Prospective studies of avian influenza transmission in asia
1 / 22

Prospective Studies of Avian Influenza Transmission in Asia - PowerPoint PPT Presentation

  • Uploaded on

Prospective Studies of Avian Influenza Transmission in Asia. Laura Lee MPH Candidate The University of Iowa Mentor: Dr. Gregory Gray Preceptor: Dr. Robert Gibbons The Armed Forces Research Institute of Medical Sciences . Abstract. May - August 2007

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'Prospective Studies of Avian Influenza Transmission in Asia' - Faraday

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Prospective studies of avian influenza transmission in asia l.jpg

Prospective Studies ofAvian Influenza Transmission in Asia

Laura Lee

MPH Candidate

The University of Iowa

Mentor: Dr. Gregory Gray

Preceptor: Dr. Robert Gibbons

The Armed Forces Research Institute of Medical Sciences

Abstract l.jpg

  • May - August 2007

  • Worked as a local study coordinator at the KAVRU, Kamphaeng Phet, Thailand

  • Prospective Studies of Avian Influenza Transmission in Asia

  • PI: Dr. Gregory Gray

  • Follow 1600 adults with exposure to poultry in Cambodia and Thailand for the evidence of avian influenza infection for over three years

  • Collaboration with the United States Department of Defense overseas laboratories and Ministry of Health officials in Thailand and Cambodia

Interventions activities l.jpg

  • Assisting a local staff obtain an Institutional Review Board (IRB) approval from the Thai Ministry of Health (MOH)

  • Selecting field sites by compiling and updating demographic and animal-related data from local public health offices and villages

  • Assisting in writing a Standard of Operating Procedures (SOP)

    • Designing a log number system for specimen collection and processing

  • Planning for village enrollment

Collaborating research centers l.jpg
Collaborating Research Centers

  • The Center for Emerging Infectious Disease (CEID)

    • Research center in the College of Public Health at the University of Iowa, Iowa City, Iowa

    • Focuses in researching emerging infectious diseases with special interest in emerging respiratory viruses such as adenoviruses, human metapneumovirus, and influenza

  • U.S. Naval Medical Research Unit No. 2 (NAMRU-2)

    • Department of Defense overseas laboratory located in Jakarta, Indonesia

    • Its primary mission is to study infectious diseases of military importance in Asia

    • A satellite laboratory in Phnom Penh, Cambodia

Armed forces research institute of medical sciences afrims l.jpg
Armed Forces Research Institute of Medical Sciences (AFRIMS)

  • Located in Bangkok, Thailand

  • Established in 1958 to study cholera epidemic in Thailand

  • Current research interests include vector-borne diseases, malaria, emerging infections, and enteric diseases of military importance in Asia

  • Over 40 field sites and research laboratories in Southeast Asia

  • Funded by the US Department of Defense

Afrims mission objectives l.jpg
AFRIMS - Mission & Objectives

  • Monitor and assess potential disease threats - especially emerging infectious diseases

  • Evaluate new drugs and vaccines for prophylaxis and treatment of militarily important infectious diseases

  • Develop and test new forward-deployable rapid diagnostic methods

  • Investigate and test new control measures against infectious disease vectors to interrupt disease transmission

  • Define the epidemiology of militarily-important diseases endemic to tropical regions

  • Advise the Commander-in-Chief (CINC), Pacific Command and the U.S. Ambassador, Thailand on tropical disease threats

  • Develop infrastructure and continue proactive training, development and technology transfer to Thai medical research for Thai control and responsibility

Kamphaeng phet afrims virology research unit kavru l.jpg
Kamphaeng Phet-AFRIMS Virology Research Unit (KAVRU)

  • One of AFRIMS’ satellite research laboratory

  • Has been involved with vaccine developments and field testing of new vaccines

  • Current project: Prospective Study of Dengue Virus Transmission and Disease in Primary School and Village Children in KPP (2003-07)

    • As of 2007, finished collecting 4-year-surveillance data

    • Planning a vaccine trial involving 2000 school children

Avian influenza bird flu l.jpg
Avian Influenza (“bird flu”)

  • AI is an infectious disease of birds caused by type A strain of the influenza virus, which causes a wide range of symptoms in birds

  • AI do not normally infect humans. Highly pathogenic strains such as H5N1 may cause severe respiratory illness in humans

  • Most of human cases have occurred among those in close contact with infected birds or objects contaminated with their feces

  • However, a virus may mutate and be easily transmissible between humans leading an influenza pandemic

World Health Organization

Ai in southeast asia l.jpg
AI in Southeast Asia

  • H5N1 outbreaks in many Asian countries since late 2003

    • Among poultry (5): Bangladesh, Indonesia, India, Myanmar, and Thailand

    • Human cases (2): Indonesia and Thailand

  • 25 human cases in Thailand*

    • 17 cases have been fatal

    • Most cases occurring in 2004

    • Last reported case in Sept 2006

  • A need for good epidemiological collection and surveillance system

*As of November 12, 2007, WHO

Study objectives hypothesis l.jpg
Study Objectives/Hypothesis

  • Design:

    • A three-year prospective study of H5N1 transmission among 1600 adults with exposure to poultry in Asia: 800 subjects from KPP, Thailand and 800 subjects from Kampong Cham Province, Cambodia.

  • Objectives:

    • To monitor adults with poultry contact for evidence of H5N1 infection

    • To determine risk factors for H5N1 infection among people with close poultry exposure

    • To characterize H5N1 isolates associated with human infections

  • Hypothesis:

    • Prevalence and incidence of H5N1 infection will be higher for those with more hours of exposure to poultry per week than those with less hours.

