1. An introduction to GEIS and DOD Tropical Medicine Pathways LTC Kofi Wurapa MD, MTM&H GEIS Director 21 Nov 2012

2. Agenda 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

3. Disease non battle injury Why a presence out side the USA is Key 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 3

4. 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 4

5. USAMRU-K ORGANIZATIONAL FOOTPRINT

6. Overseas Labs Peru Kenya Egypt Thailand Southeast Asia NHRC USAFSAM WRAIR/NMRC Germany Korea USAPHC (Prov) NMCPHC

7. GEIS Vision and Mission 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. 7 Established by a Presidential directive in 1996 tasking the DoD to play a significant role in disease surveillance globally

8. GEIS Operations ARD GI Febrile Dis DRO STI Assessment and Communication of Value Added Research, Innovation and Integration Surveillance and Response Training and Capacity Building RI GI AR STI FVBI Force Health Protection RI = Respiratory Infection GI = Gastrointestinal Infection FVBI = Febrile and Vector-borne Infection AR = Antimicrobial Resistance STI = Sexually Transmitted Infection Strategic Goals and Priority Pillars 8 Outbreak and Capacity building Complex Pillar: Human, Vector, Environment Great DoD Significance

9. Global Emerging Infections Systems(GEIS)/ Department of Emerging Infectious Diseases (DEID) Program Support Scientific Sections Admin/ Logistics Leah Muthigani QA/ QC Julia Wangui (Influenza) Procurement Evangeline Kinya Property Manager Keneth Mitei (Influenza) Safety Bonventure Juma Attachment/ Training Janet Majanja Finnley Osuna Charles Magiri Database Mgt Auxiliary Staff Jacinta Wanjiru (Influenza) MDR Malaria Dr. Elizabeth Wanja Influenza/ Respiratory Dr. Wallace Bulimo Cell Culture Albina Makio Edith Koskei Samuel Owaka (data) Serology Dr. Samson Limbaso Victor Ofula Molecular Caroline Ochieng Albert Nyunja Virus Isolation / Characterization Josphat Mwangi Julia Wangui Silvanus Mukunzi Clean Cell Culture Steven Ocholla Database Manager James Njiri Lab QA/QC Janet Majanja Janet Nyambura Genomics Platform Benjamin Opot Laboratory Manager Rachel Achilla Investigators Dr. Ben Andagalu Dr. Fred Eyase LTC Eyako Wurapa Director DEID Maintenance Edwin Webala Jesse Waitherero Accounts Wilfred Chepkwony Entomology James Mutisya Hellen Koka Joel Lutomiah Dunstone Betti John Gachoya Reuben Lugalia Epidemiology / Study Design Biostatistics WHO Reference. Virology VHF, Arbovirus Dr. Rosemary Sang 2012 AFI Dr. John Waitumbi Laboratory Manager Nancy Nyakoe Enterics Dr. Brook Danboise Dr. Willie Sang David Oullo Dan Ngonga Entomology MAJ. Josh Bast = full time GEIS employees = Partial salary from GEIS = unfilled GEIS positions Berhane Assefa Deputy Director DEID Site Coordinator Duke Omariba Leah Muthigani DTRA Epidemiology Training Shirley Segecha Josephine Kabutu Site Staff Laboratory Manager Dr. Samoel Khamadi STI Surveillance Dr. Margaret Mbuchi Laboratory Manager Valerie Oundo Molecular Biology and Drug sensitivity Assay Meshack Wadegu Janet Majanja Finnley Osuna Serology Silvanos Mukunzi Josephat Mwangi Finnley Osuna Alice Ketta Keneth Mitei Principal Scientist Dr. Lillian Musila Culture Hosea Akala Molecular Angela Omondi Dennis Juma Agnes cheryuot Charles Okudo Redemptah Yeda Janet Ndonye Margaret Koech Ronald Kirera Cliff Philip Abigael Ombogo Erick Kipkirui Beth Mutai George Awinda Maureen Maraka Josphat Nyataya Rachel Githii Note: Site staff also report to PIs of the protocols which run at the sites they work in Laboratory Manager Elizabeth Odundo Simon Muriithi

10. 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 10

11. 11 University of Buea, Cameroon Global Viral Forecasting (GVF), Yaoundé, Cameroon Makerere Univ Walter Reed Project (MUWRP), Uganda Tanzania People’s Defense Force Kenya

12. Field Site Growth Key to growth 12 Kahawa Army Barracks

13. 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

14. Surveillance Activities in Cameroon Two GEIS-funded laboratories GVF: 6 sites –Influenza surveillance in the six French speaking regions of Cameroon UoB-LEID: 4 sites –Influenza surveillance in the four English speaking regions of Cameroon 14 GVFI UoB –LEID Abong Mbang Hevecam Buea Bamenda Kumba Mamfe Niete

15. Cameroon Activities 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

16. Uganda Sites 16 Makerere University Walter Reed Project

17. Uganda Activities 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

18. Tanzania: Surveillance Sites 18 TPDF sites MOHSW sites 80% Civilian patients

19. 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

20. 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 20

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23. Eldoret clinic during renovation 23

24. Eldoret Clinic 24

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27. 27 HPSP/ USUHS / Off Street Residency: Specialty / Fellowship US Army GME

28. 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 28

29. 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 29

30. 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 30

31. 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 31

32. Other Non Physician Experts PhD Scientists with a range of expertise: Maters level staff: Limited to Lab specific management skill sets Epidemiologist Biostatisticians 32

33. Thank you 33

34. “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! 34 Author unknown

35. Thank You

36. 36 Activity# of sites MOH MOD Respiratory # sites Enterics # sites Acute Febrile Illness # sites Anti microbial Resistance # sites Sexually Transmitted Illness # sites Human Capacity Infra structural Capacity Kenya10 5 YES MOH 10 KDF 5 YES MOH 9 KDF 1 RBA 1 YES MOH 10 YES MOH 5 YES MOH 2 KDF 2 YES MCoE MTM YES Uganda4141 YES MOH 4 X X YES MOH 2 UPDF 1 XYES MTM YES Cameroon6262 YES MOH 6 CDF 2 XXXYES MOH 1 CDF 1 YES Tanzania0202 YES TPDF 2 X X XXYES 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

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