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A response to combat Zika virus and other mosquito-borne infectious disease threats in under-resourced countries

A comprehensive, multi-tiered approach toward controlling and reducing the impact of Zika virus in Belize and neighboring countries.

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Mayo Clinic’s Program in Underserved Global Health, led by John W. Wilson, M.D., outlined a four-tiered project to reduce mosquito-borne infectious disease, expand the diagnostic capacity of vector-borne infections and increase public health education and awareness of these infections.

There is a substantial and urgent need for a comprehensive, multi-tiered approach toward controlling and reducing the impact of Zika virus.

Therefore, the team initially intends to focus on Zika virus in Belize, a public health emergency of international concern. Our hope is to give local communities complete autonomy so they can more readily diagnose and manage these infections in country. We also seek to empower the Ministry of Health in Belize with epidemiology tracing tools so they can more accurately monitor the prevalence of these infections. We will provide the Ministry of Health with educational tools enabling them to relay more effective and enduring messages to the general public on preventative measures and certain treatment methods. Lastly, this project will serve as a proof of concept for implementation in other neighboring Latin American countries.

As our initial focus, we will explore the epidemiological and entomological surveillance of Zika virus. Zika is spread through the bite of infected mosquitoes, and is linked to severe birth defects and neurological disorders. Unfortunately, for most resource-limited countries, like Belize, human and mosquito samples have to be screened outside the country. This capacity limitation contributes to delays in implementing control strategies and increases the risk of exposure to community members. Active surveillance of Zika virus will serve as a key component to improving the quality of life in these communities.

Understanding the prevalence of these Zika and other viruses is necessary to ensure appropriate treatment and preventative strategies that will minimize public exposure. Many of these types of infections can be life-threatening and have significant impact on affected communities. International air travel enables these infections to become readily exportable to neighboring countries and into the United States. For these reasons, there is an urgent need to ma the prevalence of vector-borne viral, bacterial and parasitic infections, improve the diagnostic capacity of in-country laboratories, and expand public health education to reduce the exposure to these pathogens.

Mayo Clinic’s Program in Underserved Global Health is focused on initiatives that are sustainable and involve community health empowerment, enabling local health providers and communities more autonomy and further self-reliance. Education — to health providers, patients and families — and research initiatives focused on local communities have the best potential for meaningful impact. Our three-tiered approach integrating health professional training, epidemiological and entomological surveillance and public health awareness and education will ensure rapid advancement toward reducing the health burden caused by Zika in Belize. This will simultaneously establish a foundation for sustained community health benefits for other diseases, including dengue and Chikungunya virus, in neighboring countries.

Explain your idea

For some Latin American countries with supplemental resources, such as Brazil, the corresponding Ministries of Health are very active in laboratory surveillance testing, public education and preventative measures. However, for countries with more limited resources, including Belize, there remains a critical need for enhanced microbiology laboratory training, increased testing and diagnostic capacity, mosquito control measures and public education on preventative measures. Although the Pan American Health Organization and World Health Organization are working toward a more coordinated response in the western hemisphere, currently, there is not a unified strategy to address these measures in every Latin American country. In collaboration with the Ministry of Health in Belize and a number of referral hospital clinical microbiology laboratories, our objective is to implement a multi-tiered initiative to address gaps in health professional training, laboratory testing capacity for surveillance of viral pathogens in human, mosquito, and tick samples, and public health education on awareness and preventative measures. Project activities include: Tier One: Health Professional Training • Conduct multiple trainings per year on select viral and bacterial pathogen diagnostic testing. Tier Two: Insect Surveillance Testing for Select Vector-Borne Infections • Enabling more comprehensive vector-based surveillance mapping across Belize. Tier Three: Human Surveillance Testing for Select Vector-Borne Infections • Increasing population-based and country-wide mapping of select diseases. Tier Four: Public Health Awareness, Education and Research • Enhance public health education and awareness and increase opportunities. • Radio and videography-based public health education session every year. • Public health fair presentations with local and regional health departments. Our anticipated project outcomes will improve skills, knowledge, practices, quality metrics, policies and awareness related to detection, prevention and control, including: • Enhanced microbiologist competency to perform appropriate diagnostic testing and capacity to teach other laboratory technologists. • Improved laboratory quality monitoring by implementing technologist competency assessments and proficiency testing programs. • Enhanced in-country capacity for diagnostic testing for more accurate disease surveillance. • Increased and more accurate in-country data mapping regarding prevalence of select infections, including Zika virus, Chikungunya virus and Dengue virus. • Reduced mosquito populations that spread these infections. • Enhanced public health education and awareness of mosquito- and tick-borne diseases and strategies to minimize risk of infection. • Educate health providers of in-country prevalence of vector-borne infections. • Increase opportunities for “field research” by students, trainees and clinicians.

