Brazil

Salvador, Brazil


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

Salvador, BrazilAmelia Kasper, MD, MHS is a Global Health Equity Scholars Fellow studying dengue transmission patterns in urban slums of Salvador, Brazil. Here, she follows up with a resident of the Pau da Lima community who sought care at the local urgent care clinic for fever. 

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 and acute respiratory infections, vaccine preventable diseases and dengue.  The site also provides research training opportunities in non-communicable diseases which affect slum populations such as hypertension, food insecurity and violence.  Furthermore, Fiocruz and Yale coordinate a NIH-sponsored Global Infectious Disease Training Program (D43 TW00919) and sponsored ten Fulbright fellows and ten Global Health Equity Scholars and Fogarty International Clinical Research Scholars fellows in the past 10 years. Please contact the site PIs for more specific details.  On-going projects 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 evaluating the effectiveness of this rapid test for diagnosis and in combination with treatment, preventing life-threatening complications.
  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 to build an understanding of the links from leptospirosis in its reservoirs to 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: https://portal.fiocruz.br/
Yale: http://publichealth.yale.edu/emd/research/urban/index.aspx
http://publichealth.yale.edu/emd/people/albert_ko-3.profile