Grants Fund Ebola, Obesity & Other Global Health Research

The Explorations in Global Health faculty research grants are designed to foster the development of research partnerships and projects in global health. Grants are made to UNC faculty for international travel or to bring international colleagues to campus to establish or maintain research relationships (with the aim of applying for external funding) or to undertake small-scale, discrete research projects with international collaborators.

This year, the IGHID is supporting six, diverse projects in Nicaragua, West Africa, Indonesia, Sri Lanka, Tanzania and Mexico.

Will you be next? The 2015-16 call for applications will be released in October or November.

Sylvia Becker-DrepsNorovirus in Nicaragua
“Innovative laboratory techniques for evaluation of Norovirus transmission”

Sylvia Becker-Dreps, MD, MPH, Assistant Professor, Department of Family Medicine, UNC School of Medicine, and Ralph Baric, PhD, Professor of Epidemiology, UNC Gillings School of Global Public Health

Ralph BaricGastroenteritis is one of the most common causes of child mortality worldwide. Following the global roll-out of rotavirus vaccines, norovirus is now the most commonly detected enteropathogen in children with gastroenteritis, both in the community and in health facilities in developing countries. In Nicaragua, norovirus was detected in over one in five cases of gastroenteritis. A better understanding of risk factors for norovirus diarrhea and norovirus transmission patterns is crucial to develop effective control strategies. In particular, candidate norovirus vaccines are now entering clinical trials, and our work may inform targeted immunization approaches to avoid spread of norovirus within households.

William FischerEbola in West Africa
“Longitudinal study of Ebola survivor cohort to characterize the clinical sequelae of infection as well as create a biorepository of blood, semen, and vaginal secretions to determine the compartmental dynamics of virus replication and shedding”

William Fischer, MD, Assistant Professor of Medicine, Division of Pulmonary and Critical Care Medicine, UNC School of Medicine, and David Wohl, MD, Associate Professor of Medicine, Division of Infectious Diseases, UNC School of Medicine

David WohlThe Ebola epidemic currently devastating West Africa has evolved into an unprecedented humanitarian crisis. As of January 14, 2015, 21,296 infections and 8,429 deaths have been reported by the World Health Organization (WHO) – a likely underestimate but already eclipsing the numbers of infections and deaths in all previous Ebola outbreaks combined. While the rate of confirmed cases of Ebola is declining in Liberia and Sierra Leone, it is certain that regardless of the short-term trends in the epidemiology of this outbreak, the social, economic and healthcare dynamics in West Africa will long be altered. The proposed studies will better characterize the viral dynamics in urogenital compartments in a large survivor cohort in order to inform public health policies. In addition to addressing many unknown questions about EVD, the proposed investigations will provide opportunities for Dr. Fischer to develop skills in clinical research design and implementation in outbreak settings that will complement his expertise in emerging viral pathogens.

LinMalaria in Indonesia
“Malaria Relapses in Indonesia – Detecting genetic signatures of Plasmodium vivax relapse in Indonesian soldiers”

Jessica Lin, MD, Assistant Professor of Medicine, Division of Infectious Diseases, UNC School of Medicine

Plasmodium vivax, the most widespread human malaria parasite, causes over 100 million malaria episodes each year. Those infected can suffer periodic relapses, yet few persons receive adequate antirelapse therapy with primaquine because of the long courses needed and the drug’s side effects. Hence, P. vivax relapses drive ongoing transmission and represent an important obstacle to malaria elimination.

In Southeast Asia, up to two-thirds of P. vivax infections lead to relapse. Relapse potential seems to be intrinsically determined by parasite genetics: historically, those inoculated with different vivax strains exhibited different patterns of relapse. Unfortunately, studies of vivax relapse in endemic settings have been hindered by an inability to distinguish relapses (arising from activation of hypnozoites) from re-infections (due to new mosquito bites). One way to overcome this is to study relapses in persons returning to malaria-free areas where re-infection is impossible. This project aims to achieve a better understanding of the genetic determinants of P. vivax relapse by detecting genetic signatures of relapse among a unique cohort of returning Indonesian soldiers using next generation sequencing methods.

