Dr. Kotloff's Global Health Mission: Defeating Diarrheal Illness

Dr. Karen Kotloff finds herself in remote areas of sub-Saharan Africa and South Asia to help children survive diarrheal illnesses that we take for granted in the United States thanks to our health care system. Kotloff discusses what her work in global health looks like, in part thanks to the Bill & Melinda Gates Foundation, and explains why some countries continue to battle these illnesses. Kotloff is a professor in the University of Maryland School of Medicine’s Department of Pediatrics; head, Division of Infectious Disease and Tropical Pediatrics, and associate director of clinical studies, Center for Vaccine Development and Global Health; and a UMB Distinguished University Professor. 

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Dana Rampolla 0:00

We've heard so much about vaccines the last few years, and I feel like we're all just overwhelmed with talk of the Covid vaccine and sometimes forget that there's a lot of other vaccines that are being researched and studied and implemented, not just here in the US but across the world.

Jena Frick 0:17

Right. And, our changemaker today is really heavily involved in a lot of vaccine development, particularly in developing countries, all over the place.

Charles Schelle 0:27

There are vaccines that we probably take for granted, and our guests today can talk a lot about those in Interesting areas of the world that you might not expect her to be. Her name's Dr. Karen Kotloff from the University of Maryland School of Medicine. We talked with her remotely and which is appropriate considering she finds herself in Sub-Saharan Africa in, uh, Bangladesh. You know, you name it, she's probably been there.

Jena Frick 0:59

She, she is all about that global health and making sure that, uh, people from all over the world, all different cultures have, uh, the right access to live the healthiest lives that they can. You're listening to the heartbeat of the University of Maryland, Baltimore, the UMB Pulse. Joining us today is a change maker with an incredible story. She is a pediatric infectious disease expert at the University of Maryland School of Medicine, where she is both a professor and the head of the Infectious Disease and the Tropical Pediatrics Department. She's also the Associate Director for clinical research at the Center for Vaccine Development and Global Health, and a fellow of the American Society for Tropical Medicine and Hygiene. She is the principal investigator of four grants funded by the Bill and Melinda Gates Foundation, studying the prevention of death among infants and children in developing countries. And the principal investigator of a National Institute of Allergy and Infectious Disease funded Vaccine Treatment and Evaluation Unit. And last but not least, she has published more than 200 manuscripts in peer reviewed journals. We are so happy to be speaking with this change maker today. Please welcome Dr. Karen Kotloff

Karen Kotloff 2:22

Well, thank you so much for having me, Jena.

Jena Frick 2:25

Yeah, we're very excited to have you here today so,

Dana Rampolla 2:28

Dr. Kotloff you have accomplished so much in your career. It's Hard to pick a starting point to have our conversation. Um, before we jump into the specifics, do you mind giving us a brief summary of the work and the research that you do?

Karen Kotloff 2:42

Sure. So I have two lines of research that I do. One line as the, um, head of the VTU, the Vaccine and Treatment Evaluation Unit, I conduct clinical trials, um, in all age groups in the US and abroad. Um, and the purpose of that grant from N I A I D is to try to develop vaccines that may be impeded for some reason, that there's, um, maybe not commercial interest because these are vaccines that, um, help people in developing countries, for example, or vaccines that are responding to a public health emergency, such as Covid. So that's one of the lines of research that I do. And the other is to, uh, do work in developing countries. And in developing countries, I try to prevent, um, infectious disease and infectious disease mortality. By studying the burden of disease, um, trying to find interventions that may decrease that burden, measuring the effectiveness of those interventions, um, and then trying to get, um, interventions that work into public policy.

Charles Schelle 4:02

Great. So as, as you mentioned, a lot of your work is centered around global and public health. Um, tell us about some of the steps involved to handle a public health dilemma..

