The UCLA-DRC Program has several ongoing research projects.
Ebolavirus Disease Research
Since first described in 1976, Ebolavirus has been associated with more than 20 outbreaks worldwide, 8 of which have occurred in the DRC. The 2013-2016 outbreak of Ebolavirus disease (EVD) in West Africa was the largest on record, with 11,000 fatalities, but left an estimated 16,000 EVD survivors who we now know are at-risk for long-term health consequences, including systemic and ophthalmic sequelae, such as sight-threatening inflammation of the eye, arthritis, mental health disorders, and morbidity from chronic, organ-specific diseases. New evidence suggests mild or asymptomatic EVD may occur and may cause long-term sequelae.
We are bringing together leading experts on Ebola to better understand the long-term effects of Ebolavirus exposure, including measuring persistence of immunity in both individuals with documented history of EVD as well as individuals in the same communities with no history of disease, but who may be protected from this deadly virus. The best, and only opportunity to study the decades-long aftermath of Ebolavirus is to study the oldest known living cohorts of EVD survivors. We are examining the individuals from the first recorded outbreaks in 1976 and 1995, now 40 and 20 years past infection as well as prospectively studying recent 2014 outbreak survivors. We are carefully characterizing current health statuses of these individuals and collecting biological samples that will be used to profile altered immune states that drive persistent sequelae, as well as define determinants of robust long-term immunity to Ebolavirus. Mining the immune responses for Ebola antibodies from survivors and asymptomatically infected individuals can be used for the development of targeted prophylaxis and therapeutics, and will also allow us to better understand long term consequences of an Ebola outbreak and to anticipate the road ahead for thousands of survivors and communities in W. Africa. We are also coordinating protocols with ongoing EVD natural history studies in Liberia, ensuring our data are directly applicable to W. Africa, and create a scientific advisory committee including original 1976 EVD outbreak investigators, WHO, and other stakeholders.
Sponsored by: Bill and Melinda Gates Foundation, the Faucett Catalyst Fund and FDA
Mapping for Health:
The Democratic Republic of the Congo (DRC) is the largest country in Sub-Saharan Africa, with an area the size of Western Europe. The majority of DRC’s population lives in rural and isolated communities that are extremely difficult to access on the country’s crude transportation networks. Today, the DRC Ministry of Health and its Direction for Disease Control (DLM) face the enormous task of tracking down and controlling disease outbreaks throughout the country’s vast expanse. An essential requirement in being able to conduct disease surveillance is to be able to locate and travel to every village. However, to date, the vast majority of the DRC’s 516 health zones and their tens of thousands of villages have yet to be accurately mapped, with most health zone staff using imprecisely hand-drawn paper maps to reach villages and their populations.
UCLA-DRC has been working for the past two years to use high resolution satellite imagery and remotely sensed settlement data to map out the health zones of former Bandundu province, using local health zone staff’s detailed geographic knowledge of these areas. These maps have been able to put thousands of villages on the radar of the Ministry of Health so that these remote populations can be reached, whether for vaccinating against measles or screening for sleeping sickness. UCLA-DRC is also currently implementing a microcensus throughout Bandundu and Kinshasa provinces to produce high-resolution population estimates for all human settlements visible on satellite imagery; these estimates, used in hand with improved mapping data of these areas will better enable the DRC Ministry of Health to allocate limited resources and provide services to populations with the greatest need.
Over the last few months, UCLA-DRC has also been actively working with the DRC Direction for Disease Control, PATH, and OpenStreetMap DRC to map out villages affected by the Ebola outbreak in Bas-Uele province and the roads that connect them. These maps have been crucial for the country to be able to properly deploy to these areas and respond to this outbreak. Going forward, UCLA-DRC will be continuing to work with the Congolese Ministry of Health to expand health zone and village mapping to other provinces, and to build local mapping capacity through GIS trainings and working groups.
Sponsored by: Bill and Melinda Gates Foundation
Polio and Other Vaccine Preventable Diseases:
Prolonged interruptions in vaccination activities due to conflict and unrest in the DRC over the last decade may have resulted in significant immunity gaps in older children and adults, potentially leaving entire cohorts susceptible to poliovirus. Poor infrastructure and difficult terrain isolate many villages in DRC making vaccine delivery, supply, and storage under proper conditions difficult, which can compromise vaccine efficacy and result in insufficient immunity levels. Polio eradication largely depends on maintaining high immunization coverage with quality vaccination throughout the whole of the DRC.
