Caracterización de la infestación de viviendas por Aedes aegypti en el área metropolitana de Cochabamba, Bolivia: nuevos registros altitudinales / Characterization of dwellings' infestation by Aedes aegypti in the metropolitan area of Cochabamba, Bolivia: new altitudinal records

La rápida proliferación del vector en áreas de clima cálido y baja altitud, como el oriente y la amazonia boliviana, generó la necesidad de analizar la adaptabilidad del A. aegypti en zonas templadas, tal es el caso de los valles mesotérmicos de la ciudad metropolitana de Cochabamba. La evaluación entomológica se realizó en una muestra de 264 viviendas seleccionadas al azar en Abril del 2016. El área de estudio abarca zonas urbanas de seis municipios (Cercado, Sacaba, Colcapirhua, Tiquipaya, Quillacollo y Vinto) del departamento de Cochabamba. El diseño para el estudio fue epidemiológico, transversal de diagnóstico comunitario. De la muestra referida, 100 viviendas se encontraron larvas de A. aegypti , que corresponde a un 38% de infestación larvaria y un Índice Breteau de 1,0. Las llantas, turriles y recipientes desechables son un factor de riesgo para la propagación y adaptación del vector en nuestra región. Los hallazgos confirman la dispersión del A. aegypti con algunas regiones con mayor prevalencia (zona sud de cercado urbano, Colcapirhua y Quillacollo en el valle bajo). También se evidenció por primera vez que la dispersión y colonización de larvas de A. aegypti en el área de estudio alcanzó una altura mínima de 2 538 m/s/n/m. y una altura máxima de 2 623 m.s.n.m. La prevención y el control de A. aegypti , en la metrópoli de Cochabamba va a requerir un trabajo mancomunado integral e intersectorial enfocados en una estrategia de intervención de gestión socioambiental de corresponsabilidad y participación comunitaria, generando como resultado un Manejo Integrado del Vector.

The fast proliferation of the vector at warm weather and low altitude over the sea level, such as the Bolivian valleys (as Cochabamba city), generates the need to analyze the adaptability of A. aegypti . This study of comunitary diagnosis, was developed at the metropolitan area of Cochabamba city, it confirms an spread A. aegypti , shown by georeferences of identified focus of high prevalence (sud of the city, Colcapirhua and Quillacollo as a low valley). For the first time this vector spread, reached between 2 538 to 2 623 meters over sea level. From 264 inspected houses over the city, 100 cases were found positive for A. aegypti (38%) (Breteau Index: 1,0). According to the study, tires, barrels and small containers are a risk factor for the spread and adaptation of the vector in our region. Prevention and control of A. aegypti in the metropolis of Cochabamba will require an integrated and intersectoral joint work, focused on a strategy of intervention socio-environmental and community participation, generating results in an Integrated Vector Management.

Perfil epidemiológico de la Influenza Humana A H1N1 en Cochabamba, Bolivia, gestiones 2009 a 2014 / Epidemiological profile of AH1N1 influenza in Bolivia Cochabamba; years 2009 to 2014

Introducción: en julio de 2009, la Organización Mundial de la Salud alertó acerca de la pandemia debida al virus A H1N1 que elevó la fase epidemiológica a 6, producto del grado de diseminación del virus pero no a la gravedad e impacto de la enfermedad, lo que depende de la vulnerabilidad de la población y la capacidad de respuesta sanitaria de cada región, país y continente respectivamente. Objetivo: analizar el perfil epidemiológico de la influenza A H1N1 en el departamento de Cochabamba, Bolivia. Métodos: el presente estudio es de tipo observacional, descriptivo y de corte transversal, realizado en el departamento de Cochabamba, mediante el análisis de todas las fichas epidemiológicas de los casos sospechosos durante las gestiones 2009 al 2014, con una muestra de 3655 fichas. Resultados: del total de casos sospechosos el 52% fueron varones y el 48 % mujeres, el grupo etario con mayor proporción fue el de los menores de 5 años con un 16%, del total de casos sospechosos el 79% fueron negativos y solo el 21% fueron positivos, los síntomas más frecuentes fueron la tos presente en el 84% de los casos, la faringitis en el 78%, la cefalea y la rinorrea en el 76%. Conclusión: la prevalencia de Influenza Humana A H1N1 en el departamento de Cochabamba, disminuyó progresivamente, existiendo un rebrote de la patología el 2014 con un aumento en el número de casos positivos y los casos de mortalidad.

