Tag Archives: Salmonella

Marie Anne and the WHO investigate Cholera in Sierra Leone

I believe accurate reporting of infectious diseases, including diarrhoeal diseases, to be a significant issue of consideration in both developed and developing nations.  Accurate reporting by the individual, as well as by medical and government institutions, is imperative for analysis of infectious disease epidemiology. With accurate reporting, especially of cholera cases and cholera typing, appropriate therapeutic and preventative measures can be put in place. 

Here, Marie Anne Chattaway, a microbiologist from the UK, describes her experiences working with the WHO in Sierra Leone establishing an Enteric Bacteria Laboratory in Sierra Leone.  Their goal was to aid cholera diagnosis and reporting in this region.  I can’t thank Marie Anne (marie.chattaway@hpa.org.uk) enough for sharing her project.  I wish her and the taskforce every success in the future.

Thank you to Marie Anne, WHO and Sierra Leone.      

Alyson

Marie Anne and Cholera in Sierra Leone

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Picture 1: Map of Sierra Leone

I first became interested in developing countries when I started to volunteer for JIDC (The Journal of Infection in Developing Countries) a couple of years ago as a scientific editor and reviewer where the focus was mentoring scientists to publish their research in a scientific journal. I have been working with enteric pathogens for over five years at the Health Protection Agency of the UK and now realise just how much of an impact bacterial enteric infection has in developing countries. Until now, I had only managed to help from the UK, but the outbreak in Sierra Leone provided me with an opportunity to really use my microbiological skills where it was needed the most.

Cholera outbreak in Sierra Leone

Sierra Leone (Picture 1) has recently battled its worst cholera outbreak in 15 years. In

Picture 2: Crowded housing at risk of cholera

Picture 2: Crowded housing at risk of cholera

July and August 2012, the epidemic rapidly spread to all but one of Sierra Leone’s 13 districts. With a combination of crowded housing (Picture 2), unsafe water supplies, poor sanitation and the rainy season ahead, intervention was paramount. On 16 August 2012, the Sierra Leone government declared the outbreak to be a public health emergency, and established the Presidential Taskforce on Cholera. As of 2 October 2012, there had been 20,736 cases, including 280 deaths (case fatality rate or CFR=1.35%). The western area of the country where the capital city of Freetown is located was the most affected area with more than 50% of total cases. Initial training and some supplies were provided to the Central Public Health Reference Laboratory (CPHRL), Lakka and Connaught Hospital, in Freetown by the World Health Organization (WHO) and International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B).  The Global Outbreak Alert Response Network (GOARN) later requested a microbiologist to further evaluate laboratory facilities and provide technical advice and assistance to strengthen laboratory services for detection of cholera cases, capacity for confirmation by laboratory identification and for conducting differential diagnosis for main enteric pathogens (e.g., Vibrio cholera, Shigella, Salmonella, E. coli). The Health Protection Agency (HPA), UK, sent a microbiologist from the Gastrointestinal Bacteria Reference Unit (GBRU) to undertake this task from 10 October to 8 November 2012.

Travel to Freetown

The HPA was already involved with the cholera outbreak with a focus on epidemiology and case management; Sarika Desai and William Welfare from the HPA had already been deployed as WHO consultants. The specific request for a microbiologist to go to Sierra Leone for the month came later and though I had volunteered to go, in the end I had only 24 hours’ notice that I was on the flight the next day and that urgent supplies were needed. Needless to say, my two large suitcases were filled with consumables as well as clothes, a ridiculous amount of a range of pharmaceutical products (which I did end up using – unfortunately), and insect repellent (the insects still got me, though). I’m not sure what part of the journey was the worst: the bad turbulence on the plane with the woman behind me screaming; the small speedboat trip across the sea in the pitch black;  the jolting of the spine across the dirt tracks in the jeep;, or the sickness on arriving when adapting to the humidity and heat (as you know, we English are used to the cold). Either way, I did make it in one piece and was so happy that I didn’t crash in the plane and impressed by the stunning views (Picture 3) that actually I didn’t mind the bumpy roads.

Picture 3: One of the many stunning views in Freetown

Picture 3: One of the many stunning views in Freetown

Assessment of the laboratory

I was fortunate that there was a dedicated laboratory which had been selected to develop testing based at the Central Public Health Reference Laboratory (CPHRL) in Lakka. It was an hour away from the WHO office. Prior to intervention the department was faced with challenges of the lack of supplies, shortage of available trained staff, poor processing systems, and inadequate Health and Safety protocols in the enteric bacteria section of the CPHRL. The icddr-b had done a fantastic emergency response but further work was now required to establish and maintain an enteric bacteria laboratory in Sierra Leone.

