Reunión del Grupo Consultivo Estratégico y Técnico de la OPS sobre la eliminación de enfermedades. Informe de la reunión y recomendaciones. 29 y 30 de noviembre del 2022

La Organización Panamericana de la Salud (OPS) es un líder reconocido en la eliminación de enfermedades, que trabaja de la mano con los países de la Región y sus asociados con el fin de impulsar los logros en materia de salud pública a nivel regional y mundial. Estos esfuerzos han contribuido a la erradicación de la viruela, la eliminación de la poliomielitis y el tétanos neonatal de la Región de las Américas, la eliminación de la transmisión endémica del sarampión, la rubéola y el síndrome de rubéola congénita, así a como la eliminación de la transmisión maternoinfantil del VIH y la sífilis en ocho países. La Región también ha avanzado de manera considerable hacia la eliminación de la malaria, la lepra, el tracoma, la filariasis linfática, la oncocercosis y la rabia humana transmitida por perros. En septiembre del 2019, el 57.° Consejo Directivo de la OPS aprobó la Iniciativa de la OPS para la Eliminación de Enfermedades, una política innovadora que promueve un enfoque integrado y sostenible encaminado a acelerar el avance de los países hacia la eliminación de las enfermedades transmisibles y otras afecciones relacionadas. La eliminación de enfermedades se basa en la trayectoria eficaz de eliminación de enfermedades en la Región de las Américas y tiene como objetivo catalizar la voluntad política y aprovechar la capacidad técnica necesaria para lograr un futuro sin la carga de 35 enfermedades transmisibles y otras afecciones relacionadas en la Región de las Américas en el 2030 y contribuir al progreso hacia los Objetivos de Desarrollo Sostenible (ODS). Al tiempo que los países se recuperan del impacto de la pandemia de COVID‑19, la OPS reconoció la importancia de convocar al Grupo Consultivo Estratégico y Técnico externo sobre eliminación de enfermedades con el objeto de hacer un balance del nuevo panorama de salud pública y las evoluciones recientes en la eliminación de enfermedades y buscar orientación y recomendaciones sobre temas prioritarios con el fin de respaldar la agenda de eliminación de enfermedades en la Región de las Américas. En el presente informe se presenta un resumen de los procedimientos, conclusiones y recomendaciones de la segunda reunión del Grupo Consultivo Estratégico y Técnico de la OPS sobre eliminación de enfermedades, que tuvo lugar el 29 y 30 de noviembre del 2022.

Differential growth of Mycobacterium leprae strains (SNP genotypes) in armadillos.

Leprosy (Hansen's Disease) has occurred throughout human history, and persists today at a low prevalence in most populations. Caused by Mycobacterium leprae, the infection primarily involves the skin, mucosa and peripheral nerves. The susceptible host range for Mycobacterium leprae is quite narrow. Besides humans, nine banded armadillos (Dasypus novemcinctus) and red squirrels (Sciurus vulgaris) are the only other natural hosts for M. leprae, but only armadillos recapitulate the disease as seen in humans. Armadillos across the Southern United States harbor a single predominant genotypic strain (SNP Type-3I) of M. leprae, which is also implicated in the zoonotic transmission of leprosy. We investigated, whether the zoonotic strain (3I) has any notable growth advantages in armadillos over another genetically distant strain-type (SNP Type-4P) of M. leprae, and if M. leprae strains manifest any notably different pathology among armadillos. We co-infected armadillos (n = 6) with 2 × 109 highly viable M. leprae of both strains and assessed the relative growth and dissemination of each strain in the animals. We also analyzed 12 additional armadillos, 6 each individually infected with the same quantity of either strain. The infections were allowed to fulminate and the clinical manifestations of the disease were noted. Animals were humanely sacrificed at the terminal stage of infection and the number of bacilli per gram of liver, spleen and lymph node tissue were enumerated by Q-PCR assay. The growth of M. leprae strain 4P was significantly higher (P < 0.05) than 3I when each strain was propagated individually in armadillos. Significantly (P < 0.0001) higher growth of the 4P strain also was confirmed among animals co-infected with both 3I and 4P strain types using whole genome sequencing. Interestingly, the zoonotic strain does not exhibit any growth advantage in these non-human hosts, but the varied proliferation of the two M. leprae strains within armadillos suggest there are notable pathological variations between M. leprae strain-types.

