Abstract: Chagas disease is caused by infection with the protozoan Trypanosoma cruzi, and although over 100 years have passed since the discovery of Chagas disease, it still presents an increasing problem for global public health. A plethora of information concerning the chronic phase of human Chaga...s disease, particularly the severe cardiac form, is available in the literature. However, information concerning events during the acute phase of the disease is scarce. In this review, we will discuss the current status of acute Chagas disease cases globally, the immunological findings related to the acute phase and their possible influence in disease outcome, and reactivation of Chagas disease in immunocompromised individuals, a key point for transplantation and HIV invection management.
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Population movements have turned Chagas disease (CD) into a global public health problem. Despite the successful implementation of subregional initiatives to control vectorial and transfusional Trypanosoma cruzi transmission in Latin American settings where the disease is endemic, congenital CD (cCD...) remains a significant challenge. In countries where the disease is not endemic, vertical transmission plays a key role in CD expansion and is the main focus of its control. Although several health organizations provide general protocols for cCD control, its management in each geopolitical region depends on local authorities, which has resulted in a multitude of approaches. The aims of this review are to (i) describe the current global situation in CD management, with emphasis on congenital infection, and (ii) summarize the spectrum of available strategies, both official and unofficial, for cCD prevention and control in countries of endemicity and nonendemicity. From an economic point of view, the early detection and treatment of cCD are cost-effective. However, in countries where the disease is not endemic, national health policies for cCD control are nonexistent, and official regional protocols are scarce and restricted to Europe. Countries of endemicity have more protocols in place, but the implementation of diagnostic methods is hampered by economic constraints. Moreover, most protocols in both countries where the disease is endemic and those where it is not endemic have yet to incorporate recently developed technologies. The wide methodological diversity in cCD diagnostic algorithms reflects the lack of a consensus. This review may represent a first step toward the development of a common strategy, which will require the collaboration of health organizations, governments, and experts in the field.
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Chagas disease caused by Trypanosoma cruzi is a public health issue in Latin America. This highly diverse parasite is divided into at least seven discrete typing units (DTUs) TcI-TcVI and Tcbat. Some DTUs have been associated with geographical distribution in epidemiological scenarios and clinical m...anifestations, but these aspects remain poorly understood. Many studies have focused on studying the parasite and its vectors/hosts, using a wide variety of genetic markers and methods. Here, we performed a systematic review of the literature for the last 20 years to present an update of DTUs distribution in the Americas, collecting ecoepidemiological information. We found that the DTUs are widespread across the continent and that there is a whole gamma of genetic markers used for the identification and genotyping of the parasite. The data obtained in this descriptor could improve the molecular epidemiology studies of Chagas disease in endemic regions.
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Leptospirosis, a spirochaetal zoonosis, occurs in diverse epidemiological settings and affects vulnerable populations, such as rural subsistence farmers and urban slum dwellers. Although leptospirosis is a life-threatening disease and recognized as an important cause of pulmonary haemorrhage syndrom...e, the lack of global estimates for morbidity and mortality has contributed to its neglected disease status
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The purpose of this guide is to provide practical advice for health staff undertaking infectious disease preparedness and response activities to ensure that access to safe abortion care (SAC) is maintained when an infectious disease outbreak occurs. It is an operational guide which can serve to supp...ort health actors to maintain SAC services during outbreaks and ensure that necessary SAC considerations are integrated within outbreak responses; it is not a clinical guide. The locational focus of this document is humanitarian and fragile settings; however, recommendations may apply to infectious disease outbreaks in all low-resource populations. This guide is intended to complement Sexual and Reproductive Health and Rights During Infectious Disease Outbreaks: Operational Guidance for Humanitarian and Fragile Settings.
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El objetivo de esta guía es brindar recomendaciones prácticas al personal de salud que se hace cargo de las actividades de preparación y respuesta a las enfermedades contagiosas para asegurar que se mantenga el acceso a servicios de aborto seguro (SAS) cuando surja un brote de enfermedades contag...iosas. Es una guía operativa que puede servir para apoyar a los actores de la salud para que los SAS se mantengan durante los brotes y asegurar que las consideraciones necesarias de SAS se integren dentro de la respuesta al brote; no es una guía clínica. El enfoque centrado en la ubicación de este documento se dirige a los asentamientos frágiles y de ayuda humanitaria; sin embargo, las recomendaciones pueden aplicarse a brotes de enfermedades contagiosas a cualquier población con escasez de recursos. Esta guía busca complementar el trabajo llamado La salud sexual y reproductiva y los derechos durante los brotes de enfermedades contagiosas: Guía operativa para escenarios frágiles y de ayuda humanitaria.
