Research and Training Research and Training in Infectious Diseases in Infectious Diseases

in Africa, the Americas and PNGin Africa, the Americas and PNG

Uriel KitronUriel KitronCenter for Zoonoses Research Center for Zoonoses Research

College of Veterinary MedicineCollege of Veterinary Medicine

University of IllinoisUniversity of Illinois

Infectious Diseases Infectious Diseases

are one aspect of are one aspect of

Global HealthGlobal Health

What is included in "Global Health?"What is included in "Global Health?"

Health of the Globe Health of the Globe (biological, chemical, physical (biological, chemical, physical interactions)interactions)

Human diseasesHuman diseases that occur worldwide that occur worldwide Comparative health patterns among countriesComparative health patterns among countries Reducing diseasesReducing diseases that affect people throughout the that affect people throughout the

world (Global Health Fund)world (Global Health Fund) International Health in developing countriesInternational Health in developing countries Analysis of Analysis of commoncommon causes of diseasecauses of disease linked to linked to

"globalization""globalization"

Global HealthGlobal Health

Public Health ChallengePublic Health Challenge: How to integrate : How to integrate research on and intervention against diseases that research on and intervention against diseases that arise from arise from multiplemultiple causes? causes?

Training Opportunities: Training Opportunities: Involve students as Involve students as members of projects that address "global" members of projects that address "global" processes, whether of domestic or international processes, whether of domestic or international origin. origin.

Some Some ChallengesChallenges and and OpportunitiesOpportunities

Infectious diseases grants Infectious diseases grants awarded by NIH and NSFawarded by NIH and NSF

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

http://www.nsf.gov/bio/pubs/awards/eid.htm

Components of an Components of an epidemiologic studyepidemiologic study

Agent – what is the causative pathogenAgent – what is the causative pathogen Transmission- how does the pathogen get to Transmission- how does the pathogen get to

and from a host? and from a host? Surveillance – of cases, transmission, Surveillance – of cases, transmission,

reservoirs, vectors, environmental risk factors reservoirs, vectors, environmental risk factors and control and control

Control - of disease, infection, transmission or Control - of disease, infection, transmission or risk factors risk factors

Arthropods, humans Arthropods, humans and other animalsand other animals

Many vector-Many vector-borne diseases borne diseases are zoonosesare zoonoses

Different roles Different roles and impacts for and impacts for wildlife, domestic wildlife, domestic animals and animals and humanshumans

Strong impact fo Strong impact fo climate, climate, environmentenvironment

4. Eco-Epidemiology of Chagas 4. Eco-Epidemiology of Chagas Disease in northwest ArgentinaDisease in northwest Argentina

Ricardo Gurtler, Carla Cecere Ricardo Gurtler, Carla Cecere Univ. of Buenos Aires, Argentina Univ. of Buenos Aires, Argentina

Joel Cohen, Rockefeller University, NYJoel Cohen, Rockefeller University, NY Sonia Blanco – National Vector Control Sonia Blanco – National Vector Control

Program, Argentina Program, Argentina Uriel Kitron, Univ. of IllinoisUriel Kitron, Univ. of Illinois

Supported by NIH/NSF Ecology of Infectious Disease Supported by NIH/NSF Ecology of Infectious Disease ProgramProgram

CHAGAS DISEASECHAGAS DISEASE ZOONOSIS CAUSED BY PROTOZOAN ZOONOSIS CAUSED BY PROTOZOAN

TRYPANOSOMA CRUZI. ONLY IN THE AMERICAS.TRYPANOSOMA CRUZI. ONLY IN THE AMERICAS.ONLY INFECTS ONLY INFECTS MAMMALSMAMMALS..

10-18 MILLION PEOPLE INFECTED, 10-18 MILLION PEOPLE INFECTED, ~30% AFFECTED BY ~30% AFFECTED BY HEART DISEASE.HEART DISEASE.

MOST INFECTIONS INITIALLY MOST INFECTIONS INITIALLY ASYMPTOMATIC, PROGRESS TO ASYMPTOMATIC, PROGRESS TO CHRONIC.CHRONIC.

