Title: Tropical Diseases Research in Panama: Historical Perspectives and Current Opportunities
1Tropical Diseases Research in PanamaHistorical
Perspectives and Current Opportunities
- Joel G. Breman, M.D., D.T.P.H.
- Fogarty International Center
- National Institutes of Health
- Bethesda, Maryland, USA
- Workshop to Establish the Santiago Center for
Geographic Medicine and Emerging Tropical Disease - Santiago, Panama
- 67 December 2002
2- 40 Years of Tropical Medicine Research
- A History of the Gorgas Memorial Institute of
Tropical and Preventive Medicine, Inc. and the
Gorgas Memorial Laboratory - Willard H. Wright, D.V.M., M.S., Ph.D.
- Washington, 1970
- Reese Press, Baltimore, Maryland
3The Gorgas Memorial Laboratory, 1928-1968 Six
Epochs
- 1928 1934 (political will)
- Founded by Dr. Belisario Porras, President,
Republic of Panama - - Land
- - Building
- - U.S. Congress support
- 1934 1943 (scientific expertise)
- Staffing
- - Protozologist (C.M. Johnson)
- - Helminthologist (A.O. Foster)
- - Entomologist (C.E. Rozeboom)
- 1943 1949 (scientific priorities)
- Insect repellents, insecticides
- - U.S. Army Corps of Engineers
4The Gorgas Memorial Laboratory, 1928-1968 (2)
- 1949 1956 (public health priorities)
- Yellow Fever (Santo Tomás, Hospital)
- Yellow Fever Service of Panama
- 1956 1960 (resource increase)
- 150,000 from U.S. Congress (tripled budget)
- NIAID grant, leishmanasis
- 1960 1968 (resource increase)
- 500,000 from U.S. Congress for infrastructure
- Insectary
- Grants and gifts
-
5The Gorgas Memorial Laboratory, 1928-1968
Types of Research
- Core activities
- - Epidemiology
- - Treatment
- - Control
- - Laboratory work in support of field activities
6The Gorgas Memorial Laboratory, 1928-1968Types
of Research (2)
- Major themes
- - Malaria
- - Yellow fever
- - Other arboviral infections
- - Chagas disease
- - Leishmaniasis
- - Equine trypanasomiasis
- - Residual insecticides
7The Gorgas Memorial Laboratory, 1928-1968
Types of Research (3)
- - Helminithic and protozoal infections
- - Diarrheal diseases
- - Reservoir hosts
- - Immunology
- - Other herpetology, insect genetics
(Drosophila)
8Short- and Long-Term Research Trends
- Short-term
- - Equine trypanosomiasis, 1930-1946 (H.S.
Eakins), retirement horses used less - Equine helminthiasis, 1934-1939 (A.O. Foster)
- Cattle trypanasomiasis, 1940-1943 (war
priorities) - Intestinal helminths, 1930 (intermittent, E.C.
