Zika prevention approaches in Jamaica

John F. Lindo Deputy Dean (Research) Faculty of Medical Sciences

The University of the West Indies, Mona Kingston, Jamaica

Format of presentation

• Public health response – Dr Melody Ennis (MOH)

– Dr Lundie Richards (MOH)

• Laboratory capacities – Dr Ivan Vickers (Virology, Microbiology)

– Mr Compton Beecher (CARIGEN)

– Professor Wayne McLaughlin (CARIGEN)

• Global Virus Network Centre of Excellence

• Research gaps

• The Pitch

Objectives of MOH, Jamaica

• To detect and contain the Zika virus in Jamaica

• Reduce morbidity and mortality

• Reduce the Aedes population

– Ensure a responsive / robust system

– Utilize resources to achieve best outcome

– Ensure sustainability

MOH Responsibility

• Ensure appropriate systems, procedures, and resources are implemented

• Provide prompt, effective assistance to infected persons

• Facilitate relief measures and rehabilitation of services

Primary mandate

Before, During and After

• Provide Emergency Health / Medical Care

• Ensure uninterrupted Health Service Delivery

• Maintain Public and International Health

Additionally

THE MOH MUST

• Provide accurate information

• Dispel rumors about medical and health conditions

• Keep the international assistance community abreast of the changing situation

• Provide verified facts to the national and international media

Situation analysis

• Confirmation 29 January 2016

• Activated MOH NEOC

– SERHA EOC

• Mobilized and Deployed

– Staff

– Equipment

– Chemicals

Situation analysis

• US advised that Jamaica has local transmission

• Intensified surveillance and vector control activities

• Engaged public and private sector in the response

• WHO declared Zika a Public Health Emergency of International Concern

GAPS

• Inadequate baseline data

• Insufficient public awareness

• Vector Management – Human resources

– Vehicles

– Chemicals

• Limited laboratory capacity (Need RTPCR machine and reagents)

• Limited social input

GAPS

• Training needs

• Insufficient resources

• Weak Intersectoral Collaboration

• International Cooperation to be strengthened

• Resource Mobilization required

MOH Focus

• Heightening surveillance to detect and contain the virus

• Facilitating Risk Communication and Public Awareness • Enhancing the Integrated Vector Management

Programme • Building laboratory capacity • Training • Social Mobilization • Inter-sectoral collaboration • International cooperation • Resource Mobilization

Heightened Surveillance

• Zika virus made a Class 1 Notifiable condition

• The MOH Zika Epidemiological Surveillance Plan was developed to guide the response

• Surveillance to detect and monitor

– all fever and rash cases

– neurological syndromes

– congenital malformations

Risk Communication / Public Awareness

• Media campaign

• Weekly press releases

• Website regularly updated

• Zika alert flyers

• Pregnancy and Zika brochure

• Zika posters

• T-Shirts

Integrated Vector Management

Main Components

1. Strengthening Management Systems

– Link between technical and administrative operations

2. Capacity Building

– Recalling staff

– Volunteers

– Temporary Workers

Integrated Vector Management 3. Intersectoral Collaboration – actively engaged

– NWC

– NSWMA

– SDC

– NWA

– NHT

– Local Board of Health

– FBO

– CBO, Private sector, Public Sector Institutions: schools, penal, nursing homes hostels, women centers etc

Integrated Vector Management

4. Social Mobilization and Community Participation

– Call the community to action • Town Hall Meetings

• Social groups: – SDC ,schools, churches

• Engage local and cable radio stations

Individual and corporate search to identify and destroy Aedes breeding sites

Integrated vector management

5. Heightened Surveillance and Control

–Implement blitz protocol as necessary

–Prioritize high risk communities

–Resource mobilization and sharing

Integrated vector management

6. Targeted Intervention – Schools (to include universities)

– HCF -Public And Private

– Urban Centers

– Unplanned Settlements

– Communities without Piped Water

– Tyre shops, garages and dumpsites

– Points of entry

– Enforcement

LABORATORY CAPACITY • Decision taken to upgrade the UHWI virology

lab

• Engage PAHO

• Training and validation done

• Reagents purchased

• In country testing to begin 7 March 2016

TRAINING

• On-going with health care providers

• Protocols Prepared and disseminated

– Clinical management

– Surveillance

– Laboratory

– Risk communication

SOCIAL MOBILIZATION

• Operation Mosquito Search and Destroy Launched

– All Ministries, Departments and Agencies engages

– SDC

– Churches

– Communities

Intersectoral Collaboration

• MOH has partnered with

– NWC

– NSWMA

– NWA

– NHT

– JPS Co

– FBO

– Private sector

International Cooperation

• Collaboration with PAHO / WHO / CARPHA / CDC – PAHO has offered two interns to assist the MOH