Who Benefits?

Tier One: Health Professional Training • 40 laboratory technicians, 40 field officers and six laboratory technologists (supervisors). • Health care providers will gain a better understanding of Zika virus and other common mosquito- and tick-borne diseases, which will cause more appropriate patient testing and recommendations for infection management. Tier Two and Three: Epidemiological and Entomological Surveillance • Entire communities and country-level population (about 380,000 people in Belize). • Ministry of Health in Belize will be positively impacted because of public health intervention and provider education. Tier Four: Public Health Awareness, Education and Research • Entire communities, local Belizean health providers and at least 10 students per year. Tourists, business and extended family travelers will also be indirectly impacted by this program.

How is your idea unique?

Every year, millions of people die from diseases that go undetected or untreated due to a lack of the appropriate diagnostic and treatment tools. There is a significant need for education and training in basic diagnostics to identify the incidence of mosquito-borne infections, including Zika virus, in many Latin American countries. As with all health burdens, the immediate goal is to provide appropriate care to those infected. This requires accurate diagnostics. The long-term goal is to prevent further infections in the communities where cases occur. This requires appropriate surveillance and public health education. Sustaining improvements demands training and engagement with next generation global health experts in countries where these burdens exist. Our approach will serve to address all of these needs. Currently, no such coordinated initiative exists in Belize. This project may serve as a model and ‘proof of concept for implementation across Latin American countries.

Idea Proposal Stage

  • Full-scale roll-out: I have completed a pilot and analyzed the impact of that pilot on the users I am trying to reach with my idea. I am ready to expand the pilot significantly.

Tell us more about you

Mayo Clinic developed gradually from the medical practice of a pioneer doctor, Dr. William Worrall Mayo, who settled in Rochester, Minnesota, in 1863. His dedication to medicine became a family tradition when his sons, Drs. William James Mayo and Charles Horace Mayo, joined his practice in 1883 and 1888, respectively. From the beginning, innovation was their standard and they shared a pioneering zeal for medicine. As the demand for their services increased, they asked other doctors and basic science researchers to join them in the world's first private integrated group practice. As the success of their method of practice became evident, so did its acceptance. Patients discovered the advantages to a "pooled resource" of knowledge and skills among doctors. In fact, the group practice concept that the Mayo family originated has influenced the structure and function of medical practice throughout the world. “The Mayos' Clinic" also developed a reputation for excellence in individual patient care. Doctors and students came from around the world to learn new techniques from the Mayo doctors, and patients came from around the world for diagnosis and treatment. What attracted them was not only technologically advanced medicine, but the caring attitude of the doctors. That teamwork in medicine is carried out today by more than 60,000 doctors, nurses, scientists, students and allied health staff at Mayo Clinic locations in the Midwest, Arizona and Florida. Mayo Clinic's reputation for excellence in integrated patient care, research and education is substantiated by the numerous external grants we are honored to receive. Even so, the need for additional financial resources to support the Mayo mission is great. Philanthropic gifts are a vital resource for enabling Mayo to advance its daily work. As a private, not-for-profit organization, Mayo Clinic works in partnership with generous patients and friends who share our commitment to excellence, and to finding answers. Such partners are vital to carrying on the innovative research and world-renowned patient care that Mayo delivers to a million people each year. The success and sustainability of this project depends on our collaboration with the following organizations nationally and internationally: • University of Notre Dame, Eck Institute for Global Health • Belizean Ministry of Health • Participating local and regional hospitals and laboratories • University of Belize

Expertise in sector

  • 7+ years

Organization Filing Status

  • Yes, we are a registered non-profit.

1 comment

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Photo of Bettina Fliegel

Thanks for sharing this project! I would like to learn more.
What was the focus of, and learnings from, the pilot project? How did this partnership form? In terms of education, looking forward, will student participation be from medical schools in Belize and the US? Good luck developing this initiative!