Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System A Program Review (2001) / Chapter Skim
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6 GEIS at U.S. Army Medical Research Unit, Kenya
6 GEIS at U.S. Army Medical Research Unit, Kenya
Pages 99-120
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From page 99... ...
, the Kenyan governmental agency responsible for all biomedical research in Kenya. Research focused on the immunobiology of trypanosomiasis and on the development of a potential vaccine until the early 1980s, when investigators began research on Rift Valley fever, malaria epidemiology, and clinical and field aspects of leishmaniasis.
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From page 100... ...
. Limited virological capabilities are available within KEMRI through the KEMRI Center for Virus Research, a WHO Collaborating Center for Arbovirus and Viral Hemorrhagic Fever Reference and Research.
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From page 101... ...
At the time of the subcommittee's visit, the KEMRI Center for Virus Research did not possess the technology and reagents necessary to diagnose Ebola, Marburg, Lassa, or Crimean-Congo hemorrhagic fever.
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From page 102... ...
At all sites that the IOM subcommittee visited, USAMRU-K's physical facilities range from marginally adequate to basic. In addition, lack of reagents such as those that would be necessary to enable capabilities for the diagnosis of viral hemorrhagic fevers limits USAMRU-K's capacity to achieve its full potential as part of GEIS.
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From page 103... ...
The current lack of foreign service nationals among senior-level staff at USAMRU-K represents a missed opportunity for USAMRU-K and for GEIS. Given the scope of GEIS and the threat that viral infectious disease entities pose in Kenya and the region, the placement of another virologist within the KEMRI laboratory, funded by USAMRU-K, may also be worth considering for the purposes of expanding the scope of virological surveillance activities in country and providing USAMRU-K and GEIS with better access to virological support.
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From page 104... ...
However, an overall information plan a comprehensive strategy for making use of technical resources to share information with and receive information from public health partners does not exist. No regular surveillance bulletin or other means of routine distribution of GEIS project data is undertaken specifically by USAMRU-K, although KEMRI has plans to begin producing a quarterly newsletter that will provide updates on specimen numbers, diagnoses, epidemics, profiles of laboratory methods, staff profiles, and a forum for discussion.
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From page 105... ...
A GEIS implementation plan for fiscal years 2000 through 2004 has been developed. The primary areas of USAMRU-K GEIS program focus are as follows: · strengthening of the infrastructure for surveillance, · surveillance for the agents of dysentery and associated antibiotic resistance, · surveys of hantavirus and rickettsia in Kenya, · surveillance for viral hemorrhagic fevers, and · surveillance for drug resistance in malaria parasites.
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From page 106... ...
The installation of a backup generator at the KEMRI Virus Research Center has also contributed to strengthening of the infrastructure. Future plans include the expansion of the KEMRI communications network to connect all KEMRI investigators to the VSAT system and the contribution of funds to develop a laboratory with rooms dedicated to GEIS and geographic information system (GIS)
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From page 107... ...
Surveillancefor Fevers of Unknown Origin and Viral Hemorrhagic Diseases Surveillance for fevers of unknown origin and viral hemorrhagic diseases is being undertaken in collaboration with the KEMRI Center for Virus Research and is based in the same 24 mission and district hospitals as the study of Rickettsia. The KEMRI virologist has been proactive in reactivating these sites for the purpose of limited surveillance for hemorrhagic fever, an effort that receives GEIS support.
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From page 108... ...
Conclusions USAMRU-K is well positioned to meet the goals and objectives of GEIS and can substantially contribute to a global infectious disease surveillance and response network. Current and planned surveillance activities are generally in line with the GEIS mission, but these activities could be expanded, resources permitting.
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From page 109... ...
However, because influenza is one of the GEIS pillars and because influenza surveillance activities are lacking throughout much of Africa, it would be prudent to capture some information regarding currently circulating influenza viruses to enhance the global influenza surveillance effort. RESPONSE CAPACITY Epidemics of emerging infectious diseases with known and unknown origins occur regularly in Kenya and within Eastern Africa.
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From page 110... ...
In 1997-1998, during a Rift Valley fever epidemic in Kenya, USAMRUK was reportedly active in epidemic response efforts. It was also reported that at the time of this epidemic, additional diagnostic tools and staff resources were available to USAMRU-K.
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From page 111... ...
and viral hemorrhagic fevers. Other collaborative projects have included work on dengue virus transmission, measles virus shedding in HIV-positive individuals, and a study of fevers of unknown origin.
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From page 112... ...
Work with the WHO has focused primarily on support of surveillance for fevers of unknown origin by use of the WHO Yellow Fever Network (a network of sites that was active during the yellow fever epidemic of 1992-1993 in Kenya but that subsequently became inactive and that is now being redeveloped) , support for the KEMRI Center for Virus Research, and support for studies of hantavirus and rickettsia.
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From page 113... ...
Notably, USAMRU-K is not involved in managing the viral respiratory surveillance and acute febrile illness surveillance Projects being conducted by the GEIS Central Hub in Uganda. Conclusions ~ J USAMRU-K faces many challenges in a country that is lacking in basic public health and communications infrastructures and that is rife with political difficulties.
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From page 114... ...
Although the subcommittee was not able to meet with representatives of USAID, the WHO, the Oxford-Wellcome group, or MSF to fully explore existing partnerships and to discuss opportunities for and con~ · ~ rr ~ · 1 1 1 1 1 ~ 1 1 e 1 ~ 1 ~ stramts attectmg expanded collaboration, It would appear that each of these organizations, whose missions focus on improving and enhancing public health and infectious disease surveillance throughout the world, represents a potentially valuable collaborator. As the committee site visit occurred during the early stages of the Ebola virus epidemic in the Gulu District of Uganda, it was particularly evident that close collaborations with and support of the WHO Collaborating Center for Arbovirus and Viral Hemorrhagic Fever Reference and Research and its associated Yellow Fever Surveillance Network are important to USAMRU-K, to Kenya, and throughout the region.
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From page 115... ...
Direct involvement in the WHO integrated disease surveillance project seems to offer the potential to advance GEIS surveillance objectives. The subcommittee notes, with alarm, the fragmentation of GEIS activities within the region, as evidenced by a lack of coordination and communication between the GEIS Central Hub and USAMRU-K regarding surveillance projects for viral respiratory diseases and acute febrile illnesses in Uganda and Kenya.
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From page 116... ...
Such resources are crucial to the work of GEIS at USAMRU-K and, more generally, to public health surveillance and emerging infectious disease response capacities in Kenya. Recommendation: USAMRU-K and the GEIS Central Hub should facilitate the acquisition of reagents for the diagnosis of Ebola, Marburg, Crimean-Congo, and Lassa hemorrhagic fevers (and other infectious disease entities, as applicable)
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From page 117... ...
At the district level, this may include training and the provision of equipment and laboratory support. At the national level, this may include provision of equipment, communications support, and active participation in planning to address emerging infectious diseases.
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From page 118... ...
Recommendation: Effort should be directed to enhance the public health application of current GIS work (carried out in collaboration with the International Livestock Research Institute) so that such efforts can better result in information for action.
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From page 119... ...
Carter, head, Laboratory Programme, African Medical and Research Foundation Orgenes Lema, chief laboratory technologist, African Medical Research Foundation Brian D Perry, veterinary epidemiologist, coordinator, Epidemiology & Disease Control, International Livestock Research Institute Russ Kruska, GIS analyst, International Livestock Research Institute Andrew G
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From page 120... ...
Meet with Koech, director general, KEMRI International Livestock Research Institute (B.
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