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Ce guide a pour objectif de fournir des conseils pratiques à destination du personnel de santé entreprenant des activités de préparation et de réponse aux maladies infectieuses afin de maintenir l’accès à des Soins d’Avortement sans Risque (SAR) durant une épidémie de maladie infectieus...e. Il s’agit d’un guide pratique destiné à aider les acteurs du secteur de la santé à garantir le maintien des services de Soins d’Avortement sans Risque (SAR) pendant les épidémies et à veiller à ce que les considérations nécessaires en matière de Soins d’Avortement sans Risque soient intégrées à la riposte à l’épidémie; il ne s’agit pas d’un guide clinique. Ce document se concentre sur les situations de crise humanitaire et les contextes fragiles, toutefois les recommandations peuvent s’appliquer aux épidémies de maladies infectieuses auprès des populations à faibles ressources. Ce guide est prévu en complément du document: Santé et droits en matière de sexualité et de procréation durant les épidémies de maladies infectieuses: orientations de mise en oeuvre pour les situations de crise humanitaire et les contextes fragiles.
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Snakebite envenoming affects millions of people worldwide annually and is a significant source of mortality. Preventing and treating the problem is complex and requires collaboration among the fields of public health, medicine, ecology, and laboratory science. After being removed from the category A... neglected tropical disease (NTD) list in 2013, snakebite envenoming was reinstated in 2017 in response to antivenom shortages and advocacy from researchers and international NGOs. In 2019, the World Health Organization (WHO) set a target to halve the number of deaths and cases of snakebite envenoming by 2030.
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Snakebite envenoming is a serious public health problem in Central America, where approximately 5,500 cases occur every year. Panama has the highest incidence and El Salvador the lowest. The majority, and most severe, cases are inflicted by the pit viper Bothrops asper (family Viperidae), locally kn...own as ‘terciopelo’, ‘barba amarilla’ or ‘equis’. About 1% of the bites are caused by coral snakes of the genus Micrurus (family Elapidae). Despite significant and successful efforts in Central America regarding snakebite envenomings in the areas of research, antivenom manufacture and quality control, training of health professionals in the diagnosis and clinical management of bites, and prevention of snakebites, much remains to be done in order to further reduce the impact of this medical condition. This essay presents seven challenges for improving the confrontation of snakebite envenoming in Central America. Overcoming these challenges demands a coordinated partnership of highly diverse stakeholders though inter-sectorial and inter-programmatic interventions.
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Leishmaniases are a group of diseases of zoonotic importance caused by over 20 species of protozoa of the genus Leishmania, in which domestic dogs are considered to be the main reservoir for the disease. However, the involvement of other vertebrates as reservoirs for these parasites has also been in...vestigated. Therefore, the objective of the present study was to carry out a systematic review with meta-analysis on occurrences of leishmaniasis in equids. The case reports described animals with cutaneous symptoms of leishmaniasis (papules, nodules, ulcers or crusts) that regressed spontaneously, located mainly on the head and limbs, from which three species of protozoa were identified in the lesions: Leishmania braziliensis, Leishmania infantum and Leishmania siamensis. In turn, the meta-analysis showed a combined prevalence of 25%, although with high heterogeneity among the studies, which was attributed to the use of different methods for diagnosing the disease. Leishmaniasis in equids is a benign disease but it should be included in the differential diagnosis of cutaneous diseases among these species. Seroepidemiological studies are important in investigating and monitoring suspected exposure of these hosts to the parasite, especially in endemic areas. However, there is also a need to standardize diagnostic methods.
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A group of enzootic and zoonotic protozoan infections, the leishmaniases constitute among the most severely neglected tropical diseases (NTDs) and are found in all continents except Oceania. Representing the most common infectious diseases, NTDs comprise an open-ended list of some 20 parasitic, bact...erial, viral, protozoan and helminthic infections. Called “diseases of the poor,” because of their characteristic prevalence in poor populations regardless of a country's income status, they infect over one billion people in over 140 countries, with about 90% of the global burden in Africa. While NTDs do not contribute significantly to global deaths, they are debilitating and remain the most common infections among the poor worldwide, preventing them from escaping poverty by impacting livelihoods such as agriculture and livestock, and affecting cognitive, developmental and education outcomes.
