Joshua Anzinger works at the Virology Laboratory, University Hospital of the West Indies, Kingston, Jamaica
Identifying arboviral infections is a key component of the study. Unfortunately, diagnostic laboratory testing of Zika virus is particularly challenging in dengue virus endemic regions like Jamaica, as some routine tests may not be able to differentiate these two viruses. Together with the ZIKAction international team of experts, we have selected a panel of sensitive and specific tests for Zika, chikungunya, and dengue viruses that will soon be implemented to test samples for markers of infection with these arboviruses.
The clinical team is composed of three fulltime research nurses, one research nurse coordinator, dr. Celia Christie and dr. Russell Pierre; obstetricians will be involved when the women test positive and a psychologist attends some of the enrollment visits. The clinical team has been working tirelessly to enroll pregnant women and their babies and ensure that appropriate samples are collected and transported in proper storage conditions to the Virology Laboratory at the University Hospital of the West Indies. In the tropical environment of Jamaica, it is critical that samples are stored cool and transported rapidly. The clinical team personally transports samples in Igloo coolers containing icepacks to maximise sample integrity. Although all current clinics and hospitals taking part in the study are within 30 kilometers to the laboratory, traffic in the Kingston metropolitan area can be intense, with commutes many times taking over an hour to traverse less than 30 kilometers.
Much of this clinical work is being done indoors and outdoors, depending on the site in the relentless heat of the Caribbean summer, which has a way of draining energy and making everything feel twice as difficult. The majority of clinical work takes place at ambient temperature that can sometimes approach sweltering conditions with heat waves (e.g., the heat index reached 43°C several days during the preceding week). Electricity is very expensive in Jamaica, making fans, rather than air conditioning, the major method for cooling rooms.
We look forward to the addition of other countries to the ZIKAction vertical transmission study and hope our initial experiences will help provide a smooth start to the study in these countries.
