After completing her bachelor’s degree in Tennessee and medical school in India, Abraham arrived in Louisville seven years ago. She was shadowing doctors and getting ready for a medical residency when she became intrigued by the idea of helping not just individuals but populations.

“I am a numbers person so I was comparing clinical versus population health data and seeing how research could impact a lot more people,” Abraham said.

Once she decided to embark on her master’s degree in public health at the University of Louisville School of Public Health and Information Sciences (SPHIS), Abraham met Stephanie Boone, a two-time UofL alumna (MPH ’08, PhD ’13) and associate professor in the Department of Epidemiology and Population Health and faculty member at the Brown Cancer Center, Boone encouraged her to apply for the PhD program and got her involved in epidemiological research.

Now a graduate of SPHIS, Abraham has been working as the coordinator of the Kentucky Core (Boone, PI) of the RURAL (Risk Underlying Rural Areas Longitudinal) Study. This is a large National Institutes of Health-funded study to conduct community engagement and evaluate heart and lung diseases among rural populations in four states: Kentucky, Alabama, Mississippi and Louisiana.

Abraham has connected with local communities in Perry, Breathitt, Boyle and Garrard counties in Kentucky, to help recruit more than 1,000 residents and provide education and resources for unmet needs for hundreds at community meetings and events.

Since 2021, Abraham has been building a network, spreading the message and promoting the study, becoming a constant presence and trusted local contact in these counties. A mobile exam unit is traveling county by county and offering free health screenings to participants to determine lung, heart and overall wellness indicators.

Abraham, Boone and epidemiology graduate assistant Scotland Stewart, along with Community Advisory Boards established from each of the counties, meet with residents virtually or in person at city councils, church events, health fairs and festivals.

“You don’t want them to think you’re just there to use them for their data and leave,” Abraham said. “We want to share the results with the community and help them find funding or grants and design programs for what the data shows is lacking in their community.”

Establishing the participant cohort for the study has been a game changer for each community’s health now and in the future. “The CT scan on the mobile unit can measure Coronary Artery Calcium, which could show an individual if they are at risk for future heart disease, but also the scans have found incidental findings in the lung or other health concerns that people did not know existed, which is life-changing,” Abraham said. “It’s gratifying to know that your work does mean something and it is actually making a difference.”

Abraham plans to continue in her role until study participant recruitment is completed in Kentucky. After that, Abraham said she hopes to seek post-doc opportunities to take her population level research one step further into dissemination and implementation.

“Research shouldn’t just be about publishing papers, it should be about translating your findings to make a positive impact in people’s lives – that’s where my heart is.”

Bacteria called Group B Streptococcus or Streptococcus agalactiae (Group B strep, GBS) commonly live in people’s gastrointestinal and genital tracts. Most of the time, the bacteria are not harmful and do not make people feel sick or have any symptoms. Sometimes, however, the bacteria invade the body and cause certain infections, which are known as GBS disease. GBS bacteria can cause bacteremia (bloodstream infection) and sepsis (the body’s extreme response to an infection), meningitis, pneumonia, bone and joint and skin and soft-tissue infections. An invasive GBS infection is one that involves blood or internal organs, whereas a noninvasive infection could involve skin or other soft tissue, the urinary tract or bones and joints.

Previous studies describing the burden of GBS infection in adults have primarily focused on invasive disease because existing surveillance systems rely on blood culture collection. In the new study, however, non-invasive disease was three to four times more common than invasive disease, suggesting that adult GBS burden is considerably greater than previously recognized. Of the infections reviewed, 79% were non-invasive. In 60% of the infections, GBS was identified as the only pathogen.

“These new data suggest that the burden of GBS infection is considerably greater than previously recognized in earlier surveillance studies that only focused on invasive disease, ” said Julio Ramirez, MD, chief of the Division of Infectious Diseases at UofL. “Importantly, we found that the rates of GBS infection in this study are comparable to that of other adult infections for which vaccines are routinely recommended, which underscores the need for developing approaches for preventing this infectious disease among an aging adult population.”

