An introduction to GEIS and DOD Tropical Medicine Pathways LTC Kofi Wurapa MD, MTM&H GEIS Director 21 Nov 2012

1. An introduction to GEIS and DOD Tropical Medicine PathwaysLTC Kofi Wurapa MD, MTM&HGEIS Director21 Nov 2012

2. Agenda • Background of GEIS • Infectious disease in the US Military • USAMRU- Kenya: Historical over view • GEIS: History, Mission, Activities in Africa • US Military GME • Tropical Medicine: Options • Options open to partners

3. Disease non battle injuryWhy a presence out side the USA is Key • WW II: Enteric infections, Malaria, Respiratory • Vietnam: Enteric infections, Malaria • Gulf War: Enteric infections, Sports injury • OEF: Enteric infections, NB injury • OIF: Enteric infections, NB injury • Liberia: 2003: 241 USMC, 41% attack rate of AFI, evacuation cost 2.1 million, termination of mission. Malaria. 2 deaths currently

4. USAMRU-Kenya Background • Established in 1969 at the invitation of the Kenyan Government to study trypanosomiasis in Western Kenya • Permanently established in 1973 • One of 6 US military overseas research labs

5. USAMRU-K ORGANIZATIONAL FOOTPRINT

6. Overseas Labs WRAIR/NMRC USAPHC (Prov) Germany Korea NHRC Egypt USAFSAM Thailand NMCPHC Kenya Peru Southeast Asia

7. GEIS Vision and Mission Established by a Presidential directive in 1996 tasking the DoD to play a significant role in disease surveillance globally • Vision: Successfully develop, implement, support, and evaluate an integrated global emerging infectious disease surveillance and response system that promotes preparedness in the US Forces, the Military Health System and the Global Public Health community. Mission: Contribute to Force Health Protectionand Global Public Healthby centrally coordinating a global system of partners that conduct emerging infectious disease surveillance and response; research, training and capacity building; innovation and integration; and assessment of value added in a timely, efficient, comprehensive and communicativemanner.

8. Force Health Protection RI GI AR STI FVBI Surveillance and Response Training and Capacity Building Research, Innovation and Integration Assessment and Communication of Value Added GEIS Operations Complex Pillar: Human, Vector, Environment Great DoD Significance Strategic Goals and Priority Pillars RI = Respiratory Infection GI = Gastrointestinal Infection FVBI = Febrile and Vector-borne Infection AR = Antimicrobial Resistance STI = Sexually Transmitted Infection Outbreak and Capacity building ARD DRO STI GI Febrile Dis

9. 2012 Global Emerging Infections Systems(GEIS)/ Department of Emerging Infectious Diseases (DEID) LTC Eyako Wurapa Director DEID = full time GEIS employees = Partial salary from GEIS = unfilled GEIS positions Berhane Assefa Deputy Director DEID Program Support Scientific Sections Admin/ Logistics Leah Muthigani QA/ QC Julia Wangui (Influenza) STI Surveillance Dr. Margaret Mbuchi WHO Reference . Virology VHF, Arbovirus Dr. Rosemary Sang Principal Scientist Dr. Lillian Musila Entomology MAJ. Josh Bast Influenza/ Respiratory Dr. Wallace Bulimo Enterics Dr. Brook Danboise Dr. Willie Sang MDR Malaria Dr. Elizabeth Wanja Procurement Evangeline Kinya Property Manager Keneth Mitei (Influenza) Laboratory Manager Valerie Oundo Laboratory Manager Dr. Samoel Khamadi Laboratory Manager Rachel Achilla DTRA Epidemiology Training Shirley Segecha Investigators Dr. Ben Andagalu Dr. Fred Eyase David Oullo Dan Ngonga Simon Muriithi Accounts Wilfred Chepkwony Laboratory Manager Elizabeth Odundo Culture Hosea Akala Molecular Angela Omondi Site Coordinator Duke Omariba Leah Muthigani Serology Dr. Samson Limbaso Victor Ofula Cell Culture Albina Makio Edith Koskei Samuel Owaka (data) Molecular Caroline Ochieng Albert Nyunja Entomology James Mutisya Hellen Koka Joel Lutomiah Dunstone Betti John Gachoya Reuben Lugalia Josephine Kabutu Janet Ndonye Margaret Koech Ronald Kirera Cliff Philip Abigael Ombogo Erick Kipkirui Site Staff Beth Mutai George Awinda Maureen Maraka Josphat Nyataya Rachel Githii AFI Dr. John Waitumbi Dennis Juma Agnes cheryuot Charles Okudo Redemptah Yeda Safety Bonventure Juma Laboratory Manager Nancy Nyakoe Attachment/ Training Janet Majanja Finnley Osuna Charles Magiri Genomics Platform Benjamin Opot Database Manager James Njiri Clean Cell Culture Steven Ocholla Virus Isolation / Characterization Josphat Mwangi Julia Wangui Silvanus Mukunzi Serology Silvanos Mukunzi Josephat Mwangi Finnley Osuna Alice Ketta Keneth Mitei Lab QA/QC Janet Majanja Janet Nyambura Molecular Biology and Drug sensitivity Assay Meshack Wadegu Janet Majanja Finnley Osuna Database Mgt Auxiliary Staff Jacinta Wanjiru (Influenza) Epidemiology / Study Design Biostatistics Maintenance Edwin Webala Jesse Waitherero Note: Site staff also report to PIs of the protocols which run at the sites they work in

