Neurodevelopment and Vector-borne Diseases: Building Research Capacity in the Tropics

项目总结/摘要 病媒传播疾病（VBD）在整个发展中国家构成重大的经济和公共卫生威胁。 世界各地的热带地区，包括加勒比地区。2013年12月的引进和迅速蔓延， 基孔肯雅病毒（CHIKV）在所有加勒比国家，最近出现的 苏里南和马提尼克的寨卡病毒疫情凸显了发展区域调查、预测 包含并响应VBD。例如，最近来自留尼汪岛的证据表明，CHIKV可以 对婴儿的神经发育产生负面影响，这些婴儿的母亲在怀孕期间感染了病毒， 怀孕然而，这些结果尚未在国际上的其他地点复制，例如 加勒比-也没有进行任何纵向研究，跟踪那些经历过 与CHIKV感染相关的神经认知延迟。在建立VBD研究时解决数据缺乏问题 这些疾病是地方病，神经发育受损的负担是 格林纳达圣乔治大学（SGU）的研究人员将与来自 斯坦福大学、牛津大学和留尼汪大学：（1）确定 格林纳达孕妇中CHIKV的母婴传播;（2）测量 在子宫内不同孕期暴露于CHIKV的2岁儿童，并将其与未暴露的儿童进行比较 （3）评估混杂因素的负担，以更好地了解VBD对儿童的具体影响。 神经发育和告知公共卫生优先事项;（4）建立当地的虫媒病毒和 神经发育测试为了实现目标1，379名母亲和她们在2009年出生的婴儿， 格林纳达爆发CHIKV疫情，473名母亲及其婴儿在疫情爆发后出生， 190名母亲和她们的婴儿，他们在怀孕后至少9个月出生， 爆发（因此，不太可能在子宫内暴露于病毒）将完成一项详细说明发病情况的调查 和与他们的CHIKV感染相关的症状，然后通过ELISA测试暴露于CHIKV。非 暴露于CHIKV的婴儿和母亲，暴露于CHIKV但不暴露于婴儿的母亲，暴露于CHIKV的母亲和婴儿， 将使用妊娠期间暴露的时间和剂量分组，以进行2年时的神经认知比较 年龄。为了实现目标2和3，我们将实施共生21神经发育评估- a 牛津大学开发的儿童早期发展的整体评估-同时控制 混杂的神经发育因素。为了实现目标4，我们将建立一个儿童问题区域中心， 神经发展，同时解决七个关键领域所需的研究支持：（1）财政（即，granting）; (2)专业知识;（3）实地人力资源;（4）培养当地能力的学员;（5）设备， 信息技术和设施支助;（6）实地大学和研究机构行政支助;以及（7） 地方和区域政府、相关非政府组织和专业/学术机构的支持。

Project Summary/Abstract Vector-borne diseases (VBD) pose a significant economic and public health threat throughout developing tropical regions worldwide, including the Caribbean. The introduction in December 2013 and rapid spread of the chikungunya virus (CHIKV) throughout all the Caribbean nations, and more recently the emergence of the zika virus in Suriname and Martinique highlights the need to develop regional capacity to investigate, predict, contain, and respond to VBD. For example, recent evidence from la Réunion suggests that CHIKV can negatively impact neurodevelopment among infants born to mothers who were infected with the virus during pregnancy. However, these results have not yet been replicated in other sites internationally – such as the Caribbean – nor have any longitudinal studies been carried out to follow children who have experienced neurocognitive delay related to CHIKV infection. To address the paucity of data while building VBD research capacity in tropical LMICs where these diseases are endemic and the burden of impaired neurodevelopment is felt most, researchers from St. George's University (SGU) in Grenada will partner with researchers from Stanford University, Oxford University, and the Université de La Réunion to: (1) Determine the prevalence of mother to child transmission of CHIKV in Grenadian pregnant mothers; (2) Measure the neurodevelopment of children at 2 years of age exposed at different trimesters in utero to CHIKV and compare them with unexposed children; (3) Assess the burden of confounding factors to better understand the specific impact of VBD on neurodevelopment and inform public health priorities; (4) Build local capacity for arboviral and neurodevelopmental testing at SGU. To achieve Aim 1, 379 moms and their infants who were born during the CHIKV outbreak in Grenada, 473 moms and their infants who were born after the outbreak and may have been exposed to the virus in utero, and 190 moms and their infants who were born at least nine months after the outbreak (and thus, very unlikely to be exposed to the virus in utero) will complete a survey detailing the onset and symptoms related to their CHIKV infection and will then be tested for exposure to CHIKV by ELISA. Non CHIKV-exposed infants and moms, CHIKV-exposed moms but not infants, CHIKV-exposed moms and infants, and time of exposure during pregnancy will be used to divide groups for neurocognitive comparison at 2-years of age. To achieve Aims 2 and 3, we will administer the intergrowth 21st Neurodevelopment Assessment – a holistic assessment of early child development developed at Oxford University – while controlling for confounding neurodevelopmental factors. To achieve Aim 4, we will establish a Regional Center for Child Neurodevelopment while addressing seven key areas of needed research support: (1) Financial (i.e., granting); (2) Expertise; (3) On-the-ground human resources; (4) Student trainees to build local capacity; (5) Equipment, IT, and facilities support; (6) On-the-ground university and research institute administrative support; and (7) Local and regional government, relevant NGO, and professional/academic institutional support.