Buffalo HealthCast
The official health equity podcast of the University at Buffalo’s School of Public Health and Health Professions.
Buffalo HealthCast
"Tools of the Trade: Diagnostics and Surveillance in Environmental Health"
Welcome to Buffalo HealthCast, the official podcast of the University at Buffalo's School of Public Health and Health Professions 🎙️
In this episode of Buffalo HealthCast, podcast producer and MPH student Vennela Damarla speaks with Dr. Kelly Baker, Associate Professor and Director of the Center for Climate Change and Health Equity at the University at Buffalo. Dr. Baker discusses the powerful role of diagnostic and surveillance tools in environmental health, especially in the context of diarrheal disease, climate change, and One Health—a framework that links the health of people, animals, and the environment.
From high-throughput pathogen detection technologies to locally producible rapid diagnostics, Dr. Baker explores how these tools are being developed and adapted for use in low-resource settings. She shares insights from global studies, including the use of geo-trackers to trace transmission pathways, and explains how simple, affordable diagnostic tools can help address health inequities and inform targeted public health interventions.
Tune in to learn how cutting-edge tools are shaping global strategies for water sanitation, infectious disease prevention, and health equity.
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Hi. Welcome back to another episode of buffalo Health Cast, the official school podcast of University at Buffalo School of Public Health and Health Professionals. This is Vennela Damarla Podcast Producer, and also an MPH student. Today we have Dr Kelly Baker. Dr Kelly Baker is an Associate Professor and Director of the Center for Climate Change and Health Equity at the University at Buffalo. Her research focuses on maternal and child health, infectious disease prevention and impact of climate change on health using One Health approach, she addresses the connections between humans, animals and environmental health, with a focus on water quality, antimicrobial resistance and global health equity, Dr Baker's work advances solutions for vulnerable populations affected by Flooding, water insecurity and poor sanitation. Through her work, she advances global health equity and resilience in the face of climate change. Thank you so much. Dr Kelly Baker, for joining us today. We are very honored to have you on buffalo health cast. Thank you for having me so let us start with the first question. Dr Baker, can you tell us a bit about yourself and what inspired you to pursue this field and research?
Dr. Kelly Baker:Absolutely, as you mentioned, my expertise lies in global health equity and one health and I thought maybe before we dove into my research, it would be useful to just define those because I think those terms mean different things to different people. So throughout our conversation today, when we talk about global health, I just want to emphasize that global health a lot of people think it's about health problems in low and middle income countries. Global Health is, in fact, health problems that affect multiple countries, even spillover between countries, like pandemics, that includes high income populations, right? So it's problems that we all share in this big global fishbowl. And one health. A lot of people think of One Health as zoonotic disease transmission and infectious diseases. So I also just wanted to sort of redefine One Health, which is, as you mentioned, the interconnected issues shared by humans, animals and environment or ecosystems. One Health is, is the promotion of interventions, policies, programs, ideas that recognize and give equal weight to the health of animals and ecosystems as it does to human health. I got started in these topics through doing a lot of international travel when I was younger and taking an interest in the lives of people around me and recognizing that, relatively speaking, I came from a place of comfort and privilege and wanted to address, you know, wanted to make those opportunities for health available to people all around the world, whether we are talking about communities here in the United States or communities in low and middle income countries. My undergraduate degree was actually in ecology. So you know, my training has come full circle from that ecology training through training in human vaccines and diagnostics and infectious disease to this sort of more holistic program that I operate today.
Vennela Damarla:Well, thank you. Dr Baker, that was very insightful to know about the global health One Health approach, and what the inspiration that you took in order to get into this field and research. Moving on to next question, what are diagnostic and surveillance tool in the context of environmental health, how do they fit into broader public health landscape? Right?