Faust) - Tropical climatology, 1941
- - Tuberculosis, BCG vaccination, 1949-1951 (taken
over by Servicio Cooperativo Interamericano de
Salud Publica)
9Long Term Projects
- Malaria, 1929 (H.C. Clark, C.M. Johnson)
- Chagas disease, 1931 (C.M. Johnson)
- Leishmaniasis, 1944 (M. Hertig, A. Herrer)
- Insect taxonomy, 1929 (D.P. Curry)
- Santa Rosa Field Station, 1931 and Chagres River
Villages (DDT use)
10How Research Projects Chosen
- Incidence, prevalence, epidemics
- Available staff
- Outside scientific collaboration
- Resources
- Serendipity
11Major Achievements
- Malaria, began in 1929
- Drug treatment
- - Quinine studies, 1931
- - Atebrin/plasmochin, 1935
- - Quinine/plasmochin, 1935
- - DDT house spraying, 1945 (continued to 1977)
- - Chloroquine/paludrine weekly, 1947
- Parasite rates dropped
- 26.5 ? 0.7 (CQ)
- 34.8 ? 1.5 (P)
- - Pyrimethamine/primaquine DDT, 1960
- (La Repressa and Mendoza villages) eliminated
disease after 2 months! - Maintained 2 years
- But 53 cases detected from 1962 - 1964
12Malaria (cont)
- Primate malaria
- - P. brasilianum, attempt transmission to human
volunteers, 1930 - - Immunity and P. falciparum, 1931
- - Human malaria to monkeys, 1966
- Aotus trivirgatus and P. vivax, 1967
- Aotus (night monkey)
- Ateles (spider monkey)
- Saquinus (marmoset)
- Cebus
- Transmission with Anopheles albimanus
- DDT resistance detected after 8 years of use,
late 1960s -
13American Trypanasomiasis (T. cruzi) Chagas
Disease, began 1931
- Diagnosis
- Prevalence
- Manifestations
- Treatment
- Epidemiology
- Hosts
- Vectors and ecology
- 3.8 positive of 1,251 tested by CF test, 1963
- 40,000 cases, 1966
14Chagas Disease (2)
Surveys, 1967 Number Pos
Blood bank 6,253 2.0
Outpatients 1,294 11.4
Surveys 399 12.5
- Studies in Santo Tomás Hospital
- Arrythmias (RBBB, LBBB, A/V block)
- Ventricular and atrial enlargement
- Ventricular aneurysms
- Treatment
- 8 aminoquinolines
15Chagas Disease (3)
- Parasitology and Ecology
- - T.cruzi found in 33 animal species dogs, rats,
positive - - T. rangeli found to cross-react
- Entomology and Ecology
- - Rhodnius pallescens efficient, but R. prolixus
(not native) could not be infected with local
isolates. - - Other triatomes identified, but R. pallescens
found in native houses of 3,203. 32.1 infected
with T. cruzi and 4.1 - 8.1 with T. rangeli
(non-pathogenic, 1960s)
16Leishmaniasis, 1944
- Epidemiology
- Treatment
- Vectors and ecology
- Findings
- - Forest disease, disappears when forests
cleared - - Pyrimethamine, 90 cure
- - Geographic strain differences
- - Natural infection in wild caught
Phlebotomines, infection rate 8.1 - - Animal model studies tried rats, mice,
hamsters, kinkajou, olingo, porcupine, marmoset - Succeeded with spiny rat
17Helminths, 1930
- Ascaris lumbricoides, common, 80 prevalence
- Necator americanus, common, 80 prevalence
- Trichuris trichiura, 1.0 - 21.0, pos.
- Strongyloides stercoralis, 20 pos. of 1,663 in
Santa Tomás Hospital with 10.5 of those positive
having symptoms - Mansonella ozzardi, 9.9 of 244
- Capillaria hepatica in 8 of 194 stools
- First report of Echinococcus oligarthrus from
fatal case seen in puma, jaguar, jaguarundi,
agouti - Trichinella spiralis EEE, Ilhéus virus, Jap B
encephelitis, ended fatally in animals
18Rickettsial and Viral Diseases
- Rickettsial
- Q fever, first report in Panama, 1946
- Murine typhus, first report, 1947
- RMSF, first report, 1951
- Viruses
- Mosquito vectors of yellow fever, first
description in Panama and Central America, 1949 - Vector ecology and transmission studies, 1949
- SLE, first recovery and identification of human
patients, 1957 - Ilhéus virus, first isolation, 1958
- Changuinola, first isolation, 1960
- New arboviruses discovered, Madrid, Ossa, Patois,
Zegla, 1961 - Wyeomia subgroup, first isolated from human, 1963
- Bussuquara, first isolation from human, 1964
- Ilhéus virus, first case of encephalitis, 1964
- SLE found Deinocerites (crab-hole mosquitoes) as
host, 1964 - Vesicular Stomatitis Virus, isolation from
humans, sentinel monkeys, 1968
19- Entomology
- - Dermatobia hominis (human botfly), lifecycle in
man, 1929 - - An. albimanus, first laboratory colony in
Central America, 1935 - - DDT for Phlebotomine control, 1944
- - DDT for Simulium control, 1945
- - DDT for Culicoides sandflies, 1945
- - Trombiculidae (chigger mites), habits and
ecology, 1945 - - Inventory of ticks and biting insects, 1966
- Miscellaneous
