Transcript Overview Briefing for AFRICOM Partners Health Engagement Forum

Emerging Infectious Disease
Surveillance and Response
US Army Medical Research Unit - Kenya
African Partner Outbreak Response Alliance
(APORA)
COL Rodney Coldren
22 April 2015
UNCLASSIFIED
Basis of US Involvement
•
The US National Security Strategy, February 2015, lists increasing
global health security as a key security component
“We will save lives by … developing a global system to prevent avoidable
epidemics, detect and report disease outbreaks in real time, and respond
more rapidly and effectively.”
•
US Global Health Security Agenda Objectives (selected)
o Prevent the emergence and spread of antimicrobial drug resistant
organisms and emerging zoonotic diseases
o Reduce the number and magnitude of infectious disease
outbreaks
o Launch, strengthen and link global networks for real-time
biosurveillance
o Train and deploy an effective disease surveillance workforce
•
Presidential Directive NSTC-7 (1996)
“The mission of the DoD will be expanded to include support of global
surveillance, training, research, and response to emerging infectious
disease threats.”
[email protected]
22 April 2015
UNCLASSIFIED
2
USAMRU-K
Background
•
An overseas activity of the Walter Reed Army Institute of Research
•
USAMRU-K was established in 1969 at the invitation of the Kenyan
Government; initial collaboration was with the Kenya Trypanosomiasis
Research Institute. Shifted to Kenya Medical Research Institute in 1979.
•
Based in Nairobi with major field stations in Kisumu and Kericho
•
USAMRU-K executes its mission through cooperative agreements with the
Kenya Medical Research Institute (KEMRI) and the Henry M. Jackson
Foundation-Medical Research International (HJF-MRI).
[email protected]
22 April 2015
UNCLASSIFIED
3
USAMRU-K
Mission
•
Develop and test improved means for predicting, detecting, preventing, and
treating infectious disease threats important to the U.S. military and the host
nation
•
Conduct surveillance, training, research, and response activities related to
emerging infectious disease threats
•
Partner in executing the President’s Emergency Plan for AIDS Relief (PEPFAR)
and the President’s Malaria Initiative (PMI)
•
Support the AFRICOM Commander’s health-related Theater Security
Cooperation activities through engagement of nations in the region in
conducting our mission
[email protected]
22 April 2015
UNCLASSIFIED
4
Surveillance Strategy in Kenya
•
Highly capable central laboratories
o Antimicrobial Resistance/STI (Nairobi/Kericho)
o Arbovirology Laboratory (Nairobi)
o Basic Sciences Laboratory (Kisumu)
o Entomology (Kisumu)
o Malaria Diagnostics Center of Excellence (Kisumu)
o Malaria Drug Resistance (Kisumu)
o Microbiology Hub (Kericho)
o Respiratory Laboratory (Nairobi)
•
Multiple small footprint surveillance sites
[email protected]
22 April 2015
UNCLASSIFIED
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USAMRU-K Central Laboratories
[email protected]
22 April 2015
UNCLASSIFIED
6
USAMRU-K DEID Surveillance Sites
MOH Site
KDF Site
[email protected]
22 April 2015
UNCLASSIFIED
7
Antimicrobial Resistance
•
Examine cause and antibiotic susceptibility of wound and other infections
of military significance
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Collect samples from both military and civilian sites
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Examine both community- and health-care acquired infections
[email protected]
22 April 2015
UNCLASSIFIED
8
Acute Febrile Illness Surveillance
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Determine the etiology of febrile illnesses that may be of local or military
significance
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Leishmaniasis surveillance
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Dengue endemicity studies
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Rickettsia in humans and domestic animals
•
Define epidemiology of these pathogens in Kenya
[email protected]
22 April 2015
UNCLASSIFIED
9
Enterics
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Highly capable, CAP-certified laboratory with ability to do both traditional
microbiologic work and molecular diagnosis
•
Examines bacterial, parasitic, and viral etiologies
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Significant work in antimicrobial susceptibility
[email protected]
22 April 2015
UNCLASSIFIED
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Malaria
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The Malaria Diagnostic Center of Excellence provides world-class malaria smear
reference reading and training
o Provides training for the East Africa Malaria Task Force supported by the US
AFRICOM Surgeon’s Office
•
The Malaria Drug Resistance Laboratory performs in vitro and in vivo analysis of
antimalarial drug resistance patterns and emergence
•
The Clinical Trials Center performs regulated trials of antimalarial
countermeasures
[email protected]
22 April 2015
UNCLASSIFIED
11
Respiratory
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Look at both Influenza-Like Illness (ILI) and Severe Acute Respiratory Illness
(SARI) cases
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Pathologies identified
o Influenza (A most common)
o Adenoviruses
o Enteroviruses
o Human parainfluenza viruses
o Human coronaviruses
o Human respiratory syncytial viruses
o Human rhinoviruses
o Human metapneumoviruses
[email protected]
22 April 2015
UNCLASSIFIED
12
STI
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Look for prevalence and risk factors for gonorrhea and chlamydia
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Antimicrobial susceptibility of gonorrhea isolates
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Samples will be sent to USUHS/IDCRP for further characterization and inclusion
in their repository
[email protected]
22 April 2015
UNCLASSIFIED
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Viral Hemorrhagic Fever / Arbovirology
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KEMRI laboratory operated collaboratively
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Serves as regional reference laboratory
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Combined unit of microbiologists, entomologists, and veterinarians
o True OneHealth approach
o Both laboratory and field elements
[email protected]
10 March 2015
UNCLASSIFIED
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USAMRU-K Regional Efforts
Emerging Infectious Disease Surveillance
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Tanzania
o Managed by non-profit PharmAccess
o Human influenza surveillance at Tanzania People’s Defense Force hospitals
o Testing at National Influenza Center
•
Uganda
o Managed by non-profit Makerere Univeristy Walter Reed Project (MUWRP)
o Human influenza surveillance and antimicrobial resistance work at Uganda
People’s Defense Force (UPDF) hospitals
o Migratory waterfowl influenza surveillance
o SAGES – Suite for Electronic Global Biosurveillance for the UPDF
[email protected]
10 March 2015
UNCLASSIFIED
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Examples of Recent Outbreak Engagements
by USAMRU-K
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2013 – Coastal Dengue (in collaboration with the KDF and MoH)
o Laboratory confirmation
o Entomologic investigation and intervention
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2014 – Q Fever in northern Kenya
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2014/15 – EVD/Marburg
o Served as national reference laboratory for Kenya
o Trained KDF, MoH, and UNISOM on PPE use and safe sample shipping
o Advised KDF on construction/establishment of an isolation ward
•
2015 - Cholera
[email protected]
10 March 2015
UNCLASSIFIED
16
Area of Potential Support for APORA’s
Outbreak Response Pillars
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Early Detection
o Highly capable laboratories for confirmatory testing
 Antimicrobial Resistance
 Arbovirus/VHF
 Enterics
 Febrile Illnesses
 Malaria
 Respiratory Illnesses
 STIs
o Training
 Malaria diagnostics
 PPE use
 Safe laboratory sample shipment
[email protected]
10 March 2015
UNCLASSIFIED
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Area of Potential Support for APORA’s
Outbreak Response Pillars
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Early and Efficient Response
o With a validated request approved by higher headquarters, can field a
limited response team to assist in the investigation of outbreaks
 Clinicians
 Entomologists
 Laboratory scientists
[email protected]
10 March 2015
UNCLASSIFIED
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The Army’s Home for Health…
Saving Lives and Fostering Healthy
and Resilient People
~ Partnerships Built on Trust