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Pediatric outcomes of Zika prenatal exposure and postnatal infection
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After completing my pediatric residency training in Boston, Massachusetts in 1982, I returned to Puerto Rico and practiced as a general pediatrician having the privilege of caring for 2 generations of pediatric patients. At the same time I started my academic career at the Ponce School of Medicine (PSM) through teaching and clinical supervision of students and residents in my clinical practice and the medical school campus. I am now Professor of Pediatrics of the Ponce Health Sciences University (PHSU) and have enjoyed an exciting career of over 30 years as clinician, educator, academic administrator and most recently researcher at the School of Medicine and its principal clinical affiliate, Centro Médico Episcopal San Lucas (CMESL) in Ponce. My interest in arboviral diseases emanated from clinical practice and thrived as I became an expert trainer for the Dengue Clinical Management Course offered by the CDC and the Puerto Rico Department of Health to practicing physicians from 2011 to 2013. My work as a dengue physician trainer lead to a Centers for Disease Control and Prevention (CDC) Cooperative Agreement to study dengue epidemiology, prevention and outcomes from an institution-based surveillance system in Ponce in 2012 that continues to the present. This grant was instrumental in the implementation of the first Sentinel Enhanced Dengue and Acute Febrile Illness (AFI) Surveillance System (SEDSS) in Puerto Rico. Under my leadership from 2012-2020, over 30,000 febrile cases were enrolled from a population of 500,000 in southern Puerto Rico, reaching a diagnosis in about 40% of cases. SEDSS facilitated the study of AFI caused by dengue virus (DENV), Influenza A and B and other common respiratory viruses and emergent pathogens: chikungunya (CHIKV) and Zika virus (ZIKV). As Principal Investigator and Program Director for SEDSS, I was able to strengthen the collaboration between the PHSU School of Medicine and Public Health Programs and the CMESL clinical site in the conduction of research. Most importantly, I had the privilege of mentoring public health and medical students, and clinical residents promoting their interest and skills in research, which is research capacity building for Puerto Rico. In 2017, during the Zika epidemic, the SEDSS collaboration with the Puerto Rico Department of Health for the notification to mothers with ZIKV infection during pregnancy, lead to the implementation of studies: Pediatric Outcomes of Prenatal ZIKV Exposure (POPZE cohort study) under my leadership, and Outcomes of Postnatal Zika Infection (OPAZi case-control study) under my mentoring. I was able to contribute to the medical literature on the epidemiology and clinical presentation of Zika in children, and our team presented on the pediatric outcomes of prenatal and postnatal Zika infections at local and national meetings. With funding from the National Institutes of Health (NIH) and along with Dr. Mary Rodriguez-Rabassa Co-Principal Investigator, we continue the study of prenatal ZIKV exposure's outcomes and explore environmental and health system factors that affect child health and development. Through this study, my research path has returned to the field of Pediatrics, my professional passion. And it is this pathway that lead to the NIH funded COVID 19 research: Study of Life Experiences, Adversity and Resilience (SOLEAR study) on how the pandemic impacted vulnerable Hispanic children and families. The experiences and accomplishments described above have prepared me to assume an important role in research of early life adversities and future health disparities, aiming to identify protective factors and the best preventive measures.
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