In conducting the study, the researchers reviewed laboratory and medical records from six hospitals in Louisville between Jan. 1, 2014 and Dec. 31, 2016. Louisville’s population is generally similar to the United States in terms of demographics and prevalence of underlying chronic medical conditions.

Rates of GBS-associated hospitalization were significantly higher in adults 65 years and older, African Americans and people with underlying chronic medical conditions such as obesity, diabetes, chronic renal disease and coronary artery disease. The finding that obesity and diabetes put patients at increased risk for GBS-associated hospitalization is especially noteworthy given that recent Centers for Disease Control and Prevention reports have highlighted that 42% of U.S. adults are obese and that as many as 34 million American adults (roughly 13% of all U.S. adults) have diabetes, with another 88 million having pre-diabetes.

Additional findings from the study included the following:

• Annual rates of GBS infection in African American adults were 2.6 times higher than in white adults, or 157 per 100,000 in African American vs. 60 per 100,000 in white adults.
• Compared with the general population, annual GBS infection rates were 2 to 6 times higher among adults with underlying chronic medical conditions, such as chronic kidney disease, diabetes, obesity or heart disease.

“This type of study, evaluating both invasive and non-invasive GBS infections, is essential for understanding the full spectrum of GBS disease burden among adults,” said John M. McLaughlin, PhD, Global Epidemiology and Scientific Affairs Lead, Pipeline Vaccines, Pfizer Inc., and the lead study author. “These data should aid health care providers with clinical decision-making. Our population-based study gives the first estimates of total annual GBS burden in the United States, emphasizing the importance of preventive efforts in the growing population of adults who are older or have chronic medical conditions, and will inform future vaccination strategies.

In January, Pfizer launched its , a global program of collaborations with academic institutions to conduct real-world epidemiologic research to accurately identify and measure the burden of specific vaccine-preventable diseases and potentially evaluate vaccine effectiveness in adults. At that time, the UofL Division of Infectious Diseases was designated as the first . This collaboration is aimed at determining the human health burden of important infectious diseases and potential vaccine effectiveness

The GBS collaborative study between UofL and Pfizer was completed prior to the university being named as Pfizer Vaccine’s first Center of Excellence site.

UofL has been designated the first Center of Excellence by Pfizer Vaccines.

“UofL’s Division of Infectious Diseases has a rich history of collaboration with Pfizer through the successful implementation of numerous clinical epidemiological research studies. We are excited to formalize a long-term collaboration that builds on these past successes,” said Julio Ramirez, MD, chief of the Division of Infectious Diseases at the .

The Center of Excellence, directed by Ramirez, is a collaboration between the university and the pharmaceutical corporation aimed at determining the human health burden of important infectious diseases and potential vaccine effectiveness. The data will provide robust evidence to national health officials and independent policy makers who develop recommendations for the use of vaccines in immunization programs worldwide. Studies will take place in hospitals, long-term care facilities and the community.

UofL is the first Center of Excellence selected by Pfizer Vaccines Medical Development and Scientific/Clinical Affairs to be part of an international network of epidemiological research organizations. This designation is for a period of three years with an option for renewal. Pfizer selected UofL because of the university’s exceptional capabilities for conducting population-based surveillance and clinical research that engages multiple health care facilities, health care personnel, industry and communities-at-large.

“Pfizer has had an outstanding working relationship with the University of Louisville for more than 10 years,” said Luis Jodar, PhD, chief medical and scientific affairs officer, Pfizer Vaccines. “The quality of disease burden evidence varies widely worldwide. Deriving accurate and credible population-based incidence estimates require comprehensive surveillance to identify cases of diseases within a well-defined and well-characterized geographic area. Thanks to UofL’s excellent network of research partners, the population available for research studies in Louisville can provide the data to derive estimates of disease burden that can be generalized nationally.”

