Building Capacity for Surveillance and Diagnosis of Respiratory Viruses in Sarawak, Malaysia (2017-2018)

Background

In recent history, emerging respiratory viruses have led to considerable human and animal morbidity and mortality across Southeast Asia. The region is considered a hotspot for novel respiratory virus emergence as often dense populations of humans and domestic animals live in close proximity. Some areas have the additional risk of pathogen emergence due to the mixing of pathogens reservoired in wild animals with the human and domestic animal populations.

Such is the case for the state of Sarawak in eastern Malaysia. Sarawakians often engage in marketing and eating jungle products such as wild mammal meat. Novel pathogens have been detected there, including the recent detection of a fifth species of human malaria (Plasmodium knowlesi).

Project Description

This Bass Connections project builds on an existing Duke University/Duke-NUS Medical School respiratory research project in Sarawak. This project team will expand the hospital-based respiratory virus surveillance project to the surrounding community, focusing on areas where dense populations of humans and animals mix. The team will partner with Sibu Hospital and Sarawak’s State Health Department in surveilling for influenza viruses, coronaviruses, adenoviruses and enteroviruses of human or animal origin in medical waiting rooms, open markets, poultry and swine farms and meat processing plants in Sarawak.

The goals of this project are to provide knowledge regarding respiratory pathogens that may circulate in public or agricultural spaces and to train Sarawakians and Duke University/Duke Kunshan University students in conducting such surveillance. The team will use a community-based approach to complement the hospital-based study, working toward a common goal: to improve understanding of the factors contributing to the spread of respiratory illness, ultimately enhancing preparedness for and possibly prevention of disease outbreaks. Team members will work toward the following objectives:

  1. Adapt bioaerosol sampling for respiratory viruses in various community settings in Sarawak (medical waiting rooms, open markets, poultry and swine farms and meat processing plants).
  2. Train Sarawakian public health professionals and Duke University/Duke Kunshan University students in conducting such surveillance, including both laboratory molecular work and aerosol sampling methods.
  3. Conduct occupational surveys in these public or agricultural settings to understand knowledge, attitudes and practices related to the spread of respiratory pathogens and inform the future development of educational materials to reduce the spread of infectious disease.
  4. Develop graduate trainees’ abilities to work collaboratively and with cultural competency in new settings.

Team members will conduct fieldwork in two primary locations: semiurban Sibu and the isolated jungle village of Kapit. Students will visit open markets and other areas where populations of humans and animals share space. They will use off-the-shelf aerosol stationary samplers in these settings as well as ask workers to wear backpack-mounted bioaerosol samplers to assess occupational respiratory virus transmission risk. Filtrates from these samplers will be studied by the team as supervised by virologists at Duke University and Duke-NUS Medical School for the four virus types. Team members will administer a survey to workers in these public and agricultural settings to understand knowledge, attitudes and practices related to the spread and etiology of respiratory illnesses, providing valuable sociocultural information that will help to increase understanding of information obtained from hospital patients and to identify areas appropriate for educational outreach.

Anticipated Outcomes

Preliminary data to guide grant submissions; scientific abstracts and manuscripts for submission to conferences and scientific journals; improved capacity for detection of viral pathogens; educational materials to prevent the spread of respiratory viruses

Student Opportunities

All students will be encouraged to attend Duke’s three-week One Health Training Program in early Summer 2017 (no tuition charges for master’s students). This nine-credit program instructs students in the interdisciplinary One Health approach and includes a basic virology course. Students will then travel to Sibu, Sarawak, for approximately 11 weeks of field and laboratory work. The team will work out of the Hospital’s Clinical Research Center.

In Sarawak, students will gain experience conducting field research in a foreign community setting as well as learn some molecular diagnostic techniques. Undergraduates will have the opportunity to extend their learning by enrolling in an independent study with Dr. Gray in future semesters of their undergraduate training, and they will have the option of contributing to publications that result from the project. Master’s students will gain valuable experience working collaboratively and supervising teams of researchers. They will have the opportunity to develop their components of the team project into their thesis projects as well as to participate in writing peer-reviewed scientific publications.

A team of five Duke University students (three master’s level and two undergraduates) and one Duke Kunshan University master’s student are expected to work on the project for at least six weeks before travel to Sarawak and for 12 weeks after returning. The Duke Kunshan student will necessarily link via email and Skype.

Students are expected to work in Sarawak for approximately 11 weeks. When not in Sarawak, students will be required to attend biweekly project meetings throughout the academic year, and will also submit monthly activities to the master’s student project manager by 5:00 p.m. before each meeting. When in Sarawak, team members will meet daily, and each Friday they will send via email a weekly report to team leaders and participate in periodic Skype conference calls. At the midway point of each semester, team members will meet individually with Dr. Gray to discuss their progress, concerns and goals for the remainder of the project term. Team members will be encouraged to blog about their experiences in the field and during other stages of the project.

We are recruiting individuals from various disciplines and educational levels. We plan to engage two global health master’s students and two Duke undergraduate students (particularly those majoring in global health, biology, environmental science or engineering). While previous laboratory experience is recommended, it is not required. One of the master’s students will serve as the project manager and be responsible for documenting the team’s progress toward milestones, leading team meetings and directing communications among team members and leaders. The other master’s student will serve as the assistant budget manager, tracking the team’s expenses and communicating with grant managers on fund administration.

In addition, a master’s student from Duke Kunshan University has been identified, as has a third-year Duke medical student now studying at Duke-NUS.

Timing

Spring 2017 – Spring 2018

  • Spring 2017: Begin developing proposal and materials for summer fieldwork; draft study IRB applications with consent forms and questionnaires; optimize bioaerosol backpack sampling approach; meet in person biweekly to prepare for fieldwork/discuss project
  • Summer 2017: Participate in Duke One Health Training Program (suggested); travel to Malaysia; collect bioaerosol samples in various public and agricultural settings; assist Sibu Hospital staff with molecular assays; administer surveys to community members, enter data and analyze data; assist with existing research study in Sibu and Kapit hospitals
  • Fall 2017: Analyze bioaerosol samples in laboratory; analyze survey data; identify gaps in knowledge/possible areas for educational intervention; present poster at Duke Global Health Showcase
  • Spring 2018: Write up findings; develop educational materials for use in later work; submit for publication

Crediting

Independent study credit available for fall and spring semesters; summer funding

Themes

Faculty/Staff Team Members

Kristen Coleman, Duke-NUS Medical School, Singapore
Gregory Gray, School of Medicine - Infectious Diseases*
Nathan Thielman, School of Medicine - Infectious Diseases*

Community Team Members

Multiple Contributors, State Health Department, Sarawak, Malaysia
Teck Hock Toh, Sibu Hospital, Malaysia

* denotes team leader

Status

Active