Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System A Program Review (2001) / Chapter Skim
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2 GEIS at Naval Medical Research Center Detachment, Peru
2 GEIS at Naval Medical Research Center Detachment, Peru
Pages 29-46
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From page 29... ...
The agreement established a cooperative medical research program to study infectious diseases of interest to both parties. NMRCD is a field detachment of its parent command, the Naval Medical Research Center, Forest Glen, Maryland (GEIS, 2000g; NMRCD, 2000d)
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From page 30... ...
Currently, the largest-capacity laboratory maintained by the INS operates at BSL-2 and is located in Lima. NMRCD uses its laboratory capacity to support Peruvian infectious disease surveillance efforts by augmenting regional laboratory supplies and providing specimen-processing assistance when requested.
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From page 31... ...
Dedicated, contracted field personnel manage NMRCD field operations on a full-time basis. No full-time employee works exclusively on GEIS projects.
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From page 32... ...
An on-site data center supplies computer systems support, as well as data entry and analysis services and surveillance data reporting, as needed. At the Iquitos field site, access to e-mail, fax, telephone, and photocopying capabilities are available.
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From page 33... ...
Most GEIS projects are in their first year of full funding. Projects funded in fiscal years 2000 to 2004 include continued studies of drug-resistant malaria, surveillance for influenza and drugresistant enteric bacteria, as well as projects addressing acute febrile illness and entomological surveillance activities.
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From page 34... ...
The long-term goal of this project is the transfer of a sustainable antimalarial drug resistance program to host country public health authorities (NMRCD, 2000a,b)
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From page 35... ...
This study will be linked with other GEIS efforts, such as entomological, influenza, and antimalarial drug resistance surveillance activities. Improvements in regional laboratory capacity and the training of locals are additional benefits of this work.
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From page 36... ...
The current surveillance system generates local epidemiological bulletins and early warnings and alerts. Although the USAID investment is creating an impressive surveillance infrastructure for the rapid reporting of the incidence and prevalence of 14 legally notifiable infectious diseases, several observers noted that there is still room for greater analysis of the available data and for the subsequent use of the resulting information to formulate national health policy and to generate public health action.
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From page 37... ...
With the exception of the influenza surveillance pillar, GEIS project areas and Peruvian national epidemiological priorities are compatible. Malaria parasite antimalarial drug resistance, enteric pathogen antimicrobial drug resistance, and undiagnosed fevers (especially those due to arboviruses, such as dengue virus)
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From page 38... ...
However, NMRCD GEIS influenza surveillance projects are low cost as a result of ties with the DoD Laboratory-Based Influenza Surveillance Program, and they are of use to the global community. For example, specimens sent by NMRCD to the DoD Laboratory-Based Influenza Surveillance Program in April 1999 identified the presence of the influenza strain A/New Caledonia/20/99 in the Americas and influenced the WHO recommendation to include this strain in the 2000 Southern Hemisphere and the 2000-2001 Northern Hemisphere vaccines (Gaydos, 2001d; GEIS, 2000b; Kelley, 2000b)
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From page 39... ...
COLLABORATIONS Steps have been taken to integrate GEIS with current, ongoing activities at the INS, OGE, and the Universidad Peruana Cayetano de Heredia4Also of potential public health interest: only 50 to 60 percent of the deaths in Peru are registered, potentially masking emerging infectious disease threats. Sentinel surveillance of deaths in the 15- to 49-year-old age group may uncover deaths due to unrecognized infectious causes ~PAHo, 1998, pp.
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From page 40... ...
She has worked to establish and maintain relationships that will be vital to the success and integration of the work of GEIS into the Peruvian public health infrastructure. In addition, the FSN manager of the Iquitos field site has an understanding of the NMRCD mission, as a result of her years of working in the Lima laboratory before transferring to Iquitos.
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From page 41... ...
For instance, it may be useful to have the coordinators for all GEIS projects on AFI in all DoD laboratories develop criteria for definitions of cases for syndromic surveillance instead of having each site struggle with such criteria on its own. The review team heard several comments regarding the forms of support that NMRCD should be offering to in-country programs.
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From page 42... ...
Additional epidemiological support (including, but not necessarily limited to, a dedicated GEIS program manager) should be provided to help facilitate public health-oriented data analysis and study design and to provide a permanent link between NMRCD and the OGE national surveillance system, as well as other public health partners.
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From page 43... ...
Recommendation: NMRCD should take continued steps to maintain and enhance the multiple national and international partnerships that are necessary to fulfill the GEIS mission and build national capacity in Peru. · The subcommittee recognizes that the GEIS pillar disease areas are important ones and that defining these targets helps to provide some standardization of GEIS activities across sites, but the pillar structure should be flexible enough to permit, on a case-by-case basis, local infectious diseases that are of global concern (e.g., tuberculosis)
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From page 44... ...
Furthermore, it is important that the GEIS Central Hub review and approval process for GEIS projects provides NMRCD with follow-up guidance regarding project progress in a consistent and timely manner (see also Chapter 7~. Recommendation: Consideration should be given to revising the current GEIS project application and review process.
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From page 45... ...
1130 Return to NMRCD and Lunch 1600 Flight to Iquitos 1700 Arrive Iquitos 1830 Visit NMRCD laboratory/house Wednesday, June 21 0 730 Visit Lab oratorio Referencial Loreto 0900 Appointment with Dr. Carlos Calampa, Director, Loreto Regional Health Department 1000 Hospital de Apoyo de Iquitos 1100 Centro de Salud San wan 1200 Lunch 1530 Leave for airport 1700 Return flight to Lima
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From page 46... ...
46 Thursday, June 22 0800 Depart hotel 0830 Meeting with USAID VIGIA staff at USAID 1000 Meeting with Pan American Health Organization representative 1200 Return to NMRCD for lunch 1330 Follow-up discussions with NMRCD staff 1700 Return to hotel PERSPECTIVES ON GETS Friday, June 23 0815 Depart hotel 0900 Meet with staff, Universidad Peruana Cayetano de Heredia 1230 Return to hotel for discussion, drafting of preliminary assessment, and assignment of writing tasks
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