Study components l.jpg
Study Components

  • Enrolling subjects

    • Sera and questionnaires collected

  • Weekly home & annual follow-up visits

    • Report any Influenza-Like Illnesses (ILI)

    • Village health workers

  • Investigation of ILI

    • 24-hour on-call staff

    • Serum & throat swabs collected

  • Family study of influenza transmission

    • Family members asked to participated

  • Specimen processing

    • KAVRU, CEID, Thai MOH

Kamphaeng phet province kpp l.jpg
Kamphaeng Phet Province (KPP)

  • One of the 76 provinces in Thailand

  • Mainly rural

  • Total population: 728,000

    • Male: 362,000

    • Female: 366,000

  • Region most affected by an outbreak of H5N1 in 2004-05

  • Extensive culling occurred to control the outbreak, which lead to significant depopulation of poultry

  • Since, culling has been discouraged due to decreasing reports of large poultry die-offs

  • Many have repopulated their poultry

  • Caging of poultry encouraged yet poorly enforced



Field site selection l.jpg
Field Site Selection

  • Source of information:

    • Ministry of agriculture and Livestock office provided animal-related data

    • Local public health offices provided specific info on housing layout and population demographics

  • Selection criteria:

    • Distance to healthcare facility

    • Distance to KAVRU

    • Density of poultry in sub-district

    • Population

    • Number of households

    • Density of animals such as fighting-cocks, ducks, pigs, wild birds, and cats

    • Recent outbreak of AI (2004 or 2005)

Field site selection cont l.jpg
Field Site Selection (cont.)

  • Eight sites selected in the Meung District, KPP

  • Accessibility

    • All sites are within 35 km from the KAVRU

    • Villages are within 10 min drive of a local PH office

    • Villages are near a major road unless otherwise specified

  • Exposure

    • Moderate to high animal-animal cross-interaction and human-animal interaction

    • Caging encouraged yet poorly enforced

    • Some villages have many fighting-cock breeders

    • Confirmed outbreak of AI in 2004-05

Log number system l.jpg
Log Number System

  • A multi-site study that involved collecting multiple numbers and types of specimens

  • Designed a log system for specimen collection/processing

  • Each site assigned a site code that every label will start with

  • Each subject assigned a unique number during enrollment

  • During family ILI-investigation, the number assigned to each family member will contain matching cohort number

    • Three family members with a subject number 089 at site T4

      • T408900 (cohort), T408901 (family #1), T408902 (family #2)

  • A letter at the end will indicate type of specimen

Results lessons l.jpg

  • I developed skills and knowledge to work well in a diverse public health setting and dealt with challenging situations involving an international study involving multiple sites

  • Learned to effectively communicate both in writing and orally to accurately relay information to public health professionals

  • I had the rare opportunity to interact and work with many public health professionals from various international organization.

  • I observed at first hand how the PH professionals were dealing with current challenges of emerging global PH threat

Recommendations l.jpg

  • Working closely with the Thai Ministry of Health (MOH) to obtain the IRB approval

  • Before an enrollment can begin,

    • Pilot testing questionnaires to a selected group of villagers

    • Conducting a village-wide meetings to inform villagers and local PH officials about the aims of the study

    • Creating a system for selecting houses so the research nurses will know exactly which houses to visit

  • Hiring more staff

    • A need of 24-hour on-call team for ILI investigation

    • Laboratory technicians, and research nurses

Communication skills l.jpg
Communication Skills

  • Participated in weekly teleconference calls with the PI and other collaborating researchers

  • Wrote weekly reports to inform the PI of daily activities

  • Kept in regular correspondence through emails

  • Relayed scientific information between the local staff and other researchers

    • Informed local staff about specifics about the study and relayed concerns of the PI

Analytical assessment skills l.jpg
Analytical/Assessment Skills

  • Collected and updated information on animal-related and demographic data in order to select eight field sites

    • Identified relevant and appropriate data and info source

    • Visited villages and discussed the info with the local staff to attach meaning to the collected data

    • Identified gaps and discrepancies in sources of the data

  • Designing a log number system for specimen collection

    • Assessed and analyze the main components of the study

    • Worked closely with the statistician and the local administrative team to identify and fix the problems of the system

Cultural competency skills l.jpg
Cultural Competency Skills

  • All-Nets

    • Three months of Thai tutoring lessons to learn about the culture and the language

  • Working with the local staff

    • Only foreigner in the laboratory

    • Learned to communicate with the staff who were at different levels of English

    • Consulted the local staff on site selection and log number system so that they also felt comfortable with the information and that the info applied to the local setting

    • Participated in several activities outside the work in order to learn about their culture and to share mine.

      • Playing sports, cooking, taking weekend trips, etc.

Acknowledgements l.jpg

  • Dr. Gregory Gray and the staff; The Center for Emerging Infectious Disease (CEID)

  • Drs. Robert Gibbons,In-Kyu Yoon, and the staff; The Armed Forces Research Institue of Medical Sciences (AFRIMS)

  • Dr. Thomas Cook and Kristina Venzke; The Minority Health International Research Training (MHIRT) program

  • The University of Iowa College of Public Health

References l.jpg

  • University of Iowa, 2006- Center for Emerging Infectious Diseases.

  • Council on Linkages Between Academia and Public Health Practice.

  • The World Health Organization. Avian Influenza fact sheet.

  • The Armed Forces of Research Institute of Medical Sciences.