Establishing an Enteric Bacteria Laboratory in Sierra Leone

Before training could even begin, a supplies stock system with the support of the WHO, HPA, CDC and Ministry of Health and Sanitation (MoHS) was set up to receive the required equipment and supplies. Molly Freemen from the Enteric Diseases Laboratory Branch of the CDC joined me for 11 days and the collaboration of all these organisations enabled the success of this mission. Intense training of multiple staff was necessary to maintain function after I left and the staff worked incredibly hard, even coming in at weekends and public holidays. A quality accredited process was set up, including the design of request forms for necessary information, the development of protocols for taking samples, receiving and logging the samples into CPHRL, and testing and recording results on the enteric result database for reporting (Picture 4). A surveillance link was also set up

Picture 4: Left to Right: Musu Abu entering laboratory results with Marie Anne Chattaway

Picture 4: Left to Right: Musu Abu entering laboratory results with Marie Anne Chattaway

so that regular weekly reporting of confirmed enteric pathogens is fed back. The two weeks of practical (Picture 5) and theoretical training was followed by intense three-day theory and practical competency testing. Staff were then certificated in “Isolation and identification of Vibrio cholerae, Salmonella typhi, non-typhoida, lSalmonella, Shigella sp. and E. coli O157” and “Health and Safety and Quality Systems in the enteric bacteria laboratory” (Picture 6).

Picture 6: Left to Right: Musu Abu, Fay Rhodes and Marie Anne Chattaway in Enteric Bacteriology, Quality and Health & Safety training

Picture 5: Left to Right: Musu Abu, Fay Rhodes and Marie Anne Chattaway in Enteric Bacteriology, Quality and Health & Safety training

Challenges and future Work

To sustain the new laboratory service, there is still much work to be done.  The supply system must be managed to ensure stock is available when needed.  Regular testing at the laboratory and reporting of results are essential for monitoring the cholera situation in the country. The biggest challenge will be the organisation and implementation of regular sample collection and transport to CPHRL.  Without regular samples from the districts, the testing competency and surveillance cannot be maintained. The impact of this part of the international response has been considerable; there is now a system for detecting and confirming cholera and other enteric pathogens within Sierra Leone.  If this laboratory component of surveillance is sustained it will lead to a better understanding of the incidence of cholera in the country and provide earlier recognition should the infection become epidemic again, thus enabling a rapid response.

Picture 6: Left to Right: Molly Freeman, Ahmed Foray Samba, Musu Abu, Slyvester Kamanda, Dr Abdual Kamara, Fay Rhodes and Marie Anne Chattaway. Other staff who participated and not in this photo include Eric Sefoi and Doris Harding.

Picture 6: Left to Right: Molly Freeman, Ahmed Foray Samba, Musu Abu, Slyvester Kamanda, Dr Abdual Kamara, Fay Rhodes and Marie Anne Chattaway. Other staff who participated and not in this photo include Eric Sefoi and Doris Harding.

Would I recommend this experience

Absolutely! It was an amazing experience, from networking and collaborating on an international scale with the most amazing and interesting people to experiencing the culture. I felt a real sense of achievement seeing how I can personally make a difference. It is hard work, working long hours with little breaks in sometimes difficult conditions, but the end result was worth any hardship. My favourite challenge was when I first opened the incubator to find lots of small ants favouring the Trypticase Soy agarplates. At first I didn’t think much of it, but when I looked at the plates carefully I saw tiny ant footsteps left by the insects that had walked on a cholera plate just after it had been inoculated. The ants had walked across the plate, dragging the bacteria with it (Picture 7). It is possible that perhaps there is a vector influence with the spread of some diseases that we wouldn’t normally consider!

By Marie Anne Chattaway

**Pictures taken by Marie Anne Chattaway, HPA.

Picture 8: Ant trail spreading cholera on a Trypticase Soy Agar plate (see line from top of plate to the bottom across the middle).

Picture 7: Ant trail spreading cholera on a Trypticase Soy Agar plate (see line from top of plate to the bottom across the middle).