UCLA-DRC has spent the last several years assisting the DRC Ministry of Health to identify populations and regions with low immunity to vaccine preventable diseases (VPDs). We have largely done this through implementing serosurveys to measure the prevalence of specific IgG antibodies to various diseases, such as through the 2013-2014 Demographic and Health Survey and a targeted serosurvey in 2016 in Haut-Lomami province, an area that has experienced repeated outbreaks of Vaccine Derived Poliovirus. These serosurveys have been a direct and accurate method to assess population susceptibility to VPDs, and have provided critical insight into ongoing immunity gaps and operational program efficiency. UCLA-DRC has also worked extensively with the DRC Expanded Program on Immunization (EPI) on building local capacity to analyze and interpret these serosurvey data alongside existing immunization program indicators and validate questionnaire-based surveys of vaccination coverage.
Sponsored by: Bill and Melinda Gates Foundation
African Sleeping Sickness:
African sleeping sickness, or Human African Trypanosomiasis (HAT), is a parasitic disease occurring in parts of Central and Western Africa. HAT is transmitted through the bite of the tsetse fly, which can be fatal if left untreated. DRC is home to 90% of all reported cases of HAT. More than half of all HAT cases in DRC occur within former Bandundu province.
UCLA-DRC is currently working in collaboration with the DRC National Program against Human African Trypanosomiasis (PNLTHA) to improve the quality and utility of surveillance data and to provide key information on the true burden and distribution of HAT infection. Through creating a digital database of all historic HAT cases in DRC and improving map data of the most HAT endemic and high incidence regions (such as former Bandundu province), we are providing crucial data inputs necessary to pinpoint at-risk populations, improve operational program efficacy, and guide program decisions to focus resources where they are needed most in the goal of accelerating progress towards achievement of HAT elimination milestones.
Sponsored by: Bill and Melinda Gates Foundation
Sexually Transmitted Infections, HIV, and Schistosomiasis Co-Infections in Pregnant Women:
Sub-Saharan Africa continues to bear a disproportionate share of the global HIV burden resulting in significant morbidity and mortality in the region. Urogenital schistosomiasis is also widespread throughout the continent, causing substantial morbidity, especially in the freshwater region of the Congo Basin. Recent epidemiological studies suggest that genital infection with schistosomal worms may increase the risk of HIV acquisition in young women. Additionally, schistosomal co-infection may accelerate HIV disease progression and facilitate HIV transmission to sexual partners and unborn infants. New estimates suggest that female genital schistosomiasis may occur in as many as 100 million African girls and women defining this infection as one of the most common and emergent gynecologic conditions in Sub-Saharan Africa.
Our goals for this research study are to assess the burden of schistosomal infections in pregnant women seeking prenatal care at established antenatal clinics in the Democratic Republic of the Congo (DRC), to quantify the increased risk of HIV infection in women with schistosomiasis, and to describe the maternal and perinatal health outcomes associated with disease among this sensitive subpopulation. The results of our study may lend insights into potential strategies for synergizing detection and control efforts of these viral and parasitic gynecologic conditions.
Sponsored by: UCLA Center for AIDS Research and the National Institutes of Health (NIH)
Birth Defects Registry:
Approximately 3.2 million birth defect-related disabilities occur each year, according to The World Health Organization (WHO) with an estimated 300,000 newborns dying within the first month of life due to these anomalies. Their worldwide impact of birth defects on public health is extraordinarily high, impacting not only on the quality of life of affected individuals but also the economies of health care systems strained by high incidence of long term disabilities. A resolution from the 63rd World Health Assembly promoted the improved prevention and health of children affected with congenital anomalies through “developing and strengthening registration and surveillance systems” and “strengthening research and studies on etiology, diagnosis and prevention”.
In response to this call, we are organizing a multidisciplinary group of investigators (Genetics, Public Health and Epidemiology, Pediatrics) to mobilize resources to set up a Birth Defect Registry in Kinshasa, Democratic Republic of the Congo. Because birth defects may be caused by multiple factors, including genetic, infectious, or environmental causes, epidemiologic measures involving these three etiologic components will be undertaken. Additionally, the deployment of mobile technologies such as face recognition applications which allow for precise phenotyping in remote locations and electronic health technologies will be used to create a registry of standardized data. Creation of a registry will allow for evaluation of baseline incidence of specific birth defects and longitudinal monitoring and evaluation of efficiency of interventions. Birth defect registries also play a key role in long term analysis and monitoring of overall population health. This project will debut in 2018.
