Candidate: Sylvia Becker, MD, MPH is an NRSA-Primary Care Research Fellow in the Department of Family Medicine at the University of North Carolina at Chapel Hill (UNC). Career Development Plan: the candidate Will conduct mentored research and strengthen vital knowledge in global health research. The candidate will be positioned to become leader in vaccine effectiveness in the developing world. Immediate Objective: to acquire expertise in infectious disease epidemiology and vaccine effectiveness;to assess the effectiveness ofthe rotavirus vaccine in a developing world setting. Long-term Objective: to provide evidence on vaccine effectiveness for developing world decision makers.
Specific Aims : 1) Determine the effectiveness ofthe rotavirus vaccine in the primary care setting. 2) Characterize the circulating genotypes of the virus following UIRI implementation. 3) Determine the effect of UIRI on the childhood diarrhea incidence rate in a community. Research Methods:
In Aim 1, we will a case control design to determine the vaccine's effectiveness in reducing primary care visits among children for rotavirus diarrhea at eight primary care centers in Leon, Nicaragua.
In Aim 2, we will characterize the genotypes among all rotavirus-positive stool samples collected in Aim 1 and explore whether type replacement may be occurring.
In Aim 3, we will measure the diarrhea incidence rate among children in the community using a population-based sample provided by an existing Surveillance System based at University of Nicaragua, Leon (UNAN) and compare to the incidence prior to universal rotavirus immunization. Environment: we will work with eight primary care centers in Leon that have a long history of collaboration with members of the research team. Laboratory studies for Aim 1 will be carried out in a laboratory at UNAN while those for Aim 2 will be carried out at the CDC.
Aim 3 will make use of an existing Surveillance System that has an international reputation for the quality of its research. Database management is within this Surveillance System. Mentorship: primary mentorship at the UNC will be provided by epidemiologist and infectious disease specialist, David J. Weber, MD, MPH. Primary mentorship at UNAN will be provided by Felix Espinoza, MD, PhD (Aims 1 and 2) and Rodolfo Peria, MD, PhD (Aim 3). Additional mentorship is provided by leaders in rotavirus epidemiology and vaccine effectiveness, Drs. Umesh Parashar and Manish Patel, by medical geographer, Micheal Emch, PhD, by biostatistician, Michael Hudgens, PhD, by vaccine epidemiologist Jennifer Smith, PhD, MPH, and by gastroenterologist, Douglas Morgan, MD, MPH, who has led the UNC-UNAN research collaboration.

Public Health Relevance

We have the unique opportunity in Leon, Nicaragua to determine the effect of UIRI on the primary care and community levels. At the end of the proposed study, we would provide needed information to others in the developing world who are currently considering adding rotavirus vaccines to their vaccine armamentarium.

National Institute of Health (NIH)
Fogarty International Center (FIC)
Research Scientist Development Award - Research & Training (K01)
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Special Emphasis Panel (ZRG1-ICP2-B (51))
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Jessup, Christine
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University of North Carolina Chapel Hill
Family Medicine
Schools of Medicine
Chapel Hill
United States
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Becker-Dreps, Sylvia; Zambrana, Luis Enrique; Reyes, Daniel et al. (2014) Household management of childhood diarrhoea: a population-based study in Nicaragua. J Health Popul Nutr 32:149-54
Becker-Dreps, Sylvia; Bucardo, Filemon; Vilchez, Samuel et al. (2014) Etiology of childhood diarrhea after rotavirus vaccine introduction: a prospective, population-based study in Nicaragua. Pediatr Infect Dis J 33:1156-63
Panozzo, Catherine A; Becker-Dreps, Sylvia; Pate, Virginia et al. (2014) Direct, indirect, total, and overall effectiveness of the rotavirus vaccines for the prevention of gastroenteritis hospitalizations in privately insured US children, 2007-2010. Am J Epidemiol 179:895-909
Vilchez, Samuel; Becker-Dreps, Sylvia; Amaya, Erick et al. (2014) Characterization of enterotoxigenic Escherichia coli strains isolated from Nicaraguan children in hospital, primary care and community settings. J Med Microbiol 63:729-34
Becker-Dreps, Sylvia; Melendez, Marlon; Liu, Lan et al. (2013) Community diarrhea incidence before and after rotavirus vaccine introduction in Nicaragua. Am J Trop Med Hyg 89:246-50
Panozzo, Catherine A; Becker-Dreps, Sylvia; Pate, Virginia et al. (2013) Patterns of rotavirus vaccine uptake and use in privately-insured US infants, 2006-2010. PLoS One 8:e73825
Becker-Dreps, Sylvia; Paniagua, Margarita; Dominik, Rosalie et al. (2011) Changes in childhood diarrhea incidence in nicaragua following 3 years of universal infant rotavirus immunization. Pediatr Infect Dis J 30:243-7
Becker-Dreps, Sylvia; Paniagua, Margarita; Zambrana, Luis Enrique et al. (2011) Rotavirus prevalence in the primary care setting in Nicaragua after universal infant rotavirus immunization. Am J Trop Med Hyg 85:957-60
Becker-Dreps, Sylvia; Otieno, Walter Agingu; Brewer, Noel T et al. (2010) HPV vaccine acceptability among Kenyan women. Vaccine 28:4864-7
Becker-Dreps, Sylvia; Morgan, Douglas; Pena, Rodolfo et al. (2010) Association between intimate partner violence and irritable bowel syndrome: a population-based study in Nicaragua. Violence Against Women 16:832-45