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Introducing DR. Ana Carolina Ritter, PhD! Moving from PhD student to Post Doctoral Fellow

So you can’t wait to finish your PhD.  The years have been slowly slugging by.  It seems you have been at it for eternity…  And then BAM!!! You are done.  It seems it has come all at once.  So what comes next? What comes after the PhD is completed?  And importantly, now that you have finished (which is what you have been waiting for), it may be hard to know how to move on or what to do next.  I HAVE BEEN THERE. And so has Ana Carolina.

Ana last wrote of her interesting PhD research on Salmonella, telling us how she was able to study and conduct her lab work in both Italy and in her native Brazil.  Now Ana updates us with her exciting news that she has received her PhD.  She also shares how she navigated the difficult road from PhD to landing a postdoctoral fellowship in Bologna, Italy.

Good Luck Ana!

Alyson

Italy, I’m coming!

Hello! Good news, I’m going back to Italy … To do the postdoctoral research, this time in Bologna!

In my last blog post, I wrote a little bit about my experience completing part of my PhD at the University of Sassari… Since then, I have completed my PhD and the desire to return to Italy increased!

AnaPhD Talk

Ana’s PhD Seminar in Brazil

Therefore, while completing my doctorate, I sought out a group conducting strong research in food microbiology in Italy to do my postdoctoral research. After searching through PubMed, I found some papers published by the group led by Professor Maria Elisabetta Guerzoni.  I was very interested in the research they perform at the University of Bologna, more precisely in the Distal.  I contacted Professor Guerzoni and we were extremely well matched.

Upon receipt of her acceptance, I applied for a scholarship from a Brazilian funding agency for research, called “National Counsel of Technological and Scientific Development” (CNPq)1.  I outlined a project where I proposed working with new technology for disinfection of food, called Gas plasma2.  In late September I received a positive response from the Brazilian government, and will embark for Bologna in January 2013! Very cool huh?

Currently, it is exciting times for research in Brazil as the government is supporting researchers in bringing new technologies to Brazil by funding global travel for scientific education.  This initiative supports the development of competent professionals, through the granting of many scholarships to enable researchers to study in top universities worldwide.

I’m very excited as I am going through a new experience both in my personal life and academic life. And I hope that this partnership with the University of Bologna allows me to publish work as was the case happened with the University of Sassari3… And of course, I’ll be closer the Central Office of JIDC and old friends.

See you!

1: http://www.cienciasemfronteiras.gov.br/web/csf-eng/

2: Ragni, A., Berardinelli,A.,, Vannini, L., Montanari, C, Sirri, F., Guerzoni, M.B., Guarnieri, A. Non-thermal atmospheric gas plasma device for surface decontamination of shell eggs. Journal of Food Engineering 100 (2010) 125–132.

3: Ritter, A. C., Bacciu, D., Santi, L., Silva, W.O.B, Vainstein, M. H., Rubino, S., Uzzau, S., Tondo,E.C. Investigation of rpoS and dps genes in Sodium Hypochlorite Resistance of Salmonella Enteritidis SE86 Isolated from Foodborne Illness Outbreaks in Southern Brazil. Journal of Food Protection. Journal of Food Protection. , v.75, p.437 – 442, 2012.

AnaPhDParty

Ana’s PhD Graduation Celebration

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Ana: Salmonella in Sardinia

I am please to present a Postcard written by the lovely Ana Carolina!  Ana is a microbiologist from Brazil who carried out part of her PhD in Sardinia, Italy studying salmonella.  I was lucky enough to work in Sardinia at the same time as Ana Carolina while I was completing my Visiting Professorship at the University of Sassari.  Ana works incredibly hard but always with a smile on her face.  It was a delight to see her everyday. I am happy to call Ana a colleague and a friend!

I went to Sardinia!

In 2008 I started my PhD in food microbiology at the Federal University of Rio Grande do Sul (UFRGS), in Porto Alegre, Brazil. It was a moment of transition, because I did my master’s degree working with mycotoxins and now I decided to work with Salmonella. I was accepted to a group that has studied the occurrence of outbreaks of salmonellosis in the state of Rio Grande do Sul (RS) (southern Brazil) for 10 years, the Laboratory of Food Microbiology of the ICTA/UFRGS.

