Modelaje de los componentes de tendencia y estacional del SARS-COV2 en la República Bolivariana de Venezuela / Modeling the trend and seasonal components of the SARS-COV2 in the Bolivarian Republic of Venezuela

A más de cuatro meses de la pandemia que azota al planeta, existe la urgente necesidad de proyectar cómo la transmisión del nuevo SARS-CoV-2 se desarrollará en los meses venideros. En el interés de modelar el comportamiento del SARS-CoV-2 en la República Bolivariana de Venezuela, desde el Observatorio Nacional de Ciencia, Tecnología e Innovación (ONCTI), realizamos análisis estadísticos a objeto de pronosticar con base en los valores de las series de tiempo de contagios de la Covid-19 de procedencia comunitaria, la Estimación Promedio de Contagios Comunitarios. Dichos análisis han permitido evidenciar que la inédita dinámica de propagación de esta pandemia dependerá de la estacionalidad, la duración en encontrarse una vacuna de inmunidad y de los otros factores como, por ejemplo, la erradicación de procedencia de los contagios de orígenes transnacionales o importados. De allí que, utilizando datos que reflejan el comportamiento del SARS-CoV-2 durante los primeros 120 días de pandemia en la República Bolivariana de Venezuela, medimos cómo estos factores afectan la transmisión comunitaria. Para ello construimos un modelo matemático que permitió observar el comportamiento de la transmisión de SARS-CoV-2; y proyectamos qué tan recurrentes serán los brotes de SARS-CoV-2 durante las próximas 3 semanas, los cuales probablemente ocurrirán después del brote de la ola pandémica inicial(AU)

More than four months after the start of the pandemic that plagues the planet, there is an urgent need to project how the transmission of the new SARS-CoV-2 will develop in the upcoming months. Intending to model the behavior of SARS-CoV2 in the Bolivarian Republic of Venezuela, the Observatorio Nacional de Ciencia y Tecnologia (ONTIC) carried out statistical analysis to forecast based on the values of the time series of Covid-19 infections of communitarian origin, the Estimate Average of Community Contagions. These analyzes have shown that the unprecedented spread's dynamics of this pandemic will depend on seasonality, the finding of a vaccine, and other factors such as, for example, the eradication of origin of contagions of transnational or imported origin. Hence, using data that reflects the behavior of SARS-CoV2 during the first 120 days of the pandemic in the Bolivarian Republic of Venezuela, we measure how these factors affect communitarian transmission. To do this, we built a mathematical model that allowed us to observe the behavior of SARS-CoV-2 transmission, projecting how recurrent outbreaks of SARS-CoV-2 will appear over the next 3 weeks, which are likely to occur after the first wave of the pandemic(AU)

Evidencias clínico-epidemiológicas vinculadas a Lissachatina fulica en un adulto con meningoencefalitis eosinofílica causada por Angiostrongylus cantonensis / Clinical-epidemiological evidence related to Lissachatina fulica in an adult with eosinophilic meningoencephalitis caused by Angiostrongylus cantonensis

Introducción: El helminto Angiostrongylus cantonensis es un parásito habitual en los pulmones de la rata y puede ocasionar meningoencefalitis eosinofílica en el hombre cuando se pone en contacto con las larvas por ingestión accidental. En Cuba es endémico y el riesgo de contraerlo aumenta con la entrada del caracol gigante africano en el país. Objetivo: Describir las acciones desarrolladas por las autoridades sanitarias locales para el control del caracol gigante africano entre 2016 y 2018 y la aparición de un paciente en 2018 con meningoencefalitis eosinofílica causada por Angiostrongylus cantonensis vinculado epidemiológicamente con la presencia de este caracol. Métodos: Se realizó un estudio cualitativo a partir de un grupo focal con el que se trabajó ante la aparición del caracol gigante africano en un área de salud del municipio San Miguel del Padrón. Se realiza una encuesta semi-estructurada. Resultados: Se trazaron las estrategias para la erradicación de la especie invasora a partir de un trabajo comunitario. Dos años después, se observa nuevamente el caracol gigante africano y un paciente con meningoencefalitis eosinofílica epidemiológicamente asociado a Angiostrongylus cantonensis. Conclusiones: Las acciones realizadas entre 2016 y 2018 resultaron ser insuficientes por el nuevo avistamiento del caracol en el área, con el agravante de encontrar un paciente con meningoencefalitis eosinofílica epidemiológicamente asociado con el molusco(AU)

