Transcript LTG BLANCK

Armed Forces Research Institute of Medical Sciences
Welcome from AFRIMS
A joint medical research facility of the
Royal Thai Army and the United States
Army Medical Research and Development
Command
“…probably the most
sophisticated diagnostic and
research laboratory in all of
Southeast Asia.”
U.S. Institute of Medicine report on DoD-GEIS, 2001
Armed Forces Research Institute of Medical Sciences
Major Research Initiatives at
AFRIMS
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Japanese Vaccine Development in 1990s
Dengue Vaccine Development – current
HIV Vaccine Development – current
Diarrhea Research and Surveillance of Drug
Resistance
• Malaria Drug Development (mefloquine,
tetracycline, new artemisinins) and
Surveillance of Drug Resistance
• Mosquito and other Insect Biology
• Emerging Diseases Surveillance and Response
Armed Forces Research Institute of Medical Sciences
Global Emerging Infectious
Diseases Surveillance (GEIS)
• What is an Emerging Disease?
• a new disease, not previously described (e.g. SARS)
• an underestimated disease (e.g. leptospirosis),
• a re-emerging disease, often with increased drug resistance
(MDR-TB or MDR-Pf)
• The DoD-GEIS program at AFRIMS:
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Febrile illness surveillance (Sangkhlaburi, Kamphaeng Phet, Nepal)
Drug resistant malaria surveillance
Drug resistant diarrheal pathogen surveillance
Rapid sentinel surveillance at RTA hospitals
Outbreak response
Armed Forces Research Institute of Medical Sciences
Summary of Presentations
• Fever Study
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Overview
Specific causes of fever
Clinical characterizations
Leptospirosis
Rickettsial Illnesses
Dr. Scott Miller
Dr. Mark Fukuda
Nichapat U-Thaimongkol
Dr. Ruth Ellis
Dr. Scott Miller
• Diarrhea Study
• Malaria Drug Resistance
• New Directions
Dr. Ladaporn Bodhidatta
Dr. Scott Miller
Drs. Krisada Jongsakul &
Mark Fukuda
Armed Forces Research Institute of Medical Sciences
Surveillance of Febrile Illnesses of
Adults in Sangkhlaburi District
1999-2003
Department of Immunology and Medicine
AFRIMS
Dr. R. Scott Miller, M.D.
Armed Forces Research Institute of Medical Sciences
Background
• AFRIMS started doing surveys for malaria
prevalence and drug resistance patterns
surveys in the Sangkhlaburi district in 1995
• Testing an antibiotic, azithromycin:
• for prevention of malaria in 1996;
• for treatment of PF with quinine in 2000-2001
• Started an relationship with Kwai River Christian
Hospital
• What is causing the other 70% of fevers at the hospital?
Armed Forces Research Institute of Medical Sciences
Objectives
• To define the specific cause of undifferentiated febrile
illnesses:
• To identify specific rickettsial, arboviruses and zoonotic
pathogens.
• To identify the patterns of drug resistance of diarrheal
pathogens and enteric fevers (typhoid)
• Evaluate the prevalence of these illnesses by sero-surveys
of the local populations
• To evaluate test kits for rapid diagnosis of undifferentiated
febrile illnesses as compared to standard diagnostics.
• Study approved by Committee on Research in Humans
Subjects, MOPH
Armed Forces Research Institute of Medical Sciences
Fever Study Methods
• Identify volunteers from those presenting to
with a fever or history of fever
• Informed consent obtained
• Blood drawn for:
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Malaria smear and rapid testing
WBC, HCT and platelet count
Renal and liver tests
Serum for acute serology testing
• Medical history and physical exam
• Treatment by hospital staff or volunteers
Armed Forces Research Institute of Medical Sciences
Fever Study Methods
• Return for follow-up visit at 3-4 weeks
• And earlier visits as needed
• Interim medical history and exam
• Additional blood drawn for:
• Repeat WBC, HCT and platelet count
• Renal and liver tests, if initially abnormal
• Serum for paired convalescent serology testing
• Fever syndrome classified by clinical and
laboratory features
Armed Forces Research Institute of Medical Sciences
Fever Syndrome Classification
a). fever with upper respiratory
disease
b). fever with lower respiratory
disease
c). fever with meningitis, encephalitis,
or neuropathy
d). fever with gastrointestinal
disease
e). fever with renal disease
f). fever with abnormal bleeding
g). fever with liver disease
h). fever with anemia, leukopenia or
thrombocytopenia
i). fever with hepatomegaly or
splenomegaly (circle)
j). fever with lymphadenopathy
k). fever with arthritis (mono- or
polyarticular)
l). fever with rash
m). fever with eschar
n). fever with shock
o). fever with non-specific
symptoms
p). isolated fever without systemic
symptoms
q). fever with other symptoms
(specified) _______________
Armed Forces Research Institute of Medical Sciences
Fever Study
Village Seroprevalence Study
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Cross-sectional surveys of adult volunteers
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End of dry season and rainy season (every 6 months)
1999-2001 (2 monsoon cycles)
Serum collection and malaria smear
Volunteers from three villages near KRCH (n=497)
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Viakadee (n=182)
Mong Satur (n=175)
Mong Satur Tai (n=140)
Tested for exposure to: rickettsia, leptospirosis,
and other animal diseases