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/