MAIN ROUTES OF INFECTION:MAIN ROUTES OF INFECTION:VECTOR-BORNEVECTOR-BORNE; ; FROM MOTHER TO NEWBORN;FROM MOTHER TO NEWBORN;BLOOD TRANSFUSION; BLOOD TRANSFUSION;

CONTROLCONTROL NO VACCINE. NO VACCINE.

NO EFFECTIVE DRUGS FOR CHRONIC DISEASE. NO EFFECTIVE DRUGS FOR CHRONIC DISEASE. MOSTLY RESIDUAL MOSTLY RESIDUAL INSECTICIDE SPRAYINGINSECTICIDE SPRAYING

AND SCREENING OF BLOOD DONNORSAND SCREENING OF BLOOD DONNORS..

The The most important parasitic most important parasitic infection in Latin Americainfection in Latin America

Life cycle of Trypanosoma cruziLife cycle of Trypanosoma cruzi

Chagas’ diseaseChagas’ disease

Geographic distribution Geographic distribution determined by presence of determined by presence of efficient vectorsefficient vectors

Three main transmission Three main transmission cyclescycles– SylvaticSylvatic

– PeridomesticPeridomestic

– DomesticDomestic

Also transfusion, congenital, oralAlso transfusion, congenital, oral

Infection Tainting America's Blood Infection Tainting America's Blood Supply?Supply?FDA Concerned About Parasite Entering StatesFDA Concerned About Parasite Entering StatesPOSTED:POSTED: 5:14 p.m. PST November 18, 20035:14 p.m. PST November 18, 2003

SAN DIEGO -- Is America's blood supply at risk? SAN DIEGO -- Is America's blood supply at risk? That is the question the Food and Drug That is the question the Food and Drug Administration is asking after Chagas disease -- an Administration is asking after Chagas disease -- an infection from Latin America -- showed up in the infection from Latin America -- showed up in the United States in higher numbers. United States in higher numbers.

The Gran Chaco of The Gran Chaco of Argentina, Bolivia, Paraguay and BrazilArgentina, Bolivia, Paraguay and Brazil

1)1) High levels of povertyHigh levels of poverty

2)2) Low population densityLow population density

3)3) Mostly rural populationMostly rural population

4)4) Subsistence economySubsistence economy

5)5) Limited health services, politcial Limited health services, politcial support support

6)6) High disease burdenHigh disease burden

7)7) High T. infestans infestation High T. infestans infestation prevalence and transmision of prevalence and transmision of T. T. cruzi.cruzi.

Santiago del EsteroProvince

Argentina

Tintina

Departamento MorenoDepartamento

Moreno

Study area in Northern Argentina, Study area in Northern Argentina, part of the Gran Chaco of part of the Gran Chaco of

Argentina, Bolivia, Paraguay and BrazilArgentina, Bolivia, Paraguay and Brazil

Amama

Thorn forest of Quebracho and AlgarroboThorn forest of Quebracho and Algarrobo

Semi-arid area; Mean annual temp. of 22º CSemi-arid area; Mean annual temp. of 22º CDry Chaco:Dry Chaco:

Local economy is based on exploitation Local economy is based on exploitation of the forest:of the forest: Wood-chopping, production of coal Wood-chopping, production of coal and hardwood posts.and hardwood posts.

Cattle operation and Cattle operation and

soybean cultivationsoybean cultivation

by large landownersby large landowners

result in further deforestation,result in further deforestation,

fencing of large areas, migrationfencing of large areas, migration

and displacement of livestock and displacement of livestock

Typical Compound with home and multiple peridomestic structures

Domiciliary area

Nearly all Transmission of T. cruzi takes place under the Nearly all Transmission of T. cruzi takes place under the thatched roofs and in the patios of the domiciliary sites thatched roofs and in the patios of the domiciliary sites

Peridomestic Structures – refuge for bugsPeridomestic Structures – refuge for bugs