Karen Kotloff 4:13

Sure. So, um, we know from some of the global health statistics what the major causes of mortality are among children. So we understand that diarrhea disease, for example, is one of the major killers of children in developing countries, whereas in, um, wealthy countries such as the us um, these diseases are, are minor illnesses that children easily recover from. And, um, I did, um, I have devoted a lot of my career into understanding better what causes diarrhea, diseases and why they adversely affect children's health. So, um, for example, um, I helped to lead a study that we call GEMS, the Global Enteric Multicenter Study. Where we went into seven countries in Asia and Africa and recruited large populations of children with diarrhea and healthy children and tried to understand what the major causes, the major viruses in bacteria and parasites, that were causing these diseases. And then we followed up these children to try to understand what the consequences were, um, whether children recovered from these diseases, how often they developed persistent diarrhea, what the effect of their illness on their nutritional status was, and, and finally, How often these were deadly diseases and which were the major pathogens, the major germs that were causing bad outcomes. That study really was very informative to understand which of the germs are most important to, um, direct interventions against. Um, and so for example, um, what we found is that the children with diarrhea over a two to three month period had an eight and a half fold increase in mortality. Following an episode of, of diarrhea requiring medical attention. And, uh, we also found that following, um, an episode of diarrhea. Children's, they stopped growing for, um, a period of time that they were under observation. And so the children who survived had adverse nutritional consequences, and we learned what the major causes were and. These findings help to direct, um, interventions. So we learned a lot about the, um, major bacteria, parasites and viruses that were causing these severe illnesses, and that helped to understand. Um, what, what agent should be targeted for, should be prioritized for vaccine development and, and maybe drugs or other appropriate interventions. And we learned that the, there wasn't enough attention to children's nutritional status when they had an episode of diarrhea. And, um, we actually now have some interventions, um, to try to improve the nutrition of these children when. Severe disease, so severe diarrhea, disease, and so those kinds of studies teach us a lot about interventions that are needed. And then there's a whole, um, Number of follow on studies that are going on to try to develop vaccines now against the major pathogens. We're participating in a study with the World Health Organization on nutritional interventions and so it, it really helps to guide kind of the next era of research, um, to try to find, um, ways to, uh, improve children's ability to survive in a healthy way. Um, these types of infections,

Charles Schelle 8:22

That really puts some of that in perspective. Didn't, you know, think about diarrheal diseases in that frame, you know, when it comes to, um, growth and development, but you mentioned your, your work in Africa, um, let's kind of zone in here. Uh, what countries or what country in Africa is your work based in and why that location?

Karen Kotloff 8:44

70% of children who die from diarrhea disease are living in sub-Saharan Africa and South Asia. So if we're trying to understand this problem, that's where we wanna go. And because of weak infrastructure, that's where the least amount of information was coming. And so that's where we went for this, this first study, we were in four countries in Sub-Saharan Africa and three in South Asia. So I got a lot of frequent flyer miles, uh, during those, those years Um, and uh, we set up sites, um, that were population based. So we, we, we went into areas and got a, a census so that we could really understand what the numbers meant that we were getting by, by anchoring them within the population. If, you know, there's a hundred um, deaths, but you don't know if that's among a million children or 110 children. It means something very different. And so we worked in census populations in these areas, um, to do these studies and, um, you go where the problem is the worst to try to fix it.

Charles Schelle 9:59

So what's it like working in and, and those developing countries, if you can maybe pick out, uh, a couple of them, but I'm also imagine at the same time, you know, the cultures are so different from country to country in Sub-Saharan Africa, you know, what's it, what's it like living there and, and, and working in that environment?

Karen Kotloff 10:19

So for me it's, it's just absolutely fascinating and gratifying, um, to work in other areas and it's, it's very different as a tourist to travel an area and to work in an area where you really get to know people, you get to know their families where they live. Um, you make connections and engage with these people. Um, and I mean, in any environment, that's the gratifying part of, of work that we do. When, when you enjoy working with people and learning about similarities and differences in a group that is working together for a common purpose, um, for me is just one of the most gratifying things that I.

Dana Rampolla 11:13

And Karen, what, what is the surroundings like there? You know, we're used to, to Baltimore where we're recording. Give us a little picture of what it actually looks like there.

