Award: Clinical Trainee Award

Dr. Shah is the Stephen Bechtel Endowed Postdoctoral Fellow for her project titled “Malaria and Arbovirus Co-Infections in Kenyan Children” (2018)

Total Award Amount: $123,000

Aims: Dr. Shah has been working on two main projects, both supported by MCHRI resources. One aims to explore the etiologies of febrile illness (described in her Clinical Trainee award application), and another investigates how climate change impacts malaria risk. The second project is a result of trends Dr. Shah observed in the febrile illness dataset.

Febrile Illness Findings and Implications: Dr. Shah partnered with Associate Professor of Pathology and Medicine Benjamin Pinsky, MD, PhD, who is a co-mentor on her Clinical Trainee grant along with Associate Professor of Pediatric Infectious Diseases A. Desiree LaBeaud, MD, MS. As the Medical Director of Stanford’s Clinical Virology Laboratory, Dr. Pinsky has developed a highly sensitive PCR test that can detect viruses in blood samples. Using Dr. Pinsky’s assay, Dr. Shah studied 1200 samples that Dr. LaBeaud’s team had collected from Kenyan children with febrile illness. What she found was clinically significant—30 to 40 percent of the samples tested positive for dengue or chikungunya. This finding hasn’t been previously reported partly because the clinical symptoms of dengue and chikungunya—fever, headaches, body aches, diarrhea—are essentially identical to the clinical symptoms of malaria. Most children who present with a fever are told they have malaria.

Now that scientists are learning more about co-infections, the goal of Dr. LaBeaud’s lab is to improve diagnostics. Dr. Shah explains that about 50 percent of children are being given anti-bacterials and anti-malarials, when often they may not need them because their fever is due to an arbovirus infection. By considering the range of etiologies of febrile illness we may able to reduce the spread of antimicrobial resistance.

Climate Change Findings and Implications: It’s not that malaria risk will follow a linear trajectory and increase as temperatures rise. Instead, Dr. Shah and her colleagues found malaria risk follows a bell-shaped curve—there’s a peak at 25 degrees Celsius (or 77 degrees Fahrenheit). As temperatures rise above 25°C, malaria risk goes down. Already, some places in Africa are at that peak, but there are mountain regions and cooler areas in Southern Africa that will inch closer to that 25°C mark over time as climate change progresses. Additionally, disease risk may shift from malaria to dengue and chikungunya because the peak for the latter two is at temperatures above 25°C. Dr. Shah explains that this is a highly dangerous situation because populations in areas with new exposures to these arboviruses will not have acquired any immunity. We could expect to see these populations develop severe clinical manifestations of disease and be at higher risk for death. Dr. Shah’s paper on malaria risk and temperature has been accepted for publication in the journal Parasites and Vectors.

MCHRI Impact: “One of my mentors told me the point of these years is to get to your burning question so that you can write a grant, develop your career, and study what you want to study. I think that's what MCHRI has helped me do,” says Dr. Shah.

So what is her burning question? She says it changes, but right now she wants to figure out why there have been three large outbreaks of chikungunya in a particular region of Kenya. Is the same strain of chikungunya virus responsible for the outbreaks or have there been importations from other areas?

This capsule is a complimentary piece to a larger story. To read the article, click here.