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Managua, Nicaragua

Site Institution: Sustainable Sciences Institute (SSI), Centro Nacional del Diagnóstico y Referencia
U.S. Institution: UC Berkeley
Research Areas: Vector-Borne Diseases: Dengue, Influenza, Chikungunya, Zika Transmission

Site Description:
SSI-Nicaragua was incorporated in 2004 as a subsidiary of SSI-California. It administers numerous research and capacity-building projects in-country, including the Pediatric Dengue Cohort Study, hospital- based dengue studies, influenza studies, and local scientific capacity building workshops. SSI has signed a memorandum of understanding (“convenio”) with the Ministry of Health to facilitate research projects in Nicaragua.

The GHES program works with the following institutions: the National Virology Laboratory at the Centro Nacional de Diagnóstico y Referencia, directed by Dr. Angel Balmaseda; the Infectious Diseases Unit of the National Pediatric Reference Hospital, Hospital Infantil Manuel de Jesús Rivera (HIMJR) directed by Dr. Federico Narvaez; and the Centro de Salud Sócrates Flores Vivas (HCSFV), directed by Dr. Guillermina Kuan. The HIMJR is the site of an 18-year ongoing hospital-based study of biological, immunological, and clinical aspects of severe dengue, as well as chikungunya and Zika, and the HCSFV is the site of the 13-year Pediatric Dengue Cohort Study following 3,500 children and the 10-year influenza cohort study, both of which are ongoing and have been expanded to include chikungunya and Zika. All studies are supported by NIH, including a Program Project Grant (P01) and a Human Immunology Project Consortium (HIPC U19) grant (both of which Dr. Harris is the PI/PD), an R01 grant to Nicaragua of which Dr. Balmseda is the PI, and a grant from the Bill and Melinda Gates Foundation/Instituto Carlos Slim de la Salud, among others. The site is also supported by the NIAID Centers of Excellence for Influenza Research and Surveillance (CEIRS) Program for an influenza cohort study and household transmission study.

The National Virology Laboratory (NVL) is in the National Center for Diagnosis and Reference (Centro Nacional del Diagnóstico y Referencia, CNDR). In addition to carrying out scientific research, the NVL’s main functions are to support the National Epidemiological Surveillance Programs and the Expanded Immunization Program of the Ministry of Health through diagnosis of dengue, Zika, chikungunya, influenza, other respiratory viruses, STDs, HIV, rabies, measles, hepatitis A, B and C, and rubella, among others. The NVL houses the SSI Nicaragua Virology Program (SSI-NVP), which has been a principal collaborator of Dr. Eva Harris (University of California, Berkeley) and Dr. Aubree Gordon (University of Michigan) on dengue, chikungunya, Zika, influenza, and SARS-CoV-2 studies since 1995, 2014, 2016, 2006, and 2020 respectively. All samples from the Pediatric Dengue Cohort Study (PDCS), Hospital-based Dengue Study, and Household Influenza Cohort Study (HICS) are processed and stored at the NVL/SSI-NVP. The NVL consists of six separate laboratories with newly renovated tissue culture and molecular biology facilities, a darkroom, and full capability for serological, virological, and molecular biological assays. The NVL also contains a BSL3 laboratory equipped with two A2 biosecurity hoods, one refrigerated centrifuge, and an autoclave for disposing of infected material. The SSI-NVP at the NVL currently has 35 -80°C and -20°C freezers and approximately twenty liquid nitrogen tanks. All -80°C freezers and liquid nitrogen tanks are located in two large dedicated, air-conditioned freezer rooms with two emergency power back-up generators.

Health Center Sócrates Flores Vivas (HCSFV)
The Health Center Sócrates Flores Vivas (HCSFV) is one of 21 health centers run by the Municipal Health System of Managua and is the primary health care facility serving a catchment area of approximately 62,500 residents. The HCSFV is a 24-hour facility with an emergency clinic and in-house laboratory and pharmacy. Its 107 staff members serve approximately 500 patients per day. The center’s objectives are to provide primary care, vaccination, emergency measures for any disasters in the area, and education and prevention of infectious diseases. Its services include dental care, physical therapy, nutritional support and mental health consults. The HCSFV is well-mobilized in the community and conducts vaccination campaigns, birth/death monitoring, pre-natal care monitoring, health education, and dengue vector control activities, including monitoring of mosquito indices and insecticide treatments. Within the HCSFV, four patient examination rooms, a nurses’ station and an office for quality control and field work staff are dedicated to the study, in addition to the office space for SSI’s administrative, ICT and data management personnel. Study personnel and operations share the HCSFV procedures room, admissions desk, medical chart room, data entry room, and auditorium.

The Clinical Laboratory at HCSFV is the primary site of blood draws for PDCS acute cases and annual samples. The HCSFV laboratory regularly performs complete blood count (CBC), blood chemistries, peripheral blood smears, rapid HIV tests, urinalysis and fecal cytology. Additionally, the laboratory technicians collect respiratory swab samples and nasopharyngeal aspirate samples for influenza and other respiratory viruses testing. The laboratory includes a private blood draw area and dark room for immunofluorescent imaging.

Hospital Infantil Manuel de Jesús Rivera (HIMJR)
The Hospital Infantil Manuel de Jesus Rivera (HIMJR) is the national pediatric reference hospital. It is a 24- hour facility that employs 13 sub-specialty pediatricians. It is equipped with more than 270 hospital beds, three coronary intensive care and neonatal units, an imaging unit and three ultrasound machines (one portable). The hospital carries out approximately 550 consultations a day, including 300 pediatric emergency visits. The HIMJR also has an Infectious Disease unit that includes 22 beds with an additional 12 beds available during high season. During high season, the hospital employs additional staff including two pediatricians, a general physician, and two nurses to provide 24-hour care. The hospital is equipped with a general laboratory that includes bacteriological and respiratory virus examination units and a sample collection room.

The NVL/CNDR has various scientific research collaborations with organizations such as UC Berkeley, PAHO, the TDR/WHO, CDC, PATH, the European Union, and the Instituto Pedro Kouri in Havana, Cuba. The CNDR trains Nicaraguan researchers and students and supports teaching in local organizations such as the Universidad Nacional Autónoma de Nicaragua