Dr. Anne W. Rimoin, Ph.D., M.P.H.

Assistant Professor - Department of Epidemiology - UCLA School of Public Health
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Dr. Anne W. Rimoin - Human Monkeypox in the Democratic Republic of Congo


The Epidemiology of Human Monkeypox in the Democratic Republic of Congo
Human monkeypox (MPX) is a smallpox-like zoonotic infection that occurs mostly in the rainforests and savannah of central and West Africa. MPX has presumably occurred in sub-Saharan Africa for thousands of years, whenever humans acquired the virus through direct contact with infected animals. However, it was not recognized as a distinct disease until 1970, when the elimination of smallpox from the Democratic Republic of Congo (DRC), formerly known as Zaire, revealed the continued occurrence of a smallpox-like illness in rural areas. An outbreak of MPX in the mid-Western part of the United States in 2003 highlights this virusís capacity to suddenly emerge from its endemic regions in surprising clusters of infection with an atypical clinical presentation. Although it is considered to be the most important orthopoxvirus since the eradication of smallpox, MPX disease in humans is poorly understood, its transmission pathways are largely unknown and only a handful of articles have been published in the medical literature describing the disease in its native range. Many factors have hampered research on human MPX infection, including the remote location of cases, war, and lack of field-ready diagnostic tests. The reservoirs for MPX remain largely undefined.
To study the epidemiology of human MPX, we are conducting two linked infection/disease burden studies in the Sankuru district of the Kasai Oriental province, a MPX-endemic region of the DRC that has consistently reported the greatest number of MPX cases in the country. The principal aim of these studies is to determine the burden of infection/disease of human MPX. Additional aims include: 1) establish risk factors for acquiring MPX infection; 2) update the current MPX clinical case definition; and 3) enhance local MPX surveillance and laboratory diagnostic capabilities in the DRC.
These clinical surveillance and seroepidemiologic studies will provide the necessary data to determine the MPX infection /disease burden and the associated epidemiology in humans in the DRC and therefore contribute to a better understanding of the public health significance of human MPX. Additionally, these studies will provide essential information for the development of future ecologic studies and vaccine and therapeutic trials for prevention and control of orthopoxviruses in a community setting.

Dr. Anne W. Rimoin - The Epidemiology of Human Monkeypox in the Democratic Republic of Congo
Monitoring Select Populations for Emerging Zoonotic Infections
The majority of emerging infectious diseases (EIDs) have animal origins including: Ebola, monkeypox, plague, SARS, West Nile virus, and most recently, avian influenza. The entry of novel animal diseases into human populations can have a devastating impact on global health, economy, and security. There are currently no effective systems in place to monitor and stop zoonotic EIDs before they emerge. This study utilizes a novel multi-disciplinary approach to monitoring for the emergence of such diseases in individuals who are at the nexus of animal and human interaction. This study focuses on populations of individuals in the DRC that are regularly exposed to wild animals (bats, non-human primates, rodents, etc.), due to their reliance on these animals for a source of food. Individuals in this population will be enrolled into a study aimed at determining the presence of zoonotic infection. Serologic, microarray and PCR-based techniques are used to screen the collected blood samples for infection with known and novel viruses. This study will provide critical information that may lead to an understanding of which zoonotic microorganisms have the potential to infect, cause disease, and spread in human populations.

Dr. Anne W. Rimoin - The Epidemiology of Human Monkeypox in the Democratic Republic of Congo
An Innovative Model for Detecting Interspecies Disease Transmission and Novel Pathogen Detection at Lola ya Bonobo Sanctuary, Democratic Republic of Congo
Recent studies have highlighted Central Africa as an emerging infections hotspot and African apes as a reservoir of pathogens posing risk to humans. We have harnessed a uniquely skilled team to pilot an index-cluster study for detection of interspecies disease transmission at Lola ya Bonobo sanctuary in the Democratic Republic of Congo (DRC). We are currently focusing on respiratory viruses given the transmissibility, sample accessibility, and potential for global distribution. We have established surveillance for symptomatic respiratory illness among humans and bonobos (Index Cases). For each of five separate index events, we serially sample (5 days) a contact cluster of 5 bonobos and 5 human staff to determine secondary attack rate and risk factors for transmission. We aim to detect known viruses from respiratory samples using an established multiplex PCR algorithm in Durham, NC and create a biorepository for biomarkers of early disease and pathogen discovery. Veterinary history of the sanctuary bonobos suggests we will document pathogen transmission between and among the sanctuary bonobos and the animal care staff. Our specific aims are:
  1. To detect intra- and inter-species transmission (symptomatic and asymptomatic) of respiratory viral pathogens in the Lola ya Bonobo (LyB) animal sanctuary in DRC.
  2. To determine risk factors for intra- and inter-species transmission of respiratory viral infections among enrolled subjects in SA 1.
  3. To establish an interspecies biorepository for pathogen discovery and biomarker development.
  4. To further develop existing laboratory capacity for clinical and research programs at the INRB in DRC.