Introduction: as of June 2009, the World Health Organization alerted about the pandemic due to A H1N1 raising the epidemiological phase 6 "pandemic” by degree of spread of the virus but not to the severity and impact disease, which depends on the vulnerability of the population and the health response capacity in each region, country and continent respectively. Objective: to analyze the epidemiological profile of influenza A H1N1 at Cochabamba, Bolivia Methods: an observational, descriptive and cross-sectional study conducted at the Department of Cochabamba, through the analysis of all epidemiological records of suspected cases; during the years 2009 to 2014, with a sample of 3655 patients. Results: of all suspected cases, 52% were male and 48% female, the age group with the highest proportion was that of the children under 5 years with 16% of the total suspected cases, 79% were negative and only 21% were positive, the most common symptoms reported were present in 84% of cases, cough, sore throat in 78%, headache and rhinorrhea in 76%. Conclusion: the prevalence of human influenza A H1N1 at the Department of Cochabamba, decreased progressively, there a new outbreak of the disease in 2014 with increased the number of positive cases and mortality.

Novel strain of Andes virus associated with fatal human infection, central Bolivia.

To better describe the genetic diversity of hantaviruses associated with human illness in South America, we screened blood samples from febrile patients in Chapare Province in central Bolivia during 2008-2009 for recent hantavirus infection. Hantavirus RNA was detected in 3 patients, including 1 who died. Partial RNA sequences of small and medium segments from the 3 patients were most closely related to Andes virus lineages but distinct (<90% nt identity) from reported strains. A survey for IgG against hantaviruses among residents of Chapare Province indicated that 12.2% of the population had past exposure to >1 hantaviruses; the highest prevalence was among agricultural workers. Because of the high level of human exposure to hantavirus strains and the severity of resulting disease, additional studies are warranted to determine the reservoirs, ecologic range, and public health effect of this novel strain of hantavirus.

Arboviral etiologies of acute febrile illnesses in Western South America, 2000-2007.

BACKGROUND: Arthropod-borne viruses (arboviruses) are among the most common agents of human febrile illness worldwide and the most important emerging pathogens, causing multiple notable epidemics of human disease over recent decades. Despite the public health relevance, little is know about the geographic distribution, relative impact, and risk factors for arbovirus infection in many regions of the world. Our objectives were to describe the arboviruses associated with acute undifferentiated febrile illness in participating clinics in four countries in South America and to provide detailed epidemiological analysis of arbovirus infection in Iquitos, Peru, where more extensive monitoring was conducted. METHODOLOGY/FINDINGS: A clinic-based syndromic surveillance system was implemented in 13 locations in Ecuador, Peru, Bolivia, and Paraguay. Serum samples and demographic information were collected from febrile participants reporting to local health clinics or hospitals. Acute-phase sera were tested for viral infection by immunofluorescence assay or RT-PCR, while acute- and convalescent-phase sera were tested for pathogen-specific IgM by ELISA. Between May 2000 and December 2007, 20,880 participants were included in the study, with evidence for recent arbovirus infection detected for 6,793 (32.5%). Dengue viruses (Flavivirus) were the most common arbovirus infections, totaling 26.0% of febrile episodes, with DENV-3 as the most common serotype. Alphavirus (Venezuelan equine encephalitis virus [VEEV] and Mayaro virus [MAYV]) and Orthobunyavirus (Oropouche virus [OROV], Group C viruses, and Guaroa virus) infections were both observed in approximately 3% of febrile episodes. In Iquitos, risk factors for VEEV and MAYV infection included being male and reporting to a rural (vs urban) clinic. In contrast, OROV infection was similar between sexes and type of clinic. CONCLUSIONS/SIGNIFICANCE: Our data provide a better understanding of the geographic range of arboviruses in South America and highlight the diversity of pathogens in circulation. These arboviruses are currently significant causes of human illness in endemic regions but also have potential for further expansion. Our data provide a basis for analyzing changes in their ecology and epidemiology.

