UH Med Now
Dr. Thane Hancock, Zika Detective: JABSOM alumnus helped diagnose the world’s first Zika outbreak
Pictured: Dr. Hancock on Piig Island in Yap State surrounded by children he served as a family physician, 2007.
By Tina Shelton, JABSOM Communications Director
When the first patient came in complaining of joint pain, rash, and conjunctivitis, or “red eyes,” Dr. W. Thane Hancock wasn’t sure what was causing the condition. He scribbled down “viral exanthem” as the diagnosis. (Exanthem is the medical term for rash.)
When another patient came in that same morning with identical symptoms, Dr. Hancock thought to himself, “that’s weird.” After lunch, a third patient presented with similar symptoms, he suspected something was going on. That’s when Dr. Hancock began to piece together what would become the world’s first reported outbreak of Zika virus infections.
It was 2007, and Dr. Hancock, who graduated in 2003 from the University of Hawai’i John A. Burns School of Medicine (JABSOM), was only nine months into his job as a family doctor on the island of Yap, part of the Federated States of Micronesia. At the time he was the only U.S. trained physician working on the small Micronesian island of Yap.
Dr. Hancock, schooled in the “Problem-Based Learning” (PBL) curriculum at JABSOM, was accustomed to thinking broadly. When confronting a medical mystery, PBL students are taught not to rule out anything too early, but to list all possibilities, then plug away at eliminating possible causes one by one.
“The PBL process that encourages curiosity and a determination to find out what it is,” that served me very well in Yap,” said Dr. Hancock, who grew up on Hawai’i Island. “The curriculum at JABSOM emphasizes life-long learning,” said Hancock, and that is how he approaches every case.
“What do you think? Should we report this?”
They assembled an infectious disease committee and began gaining information about similar cases.
“It turned out that one of my favorite Family Medicine faculty, Tai Ho Chen, had just left the University of Hawaiʻi Residency Programs to join the Epidemic Intelligence Service at the Centers for Disease Control (CDC), so I emailed him asking if CDC might be willing to help investigate and test specimens from the suspect cases.”
“I told him I didn’t think the syndrome was due to dengue. The local physicians had experienced dengue outbreaks in the past, and they felt fairly confident that this illness didn’t fit the usual presentation of dengue they experienced in Yap.”
CDC agreed to assist and they sent a team to Yap. They suspected this might be the first Pacific outbreak of chikungunya (a mosquito-borne disease similar to dengue), and were eager to investigate it. What it turned out to be surprised them all.
After about two weeks of testing at the CDC, a conference call was arranged to share the results. On the call were some of the top leadership from CDC, so the small team in Yap knew there must have been something special about the test result. That’s when the director of the arboviral diseases branch shared that the cause of the outbreak was Zika.
“All of us sitting at the conference call, two of CDC’s Epidemic Intelligence Service Officers, a World Health Organization Epidemiologist, and myself looked at each other and said, ‘What?’ None of us had heard of Zika virus before. It was not on any of the lists of possible diagnoses we had put together during the investigation.”
Up to that point, there had never been a reported outbreak of Zika. The Zika virus was first discovered in a caged monkey from the Zika Forest in Uganda in 1947. From 1947 to 2007, only 14 sporadic cases of Zika disease had been reported. The virus is a flavivirus like dengue, and is spread by the bite of an infected mosquito.
Soon after that call, a larger CDC team was sent to Yap to conduct an expanded investigation on the outbreak that included a community-wide serosurvey (a test of blood). About four months after the outbreak was first reported, the outbreak was declared over in Yap. There were no hospitalizations or deaths due to the outbreak, and the outbreak was gone as quickly as it arrived. Dr. Hancock was worried that Zika might spread from Yap to seed outbreaks in other Pacific Islands, but there were no other outbreaks of Zika in the Pacific soon after the Yap outbreak.
Eventually, Zika struck again, first in 2013 in French Polynesia, and then in 2015 in Brazil, where it appeared that infected mothers were at higher risk of delivering babies with birth defects. By January 2016, The Hawaiʻi Department of health reported a case of microcephaly in Hawaiʻi, a birth defect to an infant born to a woman who had lived in Brazil early in her pregnancy. By 2016, health officials realized Zika could be spread though sex as well as by mosquitos. And the world was now well-aware of the unknown virus that Dr. Hancock first encountered in his small clinic in Yap.
