Here’s to Fresh STARTs: Sustainable Transitions And Reachable Targets

From the title, you might be able to tell that I’ve been busy on Lab Management University (LMU). Going through the online modules and lessons in the LMU certificate program I mentioned this past May, I’ve been able to hone several skills in interpersonal communication, resource management, and project leadership. (A worthwhile investment through ASCP which I highly recommend!) Another thing that’s kept me quite busy over the last two years has been Zika-virus and mosquito-related public health initiatives both inside and outside the laboratory. In a recent blog post, I discussed the correlation between measuring success in projects like these just as one would with common lab-centric goals. And, as a conclusion to that hard work, this will be my last directly-related Zika/public health post. Transitioning to the second half of medical school, I’ll be leaving behind a true grassroots project that not only reached countless people but has the promise to be sustainable after my departure from the island of Sint Maarten back to the states.

As with many times in life, I would say fresh starts are a welcome chance to reflect and grow upon things you might have learned or goals you might be closer to finishing. What has been made clear to me in my time working through classrooms, cases, exams, and projects is that the “jargon” we use as laboratorians is definitely worth its weight. It isn’t full of hollow charges for metrics and goals; it’s about real data and real solutions. Having the ability to apply my prior experiences in laboratory medicine throughout medical school—both inside and outside the classroom—has been an invaluable benefit. The general principles that guided my last blog post reflected simple goals (i.e. turnaround time compared with public health metrics) which utilize fundamental models of data collection, adjustment, and success. The essential model I described a few months ago is now a mainstay of a project that will continue to improve public health statistics slowly as time goes on.

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The model as it stands now consists of clear steps to identify problems which require interventions, highlight gaps in current practice, data collection from literature exists currently, collaboration with partners in a community of trust, and continuing those partnerships as improvements are made incrementally over time. The model has been repeated and successfully modified for these last two years from on-campus blood testing with procedural write-ups and data evaluation, to teaching school-aged children about mosquito prevention, to partnering with local government officials and having your projects adopted into their portfolio, and visiting individuals in their homes to discuss health and prevention.

To keep it brief, I’ve had an amazing experience here being able to lead and contribute to a wonderful and impactful project such as this. It has become increasingly clearer to me throughout this work that the values and skills programs like LMU teach are directly parallel with successes in various clinical settings. From the bedside to the laboratory to public health in the field, the lessons of how to effectively engage people and solve problems are critical. My time in laboratories before medical school, the daily grind of classwork here, and the projects I’ve been able to write about have all given me the space to try these skills on real situations—and hopefully that will make me the best clinician I can be after medical school is completed. Check out my “highlight reel” of partnerships, workshops, and active management in Zika prevention below.

Be sure to check back here next time, I’ll be writing from my hometown as I’ll explore ASCP’s Annual Meeting in Chicago, IL this coming September and report back on why it’s important to network and stay involved with our great professional community. Thanks for reading!

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Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.

 

The Voice of Sint Maarten

It’s often difficult for a medical student to take time out of their schedule and work on projects in their community. Our free time is often encumbered with the “fire hose” of information that we all need to process and master before we sit for board exams. To be fair, there isn’t any free time per se. It is apparent (in medical school more than any other time I’ve known) that every minute of the time we schedule is, by choice, purposeful or not. With that noted, something exceptional happened this month in a span of three days that I am truly proud of. My “Z-Pack” Zika virus prevention initiative team all came together and tackled three extraordinary events around our Sint Maarten community.

If you’re just joining the Zika-related action, check out the background behind my work as well as some of the major accomplishments, achievements, and noteworthy lessons along the way this past year. My team’s work bridges a gap that exists between public health and the data we laboratorians acquire through diligent research.

The whirlwind of public health outreach events the Z-Pack was able to do were highly productive to the cause:

  • We have bolstered our public health and source reduction message on local radio, television, and print.
  • We have engaged and partnered with innumerable entities within this community and were an integral part of a mainstay annual health fair.
  • We engaged with local community members, not as students, but as public health liaisons fielding in-depth questions and addressing real concerns of the local population.
  • During these episodes, we were able to procure true data which we continue to collect, analyze, and use to formulate new approaches to positive health outcomes.