Goat corralGoat corral

Pig corralPig corral

StoreroomStoreroom

Chagas disease studyChagas disease studya.a. Mapping and creating a georeferenced databaseMapping and creating a georeferenced database

b.b. Vector studies - Reinfestation by triatomine bugsVector studies - Reinfestation by triatomine bugs

c.c. Reservoir studies – infection and infectiousness Reservoir studies – infection and infectiousness of domestic animalsof domestic animals

d.d. Sylvatic studies of wildlife and bugsSylvatic studies of wildlife and bugs

e.e. Spraying strategySpraying strategy

f.f. Scale of study and heterogeneityScale of study and heterogeneity

g.g. Spraying strategies – cost effectivenessSpraying strategies – cost effectiveness

h.h. Surveillance and control strategy Surveillance and control strategy recommendationsrecommendations

Project based on 20+ years of extensive field and experimental work by Project based on 20+ years of extensive field and experimental work by

UBA team, NVCP and collaboratorsUBA team, NVCP and collaborators

Chagas study - ComponentsChagas study - Components FieldField studies – parasitology, entomology, demography, studies – parasitology, entomology, demography,

epidemiology, spatial description and mapping, field epidemiology, spatial description and mapping, field experiments experiments

LaboratoryLaboratory – diagnostic, morphometric, molecular, – diagnostic, morphometric, molecular, experimental experimental

ComputerComputer – database, remote sensing, GIS, spatial statistics, – database, remote sensing, GIS, spatial statistics, modelingmodeling

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

Training activitiesTraining activities

Workshops in ArgentinaWorkshops in Argentina- GIS and spatial analysis- GIS and spatial analysis- Mathematical modeling- Mathematical modeling

Visiting scientists and students to UIUCVisiting scientists and students to UIUC Joint field work in Argentina and USAJoint field work in Argentina and USA Fulbright fellowship and grants to provide Fulbright fellowship and grants to provide

individual and group training in UBA individual and group training in UBA Study is led by Argentinean team membersStudy is led by Argentinean team members

IKONOSIKONOSThe IKONOS satellite is a high resolution satellite The IKONOS satellite is a high resolution satellite capable of creating 1-mcapable of creating 1-m22 panchromatic and 4-m panchromatic and 4-m22 multi-spectral images.multi-spectral images.

1-m1-m PanchromaticPanchromatic 4-m multi-spectral4-m multi-spectral

SPATIAL SPATIAL STATISTICS STATISTICS

Mapping and geostatistical tools

Sketch maps made in the field during 1993-2002

Ikonos Satellite imagery (1-4m2)

Digital mapfor each village

Joining ofJoining ofattribute attribute data to a data to a GIS fileGIS file

Clusters of high infestation and potential sources of community reinfestation

Field workField work

only

Graduate and veterinary students from Illinois being trained in ArgentinaGraduate and veterinary students from Illinois being trained in Argentina ..

Looking for Looking for the bugsthe bugs

Fig. 6. Graduate and veterinary students from Illinois Fig. 6. Graduate and veterinary students from Illinois training in Argentina (sampling wildlife).training in Argentina (sampling wildlife).

Cardinal MV, Levin M, Grijalva E, Cardinal MV, Levin M, Grijalva E, Kitron U, Dieter R, Cortinas R, Ceballos LA, Kitron U, Dieter R, Cortinas R, Ceballos LA, Gürtler RE, Petrocco F, Gurevitz JM, Gürtler RE, Petrocco F, Gurevitz JM, Vazquez-Prokopec GM. Amamá, July 2003 Vazquez-Prokopec GM. Amamá, July 2003

Project is a true Project is a true InterdisciplinaryInterdisciplinarycollaboration collaboration between UBA, between UBA, UIUC, CDC, UIUC, CDC, Rockefeller andRockefeller andNat’l Vector Nat’l Vector Control Control Programme;Programme;and includes a and includes a strong training strong training componentcomponent

Other international projectsOther international projects

1) Schistosomiasis in Kenya1) Schistosomiasis in Kenya

2)2)   Malaria in Kenya and Trinidad Malaria in Kenya and Trinidad

3) Dengue in Trinidad and Peru3) Dengue in Trinidad and Peru

4) Malaria and filariasis in Papua New Guines4) Malaria and filariasis in Papua New Guines

