Albert Ko, MD

The Division of International Medicine and Infectious Disease, Weill Medical College of Cornell University (Cornell) has had a joint training and research program on endemic tropical diseases with Brazilian institutions in the city of Salvador since the 1964. More recently, the investigations of Cornell and its Brazilian collaborators have brought to attention infectious diseases, such as epidemic leptospirosis, which have emerged in the urban setting due to rapid urbanization and increasing social inequality. Through the Fogarty-sponsored International Training in Emerging Infectious Diseases (ITREID) Program, we have been established at the Oswaldo Cruz Foundation (Fiocruz), Brazilian Ministry of Health in Salvador: 1) a multidisciplinary team of epidemiologists, clinicians, microbiologists and basic researchers, 2) on-going population-based surveillance for leptospirosis and bacterial meningitis; 2) a diagnostic laboratory that is now the national reference center for leptospirosis surveillance; 3) a molecular strain typing center, and 4) field sites to perform community-based longitudinal studies designed to identify determinants of transmission for leptospirosis and the etiologic pathogens for bacterial meningitis. Moreover, ITREID projects have convinced the Brazilian government to prioritize emerging infectious diseases such as leptospirosis, and in turn have led to national projects to sequence the Leptospira genome and develop a vaccine against leptospirosis. The infrastructure created at Fiocruz since 1996 provides a vehicle to pursue multidisciplinary training approaches for emerging infectious diseases. In this program, we are using leptospirosis and bacterial meningitis as disease models to address the following specific objectives: 1) Expand training opportunities that will provide Brazilian trainees at the Oswaldo Cruz Foundation (Fiocruz) the capacity to develop treatment, control and prevention strategies for emerging infectious diseases; and 2) Work jointly with the Brazilian Ministry of Health to disseminate expertise already established at Fiocruz in laboratory-based surveillance, outbreak investigations and molecular epidemiology to other regions of Brazil. The program emphasizes the use of in-country expertise and resources to provide training. For the first aim, we proposed long-term training to 6 predoctoral and 2 postdoctoral fellows each year to address specific needs in expertise within the areas of clinical and field epidemiology, molecular epidemiology, pathogenesis and biotechnology application to develop public health interventions. In-country training provided by outstanding Brazilian mentors will be augmented with short training experiences in the institutions of long-standing US collaborators. For the second aim, Fiocruz is working with the National Center of Epidemiology, Brazilian Ministry of Health in providing short-term training opportunities and a yearly course, the National Course in Molecular Epidemiology in Emerging Infectious Diseases, which are designed to enhance the capacity of local public health epidemiologists and reference laboratory staff to perform laboratory-based surveillance and apply molecular strain typing tools to epidemiological investigations.