Projects in Nicaragua

The Household Influenza Cohort Study

Investigators

Aubree Gordon, PhD, MPH; Angel Balmaseda, MD and Guillermina Kuan, MD

Purpose

To examine transmission and susceptibility to influenza infection in a household setting.

Rationale

Pneumonia is the leading infectious cause of death in children under 5, with most of the deaths occurring is in low- and middle-income countries. It is estimated that 30-60% of influenza transmission occurs in households.  For young children who do not attend daycare, such as those in many low and middle-income countries, the household is likely the main setting where they acquire influenza. Factors associated with poverty, including household crowding and poor nutrition can increase both transmission and affect the severity of influenza disease.

Study design and methods

The Household Influenza Cohort Study is an ongoing prospective cohort study of families with an embedded transmission study.

Anticipated undergraduate/graduate student activities on project

  1. To create applications for the collection of data.
  2. To perform laboratory assays including RT-PCR and serological assays.
  3. To perform data management tasks including learning how to code in SAS.
  4. To perform the statistical analysis of the data including investigating the association between nutrition and influenza infection.

Techniques/methods students should become familiar with in advance

  1. Students taking on statistical analysis projects should have some familiarity with SAS, STATA or R and have completed at least one class in statistics.
  2. Students completing projects around data management will be taught relevant skills
  3. In the lab the student will learn how to handle the analysis of the different tests.

Suggested readings (minimum of 3-5 articles)

  1. Gordon, A., Tsang, T., Cowling., B., Kuan, G., Ojeda, S., Sanchez, N., Gresh, L., Lopez, R., Balmaseda, A., and Harris, E. Influenza Transmission Dynamics in Nicaraguan Households. Emerg Infect Dis. 2018 Oct;24(10):1882-1888.
  2. Ng, S., Nachbagauer, R., Balmaseda, A., Stadlbauer, D., Ojeda, S., Patel, M., Rajabhathor, A., Lopez, R., Guglia, A.F., Sanchez, N., Amanat, F., Gresh, L., Kuan, G., Krammer, F., and Gordon, A. Novel correlates of protection against influenza A(H1N1)pdm infection Nature Medicine 2019 Jun;25(6):962-967.
  3. Petrie, J. and Gordon, A.  Epidemiological Studies to Support the Development of the Next Generation of Influenza Vaccines. Vaccines 2018 6(2), 17; doi:10.3390/vaccines6020017
  4. Maier, H., Lopez, R., Ng, S., Gresh, L., Ojeda, S., Burger-Calderon, R., Harris, E., Balmaseda, A., and Gordon, A. Obesity increases influenza A shedding in adults. J Infect Dis 2018 Sep 22;218(9):1378-1382.

The Nicaraguan Pediatric Influenza Cohort Study

Investigators

Aubree Gordon, PhD, MPH, Angel Balmaseda, MD and Guillermina Kuan, MD

Purpose

To examine the incidence and severity of influenza in children as well as the development of immunity to influenza. Secondarily, we will also investigate RSV.

Rationale

Pneumonia is the leading infectious cause of death in children under 5, with most of the deaths occurring is in low- and middle-income countries. Both RSV and Influenza are significant viral causes of pneumonia. Our current vaccine for influenza is suboptimal as it has limited effectiveness, is strain specific and lasts for only a year, making it a vaccine that is difficult to deploy in low-income settings. RSV does not currently have a vaccine.

Study design and methods

The Nicaraguan Pediatric Influenza Cohort is an ongoing prospective cohort study of children aged 0-14 years in Managua, Nicaragua.  Children are provided with all primary medical care through the study and data are systematically recorded.

Anticipated undergraduate/graduate student activities on project

  1. To create applications for the collection of data.
  2. To perform laboratory assays including RT-PCR and serological assays.
  3. To perform data management tasks including learning how to code in SAS.
  4. To perform the statistical analysis of the data.

Techniques/methods students should become familiar with in advance

  1. Students taking on statistical analysis projects should have some familiarity with SAS, STATA or R and have completed at least one class in statistics.
  2. Students completing projects around data management will be taught relevant skills
  3. In the lab the student will learn how to handle the analysis of the different tests.

Suggested readings (minimum of 3-5 articles)

  1. Gresh L, Kuan G, Sanchez N, Azziz-Baumgartner E, Ojeda S, Melendez M, Lopez R, Martin ET, Widdowson MA, Bresee J, Harris E, Balmaseda A, and Gordon A. Burden of Influenza and Influenza-Associated Pneumonia in the First Year of Life in a Prospective Cohort Study in Managua, Nicaragua. Pediatr Infect Dis J. 2016 Feb; 35(2) 152-6.
  2. Gordon A, Kuan G, Aviles W, Sanchez N, Ojeda S, Lopez B, Gresh L, Balmaseda A, Harris E. The Nicaraguan pediatric influenza cohort study: design, methods, use of technology, and compliance. BMC Infect Dis. 2015 Nov 9;15(1):504. doi: 10.1186/s12879
  3. Petrie, J. and Gordon, A.  Epidemiological Studies to Support the Development of the Next Generation of Influenza Vaccines. Vaccines 2018 6(2), 17; doi:10.3390/vaccines6020017
  4. Kubale, J., Kuan, G., Gresh, L., Ojeda, S., Azziz-Baumgartner, E., Sanchez, N., Lopez, R., Harris, E., Balmaseda, A., and Gordon, A. Assessing the Burden of Respiratory Syncytial Virus (RSV) within a Community-based Prospective Birth Cohort Clin Infect Dis. 2019 Jun 29. pii: ciz585. doi: 10.1093/cid/ciz585. [Epub ahead of print]