Cuarta Reunión Regional de los Gerentes de Programas Nacionales de Eliminación del Tracoma como un problema de salud pública de las Américas

[Resumen]: RESUMEN La Cuarta Reunión Regional de los Gerentes de Programas Nacionales de Eliminación del Tracoma como un Problema de Salud Pública de las Américas ha servido para consolidar un espacio de intercambio de información y experiencias para reforzar las acciones destinadas a eliminar el tracoma como problema de salud pública en las Américas. La participación de los representantes nacionales de los países con focos conocidos de tracoma, así como de los países que comparten fronteras con focos activos, ha permitido conocer la situación en cada nación y definir acciones conjuntas y de cooperación técnica para recabar la información epidemiológica necesaria. Las evidencias presentadas constituyen importantes avances para elucidar el panorama epidemiológico de la enfermedad y para definir las acciones que hay que implementar para su eliminación. Los países con focos activos han dirigido sus esfuerzos a reforzar los componentes de la estrategia SAFE (cirugía, antibióticos, higiene facial y mejoramiento ambiental; del inglés, Surgery, Antibiotics, Facial cleanliness and Environmental Improvement), a realizar encuestas de prevalencia, a buscar activamente casos de triquiasis tracomatosa (TT) y al mapeo de áreas con comunidades en condiciones de vulnerabilidad que pueden hacer que el tracoma sea un problema de salud pública. Colombia ha finalizado la encuesta de mapeo alrededor de su primer foco identificado, lo que ha permitido reconocer nuevos focos activos. A pesar de una situación política y económica adversa, Guatemala ha logrado completar la administración masiva de medicamentos (AMM) en el 2014 y recientemente se han publicado los resultados de la encuesta de prevalencia del 2011, aunque no ha realizado la encuesta de impacto, que se espera que se complete en el 2017. En Brasil, los mejores resultados se han conseguido mediante la campaña integral contra el tracoma, la lepra, la esquistosomiasis y las helmintiasis transmitidas por contacto con el suelo (HTS), demostrándose la eficacia de las acciones integradas para hacer frente al tracoma y a otras enfermedades infecciosas desatendidas (EID). Brasil está concluyendo el plan para realizar el mapeo del tracoma en municipios prioritarios, así como la búsqueda activa de casos de TT. Entretanto, México ya cumple con los indicadores de la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) para validar la eliminación y está a la espera de la misión de expertos del Grupo Revisor del Dossier del Tracoma (GRD) para dicha validación. Paraguay, Perú y Venezuela carecen de datos epidemiológicos recientes sobre el tracoma. Sin embargo, estos países se han sumado a los esfuerzos para buscar casos de tracoma en áreas limítrofes con focos activos de Brasil y Colombia. Las recomendaciones generales a los países participantes se han concentrado en fortalecer la búsqueda activa y en el seguimiento de casos de TT, el mapeo de regiones endémicas y no endémicas, en la incorporación de nuevas tecnologías (como la plataforma Tropical Data), en la capacitación continua del personal médico y de los examinadores, y en el reforzamiento de los componentes de higiene facial y el mejoramiento del ambiente, como acciones para mantener e incrementar los avances alcanzados hasta el momento con la estrategia SAFE...

Innovation for the 'bottom 100 million': eliminating neglected tropical diseases in the Americas.

