Site: Salvador, Brazil

Global Health Equity Scholars Program

Focus: Urban slum health

Affiliation: Oswaldo Cruz Foundation (Fiocruz), Brazilian Ministry of Health; Yale Schools of Public Health and Medicine

Contacts: Mitermayer G. Reis, MD, PhD, miter@bahia.fiocruz.br; Guilherme S. Ribeiro, MD, PhD, gsribiero@gmail.com; Dr. Albert Ko, MD, albert.ko@yale.edu

Projects:Fiocruz, the research branch of the Brazilian Ministry of Health, and Yale University have a long-standing research and training program in the city of Salvador which focuses on health problems that have emerged due rapid urbanization and the growth of urban slum settlements.  The program focuses on infectious diseases such as leptospirosis, a rat-borne disease which is the cause of epidemics of pulmonary hemorrhage syndrome, bacterial meningitis, vaccine preventable diseases and dengue.  Furthermore, Fiocruz and Yale coordinate a NIH-sponsored Global Infectious Disease Training Program (Fogarty D43 TW00919) and sponsored eight Fulbright fellows and seven Fogarty International Clinical Research scholars and fellows in the past 10 years. Please contact the site PIs for more specific details.  On-going projects for fellows include:

1. NIAID-supported project, Natural History of Urban Leptospirosis(R01 AI052473), is a cohort study of 14,000 urban slum residents, initiated in 2003, which is characterizing the natural history of leptospirosis and determining the effectiveness of improved sanitation and other community-based interventions in preventing this zoonotic disease.
2. NIAID-supported International Collaboration in Infectious Disease Research program, Disease Determinants of Urban Leptospirosis(U01 AI088752) is applying combined field and translational research approaches to identify the pathogen, environment and host-related factors for leptospirosis and its transmission.  Projects in this program include active surveillance for leptospirosis and its severe disease forms, identification of virulence factors in the spirochete pathogen, development of environmental detection assays for the agent, and the use of proteome microarray to identify candidate antigens for diagnosis, prognosis and vaccine development.  The long-term goal is to identify new intervention strategies for this neglected tropical disease
3. NIAID-supported project, Rapid Serodiagnostic Test for Leptospirosis(R44 AI072856), has developed a point-of-care test for leptospirosis and is currently evaluating the effectiveness of this rapid assay for early diagnosis of the disease and when combined with timely therapy, for preventing life-threatening late-phase complications such as renal failure and pulmonary hemorrhage.
4. Fogarty-supported project, Ecoepidemiology of Leptospirosis in the Urban Slums of Brazil(R01 TW009504), was initiated this year as part of the NSF-NIH Ecology and Evolution of Infectious Disease Program.  The project performs a systematic interdisciplinary evaluation of the reservoir host, pathogen, environment and social determinants of urban poverty which is needed to understand the timing, location and intensity of leptospirosis epidemics.  We incorporate eco-epidemiological studies of rat and environmental reservoirs with long-term prospective studies of slum (favela) residents in order to build an understanding of the links from leptospirosis in its rodent and environmental reservoir to the risk of infection in humans.
5. Fogarty-supported project (Transmission of Drug-Resistant Streptococcus pneumoniae in Brazil, R01 TW007303), is tracking the incidence and risk factors for bacterial meningitis and the transmission of its causative agents, including S. pneumoniae, in Brazil. Furthermore current studies are determining the effectiveness of vaccine interventions against bacterial meningitis in urban slum populations.
6. Brazilian Ministry of Health and Fogarty-supported project (Disease Burden of Dengue in Brazil) is characterizing the transmission of urban dengue using on-going active surveillance systems and cohort studies in the city of Salvador.  The overall aim is to obtain baseline epidemiological information on dengue and prepare a field site for future clinical trials which will evaluate an inactivated dengue vaccine that is being developed as a joint venture between Fiocruz and private pharmaceutical industry partners.

Webpages for sites and research programs: 
Fiocruz:  http://www.bahia.fiocruz.br/
Yale:       http://publichealth.yale.edu/emd/research/urban/index.aspx
http://publichealth.yale.edu/emd/people/albert_ko-3.profile

Qualifications of potential trainees:Posdoctoral fellows who are graduates of PhD, M.D. and D.V.M. programs; Pre-doctoral trainees who are Ph.D. candidates who completed the first two years of their program, post-third year medical school students, D.V.M. degree candidates who completed their basic science courses and one year of clinical clerkship prior to the start of the fellowship year, post Master’s of Science/MPH level trainees.