Mergler, Michelle

Public Health

PhD

Nepal

Burden and Risk Factors for Bordetella Petussis Infection in Mothers and Their Infants

Pertussis is a significant contributor to childhood deaths in developing countries. Infants <6 months are at greatest risk of morbidity and mortality due to their immature immune systems. Vaccination at birth does not provide critical protection during early infancy. Maternal vaccination during pregnancy may be an effective strategy for prevention of pertussis in young infants. However, population-based estimates of disease burden in pregnant women and children, and an understanding of how maternal antibodies transferred during pregnancy may provide protection to infants is lacking. The objective of this study is to estimate prospectively the incidence of and risk factors for pertussis in pregnant/postpartum women and their infants followed through 6 months of age in Nepal. The study also aims to characterize the association of maternal and infant pertussis antibodies and the clinical relevance of maternal antibodies in infants. The expected outcome of the study will be to provide the most accurate estimate of the burden of and risk factors for pertussis in vulnerable populations (pregnant/post-partum women and infants <6 months) in a developing country setting. The characterization of the epidemiology and immunology will provide the necessary foundation to inform future pertussis immunization strategies, with a primary focus on maternal immunization.

Prior to arriving in Nepal I had been developing my research plan for over a year and had worked intimately with manuals and protocols from the field site. I was ecstatic to finally be in the field experiencing what I had only read about prolifically. Nepal was a sensory overload. The most apparent visual experience is the abundance of color. Women’s clothing, temples, spices, and tika drew from a vivid rainbow palette. The food was spicy and included delicacies such as “prawn chips”, which expand like magical towels when immersed in hot oil. At the field site we lived on the grounds of a sugar mill so we absorbed the smells of the factory and trucks bearing sugar cane. The preferred mode of transportation around the field site was by motorcycle. At first I was petrified to ride on the back of a motorcycle on the bumpy roads but after a short while it became a highlight of the day. One of the reasons was the extreme heat that existed during my stay. The breeze felt while on the motorcycle provided a brief respite from the heat and heavy humidity that was otherwise constant. The last sense, hearing, was also a source of constant stimulation. Vehicles used honking for many reasons, little of which I observed were for anger, but seemed to permeate most roadways. Nepali culture is filled with holidays and these generally involve music blaring from speakers in celebration, regardless of time of day. Nepali language was intimidating for me, as at first it seemed impossible to break the code to make any of the sounds intelligible to my ears. I was fortunate enough to have Nepali language instruction at the beginning of my stay and was able to continue the learning independently through Nepali books and the necessity of using the language while in the field. Given the vibrancy of life in Nepal I felt as though there was never a dull moment during my stay.

Overall I found the Nepali people I met to be extremely welcoming and accommodating. I was impressed with the overall organization of the field site and the dedication of the workers. I have never worked in a place with such cohesiveness and pride in the history of the site. Some staff members have worked with the organization since its inception 25 years ago. I also appreciated that it employed large numbers of married women. Women generally have less opportunities than men in Nepal and providing women the ability to work outside the home earning money helps to increase their status. Gender disparities remain though and it was difficult to even process what vastly different opportunities were available to a Nepali woman versus a US woman. I was in Nepal, away from my husband for 4 months, doing research in the field I am passionate about, public health. For my female Nepali counterparts to have the same opportunity would be rare. This experience made me grateful that I am able to be independent and pursue my passions. It also redoubled my commitment to working through health to improve the lives women in some small way.

I had spent extended time in developing countries (Kenya, Zambia, and China) before so I knew generally what to expect in term of poverty and health. However, the experience of living in Nepal, jolted me, brought clarity, which cannot come through reading alone. Nepal is an extremely poor country. The World Bank places Nepal’s Gross Domestic Product per capita at 161 out of 180 ranked nations. By the luck of the draw some people (including myself) were born in places where we have enough food, clean water, electricity, and access to a decent public education. This realization of luck is not new to me but I tend to forget it as the passage of time mutes the impact of previous experiences. It sounds cliché but it’s absolutely true. It’s effortless to forget or put out of mind the depths of poverty in the world once I’m back in my bubble in the US. Despite prior experiences, the poverty continues to leave a deep impression. For me there is no substitute to actually immersing yourself (to a degree) into this environment to get a real grasp on disparities. It centers me. The challenge I have had since returning to the US is to keep my memories fresh from my time in Nepal (and other places) and use that to help ground me as I am carried away with life in the US.

People

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...
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October 2017

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