Progress and PCR

Progress and PCR

by Geoff Kahn, MHSc

I must admit, I’m still fairly new to IVAC and to the kind of work we do here. A year and a half ago I worked in a lab, and the only contact I had with the outside world was when the FedEx delivery man would drop off a batch of new samples. Now I collaborate with doctors and other scientists halfway across the world. Specifically, I work in India, and I’ll tell you that at least as far as public health is concerned, 2012 is off to a good start:

On January 13 India celebrated one year without a new polio case; the introduction of the Hib-containing pentavalent vaccine that was launched in two states on December 14 and 17, 2011 continues unabated; and this month a hospital in Chennai will begin using a new, state-of-the-art real-time PCR machine to examine the causes of childhood meningitis with greater precision than ever before. While not as prevalent an illness as pneumonia or diarrhea, meningitis is nevertheless a fearsome disease due to its high mortality rate even in settings with advanced healthcare and its propensity for leaving up to a third of survivors with permanent disabilities, including deafness, mental retardation and seizure disorders. It is also linked inexorably with the more widespread pneumonia, as several bacteria species, notably Hib and pneumococcus, are leading causes of both diseases. The Institute of Child Health and Hospital for Children in Chennai, Tamil Nadu, is one of several sites in India where IVAC has been providing technical assistance to ICH to conduct surveillance of childhood meningitis. Their new PCR machine will enable scientists and doctors to test for over 10 different species of bacteria and viruses with greater sensitivity, leading to improved understanding of the causes, and therefore the means to combat, childhood meningitis in India.

But, to me, this machine is as much a symbol as it is a tool. It is a symbol of what is possible when local dedication, technical expertise, and international support come together. See the transformation that has been wrought:

Left: Not terrible, but also not much more than a box: cluttered space, no laminar air flow or UV lamps to keep things sterile. Right: That’s the new PCR machine in white, and yes, it is so fancy that it requires its own dedicated computer.

As impressive as it is, one is sobered by the realization that with success comes raised expectations. This hospital in India now possesses technology on par with any machine to be found at the CDC in Atlanta; it possesses scientists trained to use that technology, and it already possesses a commitment from the state government to take over funding the PCR work in 2013, once the support from IVAC ends. As advances like new machines, new vaccines, the fall of polio are made, the shortfalls – maternal and under-5 mortality rates that are currently trending to fall short of MDG goals, malnutrition that runs rampant, gender equity that remains elusive – become less and less tenable.

It is great that India is making the advances that it is, and it has been wonderful to work with the doctors and researchers in Chennai and elsewhere, but we (IVAC, the public health community, and you) must always be wary of stopping too long to rest on our laurels. It has been my pleasure to share the accomplishment of our partners in Chennai, but now, if you will excuse me, it’s time to get back to work.

Geoff Kahn, MHSc is a Research Associate at the International Vaccine Access Center at Johns Hopkins Bloomberg School of Public Health