Global Health Center Infectious Disease

Assessing surveillance and screening as tools to prepare for future zika virus epidemics in the Americas

Written by Qiao Luxi, MD candidate at Washington University in St. Louis

Qiao worked with the Microcephaly Epidemic Research Group in Recife, Brazil

This summer I had the opportunity to work with Professor Elizabeth Brickley at the London School of Hygiene and Tropical Medicine (LSHTM) and with collaborators in Brazil on a project assessing surveillance and screening as tools to prepare for future Zika virus (ZIKV) epidemics in the Americas.

ZIKV is a globally transmitted emerging infectious disease that is unique among the arboviruses because it can cause severe adverse birth outcomes, including Congenital Zika Syndrome (CZS). Due to the complex nature of the clinical condition, this project allowed me to learn about a wide variety of topics ranging from the legal limitations for pregnancy termination in many Latin American countries, to the biochemical mechanism of the different diagnostic tests available, the cost-effectiveness of other prenatal infection screening programs, and the unique considerations when designing public health interventions for pregnant women.

While at LSHTM, I was also able to take advantage of the educational programming offered by this renowned public health research institution. One panel discussion about vaccines with a pharmaceutical company executive, a government official, a community worker, and a professor was especially informative as I learned about each sector’s unique role in the implementation of public health strategies requires the collaboration between them all. Surrounded by students from all around the world with a wealth of diverse experiences working with organizations such as Medicines Sans Frontiers (MSF) and the World Health Organization (WHO), it was also valuable for me to learn about different career paths in global health.

As the northeast of Brazil was the location of the major ZIKV outbreak in 2015, I spent some time in the city of Recife working with our collaborators from the Microcephaly Epidemic Research Group (MERG). While there, I shadowed a pediatric neurologist, Dr. Paula Fabiana Sobral da Silva, and saw many infants with CZS and other ZIKV-related birth defects. While I had already spent a few weeks reading about the clinical features of infants with CZS, seeing them changed the factoids and statistics in my head to faces and stories of individuals and instilled new motivation and meaning to my research.

I also worked closely with Dr. Celina Turchi, who was instrumental in drawing the connection between the rise in microcephaly cases with the ZIKV epidemic. As someone who is directly involved in Brazil’s public health and research responses, she provided an immensely valuable perspective to my project. It is also humbling to realize that this perspective is often understated or absent from many studies published by academics from countries and institutions that were not directly affected by the epidemic.

The unique disease presentations endemic to only certain areas of the world are often studied extensively by foreign researchers. Many of these researchers are able to enter and leave the setting whenever they desire without worrying about the impact of their research on the locals, and are able to publish their work without receiving input or feedback from local researchers who are deeply invested in the local community and are often the first people to respond to actual epidemics. These actions do not align with the principles of equity and collaboration that global health work emphasizes. I resolve to be mindful of and stop perpetuating these sources of inequity and bias. Though I was only in Brazil for a week, the experience helped to define key values that will guide my work and to reaffirm my interest in a career in global health.

I am very grateful to the Summer Opportunities Abroad Program for providing me with this research and educational opportunity. This experience not only reinforced my interest in public health and global health but also helped me to mature as a physician and researcher in training by allowing me to develop valuable new skills, perspectives, knowledge, and connections.

Mentored by Caline Matter, MD, an Institute Faculty Scholar, MD candidate, Qiao Luxi, is just one of many Washington University students learning to work in Global Health.