Karen Kotloff 11:24

Well, it depends on where you are. So I was working in one area, which was a rural area, um, outside of daca, Bangladesh called Meur. Where as far as you can see, there were fields of mustard plants with yellow flowers and rice patties. Um, with, um, what's the name of the buffalo and rice patties with water buffalo, uh, pulling along cloud. And, uh, we were riding in a car and it was, um, the end of rainy season and we got stuck, uh, attire deep in mud. Um, and the villages were just these really, it was just a bucolic, um, environment just. A beautiful place to be. And, and what you also learn when you, when you go in these places, is that how, how resilient people are, that people are happy, um, with what they have, um, with their families. I mean, there's so many shared values of, of, of what's important. And it doesn't matter how much you. There are some people who don't have enough, no matter how much they have. And there are people who, um, get happiness and appreciate what they have, even if it seems, um, minimal to somebody from, from another culture. Mm-hmm. So that was, that's um, one environment. Um, in Africa we were in, um, three rural and one urban area. And, um, it's almost the same themes. I mean, the, the rural areas for me, looking at straw huts and just, you know, going across the countryside, um, is, is um, absolutely beautiful. Um, and then the bustle of a city is beautiful, and then the way that you see people making due with what they have. So you can see somebody riding a bicycle with 25. Straw roofs on the back of their bicycle and, you know, a, a husband and a wife in the front. I mean, it's just amazing, um, how people make do with, with what they have, um, and how creative they are. And, um, that, that was also a part of life that I really enjoyed seeing.

Dana Rampolla 14:09

Well, and you work primarily with children. So in the early days of your work, what happened when a child was taken to a hospital? It sounds like a lot of these rural areas, a hospital would've been hard to come by and then the treatment there, How, how did, How did a child fair when they went to the hospital?

Karen Kotloff 14:29

So, the first place I worked was in Bamako, Mali. and going to that hospital honestly just makes you cry. Um, children come in, there's an insecure source of oxygen. Uh, there may or may not be IV fluids. They may have to pay for any treatment they get before they, they receive that treatment. And the mortality of children coming into that hospital is 20%. It's heartbreaking because they're dying from diseases that barely affect children, um, who are well nourished and living in clean environments. Um, and it's almost easy to understand some of the solutions because the solutions are already being executed in countries that can afford them, and the goal is to speed the introduction of those same vaccines and other interventions into use in these countries..

Jena Frick 15:38

Well, speaking of, um, introducing vaccines, um, into these countries, you, uh, in doing so to address these health concerns you had to create a vaccination program. And I'm sure putting in a plan like that in a third world country and a developing country had a lot of challenges and moving parts to really like, make it all come together. Can you tell us what that process was like for you and your team?

Karen Kotloff 16:01

Sure. So the first time I went to Mali, I went with my mentor, uh, Dr. Mike Levine, who was the founder of the Center for Vaccine Development. And, um, we, we went there and looked through the charts at the major children's hospital to see. What illnesses the children were getting. And we found that over 70% of the children who were admitted to the hospital had evidence of having an infection. And about 20% of those children never made it out of the hospital. And most of them, um, when they, you know, it was recognized that they had an infection and it was thought that they had malaria because it was a malaria endemic. Um, But they had no microbiology laboratory to be able to diagnose bacterial infections. And so, um, my mentor had the, um, vision to set up a microbiology laboratory in that hospital and look and see what kind of bacterial infections these children were getting that were caus. What we call sepsis, which is when bacteria get in your blood and meningitis, which is an infection of the brain and spinal column. And we, we set up that lab, we brought Malians to the US and trained them. Um, we, um, put them back in the lab and started getting, um, some blood from each of the children who came in with this clinical appearance of, of a serious infection. And we found a huge burden. Uh, bacterial infections for which there were already licensed vaccines in this country. Um, hi. You may have heard of HIB, Pneumococcus, Meningococcus. And so we went to the president of the country and said, Look, this is the information that we are finding. It's not that these children are all dying from malaria, they're dying from preventable infections. And he said, We need to introduce those infections. At about the same time, the Gates Foundation had contributed a huge amount of money to an organization that they formed called Gavi. Um, And Gavi was developing methods to accelerate introduction of vaccines into developing countries. And so we used this information to, to apply to Gavi for vaccine development. And this was serially over a number of years and one after the other. We, we helped to introduce vaccines and to strengthen the um, existing immunization system to be able to handle the new vaccines. And then we measured the impact and, and you could see the reduction in hospitalizations, the reduction in deaths that resulted from introducing these vaccines, which was um, for me, just a paradigm life changing event to see the impact that public health interventions such as vaccines can have on the health of children and this survival of.

Charles Schelle 19:21

For those who are listening to this, uh, describe what, HIB is that they haven't heard about it.