Introduction: Helmint Angiostrongylus cantonensis is a natural parasite in the lungs of ratas. Ocassionally it can produced an eosinophilic meningoencephalitis in men by larvae accidental ingestion. Methods: A qualitative study was performed from a focal group by a semi-structural survey in a health area from San Miguel del Padrón municipality. Objectives: To describe the actions developed by the local sanitarian authorities for the control of African giant snails between 2016 and 2018 and the appearance of a patient suffering from eosinophilic meningoencephalitis due to Angiostrongylus cantonensis linked to the presence of this snail. Results: It has been established an eradication strategy for the elimination of this invasive species based on a community work. Two years later, it was observed again the giant African snail in the area with a patient suffering from Angiostrongylus cantonensis eosinophilic meningoencephalitis epidemiologically associated. Conclusions: The 2016 actions were not efficient due to the emerging vector and the further finding of a patient linked with the parasite(AU)

Hepatitis C disease burden and strategies for elimination by 2030 in Brazil. A mathematical modeling approach

ABSTRACT Introduction and aim: Hepatitis C is a key challenge to public health in Brazil. The objective of this paper was to describe the Brazilian strategy for hepatitis C to meet the 2030 elimination goal proposed by World Health Organization (WHO). Methods: A mathematical modeling approach was used to estimate the current HCV-infected Brazilian population, and to evaluate the relative costs of two different scenarios to address HCV disease burden in Brazil: (1) if no further changes are made to the HCV treatment program in Brazil; (2) where the WHO targets for 2030 elimination are met through diagnosis and treatment efforts peaking before 2024. Results: An anti-HCV prevalence of 0.53% was calculated for the total population. It was estimated that the number of HCV-RNA+ individuals in Brazil in 2017 was 632,000 (0.31% of the population). Scale-up of treatment and diagnosis over time will be necessary in order to achieve WHO targets beginning in 2018. Direct costs (diagnostic, treatment and healthcare costs) are projected to increase significantly during the scale-up of treatment and diagnosis in the initial years of the intervention scenario, but then fall below the base case on an annual basis by 2025-2036, once HCV is eliminated, due to health sectors savings from the prevention of HCV liver-related morbidity and mortality. Conclusion: Achieving the WHO targets is technically feasible in Brazil with a scale-up of treatment and diagnosis over time, beginning in 2018. However, elimination of hepatitis C requires policy changes to substantially scale-up prevention, screening and treatment of HCV, together with public health advocacy to raise awareness among affected populations and healthcare providers.

Consideraciones referente a la posibilidad de introducir la dosis fraccionada de la vacuna antipoliomielitis inactivada en el calendario de Inmunizaciones del Niño Latinoamericano / Remarks on the possibility of the introduction of fractionated dose of the inactivated poliomyelitis vaccine in the Latin American Child Immunization Schedule

As last notified case of poliomyelitis due to wild poliovirus type 2 was 1999, in 2012, the Strategic Advisory Group of Experts on Immunization (SAGE) of the World Health Organization (WHO) recommended the withdrawal of the type 2 component of oral polio vaccine (OPV) and the introduction of bivalent OPV (bOPV) in all countries by 2016. WHO recommended also that the withdrawal should be preceded by the introduction of at least one dose of inactivated poliovirus vaccine (IPV) in routine immunization schedules. The introduction of IPV prior to the change of the bOPV in 2016 to trivalent OPV (tOPV) was based on the concept of ensuring that a substantial proportion of the population would be protected against type 2 polio after the removal of the type 2 OPV. However, the world's two producers of IPV (Bilthoven Biologicals and Sanofi) have faced problems in the production of this vaccine and therefore reported reduction in IPV global supply. In response to the possible shortage of IPV, the SAGE and Technical Adviser Group (TAG) of the Pan American Health Organization (PAHO), in the meeting of March 10, 2017, has urged that countries in the Latinamerican region should replace the routine administration of the full doses of polio inactivated vaccine (IPV-C) in the immunization schedule (administered by intramuscular route) by the administration of a fraction of the full dose in two shots by intradermal route (IPV-f). The possibility of this strategy was analyzed by leaders of opinions gathered by the call of the Paraguayan Pediatric Society with the support of the Latin American Society of Pediatric Infectious Diseases (SLIPE) and Latin American Association of Pediatrics (ALAPE). The results of the discussion are presented in this document.

