Ebola Outbreak.
Detecting and Investigating the Unpredictable: Zika
In late 2015, health officials in American Samoa began seeing an unusual rise in fever and rash illnesses. Territorial leadership soon confirmed that Zika was spreading locally. The CDC recommended that mandatory screening for pregnant women was critical to protect them from acquiring Zika, and monitoring of infants to determine if they had contracted Zika.
Tropical islands, such as American Samoa, are particularly vulnerable to mosquito-borne virus outbreaks due to their unique ecology, climate, and high volume of travel. All blood and urine samples had to be shipped to labs in Hawaii or Atlanta, and the American Samoa Department of Health (ASDOH) requested external support. I deployed to the island in January 2016 to help establish consistent screening and monitoring protocols which included: ongoing testing remained recommended for anyone with Zika-like symptoms, asymptomatic pregnant women who conceived on or before December 10, 2016, pregnant women with ultrasound findings suggestive of congenital Zika syndrome, newborns with signs of congenital Zika syndrome or whose mothers had evidence of infection, and pregnant women exposed through travel from an area with active transmission. Addressing these tests required tight coordination among public health officials, environmental agencies, and local communities.
The immediate challenge was to work with local officials to create an electronic surveillance system that flagged Zika-like symptoms across clinics. As the pregnancy registry was being developed, I worked with local hospitals to remove financial barriers to prenatal care. I then focused on enhancing local laboratory capacity (e.g., adding PCR and ELISA), which required procuring testing supplies and other materials, implementing new processes to address the lab testing backlog, and addressing facility management concerns (e.g., power outages, HVAC failures, and plumbing issues). At the same time, staffing was limited (e.g., epidemiology team, nurse educators), and the health department needed a way to guide mosquito control efforts and engage the community. I helped facilitate the rollout of a public education campaign on mosquito control (e.g., Tip ‘n Toss to eliminate mosquito breeding grounds) and prevention through the distribution of Zika prevention kits.
All these efforts enabled ASDOH to quickly identify suspected cases and focus resources where they were most needed. As lab testing and surveillance improved, we confirmed a drop in active Zika transmission and saw the number of suspected infections drop from several per week to far fewer. Another milestone was the expansion of the local public health laboratory, which is now capable of confirming Zika, Dengue, and Chikungunya.
By the end of the deployment, the island’s long-term surveillance capacity was strengthened, delays in lab testing were reduced, and healthcare costs were reduced. These emergency response activities helped ASDOH activate its response significantly faster than it would have otherwise. By creating a more coordinated public health response, I assisted the territory in protecting pregnant women, preventing further spread, and developing clearer decision-making tools. Field team efforts also sustained weekly surveillance reports, community testing clinics, and partnerships with healthcare providers, all of which contributed to a more resilient system now better prepared for future outbreaks.
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