Karen Kotloff 19:27

So, HIB, it's Hemophilus Influenza Type B. It's a vaccine that all children get routinely in the US. It's been introduced in the US uh, for many decades. Um, it was known as a major cause of sepsis that is bloodstream infections of meningitis of something called epiglottitis infecting the throat so children couldn't breathe. And when I was a pediatric resident, This was one of the most common causes of, um, hospital admission, death, and disability, uh, for children. And we don't see it anymore because of the vaccine. And that vaccine had not been introduced into Mali. And because they didn't have the ability to make the diagnosis, they didn't even know what a big problem it. Wow,

Charles Schelle 20:23

It's amazing. And, and, you know, talk about something introduced in the US and, and seeing cases go down. You know, we don't typically think that a bacterial infection associated with diarrhea is going to lead to death in this country. Um, so talk a little bit about, you know, there's rates that, that you had mentioned, um, about how in sub-Saharan Africa and South Asia, you know, there are high mortalities from, from these diarrhea disease.

Karen Kotloff 20:51

So I do wanna make clear when I talk about HIB and, and pneumococcus, they're not causes of, of diarrhea disease. Mm-hmm. They're causes of bloodstream infection and meningitis and pneumonia. Um, but diarrhea disease is also one of the leading killers of children under five. And, um, some of the germs that cause it like rotovirus are germs that, um, commonly infect children throughout the world. Uh, there are some researchers who call them democratic viruses because they don't select any particular population. In the US because of, um, you know, ready access to healthcare, all you have to do is prevent these kids from getting dehydrated. And so in the US there were very few deaths, um, before the vaccine was introduced in this country. But in developing countries, there are children who can't get to health centers and get life saving fluids. And children who get, because they're small and malnourished, get dehydrated very quickly. And so they have a much higher mortality from these infections. And when we did our, our GEM study, we found that rotovirus was the leading infection and, um, we, um, helped to do work to. The vaccine introduced into, um, Mali and, and, um, other, other African countries. And then we did a follow on study to look at the impact of how that, um, reduced mortality and um, um, you know, dehydrating infection. There are other, um, infections that we see in developing countries that we rarely see in the us and also if we do see them, uh, children also recover pretty quickly. And so examples of those are, um, one is shigella. It's the major cause of dysentery, which is, is bloody diarrhea. Children get much milder infections and they're infected much less commonly in this country because, um, it's spread from person to person where there's, where hygiene is insufficient. So when you have crowding and lack of good hygiene and sanitation in a developing country, she is all over the place. And in the US we see. In places where hygiene is, is compromised. So we'll see outbreaks in, in daycare centers or prisons, um, places like that. But because people's health is so much better, they recover from she and when children in developing countries get she. They just can't recover from the intestinal injury. It's a very invasive, um, bacteria and they just don't bounce back the the same way. And so they end up with, um, worsened malnutrition or new onset malnutrition. And those cycles are very hard for children in, in, in developing. To escape from. So they get one infection and their nutrition is compromised and they're just starting to recover. They get another infection and so they can never get back on track, and that can have very dire consequences.

Charles Schelle 24:27

Yeah, I was about to ask, you know, you mentioned the vaccine program and, and I'm sure it's, it's helping those patients with that, that, you know, one infection. But uh, with what you just described, are you seeing a lot of that where it's like, okay, we got this, you know, one part taken care of, but now they're, they're getting a, another disease because there's another, you know, a gap in the system? Yes.