Dr. Kelly Baker:So diagnostic tools are simply speaking tools that are meant to detect disease at the point of care. So think about COVID tests. Think about diabetes tests. It's not just about infectious disease, it's any kind of disease. Diagnostic tools are typically referring to that point of care context, whether we are referring to a clinic and a physician or a veterinarian, or in the case of environmental health, the new sort of hot and powerful topic for diagnostics is wastewater surveillance. Surveillance tools to tend to be broader. They're really meant to capture ongoing dynamics around disease emergence and collapse in populations and so. They are often not done at the point of care, but do require samples or specimens to come from places where diseases are occurring to laboratories that can document what is in those samples and record it and share it broadly for long term tracking by a bunch of different communities and policy makers. Okay,
Vennela Damarla:so in your research on diarrheal disease, what are some of the key factors that make it so prophetic in low income communities,
Dr. Kelly Baker:it's a combination of things. It's a complex disease, because diarrheal diseases, or any kind of disease that occurs via oral ingestion and infection of the gastrointestinal tract. It's caused by a lot of different kinds of pathogens, from famous ones like cholera and typhoid to organisms that we're still just discovering today. These organisms, these pathogens, can be spread by humans to other humans. They can be sped by animals. But then we also have pathogens that have environmental reservoirs, like copepods and plankton that can harbor those organisms until someone comes along and accidentally ingest them. So for example, cholera has environmental reservoirs in salt water environments, and it can persist there throughout the year until somebody ingests that water or uses it for cooking and then gets infected.
Vennela Damarla:So to what extent this diagnostic tools, as well as surveillance tool, help in diagnosing
Dr. Kelly Baker:maybe starting with surveillance tools, surveillance tools can be very powerful for understanding how often these types of pathogens occur in people, in animals and in the environment, which can then be used to strategize or prioritize where interventions should be conducted to keep to improve the health of those impacted humans, animals or ecosystems, but also to prevent any diseases that are emerging in those locations from spreading beyond to other communities. Diagnostic tools are really meant to be used for improving treatment decision making, right? So we want diagnostic tools to go into the hands of people who are seeing animals or who are seeing humans and making decisions about whether they, for example, should be given antibiotics to cure those infections, right? So it's really meant for point of care.
Vennela Damarla:Well, thank you, Dr Baker for clarifying that. Moving on to next question, how do high throughput multi pathogen detection tools used in your studies enhance our understanding of disease trans patient in these settings? How do these findings help inform the development and application of rapid diagnostics
Dr. Kelly Baker:so we use a variety of complex and more expensive tools for surveillance purposes, for research purposes. In our studies, we use them because they offer the capacity to look for a lot of different kinds of pathogens at once. Sometimes we don't know what's in the environment or what's in a human or animal that can be passed on to someone else, and so it increases the chances that we're going to detect the cause of disease and disease spread, and identify how that disease is spreading, so that we can then recommend interventions. These tools, while they are very powerful, have traditionally been very difficult to do on site in low resource settings because they need fancy equipment. That equipment has to be maintained, the reagents or supplies that we need to perform those assays are hard to get in those communities because they require cold chain storage and distribution. So in many cases where the those types of tools are used, that kind of research is done is distant from the communities that actually need sort of rapid feedback about what's going on. So we use them in the contest context of exploring what interventions would be most powerful in a community for resolving disease burden, for preventing transmission. For example, we have applied these types of tools to look at how where human versus animal waste in a community, to understand where the leading sources of fecal born pathogens that cause diarrhea are coming from. These tools have helped us really point about the bit more at sanitation issues related to animal feces. Animal feces being widespread across the environment and being sources of pathogens versus human sanitation scenarios. We've also used these tools to look at. At infection burden across different ages of children to understand where children really need to be monitored and screened early on, we've used these tools to explore the likelihood of foodborne disease outbreak in children's food. So testing children's milk, for example, for a variety of different pathogens, to see what's there and where might it be coming from, and to explore whether the sort of food borne risks that children face are coming from food supply chains versus in household food hygiene behaviors that are suboptimal.
Vennela Damarla:Well, that was very interesting to know. Dr Baker, so how do we manage to bring these tools in the low income settings? Like you mentioned, they they are very expensive equipments, and also they need a lot of resources for storage or something. So is there any plan to bring those in the low income settings?
