laid down under a pile of blankets, and his fever rose to 103F. After several hours, he was put on IV fluids, and given the antibiotic ciprofloxacin. Within four hours, his condition started to improve, as he went from "death's door" to coherent, lucid, and able to walk and talk "with a little bit of effort."
"I was exhausted and felt miserable, but I didn't feel fear," he said. "I knew this is something I signed up for, and it will pass, and I'm not going to die or anything. But even if I had been just at home and had somehow come across this, I would've been terrified, because it was just awful. And the deterioration was so rapid."
Participants were isolated, and had to bleach the toilet after each use
People with shigellosis can infect others with the bacteria. That meant the study participants had to stay inside and eat alone during this entire 11-12 day study.
Going to the bathroom during the study was a multi-step, 15-minute event involving a special toilet "hat," a nurse, and bleach.
Every time Eberts had to relieve himself, he'd put the white hat (pictured below) over the brim of a toilet, do his business, then cover it with a paper towel or biohazard bag, and cart it down the hallway, for sample extraction. Once the nurses had taken what they needed from him, he'd pour the rest of his waste in a toilet, cover it with bleach, wait five minutes, and flush away.
When Eberts got really sick, the nurses rolled in a commode and did the sample processing for him.
This diligent feces and urine collection — painstaking though it may be — has an important role to play in discovering how well this vaccine works.
Taking precise measurements from participants' blood, urine, and poo helps researchers like Chen learn exactly what kind of immune response the vaccine elicits.
Researchers can better gauge whether the vaccine truly lessens the burden of disease by analyzing the level of anti-shigella IgA antibodies a person is excreting, and determining the amount and type of cytokines circulating in their stool.
"It is a way for us to be able to learn about the mechanisms of protection," Chen said.
Eberts inspired others to sign up for vaccine 'challenges' on Twitter
Motivated by how awful the disease made him feel, Eberts raised more than $23,900 for The Water Project while in isolation. And, his barrage of detailed tweets about the experience while inpatient inspired several dozen others to volunteer to take part in this style of vaccine research too.
"I've been spending my career trying to tackle this, and it's always a challenge to try to find willing volunteers," Chen said, adding that within a few days of Jake's tweeting the center had "20 or 30-some people that signed up with interest" for their trials.
"He was just sharing from the heart, and I think people liked it," Chen said.
Now that the trial is over, and Eberts is allowed to go outside and touch grass again, he's looking forward to spending some time with his dog, and enjoying a latte or two ("there's no espresso machine" at the trial site, he said.)
Eberts is ineligible for another shigella trial like this now that he's been exposed to the bacteria, but he said he would consider trying another vaccine "challenge" like it again. Other trials are being run for dengue fever, flu, and malaria vaccines.
"Some people go to soup kitchens to get their charity fix, this might be the way I do it," he said.