An estimated 100 million people in the Latin American and Caribbean (LAC) region live on less than US$2 per day, while another 46 million people in the US live below that nation's poverty line. Almost all of the 'bottom 100 million' people suffer from at least one neglected tropical disease (NTD), including one-half of the poorest people in the region infected with hookworms, 10% with Chagas disease, and up to 1-2% with dengue, schistosomiasis, and/or leishmaniasis. In the US, NTDs such as Chagas disease, cysticercosis, toxocariasis, and trichomoniasis are also common among poor populations. These NTDs trap the poorest people in the region in poverty, because of their impact on maternal and child health, and occupational productivity. Through mass drug administration (MDA), several NTDs are on the verge of elimination in the Americas, including lymphatic filariasis, onchocerciasis, trachoma, and possibly leprosy. In addition, schistosomiasis may soon be eliminated in the Caribbean. However, for other NTDs including hookworm infection, Chagas disease, dengue, schistosomiasis, and leishmaniasis, a new generation of 'anti-poverty vaccines' will be required. Several vaccines for dengue are under development by multinational pharmaceutical companies, whereas others are being pursued through non-profit product development partnerships (PDPs), in collaboration with developing country manufacturers in Brazil and Mexico. The Sabin Vaccine Institute PDP is developing a primarily preventive bivalent recombinant human hookworm vaccine, which is about to enter phase 1 clinical testing in Brazil, as well as a new therapeutic Chagas disease vaccine in collaboration with several Mexican institutions. The Chagas disease vaccine would be administered to seropositive patients to delay or prevent the onset of Chagasic cardiomyopathy (secondary prevention). Together, MDA and the development of new anti-poverty vaccines afford an opportunity to implement effective control and elimination strategies for the major NTDs in the Americas.

[Present leprosy situation in the world in 2011].

The epidemiological situation of leprosy is reported by the health division of each country to WHO. The reported data is collected by WHO and is immediately run on the Weekly Epidemiological Record. On this latest edition, data from the beginning of 2010 was reported. The Enhanced global strategy for further reducing the disease burden due to leprosy (plan period: 2011-2015) emphasizes reducing grade-2 disabilities among new cases. The burden of leprosy continues to decline globally as a result of sustained efforts carried out by national leprosy programmes along with continued support from both national and international partners. Improving the management of complications through the development of an effective referral service and increased community awareness about the disease will ensure that cases present for diagnosis at an early stage and will help reduce the disease burden further.

Boletín Informativo: Lepra

Lepra es una de las enfermedades desatendidas, que afectan principalmente a las poblaciones más pobres y vulnerables, de tipo infecciosa, de nula transmisibilidad cuando está debidamente controlada; es causada por Mycobacteriumleprae, un bacilo acidorresistente. La enfermedad afecta principalmente la piel, los nervios periféricos, la mucosa de las vías respiratorias altas y los ojos. La lepra es una enfermedad curable. Si se trata en las primeras fases, se evita la discapacidad.

On the origin of leprosy.

Leprosy, a chronic human disease with potentially debilitating neurological consequences, results from infection with Mycobacterium leprae. This unculturable pathogen has undergone extensive reductive evolution, with half of its genome now occupied by pseudogenes. Using comparative genomics, we demonstrated that all extant cases of leprosy are attributable to a single clone whose dissemination worldwide can be retraced from analysis of very rare single-nucleotide polymorphisms. The disease seems to have originated in Eastern Africa or the Near East and spread with successive human migrations. Europeans or North Africans introduced leprosy into West Africa and the Americas within the past 500 years.

On the origin of leprosy

Leprosy, a chronic human disease with potentially debilitating neurological consequences, results from infection with Mycobacterium leprae. This unculturable pathogen has undergone extensive reductive evolution, with half of its genome now occupied by pseudogenes. Using comparative genomics, we demonstrated that all extant cases of leprosy are attributable to a single clone whose dissemination worldwide can be retraced from analysis of very rare single-nucleotide polymorphisms. The disease seems to have originated in Eastern Africa or the Near East and spread with successive human migrations. Europeans or North Africans introduced leprosy into West Africa and the Americas within the past 500 years.

