Mayo Clinic and the University of Notre Dame’s Eck Institute for Global Health have launched a four-tiered joint project to better characterize and further assist in the detection of vector-borne infectious diseases in Belize, such as Zika. The project is known as IMPACTS, which stands for Integrated Mayo Clinic Program for Arbovirus Community health education, Training, and Surveillance.
In collaboration with the Ministry of Health in Belize, this five-year project aims to expand on the in-country diagnostic testing capacity and characterization of arboviruses (arthropod-borne viruses) and other vector-borne diseases, which are transmitted by arthropods such as mosquitoes, ticks, and fleas. A better understanding of the prevalence of these vector-borne diseases, including Zika, dengue, and chikungunya viruses, in both human and arthropod populations, will allow for enhanced public health and provider education regarding these potentially debilitating infections.
“Mayo Clinic is bringing in medical, clinical, and laboratory expertise, and Notre Dame is bringing in vector and entomology expertise,” says John W. Wilson, M.D., a co-leader on the project via Mayo’s Division of Infectious Diseases, along with Elitza Theel, Ph.D., in Mayo Clinic’s Division of Clinical Microbiology. “So, this really is a true collaboration with both entities contributing unique knowledge and skill sets.”
John W. Wilson, M.D.Additionally, medical students from Mayo Clinic and master’s students from the University of Notre Dame’s Eck Institute of Global Health will be integrated into all activities associated with the IMPACTS initiative.
“Infectious diseases, especially vector-borne diseases, have no borders,” says Dr. Wilson. “So, understanding what goes on within our Latin American neighbors is paramount toward identifying and mitigating the spread of some communicable diseases in the Americas.”
“Our collaborative approach will strengthen in-country laboratory testing capabilities, with the ultimate goal to create long-term sustainability in clinical laboratory medicine,” says Dr. Theel, a microbiologist who directs Mayo’s Infectious Diseases Serology (IDS) Laboratory. “So, one of the goals in the first couple years of this project is to conduct training events in Belize and at Mayo Clinic, to establish appropriate testing schemes for Zika and other vector-borne diseases.”
The Four Tiers of IMPACTS
Each IMPACTS tier has a separate function and purpose, yet all four work in cohesive harmony as follows:
Tier 1: Clinical Microbiologist/Laboratory Technologist Training
Over the five-year project span, a Mayo Clinic team led by Dr. Theel will conduct periodic workshops for Belizean clinical microbiologists throughout the country on testing techniques and quality assurance to optimize laboratory medicine. These workshops are also meant to expand the capacity of these laboratories for new serologic and molecular testing for infectious diseases to reduce outsourcing.
In addition to in-country workshops, Mayo has begun hosting Belizean laboratory technologists at the IDS Laboratory in Rochester, Minnesota, for training.
“Last April, we hosted a technologist from the Central Medical Laboratory in Belize City,” says Dr. Theel. “He spent one week in our lab and received training on how we perform serologic testing for vector-borne diseases, including Zika, dengue, chikungunya, and West Nile viruses. He also observed our quality specialists and came away with many feasible ways to enhance the quality of testing in his own lab.”
Tier 2: Human Arbovirus Seroprevalence Surveillance and Geo-Mapping
This tier will improve upon the current diagnostic testing capacity within the Central Medical Laboratory to assess what arboviruses and other vector-borne illnesses are circulating in Belize.
“Many arboviral diseases present with similar overlapping clinical features,” says Dr. Wilson. “That’s a real problem. Without a full understanding of the prevalence of select, regional arboviral diseases, it becomes difficult to know what specific infections to test for, how to manage afflicted patients, and how best to educate the public.”
Hence, the IMPACTS team is testing serum from both symptomatic and asymptomatic individuals from across all districts of Belize.
“So far, our laboratory in Rochester has received almost 700 blood samples, and we’re expecting to receive additional samples throughout the course of the project,” says Dr. Theel. “The goal is to test these samples for antibodies to about 15 different vector-transmitted infections and establish a more comprehensive seroprevalance rate for these diseases in the country.”
Preliminary results are already hinting that a large percentage of the population has been exposed to flaviviruses, a subgroup of arboviruses that includes Zika and dengue viruses. A smaller percentage of individuals has also been identified with select tick-transmitted Rickettsia infections, infrequently reported in Belize.
Tier 3: Mosquito Capture/Testing for Arbovirus Carriage and Geo-Mapping
This tier will enhance the capacity of the Vector Control Unit of the Ministry of Health in ongoing vector surveillance by bringing in medical entomology expertise and local knowledge of Belizean vectors by John Grieco, M.D., and Nicole Achee, Ph.D., both from Notre Dame’s Eck Institute for Global Health. Drs. Grieco and Achee are also co-directors of the Belize Vector and Ecology Center.
“In order to gain a more comprehensive view of the transmission dynamics around vector-borne diseases, it is also necessary to characterize the presence of these pathogens in the vector population, including both mosquitos and ticks,” says Dr. Theel. “The Notre Dame faculty members have a long-standing history of working in regions where these arboviral pathogens are highly endemic and pose significant health risk to the public.”
“Vectors are being captured from various parts of the country and tested for arboviruses using multiple different types of assays, including PCR, ELISAs, and rapid tests,” adds Dr. Wilson. “In conjunction with the Ministry of Health, mapping of the presence of these infected vectors will help guide prevention and control activities in-country.”
Combining information from tiers 2 and 3, the IMPACTS team will be able to superimpose the human prevalence of arboviral infections with the prevalence of these viruses in vectors to identify the regional “hot spots”—whether urban-, rural-, or tourist-centered—where the risk of exposure and arboviral infections are highest.
Tier 4: Public Health Education on Mosquito/Tick Vectors and Associated Infections
The content of this educational tier is predicated on the data that will originate from tiers 2 and 3. Once the IMPACTS team gains a better understanding of the human disease prevalence and combined pathogen-vector geo-mapping, public health education strategies will be implemented in partnership with the Ministry of Health in Belize with local health fairs, radio messaging, and videography-based education.
“We will share our knowledge of the commonality of these infections with Belizean health care providers,” says. Dr. Wilson. “We hope this kind of information can help assist local providers who are evaluating and treating patients on what to consider in individuals who present with specific symptoms.”
Future Expansion of IMPACTS
IMPACTS hopes to expand with a fifth tier, which will include collaborating with Belizean partners to further enable in-country maintenance and repair of medical, diagnostic, and environmental equipment, facilitated by Mayo Clinic bioengineering graduate students. Once completed, IMPACTS may serve as a proof-of-concept for implementation in other countries.