in the area of surveillance and disaster risk management

• PAHO Consultant assisted in the establishment of the Virology Laboratory

• CARPHA test samples from Jamaica for Zika virus

Resource mobilization

• Gap analysis conducted

• Local and international funding agencies contacted

• Funds redirected and committed

• CHASE Fund – released funds to the lab

Closing the gaps

• J$200M – Procure vehicles

– Chemicals

– Authorization to hire

– Embarked on research

– Social mobilization

– Resource mobilization

What is required????

• Sustained effort

• Behaviour change

Laboratory capacities at UWI, Mona

Department of Microbiology

• Virology laboratory designated national testing centre

• Jamaica’s only virus lab

• Recently assessed for ISO accreditation

• MOH provided resources for testing

– $J10M

– Reagents

– RTPCR thermal cycler

ARBOVIRUS TESTING

DENGUE, CHIKUNGUNYA, ZIKA VIRUS Serological

Molecular

Zika virus Testing: Samples • Type of sample

– Serum: 4-5mls in plain red top tube

• Storage of sample

– Keep refrigerated (2-8 C) for < 48 hrs

– Keep frozen (-10 – -20) for >48 hrs

• Transport samples on ICE to:

– NPHL CARPHA (Now)

– Virology Lab/UHWI

• MOH reference testing lab

• Parallel testing with CARPHA

Zika virus Testing: Sample REJECTION • Samples come with the following

information:

• Name of patient

• Age of patient (DOB)

• Address

• Date of onset of symptoms (DOO)

• Date of collection of sample (DOC)

• Clinical features: symptoms experienced

• Lab tests performed & results eg rapid dengue

• Pertinent Travel history

Zika virus Test: Other samples

• The use of saliva samples

– has been shown to increase the rate of molecular detection in the acute phase,

• The use of urine as a specimen for viral genome detection by RT-PCR might be a diagnostic method

– to consider in order to extend the period of detection

• Amniotic fluid

• Semen

Currently only sera used in Zika testing at Mona

Arbovirus Serological Tests • Screen @ arbovirus algorithm

– Dengue ELISA/IFT/ICT • IgM, NS1 antigen*, IgG

– Chikungunya ELISA /IFT/ICT • IgM, IgG, CHIKV antigen*

– Zika virus ELISA/IFT • IgM, IgG

• Most are In-house assays samples

• Few commercial assays available

• Non are FDA approved

• Cross reactivity

Arbovirus Molecular Tests

DENV, CHIKV and ZIKV NA tests

• PCR

– Conventional PCR

– Real Time PCR

• NASBA

• LAMP

Real Time PCR machine

ARBOVIRUS DIAGNOSTIC ALGORITHMS

Serological: Antibodies, Antigen Molecular: Nucleic Acid

PAHO

PAHO

PAHO

CDC Arbovirus algorithm

CDC recommended Algorithm

CDC recommended Algorithm

CARIGEN

CARIGEN –Caribbean Genetics

• Private company owned by Mona • Offers genetic (PCR) testing for infectious diseases • Runs an ARBOVIRUS panel

– Dengue and Chikungunya – Zika

• Applies multiplex PCR • Director – Professor Wayne McLaughlin • Chief Analyst – Mr Compton Bourne • T. 1-888-DNA-TEST

T. 1-888-362-8378 T. 1-876-977-4342 T. 1-876-935-8791 E. info@caribbeangenetics.com

Capacity of CARIGEN

• Uses CDC approved protocols

• Participates in External Quality Assessments

• High throughput (RAPID turnaround)

• Able to handle samples from around region

• Results delivered electronically

Mona campus and the Global Virus Network

The Global Virus Network

• The Problem

• Emerging and re-emerging infectious diseases account for a considerable portion of the global burden of disease

• New and re-emerging viral infections – Ebola, Marburg, Chikungunya, Middle East Respiratory

Syndrome (MERS), Severe Acute Respiratory Syndrome (SARS)

– Hold power to cause global pandemics with devastating consequences.

