Research and Training in Infectious Diseases in Africa, the Americas and PNG

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Research and Training in Infectious Diseases in
Africa, the Americas and PNG

• Uriel KitronCenter for Zoonoses Research
• College of Veterinary Medicine
• University of Illinois

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Infectious Diseases are one aspect of Global
Health
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What is included in "Global Health?"

• Health of the Globe (biological, chemical,
  physical interactions)
• Human diseases that occur worldwide
• Comparative health patterns among countries
• Reducing diseases that affect people throughout
  the world (Global Health Fund)
• International Health in developing countries
• Analysis of common causes of disease linked to
  "globalization"

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Global Health
Some Challenges and Opportunities

• Public Health Challenge How to integrate
  research on and intervention against diseases
  that arise from multiple causes?
• Training Opportunities Involve students as
  members of projects that address "global"
  processes, whether of domestic or international
  origin.

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Infectious diseases grants awarded by NIH and NSF

• Joint program supports initiatives that seek
  to understand the ecological and biological
  mechanisms that govern relationships between
  human-induced environmental changes and the
  emergence and transmission of infectious
  diseases.

http//www.nsf.gov/bio/pubs/awards/eid.htm
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Components of an epidemiologic study

• Agent what is the causative pathogen
• Transmission- how does the pathogen get to
  and from a host?
• Surveillance of cases, transmission,
  reservoirs, vectors, environmental risk factors
  and control
• Control - of disease, infection, transmission
  or risk factors

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Arthropods, humans and other animals

• Many vector-borne diseases are zoonoses
• Different roles and impacts for wildlife,
  domestic animals and humans
• Strong impact fo climate, environment

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4. Eco-Epidemiology of Chagas Disease in
northwest Argentina

• Ricardo Gurtler, Carla Cecere Univ. of Buenos
  Aires, Argentina
• Joel Cohen, Rockefeller University, NY
• Sonia Blanco National Vector Control
  Program, Argentina
• Uriel Kitron, Univ. of Illinois
• Supported by NIH/NSF Ecology of Infectious
  Disease Program

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CHAGAS DISEASE

• ZOONOSIS CAUSED BY PROTOZOAN
• TRYPANOSOMA CRUZI. ONLY IN THE AMERICAS.
• ONLY INFECTS MAMMALS.
• 10-18 MILLION PEOPLE INFECTED,
• 30 AFFECTED BY HEART DISEASE.
• MOST INFECTIONS INITIALLY
• ASYMPTOMATIC, PROGRESS TO CHRONIC.
• MAIN ROUTES OF INFECTION
• VECTOR-BORNE
• FROM MOTHER TO NEWBORN
• BLOOD TRANSFUSION
• CONTROL NO VACCINE.
• NO EFFECTIVE DRUGS FOR CHRONIC DISEASE.
• MOSTLY RESIDUAL INSECTICIDE SPRAYING
• AND SCREENING OF BLOOD DONNORS.

The most important parasitic infection in Latin
America
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Life cycle of Trypanosoma cruzi
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Chagas disease

• Geographic distribution determined by presence of
  efficient vectors
• Three main transmission cycles
• Sylvatic
• Peridomestic
• Domestic
• Also transfusion, congenital, oral

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Infection Tainting America's Blood Supply?FDA
Concerned About Parasite Entering States POSTED
514 p.m. PST November 18, 2003 SAN DIEGO -- Is
America's blood supply at risk? That is the
question the Food and Drug Administration is
asking after Chagas disease -- an infection from
Latin America -- showed up in the United States
in higher numbers.
What Is Chagas? Fact Sheet Millions of people
donate blood, but not before being screened and
tested for AIDS, hepatitis and more, 10News
reported. There is concern over the potential
of an infectious parasite getting into the blood
supply from those who either lived or traveled in
rural areas of South and Central America and
southern Mexico.
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The Gran Chaco of Argentina, Bolivia, Paraguay
and Brazil

• High levels of poverty
• Low population density
• Mostly rural population
• Subsistence economy
• Limited health services, politcial support
• High disease burden
• High T. infestans infestation prevalence and
  transmision of T. cruzi.