Karen Kotloff 24:52

So, As a follow up to the studies we did on diarrhea diseases, um, in my, for my entire career spanning close to 40 years, I've been working on shigella vaccines slowly with the grants that, that we can, uh, get. And it's been a very slow process and when she was demonstrated as such an important problem. Uh, really the Gates Foundation saw that. They've been funding a lot of these studies and they're, they, they have invested a lot of resources into accelerating she vaccine development. Um, and so that's one way, hopefully, um, one day there will be an effective vaccine that can prevent those infections. Um, something that I've been doing more recently in my career is, um, rather than trying to fight infection by infection to also try to look at at interventions that are agnostic to the specific germ and maybe just improve child survival. So I'm involved in two studies. Um, one is called CHAMPS, and that's a study whose aim it is, who's name it is to understand better why children under five are, are dying. When you don't have good healthcare and access to diagnostics, you don't often know why these children are dying. You can only kind of put the symptoms together retrospectively, um, from what people call verbal autopsies, which are postmortem interviews. That's how a lot of information of the causes of death had been, um, require. The Champ Study actually asked parents if they would be willing, uh, to allow their children after death to have needle biopsies. Um, so just taking, taking a small needle and putting it in different tissues and then looking at those tissues for, um, the pathology and the infection. That may have caused their, um, their demise. And so that is one way of just kind of looking globally and trying to prioritize, um, what the causes of death are. And then there's another fascinating, uh, field that I've had the opportunity to become involved in. Um, and um, that is the use of the antibiotic azithromycin to prevent infant mortality. So, um, there was a discovery by these very smart eye doctors, ophthalmologists, who were trying to eradicate the major infectious cause of blindness, um, in Africa, which is called trachoma with Azithromycin and they were doing mass campaigns where they would give everybody a dose of, of, um, azithromycin and they had control groups to see if it was working. And they noticed that the children in the control groups were dying at a higher rate and they made this really, uh, incisive observation. That's for some reason the azithromycin was preventing these children from dying. And so, they turned and did a study that was called Mordor, where every six months they gave children under five, a single dose of azithromycin. And then in other villages, um, they gave those children placebo and they actually showed that, um, this was in three countries in Africa. They showed that overall there was about a 15% reduction in under five mortality, and in the youngest children it was a 25% reduction in mortality. There's nothing that does that. Has that kind of impact. And so we were asked again, by the Gates Foundation, um, whether we would be willing to do a, a different approach with the same drug, and that is to give it to pregnant women. And children, just a single dose three times during pregnancy, and then with the th first and third baby shot. And see if you give it programmatically so you don't have to go take a whole team and go village to village. But just when either the moms come in for antenatal care or the kids come in for their routine vaccinations, they get a, they get a dose of oral azithromycin and see if you can have the same. So we're doing this, that study, we have 40,000, uh, pregnant women enrolled, um, and their children in Mali. Uh, our aim is 50,000. So we're gonna finish this in early 2023 and understand, um, how, if that's an effective approach. And that's, um, you know, I, I pray that it's going to work. Um, and that will have an impact, a big impact in, in, you know, biting my nails until we get the results.

Charles Schelle 30:13

Yeah. That, that's amazing participation.

Karen Kotloff 30:15

Yeah, it is.

Dana Rampolla 30:17

Wow, that's incredible. Are there any downsides to those doses of azithromycin?

Karen Kotloff 30:24

It's a very safe antibiotic. Um, and we're following, um, safety, very, very careful. And so, you know, with the ability to compare safety events between people, women and children who get the azithromycin and those who don't, um, will be able to take a very close look at safety. The only known, um, effect is that, um, something, um, there's, there's a swelling of, um, the stomach that can occur. When young babies are given azithromycin or erythromycin, um, and that can, um, sometimes cause an obstruction that needs to be relieved. Um, And so that is a precaution. It's still, the drug is still used when it needs to be, when the, when the, um, benefit far outweighs the risk. We have seen one case of that the baby did fine, um, but we don't know if that baby got azithromycin or um, placebo. And it's a condition that also occurs normally in that same age group. So, It's quite possible that the baby had gotten placebo. Uh, we don't know. And that's, that's the only rare side effect that we anticipate, um, that could happen. I mean, there can be allergies to any antibiotic, but we really haven't seen any, any serious allergic reaction.

Dana Rampolla 32:03

That's great. Really incredible news and outcomes. Um, I wanna back up just for a quick second. You mentioned those, um, light touch autopsies. I'm just curious, like culturally, how do the parents receive that request? Is that something that seems completely foreign to them or because it's just such a light touch, they're not really bothered, just culturally?

Karen Kotloff 32:28

That's a great question. Um, and we're conducting this study in, in Mali, which is a largely, um, Muslim country. And so, um, we also felt that it was very important to understand the religious implications of what we were doing in addition to introducing something that's quite new culturally, um, you know, to a country where surviving and doing research to help people survive is what's perceived as the priority, um, not studying children who didn't survive. So it was, it was a change in mindset and we, um, began the study with, with, um, several months of doing, um, Social Behavioral Research, SBS is what we call it. And so there were Mali and anthropologists and, and, um, behavioral scientists who helped us and we had focus groups and we, um, explained the reason for the research to these people, um, people from all walks of life and got lots of responses and feedback. They perceived this work and we tried to explain our perspective, and this is an ongoing process. So it took, um, you know, it, it took, it takes a lot of work. For it to be accepted as something that has potential benefit. Um, but it is, you know, it's not accepted by everyone and we completely understand that. Um, but we are getting a lot of important, um, information out of this study. It's happening in, in nine sites now throughout the world sites with high mortality, and we're learning. A lot, Um, for example, In Ethiopia, we learned that there was a much higher frequency of, um, mal babies being born with malformations of their brain and spinal cord, and it was related to mothers not getting enough folate during their pregnancy. And so we do data to action. When we discover that there are, um, events that are occurring that are leading to mortality, um, we, we try to develop an intervention too, and that, and so we're also hoping that people will understand the value by seeing, um, that data to action.