Global response to EIDs

• World Health Organization

– One Health Initiative

– Responses include surveillance

– specific interventions to halt epidemics and treat endemic cases

The Global Virus Network

• Launched in 2011 – Dr. Robert Gallo (USA) – Dr. William Hall (Ireland) – Dr Reinhard Kurth (Germany)

• Coalition of leading virologists in 25 nations • To advance knowledge about how viruses cause

disease • Vaccine and drug development • Covers every virus causing disease in people

The UWI in GVN

• Prevention and treatment of infectious diseases

• Support the tourism sector

• Support the local health authorities

• Prevent economic loss from the major burden of diseases attributable to viral infections

Why GVN at The UWI • Jamaica’s only Virology Laboratory

• Staff of highly trained scientists, consultant virologists and medical technologists

• Jamaica’s only Biosafety Level 3 Laboratory

• Hosts the National Influenza Centre

• UWI leads the region in research in human virology

• Recently invested in an HIV pathogenicity laboratory

• Centre for Tourism and Policy Research is best positioned to incorporate health findings into tourism policy

Benefits of GVN membership • Potential for research collaborations with leading

medical virologists globally on priority viral challenges facing Jamaica

• Access to training programs, workshops and other skill-building activities to strengthen local expertise while building a globally-minded workforce of the future

• Opportunities for GVN scholars from abroad to visit Jamaica for teaching and to build international research collaborations

• Reduction in illnesses caused by viral infections in the local population

• Access to GVN partner organizations for leveraging of funding and expertise

Benefits of GVN membership

• Provision of technical advice and expertise in helping the country to address, manage and prevent viral diseases

• Share ideas, knowledge, resources and experiences with international experts as part of the Global Virus Network.

• Opportunities for Jamaican virologists to work more closely with public health leaders through GVN – related efforts

Steps to GVN membership

• MOU between UWI (Mona) MoH Jamaica and the Center for Integrated Global Health Sciences (CIGHS), University at Buffalo (UB, SUNY) which is a GVN center of excellence.

• Major refurbishing of the Virology laboratory

• Provide modern equipment for the diagnosis

• Participated in GVN sponsored course at the Institute of Human Virology in Baltimore, Maryland

Steps to GVN membership

• Collaboration with Rush University, Chicago, Albert Einstein School of Medicine

– Study chronic non communicable diseases in long term survivors with HIV

• Sought funding for support of GVN activities from the Jamaican private sector

Identifying research gaps

• Medical entomology – Detect Zika (and other ARBO viruses) in

mosquitoes • Predict epidemics???

• Track control programmes???

• Clinical management of children with Zika

• Clinical management of pregnant women

• The immune response in a naïve population

• The nature of the virus

Establishing a general research lab

• The work to be undertaken involves the use of both veterinary and human samples and must be conducted in a designated laboratory. FMS assigned a laboratory for the work but it must be equipped with the following:

• Basic laboratory equipment (refrigerators, freezers, centrifuges, micropipettes)

• Light, Fluorescence and inverted microscopes • Molecular diagnostic equipment (PCR equipment and

supplies) • DNA sequencing facilities • Reagents • Disposables and consumables.

Description Year1 Year 2 Year 3 Total

Research Fellow 17,336.00 17,852.00 26,270.00 61,458.00

Research Assistant 9,975.00 9,975.00 9,975.00 29,925.00

RTPCR Thermal cycler 126,721.00 0.00 0.00

126,721.00

DNA sequencer

131,147.00 1,721.00 1,721.00

134,589.00

GVN membership

50,00.00 0.00 0.00

49,577.00

Laboratory

equipment 93,260.00 0.00 0.00

93,260.00

Molecular diagnostic

equipment 39,917.00 0.00 0.00

39,917.00

Consumables

68,473.00 68,473.00 68,473.00

205,419.00

Reagents

134,016.00 134,016.00 134,016.00

402,048.00

Grand Totals

670,422.00 232,037.00 240,455.00

1,142,914.00

Thank You