Paediatric Fevers

Group leader: Prof. Dr. Jürgen May

Phone: + +49 40 42 818 369
Fax: +49 40 42 818 512
E-Mail: may@bnitm.de

Team coordinator: Dr. Oumou Maiga-Ascofare

Phone: +233 220 60351
Fax:
E-Mail: maiga@kccr.de

Staff:

Dr. Nimako Sarpong (Field Coordinator)
Matilda Akorno (PhD candidate)
Kennedy Gyau Boahen (PhD candidate, bacteriologist)
Charity Wiafe Akenten (PhD candidate, bacteriologist)
Henry Hanson (Research Assistant, parasitologist)
Geoffrey Foli (Lab assistant, parasitologist)
Kwabena Oppong (MPhil candidate, lab assistant)
Felix Osei Boateng (Biostatistician)
Berchie Agyemang Nti (Data Manager)
Grace Owusu (Field worker)
Richard Afreh (Field worker)
Emmanuel Baah (Data clerk)

The Research Group “Infectious Disease Epidemology” based at KCCR is a part of the Department  of Infectious Disease Epidemiology at the Bernhard Nocht Institute for Tropical Medicine (BNITM) in Hamburg, Germany.

Our main focus is the performance of studies on communicable diseases in humans. The concept includes the planning, preparation, supervision, performance and analysis of observational studies and clinical trials, combining classical, molecular and clinical epidemiology. Focus diseases are malaria, salmonellosis, cryptosporidiosis, sepsis, neglected tropical diseases (NTD) and co-infections in resource-poor settings. The group is interested in the development, evaluation and application of advanced diagnostics of infectious diseases, integration of electronic surveillance, definition of health priorities, and the analysis of the pathogens and their transmission conditions. The latter includes the analysis of genetic, environmental, socio-economic, demographic, and spatio-temporal risk factors on the host site as well as influence factors of the pathogens and vectors. The superior aim is the translation of results to implementation of diagnostics, treatment, prevention and capacity building in endemic countries. The field studies are mainly performed at the Agogo Presbiterian Hospital and communities in the Ashanti Region. Other cooperation partners are in many other Ghanaian regions and other African countries specially Madagascar, Gabon and Tanzania.

Establishment of a Platform for the Evaluation of Infectious Diseases Diagnostics

The intention of this project is to establish a platform for the evaluation and validation of innovative diagnostics of infectious diseases. As a first project it is planned to create a network of platforms for the evaluation of innovative POC diagnostics, in particular for the use in countries were malaria is endemic. To increase the comparability of lab results, a SLIPTA like process for the improvement and standardization of the malaria diagnostic laboratory at KCCR in ongoing based on three tools: microscopy, PCR based diagnostic and cell culture.

From 2019, emphasis will also be made on detection of antimicrobial resistances (AMR) to address the knowledge gaps concerning incidence, prevalence, range across pathogens, and geographical patterns related to AMR. Within the first year, a surveillance manual, the IT, quality management as well as the laboratory infrastructure will be developed. During the second year, base-line AMR data will be collected from priority specimens, which are routinely sent to the laboratories for clinical purposes

Contact person: Dr. Oumou Maiga Ascofaré (maiga@kccr.de), Dr. Denise Dekker (dekker@kccr.de), Dr. Daniel Eibach (eibach@bnitm.de)

Genetic Determinants for the Transmission of Cryptosporidium parvum/hominis among Humans and Animals in Africa (C16)

Cryptosporidiosis is increasingly identified as an important cause of morbidity and mortality worldwide. The apicomplexan parasite Cryptosporidium is the causative agent of cryptosporidiosis, recognized as an opportunistic infection in AIDS, but is also responsible for large outbreaks in immune-competent individuals. In resource-poor countries, cryptosporidiosis is a common cause of prolonged and persistent diarrhea, malnutrition and growth deficits among immune-competent children and of severe diarrhea in immune-compromised persons. Cryptosporidium is transmitted anthroponotically or zoonotically depending on the subspecies. Data on the main transmission routes, environmental contamination and animal reservoirs are still missing from sub-Saharan Africa.

The aim of the study is to understand routes of transmission and to identify genetic determinants in the parasite’s genome being responsible for host specificity.