The first exciting development I listed was the debut into our media campaign. Being invited to the local radio to advertise our work and promote upcoming events was both exciting and reaffirming. In a short interview, I addressed Zika and other virus threats to the island community and discussed epidemiologic data and what it means in the scope of public health. Talking about our work alongside two of my team members and the project manager of the Ministry of Health’s vector control program was a thrill. A fellow team member and I were also fortunate enough to be flagged down by a local cable access television program to promote our work on a short video spot during our presence at the Lion’s Club Annual Health Fair I’ll discuss shortly. These media outlets reminded me of moments back in the laboratory when I had to present data clearly and field questions “on the fly.” Whether it was a staff meeting, educational resource assessment, or CAP inspection response, I couldn’t have been more prepared to handle the translational bridge from data to public view.

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Image 1: “Z-Pack” on the radio!

(Listen to the 16 minute radio spot here from PJD2 102.7FM/1300 AM The Voice of Sint Maarten)

I mentioned the Health Fair the local Lion’s Club sponsors each year, with booths that address a plethora of health education outlets from diet/nutrition, to diabetes, to (of course) mosquito reduction.  Partnering with our colleagues in the Ministry of Health we set up several tables in a tented booth and made available all kinds of educational resources for the public. There was a station designated to secondary interventions for combating mosquito risk reduction such as fogging guns and larvicides for standing water areas. I designed some clear-message flyers to distribute to patrons and others passing by our booth and was able to spark some interesting conversations with local community members and business owners who wanted more information—they wanted to distribute and display the same information in their offices and homes. Gaining popularity with the local community, we decided to record those interested parties and give them the title of “official community partners.” Not only will they feel more involved in the process of empowering and advocating for health for their community, but they will be motivated from within! I will say that my absolute favorite part of this health fair was the station our Ministry partners set up which included all their laboratory equipment they use to speciate, quantify, and analyze the local mosquito threat. This, alongside with our friends in local laboratory medicine who were collecting specimens to screen for Zika serologically, made this a very friendly environment for a laboratory professional like myself. You can bet I was happy to talk to visitors about epidemiology and risk reduction over a few microscopes!

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Figure 1: Clear-message informational flyers for public patrons to our booths at the health fair.
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Image 2: Health fair snapshots, a fogger gun, and some team building with microscopes.
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Figure 2: Preliminary data processing reveals an improvement in perceptions, attitudes, and behaviors toward Zika virus and overall arbovirus risk reduction.

On a more serious note, I want to speak briefly on the amazing opportunity that our community meeting offered for my team and I to learn some real truths about public health here on the island. With the success of partnering with laboratory services, research work in the field, and participating in a growing media campaign, the Z-Pack arranged a community meeting at a local religious center. Our “community meetings” as proposed in part from our earlier work focus on presenting audience and culturally specific information about reducing arbovirus risks and addressing health within the community. A community liaison connected us to a local Islamic center, where we conducted one of these meetings. Our presentation was received well, and a vigorous discussion followed. Having a partner from the Ministry of Health with us that day provided some clout to our discussions. I drew heavily on my interpersonal skills as a laboratorian when I fielded some really challenging questions from the adult crowd. Concerns in this particular community included specific objections to the effectiveness of the Ministry’s work on reducing mosquito populations, frustration over tourist-heavy areas receiving unfair attention, and true worry over improving health outcomes in a constructive and collaborative way. Taking the time to share their personal experiences was greatly appreciated by my team. Really engaging with the community on an individual level really makes it feel as though we are creating positive change. As a part of our work, data was collected on the effectiveness of our message. Still in its early stages, the data (Figure 4) shows qualitative improvements toward answers in post-presentation surveys which reflect new facts learned, potential for social/behavioral change, and establishment of health risk as a community priority.

 

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Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.

IRBs and Public Health Pathology

Hello again! Welcome back to my latest check-in following my progress with Zika risk reduction and public health outreach. Partnering with the Sint Maarten Ministry of Health through my medical school has provided amazing resources to take a look at social determinants of risk under the purview of public health, integrating both medical sciences and community service.

