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A pinch in the leg, a squeal and a trickle of tears. One baby after another in Malawi is getting the first and only vaccine against malaria, one of history’s deadliest and most stubborn of diseases.The southern African nation is rolling out the shots in an unusual pilot program along with Kenya and Ghana. Unlike established vaccines that offer near-complete protection, this new one is only about 40% effective. But experts say it’s worth a try as progress against malaria stalls: Resistance to treatment is growing and the global drop in cases has leveled off. With the vaccine, the hope is to help small children through the most dangerous period of their lives. Spread by mosquito bites, malaria kills more than 400,000 people every year, two-thirds of them under 5 and most in Africa.Seven-month-old Charity Nangware received a shot on a rainy December day at a health clinic in the town of Migowi. She watched curiously as the needle slid into her thigh, then twisted up her face with a howl.“I’m very excited about this,” said her mother, Esther Gonjani, who herself gets malaria’s aches, chills and fever at least once a year and loses a week of field work when one of her children is ill. “They explained it wasn’t perfect, but I feel secure it will relieve the pain.”There is little escaping malaria -- “malungo” in the local Chichewa language -- especially during the five-month rainy season. Stagnant puddles, where mosquitoes breed, surround the homes of brick and thatch and line the dirt roads through tea plantations or fields of maize and sugar cane. In the village of Tomali, the nearest health clinic is a two-hour bike ride away. The longer it takes to get care, the more dangerous malaria can be. Teams from the clinic offer basic medical care during visits once or twice a month, bringing the malaria shot and other vaccines in portable coolers. Treating malaria takes up a good portion of their time during the rainy season, according to Daisy Chikonde, a local health worker.“If this vaccine works, it will reduce the burden,” she said.Resident Doriga Ephrem proudly said her 5-month-old daughter, Grace, didn’t cry when she got the malaria shot.When she heard about the vaccine, Ephrem said her first thought was “protection is here.” Health workers explained, however, that the vaccine is not meant to replace antimalarial drugs or the insecticide-treated bed net she unfolds every night as the sun sets and mosquitoes rise from the shadows. “We even take our evening meals inside the net to avoid mosquitoes,” she said.It took three decades of research to develop the new vaccine, which works against the most common and deadly of the five parasite species that cause malaria. The parasite’s complex life cycle is a huge challenge. It changes forms in different stages of infection and is far harder to target than germs.“We don’t have any vaccines against parasites in routine use. This is uncharted territory,” said Ashley Birkett, who directs PATH’s Malaria Vaccine Initiative, a nonprofit that helped drugmaker GlaxoSmithKline develop the shot, brand-named Mosquirix. The bite of an infected mosquito sends immature parasites called sporozoites into the bloodstream. If they reach the liver, they’ll mature and multiply before spewing back into the blood to cause malaria’s debilitating symptoms. At that point, treatment requires medicines that kill the parasites.Mosquirix uses a piece of the parasite — a protein found only on sporozoites’ surface — in hopes of blocking the liver stage of infection. When a vaccinated child is bitten, the immune system should recognize the parasite and start making antibodies against it.Scientists also are searching for next-generation alternatives. In the pipeline is an experimental vaccine made of whole malaria parasites dissected from mosquitoes’ salivary glands but weakened so they won’t make people sick. Sanaria Inc. has been testing its vaccine in adults, and is planning a large, late-stage study in Equatorial Guinea’s Bioko Island.And the U.S. National Institutes of Health soon will start initial tests of whether injecting people periodically with lab-made antibodies, rather than depending on the immune system to make them, could offer temporary protection during malaria season. Think of them as “potentially short-term vaccines,” NIH’s Dr. Robert Seder told a recent meeting of the American Society of Tropical Medicine and Hygiene.For now, only babies in parts of Malawi, Kenya and Ghana are eligible for the Mosquirix vaccine. After the vaccine was approved in 2015, the World Health Organization said it first wanted a pilot roll-out to see how well it worked in a few countries — in real-world conditions — before recommending that the vaccine be given more widely across Africa. “Everyone is looking forward to getting it,” said Temwa Mzengeza, who oversees Malawi’s vaccine programs. Those eager for the shots include her husband, whom she had to stop from trying to get them, she said.Mzengeza used to come down with malaria several times a year until she started following her own advice to sleep under a net every night. Unlike many other kinds of infections, people can get malaria repeatedly, building up only a partial immunity.In the pilot program that began last year, 360,000 children in the three countries are meant to be vaccinated annually. The first dose is given at about age 5 months and the final, fourth booster near the child’s second birthday.Experts say it is too early to know how well the vaccine is working. They’re watching for malaria deaths, severe infections and cases of meningitis, something reported during studies but not definitively linked to the vaccine.“To do something completely new for malaria is exciting,” said researcher Don Mathanga, who is leading the evaluation in Malawi. The rainy season has brought new challenges, making some rural roads impassable and complicating efforts to track down children due for a shot. So far in Malawi, the first dose reached about half of the children targeted, about 35,000. That dropped to 26,000 for the second dose and 20,000 for the third. That’s not surprising for a new vaccine, Mzengeza said. “It will pick up with time.”At the health clinic in Migowi in Malawi’s southern highlands, workers see signs of hope. Henry Kadzuwa explains the vaccine to mothers waiting at the clinic. He said there was a drop in malaria cases to 40 in the first five months of the program, compared to 78 in the same period in 2018.Even though he wishes his 3-year-old daughter, Angel, could receive the vaccine, “it’s protecting my community. It also makes my work easier,” Kadzuwa said. The Migowi area has one of the country’s highest rates of malaria, and a worn paper register in the clinic’s laboratory lists scores of cases.At the clinic, Agnes Ngubale said she had malaria several years ago and wants to protect her 6-month-old daughter, Lydia, from the disease.“I want her to be healthy and free,” she said. “I want her to be a doctor.”And she has memorized the time for Lydia’s second dose: “Next month, same date.”___Neergaard reported from Washington.___The Associated Press Health and Science Department receives 7200