The demographics of Jefferson County, Kentucky, are similar to the United States in general, including racial and ethnic make-up, socioeconomic status, and the proportion of rural and urban populations.

The research studies conducted as part of the center may lead to economic growth and development for the city of Louisville and the Kentuckiana region, including jobs and educational opportunities in the health care industry.

“This collaboration will provide increased visibility for the university on a global scale, making UofL attractive for high-caliber researchers and research grants,” said Neeli Bendapudi, PhD, president of UofL. ”It also presents an exceptional opportunity for our researchers to improve the human condition by helping to reduce the burden of infectious diseases worldwide by generating data that will inform governments and health care policymakers.”

Pfizer studies anticipated for UofL include population-based surveillance of infectious diseases including Streptococcus pneumoniae, a bacteria which causes pneumonia and other infections, Clostridioides difficile, a bacteria that causes severe diarrhea and colitis, and respiratory syncytial virus (RSV), a common virus associated with mild cold-like symptoms but can cause severe infection in some people, including older adults. Visit for additional information on these diseases and two Center of Excellence studies already underway at UofL:

• The City of Louisville Diarrhea (CLOUD) study launched in September 2019. Pfizer will be providing up to $6.5 million in funding for a one-year study of the incidence of diarrhea among Louisville-area residents.
• The Louisville Pneumonia study is up to $4.5 million in funding provided by Pfizer for a one-year study of the incidence of pneumonia among adults in Louisville that launched in November 2019.

Check out the video for more information: 

Prior to entering the PhD program at UofL, she worked as a medical laboratory technologist for the State of North Carolina, UNC Healthcare and the Department of Agriculture and Consumer Services. She also has experience working for an international health non-profit organization, developing fundraising activities for the organization to provide medical and social services for Chinese orphans with special needs. Kuo is a second-year PhD student in the epidemiology department of the School of Public Health and Information Sciences.

She took time out of her schedule to talk to UofL News about what motivates her and what her goals are as a Health and Social Justice Scholar.��

UofL News: What motivated you to invest in health and social justice?

Diana Kuo: Ever since my time as a grad student in my master’s program I was interested in epidemiology, but also international health. A lot of international health courses I took had a human rights perspective with health, so my background has been fluctuating. After I graduated from the master’s program, I worked for an international health organization in a fundraising office for our operations in China where we helped handicapped orphans. Once I left that career I went into the medical field as a medical technologist helping to diagnose diseases. Inherent in me has always been the idea that the health and wellbeing of everyone in our community is important. That sent be back to pursue my PhD. One of my main topics of interest in epidemiology is social epidemiology, which melds a lot of different disciplines to understand this bigger picture of health and why it is different in different populations.

UofL News: What is one experience that drives you to make a difference?

Kuo: My most significant experience was in my MPH program in which I did an internship with a student-run organization. We went to Uganda to catalog services offered by NGOs, MPOs, private clinics and local hospitals for HIV and AIDS patients and their friends and family who were affected. While I was there we worked with a local brother-and-sister-run orphanage. In Uganda there is no such thing as a state-run orphanage system, so it’s basically people taking in children from the street. A lot of those children are orphans because their parents died of AIDS and none of the family members want to – or can – help out. One of the days we were there we went around talking to children who had not yet gone to seek someone to help them. They were still living on the streets. A lot of them were hiding in the sewer drains. I think that was one of the most up-front and eye-opening events I ever experienced.

UofL News: What would you like to accomplish as a Health and Social Justice Scholar?

Kuo: It will depend on how we collaborate to figure out what would be the best project to help the community, but I think there are a lot of issues that are not directly related to health but contribute to whether people have healthy lives. One of the main things is to get the idea of public health out to the community and affect policy change in the city. Although I don’t know when or if we will achieve this, I hope it will be within my lifetime.

Introduced in the spring of 2016, the Health and Social Justice Scholars Program engages professional students with local communities and faculty mentors to bring about changes to benefit underserved populations in the Louisville area. Read about fellow scholars in this program, and .��