Early on in this project, I discussed the early stages in conceiving and planning these public health works in my first post “An Arbovirus Abroad.” This of course seemed like the perfect name for the proposal my team and I authored at the end of our first semester together. Done under an elective service credit, our full Internal Review Board (IRB) proposal for research within the community was called “An Arbovirus Abroad: a Service Learning Project Exploring Public Health Outreach, Social Determinants of Health, and Partnerships with Local Government to Address Zika Virus Knowledge and Community Outcomes.” The goals were to strengthen our partnership with local government offices as we aligned our efforts with reducing infectious risk and addressing community knowledge and attitudes regarding Zika.

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Figure 1. Title Page of original IRB/Research Project Proposal under G. Jackson, Ph.D., Assistant Dean, Community Affairs and Service Learning at AUC School of Medicine

After we secured IRB approval, we began work quickly. Holding meetings with the Ministry’s representative consultant for their office of Collective Prevention Services (i.e. vector control) and scheduling the remaining work for the semester. With five new members of the “Z-Pack” we established a loose timeline with our advisor. Our new goal: integrate what we learned last semester and bring it to a conclusive change within the community.

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Figure 2. Title card from initial briefing meeting with members of the Z-Pack, including coordinating partner from the Ministry of Health (CPS office) Mr. G. Davelaar.

This integration of knowledge from literature review/research, evidence-based best practices, and forward moving progress are all things those of us in the medical laboratory profession are quite familiar with. Getting IRB approval for a lab-centric project is quite involved and requires meticulous proof and substantial support to posit any claim to the benefit/risk ratio involved with human or animal subjects. I remember from my own graduate and undergraduate research that without heaps of evidence, you will be hard pressed to continue in any direction. While public health is a different science, the basis on evidence-based research is still present. During our initial assessments, literature reviews, and brainstorming, the “Z-Pack” went through hundreds of scientific articles covering everything from infection control precedents, to social behavioral change, and even the use of media and fear to illicit change.

Laboratory scientists know the impact of their work, though it may not always be the most evident to the general public. The near 70% of diagnostic information that comes from our work, and the virtual entirety of neoplastic diagnoses rely heavily on our training, skill, and certified competency in evidence-based practices. ASCP has a long-standing mission of advocacy for patients in the way its members and affiliates represent the profession at large. I believe that having those years of experience under my belt and those letters behind my name give me a head start when executing translational research. Going from raw data, analyzing it, and bringing it to life is something we all inherently train to do—and do well!

So, up to date, my team has secured two measures to contribute to our research. First, we gave an educational presentation to a community after-school program in one of Sint Maarten’s endemic regions. We had tailored a wonderful presentation I discussed in a previous post which caught the eye of the Ministry of Health and has spread to numerous places around the island under their sponsorship. With the same success, we managed to reach school-aged children in an engaging way about Zika, their health, and source reduction. Our second event is slated for this weekend where we have partnered with the Muslim student-interest group (MSA) on campus to go with them on their routine visit to a local mosque on a school-sponsored student service day we call “Community Action Day.” While the MSA students engage with their local community, the “Z-Pack” will conduct a two-part effort: to conduct a grounds-inspection for source/vector control around the mosque, and deliver a presentation for both children and adults regarding Zika prevention behavior.

How do those two events connect with my theme of evidence-based lab scientists? Well, one of my engagements when at Northwestern Medicine was to teach a course discussing transfusion protocols and laboratory information to clinical nursing staff. Presenting information, or teaching people, new ways to think about their environment at work or home is a part of being interdisciplinary. I was able to speak with medical jargon to the clinical staff, but with the children I have to use my ability in translating medical knowledge to understandable facts while also keeping the audience interested. My team proved in our last school-aged project, that when children are engaged and enthusiastic about something they have learned, they will take those messages home with them and hopefully contribute to a positive outcome. As for the second example, what could be more directly appropriate for lab folks to understand here: a surprise inspection! Sure, no one’s losing any accreditation points here, but the fact remains that we all have experience from one side or another making sure that things are up to code on pre-determined conditions and protocols. We have an SOP from the Ministry regarding the items of inspections as they relate to source control, so translating them to a new site should prove interesting.