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Study area in Northern Argentina, part of the
Gran Chaco of Argentina, Bolivia, Paraguay and
Brazil

Departamento Moreno
Santiago del Estero Province
Amama
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Semi-arid area Mean annual temp. of 22º C
Dry Chaco
Thorn forest of Quebracho and Algarrobo
Local economy is based on exploitation of the
forest Wood-chopping, production of coal and
hardwood posts.
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Cattle operation and soybean cultivation by
large landowners
result in further deforestation, fencing of large
areas, migration and displacement of livestock
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Typical Compound with home and multiple
peridomestic structures
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Nearly all Transmission of T. cruzi takes place
under the thatched roofs and in the patios of the
domiciliary sites
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Peridomestic Structures refuge for bugs
Pig corral
Storeroom
Goat corral
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Chagas disease study

• Mapping and creating a georeferenced database
• Vector studies - Reinfestation by triatomine bugs
• Reservoir studies infection and infectiousness
  of domestic animals
• Sylvatic studies of wildlife and bugs
• Spraying strategy
• Scale of study and heterogeneity
• Spraying strategies cost effectiveness
• Surveillance and control strategy recommendations

Project based on 20 years of extensive field and
experimental work by UBA team, NVCP and
collaborators
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Chagas study - Components

• Field studies parasitology, entomology,
  demography, epidemiology, spatial description and
  mapping, field experiments
• Laboratory diagnostic, morphometric, molecular,
  experimental
• Computer database, remote sensing, GIS, spatial
  statistics, modeling

Interdisciplinary study - parasitology,
entomology, demography, epidemiology, geography,
mathematics, statistics
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Training activities

• Workshops in Argentina- GIS and spatial
  analysis- Mathematical modeling
• Visiting scientists and students to UIUC
• Joint field work in Argentina and USA
• Fulbright fellowship and grants to provide
  individual and group training in UBA
• Study is led by Argentinean team members

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IKONOS

• The IKONOS satellite is a high resolution
  satellite capable of creating 1-m2 panchromatic
  and 4-m2 multi-spectral images.

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Mapping and geostatistical tools
Sketch maps made in the field during 1993-2002
Ikonos Satellite imagery (1-4m2)
Digital map for each village
Joining of attribute data to a GIS file
Clusters of high infestation and potential
sources of community reinfestation
SPATIAL STATISTICS
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Field work
only
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Looking for the bugs
Graduate and veterinary students from Illinois
being trained in Argentina.
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Project is a true Interdisciplinary collaboration
between UBA, UIUC, CDC, Rockefeller and Natl
Vector Control Programme and includes a strong
training component
Cardinal MV, Levin M, Grijalva E, Kitron U,
Dieter R, Cortinas R, Ceballos LA, Gürtler RE,
Petrocco F, Gurevitz JM, Vazquez-Prokopec GM.
Amamá, July 2003
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Other international projects

• 1) Schistosomiasis in Kenya
• 2)  Malaria in Kenya and Trinidad
• 3) Dengue in Trinidad and Peru
• 4) Malaria and filariasis in Papua New Guines
• All projects involve strong training and
  collaboration components

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Schistosomiasis in coastal Kenya

• CWRU
• Univ. of Illinois
• DVBD, Ministry of Health, Kenya
• NASA-CHAART
• LSHTM

• Charles H. King
• Uriel Kitron
• Julie Clennon
• Eric Muchiri
• Peter Mungai
• Iddi Masemo
• Curtis Kariuki
• And many others
• Louisa Beck
• Cindy Schmidt
• Robert Sturrock

NIH/NSF EID program Fogarty
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Msambweni Study Area
Mombasa
Mbuani
Study area
Vanga
TM satellite Image, May 1995, Path 166 Row 63
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Milalani village
Nimbidze pond (before drought)
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Urinary schistosomiasis project, Msambweni,
Kenya Using IKONOS image and GPS to register
field sites
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Connectivity of aquatic habitats and modeling
the dispersal potential of B. nasutus snails in
coastal Kenya

• Julie Clennon
• et al.

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Training activities

• Workshops in Kenya- GIS spatial analysis-
  Spatial Analysis
• Visiting scientists to UIUC
• Joint field work in Kenya
• Study is still led mostly by US team

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Changing Dynamics of Anopheline Transmission of
Malaria Filariasis in PNG
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Fogarty honors students (Krufinta Bun, far
Helen Keno, near) doing their thesis research in
IMR Library in Goroka.
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Global Health More Challenges and Opportunities

• Public Health Challenge Reduce excess burden of
  morbidity and mortality suffered by the poor
  - especially women and children
• Training Opportunities Develop US and
  international public health internships that
  focus on the poor, and on how global processes
  impact on their lives
• Responsibility and leadership Transfer to the
  hands of local researchers and institutions

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   "In my view, aid is a failure if in forty
years of charity the only people still dishing up
the food and doling out the money are foreigners.
No Africans are involved ..
"Aid is one of the main reasons for
underdevelopment in Africa."
  "Only Africans are capable of making a
difference in Africa. Everyone else, donors and
volunteers and bankers, however idealistic, were
simply agents of subversion."