AHMEDABAD, INDIA — President Donald Trump has opened a whirlwind 36-hour visit to India by basking in the adulation of a massive, colorful crowd at a cricket stadium in the western city of Ahmedabad. Trump and Indian Prime Minister Narendra Modi lavished praised on each other during back-to-back speeches to thousands of revelers packed into the stadium in 80-degree heat. It was the biggest rally crowd of Trump's political career. Trump's visit is meant to reaffirm U.S.-India ties strained by trade disputes. But it's also providing enviable overseas imagery for a president in re-election mode. 613

Acting US Citizenship and Immigration Services Director Ken Cuccinelli defended a change in the process for children of some federal employees and members of the US armed forces living overseas to gain US citizenship, saying it was done to comply with the law and stressing that it doesn't take away any avenue to become a citizen."What was going on before was that the USCIS approach to working these children up to be citizens was not consistent with the State Department's or the law, so we were acting illegally," Cuccinelli said Thursday in an interview with CNN's Dana Bash.The policy change released Wednesday sparked confusion among the military and diplomatic communities, which were concerned that it would place hurdles before the children of federal employees and military workers serving abroad. As a result, the alert was met with an immediate backlash, as lawyers and groups tried to parse what it meant and who it affected.Cuccinelli has since conducted several interviews, and US Citizenship and Immigration Services hosted a call with reporters on the change Thursday.The guidance does not make anyone ineligible for citizenship. USCIS officials have since explained that it changes the paperwork that some families whose children are born overseas will have to fill out."These are children born who when they were born were not US citizens who are trying to be made US citizens by their parents, and it's the paperwork they have to file. That's it," Cuccinelli said Thursday."What was happening and what's happening now is you get your documentation from USCIS and you can go to State Department, bring that child and they wouldn't give them a passport as a US citizen because they weren't legally qualified as a US citizen," Cuccinelli said. "Now all of that will mesh together correctly."A State Department official told CNN that USCIS and the State Department had been working together for some time to align the application of certain terms "when adjudicating acquisition of citizenship claims" under various sections of immigration law.US citizenship can be acquired a few ways, including being born in the country. Children born abroad can acquire citizenship through their US citizen parents either at birth or before the age of 18.A USCIS official said Thursday that children born overseas to two US citizen parents would be citizens "automatically.""Two US citizen parents who have a child born overseas -- that child is a citizen automatically. Period," an official told CNN.The agency said it expects that around 20 to 25 people a year will be affected by the rule change. A Defense Department official estimated that about 100 people annually would be affected.The public uproar and ensuing confusion come in light of President Donald Trump occasionally voicing his support for ending birthright citizenship. Last week, Trump said he was "seriously" considering ending it, though it's unclear how he'd have the legal authority to do so. Cuccinelli said Wednesday on Twitter that the new policy "does NOT impact birthright citizenship."The policy becomes effective on October 29. 3121

A proposed bill introduced by Missouri Rep. Andrew McDaniel would require all Missouri state residents to own an AR-15 rifle. House Bill 1108, or the McDaniel Militia Act, proposes that every resident of the state of Missouri "shall own at least one AR-15 rifle."A resident, the language in the proposed bill states, is someone who is "18 years of age or older and under 35 years of age" who is not prohibited by law from possessing a fire arm. "Any person who qualifies as a resident on August 28, 2019, and who does not own an AR-15 shall have one year to purchase an AR-15. Any resident qualifies as a resident after August 28, 2019, and does not own an AR-15 shall purchase an AR-15 no later than one year after qualifying as a resident," language in the bill states. The proposed bill does not state if there will be any repercussions for residents who do not purchase an AR-15. To read more about House Bill 1108, 932

A North Carolina college student has been arrested and charged after authorities found two guns in his dorm room and he reportedly confessed to plans to carry out a shooting.Paul Arnold Steber, a 19-year-old freshman at High Point University, faces two felony counts of weapons on campus or educational property and one count of making a threat of mass violence, High Point Police said. He's being held without bond for 10 days, during which time he must have a mental evaluation, police said.Steber's attorney did not immediately respond to CNN's request for comment.Steber, of Boston, is one of dozens of suspects arrested over mass attack threats since mass shootings this month in El Paso, Texas, and Dayton, Ohio. In the week after the shootings, the FBI got more than 38,000 tips, up from the typical 22,000 tips per week this year.Steber was arrested Tuesday after other students told school officials that Steber had two guns and ammunition in his dorm room, police and university officials said in news releases.Steber had a 9mm semi-automatic pistol and a double-barrel 12-gauge shotgun, police said.He confessed to having "a timeline to 'kill people,'" 1176