I’ll close this post off with an interesting piece recently posted by Ms. Susan M. Lehman, MA, MT (ASCP)SM where she discussed learner (i.e. student) experiences. She talked briefly about how online curriculums and other lab-skills courses may rely on more independent learning, changing the expectations of students. One of her students summarized it positively saying, “you get what you put into it.” That’s what I think about the service elective my work is associated with. It could be simple directed readings with great discussions, but what my “Z-Pack” team has and the skills we each bring to it have made the project and its partnerships exciting.

Thanks for reading!

 

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Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.

Laboratory Data and Global Health Security

Hello! If you’ve been following my posts these last few months you’ve seen my work here in the country of Sint Maarten regarding the Zika virus outbreak. I have been very fortunate to be involved at various levels of work with this new epidemic from lab testing and seroprevalence research to public health and policy initiatives. As 2016 comes to a close, I would like to celebrate that work by highlighting a few great milestones here and offer a few thoughts for the future starting next year.

I mentioned before that immunological lab testing has been ongoing, targeting IgM and IgG seroprevalence of Zika virus (along with other Arboviruses i.e. West Nile, Chikungunya, Dengue, and Yellow Fever etc) within the community around my medical school. Nearly two hundred samples later—and counting—the results point to a presence of nearly 10-15% of people are confirmed positive for an active (IgM) or resolved (IgG) infection with Zika. Despite the small sample size and ever-developing data sets, these numbers are highly suggestive of a correlation mimicking that presented to us by the Ministry of Health (see my Zika virus primer post from October of this year). This holds promise for future studies like these which depend heavily on that type of medical laboratory science and analytics. My involvement in the seroprevalence project has been very rewarding and I have been able to contribute my experience and skills as a laboratory professional in writing SOPs/protocols, ensuring proper laboratory safety, and highlighting specimen collection standards. With several years as a medical laboratory scientist, I have been lucky to find a place to do such good work. The opportunity to step up as a leader when it comes to laboratory skills is always fulfilling!

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Figure 1: Seroprevalence research and testing publicity for the AUC campus community, collection and specimen processing. photo credit: A. Yancone, 2016.

Along with the success of the lab-driven research at school, the project I spend the most time with is aimed at public health. My last post highlighted some of the successes my team and I have had with creating and maintaining a good relationship between members of the local Ministry of Health and the school system. In February earlier this year, my school strengthened their partnership with the Ministry by establishing a mission of public health initiatives driven by students and faculty who were engaged in community affairs, service learning, and public health. This increased sustainability will surely create a more long-lived effort for translational research to have an impact on health. I couldn’t be prouder of the work my team has done to show the community that medical students here represent the very best ASCP qualities of advocacy, partnership, and outreach through science and education. It is an honor to have my contributions recognized by the local public health officials—even moreso when they have now incorporated and sponsored my teams’ message of vector control and source reduction to schools across the island. Having children aged 4-16 enthusiastically repeat back to us and representatives from the Ministry they would “throw standing water away!” made a strong impact on public health officials, students, and their parents/families. Setting goals for the community’s health metrics are supported by local epidemiologic data and pushed forward by policy initiatives, and always rooted in diagnostics and laboratory-confirmed cases. This means that all of our efforts, all of my presentations, and each step along the way holds a foundation in laboratory science and continues to motivate me as we continue forward. We all know the lab-week tag line that “nearly 70% of a patient’s chart is lab-data-driven,” and I can attest that for issues in public health and policy the same if not more applies!

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Figure 2: American University School of Medicine Partners with Sint Maarten Ministry of Health, Social Development, and Labour to bolster public health efforts and community involvement. AUC 2016.

Last month, Sint Maarten’s Ministry of Health sent Dr. Virginia Asin, the section director of the Collective Prevention Services office, to a Global Health Security Meeting in Miami. In this meeting she presented the policy initiatives her country had in dealing with risk reduction in the Caribbean. As a leader in this field, she cited ongoing partnerships with NGOs, public health offices, and medical professionals. She also shared her strong support for a project she said was truly a foundation for success—my team’s public health outreach! Dr. Asin and other staff members from the Ministry were present at an end-of-the-quarter presentation and meeting regarding this community outreach work based from the school. She shared with us her thoughtful admiration and ongoing support for the work we do here and said she was proud to have us as colleagues. Strong words and poignant sentiment from a real public health physician working in the field. It is incredible to have these efforts noticed by the Global Health Security Agenda (GHSA)! The GHSA exists at the forefront of the CDCs efforts to address the spread of various diseases, the global preparedness for them, and their economic impact on the global community. Dr. Asin and the Ministry’s continued support continue to inspire me, as well as other students, to look toward the future in creating more opportunities to merge medicine, data analytics, and positive outcomes.

