Environmental Epidemiology in Latin America: Environmental Hotspots of Vector-borne Parasitic Infections (2019-2020)

Background

Throughout the Americas, people living in the Amazon are among the most vulnerable to adverse health outcomes. Exogenous stressors, including demand for natural resources, agricultural expansion and seasonal climate events, drive much of the health burden.

Vector-borne diseases such as malaria, dengue and leishmaniasis are especially problematic. Since 2014, no other region in the world has experienced a faster increase in malaria cases than in the Amazon. This began during the 2011-2012 Amazon flood, which caused cases in Peru, Colombia and Venezuela to double in less than two years, and cases in Ecuador to increase five-fold. Another parasitic infection of great concern is cutaneous leishmaniasis (CL), a severely neglected and highly stigmatized disease. Of the 1.5 million cases worldwide, about 90% occur in nine countries, including Peru and Colombia. CL is believed to be spreading into peridomestic and periurban areas as a result of agricultural expansion and deforestation. 

Project Description

Previous Bass Connections project teams have conducted multiscale studies of malaria and CL involving vector and wildlife collections, human surveillance, land use and climate monitoring. This research has demonstrated a strong correlation of environment and ecosystem services with vector-borne disease risk.

Building on these projects, the goal for the 2019-2020 Bass Connections project is to improve research, communication and education of the risk of parasitic infections in the Western Amazon.

The project team will develop a harmonized dataset of hydrometeorological data for the Amazon. The U.S. National Climatic Data Center provides downloadable data for 42 weather stations in Peru, 68 in Ecuador and 64 in Colombia; however, only half have current data, and over 300 stations exist in each country. The team will perform a web-scraping of hydrometeorological data for all Amazon Basin countries, producing a regional map containing geocoded stations, visualization aids and a portal to download parameters. In addition, team members will meet with government personnel to obtain missing data and create sharing agreements for purposes of improved disease monitoring and surveillance.

From health posts in Peru and Ecuador, the team will obtain surveillance blood slides of malaria and leishmania to conduct genetic sequencing. The objectives are to demonstrate proof of concept regarding collection of surveillance samples and processing for genetic sequencing, and to overlay and analyze parasite genotypes on tropical landscapes to evaluate causal associations of transmission.

Anticipated Outputs

Website on Essentials of Malaria in the Amazon, where hydroclimate data repository for the Amazon will be housed; poster presentations at Duke and at Triangle Global Health Consortium annual conference; 1-2 peer reviewed publications; preliminary data for future grant applications

Student Opportunities

Ideally, this project team will include 3-4 undergraduates and 2 graduate students representing a range of academic backgrounds and interests. Ernesto Ortiz and Robert Rolfe will serve as project managers.

Graduate students pursuing the MEM or MScGH are encouraged to apply. Undergraduate students should have an interest in global health. Spanish-language skills are preferred.

In general, students in the following areas are well-suited for the team:

  • Natural/environmental sciences: Students with a background in ecology, forestry, GIS, remote sensing or hydrometeorology would be beneficial to the project, particularly to inform the processing and interpretation of environmental factors associated with disease.
  • Health sciences/pre-med: Students with interest in health sciences would be beneficial to evaluate clinical reporting of symptoms.
  • Social sciences: Students in economics, political science and international comparative studies could help communicate key policy areas across international borders within South America.
  • Humanities: Students with an orientation to cultural anthropology could contribute to the project in the development of qualitative guides for study participants and health clinics.

The team will meet weekly to work collaboratively on the project. Tasks will be divided according to the skills and interests of the students on the team. Undergraduate students will be tasked with discrete deliverables (e.g., web-scraping) and assist in the development of visualization tools.

Students will have the opportunity to develop unique skills, such as communication and collaboration across training levels and disciplines and cross-culturally with partner organizations; development of a study protocol and IRB application; human subjects research in a community-based setting; data management and analysis; and presentation of research findings through a variety of mechanisms.

Graduate students will have the opportunity to apply more specialized skills in research design, analysis and interpretation, based on their expertise and academic discipline. They will also have the opportunity to lead academic manuscripts or posters. We anticipate that the master’s student will use the data to write an academic thesis.

Student travel opportunities are to be determined. Tentatively, two groups of students would travel to Peru and Ecuador in Summer 2019 for various lengths of time (3-4 undergraduates for 8 weeks; 1 master’s student for 10 weeks; 1 Ph.D. student for 4 weeks; 2 M.D. students for 4-8 weeks). During the fieldwork period, students would work full-time on the project.

Timing

Fall 2019 – Spring 2020

  • Summer 2019 (Optional): Approximately May 15 to July 31; Week 1-2: Project launch; collaborative visits to government institutions housing meteorological data; visits with CDC-Peru and CDC-Ecuador for recommendations regarding climate visualizations; Weeks 3-6: Team 1 visits to San Martin and Loreto regions of Peru for obtaining blood slides for genomic testing, Team 2 visits to Sucumbios, Orellana and Pastaza Amazon regions of Ecuador to obtain blood slides for genomic testing; Weeks 7-10: Visit to PUCP Genomics Laboratory to evaluate whether slides have sufficient DNA to process
  • Fall 2019: Convene first meetings with master’s and Ph.D. students; refine study goals and scope; identify potential funding sources; submit funding proposals; solicit applications from undergraduate and master’s students
  • Spring 2020: Convene first meetings with undergraduates; begin plan for web-scraping hydrometeorological data; design website structure and define visualization tools; draft IRB and study protocols for review by international collaborators (genomic testing piece); submit IRB protocols; finalize project materials and prepare for fieldwork (e.g., develop communication protocols, contingency plans, training agendas; program tablets for electronic-based data collection)

Crediting

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

See earlier related team, Environmental Epidemiology in Latin America: Impacts of Artisanal Gold Mining in the Peruvian Amazon (2018-2019).

 

Image: A la vuelta, by Sergio Ubaldo Rios Bardalesm, licensed under CC BY-NC-SA 2.0

A la vuelta, by Sergio Ubaldo Rios Bardalesm.

/faculty/staff Team Members

  • Justin Lana, Nicholas School - Environment-Ph.D. Student*
  • Marco Marani, Nicholas School of the Environment-Earth and Ocean Sciences
  • Ernesto Ortiz, Duke Global Health Institute*
  • William Pan, Nicholas School of the Environment-Environmental Sciences and Policy*
  • Robert Rolfe, School of Medicine-Medicine: Infectious Diseases*
  • Steve Taylor, School of Medicine-Medicine: Infectious Diseases

/zcommunity Team Members

  • Asociacion para la Conservacion de la Cuenca Amazonica
  • Centro de Estudios, Investigaciones, y Servicios en Salud Publica (CENSAP)
  • Center for Amazonian Science and Innovation (CINCIA)
  • Instituto de Investigaciones de la Amazonia Peruana (IIAP)
  • Mariana Leguia, Pontifica Universidad Catolica del Peru
  • Andres Lescano, Universidad Peruana Cayetano Heredia
  • Alejandro Llanos, Universidad Peruana Cayetano Heredia
  • Carlos Mena, Universidad San Fancisco de Quito