COMMAND BRIEF COL Thomas M. Logan

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An introduction to GEIS
and DOD Tropical
Medicine Pathways
LTC Kofi Wurapa MD, MTM&H
GEIS Director
21 Nov 2012
Agenda
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Background of GEIS
Infectious disease in the US Military
USAMRU- Kenya: Historical over view
GEIS: History, Mission, Activities in Africa
US Military GME
Tropical Medicine: Options
Options open to partners
Disease non battle injury
Why a presence out side the USA is Key
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WW II: Enteric infections, Malaria, Respiratory
Vietnam: Enteric infections, Malaria
Gulf War: Enteric infections, Sports injury
OEF: Enteric infections, NB injury
OIF: Enteric infections, NB injury
Liberia: 2003: 241 USMC, 41% attack rate of
AFI, evacuation cost 2.1 million, termination
of mission. Malaria. 2 deaths currently
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USAMRU-Kenya
Background
• Established in 1969 at the invitation of the
Kenyan Government to study trypanosomiasis in
Western Kenya
• Permanently established in 1973
• One of 6 US military overseas research labs
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USAMRU-K ORGANIZATIONAL
FOOTPRINT
Overseas Labs
WRAIR/NMRC
USAPHC
(Prov)
Germany
NHRC
Korea
Egypt
USAFSAM
Thailand
NMCPHC
Kenya
Peru
Southeast Asia
GEIS Vision and Mission
Established by a Presidential directive in 1996 tasking the
DoD to play a significant role in disease surveillance globally
• Vision: Successfully develop, implement,
support, and evaluate an integrated global
emerging infectious disease surveillance and
response system that promotes preparedness
in the US Forces, the Military Health System and
the Global Public Health community.
Mission: Contribute to Force Health Protection
and Global Public Health by centrally
coordinating a global system of partners that
conduct emerging infectious disease surveillance
and response; research, training and capacity
building; innovation and integration; and
assessment of value added in a timely, efficient,
comprehensive and communicative manner.
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GEIS Operations
Complex Pillar:
Human, Vector,
Environment
AR = Antimicrobial Resistance
STI
STI
DRO
AR
GI
GI
RI
ARD
FVBI = Febrile and Vector-borne
Infection
Febrile
FVBI Dis
Force Health Protection
RI = Respiratory Infection
GI = Gastrointestinal Infection
Great DoD
Significance
Strategic Goals and Priority Pillars
Outbreak and
Capacity building
STI = Sexually Transmitted
Infection
Surveillance and Response
Training and Capacity Building
Research, Innovation and Integration
Assessment and Communication of Value Added
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2012
Global Emerging Infections Systems(GEIS)/ Department of Emerging Infectious Diseases (DEID)
= full time GEIS employees
LTC Eyako Wurapa
Director DEID
= Partial salary from GEIS
= unfilled GEIS positions
Berhane Assefa
Deputy Director DEID
Program Support
Scientific Sections
Admin/ Logistics
Leah Muthigani
QA/ QC
Julia Wangui
(Influenza)
Procurement
Evangeline Kinya
Property Manager
Keneth Mitei
(Influenza)
Accounts
Wilfred Chepkwony
Site Coordinator
Duke Omariba
Leah Muthigani
STI Surveillance
Dr. Margaret Mbuchi
Laboratory Manager
Valerie Oundo
Attachment/
Training
Janet Majanja
Finnley Osuna
Charles Magiri
Auxiliary Staff
Jacinta Wanjiru
(Influenza)
Maintenance
Edwin Webala
Jesse Waitherero
Principal Scientist
Dr. Lillian Musila
Laboratory
Manager
Dr. Samoel Khamadi
Entomology
MAJ. Josh Bast
Influenza/
Respiratory
Dr. Wallace Bulimo
Enterics
Dr. Brook Danboise
Dr. Willie Sang
Serology
Dr. Samson Limbaso
Victor Ofula
AFI
Dr. John Waitumbi
Genomics Platform
Benjamin Opot
Cell Culture
Albina Makio
Edith Koskei
Samuel Owaka (data)
Laboratory Manager
Nancy Nyakoe
Database
Manager
James Njiri
Database Mgt
Epidemiology /
Study Design
Molecular
Caroline Ochieng
Albert Nyunja
Beth Mutai
George Awinda
Maureen Maraka
Josphat Nyataya
Rachel Githii
Clean Cell
Culture
Steven Ocholla
MDR Malaria
Dr. Elizabeth Wanja
DTRA
Epidemiology
Training
Shirley Segecha
Laboratory
Manager
Rachel Achilla
David Oullo
Dan Ngonga
Simon Muriithi
Site Staff
Safety
Bonventure Juma
WHO Reference .