Sponsored by: The March of Dimes
UCLA-DRC has been working for more than 15 years in collaboration with various programs of the DRC Ministry of Health and local Congolese public health institutions such as the Kinshasa School of Public Health, the National Biomedical Research Institute (INRB), and the Field Epidemiology and Laboratory Training Program (FELTP). Our program works closely with Congolese scientists, researchers, doctors, and local health staff to implement all projects, and in the process working together to build in-country capacity for disease research, surveillance, and program implementation. Some of our capacity building activities include training on surveillance and data collection methods through either one-on-one training or larger workshops, sponsoring journal clubs at the INRB and Kinshasa School of Public Health, assisting local researchers with grant and research paper writing, and providing lectures and tutorials on epidemiological methods, health mapping through geospatial information systems (GIS) software, and other requested topics.
Monkeypox Disease Surveillance:
Human monkeypox (MPX) is a smallpox-like zoonotic infection that occurs mostly in the rain forests and savannah of central and West Africa. MPX has presumably occurred in sub-Saharan Africa for thousands of years, however, it was not recognized as a distinct disease until 1970, when the elimination of smallpox from the Democratic Republic of Congo (DRC) revealed the continued occurrence of a smallpox-like illness in rural areas. An outbreak of MPX in the mid-Western part of the United States in 2003 highlights this virus’s capacity to suddenly emerge from its endemic regions in surprising clusters of infection with an atypical clinical presentation. Although it is considered to be the most important orthopoxvirus since the eradication of smallpox, MPX disease in humans is poorly understood: its transmission pathways are largely unknown and only a handful of articles have been published in the medical literature describing the disease in its native range. Many factors have hampered research on human MPX infection, including the remote location of cases, war, and lack of field-ready diagnostic tests. The reservoirs for MPX remain largely undefined.
To study the epidemiology of human MPX, we conducted two linked infection/disease burden studies in the Sankuru district of the Kasai Oriental province, a MPX-endemic region of the DRC that has consistently reported the greatest number of MPX cases in the country. The principal aim of these studies was to determine the burden of infection/disease of human MPX. Additional aims included: 1) establish risk factors for acquiring MPX infection; 2) update the current MPX clinical case definition; and 3) enhance local MPX surveillance and laboratory diagnostic capabilities in the DRC.
Sponsored by: National Institutes of Health (NIH)
Interspecies Disease Transmission:
Zoonotic transmission of diseases drives novel pathogen emergence and can lead to pandemics. Recent work pinpoints African apes as the primary source of infectious disease risk to humans and highlighted Central Africa as an emerging infection hotspot. In collaboration with Duke University, we piloted an index-cluster study for detection of interspecies disease transmission at Lola ya Bonobo (LyB) sanctuary in the Democratic Republic of Congo (DRC). We focused on respiratory viruses given the transmissibility, sample accessibility, and potential for global distribution.
The goals were to detect intra- and inter-species transmission (symptomatic and asymptomatic) of respiratory viral pathogens in the LyB sanctuary to determine risk factors for transmission of respiratory viral infections among enrolled subjects, to establish an interspecies biorepository for pathogen discovery and biomarker development, and to further develop existing laboratory capacity for clinical and research programs at the national laboratory in the DRC.
Sponsored by: Duke University Seed Grant and Faucett Catalyst Fund
Emerging Infectious Diseases:
The majority of emerging infectious diseases (EIDs) have animal origins including: Ebola, monkeypox, plague, SARS, West Nile virus, and most recently, avian influenza. The entry of novel animal diseases into human populations can have a devastating impact on global health, economy, and security. There are currently no effective systems in place to monitor and stop zoonotic EIDs before they become epidemics. This study utilizes a novel multi-disciplinary approach to monitoring the emergence of such diseases in individuals who are at the nexus of animal and human interaction. This study focuses on populations of individuals in the DRC that are regularly exposed to wild animals (bats, non-human primates, rodents, etc.), due to their reliance on these animals for a food source. Individuals in this population will be enrolled into a study aimed at determining the presence of zoonotic infection. Serologic, microarray and PCR-based techniques are used to screen the collected blood samples for infection with known and novel viruses. This study will provide critical information that may lead to an understanding of which zoonotic microorganisms have the potential to infect, cause disease, and spread in human populations.
Sponsored by: National Institutes of Health (NIH)