Neighbors unite to fight Zika across the Americas

“Central America is unique in that everyone is close to each other. If there’s an emergency in Guatemala, it is likely that an outbreak in Honduras or El Salvador will soon follow,” says Luis Hernandez, who handles emergency preparedness and response for CDC in Central America. Zika virus is no exception, which is why trainees and graduates from the Central American Field Epidemiology Training Program (CA-FETP) are on a mission to stop the virus in its tracks.

The clock is ticking: rainy season in Central America starts in May and lasts until the fall. Standing water from rain, combined with higher summer temperatures, means more mosquitoes and more disease on the horizon.

Trusted resources

Surveying a rural settlement in Guatemala.
Surveying a rural settlement in Guatemala.

Surveying a rural settlement in Guatemala.

CA-FETP trainees and residents have strong community ties, and their training builds the skills and relationships required to become trusted sources of information. This is particularly important because Central America is incredibly culturally-diverse; Guatemala alone has 27 distinct ethnic populations. FETP has a long history in Central America and a high number of graduates from three levels of training (basic, intermediate and advanced) continue to work in local public health, which makes it easier to reach everyone who might be at risk.

Preventing Zika requires controlling the mosquitoes that spread the virus, Aedes aegypti and Aedes albopictus. In fact, controlling these types of mosquitoes would reduce not only Zika, but also dengue and chikungunya. But mosquito control requires strong community participation to remove standing water habitats where mosquitoes lay eggs, which include some unexpected places, such as flower vases left at cemeteries and car tires stacked on the side of the road. CA-FETP graduates and trainees work to educate community members about these issues.

“Some cities will have a clean-up day where they remove all the tires, but if you haven’t engaged with the community and explained why this is important, guess what? The next day, tires are piled on the side of the road again,” says Augusto Lopez, former CA-FETP Resident Advisor in Guatemala.

At the beginning of the outbreak, nobody realized how complex Zika would be, especially related to birth defects and sexual transmission. Fortunately, CA-FETP’s network of more than 3,000 graduates and trainees extends to seven countries in Central America, the Dominican Republic and Haiti. The region already has systems in place to monitor diseases, so the emergence of Zika doesn’t mean that countries need to start from scratch. CA-FETP is expanding surveillance to additional sites, including areas where the mosquito population is completely unknown.

In search of answers

Many unanswered questions about Zika virus remain, and pregnant women are asking some of the hardest questions. Reina Turcios-Ruiz, the current CA-FETP Resident Advisor and Director of the CDC Central America Region office, knows a local teacher who is pregnant.

“She is an intelligent, well-read woman trying to keep updated on the latest literature on Zika,” Reina said. “Answering her question, ‘What are the chances my baby will be affected by Zika?’ has been difficult. I give her my most honest answer based on the experiences in Brazil and Colombia or from the latest science articles, but it leaves us both unsatisfied. I empathize with her. At best, I can say, ‘I don’t know, but health experts are working hard on finding the answers.’”

Making an impact

Catching mosquitoes in Haiti.
Catching mosquitoes in Haiti.

Catching mosquitoes in Haiti.

CA-FETP throughout the region is expanding surveillance, improving mosquito control, and prioritizing following up with pregnant women potentially infected with Zika.

El Salvador and Belize have both made participating in Zika investigations a requirement for their intermediate-level FETP trainees. They are collecting data that is being used to guide decision-making throughout the region. Even those with basic-level training in epidemiology can collect the information decision-makers need to navigate complicated outbreaks such as Zika.

David Rodriguez, a consultant with the Council of Ministers of Health of Central America and the Dominican Republic (COMISCA) who supports the regional FETPs, says, “Engagement in the Zika response has certainly tested resource capacity on all fronts, but it has all been worth it. It has fostered leadership development in the CA-FETP trainees and provided them with a valuable learning opportunity. There is urgency to generate something both quick and responsive, but also of high quality to achieve large impact.”

Learn more about our ongoing work fighting Zika in Belize, El Salvador and Haiti

Disease detectives in the field are working on the frontlines of global public health by fighting Zika virus in Central America and the Caribbean.

Lorna Perez, a recent CA-FETP graduate, is a nurse with experience in reproductive health who currently works in the surveillance unit of the Belize Ministry of Health. She is leading Belize’s Zika investigations, which requires her to travel to remote parts of the country without telephone or Internet access. Despite these challenges, she is able to fulfill data requests, information that helps guide the regional approach to fighting Zika.

David Rodriguez is a consultant with the Council of Ministers of Health of Central America (COMISCA) who supports the regional FETPs. When it became clear that El Salvador needed to be ready to track down cases of Zika, David knew that the best way to detect cases early was to adapt the country’s existing dengue surveillance system to also capture Zika cases. David made this idea a reality with the support of El Salvador’s Director of Surveillance, and El Salvador now has a comprehensive and efficient Zika surveillance system.

As Zika virus moved from Brazil and into other nearby countries, Haiti prepared for what seemed inevitable — patient zero. To catch the first case early, FETP students and the Ministry of Public Health (MOPH) started actively looking for Zika in December. They worked late nights and were in constant contact with field workers so they could be informed immediately about anybody with symptoms of Zika. When the first suspected cases popped up in late December, FETP graduates knew that Haiti’s national laboratory didn’t have the capability to test for Zika. They worked with the MOPH to safely transport specimens to a laboratory in Trinidad. The lab confirmed the first cases of Zika in Haiti in early January 2016.

Once they discovered that Zika had landed on Haitian soil, FETP embarked on an education campaign to let the public know. Because Haitians are familiar with malaria and chikungunya, communities have some knowledge about preventing diseases spread by mosquitoes. FETP is adding essential Zika information into their current malaria prevention field activities, and communicating specifically with pregnant women about how to prevent Zika. 

In just a few months, FETP has helped set up surveillance sites across the entire country. So far, thousands of suspected Zika cases have been identified by healthcare workers trained by FETP to look for Zika. They are actively training healthcare workers on case notification and surveillance among pregnant women.

Wilnique Pierre, a CA-FETP graduate who has been involved in Haiti’s Zika surveillance and investigation activities, says, “Detecting cases among pregnant women and avoiding microcephaly and other severe brain defects is one of the biggest challenges of the outbreak response, but it is also both enriching and rewarding.”