Virology
VHF, Arbovirus
Dr. Rosemary Sang
Laboratory
Manager
Elizabeth Odundo
Entomology
James Mutisya
Hellen Koka
Joel Lutomiah
Dunstone Betti
John Gachoya
Reuben Lugalia
Virus Isolation /
Characterization
Josphat Mwangi
Julia Wangui
Silvanus Mukunzi
Janet Ndonye
Margaret Koech
Ronald Kirera
Cliff Philip
Abigael Ombogo
Erick Kipkirui
Serology
Silvanos Mukunzi
Josephat Mwangi
Finnley Osuna
Alice Ketta
Keneth Mitei
Josephine Kabutu
Lab QA/QC
Janet Majanja
Janet Nyambura
Investigators
Dr. Ben Andagalu
Dr. Fred Eyase
Culture
Hosea Akala
Molecular
Angela Omondi
Dennis Juma
Agnes cheryuot
Charles Okudo
Redemptah Yeda
Molecular Biology and
Drug sensitivity Assay
Meshack Wadegu
Janet Majanja
Finnley Osuna
Biostatistics
Note: Site staff also report to PIs of the protocols which run at the sites they work in
Collaborations
Boston University
Makerere University Uganda
University of Buea Cameroon
University of California San
Diego
Uniformed Services University
Case Western Reserve University
University of Washington
Pfizer, Sanofi, GSK
PATH
Aeras
The Henry Jackson Foundation
University of Manchester
Cameroon Defense Ministry
Kenya Medical Research Institute
Kenya Ministry of Public Health and
Sanitation
Kenya Ministry of Medical Services
Kenya Ministry of Defense
Walter Reed Army Institute of Research
NAMRU-3
Global Virus Initiative
NIH
Wellcome Trust
WHO
CDC
USDA
Tanzanian Peoples Defense Force
DTRA
SPLA
Cost containment & Synergism
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University of Buea,
Cameroon
Makerere Univ Walter Reed
Project (MUWRP), Uganda
Kenya
Global Viral Forecasting (GVF),
Yaoundé, Cameroon
Tanzania People’s
Defense Force
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Field Site Growth
Key to growth
Kahawa Army Barracks
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Kenya Activities
• Respiratory: Flu (ILI/SARI) at 10 MOH and 5
KDF, Eldoret RTC: resp pathogens study
• Enterics: 10 MOH district hospitals, 1 KDF, RBA
• AFI: 10 MOH district hospitals, 3 UNHCR camps
• AR: 10 MOH for the MDR, MCoE
• STI: 2 MOH district hospital, 2 KDF clinics
• Capacity: Student program, GCLP, GCP, IATA
• Support the NIC and VHF labs
Surveillance Activities in
Cameroon
• Two GEIS-funded
laboratories
GVFI
UoB –LEID
• GVF: 6 sites
Mamfe
– Influenza surveillance in
the six French speaking
regions of Cameroon
Bamenda
Kumba
Buea
Niete
Hevecam
Abong Mbang
• UoB-LEID: 4 sites
– Influenza surveillance in
the four English speaking
regions of Cameroon
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Cameroon Activities
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Respiratory: Flu (ILI/SARI) at 10 MOH
Enterics: X
AFI: X
AR: X
STI: 1 Cameroon Defense Forces hospital
Capacity: GCLP, GCP, IATA
Capacity: 1 CDF hospital lab, BSL x 2
University of Buea collaboration
Uganda
Sites
Makerere University
Walter Reed Project
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Uganda Activities
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Respiratory: Flu (ILI/SARI) at 4 MOH
Enterics: X , AFI: X
AR: Bombo UPDF hospital
STI: X
Capacity: GCLP, GCP, IATA
Capacity: Referb 4 DH, 1 UPDF hospital
lab, BSL x 2
• DoD Student exchange program in
development
Tanzania: Surveillance Sites
80% Civilian patients
TPDF sites
MOHSW sites
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Tanzania Activities
• Respiratory: Flu (ILI/SARI) at 1 MOH, 2
TPDF clinics
• Enterics: X,
• AFI: Vector and Human study
• AR: X, STI: X
• Capacity: GCLP, GCP, IATA
• Capacity: Referb 2 TPDF labs, BSL2 x 1