Dana Rampolla 35:07

I have another little just people-centric question. So how, how does it tangibly work? You know, you're do, you've done all this research, it seems like you're onto a lot of great ideas of how to combat some of these illnesses, getting vaccines out. But in these rural areas, are you just. You know, are you just kind of like Wizard of Oz in your wagon traveling from village to village? Or is there some systematic way of distributing the vaccines and the rith azithromycin?

Karen Kotloff 35:39

So it depends on, on what phase you're in when you're doing research. Um, research is a very, um, uh, intentional, carefully. Um, organized, um, with huge amounts of oversight event, um, very well controlled in a circumscribed population where you're following a protocol exactly. Um, and so to once you get those results and you can trust them because you conducted the work as meticulously as you can, then comes the intervention. And so for vaccines, um, throughout the world, including developing countries, there's something called the, um, expanded program for immunization. And these are programs that were set up, um, in the 1980s to distribute vaccine equitably. So that's when people say vaccines are one of the most equitable, um, health interventions. That's because you can set up little rural health posts. Um, there are vaccines that are introduced with people with cold boxes on donkeys, on bicycles. Um, and there is a countrywide plan, uh, to get, to maintain a cold chain and distribute vaccines. And so when you introduce a new vaccine, you have to appreciate the impact that it has on that system and account for that and do the appropriate training, um, to be able to safely. Vaccines that are still in mint condition out to rural areas for azithromycin, we're still in the, um, investigative phase and so we're working in 82 health centers in rural Mali with you know, our team is running the entire study. We have hundreds of people who are trained, um, and employed in doing this in very careful oversight. And then there will be an implementation phase. Um, and that will either be done through existing antenatal care and the infant immunization program, if that works. Um, or door to door giving, giving out mass drug administration, the way that eye doctors try to eradicate Trachoma. So we'll have to see the results of these studies before we understand how to distribute the vaccine. And then the infrastructure, I mean the, the drug, sorry, is a thein in this case, acts like a vaccine because it's preventive. Um, the, there has to be an infrastructure that distributes the drug safely and effectively.

Charles Schelle 38:36

It's like, um, starting from square one with, with logistics. Um, and that goes for, you know, as you said, just not just the infrastructure and logistics of delivering healthcare, but just the infrastructure period to, to, to get some of that, um, you know, medicine or anything really delivered In those remote areas.

Karen Kotloff 38:56

The devil is in the details. You know, if you break the cold chain or let vaccines expire, then you, there's no reason to give those vaccines, you know, So you need to, um, pay careful attention to all those details.

Charles Schelle 39:11

Right. And you know, as, as we've been talking about, you know, a lot of your work centers around global health, uh, throughout your career and specifically children and giving children, a chance to, to live. I'm sure you'll, you'll talk about your education and, and everything that, that led you to this career, but I was wondering if there was anything, maybe as a child, as a child yourself, if something you watched or read that maybe sparked that imagination and, and pursuit of eventually getting to where you are today?

Karen Kotloff 39:46

Um, it's, that's a, a tough question. Um, my dad was a general practitioner with a black bag who made house calls and I would go with him on house calls. I would wait in the car because he didn't want to impose me on anybody, but somehow still, that was fun, I think because we got ice cream at the end. Um,

Jena Frick 40:14

Bribing you with ice cream.

Karen Kotloff 40:15

Exactly.

Jena Frick 40:16

But did he know that it would inspire you?