- - Inventory of poisonous snakes and incidence of
snake bites, 1930-1954
20Papers Published by the Gorgas Memorial
Laboratory, 1930-1969
Papers Mean
1930-1934 69 14
1935-1939 114 23
1940-1944 58 12
1945-1949 61 12
1950-1954 69 14
1954-1959 53 11
1960-1964 77 15
1965-1969 130 26
1930-1969 630 16
1943-1945 12 papers
21Major Topics in Publications by the Gorgas
Memorial Laboratory, 1930-1969
- Malaria, 60 papers
- Birds, 54
- Culicidae, 51
- Phlebotomus, 49
- Tabanidae, 47
- Animals, wild, 40
- Monkey diseases, 36
- Anopheles, 35
- Laboratory infection, 35
- Yellow fever, 26
- Laboratory techniques, 23
22Middle America Research Unit, National Institute
of Allergy and Infectious Diseases, Canal Zone
(1958-1972)
- Focus on arthropod virology
- Discovery of Machupo virus (Bolivian hemorrhagic
fever) - - Uncovered biology and ecology of virus, and
rodent reservoir leading to building arenavirus
family - Venezuelan Equine Encephalitis virus, discovery
of antigenic and equine virulence variants live
virus vaccine (TC-83) for lab workers - Vesicular stomatitus virus first clear
demonstration of transovarial transmission of an
arbovirus - Provided by Karl M. Johnson, MD, Director,
MARU, 1964-1972
23Every advantage in the past is judged in the
light of the future issue
Demosthenes
24Recent National Institutes of Health and
Government of Panama Collaborations
- National Cancer Institute, 1993-2001
- - Human retroviruses epidemiological survey at
Hospital - Santo Tomás and Research Triangle Park Institute
- - Establishment of cancer information center at
Instituto de Nacionale de Oncologie, Managua - National Institute on Drug Abuse, 1997-1999
- - Drug involvement among Latin Americans,
Departamento de Farmacodependencias and Johns
Hopkins University
25Recent National Institutes of Health and
Government of Panama Collaborations (2)
- National Institute on Deafness and Other
Communicable Disorders, 1997-2002 - - Neural basis of complex-sound processing
- - National de Recursos Naturales Renovables and
Washington University - Pan American Fellowship
- - PAHO/WHO partners with NIH
- - One year postdoctoral training in the NIH
intramural laboratories - - Focus on Caribbean, Central America and Andean
countries - - Regional public health issues are priority
26Recent National Institutes of Health and
Government of Panama Collaborations (3)
- Fogarty International Center
- - International Cooperative Biodiversity Group,
1995-1998 - Bioprospecting to discover new drugs for malaria
and other infectious diseases. Smithsonian
Tropical Research Institute, University of
Panama, Gorgas Memorial Institute for Health
Research, G.W. Hansens Disease Center
(Louisiana), Walter Reed Army Institute of
Research, Nature Foundation of Panama, Novartis,
Conservation International - - Fogarty International Research Collaborative
Awards - Bioprospecting in the Panamanian rainforest,
1995-1998 - Fundacion Para La Conservacion de Los Recursos
and the University of Utah - - Studies of Toxoplasma bradyzoite (1999-2002)
- Gorgas Memorial Institute for Health Research
and Stanford University
27Fogarty International CenterScience for Global
Health
MissionTo promote and support research and
training internationally to reduce disparities in
global health
28FUTURE
NEW INITIATIVES
CURRENT PROGRAMS
FOUNDATION
PLATFORM MISSION
29Fogarty International CenterDivision of
International Training and Research
- Extramural Training Grants 12 Programs
- Research Grants 5 Programs
- International Training Grants for U.S. citizens
Minority International Research Training Grant
(MIRT) Scientist Development fellowship
(post-doc) Foreign-funded fellowship (Japan)
30Fogarty International CenterTraining Grants for
Developing Countries
- HIV/AIDS
- Building Capacity in Support of ICIDR sites
- Emerging Infectious Diseases
- Environmental and Occupational Health
- FIC-NLM Medical Informatics
- Maternal and Child Health
- Population and Health
- Tuberculosis
- Research Bioethics
- Malaria
- Clinical, Operational, and Health Services
Research - Tobacco and Health Research
31Fogarty International CenterSupport Available
Through Training Grants
- Masters and Doctoral Degrees Tuition,
Stipends, Travel, Related Expenses - Post-doctoral Fellowships Tuition, Stipends,
Travel, Related Expenses - Short Courses (in U.S. or In-country) Tuition,
Travel, Per diem - Training-related In-country research grants,
Re-entry grants - Limited salary, Administrative support for U.S.
