university of florida college of public health and health professions april 11, 2014
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Research Project and Internship Report on the Investigation of Schistosomiasis ( S. mansoni ) in Haiti Presented by Kevin J. Talbot. University of Florida College of Public Health and Health Professions April 11, 2014. Background of Research Project and Internship Initiation in Haiti. - PowerPoint PPT PresentationTRANSCRIPT
Research Project and Internship Reporton the Investigation of Schistosomiasis (S. mansoni) in Haiti Presented by Kevin J. Talbot
University of FloridaCollege of Public Health and Health Professions
April 11, 2014
Background of Research Project and Internship Initiation in Haiti
Early awareness of “Project Haiti” with UF and other opportunities with AHS upon program entry
Introduction to Dr. Madsen Beau De Rochars (PHHP) in early 2013
Initial proposition and development of Schistosoma mansoni investigation in Summer of 2013
Schistosomiasis Background The global impact : 2nd to malaria only
in parasitic diseases prevalence
Affects ~200 million people in additionto the 800 million people at risk
Annually: 70 million disability adjusted life years
NTDs affect at least 149 countries
Approximately 534,000 annual deaths
General Symptoms
Depends on the Schistosoma spp. Involved (Big: 5 : S. mansoni,, S. japonicum, S. mekongi, S. intercalatum, S.
haemotobium)
Katayama Syndrome Bladder and liver function impairment and scarringHepatosplenomegalyGastrointestinal cancers with chronic exposureHIV infection increased in infected women In children: anemia, growth retardation, mental retardation,
impaired renal function and other diarrheal symptoms
Schistosoma spp.
Reproductive Cycle
Source: CDC
Rationale & Foundation for Schistosoma mansoni Investigation
in Haiti 1. No official lab confirmed cases
2. Proximal geographical endemics-DR
3. Need for re-evaluation/current state of NTDs in Caribbean, (PAHO)
4. Intermediate host snails of Schistosoma spp. in Northern Haiti
5. Increased risk of infectious/parasitic diseases post-earthquake
6. Increased travellers post-earthquake
Main Goal of the S. mansoni Investigation in Haiti
To investigate the potential existence of schistosomiasis in Haiti as caused by the trematode Schistosoma mansoni utilizing an existing community of health partnerships and a cohort of school-aged children through the diarrheal surveillance program.
Research Project Methods and Data Attainment
1. Utilization of an existing cohort from the diarrheal
surveillance program
Existing program structure and IRB protocols
Existing community health partnerships and agreements
Existing sample collection system
Existing laboratory installations
Research Project Methods and Data Attainment (continued…)
2. Rationale for the selection of the Kato-Katz
technique
USAID, WHO : stool examination still the gold standard for parasitic screening
Ease of utilization in the field Reasonable sustaining costs Continuity of endeavors by staff Ability to screen other parasites
Research Project Methods and Data Attainment (continued…)
3. Brief description of the Kato-Katz
technique:
Based on WHO Parasitic Bench Aid Recommendations
Slightly modified to suit specific Gressier, Haiti Lab needs
1. Work station
preparation
2. Stool sieve
d through
mesh
3. Inserted in
template applicator
6. Systemati
c slide examination
5. Incubatio
n4.
Smear
preparation
7. Record all observations
8.Review and seek opinions as
needed
9. Recycle,
discard
and storage of resulting material
Research Project Methods and Data Attainment (continued…)
The stool samples for this research study were:
collected Jan 5 to Feb 7, 2014
5 different sites (de-identified)
collected during the dry season
processed within ~8 hours or less of collection
Microscopically examined within 24 hours of collection and processing
Research Project Methods and Data Attainment (continued…)
Sample Sites Distribution
Results: Summary of FindingsSummary of Sample
Site Collection (Total : 169)
6.50% 14.20%
12.40%31.40
%
35.50%
% Samples by Region
G-G (11)
Leog.(24)
Gressier (21)
Jacmel(53)
P-G (60)0
20
40
60
80Sample Site Frequency
Results: Summary of FindingsS. mansoni
Investigation Results False positives
No lab confirmed cases of S. mansoni in samples examined
2 suspected cases reviewed by Dr. Song and Dr. Davies
Results: Summary of Other Findings
Relevant key findings
21.9% of all samples collected (37/169) were positive for parasite infection
Most cases originated from Petit-Gouave and Jacmel
29.70%
46.00%
5.40%
13.50%5.40%
Parasites per Site
Jacmel(11)P-G (17)G-G (2)Leogane (5)Gressier (2)
Results: Summary of Other Findings
35.10%
16.20%
5.41%5.41%
5.41%
5.41%
2.70%2.70%
21.60%
Total Parasites Frequency (169 samples) Ascaris (13)*Trichuris (6)Teania (2)Hookworm (2) **Giardia (2)**B. coli (2)E. hystolitica (1)Fasciola (1)S. mansoni (0)Cysts/Others (8)
Discussion: Summary of Findings
Clearly, the results of this initial pilot study indicated no lab confirmed cases of S. mansoni in Haiti from the 169 samples analyzed through the Kato-Katz technique and microscopy examination. However, the results from this small scale pilot study are not sufficient to exclude the presence of S. mansoni in Haiti for several reasons including key limiting factors of the current study format as enumerated as follow:
Discussion: Limitations of Study
Sample size•169 samples•I.T. > 300
B. Glabrata•No samples from northern region
Kato-Katz sensitivity•Possibly missed cases
•Low endemic?
