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Introduction INTRODUCTION The Caribbean Epidemiology Centre (CAREC) was it was a tropical island with good air and sea connections established in January 1975 succeeding the Trinidad to the Caribbean and North and South America. Further, Regional Virus Laboratory (TRVL). The TRVL itself was there was a good system of roads, a fairly dependable established in 1952 by the Rockefeller Foundation in electricity supply and a promise of a dry-ice factory partnership with the Trinidad and Tobago Government. which was needed to store viruses at extremely low TRVL was engaged in much work on insect, tick and mite temperatures. transmitted viruses, commonly called arboviruses. There was also great focus on yellow fever, and Mayaro and Before the establishment of TRVL, three arboviruses Oropouche viruses, which were new to science at that had been identified in Trinidad: yellow fever, dengue and time, and had been isolated at TRVL. In the latter years Venezuelan equine encephalitis. A surveillance system work expanded to include respiratory and enteroviruses, had been organised to monitor fevers of unknown origin such as poliomyelitis. TRVL also provided assistance to in the main hospitals and district health clinics, particularly the veterinarians in isolating the virus of Newcastle disease in rural areas. Blood samples would be taken from these in chickens. Non-viral diseases such as Leptospira, patients and tested for the presence of viruses. This Toxoplasma and Trypanosoma were also investigated. Fig. 1.1. Dr Wilbur Downs first director of system led to the isolation of the Mayaro and Oropouche Shortly thereafter, the Commonwealth Caribbean the Trinidad Regional Virus Laboratory. viruses which were new to science at that time. The Countries and the Ministry of Overseas Development dengue 2 virus was also isolated for the first time in the of the United Kingdom Government became associated Western Hemisphere. In 1954, the TRVL scientists also with this effort and contributed financially to the work of rediscovered the yellow fever virus in Trinidad after an TRVL. absence of 40 years. While the monitoring of fevers of unknown origin was being conducted, studies on The TRVL was originally housed in one of the World War mosquitoes and vertebrates such as monkeys, bats, II army barracks on the waterfront of Port of Spain. It was rodents and birds were carried on at the same time. By administered by the Rockefeller Foundation with one of the end of 1974, these studies led to the isolation of 1542 its staff members, Dr Wilbur G Downs, as its Director. The strains of arboviruses. Thirty seven of these were distinct Rockefeller Foundation had spent many years studying strains of which 19 were new to science. Most of the new yellow fever in the field and laboratory and made many strains were named after Amerindian tribes of Trinidad. discoveries on the natural history of yellow fever. Other Caribbean Governments were now seeking The Rockefeller Foundation then decided to open field assistance in outbreaks of viral diseases in their countries. laboratories in selected countries around the world to see Fig. 1.2. Dr Leslie Spence, Director of the Another arbovirus infecting humans in the Caribbean was TRVL, 1961 – 1968, shortly after receiving if there were other viruses lurking in the environment. They the Chaconia Medal (Silver) from the Trinidad dengue. There were outbreaks of dengue in 1962-1963 established laboratories in Poona, India; Johannesburg, and Tobago Government for his work at the in Jamaica, Antigua, St Kitts and Nevis, and in Curacao. TRVL, and the establishment of the Trinidad South Africa; Berkeley, California, USA; Port of Spain, and Tobago Diagnostic Virus Laboratory which Later, in 1970, Grenada witnessed an outbreak. TRVL Trinidad and Tobago; Cali, Colombia; Belem, Brazil and later became the Trinidad and Tobago Public investigated all these outbreaks. subsequently in Nigeria. Trinidad was selected because Health Laboratory. the The Caribbean Epidemiology Centre: Contributions to Public Health 1975 - 2012 9 CAREC story INTRODUCTION (continued) While TRVL was primarily engaged in a study on the assistance of the US Government, the epidemic was arboviruses, the early workers gradually started working controlled. This section of the TRVL dealing with viruses on viruses such as the respiratory and enteroviruses. Dr other than arboviruses had come of age. Leslie Spence (Fig. 1.2) who had become Director of the TRVL in 1961, was the prime mover of this aspect of the The arbovirus section of the laboratory had become laboratory. In 1956, for instance, he isolated the Asian internationally known for its excellent work and several influenza virus in Trinidad, the first for the Commonwealth scholars in arbovirology had, by this time, visited TRVL to Caribbean. see its field and laboratory work. However, by the end of 1968, TRVL started to have financial difficulties. About one In 1960, the Colonial Microbiological Research Institute third of its funding for its activities came from Caribbean (COMIRI) which had