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FY 12 accomplishments
Staff training/ Maintaining of certifications
Student program formalized (30K)
Journal Club: in its 3rd year
Increased Mil-Mil activities (KDF, UPDF,
TPDF, SPLA)
Epidemiology training program- Kenya
(700 MOH mid-level public health staff)
Renovations (Kenya: Alupe, Kissi, Kisumu, Eldoret,
Cameroon: Yaoundé, Uganda: Bombo, Tanzania: Lugalo)
• South Sudan: planning phase
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Eldoret clinic during renovation
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Eldoret Clinic
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HPSP/ USUHS / Off
Street
Residency:
US Army GME
Specialty
/
Fellowship
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Available Tropical Medicine
Trainings
• Global Medicine: 2 weeks in San Antonio TX
– Physicians
– Medical Administrators
– Physicians who’s formal training has been >10
years
– Not recommended for staff with no formal
training
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US Military Tropical Medicine
• USUHS in Bethesda, MD
• Dr. Dave Blazes
• Open to Physicians, Clinical Officers: about to
deploy, dermatologist
• Required for Preventive Medicine Residency
• 6 Weeks: 4 wks didactic, 2 wks field portion
• Have sent non US staff with justification
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MTM&H
ASTMH Certification
• USUHS, Bethesda, MD
• Open to physicians: Required part of ID
fellowship training
• MPH course work, 5 months of didactic in
Tropical Medicine, 6 month field, or may be
credited for past work
• ASTHM: certification upon completion of the
above and a certification exam at ASTMH
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One Health Global Medicine
• Most common for our GEIS staff
• University of Florida
• Open to Physicians and other researchers:
needing a foundation of Epidemiology and
Biostatistics
• Nomination process
• 4 weeks at the University of Florida
• On line: based on individual
• 41 credits towards education at UoF
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Other Non Physician Experts
• PhD Scientists with a range of expertise:
• Maters level staff: Limited to Lab specific
management skill sets
• Epidemiologist
• Biostatisticians
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Thank you
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“When a Gazelle wakes up in Africa, it knows to be
alive at the end of the day, it must run faster than
the fastest Lion. When the Lion wakes up in Africa,
it knows it must out run the slowest Gazelle in
order not to starve to death.
To me this means when you wake up in Africa no
matter who or what you are, you better start
running!
Author unknown
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Thank You
MOH: ministry of health
CDF: Cameroon Defense force
KDF: Kenya Defense Force
UPDF: Uganda Peoples Defense Force
TPDF: Tanzania Peoples Defense Force MCoE: Malaria Diagnostics Center of Excellence
MTM: Military Tropical Medicine
RBA: Royal British Army
Activity
Kenya
Uganda
Cameroon
Tanzania
# of
sites
MOH
MOD
Respiratory
Enterics
Acute
Febrile
Illness
Anti
microbial
Resistance
Sexually
Transmitted
Illness
# sites
# sites
# sites
# sites
# sites
10
5
YES
YES
YES
YES
MOH 10
KDF 5
MOH 9
KDF 1
RBA 1
MOH 10
4
1
YES
X
6
2
YES
0
2
YES
MOH 4
X
Human
Capacity
Infra
structural
Capacity
YES
YES
YES
MOH 5
MOH 2
KDF 2
MCoE
MTM
X
YES
X
YES
X
X
MOH 2
UPDF 1
MOH 6
CDF 2
TPDF 2
YES
MTM
YES
YES
YES
YES
YES
MOH 1
CDF 1
X
X
X
X
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