University of Massachusetts Medical School 2016 Global Health Poster Session

Exploring Schistosomiasis Research in a High Prevalence Setting – Kisumu, Kenya

Rebecca Gwaltney

University of Massachusetts Medical School and the Kenya Medical Research Institute/Centers for Disease Control

Introduction Community Engagement and Education Immunology Studies

Objectives

Field Work and Sample Collection

Parasitology Studies

Conclusion

Acknowledgements • University of Massachusetts Medical School (UMMS) – Global Health Pathway • Kenya Medical Research Institute/Centers for Disease Control (KEMRI/CDC) Neglected Tropical Disease Branch • Dr. Ann Moormann – UMMS • Dr. Michael Chin – UMMS • Dr. Maurice Odiere – KEMRI/CDC • Dr. John Michael Ong’echa – KEMRI/CDC

To observe the ongoing research studies at the Kenya Medical Research Institute/Centers for Disease Control (KEMRI/CDC) Neglected Tropical Disease Branch relating to schistiosomiasis.

To increase my understanding of schistosomiasis in a high prevalence setting,

from the perspectives of research, clinical practice, and public health. To develop a lasting network of contacts within the schistosomiasis research

community at KEMRI/CDC.

Household questionnaires are used to determine community perspectives and knowledge of schistosomiasis transmission in high prevalence areas around the lake. All KEMRI/CDC studies involve a health education component, in which community members and school children are educated about schistosomiasis and best hygiene practices to prevent transmission.

Several KEMRI/CDC studies require the collection of samples in the field – including urine, stool, and blood. Other data collected for studies includes anthropometric measurements, physical exam for hepatosplenomegaly, ultrasound imaging, and household hygiene questionnaires.

Stool samples are prepared and examined in the KEMRI/CDC Parasitology lab, using the Kato-Katz method. Light microscopy reveals the presence or absence of schistosome eggs in the feces. Egg count is used as a proxy for intensity of infection.

Blood samples are processed in the Immunology and Flow Cytometry labs for a variety of experiments. In one study, schistosome antigens are introduced to the blood samples and then cultured for observation of the immunological response to the parasite antigens.

Throughout my experiences observing each of these research groups and engaging with these communities, my understanding of schistosomiasis in a high prevalence setting was dramatically increased.

References

I learned many laboratory techniques, qualitative measures of assessing the burden of schistosomiasis, and study designs. I also developed relationships with the schistosomiasis research community at KEMRI/CDC, which I hope to draw upon in the the future.

• Schistosomiasis is a chronic neglected tropical disease, caused by trematode parasites of the genus Schistosoma.1, 2 • It is a major global health concern – at least 200 million people are affected and 600 million people are at risk worldwide.1, 2 • Schistosomiasis is a disease of poverty that disproportionally affects children in sub-Saharan Africa – disabling symptoms of infection include anemia, malnutrition, stunted growth, and impaired cognitive development.1, 2

• Schistosomiasis is widespread around Lake Victoria in western Kenya – over 9 million people are infected and another 16 million in 56 districts are at risk.3 • The Kenya Medical Research Institute/Centers for Disease Control (KEMRI/CDC) Neglected Tropical Disease Branch has a number of ongoing studies addressing this major public health issue in western Kenya.

1. Colley, D.G., Bustinduy, A. L., Secor, W. E., & King, C. H. (2014). Human schistosomiasis. Lancet, 383 (9936), 2253-2264.

2. Knopp, S., Becker, S. L., Ingram, K. J., Keiser, J., & Utzinger, J. (2013). Diagnosis and treatment of schistosomiasis in children in the era of intensified control. Expert Review of Anti-Infective Therapy, 11 (11), 1237-1258.

3. Odhiambo, G. O., Musuva, R. M., Atuncha, V. O., Mutete, E. T., Odiere, M. R., Rosabella, O. O., Alaii, J. A., & Mwinzi, P. O. O. (2014). Low levels ofawareness despite high prevalence of schistosomiasis among communities in Nyalenda Informal Settlement, Kisumu City, Western Kenya. PLOS Neglected Tropical Diseases.

Figure 1: Schistosome Lifecycle. Adapted from Colley, Bustinduy, Secor, and King.1

Figure 2: Map of Kenya. Adapted from http://globalvillageextra.com/wp-content/uploads/2014/06/Map_of_Kenya.gif

Members of the KEMRI/CDC Neglected Tropical Disease Branch gather for a photo.

Household surveys are administered and school children are educated about schistosomiasis.

Stool samples are prepared and examined under light microscopy, via Kato Katz technique.

Blood is drawn and ultrasound imaging obtained from school children living on the lake.

Blood samples from the field are prepared for immunological studies in the lab.

A school directly on Lake Victoria that is participating in a KEMRI/CDC study.