Chapare virus, a newly discovered arenavirus isolated from a fatal hemorrhagic fever case in Bolivia.

A small focus of hemorrhagic fever (HF) cases occurred near Cochabamba, Bolivia, in December 2003 and January 2004. Specimens were available from only one fatal case, which had a clinical course that included fever, headache, arthralgia, myalgia, and vomiting with subsequent deterioration and multiple hemorrhagic signs. A non-cytopathic virus was isolated from two of the patient serum samples, and identified as an arenavirus by IFA staining with a rabbit polyvalent antiserum raised against South American arenaviruses known to be associated with HF (Guanarito, Machupo, and Sabiá). RT-PCR analysis and subsequent analysis of the complete virus S and L RNA segment sequences identified the virus as a member of the New World Clade B arenaviruses, which includes all the pathogenic South American arenaviruses. The virus was shown to be most closely related to Sabiá virus, but with 26% and 30% nucleotide difference in the S and L segments, and 26%, 28%, 15% and 22% amino acid differences for the L, Z, N, and GP proteins, respectively, indicating the virus represents a newly discovered arenavirus, for which we propose the name Chapare virus. In conclusion, two different arenaviruses, Machupo and Chapare, can be associated with severe HF cases in Bolivia.

Fiebre amarilla en Cochabamba / Yellow fever in Cochabamba

En el departemento de Cochabamba,la zona tropical corresponde a las provincias de Chapare,Carrasco y Ayopaya,que se constituyen en áreas propicias para la existencia de patologias tropicales,por otra parte,los problemas de inmunización persisten tanto por los flujos migratorios como por la renuencia de las y los pobladores a la vacunación.(au)

Atencion primaria de salud y medicos generales de areas: Cochabamba - Bolivia 1990 / Health primary care and general doctors of areas: Cochabamba-Bolivia 1990

El presente articulo, se refiere y presenta un enfoque descriptivo y analisis de la situacion del medico general del area que trabaja en zonas marginales de la ciudad de Cochabamba, relacionado con Atencion Primaria de Salud y numero de medicos no institucionales que concursan para cargos de los primeros, todo ello refleja la desocupacion de medicos y la probable repercucion en los programas de salud en areas. La genesis de los medicos de area se remonta a 1983 y emergen de las politicas de salud del Ministerio de Salud Publica, como tambien del perfin epidemiologico de las zonas marginales de centros urbanos, donde se hallan asentados habitantes de diferentes lugares del departamento y pais. Primero fueron conocidos como medicos PIAAS, en un gobierno popular de izquierda, luego medicos PAS, actualmente son medicos de area que cumplen las funciones en los programas de salud del Ministerio de Salud Publica. Hechos importantes en las transformaciones del sistema de salud del pueblo Boliviano, fueron las movilizaciones populares de salud, para ejecutar programas de inmunizaciones en forma masiva, con apoyo financiero de organismos internacionales. Asi aumentaron los medicos con dependencia economia, para luego, en los ultimos años, ser absorvidos por el presupuesto del Ministerio, consolidandose de esea forma como funcionarios. El trabajo cotidiano que dichos profesionales desarrollan en las areas, tienen como resultado los minicentros de salud con ubicacion estrategica y atencion eficiente a las personas. El desarrollo de dichas areas en materia de slaud, antes zonas deprimidas a la fecha constituyen motivo de analisis, en el sentido de que las 8 zonas de la regional de salud de Cochabamba, son puestos a prueba de fuego con la Institucionaliza, sin embargo quedan varias interrogantes