Karen Kotloff 40:19

Yep. Get a long way with an ice cream cone. Um, and then I was always like the kind of child who liked to help people. I mean, I was going door to door collecting for charity and volunteering from a very, um, young age. So that was something that um, fascinated me and also I learned that I was fascinated with other cultures and traveling to other places and just kind of understanding what people's lives are like that are different, you know, from, from me. I don't know that, just always intrigued. I wasn't one of these. I mean, there are people who, you know, they're five years old and they know they wanna be a doctor and go into global health. I kinda accidentally meandered into my field. And then when I hit the Center for Vaccine Development, for me it was like being a kid in a candy shop or maybe in an ice cream store. Um, It was, I just watched what they were doing and no one had ever told me you could do that when you were a doctor. And it just was, you know, amazing to me. Um, and so it's hard to know what about me made me glom onto that, but it was, it, it just, um, captured my imagination and I wanted to do it. And so I.

Charles Schelle 41:49

You. It would've been great if your dad did take you with you to the patients, and he would joke, Well, this is my physician's assistant, and see the look on their face.

Karen Kotloff 41:59

Right? She's a child doctor. just, which is what I now,

Jena Frick 42:05

Oh, it all comes full circle.

Karen Kotloff 42:09

Really!

Jena Frick 42:10

Now we've been calling you Dr. Kotloff, but you also have another title. You were knighted by the government of Mali, uh, which is incredible. Can you tell us a little bit about that story?

Karen Kotloff 42:22

Sure. So, um, me and my mentor, um, Mike Levine, After we did that research that we, um, presented to the president of Mali and he, he, um, decided to, that he wanted to introduce the HIB vaccine. Um, he decided to make us chevalier. Mali is a, a previous French colony, so that's, that's what a knight is in French. Um, it was quite a surprise. I had never heard of a chevalier, uh, prior to that. Uh, it didn't come with a white horse Um, but a chevalier means a horse rider in French. So, um, that, that's why I'm saying that it did not come with a white horse. But, um, anyway, they gave us an award for doing that.

Jena Frick 43:14

That's awesome. So like we're basically talking to royalty a little bit.

Charles Schelle 43:22

She can, she can use that when she runs into Sir Paul McCartney Right, right.

Karen Kotloff 43:27

I'm not sure he'd be all that impressed, but I did go to see him this year.

Dana Rampolla 43:32

Oh, fun, Fun. Well, I'm very impressed with all that you and your team are doing. Dr. Kotloff, thank you so much for joining us today and being with us and sharing all of your, your great information.

Jena Frick 43:45

You did say that you are in the middle of, um, still doing this Azithromycin. Program, which, um, is still in the works and is, uh, not gonna be completed until sometime next year. So, um, how can people stay up to date on that research that you're working on? Or when can they expect to see the results of that? Because you know, you have a lot of participants involved.

Karen Kotloff 44:09

We'll complete enrollment in the first quarter of 2023 and then we'll complete follow. Because we have to see how the children do. Um, and the enrollment is of the pregnant women, um, a year later. So the results will be released in 2024. Um, I assume there'll be some kind of press release when the publication starts to come out or the results come out. Um, so you'll have to check back.

Charles Schelle 44:39

Our, our Intrepid staff, uh, in the communications for School of Medicine and CVD will, will be sure tout that all over the world.

Karen Kotloff 44:50

Yep, I bet, I bet they will. Yep. So, and hopefully there'll be really good results.

Charles Schelle 44:55

Absolutely.

Karen Kotloff 44:56

Fingers crossed. Yeah.

Charles Schelle 44:57

So thank you so much, Dr. Kotloff.

Karen Kotloff 45:00

Sure. Thank you.

Charles Schelle 45:03

The UMB Pulse will start a new season in 2023, focusing on alumni change makers. Our first guest in January will be Kathryn Pawlak. Kathryn is a graduate of the University of Maryland School of Dentistry who returns to the school each year to operate a dentistry camp she founded called Planet Smilez. We will learn what led her to start Planet Smilez and how her grandfather's survival in a World War II concentration inspired her to become a dentist to improve the oral health of children. Subscribe, rate and review the UMB Pulse on Apple, Spotify, and wherever you like to listen to get an alert for when our next episode drops. Feel free to reach out to us with your questions by emailing umbpulse@umaryland.edu or visit our website where you can listen to past episodes and contact us there as well at umaryland.edu/pulse. Enjoy the holiday break everybody. We will see you in the new year and thank you for listening to the UMB Pulse.

Jena Frick 46:04

UMB Pulse with Charles Schelle, Dana Rampolla, and Jena Frick is a UMB Office of Communications and Public Affairs production. Edited by Charles Schelle. Sound engineering by Jena Frick. Marketing by Dana Rampolla.