 
 

This research group had already made several discoveries regarding Salmonella Enteritidis (S. Enteritidis).  In previous work done in the Laboratory of Food Microbiology, the spvR gene (Salmonella plasmid virulance)was identified in 82.7% of S. Enteritidis infections involved in food poisoning cases which occurred in RS from 1999 to 2000 [1] . These isolates were also characterized according to their antibiotic resistance, and it was shown that there was a high percentage of sensitivity to most of the drugs tested [1] . Oliveira et al. [2] demonstrated that strains of S. Enteritidis isolated from these outbreaks which occurred in RS in 2001 and 2002 showed similar resistance profiles as the lines of the preceding period.  Interestingly, it was identified that one strain of S. Enteritidis was involved in more than 95% of the salmonellosis cases which occurred in RS [2]. Importantly, other work from the laboratory evaluated the resistance of S. Enteritidis SE86 to disinfectants commonly used in food industries [2]. It was concluded from this work that peracetic acid, sodium hypochlorite and quaternary ammonium were able to inactivate S. Enteritidis SE86; however, this strain was more resistant to the concentration of 200 ppm sodium hypochlorite (commonly used in Brazil).
 

Salmonella by gyalogbodza.hu

Continuing the investigation into the strains of S. Enteritidis which are responsible for salmonellosis and acid resistance in RS, my PhD project aims to investigate the expression of resistance genes which may contribute to the involvement of this predominant strain of S. Enteritidis in food in Brazil. That was the part of the thesis that took me to the Laboratorio di Microbiologia at Univesrsità degli Studi di Sassari.

 

So, with the desire of live outside Brazil and to enrich the Brazilian science, I went to Sardinia or Sardegna, Italy.  Sardinia is a large Island in the Mediterranean Sea.

 

To realize this dream, I sent emails to  Professore Salvatore Rubino (Editor-in-Chief of JIDC) and Professore Sergio Uzzau, asking if I could perform one year of research in their laboratory. After their positive response, I applied for a scholarship to Capes, a Brazilian funding agency for research. The result was one year living in Sassari (2009 to 2010), developing my thesis.

Landscape of Sardinia

Landscape of Sardinia by Travel around the World

In Sardinia genetic modifications in the Brasilian S. Enteritidis (strain SE86) were preformed. With the help of Doctoressa Donatella Bacciu, we performed knockout techniques [3] and epitope tagging [4] in four different genes to check the expression of these strain’s forward acidity and high temperatures, results which I am currently writing up.

It was an incredible experience! Sardinia has breathtaking landscapes, incredible history and very nice people. The university gave me all necessary support for my research; with great colleagues guiding me … I learned a lot, both inside and outside the laboratory. I returned to my country with lots of knowledge: the language, the laboratory techniques, dear friends. I love Sardinia!

 Today I am writing the articles and the thesis, because I have to finish my PhD

The Italian Island of Sardinia by Hikenow.net

by March 2012.

 Post doc? Why not? Science takes us to places that we never dreamed… 

Ana

 Ana is 31 years old. She studied biology (2000 until 2004), then did a two year master degree ( between 2005 and 2007) working with  Aspergillus flavus (food microbiology). In 2008, she started her PhD (food microbiology) at the Federal University of Rio Grande do Sul (UFRGS) in Porto Alegre, Rio Grande do Sul, Brazil. Ana’s story to be post in Portuguese soon!

 

 

Silvia, Francesca, me, Massimo and Donatella: friends and colleagues of the microbiology laboratory in SardiniaAna in Sardinia, ItalyAna in Sardinia

Amazing food and wine

Reference List

 

    1.    Geimba MP, Tondo EC, de Oliveira FA, Canal CW, Brandelli A (2004) Serological characterization and prevalence of spvR genes in Salmonella isolated from foods involved in outbreaks in Brazil. J Food Prot 67: 1229-1233.

    2.    de Oliveira FA, Brandelli A, Tondo EC (2006) Antimicrobial resistance in Salmonella enteritidis from foods involved in human salmonellosis outbreaks in southern Brazil. New Microbiol 29: 49-54.

    3.    Datsenko KA, Wanner BL (2000) One-step inactivation of chromosomal genes in Escherichia coli K-12 using PCR products. Proc Natl Acad Sci U S A 97: 6640-6645. 10.1073/pnas.120163297 [doi];120163297 [pii].

    4.    Uzzau S, Figueroa-Bossi N, Rubino S, Bossi L (2001) Epitope tagging of chromosomal genes in Salmonella. Proc Natl Acad Sci U S A 98: 15264-15269. 10.1073/pnas.261348198 [doi];261348198 [pii].

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Filed under Postcards, Salmonella