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Figure 3: Global Health Security Agenda platforms. GHSA and the CDC 2016.

Slated to begin in January of next year, my team will begin conducting a new project aimed at improving local health literacy and source reduction. Under our IRB proposals, we hope to gather the data about the residents of this island and subsequently match them with correlated health statistics (i.e. confirmed/reported Zika cases) and actively engage with the Ministry in improving these numbers. With this current momentum, I would argue that even though a few successful highlights have come, the best is yet to come. If I have learned anything during my time as a medical laboratory scientist, there is a certain exciting progress to the dynamic way data is being used as we move forward. Breakthroughs in communication and analysis are allowing these advancements to take off: ASCP pathologists consulting on cases of chronic diseases in Africa, growing credibility surrounds our profession as our voice accomplishes great things in Washington, and advancing diagnostics are getting more efficient every day. Hopefully, projects like the ones I keep all of you updated on will continue to strengthen the connections between the labs, media, and public health officials as we continue to improve outcomes globally.

Until next time! Happy Holidays and Have a Happy New Year!

(…and don’t keep standing water around if you live in a warmer area, because…vector control!)

 

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-Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.

Healthy Me

Hello again! Last month, I wrote a primer on my experiences working in the realms of public health while in medical school. I am proud to have an active role in leading some Zika virus-related research and outreach while here in the country of Sint Maarten.

I left off last time with a photo of our most current successful partnership with local government and the local Red Cross where we organized student volunteers to do home inspections and contribute to vector control efforts. Our contributions were praised and are ongoing as more students volunteer for tangible public health working experience in the field. Concurrent with another research project happening on campus regarding Zika seroprevalence, the school community is excited and engaged in all of these efforts. Though it is early now, by the next phase of that project I will be sharing how immunologic work aimed at Zika detection is done here and how labs—everywhere—are absolutely vital.

Relying on epidemiologic and laboratory data has shaped the way we look at Zika virus in this area. A vast spike in reported cases to public health offices matched with an equal increase in laboratory confirmed cases has raised alarm for local officials. While the increased ability to detect and report Zika within the community is growing due to advancing research, the measures taken to mitigate the risks of infection and transmission have not changed despite public health efforts already. With the history of Arbovirus being a routine part of life in the region, behavioral change seems to be a significant hurdle with respect to social determinants of health.

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Figure 1. Distribution of cases on Sint Maarten per epidemiologic year 2015-2016, per the Ministry of Health, Social Development, and Labor – Collective Prevention Services Department.

For now, working partnerships have grown in the last month and have brought on exciting developments. Incorporating the public health outreach within the oversight of a service-learning course at AUC School of Medicine, ongoing works related to Zika education and prevention are supported by local government. The Sint Maarten Ministry of Health, Social Development, and Labour as well as their office of Collective Prevention Services were impressed with my team’s initiative and so enthusiastic about our first public health effort that they wanted to be a involved with our work. Having such prominent sponsors is lending both credibility and attention. The relationship that has developed between the mobilized student volunteers has fostered an attitude of inclusivity and collaboration.

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Figure 2. Representative meeting of student volunteers, Sint Maarten Red Cross, and others at a briefing of the Collective Prevention Services training session, October 2016.

One of the more recent and successes involved a program aimed at school children from various parts of the island. Local churches here have a program called “Healthy Me” where by school-aged children between 4 – 16 from various regions within the Sint Maarten community come to one school or community center to learn about their own health. Often times, my medical school’s pediatric interest group will send a large number of volunteers to talk to the children about metrics of health including conducting eye exams, measuring height and weight, blood pressure, pulse, and discussing diet. This time, my team proposed we collaborate with this event and hold Zika related presentations in one of the classrooms adjacent to those other screening rooms. We were approved and held nearly ten sessions with a total of almost 400 children!