university
32Fogarty International CenterResearch Grants 7
Programs
- Ecology of Infectious Diseases
- Fogarty International Research Collaboration
Award - (FIRCA)
- HIV-AIDS and Related Illnesses Collaboration
Award - (AIDS-FIRCA)
- International Cooperative Biodiversity Groups
(ICBG) - International Studies on Health and Economic
- Development
- Proposed Global Health Research Initiative
Program - (GRIP) for New Foreign Investigators
- International Tobacco and Health Research and
Capacity Building Program
33Fogarty International CenterProgram
Characteristics
- Individual and Institutional Partnerships
- Long-term mentoring
- Advanced In-country Research (re-entry grants)
- Empowerment and mutual respect
- Networking
- Flexibility
- Leverage
- A systematic approach
- Stability and Long-term Commitment
- Response to Local Needs and Priorities
- Mutual Reinforcement of Investments in Training
and Research
34Fogarty International CenterExtramural Training
Grants
- Generally institutional training grant to U.S.
universities and non-profit research institutions
in response to a specific request for
applications (RFA) - Awardees are generally current NIH grant
recipients with demonstrated research
collaboration with foreign research institutions - Purpose support training for research-capacity
building for scientists from developing nations
35Sustainability in FIC Programs
Principles
- Commitment National Institutional
Trainee - Re-entry grants for trainees
- Diversified program themes
- Contribution of resources from all partners
36Sustainability in FIC Programs
Principles (continued)
- Sustained linkages
- Leveraged resources
- Dual appointments for faculty
- Connectivity via modern IT systems
- Centers of excellence in home countries
- Mutual benefits known to all
37Fogarty International CenterOn the Horizon
- Brain Disorders in the Developing World
- Trauma and Injury
- Health, Environment, and Economic Development
38Navigating Your Way
39FIC Website http//www.nih.gov/fic
40Fogarty International CenterScience for Global
Health
Priorities Emerging infectious diseases,
HIV/AIDS, malaria, tuberculosis, arboviral
diseases, population, environment,
tobacco-related illness, mental health,
economics, ecology, genetics, ethics, stigma
Priority areas are driven by disease burden and
scientific opportunity.
Priorities are set through background work,
consultations internally and externally
(especially Third World), international
conferences, coalition formation, national and
international organizations.
41Research, Training and Support Needs According
to Understanding of Diseases and Efficacy of
Interventions
High
High
Training
Efficacy of Control Methods
Research Needs
Low
Low
Some
High
Moderate
Research Support Needs
42Research, Training and Support Needs According
to Understanding of Diseases and Efficacy of
Interventions
High
High
Training
Efficacy of Control Methods
DengueMalaria HIV/AIDSTuberculosisEbola/Marburg
InfluenzaCancersAlzheimers
SmallpoxGuinea wormPoliomyelitisH. influenzae
type BMeaslesTetanus
Research Needs
Low
Low
Some
High
Moderate
Research Support Needs