Measles Elimination Activities in the Western Pacific Region: Experience from the Republic of Korea

We describe the global status of measles control and elimination, including surveillance and vaccination coverage data provided by the World Health Organization (WHO). Since 2000, two doses of measles vaccine (MCV2) became recommended globally and the achievement of high vaccination coverage has led to dramatic decrease in the measles incidence. Our finding indicates that, in the Western Pacific Region (WPR), substantial progress has been made to control measles transmission in some countries; however, the measles virus continues to circulate, causing outbreaks. The Republic of Korea (ROK) experienced a series of resurgence of measles due to the importation and healthcare-associated transmission in infants, however overall incidence and surveillance indicators met the WHO criteria for measles elimination. The ROK was verified to be measles-free along with Australia, Mongolia, and Macau, China in 2014. One of the effective elimination activities was the establishment of solid keep-up vaccination system in school settings. The lessons learnt from the measles elimination activities in Korea may contribute to enhancing the surveillance schemes and strengthening of vaccination programs in member countries and areas of WPR.

A experiência brasileira na erradicação da febre aftosa e o emprego do sistema I-ELISA 3ABC/EITB para certificação sanitária de bovinos e bubalinos / The Brazilian experience in the eradication of foot-and-mouth disease and the use of I-ELISA 3ABC/EITB system for sanitary certification of bovine and buffaloes

A vacinação contra febre aftosa é ferramenta eficaz para erradicação e prevenção da doença, contudo, a presença de proteínas não capsidais (PNC) na vacina, produzidas durante a multiplicação viral, tem sido o principal problema, visto que sua presença dificulta as ações de vigilância, cuja busca se baseia na detecção de anticorpos contra essas proteínas para diferenciar animal vacinado de infectado. Por esse motivo, o Ministério da Agricultura, Pecuária e Abastecimento publicou em 2008 a Instrução Normativa nº 50 (IN 50), que incluiu no controle da qualidade da vacina a pesquisa de anticorpos contra as PNC, para avaliar a retirada dessas proteínas. Considerando a interferência vacinal, objetivou-se avaliar a frequência de bovinos reagentes às PNC, analisada pelo sistema I-ELISA 3ABC/EITB, no Laboratório de Viroses de Bovídeos do Instituto Biológico de São Paulo, no período de 2002 a 2012. Dos 34.705 bovinos examinados, observou-se que a proporção de reagentes às PNC aumentou com a idade, evidenciando aumento da frequência de reagentes em animais que receberam maior número de vacinações, indicando interferência da vacinação na resposta às proteínas. Quando comparados antes e após a publicação da IN 50, observa-se diminuição da reatividade, com redução, em 2010, de quase a metade em relação a 2007, e ainda maior quando comparado com o período 2002 a 2006. Isso demonstra a efetividade da purificação da vacina em resposta ao cumprimento da IN 50, embora permaneça alguma sororreatividade em bovinos com múltiplas vacinações. O sistema I-ELISA 3ABC/EITB demonstrou ser uma ótima ferramenta para impedir a movimentação de possíveis portadores do vírus oriundos de rebanhos vacinados, desde que seja considerado todo o contexto sanitário e epidemiológico.(AU)