MoormanDengue Virus in Sri Lanka
“Deep sequencing dengue viruses from human clinical samples to identify viral determinants of severe disease”

Nathanial Moorman, PhD, Assistant Professor, UNC Department of Microbiology and Immunology

Dengue virus (DENV), transmitted by mosquitos, is the causative agent of dengue fever (DF) and dengue hemorrhagic fever (DHF). Once a public health problem in only a handful of countries in Southeast Asia, today DENV is endemic in over 100 countries worldwide, with over 400 million annual DENV infections resulting in more than 500,000 cases of severe DHF and 20,000 deaths. Dengue pathogenesis is strongly influenced by both host and viral factors. Amongst host factors, the role of pre-existing immunity is a topic of intense study. While it is well established that some dengue virus strains are more pathogenic than others, the viral genetic determinants of severe dengue remain to be defined. In 2009, a new strain of DENV1 emerged that caused more severe disease. This new DENV1 strain is responsible for the majority of current clinical dengue in Sri Lanka.

The project directly advances global public health by beginning to define the DENV genetic determinants underlying viral disease. This project also advances global public health by facilitating a nascent collaboration between Dr. Aruna Dharshan, Director of Genetech Research Institute (GRI) in Sri Lanka and UNC. Future collaborations will analyze samples from patients infected with the same DENV1 genotype that develop mild (DF) versus severe (DHF) disease, in order to determine how DENV1 genetic variation influences clinical outcome.

ChristinaShayDiabetes in Tanzania
“Expansion of Type 1 Diabetes Registries across East Africa (Expand existing T1D registry in Rwanda into several neighboring countries starting with Tanzania)”

Christina Shay, PhD, Research Assistant Professor, Department of Nutrition, UNC Gillings School of Global Public Health

The incidence of type 1 diabetes (T1D) is growing around the world and these trends are also evident in Sub-Saharan Africa. Few population-based estimates exist for the prevalence, incidence, or clinical characteristics of T1D in Sub-Saharan Africa and the majority of available reports were published several decades ago. This lack of knowledge has contributed to limited resources for T1D detection and treatment in this region and has led to significantly higher rates of diabetes-related complications and premature mortality in individuals with T1D in Sub-Saharan Africa compared to Western regions. At this critical moment in history, trends in T1D are dynamic yet poorly understood from a global perspective. Understanding the epidemiology and natural history of T1D in Sub-Saharan Africa is essential to improve patient care in this region where T1D is rapidly emerging as an urgent health care need.

SmithObesity in Mexico
“Mexico Sugar-Sweetened Beverage and Non-Essential Food Tax Evaluation”

Lindsey P. Smith, PhD, Research Assistant Professor, Department of Nutrition, Gillings School of Global Public Health

Currently, the prevalence of obesity in Mexico is over 33 percent for children 1-18 years old and about 70 percent for adults; and in 2006, the prevalence of Type 2 diabetes (T2D) in adults was 14.4 percent. Concurrent with the rise in obesity and diabetes were large increases in a sugar-sweetened beverage (SSB) and nonessential food (often termed ‘junk food’) intake. In an effort to prevent continued increases in obesity and diabetes, in January 2014, the Mexican government implemented a 1 peso per liter excise tax on nonalcoholic beverages with added sugar, and an 8 percent ad valorem tax on nonessential foods with energy density ≥ 275kcal/100g, meant to target foods high in added sugars or solid fats (e.g. chips, snacks, candy, etc.). Together, these taxes cover about 20-25 percent of daily caloric intake in Mexico across age groups. Our team’s preliminary analysis of the SSB tax shows it reduced SSB purchases by 5 percent three months after the tax went into effect. Recently, a short-lived Danish saturated fat tax appeared to change food purchasing behavior. However, it is unclear how these taxes will impact purchases over the long-term, how they will impact the nutritional quality of what people buy, and whether these changes will be greater among low socio-economic subpopulations (SES). The overarching goal of this project is to examine how Mexico’s SSB and “junk food” taxes affect the nutritional profile of food and beverage purchases of the Mexican population.

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