Having a youth-tailored presentation along with coloring-activity books, we were able to impart a strong message to the children regarding source reduction and vector control. Writing an age appropriate presentation, engaging the children with active participation, and distributing activity booklets modeled after CDC education materials received positive feedback. Our community partners with Collective Prevention Services at the Ministry of Health supplied their overwhelming support and truly enjoyed being a part of the project. They have since requested to use our presentation materials and activity books at schools throughout Sint Maarten with the hopes of contributing positive public health outcomes from children to their parents and families.

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Figure 3. Me delivering one of the Healthy Me presentations to children, October 2016.

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Figure 4. Healthy Me Zika Presentation.

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Figure 5. Pamphlets for Children.

Citing the CDC’s approach to similar Arbovirus threats in the past, it became clear to my team and I that behavioral change is a significant part of improving public health outcomes within a community. A grassroots, or “bottom up” approach, both involves the community and positively influences behavioral changes to reduce risk and transmission. While the region here is fraught with historical exposure to Arbovirus threats, awareness and risk reduction are still critical for a population’s overall health.

Recently, the WHO released a statement calling for Zika to no longer be considered an epidemiologic emergency. This news has been met with both relief and criticism. Despite the virus receiving this downgrade, they still assert that it will continue to pose a threat as an ongoing infectious agent with complications that must be monitored by public health officials. While cases continue to increase over time, the management and reduction of risk is something both laboratories and public health officials will continue to address. Regardless of its status as an emergent epidemic or not, laboratories will still conduct studies to confirm reported cases, local government will continue to address the residents of this island to reduce risk, and I will continue to report about the state of progress between them. Labs, public health, and media are all part of the mechanism which translates data into results—and I am happy to be a part of that process.

Thanks for reading!

References

1. Vlaun, N., & Davelaar, G. (2016). ZIKA Virus on Sint Maarten . Philipsburg, Sint Maarten: Ministry of Public Health Social Development and Labour, Collective Prevention Services.

2. Davelaar, G. (2016). Results of the Pilot project “Cull de Sac,” a Mosquito Surveillance Plan for Sint Maarten . Philipsburg, Sint Maarten: Ministry of Health Social Development and Labor, Collective Prevention Services.

3. Gubler, D. J. (1988, December 7). Aedes Aegypti and Aedes Aegypti-borne Disease Control in the 1990s: Top Down or Bottom Up. Washington, DC: Centers for Disease Control and Prevention.

4. WHO (2016). “Fifth meeting of the Emergency Committee under the International Health Regulations (2005) regarding microcephaly, other neurological disorders and Zika virus” Statement, 18 November 2016. http://www.who.int/mediacentre/news/statements/2016/zika-fifth-ec/en/

 

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-Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.

An Arbovirus Abroad

Hello! My name is Constantine Kanakis and I am very happy to contribute to Lab Medicine’s online blog! As my first post, I would like to introduce myself, tell you a little bit about my interests in laboratory medicine, and also discuss Zika virus research I’m actively involved in.

I studied molecular biology at Loyola University and medical laboratory science at Rush University, both in Chicago. From undergraduate to graduate school, I was fortunate enough to work on research topics involving the neurology of nematodes, enzymatic plant assays, social justice/urban planning work, microbiological lab equipment development, and novel biochemical hematopoietic interventions. This comprehensive experience in research work provided a strong foundation which I have found useful in my career both in and out of the hospital laboratory. Other than research, I spent nearly nine years working in some of Chicago’s busiest hospitals. I learned the ropes in a variety of settings: trauma center transfusion medicine, academic center quality assurance, public health work, and community hospital laboratory work. I feel personally drawn to laboratory medicine and pathology, as it connects translational research to patient outcomes and puts us in a position to mobilize fellow professionals to improve health care in our communities.