Dr. Kelly Baker:right, So the two biggest things that are needed to bring those results quickly to the communities when they need them most, to the point of need, are simplification of tools, so that the cost and the logistics and the training of the personnel running these tests is not so high, the lower the bar a bit so that anybody can use them. Think about COVID at home tests, for example. And one of the other sort of fundamental gaps is about, really about supply chain and distribution. So local production of these tools. We have a couple of different NIH grants right now, in partnership with a startup biotech company in Wisconsin called goedx, where we are developing low cost, rapid diagnostics for a variety of pathogens that do potentially merit antibiotic treatment. So there's only four that the WHO recommends be considered worthy for antibiotic treatment that is Campylobacter, cholera, right, one of the most famous ones in the world, a bacteria called Shigella that causes a lot of early childhood deaths. It causes bloody diarrhea and salmonella, which is a broad group of salmonella that range from really severe ones that cause typhoid fever, right, another famous one in human history, to common foodborne outbreaks that we see in the United States every single year. So these are the only four causes of diarrheal illness that really merit antibiotic treatment, and many of them we are seeing rising levels of antibiotic resistance to frontline antibiotics around the world. So go day x and I are collaborating on projects that number one are developing really simple, low cost tools that test for these particular organisms with very minimal resources required. So you don't need fancy thermocycler machines, you don't need shakers, you may not even need a pipette. We have a couple of different types of diagnostics and surveillance tools that we're developing, but also these tools are being designed in a way that makes them locally producible. They can be 3d printed, as far as the environmental infrastructure, and that the reagents that are used to make the diagnostics are ones that can be produced by a lot of very simple companies, you know, simple biological or manufacturing companies that can be found in the Americas, in Africa, in Asia.
Vennela Damarla:Thank you so much. Dr Baker, seems like diagnostic tools are actually reaching the every person out there. Moving on to next question, how do rapid diagnostics and surveillance tool fit into one health context, especially considering the findings from your research.
Dr. Kelly Baker:So as I mentioned, you know, a lot of these organisms are spread between environments and people, between animals and people, as well as between animals and environment. So if we have rapid diagnostics that are low enough cost that we can use them consistently and sustainably, then these types of diagnostics can be used to reach individuals in rural clinics, in humanitarian camps and a lot of places that may be hard to reach for early screening of individuals before they get really ill and face sort of severe outcomes from their infections, they can be used to improve the precision of treatment, such as the decision to provide antibiotics or no antibiotics. But the same concept, as far as humans, can also be applied to animals, if you put these types of rapid, low cost diagnos. Sticks in the hands of veterinarians or food producers, they could be using these tools to screen their flocks and detect infections early on, before there is animal to animal transmission, right? So animals that suffer from and have to be put down because of severe illnesses, cost producers, food producers money, right? So it's in their economic best interest as well, to be able to detect challenges with their animal health and call in a veterinarian or make other kinds of quarantine decisions, and then on the environmental end, right? Wastewater surveillance is, as I mentioned, blossoming as a tool for surveillance of disease problems around the world. So if you had really pathogen focused, low cost diagnostics, you they could be deployed into sort of field scenarios such as lakes or rivers, where reservoirs for pathogens are known to exist. They could be used to monitor water supplies, food supplies, lakes and rivers on a routine basis, to detect emergence of human or animal health challenges or people or animals have contact with those environments and can acquire an infection.
Vennela Damarla:Well, seems like diagnostic tools are the future. I mean, I still remember, like, especially during the COVID time, having those rapid diagnostic at home, and then it was really beneficial. I mean, it could save a lot of time, lot of money. Moving on to next question, how can advanced pathogen surveillance tool complement rapid diagnostics for practical use in low resource setting.
Dr. Kelly Baker:That's a great question, and it's one that we are hoping to tackle in the next phase of our research. Right You know, right now, our NIH grants are focused on the development and performance evaluation of these new diagnostics, but the next stage of our work is really thinking about population dissemination and exploring the application. One of the things that we would like to do is to address the supply chain issue right develop localized capacity for production of these tools so that at least surveillance laboratories can adopt them for data collection and then giving that information back to communities and to policy makers for more rapid decision making around risk to human and animal health. If the surveillance system is performing kind of sustained monitoring of people, animals and environment, then the rapid diagnostic test can be sitting in reserve so that when when problems are detected, when outbreaks are detected, you could ship or deliver a bunch of these rapid diagnostics to the providers or the veterinarians that are at the point of outbreak for enhanced population screening and treatment decision making right so they could be used in a very strategic sense, to react to outbreaks. But also, I think you know the goal, the real long term goal, is for these diagnostics to be available on the marketplace, at bare minimum, to providers so that they are available anytime they have a patient walk in the door with diarrheal illness that needs testing, and that needs testing at a low cost and rapid sort of rate with which they can walk out knowing what the cause of their infection is and how to how to treat it.