All projects involve strong training and collaboration All projects involve strong training and collaboration components components

Schistosomiasis Schistosomiasis in coastal Kenyain coastal Kenya

CWRUCWRU

Univ. of IllinoisUniv. of Illinois

DVBD, Ministry of DVBD, Ministry of Health, KenyaHealth, Kenya

NASA-CHAARTNASA-CHAART

LSHTMLSHTM

- Charles H. King Charles H. King - Uriel KitronUriel Kitron- Julie ClennonJulie Clennon- Eric Muchiri Eric Muchiri - Peter MungaiPeter Mungai- Iddi MasemoIddi Masemo- Curtis KariukiCurtis Kariuki- And many othersAnd many others- Louisa BeckLouisa Beck- Cindy SchmidtCindy Schmidt- Robert SturrockRobert Sturrock

NIH/NSF EID program Fogarty NIH/NSF EID program Fogarty

TM satellite Image, May 1995, Path 166 Row 63

Mombasa

Vanga

Mbuani

Study areaStudy area

Msambweni Study AreaMsambweni Study Area

Nimbidze pond Nimbidze pond (before drought)(before drought)

Milalani villageMilalani village

Urinary schistosomiasis project, Msambweni, Kenya: Using IKONOS image and GPS to register field sites

Connectivity of aquatic Connectivity of aquatic habitats and modeling the dispersal habitats and modeling the dispersal

potential of potential of B. nasutusB. nasutus snails in snails in coastal Kenyacoastal Kenya

Julie ClennonJulie Clennon

et al.et al.

Training activitiesTraining activities

Workshops in KenyaWorkshops in Kenya- GIS spatial analysis- GIS spatial analysis- Spatial Analysis- Spatial Analysis

Visiting scientists to UIUCVisiting scientists to UIUC Joint field work in KenyaJoint field work in Kenya Study is still led mostly by US teamStudy is still led mostly by US team

Changing Dynamics of Anopheline Changing Dynamics of Anopheline Transmission of Malaria & Filariasis in PNG Transmission of Malaria & Filariasis in PNG

Fogarty honors students (Krufinta Bun, Fogarty honors students (Krufinta Bun,

far; Helen Keno, near) doing their thesis far; Helen Keno, near) doing their thesis

research in IMR Library in Goroka.research in IMR Library in Goroka.

TRAINING CERTIFICATE

Awarded to

For successful completion of the Introductory GIS Workshop

19 – 20 September 2007, IMR. GOROKA, PNG

University of IllinoisUrbana-Champaign, USA

Certified by:

Uriel Kitron Charles King Ivo Mueller

___________________

Case Western Reserve University, Cleveland, USA

Institute of MedicalResearch, PNG

Global Health Global Health MoreMore Challenges and Opportunities Challenges and Opportunities

PublicPublic HealthHealth ChallengeChallenge: Reduce excess burden of morbidity : Reduce excess burden of morbidity and mortality suffered by the poor - especially women and and mortality suffered by the poor - especially women and childrenchildren

TrainingTraining OpportunitiesOpportunities: : Develop US and international public Develop US and international public health internships that focus on the poor, and on how global health internships that focus on the poor, and on how global processes impact on their livesprocesses impact on their lives

Responsibility and leadership:Responsibility and leadership: Transfer to the hands of local Transfer to the hands of local researchers and institutionsresearchers and institutions

   "In my view, aid is a failure if in "In my view, aid is a failure if in forty years of charity the only people forty years of charity the only people still dishing up the food and doling still dishing up the food and doling out the money are foreigners. No out the money are foreigners. No Africans are involved ..”Africans are involved ..”

"Aid is one of the main reasons "Aid is one of the main reasons for underdevelopment in Africa." for underdevelopment in Africa."

  "Only Africans are capable of "Only Africans are capable of making a difference in Africa. making a difference in Africa. Everyone else, donors and volunteers Everyone else, donors and volunteers and bankers, however idealistic, were and bankers, however idealistic, were simply agents of subversion." simply agents of subversion."