Fighting a cholera epidemic in Bangladesh

In Bangladesh, cholera becomes epidemic at times of severe flooding during monsoon rains. People living in the slums of Dhaka city, where the water and sanitation advancements of the last century have yet to be fully realized, are most likely to become infected. Each spring, as the first cholera season of the year begins, the International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B) raises tents to accommodate hundreds of patients that arrive daily for rehydration and antibiotic treatment.

At the ICDDR,B, I participate in activities ranging from patient care to vaccine immunology projects, and therefore experience the full spectrum of clinical research. I spend most of my time in the laboratory examining memory T cell responses to cholera infection using flow cytometry. I presented this work in a poster at an Emerging Infectious Diseases meeting in Calcutta, India in April. As a secondary project, I analyzed existing data on diarrheal illness in household members of cholera patients. We found that half of household contacts experience diarrhea around the time of hospitalization of the primary cholera case, and we identified risk factors for severe disease in this population. Because of this heavy disease burden, we propose that clinical guidelines advising against prophylactic treatment of household members be reconsidered. This research will hopefully meet with a broad audience at the American Society for Tropical Medicine and Public Health conference this fall.

My Fogarty year at the ICDDR,B has featured a unique combination of studying clinical outcomes, patient care in an underserved population, and exploring new frontiers in the laboratory. Experiencing these aspects of clinical research has informed my career trajectory in international health and infectious disease. In addition, the possibility that an effective cholera vaccine could someday transform Bangladesh gives me a new appreciation for the potential impact of clinical research.