The study is funded by the German Research Foundation (DFG) and is carried out also in Gabon, Madagascar and Tanzania.

Contact person: Dr. John Amuasi (amuas001@umn.edu), Dr. Daniel Eibach (eibach@bnitm.de)

Developing Excellence in Leadership and Genetics Training for Malaria Elimination in sub-Saharan Africa (DELGEME)

DELGEME aims to enrich the pool of African Scientist working in African institutions with relevant expertise particularly for the exploitation of genetics and genomics data for malaria elimination in sub-Saharan Africa.
Over five years, DELGEME will be providing short-term and degree training (MSc, PhD, Post-doctoral and Aspiring leader) to at least 85 young African scientists. Fellowships will be hosted at an African institution with a curriculum in genetics, genomics, bioinformatics, biostatistics or data science. DELGEME fellows are expected to develop a research proposal directed at elucidating critical gaps in malaria genetics and molecular epidemiological data exploration that can aid malaria elimination. For more information kindly visit the website delgeme.org.

Contact person: Dr. Oumou Maiga Ascofaré (maiga@kccr.de), Henry Hanson (henrykahus@yahoo.com)

Biomarker – Diagnosis of Malaria in Co-Infections (POC-Mal)

The project aims to develop a POC-test in order to differentiate malaria from other febrile illnesses with similar clinical presentation (e.g. bacterial blood stream infections). With data collected within a previous study (Fever Without Source). A first set of bio-chips was generated in collaboration with the Fraunhofer Institute for Silicium Technology as a proof-of-concept to set the path for a biomarker-based point-of-case (POC) test in the near future.

For the current study, samples collected from patient admitted to the children ward at Agogo Presbiterian Hospital will be tested and analyzed for their cytokine profile and a better set of biomarkers will be determined using statistical methods such as Random Forest modeling.

Contact person: Dr. John Amuasi (amuas001@umn.edu), Dr. Nicole Gilberger (Nicole.gilberger@bnitm.de)

Epidemiology of Influenza A viruses circulating in animals and animal-handlers in Ghana (Influenza Surveillance Ashanti; ISA)

Influenza A viruses affect a wide range of hosts including poultry, pigs and humans. Usually, transmission between birds and mammals is restricted by host adaptation – avian viruses do not replicate well in mammalian hosts and vice versa. Influenza viruses have evolved mechanisms to overcome host restrictions and infect other species, for example through re-assortment of gene segments during simultaneous infection of two virus subtypes. Poultry and pigs are a major source of protein and employment for the population of Ghana. These agricultural commodities contribute substantially to the food security, which is threatened by recent outbreaks of highly pathogenic avian H5N1. Although no human infection has yet been recorded, animal-handlers remain at high risk from infection by H5N1 and other Influenza A subtypes circulating in domestic animals. Data on the epidemiology of Influenza A viruses in the animal sector in Ghana is scarce. Our study aims to determine the prevalence and subtypes of circulating Influenza A viruses in poultry, pigs and their respective animal-handlers in Ghana. We further aim to assess the risk that these isolates pose to human hosts using phenotypic markers of increased transmissibility and pathogenicity.

Contact person: Matilda Ayim-Akonor (ayim-akonor@bnitm.de), Dr. Eva Mertens (mertens@bnitm.de)

Prevalence and transmission routes of antibiotic resistance genes: ESBL and MCR-1 in rural area of Ashanti Region of Ghana

Recently, resistance to available antibiotic is spreading, putting a lot of infected patient in a potential higher risk than ever before. The indiscriminate use of antibiotic and inapt practice of hygiene have been blame for the fundamental cause of antimicrobial resistance (AMR), and its spread. Globally, about 700,000 people die each year due to AMR posing a weighty drain on our human capital in particular and the world healthcare as a whole.

Plasmid mediated genes: Extended Spectrum Beta Lactamases (ESBL) gene and the recently found Mobile Colistin Resistant 1 gene (MCR) gene are the most commonly reported resistant genes. This is due to the genes ability to move from one gram-negative bacteria to another gram-negative bacteria.

Despite the rising relevance of antibiotic-resistant infections worldwide, there are paucity on studies describing their epidemiology and fecal-carriage in pediatric populations and Ghana is of no exception.

