Shaping the Caribbean's response to Zika, UWI’s Zika Task Force (www.uwi.edu/zika) is gathering and providing expert advice to develop a strategic, scientific approach for tackling the Zika virus.
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Zika Prevention Approaches in Jamaica
1. Zika prevention approaches in
Jamaica
John F. Lindo
Deputy Dean (Research) Faculty of Medical Sciences
The University of the West Indies, Mona
Kingston, Jamaica
2. 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
3. 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
4. MOH Responsibility
• Ensure appropriate systems, procedures, and
resources are implemented
• Provide prompt, effective assistance to
infected persons
• Facilitate relief measures and rehabilitation of
services
5. Primary mandate
Before, During and After
• Provide Emergency Health / Medical Care
• Ensure uninterrupted Health Service Delivery
• Maintain Public and International Health
6. 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
8. 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
9. GAPS
• Inadequate baseline data
• Insufficient public awareness
• Vector Management
– Human resources
– Vehicles
– Chemicals
• Limited laboratory capacity (Need RTPCR
machine and reagents)
• Limited social input
10. GAPS
• Training needs
• Insufficient resources
• Weak Intersectoral Collaboration
• International Cooperation to be strengthened
• Resource Mobilization required
11. 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
12. 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
13. Risk Communication / Public
Awareness
• Media campaign
• Weekly press releases
• Website regularly updated
• Zika alert flyers
• Pregnancy and Zika brochure
• Zika posters
• T-Shirts
14. Integrated Vector Management
Main Components
1. Strengthening Management Systems
– Link between technical and administrative
operations
2. Capacity Building
– Recalling staff
– Volunteers
– Temporary Workers
15. 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
16. 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
17. Integrated vector management
5. Heightened Surveillance and Control
–Implement blitz protocol as necessary
–Prioritize high risk communities
–Resource mobilization and sharing
18. 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
19. 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
20. TRAINING
• On-going with health care providers
• Protocols Prepared and disseminated
– Clinical management
– Surveillance
– Laboratory
– Risk communication
21. SOCIAL MOBILIZATION
• Operation Mosquito Search and Destroy
Launched
– All Ministries, Departments and Agencies engages
– SDC
– Churches
– Communities
23. 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
24. Resource mobilization
• Gap analysis conducted
• Local and international funding agencies
contacted
• Funds redirected and committed
• CHASE Fund – released funds to the lab
25. Closing the gaps
•J$200M
– Procure vehicles
– Chemicals
– Authorization to hire
– Embarked on research
– Social mobilization
– Resource mobilization
28. 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
30. 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
31. 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
32. 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
33. 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
34. Arbovirus Molecular Tests
DENV, CHIKV and ZIKV NA tests
• PCR
– Conventional PCR
– Real Time PCR
• NASBA
• LAMP
Real Time PCR machine
43. 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
44.
45.
46.
47. 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
49. 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.
50. Global response to EIDs
• World Health Organization
– One Health Initiative
– Responses include surveillance
– specific interventions to halt epidemics and treat
endemic cases
51. 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
52. 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
53. 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
54. 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
55. 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
56. 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
57.
58. 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
59.
60. 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
61. 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.
62. 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
