Students, spouses and employees are tested for zika at the first campus screening event.
In 2014, the St. Maarten Ministry of Health engaged AUC in a study of local mosquito breeding grounds. At the time, the Caribbean was experiencing an outbreak of chikungunya—a mosquito-borne illness that causes fever and muscle pain. Before the end of the year, 800,000 people in the Caribbean had contracted the virus and the Aedes aegypti mosquito showed no signs of leaving. As reported cases grew, the Ministry of Health set out to minimize the occurrence of chikungunya and eliminate mosquito breeding sites.
Dr. Kathleen Shupe, Professor of Microbiology and Immunology at AUC, was one of the first professors to get involved. As a former epidemiologist for the Texas Department of Health, she recognized the incredible opportunity for students to participate in public health research. In fact, years earlier, she oversaw a student research project on dengue fever—a similar mosquito-borne virus that had just begun infiltrating the Western Hemisphere. Looking only at campus exposure, Dr. Shupe and her students screened other AUC students for dengue and began drawing conclusions about conversion periods and risk factors.
“The student population was great to work with because we knew most of them were coming from either the United States or Canada—where dengue fever wasn’t endemic,” recalls Dr. Shupe. “That meant that students with positive results likely contracted it on the island, so we could hone in on things like blood type, underlying disease, sunscreen use, and exposure time.”
That research spanned six years and several students, and resulted in a poster presentation at the American Society of Microbiology.
Collaboration with Ministry of Health Expands Research Opportunities
But the chance to work with the Ministry of Health in 2014 presented many more opportunities. Dr. Shupe and her students could go into multiple St. Maarten communities and look at both the environmental risks and the individual presence of chikungunya. In one health fair, for example, they screened more than 280 individuals.
Students screen St. Maarten residents for dengue fever and chikungunya during a 2014 community health fair.
“That project was incredible,” Dr. Shupe commented. “We established a great relationship with the community and Ministry of Health—something that students are still benefiting from today.”
Results from that initiative were presented to local health authorities and healthcare providers, and Dr. Shupe presented findings at the 5th International Meeting on Emerging Diseases and Surveillance in Vienna, Austria. In 2015, students were able to present their findings at DeVry’s Research Symposium in Dominica.
Those students—now graduates—are working on a manuscript with aspirations of a future publication.
New Research Opportunities with Zika
Fast forward to today and a different mosquito-borne illness is making headlines. The zika virus, which is also carried by the Aedes aegypti mosquito, has been reported in Southeastern parts of the US, South America, and the Caribbean, including St. Maarten. Though zika has been around for decades in other parts of the world (notably Asia and Africa), it only just moved into the Americas last year, where it has been linked to cases of microcephaly.
To understand the prevalence of zika and the virus-carrying mosquitos in St. Maarten, the Ministry of Health is once again collaborating with AUC. And it’s no surprise that Dr. Shupe will again support these efforts.
The Zika Seroprevalance Study will utilize the specimens collected back in 2014. During the first phase of work, students will test the stored samples for traces of zika to determine whether the virus was present in St. Maarten earlier than originally thought. As this rescreening process takes place, new screenings will be conducted by the Ministry of Health’s Collection Prevention Service workers, AUC students, and SLS Laboratories both on the university’s campus and in various neighborhoods.
In phase two, students will work with local healthcare providers to identify and test symptomatic patients (fever, headache, muscle and joint pain, nausea, vomiting, skin rash, and general malaise). Since dengue, chikungunya, and zika present similarly in patients, students will be looking at symptomatic patients’ blood specimens for any overlap or unique characteristics.
The third and final phase of work will involve educating and informing the public about all three mosquito-borne illnesses.
“Zika’s presence in the Caribbean—and now in the US—have manifested new research findings that indicate possible changes in the symptomology of individuals previously infected with other viruses endemic to the Caribbean, such as dengue fever and chikungunya,” said Mohamed Raafat, MS, one of two students selected by Dr. Shupe to lead the Zika Seroprevalance Study. “By conducting this study, we can better understand zika, its interactions with other viral infections, possible risk factors, and its impact to the island of St. Maarten.
Fostering Campus Enthusiasm and Engagement
In addition to Raafat, Dr. Shupe has engaged a handful of students to help with the zika study and plans to recruit more as the project evolves. Second semester student Patrick Pagador, the other study lead, expressed his gratitude at the opportunity to participate in such significant clinical research.
Zika Seroprevalence Study project leads: Third semester student Mohamed Raafat (left) and second semester student Patrick Pagador (right).
"Working with Dr. Shupe in the Zika Seroprevalence Study has been incredibly rewarding,” said Pagador. “Zika, dengue, and chikungunya cannot be differentiated solely on the presence of symptoms. This project has given me the opportunity to understand the relationship between evidence based analysis and the development of treatment and prevention. Being a part of a research team that contributes relevant discoveries to the scientific and medical community is an invaluable experience for me as a medical student.”
Pagador and Raafat helped to manage the first zika screening for AUC’s campus on October 26, 2016. The event—the first of many—was a huge success and drew numerous students, spouses, and AUC employees. To be statistically significant, Pagador, Raafat and other members of the zika research group will need to collect more than 300 samples—a number that could take them well into the spring.
>> Related: AUC student Constantine Kanakis discusses his work on zika in a post on Lab Medicine Blog.
When asked how students can benefit from the research project, Dr. Shupe was quick to point out the significance.
“Being a part of research brings students closer to evidence-based medicine,” she said. “Being a part of it, you understand what it took to get there, and you can make recommendations that will guide you as a physician.”