The proposed application aims to overcome diagnostic barriers in the etiologic diagnosis of endemic and epidemic causes of acute febrile illness (AFI) by moving efficient state of the art diagnostics to an area of high endemicity. The long-term goal of this research is to understand the etiology of AFI across diverse contexts in South America and contribute to global strategies that improve etiology-specific disease estimates to inform public health practice and policy. The central hypothesis is that the technology transfer and implementation of improved diagnostics will enhance regional diagnostic capacity, epidemic responsiveness, and translation of research findings to practice maximizing the public health impact of research findings. The rationale for the research is that the documented feasibility of this approach will enable a full and appropriate evaluation for uptake by regional and national stakeholders. The goals of the research will be achieved through the execution of three specific aims: 1) Establish stable year round acute febrile illness surveillance using the TaqMan array card, which simultaneously detects over 30 pathogens of AFI across three epidemiologic contexts in Loreto, Peru; urban, riverine with extensive sylvatic exposure, and agricultural riverine context along the three country border (Peru, Brazil, and Colombia) in order to capture the diversity of pathogens causing AFI in Peru over a four year period; 2) Integrate this diagnostic platform into the regional outbreak response to determine the etiology of epidemics of acute febrile illness and validating improved storage and transport procedures; and 3) Develop and evaluate novel serodiagnostic chip to enable single platform serologic assessment and downstream point of care tests and focused diagnostics for pathogens of high prevalence and importance. The global control of emerging infectious diseases will be improved only as the areas that are not reached and included effectively in surveillance shrink and the proposed project attempts to implement a strategy to make all populations reachable to the improved diagnostics. The complexity of current diagnostic strategies is a critical barrier to the timely regional ascertainment of the etiology of most cases of acute febrile illnesses and this has important regional and global public health implications as undiagnosed AFI allows for the widespread dissemination of emerging diseases as effective disease control measures are based on accurate etiologic assessment. The plan is innovative because of the meaningful integration of highly select local researchers, educators, trainees, and policymakers. The implementation of the research strategy will be significant because it is expected to contribute to the accuracy of etiologic assessment of endemic and epidemic etiologies of AFI in an area of documented diversity of vector-borne and zoonotic agents and serve as a model for enabling local diagnostic and reporting capacity in South America.
The proposed research is relevant to public health because it offers new and improved strategies to efficiently and accurately diagnose the etiology of acute febrile illness, a requisite for effective disease control and treatment. The proposed research is relevant to the US Centers of Disease Control and Prevention as it will inform regional assessments and demonstrate a pathway for implementation of improved diagnostics by key stakeholders in a region that is highly endemic for emerging infectious diseases.