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En la Región de las Américas, las poblaciones están envejeciendo y se está experimentando una rápida transición demográfica. El índice de envejecimiento, que refleja el tamaño de los grupos de mayor edad por 100 en comparación con los menores de 15 años, demuestra claramente el aumento de... las personas de 60 años o más. En comparación con las tendencias mundiales, la Región tendrá un mayor número de personas de 60 años o más que de menores de 15 años para el 2030, aproximadamente 25 años antes que el promedio mundial. La pandemia de COVID-19 ha dado pie a una crisis de salud sin precedentes en todo el mundo. Sus efectos en las personas mayores y aquellas con enfermedades subyacentes han puesto de manifiesto los desafíos de abordar sus necesidades durante una emergencia de salud pública. Dada esta transición demográfica, es fundamental reflexionar acerca de la preparación de los sistemas y servicios con vistas a atender las necesidades de este grupo de población, incluidas la mejora de la planificación para casos de emergencia y la protección de las personas mayores.
Esta publicación forma parte de una serie titulada La Década del Envejecimiento Saludable en las Américas: situación y desafíos
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Throughout the Americas, populations are aging and the Region is undergoing a rapid demographic transition. The aging index, which reflects the size of the older age groups per 100 compared to children under age 15, clearly demonstrates the increase in people aged 60 and older. Compared to global tr...ends, the Region of the Americas will have a larger number of people aged 60 and older than children under 15 by 2030, which is approximately 25 years before the global average. The COVID-19 pandemic has presented an unparalleled health crisis around the world. The impact on older persons and those with underlying health conditions has highlighted the challenges of addressing the needs of older populations during a public health emergency. Given this demographic transition it is essential to think about preparedness of systems and services to address this population’s needs, including an increase in emergency planning and protection of older populations.
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The chapter Dementia in Latin America and the Caribbean: Prevalence, Incidence, Impact, and Trends over Time, is part of the publication series titled “Decade of Healthy Aging: situation and challenges”. This document aims to provide an outline of the current situation in Latin America and the C...aribbean in respect of the prevalence and incidence of dementia and its impact on the health status of older people. As dementia is a significant global health problem which also has social and economic impacts this document highlights the importance of monitoring dementia in the region. The document evidences that dementia is one of the main contributors to dependence and disability in older people in Latin America and the Caribbean and, although its prevalence and incidence increase exponentially with age, it is not part of normal aging. Alzheimer’s disease is the most common dementia, and there is no cure for this condition, but with timely diagnosis is possible to ameliorate symptoms. It is important to assess what are the needs of people leaving with dementia and their families and to integrate dementia risk reduction strategies in pre-existing strategies for other non-communicable diseases. As shown in the report, despite the huge burden dementia is still underdiagnosed, and it is fundamental to better monitor its prevalence, incidence and the different societal impact that dementia can have. For that, it is crucial to promote the use of harmonized methodologies to address this information in a broader number of studies and countries in the region. This can contribute to the generation of direct actions to decrease dementia risk and lead to healthier lives for people with dementia and their families.
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El presente informe incluye análisis de consultas informales en cinco de las regiones de la OMS: la Región de África, la Región de las Américas (donde se realizaron consultas separadas para el Caribe y América del Norte, y para América Latina), la Región de Asia Sudoriental, la Región de Eu...ropa y la Región del Mediterráneo Oriental, junto con tres foros en la Región del Pacífico Occidental. Se analizan las similitudes generales, los matices regionales y las prioridades planteadas en las seis regiones de la OMS para la participación significativa de las personas con experiencias vividas.
El presente informe es la segunda publicación de la serie «De la intención a la acción», un conjunto de recursos destinados a mejorar la limitada base de evidencia sobre el impacto de la participación significativa y abordar la falta de enfoques normalizados sobre cómo hacer operativa esta participación. La serie «De la intención a la acción» pretende llevar esto a cabo proporcionando una plataforma desde la que las personas con experiencias vividas, y los defensores de organizaciones e instituciones, puedan compartir soluciones, retos y prácticas prometedoras relacionadas con esta agenda transversal. La serie «De la intención a la acción» también tiene como objetivo proporcionar poderosas historias, inspiración y evidencia para la 4.ª Reunión de Alto Nivel de las Naciones Unidas sobre las ENT que se celebrará en 2025 y la consecución de los Objetivos de Desarrollo Sostenible (ODS) de las Naciones Unidas para 2030.