Our current study seek to addresses these gaps by screening ESBL and MCR-1 genes in our sample repository bank and assessing the spread of those resistance genes among community and livestock in close proximity.

Contact person: Dr. John Amuasi (amuas001@umn.edu), Charity Danquah (danquah01@yahoo.co.uk) / Kennedy Gyau (gyaukennedy@yahoo.com), Dr. Daniel Eibach (eibach@bnitm.de)

Recurrent Malaria after Artemisinin based Combination Therapy in an Endemic Area (ReACT)

Development of resistance to antimalarial drugs remains a major obstacle to the elimination of malaria. WHO introduced Artemisinin Combination Therapy (ACT) as the first line of treatment for uncomplicated P. falciparum malaria after the failure of Chloroquine. With the introduction of this drug, there was a decline in malaria morbidity and mortality rate. However, recent reports of developing resistance in South East Asia associated with a prolonged parasite clearance time creates the need for increase in surveillance of ACT efficacy in endemic countries.

This study therefore seeks to monitor parasite clearance time after exposure to ACT, distinguish recrudescence from reinfection among recurrent malaria. Common resistance markers and new genetic markers will be sought.

Contact person: Dr. Oumou Maiga Ascofaré (maiga@kccr.de), Dr. John Amuasi (amuas001@umn.edu)

Bacterial Subtype-associated Diarrhea (DECCASS)
In the past years, clinical studies on diarrheal diseases in developing countries have shed more light on the predominating causes of infection. Campylobacter spp, Shigella spp., and diarrhoeagenic E. coli (DEC) and Salmonella enterica have been among the most common pathogens isolated from patients with diarrhea. So far, no studies have been conducted on /Arcobacter/ spp. in Ghana and Tanzania. Arcobacter spp. is an emerging pathogen with its role in diarrheal disease not well understood.
In the past years, studies conducted in Africa estimated the attributable fraction of diarrheal disease on pathogen level. Moderate associations with diarrhea have been demonstrated for Shigella spp, Campylobacter spp. and DEC. However, the associations on bacterial sub-type level have not been studied thoroughly for the bacteria under investigation. But it may be specific bacterial sub-types particularly being associated with diarrhea.
This study aims to identify associations of the above-mentioned bacterial pathogens and their subtypes with diarrhea among children less than five years old.

Contact person: Prof. Richard Phillips (Phillips@kccr.de), Dr. Denise Dekker (dekker@bnitm.de

Hogan B, Eibach D, Krumkamp R, Sarpong N, Dekker D, Kreuels B, Maiga-Ascofaré O, Gyau Boahen K, Wiafe Akenten C, Adu-Sarkodie Y, Owusu-Dabo E, May J; Fever Without Source (FWS) Study Group. Malaria Coinfections in Febrile Pediatric Inpatients: A Hospital-Based Study From Ghana. Clin Infect Dis. 2018 Feb 2. doi: 10.1093/cid/cix1120.

Dekker D, Krumkamp R, Eibach D, Sarpong N, Boahen KG, Frimpong M, Fechtner E, Poppert S, Hagen RM, Schwarz NG, Adu-Sarkodie Y, Owusu-Dabo E, Im J, Marks F, Frickmann H, May J. Characterization of Salmonella enterica from invasive bloodstream infections and water sources in rural Ghana. BMC Infect Dis. 2018 Jan 19;18(1):47. doi: 10.1186/s12879-018-2957-4

Brinkel J, May J, Krumkamp R, Lamshöft M, Kreuels B, Owusu-Dabo E, Mohammed A, Bonacic Marinovic A, Dako-Gyeke P, Krämer A, Fobil JN. Mobile phone-based interactive voice response as a tool for improving access to healthcare in remote areas in Ghana – an evaluation of user experiences. Trop Med Int Health. 2017 May;22(5):622-630. doi: 10.1111/tmi.12864.

