The present book deals not only with emergency response, but also with measures designed to reduce the impact of disasters on environmental health infrastructure, such as water supply and sanitation facilities. It also aims to strengthen the ability of people to withstand the disruption of their acc...ustomed infrastructure and systems for environmental health (e.g. shelter, water supply, sanitation, vector control etc.) and to recover rapidly.
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Ce rapport montre que d’importants progrès ont été accomplis en 2015 pour atteindre les cibles de la feuille de route. Ces résultats procèdent de la mise en œuvre de cinq interventions recommandées par l’OMS pour vaincre les MTN : chimiothérapie préventive ; prise en charge innovante et... intensifiée de la maladie ; écologie et gestion vectorielles ; services de santé publique vétérinaire ; et approvisionnement en eau sans risque sanitaire et services d’assainissement et d’hygiène.
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In 2005, the World Health Organization (WHO) recognized Chagas disease (CD; Trypanosoma cruzi infection) as a neglected tropical disease (NTD) [1] and included it into the global plan to combat NTDs [2]. The Target 3.3 of the United Nations Sustainable Development Goals (UN/SDG) aims at ending the e...pidemics of NTDs by 2030 [3]. Mother-to-child (congenital/connatal) transmission is currently the main mode of transmission of T. cruzi over blood transfusions and organ transplantations in vector-free areas within and outside Latin America (LA). Based on recent demonstrations that congenital transmission can be prevented [4–7], WHO has shifted its objective, in 2018, from control to elimination of congenital CD (cCD).
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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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Chagas disease, also known as American trypanosomiasis, is a potentially life-threatening illness caused by the protozoan parasite Trypanosoma cruzi. About 6–7 million people worldwide are estimated to be infected with T. cruzi. The disease is found mainly in endemic areas of 21 continental Lati...n American countries, where it has been mostly transmitted to humans and other mammals by contact with faeces or urine of triatomine bugs (vector-borne), known as kissing bugs, among many other popular names, depending on the geographical area.
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Dengue is the fastest spreading, mosquito-borne viral infectious disease worldwide, with remarkable morbidity and mortality. In the past decades, profound contributions have been made towards understanding its epidemiology, including disease burden and distributions, risk factors, and control and pr...evention practices. Dengue continues to disseminate to new areas, including high latitude regions, and a new serotype (dengue virus serotype 5) has been identified. Vaccine research has made new progress, in which the licensed yellow fever and dengue virus quadrivalent chimeric vaccine is now under further safety assessment. In disease surveillance, because of its operational simplicity, rapidity, capability, and utility as an indicator of disease severity, dengue virus NS1 antigen detection has great promotion and application value among primary health care institutions. Vector control progress has driven new breakthroughs in biotechnology, including Wolbachia-infected Aedes and genetically modified Aedes. Both Aedes variants have been used to block transmission of the dengue virus through population replacement and suppression. In the future, vector control should still be pursued as a key measure to prevent transmission, along with anti-viral drug and vaccine research.
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This technical report presents the epidemiology of human and animal leishmaniases in the EU and its neighbouring countries and concludes that the disease remains widespread and underreported in many countries of southern Europe, northern Africa, and the Middle East and that there is a need to improv...e leishmaniasis prevention and control based on robust surveillance in humans, animals, and vectors, and to increase public awareness following a one health approach.
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Onchocerciasis causes skin and eye disease, visual impairment and neurological problems. It is mostly found in Africa, but also in Latin America and Yemen. The common name, ‘river blindness,’ gives a good indication where the disease can be found: the vector of the parasite, a small black fly of... the Simulium species, breeds in rivers where there is turbulence in the water, such as rapids, or where the flow is disturbed by overhanging vegetation.
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The objectives of the meeting were:
1. To step up the commitment of national authorities and technical and financial partners toWHO’s elimination objective for g-HAT.
2. To share achievements, challenges and views on the elimination goal among countries and implementing partners.
3. To assess t...he status of critical technical aspects to be solved in research and development of drugs and diagnostic tools, epidemiology, vector control and animal reservoirs.
4. To define the mechanisms for strengthening and organizing collaboration and coordination among stakeholders.
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The objectives of the meeting were:
1. To update the current status of the disease transmission, country capacities and plans for tackling the disease.
2. To understand the epidemiology including disease distribution and risk, the models
for estimating under-detection, the geographical variati...ons of in clinical presentation,
the roles of domestic and wild animal reservoirs and the subsequent different
transmission patterns and control approaches, including vector control.
3. To update current research and development efforts for improving diagnostic and
treatment tools.
4. To define the goals for achieving the control of r-HAT, the need for a multisectoral
approach and to discuss the strategy for controlling r-HAT and the coordination
mechanisms.
