Dr. Khan will spend his fellowship year the Public Health Research Institute in Mysore under the mentorship of A. Desiree LaBeaud, MD, MS, Purnima Madhivana, PhD, MBBS, MPH, Vijaya Srinivas, MMBS and Kiranmayee Muralidhar, MBBS, MP. . His research will focus on investigating the epidemiology and risk factors for dengue and chikungunya virus infections in southern India.
Dr. Khan is a pediatric infectious diseases physician at the Stanford University School of Medicine. He has research interests in studying infectious diagnostics in resource-limited settings and promoting antibiotic stewardship. Dr. Khan has recently been studying arboviral infections (dengue and chikungunya) in western and coastal Kenya with aspirations to im- pact global child health.
Project title: Investigating the epidemiology and risk factors for dengue and chikungunya virus infections in southern India
Project description: Arboviral infections have re-emerged as a significant global public health problem with chikungunya virus (CHIKV) transmission now occurring in 45 countries and dengue virus (DENV) transmission in 128 countries, placing nearly 4 billion people at risk (Fritzell, 2018; Bhatt, 2013). India has suffered repeated outbreaks of CHIKV and DENV in addition to other infections which can present with similar symptoms (Sharif, 2021; Ganeshkumar, 2018). Seroprevalence studies have attempted to estimate the true burden of CHIKV and DENV in India but often are hampered by spatial heterogeneity given the diversity across the country (Murhekar, 2019). Furthermore, although numerous studies have detailed molecular phylogenetic analysis for both viruses, there are few studies exploring the local risk factors and behaviors associated with infection in southern India (Rai, 2021). Interestingly, we and others have shown there is bidirectional transmission of DENV and CHIKV between Kenya and India (Sharif, 2021; Langat, 2020; Shah, 2020). CHIKV and DENV overlap in symptomatology and both are transmitted by diurnal Aedes aegypti mosquitoes, in contrast to malaria-transmitting nocturnal Anopheles spp. which feed at night (Karungu, 2019). In India and other parts of the world, as malaria diagnosis has become easier with high sensitivity point-of-care testing, vector-control strategies typically center around nocturnally-feeding Anopheles spp. mosquitoes. In Kenya, our laboratory has partnered with county and national members in the Ministry of Health to promote an integrated vector-control program that expands on the existing focus on malaria. Through this proposed pilot study, we aim to identify relationships that can be further explored in larger studies to uncover the burden of infection and better inform policy makers when considering resource allocation in southern India. To better understand these viruses in southern India we propose a pilot study to estimate community prevalence and associated risk factors. Through a cross-sectional study of adults and children we can survey the community to characterize their household factors, location, demographics, movement behavior, and built environment. In collaboration with the Public Health Research Institute in Mysore, India and the LaBeaud laboratory at Stanford University, I will work in the community to identify and survey participants, applying skills I have gained while working in Kenya. After participants are identified and surveyed, we will collect their serum to perform testing for DENV IgG and CHIKV IgG by ELISA to determine baseline seroprevalence. I will compare seropositive individuals with seronegative individuals to identify relationships pertaining to demographics, space, activity, behavior, and built environment factors. We have early data demonstrating an increased risk of arboviral infection with more surrounding trash and can also further explore this relationship in southern India. This can highlight important relationships when thinking about risk factors for infection. The goal of this pilot study is to generate meaningful data to further explore in a larger prospective study, similar to our prior and current laboratory work in western and coastal Kenya (Hortion, 2020; Grossi-Soyster, 2017).