Download Global Health?

Research and Training
in Infectious Diseases
in Africa, the Americas and PNG
Uriel Kitron
Center for Zoonoses Research
College of Veterinary Medicine
University of Illinois
Infectious Diseases
are one aspect of
Global Health
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"

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.
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
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

 Many
Arthropods, humans
and other animals
vectorborne diseases
are zoonoses
 Different roles
and impacts for
wildlife, domestic
animals and
humans
 Strong impact fo
climate,
environment
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
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.
The most important parasitic
infection in Latin America

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.
Life cycle of Trypanosoma cruzi
Chagas’ disease
 Geographic
distribution
determined by presence of
efficient vectors
 Three
main transmission
cycles
– Sylvatic
– Peridomestic
– Domestic
Also transfusion, congenital, oral
Infection Tainting America's Blood
Supply?
FDA Concerned About Parasite Entering States
POSTED: 5:14 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.
The Gran Chaco of Argentina, Bolivia, Paraguay and Brazil
1) High levels of poverty
2) Low population density
3) Mostly rural population
4) Subsistence economy
5) Limited health services, politcial
support
6) High disease burden
7) High T. infestans infestation
prevalence and transmision of T.
cruzi.
Study area in Northern Argentina,
part of the Gran Chaco of
Argentina, Bolivia, Paraguay and Brazil
Tintina
Departamento
DepartamentoMoreno
Moreno
Argentina
Santiago del Estero
Province
Amama
Dry Chaco:
Semi-arid area; Mean annual temp. of 22º C
Thorn forest of Quebracho and Algarrobo
Local economy is based on exploitation
of the forest:
Wood-chopping, production of coal
and hardwood posts.
Cattle operation and
soybean cultivation
by large landowners
result in further deforestation,
fencing of large areas, migration
and displacement of livestock
Typical Compound with home and
multiple peridomestic structures
Domiciliary area
Nearly all Transmission of T. cruzi takes place under the
thatched roofs and in the patios of the domiciliary sites
Peridomestic Structures – refuge for bugs
Pig corral
Storeroom
Goat corral
Chagas disease study
Mapping and creating a georeferenced database
b. Vector studies - Reinfestation by triatomine bugs
c. Reservoir studies – infection and infectiousness
of domestic animals
d. Sylvatic studies of wildlife and bugs
e. Spraying strategy
f. Scale of study and heterogeneity
g. Spraying strategies – cost effectiveness
h. Surveillance and control strategy
recommendations
a.
Project based on 20+ years of extensive field and experimental work by
UBA team, NVCP and collaborators
Chagas study - Components
studies – parasitology, entomology, demography,
epidemiology, spatial description and mapping, field
experiments
 Laboratory – diagnostic, morphometric, molecular,
experimental
 Computer – database, remote sensing, GIS, spatial statistics,
modeling
 Field
Interdisciplinary study - parasitology, entomology,
demography, epidemiology, geography,
mathematics, statistics
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
IKONOS
The IKONOS satellite is a high resolution satellite
capable of creating 1-m2 panchromatic and 4-m2
multi-spectral images.
1-m Panchromatic
4-m multi-spectral
Mapping and geostatistical tools
Sketch maps made in the field
during 1993-2002
Digital
map
for each
village
Clusters of high infestation and
potential sources of community
reinfestation
Ikonos Satellite imagery (1-4m2)
Joining of
attribute
data to a
GIS file
SPATIAL
STATISTICS
Field work
only
Looking for
the bugs
Graduate and veterinary students from Illinois being trained in Argentina.
Fig. 6. Graduate and veterinary students from Illinois
training in Argentina (sampling wildlife).
Project is a true
Interdisciplinary
collaboration
between UBA,
UIUC, CDC,
Rockefeller and
Nat’l 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
Other international projects
1)
2)
3)
4)
Schistosomiasis in Kenya
Malaria in Kenya and Trinidad
Dengue in Trinidad and Peru
Malaria and filariasis in Papua New Guines
All projects involve strong training and collaboration
components
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
Msambweni Study Area
Mombasa
Mbuani
Study area
Vanga
TM satellite Image, May 1995, Path 166 Row 63
Milalani village
Nimbidze pond
(before drought)
Urinary schistosomiasis project, Msambweni, Kenya:
Using IKONOS image and GPS to register field sites
Connectivity of aquatic
habitats and modeling the dispersal
potential of B. nasutus snails in
coastal Kenya
Julie Clennon
et al.
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

Changing Dynamics of Anopheline
Transmission of Malaria & Filariasis in PNG
Fogarty honors students (Krufinta Bun,
far; Helen Keno, near) doing their thesis
research in IMR Library in Goroka.
TRA IN IN G C E RTIF IC A TE
Awarded to
___________________
For successful completion of
the Introductory GIS Workshop
19 – 20 September 2007, IMR. GOROKA, PNG
Certified by:
Uriel Kitron
University of Illinois
Urbana-Champaign, USA
Charles King
Case Western Reserve
University, Cleveland, USA
Ivo Mueller
Institute of Medical
Research, PNG
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
"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."