By Cheryl Pellerin
USINFO Staff Writer

This is the second in a series of articles on the U.S. contribution to global disease surveillance.

Washington - The U.S. Department of Defense long has focused its research into infectious diseases, therapeutics and vaccines on men and women in uniform, but a growing disease-surveillance program, a network of overseas laboratories and a range of efforts with international partners have added public health to its mission.

The department’s Global Emerging Infections Surveillance and Response System (GEIS) has been part of that mission since 1996, when a presidential directive expanded the role of most federal agencies to improve domestic and international infectious disease surveillance, prevention and response. (See related article.)

But Defense had an overseas presence long before 1996, said Dr. Joseph Malone, GEIS director from 2003 to 2006, in a May 21 USINFO interview.

“The federal government has been interested in tropical diseases and international disease surveillance for many years,” Malone said, “but a concerted effort was made [in 1996] to create a coherent surveillance product and activities that would work together among agencies and cooperate with the World Health Organization [WHO] and other systems around the world.”

SCIENTIFIC OUTPOSTS

Concerns about the spread of infectious diseases in an increasingly mobile and globalized world make surveillance, research and international scientific capacity-building and training critical activities for Defense labs overseas.

“Each of five international laboratories is a collaborative operation with the host country,” GEIS's director, Colonel Loren Erickson, told USINFO May 17, “and we’re very proud that public health and research and the areas where we have common interests transcend political issues.”

The labs are the U.S. Naval Medical Research Unit No. 3 in Cairo, Egypt; the U.S. Naval Medical Research Unit No. 2 in Jakarta, Indonesia; the U.S. Army Medical Research Unit in Nairobi, Kenya; the U.S. Naval Medical Research Center in Lima, Peru; and the Armed Forces Research Institute of Medical Sciences in Bangkok, Thailand.

In Cairo, the U.S. Navy has been partnering with its neighbors in North Africa, the Middle East and Southwest Asia since 1946, when it commissioned the Naval Medical and Research Unit No. 3 (NAMRU-3) to study, prevent and control epidemic and endemic diseases in subtropical areas where Navy personnel were stationed. (See related article.)

Today, as they have for more than 60 years - including during a 1967-1974 lapse in diplomatic relations between Egypt and the United States - U.S. Navy, U.S. Army and Egyptian scientists and staff members at NAMRU-3 study viruses, disease vectors (carriers) like ticks and mosquitoes, and enteric (intestinal) diseases and establish surveillance networks to monitor the region’s most important disease threats.

The overseas labs, Erickson said, “provide the bedrock for a lot of the work we do. [Scientists stationed there] work in the host country and regionally to help countries in the area build their own capabilities - training professionals to work in laboratories, do epidemiologic investigations and conduct research.”

WORKING WITH PARTNERS

In the 11 years since the presidential directive was issued, U.S. federal agencies like the Department of Health and Human Services’ Centers for Disease Control and Prevention (CDC) also have broadened their scope to include the rest of the world.

“Since 2004,” reads an entry on the CDC Web site, “the agency has refined and begun to systematize its approach to [disease] responses through the Global Disease Detection program ... a network of international centers of excellence in emerging infectious disease outbreak detection, identification, tracking and response.”

CDC’s global strategy includes a broad emerging infections program, a training program for field epidemiology and laboratory scientists, and a team of epidemiologists focused on flu surveillance and detection. CDC also works with GEIS at the overseas labs and has a full-time epidemiologist at NAMRU-3.

“Because the CDC is also engaged in international surveillance work and some capacity building, and assisting countries with early response [to disease outbreaks],” Erickson said, “it’s important that we work together, that we don’t duplicate effort, that we don’t waste taxpayers’ money.”

Another partner is WHO in Geneva, where GEIS has a full-time staff member - a Navy captain and infectious disease specialist who works on viral hemorrhagic diseases.  This officer serves as a liaison between GEIS and WHO through WHO’s Global Outbreak Alert and Response Network, a technical collaboration of institutions and networks that pool resources to rapidly identify, confirm and respond to international outbreaks.

The overseas labs are considered WHO collaborating centers (national laboratories used for international purposes), and the NAMRU-3 Virology Research Department is a regional influenza reference laboratory for WHO’s Eastern Mediterranean Regional Office.

In that capacity, scientists confirm the identity of flu viruses isolated by national laboratories, offer laboratory training, collaborate on surveillance studies and conduct research to improve flu virus surveillance.

“It’s an exciting time to be engaged in this kind of work,” Erickson said. “Avian flu is just the tip of the iceberg - with the resurgence of Rift Valley fever and chikungunya [a viral fever spread by mosquitoes], extensively drug-resistant tuberculosis and, more broadly, microbial resistance to antibiotics, we’re going to be busy.”

More information about GEIS is available on the Defense Department Web site.

See also “International Laboratory Network Watches for Disease Outbreaks.”