This is an application for the NIAID Mentored Research Scientist Development Award (K01 Award) to promote the career development of Dr. Christine Marie George. I am a trained epidemiologist with several years of experience conducting cluster based randomized controlled trials of safe drinking water interventions in Bangladesh. I am currently an Assistant Professor of International Health at the Johns Hopkins Bloomberg School of Public Health (JHBSPH). In this position, I have two main research objectives. First, to investigate environmental transmission routes for enteric infections, and second to develop effective safe drinking water interventions. I believe it is important to my career development to have an interdisciplinary skill set which includes expertise in both the epidemiology and control of waterborne contaminants in drinking water, and in health theory driven intervention design. However, my research thus far has focused mainly on heavy metal contamination in drinking water. Therefore, my goal in applying for this K01 award is to build training in these areas. This training would complement well my previous training and research experience, and would allow me to gain a unique breadth in my field that can be used for the development of effective safe drinking water interventions. Specifically my training objectives are: 1) To enhance knowledge of the epidemiology and control of waterborne infectious diseases; 2) To gain expertise in methods for field and laboratory based detection of waterborne pathogens; 3) To gain training on the laboratory techniques that can be used to determine transmission patterns for waterborne infectious diseases; and 4) To develop skills on the application of health behavior theory to identify behavioral determinants of health and how to intervene upon them. To achieve my training objectives, I have developed an interdisciplinary mentoring team of experts in the clinical, epidemiological, and laboratory aspects of cholera, and health theory. My mentors are Drs. David Sack and R. Bradley Sack (primary mentors), and Peter Winch (co-mentor). They are Professors of International Health at the JHBSPH. My training plan includes directed readings, coursework, conferences, and field and laboratory training on waterborne pathogens. My training objectives will facilitate the implementation of my proposed prospective cohort study of household contacts of index cholera cases in Dhaka, Bangladesh. This study will be the first in-depth evaluation of the environmental and person to person transmission of V. cholerae to index cases and their household contacts using Multilocus variable-number tandem-repeat analysis (MLVA). Furthermore, I will implement an interdisciplinary approach using MLVA, a risk factor analysis, and formative research findings to develop intervention strategies to intervene upon identified transmission routes for cholera among household contacts of cholera cases. Through this experience I will gain valuable training on methods for identifying transmission patterns of waterborne diseases and developing health theory driven intervention approaches. Furthermore, I will gain preliminary data for an R01 grant for a large scale intervention study.
Previous studies in Bangladesh have demonstrated that household contacts of cholera cases are at a much higher risk of developing cholera than the general population (200-240/1000 cases vs. 2.5/1000, respectively). However, there has been little work done to determine the main transmission routes for cholera infection in these households, or to develop interventions to intervene upon cholera transmission in this population. In this prospective cohort study we will conduct the first in-depth analysis of the environmental transmission of V. cholerae to index cases and their household contacts using Multilocus variable-number tandem-repeat analysis (MLVA), and develop intervention strategies to target this susceptible population.
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