10. Collaborations Boston University Makerere University Uganda University of Buea Cameroon University of California San Diego Uniformed Services University Case Western Reserve University University of Washington Pfizer, Sanofi, GSK PATH Aeras The Henry Jackson Foundation University of Manchester Cameroon Defense Ministry Kenya Medical Research Institute Kenya Ministry of Public Health and Sanitation Kenya Ministry of Medical Services Kenya Ministry of Defense Walter Reed Army Institute of Research NAMRU-3 Global Virus Initiative NIH Wellcome Trust WHO CDC USDA Tanzanian Peoples Defense Force DTRA SPLA Cost containment & Synergism

11. University of Buea, Cameroon Makerere Univ Walter Reed Project (MUWRP), Uganda Kenya Global Viral Forecasting (GVF), Yaoundé, Cameroon Tanzania People’s Defense Force 11

12. Field Site GrowthKey to growth Kahawa Army Barracks

13. Respiratory: Flu (ILI/SARI) at 10 MOH and 5 KDF, Eldoret RTC: resp pathogens study Enterics: 10 MOH district hospitals, 1 KDF, RBA AFI: 10 MOH district hospitals, 3 UNHCR camps AR: 10 MOH for the MDR, MCoE STI: 2 MOH district hospital, 2 KDF clinics Capacity: Student program, GCLP, GCP, IATA Support the NIC and VHF labs Kenya Activities

14. Surveillance Activities in Cameroon GVFI UoB –LEID Mamfe Bamenda Kumba Buea Abong Mbang Niete Hevecam • Two GEIS-funded laboratories • GVF: 6 sites • Influenza surveillance in the six French speaking regions of Cameroon • UoB-LEID: 4 sites • Influenza surveillance in the four English speaking regions of Cameroon 14 14

15. Respiratory: Flu (ILI/SARI) at 10 MOH Enterics: X AFI: X AR: X STI: 1 Cameroon Defense Forces hospital Capacity: GCLP, GCP, IATA Capacity: 1 CDF hospital lab, BSL x 2 University of Buea collaboration Cameroon Activities

16. Uganda Sites Makerere University Walter Reed Project 16

17. Respiratory: Flu (ILI/SARI) at 4 MOH Enterics: X , AFI: X AR: Bombo UPDF hospital STI: X Capacity: GCLP, GCP, IATA Capacity: Referb 4 DH, 1 UPDF hospital lab, BSL x 2 DoD Student exchange program in development Uganda Activities

18. Tanzania: Surveillance Sites 80% Civilian patients TPDF sites MOHSW sites

19. Respiratory: Flu (ILI/SARI) at 1 MOH, 2 TPDF clinics Enterics: X, AFI: Vector and Human study AR: X, STI: X Capacity: GCLP, GCP, IATA Capacity: Referb 2 TPDF labs, BSL2 x 1 Tanzania Activities

20. FY 12 accomplishments • Staff training/ Maintaining of certifications • Student program formalized (30K) • Journal Club: in its 3rd year • Increased Mil-Mil activities (KDF, UPDF, TPDF, SPLA) • Epidemiology training program- Kenya (700 MOH mid-level public health staff) • Renovations (Kenya: Alupe, Kissi, Kisumu, Eldoret, Cameroon: Yaoundé, Uganda: Bombo, Tanzania: Lugalo) • South Sudan: planning phase

23. Eldoret clinic during renovation

24. Eldoret Clinic

27. US Army GME

28. Available Tropical Medicine Trainings • Global Medicine: 2 weeks in San Antonio TX • Physicians • Medical Administrators • Physicians who’s formal training has been >10 years • Not recommended for staff with no formal training

29. US Military Tropical Medicine • USUHS in Bethesda, MD • Dr. Dave Blazes • Open to Physicians, Clinical Officers: about to deploy, dermatologist • Required for Preventive Medicine Residency • 6 Weeks: 4 wks didactic, 2 wks field portion • Have sent non US staff with justification

30. MTM&H ASTMH Certification • USUHS, Bethesda, MD • Open to physicians: Required part of ID fellowship training • MPH course work, 5 months of didactic in Tropical Medicine, 6 month field, or may be credited for past work • ASTHM: certification upon completion of the above and a certification exam at ASTMH

31. One Health Global Medicine • Most common for our GEIS staff • University of Florida • Open to Physicians and other researchers: needing a foundation of Epidemiology and Biostatistics • Nomination process • 4 weeks at the University of Florida • On line: based on individual • 41 credits towards education at UoF

32. Other Non Physician Experts • PhD Scientists with a range of expertise: • Maters level staff: Limited to Lab specific management skill sets • Epidemiologist • Biostatisticians

33. Thank you 33

34. “When a Gazelle wakes up in Africa, it knows to be alive at the end of the day, it must run faster than the fastest Lion. When the Lion wakes up in Africa, it knows it must out run the slowest Gazelle in order not to starve to death. To me this means when you wake up in Africa no matter who or what you are, you better start running! Author unknown

35. Thank You

36. MOH: ministry of health CDF: Cameroon Defense force KDF: Kenya Defense Force UPDF: Uganda Peoples Defense Force TPDF: Tanzania Peoples Defense Force MCoE: Malaria Diagnostics Center of Excellence MTM: Military Tropical Medicine RBA: Royal British Army