Dr. Anne W. Rimoin - The Epidemiology of Human Monkeypox in the Democratic Republic of Congo
Estimating population immunity to vaccine preventable diseases in the Democratic Republic of the Congo
The DRC has not yet reported a confirmed case of wild poliovirus (WPV) in 2012. While the absence of confirmed WPV cases is an encouraging indication of progress, the DRCís success in eradicating polio depends largely on maintaining high immunization coverage with quality vaccination throughout the country. Data from campaign and routine immunization suggest that oral polio vaccine (OPV) coverage is insufficient and recent report from the International Monitoring Board (IMB) estimates that 640,000 children in DRC have never received a dose of polio vaccine. Emergence of circulated vaccine-derived polio virus type 2 (cVDPV2) is associated with lower vaccination coverage levels, and four separate lineages of cVDPV2 emerged in the province of Katanga in 2011 alone, at least 3 of which continued to circulate into 2012. Prolonged interruptions in vaccination activities due to conflict and unrest over the last decade may have resulted in significant immunity gaps in older children and adults, potentially leaving entire cohorts susceptible to poliovirus. Poor infrastructure and difficult terrain isolate many villages in DRC making vaccine delivery, supply and storage under proper conditions difficult that can compromise vaccine efficacy and result in sub-optimal immunity.
Serosurveys measuring specific antibodies are a direct and accurate method to assess population susceptibility and can provide critical insight into ongoing immunity gaps and operational program efficiency, however they are logistically challenging and expensive to undertake. As a result, they are generally limited to small geographic areas or convenience samples that may produce biased results and cannot be interpreted on a national scale.
We have therefore developed a first-of-itís-kind collaboration with the DRC Demographics and Health Survey (DHS) that was recently conducted in 2013- 2014 to obtain robust nationally representative estimates of population immunity to polio, measles, rubella and tetanus. Based on our experience, we are currently developing a standard set of materials for add-on serosurveys that can be used in future DHS surveys and/or adapted for use with any existing data collection effort in DRC and other countries. Our project is also developing local capacity to analyze and interpret these data alongside existing immunization program indicators and validate questionnaire-based surveys of coverage. Once these data have been finalized, we will conduct a landscape analysis to synthesize and aggregate existing data to provide a comprehensive understanding of how regularly available data can be best utilized, interpreted and methodologies improved/refined. These efforts will further strengthen DRCís ability to eradicate polio permanently, to clear any undetected circulating virus, and to prevent outbreaks due to reintroduction and will provide critical data upon which policy recommendations can be made at national and provincial levels. Additionally, data on population immunity to measles and rubella may be obtained which will provide baseline for future elimination and eradication programs.

Dr. Anne W. Rimoin - The Epidemiology of Human Monkeypox in the Democratic Republic of Congo

Dr. Anne W. Rimoin - The Epidemiology of Human Monkeypox in the Democratic Republic of Congo
Assessing the burden of HIV and Schistosomiasis co-infections in the Democratic Republic of the Congo
Sub-Saharan Africa continues to bear a disproportionate share of the global HIV burden resulting in significant morbidity and mortality in the region. Urogenital schistosomiasis, caused by infection with the parasite Schistosoma haematobium, is widespread and causes substantial morbidity on the African continent. Recent epidemiological studies suggest that genital infection with S. haematobium may increase the risk of HIV acquisition in young women due to local genital inflammation and systemic immunological effects. Additionally, schistosomal co-infection may accelerate HIV disease progression and facilitate HIV transmission to sexual partners and unborn infants via vertical transmission. New estimates suggest that female genital schistosomiasis may occur in as many as 100 million African girls and women defining this infection as one of the most common and emergent gynecologic conditions in Sub-Saharan Africa. In order to address the burden of disease caused by urogenital schistosomiasis, our study focuses on the following specific aims:
  1. To assess the burden of schistosomal infections, in particular, S. haematomium and S. intercalatum in pregnant women seeking prenatal care at established antenatal clinics in the Democratic Republic of the Congo (DRC) and to quantify the increased risk of HIV infection in women with schistosomiasis.
  2. To identify correlates of HIV/ schistosomal co-infection in endemic regions of the DRC, particularly sexually transmitted infections (STI) co-infection.
  3. To quantify the degree of HIV disease progression in individuals co-infected with HIV and schistosomiasis.