Discussion: Limitations of Study
S. mansoni endemic in Caribbean• Prevalence in
DR ?• Where?
Health care access• Potential
inadvertent exclusion of patients
Area of study• Not conducted
in all major cities
• Farming regions omitted
Strengths of Study
Built on partnership with local PH
authorities
Study endeavor is sustainable
Built on existing strong study foundation
Other Internship Activities : At a Glance
Strengthening of local health partnerships
Dissemination of findings to professionals
Development of research protocols
Training of Gressier lab personnel & beyond
Extensive translation work
Other Internship Activities : At a Glance
Environmental scan for Biomphalaria spp. and fresh water
Prepared inventory supplies list for S. mansoni research expansion
Prepared a correspondence for the intent of the Haitian Health Ministry
Assisted with cholera water sample surveillance
Public Health Competencies Acquired/Reinforced Through The Project Monitoring health status to identify and solve community health problems
Diagnosing and investigating health problems and health hazards in the community using an ecological framework
Informing, educating, and empowering people about health issues
Mobilizing community partnerships and taking actions to identify and solve health problems
Conducting research for new insights and solutions to health problems
Communicating effectively with public health constituencies in oral and written forms
Effectively managing public health programs and projects
Demonstrating ability to manage, analyze & interpret epidemiologic data
Conclusion
Future Research •Need for further NTDs research & awareness•Need for further schistosomiasis (S. mansoni) research•Immense opportunity for UF researchers/students
Health Partnership in Haiti •Possible and necessary•Partnerships maintenance vital to success•Numerous potential future external collaborators
UF Gressier Haiti Lab •UF Gressier Haiti Lab : “a golden mine for UF students and researchers
AcknowledgementUF –CPHHP-Dr. Beau De RocharsDr. Liang SongDr. Tony MaurelliDr. Stephen DaviesMeer TalamUF Gressier StaffSusan WhiteSlande CelesteThank You !!
References Benjamin E. et al ( 2011). Principles and Practice of Disaster Relief: Lessons From Haiti Mt Sinai J Med
78:306–318, 2011
Centers for Disease Control and Prevention (June 2011). Neglected Topical Disease. Online URL: http://www.cdc.gov/globalhealth/ntd/
Centers for Disease Control and Prevention (Nov 2012). Parasites – Schistosomiasis. Online URL : http://www.cdc.gov/parasites/schistosomiasis/
King CH, Dickman K, Tisch DJ. Reassessment of the cost of chronic helminthic infection: a meta-analysis of disability-related outcomes in endemic schistosomiasis. Lancet 2005;365:561-9.
PAHO/WHO (2007). Schisto PAHO/WHO Preparatory Meeting on Epidemiological Data Needed to Plan Elimination of Schistosomiasis in the Caribbean (St. George, Grenada, 13–14 December 2007)
Raccurt C.P., et al (1985). Biomphalaria glabrata in Haiti. Trans R Soc Trop Med Hyg. 1985;79(4):455-7.
Steinmann P, Keiser J, Bos R, Tanner M, Utzinger J. (2006). Schistosomiasis and water resources development: systematic review, meta-analysis, and estimates of people at risk. Lancet Infect Dis 2006;6:411-25
References WHO (2014). 10 Facts on malaria. Online URL:
http://www.who.int/features/factfiles/malaria/en/