Advanced training strengthens disease surveillance in Chad

An intensive training program led by Yale School of Public Health epidemiologists is helping to strengthen disease surveillance in Chad where there has been a recent surge in malaria and dengue.

The program’s focus on laboratory-capacity building and advanced training in serological, molecular, and genomic techniques recently allowed scientists in Chad to process a pathogen from sample to full sequence analysis, believed to be a first for the country, which has traditionally relied on outside support for such advanced work.

The data generated by the training participants revealed insights about the nature of the current disease outbreak and was communicated to Chad’s Ministry of Public Health.

“These sophisticated techniques and approaches for genomic surveillance in Chad will dramatically decrease the time it takes to obtain this kind of data, which ultimately is the goal of true, actionable surveillance,” said Amy Bei, an assistant professor of epidemiology (microbial diseases) at YSPH and leader of the laboratory-capacity strengthening team. “I think it is also a boost for morale that the data was generated fully in Chad by Chadian scientists. The project is the fruit of many deep collaborations aimed at increasing and supporting local lab capacity. Overall, the future is bright for public health in Chad.”

A total of 28 Chadian research scientists, physicians, public health officials, and lab technicians attended the November training in N'Djamena, the capital and largest city in Chad. Other trainers involved in the project were Joseph Fauver, PhD, a former postdoctoral fellow at YSPH who is now an assistant professor at University of Nebraska Medical Center; Yale PhD candidate Sarah Lapidus; YSPH Assistant Professor Adjunct Dr. Dawn Zimmerman, DVM; and Yale PhD student Aboubacar Ba, from University Cheikh Anta Diop in Dakar, Senegal. The sequencing protocol implemented for pan-serotype Dengue virus sequencing (DengueSeq) was developed by YSPH research scientist Chantal Vogels, PhD.

The training was funded by a grant from the United States Agency for International Development (USAID), with support from a Yale Planetary Solutions Seed Grant.

“The multidisciplinary training focused on laboratory-capacity building, including a special malaria and dengue subproject of molecular characterization of these two agents in Chad for the very first time,” said Dr. Sten Vermund, MD, the Anna M.R. Lauder Professor of Public Health at YSPH, who served as the principal investigator for the training. “With global climate change, we are seeing a surge in malaria and dengue because of more favorable vectorial capacity (the efficiency of vector borne disease transmission).”

Laboratory-capacity building using genomic surveillance began in Chad in February 2020 through efforts by YSPH. Ongoing training since then has encompassed the One Health approach to public health that recognizes the interconnection between human disease, animal disease, and the environment.

Vermund has visited Chad four times since 2020 to train, usually one-week trips, with all training taking place in N'Djamena. But some of the surveillance workers trained are from remote parts of the country, taking them up to 72 hours to travel to N’Djamena. “The backgrounds of trainees are also highly variable, so there are challenges in choosing a didactic level for training materials,” Vermund said.

The recent two-week intensive and other training programs have built skills, nurtured communications within Chad’s Ministry of Public Health, and improved systems in several areas, according to Vermund. “We have had wild successes,” he said. “The Chadians are very enthusiastic and committed. Our evaluations have been universally favorable.”

Bei has visited Chad three times since 2020, typically staying one to two weeks. The team maintains periodic team calls and activities remotely when not in person.

“As always in resource-limited settings, challenges in building sustainable lab capacity can be physical, like electrical shortages or power surges; logistical, like access to reagents, timely delivery, or increased costs when purchased in country; or access-based, like access to resources for learning and training,” Bei said. “We try to plan the best we can for all these challenges and have multiple plans in place. A simple example of this was procuring and transporting working flow cells in Chad. Thankfully, our backup plan came through.”

Bei said the scientists and clinicians in Chad are extremely motivated. “They are so eager to learn and never seem to tire in their pursuit of knowledge and experience with advanced techniques and analyses that are beneficial to the greater cause of public health,” she said. “Even when faced with 2.5 weeks of daily 9 a.m. to 5 p.m. full-time training, participants would often arrive an hour early and stay later with many thoughtful and astute questions, from specific methods to applications.”

Program trainee Mahamat Koulbou, head of the bacteriology unit at the Laboratory of the University Hospital Center for Mothers and Children of N'Djamena, said the training exceeded his expectations. “It was foremost participatory, and the trainers were able to meet our expectations through an active methodology,” Koulbou said. “The choice of subject is also innovative in the scientific world.”

Koulbou, who is currently pursuing a PhD in microbial resistance at the University of N'Djamena, noted that molecular biology and sequencing methods are topical in research and public health. “This training will bring added value not only to my academic and professional research projects, but to research in Chad,” he said.

Koulbou said the training will bolster public health in Chad as well. “Given the evolution of infectious agents, the introduction of new technologies in Chad will bring more light to the diagnosis of emerging diseases and its management decisions, such as antimicrobial resistance in Chad,” Koulbou said. “It was through this training that Chad was able to carry out its first local sequencing.”

Vermund pointed out that Chad is a strategically critical county to the United States due to the instability of neighboring countries. “Being able to provide soft power like capacity-building for health can be very helpful to the Chadians that seek peace, prosperity and good health for their country.”

To date, over 250 scientists, researchers and health officials in Chad have participated in training by YSPH since early 2020. A surgery and anesthesia initiative that focuses on upgrading surgical interventions for pregnant women and for children will likely launch in late March.