Vaccination against foot-and-mouth disease is an effective tool for eradication and prevention of this disease. However, the presence of non-capsidal proteins (NCP) in the vaccine, produced during viral replication, has been the main problem, since their presence hamper the vigilance as its relies on the detection of antibodies against NCP to differentiate vaccinated from infected animals. Therefore, the Brazilian Ministry of Agriculture, Livestock and Supply published the Normative Instruction 50 (IN 50) that included the detection of antibodies against the NCP to evaluate the removal of these proteins. Considering the vaccine interference, this paper aimed to evaluate the frequency of reagents to NCP, analyzed by I-ELISA 3ABC/EITB system in the Laboratory of Bovine Viruses (LVB), Biological Institute (IB), São Paulo, SP, Brazil, from 2002 to 2012. Of the 34,705 cattle examined, it was observed that the proportion of reagents to NCP increased with age, indicating increased frequency of reagents in animals that received more vaccines, showing interference of proteins in response to vaccination. When compared before and after the publication of IN 50, there was decreased reactivity, with reduction in 2010, of nearly half compared to 2007, and even higher when compared with 2002 to 2006. This shows the effectiveness of the purification of the vaccine in response to the implementation of IN 50, although it remains some seroreactivity in cattle with multiple vaccinations. The I-ELISA 3ABC/EITB system proved to be a great tool to prevent the movement of possible carriers of the virus derived from vaccinated herds, provided that all sanitary and epidemiological context are taken in consideration.(AU)

Extermination of the Smallpox Virus – Light at the End of the Tunnel… or not – the Stalemate Continues.

The following is a commentary on the article “Arita I, Breman JG. Evaluation of smallpox vaccination policy. Bulletin of the World Health Organization. 1979;57(1):1-9.” Abstract (of the original article): During 1978 and 1979 the Global Commission for the Certification of Smallpox Eradication will proceed with verification of smallpox eradication in 31 countries. If current surveillance activities do not discover any further cases before the end of 1979, the world will be declared smallpox free. However, the recent occurrence of two laboratory associated smallpox cases in Birmingham, England, revealed that the stocks of variola virus held in at least 12 laboratories in the world pose a real danger to the achievement of smallpox eradication and efforts are being made to reduce the number of laboratories retaining the virus to not more than 4-all WHO collaborating centres-by 1980. Scientific data indicate the unlikelihood of smallpox recurring once it has been eradicated from the human population, although further confirmatory studies are continuing. If the Global Commission verifies the eradication of smallpox, continuation of smallpox vaccination will be unjus-tifiable in view of its severe complications, however infrequent, and the expected global savings that would result from the termination of vaccination programmes.

Historia del control del paludismo en la Argentina / History of malaria control in Argentina

Se presenta la evolución del programa de control y de erradicación del paludismo en la Argentina analizando a las diferentes intervenciones en su contexto histórico, los hombres que las implementaron, el desarrollo y los resultados obtenidos desde sus inicios, hace 150 años, hasta el año 2000. Se determinan 4 etapas: modernización a través de la higiene, Plan Alvarado, Plan 46 y 47 y Programa de Erradicación de la Malaria y se describen las actividades realizadas. Los datos presentados corresponden a publicaciones científicas, administrativas de las acciones de gobierno (leyes, decretos, resoluciones y administrativas de los archivos del programa) y a comunicaciones personales a los autores. Este trabajo reseña los desarrollos locales que luego fueron aplicados internacionalmente, la influencia de los conocimientos foráneos en el desarrollo de las intervenciones locales, las decisiones políticas que influyeron en los resultados y las acciones de hombres dedicados a la investigación y la salud pública que impactaron sobre la vida de millones de personas, el desarrollo de países y en la mejora de la salud en las comunidades.

The evolution of control and eradication of malaria programmes in Argentina and the men who participated in them are analyzed since 150 years ago till 2000. Four stages that characterize activities as well as the knowledge of every age are determined: modernization through hygiene, Plan Alvarado, 46 and 47 Plan and malaria eradication program and activities carried out were described. Data presented correspond to scientific publications, administrative actions of Government (laws, decrees, resolutions and administrative files of the program) and personal communications to authors. This paper reviews local developments later applied internationally, the influence of the foreign expertise in development of local interventions, political decisions that influenced the results and the actions of men dedicated to research and public health that impacted on the lives of millons of people, the development of countries and in the improvement of health in communities.