modern facilities in Federation Park governments and the Ministry of Overseas Development closed its doors and offered its buildings to the TRVL of the United Kingdom while the Rockefeller Foundation by the Government of Trinidad and Tobago. After the which had provided about 65 per cent of its funds decided construction of a new office block and renovations, TRVL to withdraw from further participation from this programme. moved its operations in 1961 from Wrightson Road to Fig. 1.3. Dr Elisha Tikasingh. It should also be noted that apart from funding the the COMIRI buildings which were more conducive for laboratory’s core programme the Rockefeller Foundation growing tissue cultures in sterile environments. had also contributed US$189,633 to the building of an animal house and office block, and for general repairs In 1961, the administration of TRVL was transferred from and renovations of the Colonial Microbiological Research the Rockefeller Foundation to the University of the West Institute into which the TRVL had moved in 1961. They Indies and attached to the Department of Microbiology had also provided staff members who were separately in the Faculty of Medicine. This transfer was in keeping funded. In withdrawing its funding, they made it quite with the Rockefeller Foundation’s policy to move on to clear that they were not dissatisfied with the work of the other activities, leaving the local people to continue with laboratory nor the industry of its workers, but that they the work. Although the administration was transferred, were gradually reducing their work on arboviruses. This the Rockefeller Foundation continued to support the shortage of money resulted in drastic reduction of staff laboratory financially. With this transfer, the UWI agreed and the laboratory programme. to appoint two members of the TRVL staff to become faculty members. Thus, Dr Leslie Spence became Senior Up to this point, TRVL had maintained surveillance not Lecturer and Dr Elisha Tikasingh, (Fig. 1.3) Lecturer. The only for arboviruses but also for respiratory viruses and transfer to UWI did not hamper the work of the TRVL as it enteroviruses such as poliomyelitis. Various types of was a smooth transition. samples were collected and investigated from patients in hospitals and health centres of Trinidad and Tobago with On 11 December, TRVL received specimens from jaundice, encephalitis, acute respiratory disease such as Guyana from 17 children and by 17 December, TRVL had influenza, gastroenteritis and fevers of unknown origin. isolated and identified Polio Type I as the culprit. With the CAREC story 10 The Caribbean Epidemiology Centre: Contributions to Public Health 1975 - 2012 INTRODUCTION (continued) An event happened in 1971 which was to change the University of the West Indies on 19 April 1972 setting course and character of TRVL. On 6 December 1971, forth his idea for an expanded TRVL, presumably based three strains of polio virus Type I virus were isolated. on Dr Ardoin’s recommendations (Annex 1). Poliomyelitis was endemic in the country and it was not unusual to isolate a strain of the virus occasionally, but Dr Williams noted that the new laboratory could become a to isolate three strains of polio Type I in one day was Centre for Communicable Diseases in the Caribbean and unusual. The Ministry of Health was promptly advised of that it should be a self-governing body free from political these isolations. It was the beginning of an outbreak of considerations. Another letter, jointly written between the poliomyelitis caused by polio virus Type I. After the initial Trinidad and Tobago Government and the University of three isolates, there was another one on 10 December the West Indies, requested PAHO/WHO to organise a another on the 11 December (Type II), three on 5 group of multi-disciplinary consultants to review TRVL’s December, three on 20 December, one on 22 December past accomplishments and its needs for setting up a and five on 28 December. The outbreak continued into multi-national co-operative effort and requirements for January 1972. In the end, 133 isolates were made jointly broadening the programme of the laboratory. Later, by TRVL and the Ministry of Health’s Diagnostic Virus Fig. 1.4. A newspaper clipping on the in February 1973, the Caribbean Health Ministers’ Laboratory. By 8 January 1972 an emergency unit was polio outbreak. Conference (CHMC) meeting in Dominica noted the set up at TRVL with the Ministry of Health and the Pan occurrence of poliomyelitis and dengue epidemics in American Health Organization (PAHO/WHO). The US the Caribbean islands in the previous year and the Centers for Disease Control (CDC) assisted by sending world pandemic of cholera, and passed Resolution 19 two staff members, Dr L Schonberger and Dr M Hatch to which recommended the establishment of a Caribbean organise an immunisation programme. Epidemiologic Surveillance Centre at TRVL, as well as the establishment, in the Caribbean area, of a service It is interesting to note that when a call was made by for the detection of cholera.
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