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The overall objective of the framework is to support WHO and Members States in meaningful engagement of people living with NCDs, and mental health and neurological conditions to co-create and enhance related policies, programmes and services. This framework will contribute to advancing understanding..., knowledge and action on meaningful engagement and related participatory approaches from an evolving evidence base. It provides practical guidance and actions for transitioning from intention to action to operationalize meaningful engagement.
The aim of the framework is to guide people working at WHO and in Member States in ensuring meaningful engagement with individuals with lived experience. WHO will advocate for, provide technical assistance and operationalize implementation at its three levels (headquarters, regional and country offices) and will support Member States in implementation at national level through established processes and procedures.
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Lack of trained providers capable of identifying which labouring women could benefit from assisted vaginal birth (AVB), and of safely performing the procedure is a major barrier for its use. Education and training are, therefore, considered crucial for building skills and confidence in conducting AV...B and there is evidence that it would be welcomed by healthcare providers. However, acquiring and maintaining AVB skills is a complex task that requires a supportive environment, mentorship, supervision and accountability. As with other practices to manage infrequent procedures and complications, continuous education and on-site supervision are essential to ensure the safe and sustainable use of AVB.
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A System of Health Accounts 2011: Revised Edition provides an updated and systematic description of the financial flows related to the consumption of health care goods and services. As demands for information increase and more countries implement and institutionalise health accounts according to the... system, the data produced are expected to be more comparable, more detailed and more policy relevant. It builds on the original OECD Manual, published in 2000, and the Guide to Producing National Health Accounts to create a single global framework for producing health expenditure accounts that can help track resource flows from sources to uses. It is the result of a collaborative effort between the OECD, WHO and the European Commission, and sets out in more detail the boundaries, the definitions and the concepts – responding to health care systems around the globe – from the simplest to the more complicated.
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The waves of yellow fever transmission in the Region of the Americas in 2016–2018 involved the largest number of human and epizootic cases to be reported in several decades. Yellow fever is a serious viral hemorrhagic disease that poses a challenge for health professionals. It requires early recog...nition of signs and symptoms, which are often nonspecific, and it can mimic other acute febrile syndromes. Early detection of suspected or confirmed cases, monitoring of vital signs, life support measures, and treatment of acute kidney failure continue to be the recommended strategies for case management. This report is the result of discussions among experienced specialists in the Americas on the clinical management of yellow fever patients, especially during outbreaks and epidemics, in the context of current medical and scientific evidence and taking into account the technical guidelines already available in the countries of the Region. It includes flowcharts for initially addressing patients with clinical suspicion of yellow fever and proposes a minimum package of laboratory tests that may be useful in contexts where resources are limited. In addition, it considers aspects of health system organization for dealing with yellow fever outbreaks and epidemics.
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Las olas de transmisión de la fiebre amarilla ocurridas en la Región de las Américas entre el 2016 y el 2018 causaron el mayor número de casos humanos y epizoóticos registrados en varios decenios. La fiebre amarilla es una enfermedad hemorrágica viral grave que representa un desafío para el p...rofesional de salud: exige el reconocimiento temprano de signos y síntomas muchas veces inespecíficos, que pueden parecerse a otros síndromes febriles agudos. La detección temprana de los casos sospechosos o confirmados, el monitoreo de los signos vitales y las medidas de soporte vital, y el tratamiento de la insuficiencia hepática aguda siguen siendo las estrategias recomendadas para el manejo de los casos. El presente informe es el resultado de las deliberaciones sobre la experiencia de expertos de la Región en cuanto al manejo clínico de pacientes con fiebre amarilla, especialmente en brotes y epidemias, mediante la contextualización de esa experiencia en el conjunto actual de la evidencia médico-científica y la consideración de las directrices técnicas ya disponibles en los países de la Región. Presenta flujogramas para la evaluación inicial del paciente con sospecha clínica de fiebre amarilla y sugiere un conjunto mínimo de pruebas de laboratorio que puede ser útil cuando hay pocos recursos; además, detalla aspectos de la organización de los sistemas de salud para enfrentar brotes y epidemias de fiebre amarilla.
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