Estratégia para erradicação de focos da Doença de Aujeszky em suínos no Estado de São Paulo / Strategy for eradication of outbreaks of Aujeszky's Disease in pigs in the São Paulo state

Este trabalho teve como objetivo a avaliação de duas estratégias para erradicação de focos da doença de Aujeszky (DA) em suínos criados comercialmente no estado de São Paulo. Foram identificados dois focos da enfermidade, no município de Cerqueira César, um apresentando somente animais sororreagentes (Foco 1) e outro, casos clínicos da doença (Foco 2). Foram avaliadas duas estratégias de erradicação, uma por eliminação dos sororreagentes e outra por despovoamento gradual, com acompanhamento durante 12 meses. A erradicação por eliminação dos sororreagentes foi aplicada no Foco 1 e compreendeu na identificação por exame sorológico, isolamento e abate dos positivos; vacinação dos negativos e reposição no plantel com animais provenientes de propriedade livre. No início dos trabalhos, 68% do plantel era positivo e ao final 51%. No Foco 2 utilizou-se o despovoamento gradual, onde todos os animais foram enviados ao abate sanitário, realizado vazio sanitário nas instalações, seguido pelo repovoamento com animais livres. Esta última estratégia, nas condições desse trabalho, mostrou-se a mais eficaz, pois erradicou a DA.

This study aimed to evaluate strategies for eradication of Aujeszky Disease (AD) virus infection after outbreaks in swine production systems in Sao Paulo state. Two outbreaks were identified in Cerqueira César county. The first outbreak coursed with seropositive pigs (outbreak 1), and the other with pigs presenting clinical signs (outbreak 2). In order to eradicate the infection, two sanitary strategies were tested: (1) eradication of animals with positive serology and (2) by gradual depopulation, with a follow up of 12 months. The serology eradication was used in outbreak 1, and included the identification, isolation and slaughter of positive animals; followed by vaccination of negative animals and replacement with pigs from farms free of the disease. At the beginning, 68% of pigs were positive, and at the end it declined to 51%. In outbreak 2, gradual depopulation was used, and all animals were sent to sanitary slaughter, until facilities were completely empty. Afterwards, animals free of the disease were used for repopulation. It was seen that the last strategy was more effective because eradicated the infection.

Community participation in malaria control in olorunda local government area, osun state, southwestern Nigeria

Malaria is a major health burden in developing countries and needs multiple strategies for its control. Community participation as one of the strategies for malaria control promotes self-awareness and confidence; causes the people to examine the problems and to think positively about the solutions. The study was aimed at assessing the level of community participation in malaria control in Olorunda local government area of Osogbo; Osun state; Nigeria. The study employed a cross-sectional descriptive design. Multi-staged sampling technique was used to choose 550 respondents. An interviewer-administered semi-structured questionnaire was used to elicit information from the respondents. Most of the respondents (65.0) fell between the age ranges 20-39 years; with a mean age of 32.85 + 12 years. Almost all (98.4) respondents had knowledge of malaria with most of them (88.0) correctly aware that mosquito bite could lead to malaria fever. Respondents stated that stagnant pool (92.6) and refuse dump (89.0) could predispose to malaria. About two-thirds (60.6) of the respondents participated in the control of the breeding sites of mosquitoes on specific days for environmental sanitation. The association between community participation in health talk and community participation in malaria control was statistically significant (p

How do health care providers deal with kala-azar in the Indian subcontinent.

Background & objectives: Three countries, Bangladesh, India and Nepal, set out to eliminate kala-azar by 2015. This study was aimed to document the knowledge and practices in kala-azar case management of public and private health providers in these three countries. Methods: A health care provider survey was conducted in 2007 at 4 study sites, viz., Muzaffarpur and Vaishali districts in India, Mahottari district in Nepal, and Rajshahi district in Bangladesh. Interviews were conducted with formal and informal health care providers at their home or practice. Results: About half of the providers in India and Nepal knew the rapid diagnostic test rK39 recommended by the elimination initiative, but this was not in Bangladesh. Knowledge of the recommended first-line drug, miltefosine, was good in India and Nepal but less so in Bangladesh. Interpretation & conclusions: Innovative tools for VL care have not yet been fully taken up by private for profit care providers in the three countries that launched a VL elimination initiative. The elimination initiative needs to address these gaps in private providers’ knowledge, given their substantial share in the care of VL patients.