Mission:"Develop and evaluate interventions to diagnose, treat, and prevent diarrheal disease"
The Department of Enteric Diseases at the Armed Forces Research Institute of Medical Sciences (AFRIMS) in Bangkok, Thailand has a long history of conducting collaborative research, epidemiology, and preclinical and clinical trials on enteric diseases.
Vaccine Evaluation
The department actively participates in the evaluation of enteric vaccines. The Department employs both full-time GLP and GCP specialists to ensure regulatory compliance for human and animal studies. Recent projects in conjunction with the Department of Veterinary Medicine, the Walter Reed Army Institute of Research, and the National Institute of Allergy and Infectious Disease include development of primate models for shigellosis caused by Shigella flexneri and Shigella dysenteriae. Primate studies to compare the safety, immunogenicity, and efficacy of the live attenuated Shigella dysenteriae vaccine WRSd1 to four newer vaccine constructs are ongoing. Human studies to evaluate the safety and efficacy of the WRSS1 oral, live attenuated vaccine against Shigella sonnei are planned for late 2007.
Treatment Evaluation
The department conducts treatment studies of traveler’s diarrhea. In conjunction with the Naval Medical Research Center, a study on the comparative efficacy of short-course Azithromycin vs. single dose Azithromycin vs. Ciprofloxacin was completed during Operation Cobra Gold 2000-2001 in Thailand. This study clearly demonstrated that short-course Azithromycin significantly shortened return-to-duty time. In conjunction with the Naval Medical Research Unit No. 3 in Cairo and the Naval Medical Research Center, a study of diarrhea prophylaxis of the non-absorbable antibiotic Rifaximin is planned for Operation Cobra Gold 2008-9 in Thailand and at Incirlik Air Base in Turkey.
Diagnostic Evaluation
The department actively develops and evaluates of new diagnostics for diarrheal diseases. The Department has developed real-time polymerase chain reaction assays for the bacterial pathogens Shigella, Salmonella, enterotoxigenic E. coli (ETEC), Campylobacter, and Vibrio as well as the hard to diagnose Noroviruses and the parasites Cyclospora and Cryptosporidia. The Norovirus assay has been incorporated into all surveillance efforts. The ETEC assay is currently under evaluation for inclusion in the U.S. government’s Joint Biological Agent Identification and Diagnostic System.
Surveillance
The department conducts surveillance on diarrhea etiology and antimicrobial susceptibility patterns in soldiers, travelers, and children in countries in the region such as Cambodia, Vietnam, Nepal, Thailand, and the Maldives. Completed studies from the past several years include a travelers’ study in Nepal, an adult study in expatriates and Thai nationals in Bangkok, and children’s studies in Hanoi, Vietnam and Phnom Penh, Cambodia. In addition, the Department conducted diarrheal disease surveillance in US forces deploying to Thailand for Operation Cobra Gold from 1987 through 2004. Ongoing surveillance projects include a multi-site study at regional and provincial medical centers in Thailand and study at three sites in Nepal. Relevant findings include widespread high-level quinolone (Ciprofloxacin) resistance in Campylobacter species in Southeast Asia; the recognition of Norovirus as an increasingly common diarrheal pathogen; and the onset of macrolide (Azithromycin) resistance in Salmonella isolates from patients in Thailand
Personnel
The department has a staff of 35 including 4 doctoral level scientists, 15 masters level technicians, and 3 nurses. Four of the masters’ level technicians are currently completing doctoral programs.
Clinical and Preclinical Facilities
The department is located within the AFRIMS Main Research Building on the grounds of the Pramongkutlao Medical Center. AFRIMS has an AAALAC accredited Veterinary Medicine Facility with over 600 rhesus macaques on a nearby campus for the conduct of preclinical trials. AFRIMS also a fully-staffed modern clinical trial center for the conduct of outpatient studies at Bumrungrad Hospital in downtown Bangkok. In addition, the Vaccine Trial Center with a 20-bed ward specifically designed and constructed by WHO for the conduct of enteric vaccine trials is located at the Mahidol University Faculty of Tropical Medicine across the street from AFRIMS. The department also has microbiology and molecular biology laboratories at WARUN, the AFRIMS facility in Kathmandu, Nepal.
Laboratory Equipment
The department has within the department well-equipped microbiology, immunology, and molecular biology laboratories. Equipment within the department includes multiple real-time PCR machines, Luminex machine, PFGE equipments, column sequencer, ELISPOT reader, automated plate-washer, low-density microarray reader, ultracentrifuges, incubators, freezers, etc. The department also has access to additional shared equipments within AFRIMS to include multi-channel flow cytometers with cell sorting capability, multicolumn sequencers, high-pressure liquid chromatography, etc. The AFRIMS Biomedical Maintenance Section coordinates and documents periodic maintenance, repair, and calibration of equipment.
Field Sites
.AFRIMS currently has active field sites with full-time staff in Thailand at Kamphaeng Phet in central Thailand and in rural Sangklaburi on the Thai-Burmese border; in rural northwestern Cambodia near the Thai-Cambodian border; and at two sites in the Philippines. In addition, WARUN, the AFRIMS satellite laboratory in Nepal occupies a four-story building with laboratories and a staff of 25 available to support the conduct of studies within Nepal. The department has or is conducting studies at these sites and others in Thailand, Cambodia, Nepal, and Vietnam.