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The conditionality of this recommendation is largely driven by the current higher unit cost of pyrethroid-PBO ITNs compared
to pyrethroid-only LLINs and therefore the uncertainty of their cost-effectiveness. Furthermore, as PBO is less wash-resistant
than pyrethroids, its bioavailability declines ...faster over the three-year estimated life of an ITN; therefore, the added impact of
pyrethroid-PBO ITNs over that of pyrethroid-only LLINs may decline over time. The evidence comes from two sites in
eastern Africa with pyrethroid resistance and not from other geographies where transmission levels and vector characteristics
may vary. PBO acts by inhibiting certain metabolic enzymes, primarily oxidases, and so are likely to provide greater protection
than pyrethroid-only LLINs where mosquitoes display mono-oxygenase-based insecticide resistance mechanisms.
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Leishmaniasis is found in people in focal areas of approximately 90 countries in the tropics, subtropics, and southern Europe. The ecologic settings range from rain forests to deserts. Leishmaniasis usually is more common in rural than in urban areas, but it is found in the outskirts of some cities.... Climate and other environmental changes have the potential to expand the geographic range of the sand fly vectors and the areas in the world where leishmaniasis is found.
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Datos y cifras
Se calcula que en el mundo hay entre 6 y 7 millones de personas infectadas por el Trypanosoma cruzi, el parásito causante de la enfermedad de Chagas, la mayoría de ellas en América Latina.
La infección por Trypanosoma cruzi se puede curar si el tratamiento se administra al poco ...tiempo de producirse la infección.
Hasta un 30% de los enfermos crónicos presentan alteraciones cardíacas y hasta un 10% padecen alteraciones digestivas, neurológicas o combinadas que pueden requerir un tratamiento específico.
El control de vectores y otras estrategias destinadas a reducir la transmisión que estos producen son los métodos más útiles para prevenir la enfermedad de Chagas en América Latina.
Los análisis de sangre son fundamentales para prevenir la infección por transfusiones o trasplantes de órganos en todo el mundo.
La detección y el tratamiento de niñas infectadas y mujeres infectadas en edad fértil es clave, además del cribado de los recién nacidos y otros hijos de madres infectadas que no hayan recibido antes tratamiento antiparasitario.
La enfermedad de Chagas, también llamada tripanosomiasis americana, es una enfermedad potencialmente mortal causada por el parásito protozoo Trypanosoma cruzi (T. cruzi).
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A century after its discovery, Chagas' disease still represents a major public health challenge in Latin America. Moreover, because of growing population movements, an increasing number of cases of imported Chagas' disease have now been detected in non-endemic areas, such as North America and some E...uropean countries. This parasitic zoonosis, caused by Trypanosoma cruzi, is transmitted to humans by infected Triatominae insects, or occasionally by non-vectorial mechanisms, such as blood transfusion, mother to fetus, or oral ingestion of materials contaminated with parasites. Following the acute phase of the infection, untreated individuals enter a chronic phase that is initially asymptomatic or clinically unapparent. Usually, a few decades later, 40-50% of patients develop progressive cardiomyopathy and/or motility disturbances of the oesophagus and colon. In the last decades several interventions targeting primary, secondary and tertiary prevention of Chagas' disease have been attempted. While control of both vectorial and blood transfusion transmission of T cruzi (primary prevention) has been successful in many regions of Latin America, early detection and aetiological treatment of asymptomatic subjects with Chagas' disease (secondary prevention) have been largely underutilised. At the same time, in patients with established chronic disease, several pharmacological and non-pharmacological interventions are currently available and have been increasingly used with the intention of preventing or delaying complications of the disease (tertiary prevention). In this review we discuss in detail each of these issues.
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Chikungunya virus (CHIKV) is a re-emerging mosquito borne alphavirus responsible
for the recent outbreak in the Americas. Immunologically naïve population in the Americas favors the spread of epidemics. Chikungunya fever is characterized by an abrupt febrile illness, polyarthralgia and maculopapul...ar rash. In chikungunya fever, shock or severe hemorrhage is very rarely observed; the onset is more acute and the duration of fever is shorter than dengue disease. The pain is much more pronounced and localized to the joints and tendons in chikungunya fever, in comparison to dengue fever. There is no specific and effective antiviral therapy and vaccines are still in trails. The only effective preventive measures consist of individual protection against mosquito bites and vector control. Disease prevention is important due to the
economic burden it entails. Clinicians need to distinguish chikungunya fever between dengue fever and other diseases to give a successful treatment and prevent disease spreading.
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Chagas disease is currently endemic and also predicted to be at increased transmission risk under future climate change scenarios. Similarly, an expansion of areas in the United States at increased risk for Chagas disease transmission is also expected over the next several decades under climate chan...ge scenarios. Of particular interest is the predicted northern shift of triatomine species to central regions of the United States with historically unsuitable climates for T. cruzi vectors. The weight of evidence regarding the influences climate change may pose on T. cruzi vector species distributions demonstrates the sensitivity of Chagas disease transmission to future climate variability. In order to advance forecasts for the impact climate change may have on Chagas disease transmission in the Americas, it is imperative to
further develop, utilize, and perhaps combine predictive species distribution modeling approaches that integrate accurate, long term data on climate variables, vector species distributions, Chagas disease incidence, as well as other socio-ecological variables.