Trends in leprosy case detection worldwide since 1985.

Trends in case detection and case detection rate (CDR) since 1985 are described at regional and national levels. Annual case detection by WHO Region was available for 1994-2000. Using different sources, complete time series for case detection were constructed for 1985-1998 for a group of 33 endemic countries cumulatively (top 33), and for 14 individual countries (top 14). Population statistics were used to derive CDRs. India contributed 79% to global case detection in 1998. Africa, the Americas and South-East Asia each contributed about 30% when India is excluded. During 1994-2000, case detection did not decrease in these three WHO Regions. The 33 countries contributed 99% and 98% to global case detection in 1994 and 1998, respectively. Cumulative case detection for the top 33 minus India gradually increased, overall almost doubling. The contribution of the top 14 to case detection of the top 33 hardly changed over time, equalling 96% in 1998 (81% when India is excluded). In terms of annual case detection, Brazil was always ranked second after India; it accounted for 27% of 1998 case detection in the top 33 except India. In 1998, seven of the top 14 countries--including India and Brazil--had CDRs above 2 per 10,000. The CDR did not exceed 1 per 10,000 for the other half. Decreasing tendencies in CDR, either for the whole period or in the 1990s, are observed for four of the top 14 countries (Guinea and three Western Pacific countries: China, Vietnam and the Philippines). In conclusion, there is no general decline in case detection to date, and several important countries still have high CDRs. Prevalence is an irrelevant indicator for monitoring epidemiological changes in leprosy. Trends in the transmission and incidence of leprosy are still completely unclear, necessitating further research. The target to eliminate leprosy as a public health problem, defined as a prevalence of less than 1 per 10,000, is therefore also an inadequate yardstick for decision making on leprosy control.

Overcoming prejudice.

PIP: People of African descent comprise a large proportion of Brazil's population. While racism exists in the country, it is commonly denied. Most Afro-Brazilians live in poor areas, with poor health care services, sanitation, schools, and transport. Since HIV is linked to poverty, Afro-Brazilians are more affected by HIV than is the overall population. Although Afro-Brazilians contribute to Brazil's culture, they do not benefit from that contribution. Recognizing this considerable social problem, Project Araye was created in 1996 to address issues of race and HIV. Building upon religious and cultural traditions, the project is staffed by Afro-Brazilians who are knowledgeable in both health issues and Afro-Brazilian culture. Project Araye supports a wide range of diverse community leaders in linking sexual health and HIV with other health concerns which affect Afro-Brazilians such as sickle-cell anemia, diabetes, and leprosy. One important challenge has been overcoming the target population's denial of HIV and encouraging Afro-Brazilians to accept that HIV also affects them. Community leaders include religious leaders, rap musicians, artists, and other people respected by various communities. Activities include visits to samba dance schools, Umbanda and Candomble temples, and street youth groups to provide HIV-related information.^ieng

La eliminacion de la lepra de las mericas: situacion actual y perspectivas / Eliminating leprosy from the Americas: current situation and future perspectives

Leprosy, a disease that used to be shrouded in darkness and fear, can now be cured thanks to a multidrug treatment schedule with rifampicin, clofazimine, and dapsone which has been in use since 1981. In 1991 the World Health Assembly, encouraged by the efficacy of this treatment regimen, established the goal of eliminating the disease as a public health problem globally and nationally by the year 2000. This goal, which calls for reducing disease prevalence to less than one case per 10 000 inhabitants, should not be confused with the goal of eradicating the disease, which implies a complete interruption of its transmission. Eliminating leprosy is an attainable goal which will depend on the forceful and massive use of the multidrug treatment regimen. This paper describes and discusses the various initiatives that have been launched in Latin America for the purpose of achieving this goal and the results obtained so far. It also explores the factors that impact on the feasibility of eradicating the disease (AU) (AU)