Vennela Damarla:Well, how accurate can this diagnostic tools can be, or how much we can rely on them? Because sometimes there are false positives too, and you know, there are other case scenarios too. So how much do you think we can rely on those diagnostic tools, right?
Dr. Kelly Baker:So in our current projects, we're aiming for a diagnostic of 90% but really for point of need diagnostics, right? When we're talking about ones that may be really purposely intended for hard to reach places, 80% is considered the minimum accuracy acceptable for sort of using these devices for merit based use, although we obviously want these to be as precise as possible. You know, there can be some false positives, and we are thinking about that in our research, where we will be estimating how often false positives occur. We will also be exploring in what context false positives occur. So for example, if somebody has very small amounts of pathogens in their system and low concentration is if that is the reason why you might have an uncertain test, we will be, you know, generating guidelines. Through the research that describe when and where you might want to do a second test for confirmation to accompany the product itself.
Vennela Damarla:Okay, so moving on to next question, what role do these tools play in designing effective interventions in one health environments?
Dr. Kelly Baker:I think this goes back to what I was talking about with how you might deploy them in both public health surveillance systems on a long term sustained basis, as well as in response to outbreaks or known sort of seasonal peaks in disease. They have a broad range of application, from low resource clinics to veterinarian clinics to food producers, even food supply chain, right? You know, we have public health laboratories that routinely test samples of food on the market and that are also responsible for epidemiologic surveillance response to investigate causes of foodborne outbreak, salmonella, for example, being one of those. So if you had simple, low cost tools that could be put into the hands of those epidemiological officers that are responding to those scenarios, they could be testing food at the point of sale in markets, or food at the point of distribution as well, for more rapid detection of of where these outbreaks are occurring from, and then that therefore can improve how quickly they shut down and issue food recalls.
Vennela Damarla:Okay, so what are the biggest barriers to implementing diagnostic tools in low income communities, and how can they be overcome?
Dr. Kelly Baker:This is really about that supply chain and cost. So we with supply chain. You know, eliminating the need for cold chain storage is a huge hurdle, right? Because cold chain storage increased the cost of shipping and transport, it also limits the reach. If you do not have capacity to replenish, you know, cold storage reagents along a long journey, such as into very rural, remote communities, then you can't reach those rural, remote communities if you have localized production. That means that you can support local businesses at and also the cost of producing those diagnostics can be produced at local economy rates, which means that they can be sold at lower cost, because the cost of, you know, the financial recovery from selling these diagnostics needed to sustain that that local business will be far, far lower than what it costs if it is produced, for example, at a centralized location in North America and Then is shipped halfway around the world.
Vennela Damarla:Yeah, so how do you see diagnostic tools shaping policies for water sanitation hygiene initiatives globally?
Dr. Kelly Baker:we think about water sanitation and hygiene initiatives, it's really more about surveillance than diagnostics, and it's about surveillance of wastewater in particular. So there are a lot of initiatives that are ongoing around the world expanding access to tools that are being used for wastewater surveillance, like, for example, nanopore genomics, tools that look for a lot of different types of organisms. The surveillance tools that are focused on known causes of human or animal illness can be used in parallel or in complement to those more open ended data, rich tools to then explore or investigate you know, evidence that that perhaps there is a pathogen circulating in a population.
Vennela Damarla:Well, moving on to next question, how can diagnostic tools help address health inequities by identifying environmental determinants that disproportionately impact vulnerable populations?
Dr. Kelly Baker:So as we mentioned, the you know, the cost is a big barrier for ensuring long term, sustained use of these types of diagnostics, diagnostic and surveillance tools. It's also a critical determinant of whether or not people choose to seek health care and choose to have a diagnostic test performed. So obviously, individuals who are more wealthy or who have insurance have the capacity to have a lot of their illnesses, like if they go in for a diarrheal infection, to see a provider and ask for some type of treatment. If you're wealthy, you can pay for. That provider, you can also have the best test performed to determine what your illness is. Individuals who are low income may not necessarily be able to afford those tests, and so they may receive less precise health care from their provider. So having these diagnostics meet basic benchmarks of affordability is really important to ensure that people from all levels of wealth can afford to use these tests and to receive the most accurate treatment decision making possible. We've also talked about how these types of rapid, low cost devices are really important for reaching into populations that are rural or sort of off the grid, including sort of animal populations that are in rural areas, like, for example, farms. So having these tools with designed with that distribution system in mind, is really important for ensuring that those populations can access them on a global level, I have to address the global piece of this, because that's where my work lies. We've seen in, for example, the COVID 19 pandemic, a lot of inequality emerge on a global level as to where rapid diagnostics were first available and and rapidly disseminated in populations with fairly predictable patterns, with the wealthiest countries around the world having access to these tests first, and the low and middle income countries struggling to get enough to have a meaningful impact on their surveillance needs. And so, you know, global distribution equity and global distribution of these types of products can be remedied with a focus on that local production, right? So, if, if the tools needed to produce these diagnostics are available anywhere like 3d printers, and if the reagents are affordable and can also be produced locally, and the technology to do this is something that we can train people to do, then that eliminates the dependency of not just low income countries, but even rural communities in the United States, it overcomes that barrier for them in trying to get these tools when they need it.
