Zika in Nicaragua: Racing to Understand the Unknown

Matthew Collins, MD, PhD, is an Infectious Diseases Fellow at UNC and is studying Zika virus in Nicaragua.

Matthew Collins, MD, PhD, is an Infectious Diseases Fellow at UNC and is studying Zika virus in Nicaragua.

Matthew Collins, MD, PhD, is an Infectious Diseases Fellow in the Division of Infectious Diseases at the UNC School of Medicine. He is working with collaborators across UNC as well as colleagues in Leόn, Nicaragua, to define the epidemiology of Zika virus as it emerges in Nicaragua. A large portion of these studies are designed to answer questions surrounding the risk for in-utero transmission and adverse birth outcomes resulting from Zika infections in pregnant women. He traveled to Nicaragua in March and August of 2016. Below he shares the questions left to answer and why there is cause for optimism.

I woke up one morning in early March to a pleasantly warm tropical sun (read: hotter than 75○F at sunrise on the way to 97○F). After a breakfast of beans, plantains, and pineapple juice, I found myself at a small, wooden classroom desk. I was served potent indigenous coffee in a black mug bearing the unmistakable Playboy bunny icon, and scholarly men began to discuss with us in Spanish. . . what else? SEMEN. Semen and its role as a vehicle for transmission of viral infections. What the heck is going on and how did I get here?

It was March 2016, and a few weeks earlier, World Health Organization Director-General Margaret Chan had declared that the emerging Zika virus epidemic in Latin America was a public health emergency. We had come to León, Nicaragua, to meet collaborators and discuss the role our respective institutions may play in the international response to Zika.

A poster from the Ministry of Health in Nicaragua reminds residents to do their part to curb mosquito breeding, saying "prevention is in your hands."

A poster from the Ministry of Health in Nicaragua reminds residents to do their part to curb mosquito breeding, saying “prevention is in your hands.”

I sipped my scandalous café con leche and blinked hard. This was real, and I thought to myself, “I can do this job.”

Living the dream. It’s poor fodder for personal statements, but I never really dreamed of becoming a physician-scientist. Meeting several young, aspiring doctors and principal investigators on UNC’s campus reminds me what a privilege it is to partner with the sick or susceptible in improving their health, to identify critical questions and to set about building answers. It’s a mixed bag with Zika work. None of us hopes for tragedy or global health crisis, for such scourges to be disproportionately visited upon disadvantaged portions of the population as so often happens. But, as clinicians and researchers, we do find satisfaction in demand for our particular training and skills, and we typically seek to work on problems that pique our intellectual interest as well as offer some benefit to society. Immunology, foreign language, infectious diseases, travel – the focus of my fellowship is conveniently unfolding as an amalgam of my personal and professional interests. I love going to work (almost) every day, being around smart and caring people, and feeling like part of a team with a worthy mission. It is sometimes as if I’m living a dream.

However, the Zika epidemic is a nightmare for so many, particularly women of childbearing age – the burden placed on them and their partners cannot be overstated.

There had not been much Zika reported in Nicaragua yet prior to our initial visit in March, but it was definitely coming if not there already. By the time of our second trip at the beginning of August, hundreds of cases were known, including many in pregnant women, though no adverse fetal outcomes or Guillain-Barré syndrome, a neurological disorder, had been announced. The virus itself is not that scary on the surface, less severe than the common cold in the majority of cases – but the exceptions have come to define the epidemic, and it is the unknown that is always especially problematic for our race. Only a minority of infected individuals manifest any symptoms, a short-lived itchy rash, fever, and/or eye irritation. A smaller fraction still suffers the most concerning sequelae: neurologic conditions such as Guillain-Barré syndrome and birth defects like microcephaly. Why does it only happen to certain people? How often is a developing fetus affected when the mom is infected by Zika? What are the risk factors? All of these remain unclear.

consulta externa

The entrance to HEODRA Teaching Hospital in León, Nicaragua. The hospital is affiliated with the medical school at UNAN-León, UNC’s partner in Zika research.

Despite the gravity of the situation, there is also cause for encouragement. Researchers around the globe have begun to fill in large gaps in our understanding of Zika virus. At UNC, one can find movement on many fronts: basic virology, translational immunology, ethics, epidemiology, pathogenesis, pharmacology, and more. Our partners in Nicaragua are bringing their own insight, expertise and leadership to the greater effort.

As we left León, there were many banners celebrating Nicaragua’s national poet Ruben Dario, who famously wrote “you are a universe of universes, and your soul a fount of songs.“ There are so many possibilities. We may contribute to the development of a field-ready serodiagnostic, or discover a chink in the virus that can be targeted therapeutically. Ultimately, Zika is the current example in a pattern of emerging pathogens in an increasingly urbanized planet, and approaching Zika in a way that enhances systems for managing the spread of novel infectious diseases will only help for the next time around. Regardless, I’m happy join many at UNC, UNAN-León, and elsewhere to invest in meaningful and much-needed work. Hopefully the epidemic will be curbed, and those affected or at risk can more readily realize, all the worlds they are.

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