January 28, 2022 | SPARC News

Puerto Rico Public Health Surveillance Project Succeeds Amidst Natural Disasters, Covid-19, and Government Upheaval

Four years ago, the world looked a little different. Covid-19 had not yet disrupted life as we know it, the University of Minnesota’s (UMN) Strategic Partnerships and Research Collaborative (SPARC) was just getting ready to launch, and Puerto Rico (PR) was dealing with devastation stemming from 2017’s Hurricane Irma and Hurricane Maria.

Among the latter was an increase in cases of leptospirosis and melioidosis—diseases that spread from animals to humans, especially in the presence of contaminated water. History has shown the incidence of infection is exacerbated during periods of drastic environmental disturbance, such as heavy rains and floods.

The hurricanes had not only brought heavy rain and floods but had devastated PR’s electric grid, severely disturbed access to all health services, interrupted water services and access to clean water, disconnected communities, blocked and destroyed roads, and paralyzed the functioning of all systems on the island. While local officials and health experts suspected an increase in leptospirosis cases and deaths, the challenging conditions, and the need for laboratory testing to diagnose cases, made it difficult to accurately survey and implement timely and effective public health responses.

As the world has been reminded recently, a well-built and -maintained public health infrastructure geared toward both prevention and preparedness is the first line of defense against health threats. Furthermore, activities related to prevention, epidemic investigation, and control require a sophisticated level of decision making and resource coordination.

Building Laboratory Capacity and Surveillance in Puerto Rico

One of the first projects supported by SPARC was a Centers for Disease Control and Prevention (CDC) Partner Project titled, “Laboratory capacity building and implementation of enhanced surveillance for leptospirosis and melioidosis in Puerto Rico.” Jointly led by SPARC (Amy Kircher and Melissa Mueller) and the School of Public Health (Claudia Muñoz-Zanzi), the 3-year, $2.3 million project focused on developing and implementing a surveillance system for leptospirosis and melioidosis in hurricane ravaged PR.

Through the use of active surveillance methods established at partnering local hospitals and clinics, the team created a protocol for monitoring these diseases in the wake of the disaster. They also defined which areas are most susceptible for these diseases and the main risk factors that contribute to their spread, which will help guide prevention efforts going forward–ideally not only in PR but similar environmentals globally.

View from one of the hospital sites in Western Puerto Rico.

Success, Next Steps, and Lessons Learned

Over the life of the project, the team established four local hospital/clinic-based surveillance programs, trained local clinicians, collected hundreds of patient samples and surveys that will help inform additional investigation into specific risk factors at the community and individual level, animal reservoirs and community education and public health response. Data analysis is currently underway with plans to share results with colleagues at the CDC, University of Puerto Rico, partnering hospitals and the broader public health community in published papers. But perhaps most significantly, the project team learned how establishing strong partnerships and contingency planning is necessary in challenging circumstances.

“This project spanned events of political unrest, natural disasters, and the covid-19 pandemic. One of the biggest lessons we learned was how to adapt on the fly to continue project work while keeping people safe,” describes Melissa Mueller, project lead and SPARC project manager. “Our team networks and collaborations that allowed this to happen will remain strong and be a force for public health promotion into the future.”

“This project demonstrated the importance and benefit of internal and external partnership through two SPARC pillars - catalyzing collaborations and delivering practical solutions,” explains Kircher. “Building a strong technical and logistics UMN team allowed us an opportunity to effectively deliver resilient, operational solutions in collaboration with our government and academic public health partners for disease surveillance.”