Impact of American Indian Research on Global Health

Transcription

1 Impact of American Indian Research on Global Health Kate O Brien on behalf of Center for American Indian Health Department of International Health Johns Hopkins Bloomberg School of Public Health October 3, 2013 University of Amsterdam

2 Discovering the New World

3 Christopher Columbus They (Arawak Indians Bahamas) were well built with good bodies and handsome features.they do not bear arms, and do not know them with fifty men we could subjugate them.

4 Bartolome De Las Casas ( )

5 Las Casas When the local chief learned that they were coming, he and up to twenty of his men came out of their town and league in order to welcome them, presenting them with a great deal of food and supplies..endless testimonies prove the mild and pacific temperament of the natives but our work was to exasperate, ravage, kill, mangle and destroy...my eyes have seen these acts so foreign to human nature, and now I tremble to write..who in future generations will believe this? I myself write it as a knowledgeable eyewitness can hardly believe it. Zinn, H. A People's History of USA 1492-Present

6 Federal Health Service for Indian People 1803-War Department assigned responsibility for health of Indians

7 1830: Indian Removal Act

8 Trail of Tears

9 Trail of Tears From Georgia to Oklahoma removed Cherokee (Observer s Description): The Indians had their families with them, and they brought in the train the wounded, the sick, the newly born, and the old men upon verge of death. They possessed neither tents nor wagons, but only their arms and some possessions. There was no cry, no sob all were silent.

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17 Epidemics of Infectious Diseases 1500 s-1800 s Among NA Populations Smallpox Measles Cholera Influenza Scarlet Fever Malaria Typhoid

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19 Tuberculosis BCG Vaccine Trial Aronson et al N=376 N=384 N=478 N=897 N=657 Towsend et al Ann Rev Tuberc 1942; 45; 41-52

20 Joseph D. Aronson M.D

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22 60 year Follow up Dr. Naomi E. Aronson BCG Vaccine Efficacy 52% ( CI 27-69%) Naomi Aronson, et. al. JAMA May, 2004

23 Strategic Approach to Prevention Diseases of disproportionate morbidity or mortality Evaluate Effectiveness Implement Intervention Test Interventions Define Problem: Surveillance Identify Causes: Risk factors 23

24 Navajo and White Mountain Apache Reservations Navajo Nation Hopi White Mountain Apache UTAH COLORADO ARIZONA Albuquerque Phoenix Tucson NEW MEXICO

25 JHSPH TT Seminar 4 November

26 JHSPH TT Seminar 4 November

27 JHSPH TT Seminar 4 November

28 American Indian General Health Status Life expectancy reduced Unemployment rates 30% + Housing 60% heated by wood or coal 15% no regular water source 50% lack plumbing 30% have no bedrooms 75% have no landline phone Major health disparities Diabetes rates Teen/Youth suicide Injury related deaths Alcohol related deaths Infectious disease morbidity/mortality 28

29 JHSPH TT Seminar 4 November

30 Indian Health Service JHSPH TT Seminar 4 November

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32 Mathuram Santosham 32

33 Incidence Symptomatic Hepatitis B in AK Natives Vaccine Demo Program begins in Yukon Kuskokwim Delta Statewide Program -newborn immunization Lancet. Nov.14, 1987

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36 Diarrhea mortality estimates Study Year Deaths per year (millions) Snyder and Merson Institute of Medicine Martines et al Bern et al World Dev. Report Murray and Lopez Bryce et al

37 Oral Rehydration Therapy: USA Early 1980 s Not Recommended Safety concerns (Hypernatremia)

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42 Oral Rehydration Therapy..potentially the most important medical advance this century Lancet, August 5, 1978

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44 Frequency and volume of stools will usually subside rapidly in 48 hours. When this occurs oral feeding of one of the carbohydrate electrolyte mixtures may be initiated Usual dietary intake is achieved, usually in 7 to 8 days. Nelson, Textbook of Pediatrics, 11 th edition

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46 Early vs Delayed Feeding on Duration of Diarrhea 110 Mean Duration (±SEM), Hours Early Feeding Delayed Feeding 0 * P<0.001 Pediatrics 76; no 2 Aug 1985

47 Differential Deaths from Diarrhea GASTROINTESTINAL DISEASE DEATHS American Indian and Alaska Native and U.S. White deaths per 100, AI/AN, three-year average male and female all ages AI/AN White ratio: AI/AN to White selected years ratio

48 Hib meningitis White Mountain Apache tribe 3 month period (Oct-Dec 1981) 5 cases of invasive Hib disease among approximately 1,000 children <5 years

49 Manifestations of Hib disease (1) Pneumonia Meningitis Blood Stream Infections 49

50 Annual Incidence of Hib Meningitis in Children Under 5 Years Alaska Eskimo Apache Australian Aborigine, NT Navajo USA, Dallas Gambia Sweden Finland USA, Baltimore Cases per 100, 000 population Modified from Bijlmer, Vaccine, 1991; 9(suppl.):S5-9

51 Impact of Hib vaccine on Navajo children < 24 months of age Estimated Rate # of Hib cases Vaccine Efficacy Trial Begins Vaccine Efficacy Trial Ends Vaccine Licensed Year

52 Scottsdale Hib Meeting 2002

53 GAVI Funding Eligibility

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57 Global Introduction Status of Rotavirus Vaccine Already Introduced (Universal) 41 Countries Already Introduced (Regional) 6 Countries Source: IVAC, Johns Hopkins Bloomberg School of Public Health. Vaccine Information Management System (VIMS) June 2013

58 Summary of CAIH Infectious Disease Project Timelines (since Prevnar Trial, 1997-present) Phase III licensure trials Haemophilus influenzae Respiratory Syncytial Virus Rotavirus Hepatitis A and B Helicobacter pylori Streptococcus pneumoniae 58 JHSPH TT Seminar 4 November 2008

59 Pneumococcal conjugate vaccine trial Hib vaccine trial Rotavirus vaccine trial Maternal flu study

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61 JOHNS HOPKINS CENTER FOR AMERICAN INDIAN HEALTH PROGRAMS Infectious Disease Behavioral Health Training Service

62 Training Infectious Disease Research Behavioral Health Programs/Research

63 Allison Barlow Associate Director Behavioral Health Raymond Reid Associate Director

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65 William Osler to William Welch : Welch, it is lucky that we got in as professors; we could never have entered as students. " William Welch

66 half of what we teach you here is wrong Unfortunately, we don t know which half -Lisa Sanders, -New York Times

67 Traditional Philosophy Navajo Blessing way chant With beauty before me, there may I walk. With beauty behind me, there may I walk. With beauty above me, there may I walk. With beauty all around me, there may I walk. In beauty it is finished.