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The previous report of the WHO Expert Committee on this disease
followed a meeting in 1995. Intensive, coordinated efforts against HAT during
the intervening 18 years have resulted in a decrease in incidence to a point at
which elimination is considered feasible. This report provides informati...on about
new diagnostic approaches, new therapeutic regimens and better understanding
of the distribution of the disease with high-quality mapping. The roles of human
and animal reservoirs and the tsetse fly vectors that transmit the parasites are
emphasized. The new information has formed the basis for an integrated strategy
with which it is hoped that elimination of HAT will be achieved. The report also
contains recommendations on the approaches that will lead to elimination of the
disease.
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Integrating neglected tropical diseases into global health and development: fourth WHO report on neglected tropical diseases evaluates the changing global public health landscape; assesses progress towards the 2020 targets; and considers the possible core elements of a strategic vision to integratin...g neglected tropical diseases into the 2030 Agenda of the Sustainable Development Goals.
Advances have been made through expanded interventions delivered through five public health approaches: innovative and intensified disease management; preventive chemotherapy; vector ecology and management; veterinary public health services; and the provision of safe water, sanitation and hygiene. In 2015 alone nearly one billion people were treated for at least one disease and significant gains were achieved in relieving the symptoms and consequences of diseases for which effective tools are scarce; important reductions were achieved in the number of new cases of sleeping sickness, of visceral leishmaniasis in South-East Asia and also of Buruli ulcer.
The report also considers vector control strategies and discusses the importance of the draft WHO Global Vector Control Response 2017–2030. It argues that veterinary public health requires a multifaceted approach across the human–animal interface as well as a multisectoral programme of work to protect and improve the physical, mental and social well-being of humans, including veterinary, water, sanitation and hygiene.
Integration of activities and interventions into broader health systems is crucial, and despite challenges, has the potential to accelerate progress towards universal health coverage while advancing the 2030 Agenda.
In short, this report drives the message home that “no one must be left behind”.
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La serovigilancia es una herramienta que complementa los métodos tradicionales de salud pública para la vigilancia de las enfermedades transmisibles y proporciona información valiosa sobre la transmisión de enfermedades en los grupos de la población; por ejemplo, para detectar brechas en la inm...unidad frente a las enfermedades prevenibles mediante vacunación. Esta información es útil para hacer un seguimiento de la exposición de la población a enfermedades como la malaria, las enfermedades infecciosas desatendidas, las enfermedades transmitidas por alimentos, agua y vectores, así como las enfermedades infecciosas emergentes. Como muchas enfermedades infecciosas están o han estado presentes en grupos que viven en entornos donde se superponen diversos factores de riesgo, la serovigilancia integrada facilita las sinergias y optimiza la utilización de los recursos de salud pública. Este conjunto de herramientas se elaboró para facilitar el diseño, la puesta en marcha, el análisis, la interpretación y el uso de los resultados de las encuestas serológicas integradas para reforzar las capacidades de los países con vistas a la eliminación de las enfermedades transmisibles. En la primera parte se describen los conceptos básicos sobre encuestas y vigilancia serológicas, sus usos, ventajas y desafíos, formas de mejorar su eficiencia, así como su potencial para contribuir a la toma de decisiones de salud pública. Posteriormente, se presenta un proceso gradual para la puesta en marcha de la vigilancia serológica integrada basada en encuestas serológicas. Incluye recomendaciones sobre cómo determinar la necesidad y el propósito de recopilar información serológica; el diseño y la metodología de la encuesta; los métodos del laboratorio; las consideraciones prácticas para la realización de encuestas; el análisis e interpretación de los datos y el uso de los resultados para respaldar la toma de decisiones. Su objetivo principal es apoyar a los directores de programas y equipos que participan en el control y eliminación de las enfermedades transmisibles. Se elaboró para ser usado, entre otros, por los coordinadores de enfermedades transmisibles, enfermedades infecciosas desatendidas y programas de vacunación; directores de vigilancia epidemiológica; personal de laboratorios de salud pública; y otros profesionales de los ministerios de salud y autoridades nacionales y subnacionales de salud que puedan estar interesados en incorporar la vigilancia serológica integrada como parte de las herramientas de sus sistemas de vigilancia, para obtener información adicional sobre la transmisión de enfermedades infecciosas en la población.
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La fiebre amarilla es una enfermedad endémica en varios países de América Latina. Con vistas a brindar apoyo a los responsables de la toma de decisiones para priorizar las acciones preventivas frente a esta afección, la Organización Panamericana de la Salud presenta estos perfiles nacionales co...n una selección de datos concisa y exhaustiva de los países con endemicidad. En cada perfil se brinda un análisis de la situación actual del país, los factores ecológicos y climáticos asociados a la enfermedad, la distribución e incidencia de los vectores, y las claves de la actividad arboviral. Asimismo, se incluye una perspectiva histórica de la epidemiología y un resumen del estado de la vacunación contra la enfermedad en el país.
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