After his experience with reporting and investigating the Zika outbreak in Yap, Dr. Hancock became more interested in the disease detective work done at CDC. In 2011, he was accepted into CDC’s Epidemic Intelligence Service (EIS) and joined CDC in Atlanta for a two-year fellowship in applied epidemiology where he investigated foodborne and waterborne outbreaks in the United States.
Coordinating all of CDC’s response activities for the Pacific
Then in 2016, all his work shifted back to a familiar disease when Zika returned to the Pacific. “Early in 2016, a case of Zika was identified in a person from New Zealand who had recently visited American Samoa. At the time, I was conducting an outbreak training in Kosrae, Micronesia. I got a call from my boss– he told me that CDC had just sent Tai Ho Chen down to American Samoa to initiate the investigation and response, but that I had to get to American Samoa as soon as possible. Tai could only stay for a few days, and I would need to be there for over a month as team lead for the CDC response team.”
For five weeks, Dr. Hancock was in American Samoa, leading CDC’s efforts to support American Samoa in responding to the outbreak. His team established the first response plan for the territory that was used by subsequent CDC team leads. After returning from being the team lead in American Samoa, Hancock was asked to coordinate all of CDC’s response activities for the Pacific. He was now guiding teams in American Samoa, the Marshall Islands, Kosrae, and Chuuk.
“It’s better to be lucky, than good,” Thane Hancock, MD, MPH.
“It was a lot of work, but really so rewarding to be able to collaborate with the committed local health staff in islands, as well as the others that provided expert support, such as the Hawaiʻi State Lab that did the majority of the testing for the Pacific Islands,” said Hancock. “Outbreak responses are challenging, but they often bring people together, and bring out their best, as everything you do is to help protect the community.”
Dr. Hancock feels very fortunate for the experiences he’s had and opportunities he’s been given. “It’s better to be lucky, than good.” He says he was lucky to be sitting in that clinic when those first patients presented with Zika. The experience of investigating and responding to the outbreak expanded his interests into being a disease detective and helped him get into the highly selective Epidemic Intelligence Service with CDC. He also feels very fortunate to have family that helped inspire him to work in Yap in the first place.
“That experience in Yap changed my life. I went down there a typical teenager worried about what brand of board shorts I wore, and after spending nine weeks living on an outer island with no power, no running water, and no doctor, I returned a changed person. It was when I got sick on the small island of Fathrai that I realized how much we take for granted in the United States. I was sick with what would be considered a mild ailment in Hawai’i, but on Fathrai, with no health provider, it was a major issue. Fortunately, I recovered, but that experience is what inspired me to become a physician and return to Yap to work. That first trip to Yap really helped be become a better person, more focused on what really matters in life, and a life-path to follow.”
Dr. Hancock went on to graduate from HPA in 1993 and completed his pre-med work at Amherst College in Massachusetts. He returned to University of Hawaiʻi to complete his graduate training, getting his MPH (1999), MD (2003), and family residency training (2006).
Prepared by UH to serve patients in a remote setting
“The University of Hawaiʻi was always very supportive of me and my dream to serve Micronesia. Dr. John Casken was a great mentor and teacher when I was getting my MPH. Dr. Neal Palafox’s department of family medicine and community health was especially committed to helping me grow and become a physician ready to work in rural Micronesia. Dr. Lee Buenconsejo-Lum and all the other faculty members were always finding me training and experiences to help make me a better physician in remote setting. The University of Hawaiʻi was essential in helping fulfill my dream to serve Yap.”
In 2006, he graduated from the family medicine residency program, and completed the path he started on as a 14-year-old by taking a job in Yap.
“I was very fortunate that a position opened up in Yap that qualified for the National Health Service Corps (NHSC). The National Health Service Corps had paid for three years of my medical schooling, and so I owed them three years working in primary care at an underserved location.”
That year, Yap was rated the most underserved location of all the sites hiring NHSC physicians.
“It really helped me that I could repay my NHSC time while working in Yap. That made the $20,000 annual salary I was paid in Yap a little more tolerable.”
Working for the CDC in the Pacific