This bridge from lab discoveries to bedside and beyond motivated me to write for this blog community. The current Zika virus outbreak as well as the start of my medical school career has provided a great opportunity for me to explore translational research and its direct impact into a local community. Currently, I am a second year medical student at American University of the Caribbean School of Medicine located on the island of Sint Maarten, in the Netherlands Antilles (Figure 1). I find myself in the epicenter of the now infamous viral epidemic of everyone’s new favorite Arbovirus: Zika. Studying in the Caribbean, I am actively involved in projects assessing the emergence of this viral phenomenon. Today, CDC lists countries with active infections with a Level 2 travel active warning notice, “[to] Practice Enhanced Precautions.” These projects have three tiers: laboratory studies, collaboration with local health partners, and integration of research with public health efforts. My location here provides ample opportunity to gather information at its source, most notably from our neighbors in Brazil, Puerto Rico, and even Florida. This island is high on the list of endemic countries with 1,730 suspected Zika cases reported as of July, 2016, however only 12% of those cases were serologically confirmed. The suspected cases have been rising in the last few months (Figure 2) and epidemiologists are watching the trends very closely.

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Figure 1. The Centers for Disease Control and Prevention (CDC), updates regions on the world map which have reported active Zika virus infections, CDC 5 October 2016.

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Figure 2. Suspected Zika viral infection cases per epidemiological week, Pan-American Health Organization (PAHO) and World Health Organization (WHO) 2016.

As a primer for those who are interested, the Zika virus is a Flavivirus/Arbovirus undergoing its second recent epidemic spread in the last decade. Discovered in the 1950s, it has been considered a minor viral infectious agent. To date, researchers near and far are exploring both potential vaccination and prevention measures, as well as infection control efforts as some claims link the virus to microcephaly, Guillain-Barre, and other various sequale. It is transmitted primarily by mosquito bites directly into the blood, though its antigenic presence has persisted in urine and even seminal fluid. Research in public health and epidemiology has also related the management of this outbreak to previous ones, including that of the 2014 Ebola epidemic. There is contention between various public health organizations and laboratory researchers in detailing any exact correlation of the viruses secondary effects as well as the difficulty in specific detection and diagnosis relative to reported vs. confirmed cases (Figure 3).

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Figure 3. A general demonstration of the purported Zika infection cases and how this reflects the true nature of the epidemic in the Caribbean in collaboration with the PAHO and WHO, from the Caribbean Public Health Agency (CARPHA) 2016.

Several research projects are starting here on campus, a majority of which involve serologic prevalence and surveillance studies. Some new studies are aimed directly at using commercially available testing, while others compound data from previously significant outbreaks of other arboviruses (e.g. Chikungynya, Dengue, Yellow Fever, West Nile). Our work in the laboratories here is also matched with significant public outreach. I am involved in one particular service and outreach project through the university here which targets the dissemination of Zika prevention/infection knowledge through various informational outlets such as town hall meetings, health drives for children, and vector control projects in the field. Our school-based task forces have been fortunate enough to form partnerships with the local Ministry of Public Health, Social Development, and Labor here on the island. And, coordinating with their Collective Prevention Services, they are now involved in reaching out to the community at large (see Figure 4).

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Figure 4: One of the newest school projects sponsored this year included a vector control initiative partnership with the Sint Maarten Red Cross, and the Ministry of Health’s Collective Prevention Services, conducting home inspections in areas of statistically high reportable cases, photo credit: A. Yancone 2016.

On a personal note, I will add that my wife and I, along with several of our friends here have ironically been “bitten by the Zika bug.” We all suffered the same relative symptoms (fever, malaise, myalgia, headaches, and the infamous maculopapular rash), so I can speak personally on the effects of an active Zika infection! Really though, it isn’t that bad; it felt like a bad flu—most locals are not too worried about Zika because they already have several other arthropod-borne viral infections to stay away from with significantly worse courses of infection. Chikungynya, Dengue Fever, Yellow Fever, West Nile, less often Plasmodium/Malaria, and others offer more of a threatening presence than the several day woes of a Zika infection. Moreover, those other infections sometimes have even worse complications and clinical presentations.

As I begin and continue my work through these projects, I will provide updates—both on our efforts here in the laboratory as well as our work in reaching out and partnering with local public health officials to try and make a positive impact on our local community. And since I am now “inoculated,” I’ll be happy to get really close to the action for all of you.

Thanks for reading!

 

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-Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.

 

FDA Issues Revised Recommendations for Reducing the Risk of Zika Virus Transmission through Transfusion

Today, the FDA released industry guidance for reducing the risk of Zika Virus transmission through blood products. “Revised Recommendations for Reducing the Risk of Zika Virus Transmission by Blood and Blood Components”  is for immediate implementation.