Vennela Damarla:Well, Dr Baker, can you simplify and make us understand what our diagnostic and surveillance tool in the context of environmental health, how do they fit into broader public health landscape?
Dr. Kelly Baker:Absolutely so. A diagnostic tool is a tool very much like a diabetes test that your provider might perform or a COVID test, right? It's a test that is meant to be used at the point of care to make a decision about how to treat an infected person or animal, right? So it really is something that requires a very rapid turnaround. Needs to give information back in the period of time that somebody is in that office with their provider, and it needs to provide information that specifically has a treatment guideline that matches it. A surveillance tool is really about population health. So we have public health surveillance laboratories all over the country, all over the world that are tasked with collecting data from all across communities and states and countries and testing biological specimens from those humans or animals or environmental materials, like like food, for example, they're responsible for testing Those for pathogens that are considered priority issues for that population. So surveillance tests are really meant to be operated on a routine basis, consistently, day in and day out, or week in and week out, for early detection of any emergent issues. They're not necessarily meant for treating an individual patient, right there for policy making purposes. Well,
Vennela Damarla:thank you so much, Dr Baker for simplifying it and making us understand what is. What are diagnostic cancer, violence tools?
Dr. Kelly Baker:Yeah. So let me give you an example with some of the research that that we're doing. Right? So we have two NIH grants at the moment that are focused on developing and testing diagnostic and surveillance tools for diarrheal pathogens. We are focused in both of these grants on four key pathogens that that people get by oral ingestion of something. Contaminated, for example, water or contaminated putting contaminated hands in their mouth. So there these are four bacteria that are ingested, that go to the gut, that infect the gut and then cause a variety of symptoms ranging from diarrhea to enteric fevers. These four bacteria are the subject of our focus because they are also the only causes of diarrheal illness that the who the World Health Organization merits antibiotic treatment, right? So any other kinds of diarrheal infections really will heal on their own. It shouldn't be treated with antibiotics, but Vibrio cholera a very famous cause of outbreaks of disease globally. Campylobacter, which is a pathogen that infects humans and animals and can cause persistent diarrhea that lasts for 14 days or longer. Shigella, bacteria, which are a key cause of bloody diarrhea and a lot of death in children under five years of age and salmonella. Salmonella is this broad group of species that range in from the kind of salmonella that causes typhoid outbreaks, another one of those sort of famous ones that has been problematic over human long, long term human history, as well as foodborne illnesses, right? It's the one of the leading causes of foodborne outbreaks in the US and many other countries around the world, and the foodborne kind causes more mild symptoms. So we have two different types of diagnostics that are being developed and evaluated in collaboration with a company in Wisconsin, a biotech company called Go dx. One of these devices is what we would consider a surveillance tool. So it looks for all four of these organisms simultaneously in a single specimen. It uses a printed equipment piece making it locally producible, and it uses strips, very much like the COVID test that can be used in ambient temperatures. No fancy equipment needed. So these can be the surveillance tests can be used by surveillance laboratories anywhere to look for these organisms and then advise policy makers and communities that they maybe have an issue on their hands. We are also focused on diagnostic tests that can be used at the point of care by clinicians. These include simple, low cost lab on a chip, types of tests that are just like the surveillance test, but that are portable and that can be taken anywhere, and that can be used to treat a patient and see if, for example, okay, you have Shigella. You know, this is something that maybe we need to prescribe antibiotic treatment for to mitigate the risk of death. We also have another type of tool that has been developed and is underway in testing that also tests for antibiotic resistance. So it's something that's about the size of a shoe box. And the shoe box, you know, if you're provider and you have a patient that needs a test for their illness, their diarrheal illness, you have a cartridge that gets inserted into that device, and in under one hour, that device will both test for specific pathogens like Campylobacter or salmonella, but then we'll also evaluate whether the salmonella or Campylobacter are resistant or susceptible to the frontline antibiotics that a provider would typically prescribe to a patient for treatment of that illness, having that joint information about cause of infection as well as antibiotic susceptibility or resistance, then having that information available in under one hour, then Lets the provider make a very strategic decision about whether to prescribe antibiotics and which one is going to be most likely to clear that patient, that individual's infection, and put them back on the road to recovery quickly. So a variety of kind of tools in this toolbox that we're working on that have applications across the diagnostic and surveillance field.
