Information Technology Aplications in Tropical Diseases Andrés G. (Willy) Lescano, MHS, MHS, PhD Head, Department of Parasitology, and Director, Public Health Training US Naval Medical Research Unit-6 (NAMRU-6) Associate Professor School of Public Health and Management Universidad Peruana Cayetano Heredia

Disclaimers These opinions expressed are only my own. They do not reflect any position or policy of the U.S. Navy or the U.S. Government (USG) I am a USG employee and this work was prepared as part my duties. Title 17 U.S.C. § 105 provides that 'Copyright protection under this title is not available for any work of the United States Government.' Title 17 U.S.C. § 101 defines USG work as a work prepared by a USG employee as part of his/her official duties All studies described in this presentation were conducted according to local and international human subject research regulations

Outline Neglected Tropical Diseases Disease Surveillance Public Health Informatics Bio-informatics

Neglected Tropical Diseases (NTDs) Infections endemic to less developed regions (related to orphan diseases and drugs) Soil-transmitted helminths, Chagas, Leishmaniasis, yellow fever, dengue, among others Other conditions not even acknowledged (neglected NTDs) Neglected in comparison to HIV/AIDS, TB and malaria

WHO’s Department of NDTs Control

PLoS NTDs Journal

Peru-Europe TD Research UPCH-Antwerp extensive malaria and leishmaniasis collaboration Imperial College, Oxford & LSTMH TB diagnostics and epidemiology Wellcome Trust funded cysticercosis and STI/HIV/AIDS research

International Research Collaborations

Links between organizations

Peru’s Top Five Health Scientists (Web of Science, October 2011) Robert H. Gilman (JHU), 368 pubs Eduardo Gotuzzo (UPCH), 205 pubs Hector H. Garcia (UPCH), 130 pubs Gustavo F. Gonzales (UPCH), 95 pubs* Armando E. Gonzalez (UNMSM), 88 pubs * The only non-Tropical Diseases researcher

Disease Surveillance Monitoring spread of disease Predict, observe, minimize harm Traditionally, governments track cases detected in health facilities Mandatory reporting conditions mainly (WHO, GOARN, IHR), automated approaches

Google Flu Trends

Alerta + Vigila Near-real time surveillance platform created for developing countries +90% coverage in military health systems in Peru Versatile and adaptable to different settings: ships, border towns, etc Open source software developed with the Johns Hopkins Applied Physics Lab

Statistical Analysis of Surveillance Data Need for development of more specific outbreak/aberration detection methods Processing of large amounts of data controlling chances of false positive reports

Public Health Informatics ( NIH/FIC D43 TW008438, Garcia PJ) Quipu, Andean Global Health Informatics Research/Training Center, Open source e-health records system SMS and web-based patient education Cell phones + PDAs for field data entry

Evaluation of a Computer-based system using cell phones for HIV people in Peru (NIH/FIC R01 TW007896, Curioso WH) Qualitative + RCT assessment of SMS prevention/management approach Audience: HIV patients treatment under HAART Compliance + prevention messages

Common uses of Bioinformatics Primer design Multiple sequence alignments Use of sequence databases Performing similarity searches Building philogenetic trees

Bioinformatics on Tropical Diseases Extensive computational analysis required for processing whole genome sequencing from Malaria, Leishmania, Trypanosoma, etc. This vast amount of information requires extensive analysis to assembly sequences, identify genes, predict function and assign gene ontology Stored and available on databases like NCBI, Tritryp (Trypanosomatids) or PlasmoDB (Plasmodium).

Other applications Design of databases for drug target discovery for the identification of drug targets in NTDs For example, analysis of mRNA expression microarrays identified changes during the diferentiation of Leishmania promastigotes to amastigotes Lahav T et al, Multiple levels of gene regulation mediate differentiation of the intracellular pathogen Leishmania.

UPCH Bioinformatics Unit (Zimic M, Director) Development and application of tools and software to analyze large amounts of data Capacities in inmunoinformatics, drug design and discovery, protein structure prediction, genome assembly, etc. Focused on the creation and maintenance of databases, development of algorithms and computational techniques

Improved TB microscopy diagnosis (Zimic M, Trans R Soc Trop Med Hyg 2009 and Zimic M, PLoS One 2010) Simple collection of images of TB samples with mobile phone cameras for accurate diagnosis Locally-designed, highly affordable ($325) microscope 100% agreement of M. tuberculosis sputum diagnosis versus standard $5000 microscopes

Biomedical informatics Sarkar, J Translat Med 2010

There are major applications and opportunities to collaborate and conduct research in this field that are waiting for been discovered… We are just in the beginning. Where are we?

Regional Challenges Varied public investment in health infrastructure and research in the Americas, low in nearly all the Andean region Parallel in connectivity infrastructure, solid in country capitols but more limited in provinces and outlaying areas Need for more specialized, trained manpower

Summary Foundations established and positive initial experiences Some opportunities exist in Peru and probably several other countries to take advantage of current and future infrastructure Tropical Diseases can be a valuable test bed for new collaborations, harboring important home-grown science

¡Muchas gracias! Thank you very much!