Marks F, von Kalckreuth V, Aaby P, Adu-Sarkodie Y, El Tayeb MA, Ali M, Aseffa A, Baker S, Biggs HM, Bjerregaard-Andersen M, Breiman RF, Campbell JI, Cosmas L, Crump JA, Espinoza LM, Deerin JF, Dekker DM, Fields BS, Gasmelseed N, Hertz JT, Van Minh Hoang N, Im J, Jaeger A, Jeon HJ, Kabore LP, Keddy KH, Konings F, Krumkamp R, Ley B, Løfberg SV, May J, Meyer CG, Mintz ED, Montgomery JM, Niang AA, Nichols C, Olack B, Pak GD, Panzner U, Park JK, Park SE, Rabezanahary H, Rakotozandrindrainy R, Raminosoa TM, Razafindrabe TJ, Sampo E, Schütt-Gerowitt H, Sow AG, Sarpong N, Seo HJ, Sooka A, Soura AB, Tall A, Teferi M, Thriemer K, Warren MR, Yeshitela B, Clemens JD, Wierzba TF. Incidence of invasive salmonella disease in sub-Saharan Africa: a multicentre population-based surveillance study. Lancet Glob Health. 2017 Mar;5(3):e310-e323. doi: 10.1016/S2214-109X(17)30022-0.

Rutledge GG, Böhme U, Sanders M, Reid AJ, Cotton JA, Maiga-Ascofare O, Djimdé AA, Apinjoh TO, Amenga-Etego L, Manske M, Barnwell JW, Renaud F, Ollomo B, Prugnolle F, Anstey NM, Auburn S, Price RN, McCarthy JS, Kwiatkowski DP, Newbold CI, Berriman M, Otto TD. Plasmodium malariae and P. ovale genomes provide insights into malaria parasite evolution. Nature. 2017: 542(7639):101-104.

Hogan B, Ammer L, Zimmermann M, Binger T, Krumkamp R, Sarpong N, Rettig T, Dekker D, Kreuels B, Reigl L, Boahen KG, Wiafe C, Adu-Sarkodie Y, Owusu-Dabo E, May J, Eibach D. Burden of influenza among hospitalized febrile children in Ghana. Influenza Other Respir Viruses. 2017 Nov;11(6):497-501. doi: 10.1111/irv.12507.

Dekker D, Wolters M, Mertens E, Boahen KG, Krumkamp R, Eibach D, Schwarz NG, Adu-Sarkodie Y, Rohde H, Christner M, Marks F, Sarpong N, May J. Antibiotic resistance and clonal diversity of invasive Staphylococcus aureus in the rural Ashanti Region, Ghana. BMC Infect Dis. 2016 Nov 29;16(1):720.

Eibach D, Herrera-León S, Gil H, Hogan B, Ehlkes L, Adjabeng M, Kreuels B, Nagel M, Opare D, Fobil JN, May J. Molecular Epidemiology and Antibiotic Susceptibility of Vibrio cholerae Associated with a Large Cholera Outbreak in Ghana in 2014. PLoS Negl Trop Dis. 2016 May 27;10(5):e0004751. doi: 10.1371/journal.pntd.0004751.

Baffour-Awuah S, Annan AA, Maiga-Ascofare O, Dieudonné SD, Adjei-Kusi P, Owusu-Dabo E, Obiri-Danso K. Insecticide resistance in malaria vectors in Kumasi, Ghana. Parasit Vectors. 2016:9(1):633.

Maïga-Ascofaré O, May J. Is the A578S Single-Nucleotide Polymorphism in K13-propeller a Marker of Emerging Resistance to Artemisinin Among Plasmodium falciparum in Africa? J Infect Dis. 2015: pii: jiv414.

• German Center for Infection Research (DZIF)
• German Research Foundation (DFG)
• Bernhard-Nocht Institute for Tropical Medicine (BNITM)
• Wellcome Trust – Developing Excellence in Leadership, Training and Science Africa Initiative (DELTAS Africa)
• Department of International Development (DFID)
• Alliance for Accelerating Excellence in Science in Africa (AESA)
• German Academic Exchange Service (DAAD)
• Ghana Ministry of Education
• West African Agricultural Productivity Program (WAAPP)

Master Thesis

• Kennedy Gyau (2015). Serotype Distribution Of Streptococcus Pneumoniae in Agogo, Asante-Akim North and their Antimicrobial Susceptibility Patterns.
• Clinton Azuure (2016). Epidemiology of nasal carriage of Staphylococcus aureus among hospitalized children at Agogo Presbyterian Hospital, Ghana.
• Henry Hanson (2017). In vivo Detection of Artemisinin Resistance in Agogo, Ghana.