Vennela Damarla:Thank you, Dr. Baker, it was very interesting to know about the diagnostic as well as the surveillance tool and how they are used. Moving on to the next question, in your recent work involving geo trackers, what were some of the key lessons learned about using this technology to trace pathogen transmission pathways?
Dr. Kelly Baker:So right? Let me, let me describe a bit about how we're using these geo trackers. These geo trackers are being used to understand the movement of humans and the domestic animals that they live with in low to middle income communities in a study called pathome. So. So pathome is a study of pathogen transmission pathways. The goal of pathome is to identify the leading social, behavioral and environmental causes of pathogen transmission and then to provide recommendations to policy makers currently in Kenya, where the study is ongoing, to provide them recommendations as to which interventions will have the biggest impact on disease transmission in their communities. So the role of the geo trackers in pathome is to understand where people might acquire infections since and specifically we're studying children, right? So are children acquiring infections in their community? Are they acquiring infections in their home? Similarly, with animals, we have health data on both children and animals. Are the animals navigating around the community a lot and potentially picking up infections from other animals in that community and bringing it back into the household. These geo trackers also allow us to look at how often children and animals are interacting and potentially passing pathogens back and forth between each other. So by having this geolocation information and and being able to pinpoint where and how infections in children and animals might be arising, we can provide that targeted feedback to policy makers that could be practical interventions like animal penning is really important to prevent animals from acquiring and bringing pathogens from the community back into the home. Right? That might be more important, for example, than another intervention strategy that the policy maker might be considering, such as chlorination of the drinking water supply. Right? If animals are a bigger cause of transmission than the drinking water supply, then that's a more strategic financial investment to help reduce disease burden in those communities that they're responsible to.
Vennela Damarla:Well, how are those different from the surveillance tools?
Dr. Kelly Baker:So these are, these are very different, right? These are tools that are really targeting movement of humans and animals. We can link that information to data that can be collected from diagnostic and surveillance tools. So I mentioned that we have health data on humans and animals in pathome. We are taking stool samples or feces samples from humans, from their animals that they live with, but also from their environment. We collect soil and water and food and wipe surfaces in the homes where children and animals are living. We also test soil and water samples in the community where the children and animals are wandering around and playing. And when we take those samples, we isolate pathogens from them, and we test we test those still specimens for pathogens, and that lets us generate maps of where we are finding pathogens and communities. It lets us understand which pathogens we seem to be finding co occurring in humans and animals and environments at the same time. Right? It increases our confidence in where we think the biggest risks to health, for for children and animals are well.
Vennela Damarla:thank you. Dr Baker, moving on to the final question. Do you have any final thoughts or messages to share with our audience?
Dr. Kelly Baker:I would just add that you know, the diagnostics and surveillance tools are definitely something that has been prioritized by by policymakers around the world, from the US CDC to the Africa CDC, these are tools that are recognized as critically important for expediting the response to emerging infectious diseases, for controlling outbreaks once they've occurred, and preventing them from becoming big pandemics. They're critical for improving quality of life for individuals, and in particular for individuals that live in communities where Environmental Hygiene might be poor, but also for individuals who may for financial or rurality or other types of reasons, really struggle to access health care in a timely fashion. And so treating these infections, catching and treating these types of infections, like salmonella infections, like cholera infections, it's it's very important for reducing death around the world and for preventing a lot of human suffering and illness.
Vennela Damarla:Well, thank you so much, Dr Baker for sharing the valuable knowledge with us. See you on another episode of. Of Buffalo HealthCast . Thank you.