Ensuring access to essential health products: Lessons from Colombia's leishmaniasis control and elimination initiative.

BACKGROUND: This paper identifies opportunities and challenges for leishmaniasis control and elimination in Colombia, emphasizing the role of pooled procurement of essential medicines and supplies. Colombia is among the countries most affected by leishmaniasis globally, and also faces the dual challenge of procuring critically needed medicines in the context of limited national resources. It recently renewed its commitment to the control and elimination of leishmaniasis under its 2022-2031 Public Health Plan (PDSP) through a comprehensive public health approach. METHODOLOGY/PRINCIPAL FINDINGS: The methodology comprises a comprehensive literature review and key informant interviews with leishmaniasis experts from the Colombian national control program and PAHO/WHO, focusing on cutaneous, mucocutaneous, and visceral leishmaniasis. Leishmaniasis is endemic throughout Colombia, with over 11 million people at risk, many of whom live in poverty-stricken, remote and isolated rural areas with limited access to health services. Leishmaniasis care, including medicines, is provided free of charge, but many barriers were nonetheless identified at environmental, population, and health system levels, including the supply of quality-assured medicines. Opportunities to alleviate these barriers were identified, including the support of the PAHO Strategic Fund. Within the context of the sustainable development goals and international leishmaniasis control and elimination targets, Colombian officials have established their own priorities, the highest of which is the reduction of deaths from visceral leishmaniasis. CONCLUSIONS/SIGNIFICANCE: The elimination of leishmaniasis as a public health problem presents significant challenges, given its biological complexity and diversity, physical and clinical manifestations, social and economic impacts, frequently burdensome treatment regimens, and insufficient supply of necessary medicines. However, rigorous prevention and control efforts through strong political commitment and a highly motivated workforce can dramatically reduce its burden. Colombia's new PDSP, which highlights leishmaniasis control, is an opportunity for a revitalized health system response through committed leadership, intersectoral actions, and partnerships with international organizations that share a common vision.

From serological surveys to disease burden: a modelling pipeline for Chagas disease.

In 2012, the World Health Organization (WHO) set the elimination of Chagas disease intradomiciliary vectorial transmission as a goal by 2020. After a decade, some progress has been made, but the new 2021-2030 WHO roadmap has set even more ambitious targets. Innovative and robust modelling methods are required to monitor progress towards these goals. We present a modelling pipeline using local seroprevalence data to obtain national disease burden estimates by disease stage. Firstly, local seroprevalence information is used to estimate spatio-temporal trends in the Force-of-Infection (FoI). FoI estimates are then used to predict such trends across larger and fine-scale geographical areas. Finally, predicted FoI values are used to estimate disease burden based on a disease progression model. Using Colombia as a case study, we estimated that the number of infected people would reach 506 000 (95% credible interval (CrI) = 395 000-648 000) in 2020 with a 1.0% (95%CrI = 0.8-1.3%) prevalence in the general population and 2400 (95%CrI = 1900-3400) deaths (approx. 0.5% of those infected). The interplay between a decrease in infection exposure (FoI and relative proportion of acute cases) was overcompensated by a large increase in population size and gradual population ageing, leading to an increase in the absolute number of Chagas disease cases over time. This article is part of the theme issue 'Challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs'.

Lessons learned from the implementation of integrated serosurveillance of communicable diseases in the Americas.

Objective: Systematize the experience and identify challenges and lessons learned in the implementation of an initiative for integrated serosurveillance of communicable diseases using a multiplex bead assay in countries of the Americas. Methods: Documents produced in the initiative were compiled and reviewed. These included concept notes, internal working papers, regional meetings reports, and survey protocols from the three participating countries (Mexico, Paraguay, and Brazil) and two additional countries (Guyana and Guatemala) where serology for several communicable diseases was included in neglected tropical diseases surveys. Information was extracted and summarized to describe the experience and the most relevant challenges and lessons learned. Results: Implementing integrated serosurveys requires interprogrammatic and interdisciplinary work teams for the design of survey protocols to respond to key programmatic questions aligned to the needs of the countries. Valid laboratory results are critical and rely on the standardized installment and roll-out of laboratory techniques. Field teams require adequate training and supervision to properly implement survey procedures. The analysis and interpretation of serosurveys results should be antigen-specific, contextualizing the responses for each disease, and triangulated with programmatic and epidemiological data for making decisions tailored to specific population socioeconomic and ecologic contexts. Conclusions: Integrated serosurveillance as a complementary tool for functional epidemiological surveillance systems is feasible to use and key components should be considered: political engagement, technical engagement, and integrated planning. Aspects such as designing the protocol, selecting target populations and diseases, laboratory capacities, anticipating the capacities to analyze and interpret complex data, and how to use it are key.

Lessons learned from the implementation of integrated serosurveillance of communicable diseases in the Americas

[ABSTRACT]. Objective. Systematize the experience and identify challenges and lessons learned in the implementation of an initiative for integrated serosurveillance of communicable diseases using a multiplex bead assay in coun- tries of the Americas. Methods. Documents produced in the initiative were compiled and reviewed. These included concept notes, internal working papers, regional meetings reports, and survey protocols from the three participating countries (Mexico, Paraguay, and Brazil) and two additional countries (Guyana and Guatemala) where serology for sev- eral communicable diseases was included in neglected tropical diseases surveys. Information was extracted and summarized to describe the experience and the most relevant challenges and lessons learned. Results. Implementing integrated serosurveys requires interprogrammatic and interdisciplinary work teams for the design of survey protocols to respond to key programmatic questions aligned to the needs of the countries. Valid laboratory results are critical and rely on the standardized installment and roll-out of laboratory tech- niques. Field teams require adequate training and supervision to properly implement survey procedures. The analysis and interpretation of serosurveys results should be antigen-specific, contextualizing the responses for each disease, and triangulated with programmatic and epidemiological data for making decisions tailored to specific population socioeconomic and ecologic contexts. Conclusions. Integrated serosurveillance as a complementary tool for functional epidemiological surveil- lance systems is feasible to use and key components should be considered: political engagement, technical engagement, and integrated planning. Aspects such as designing the protocol, selecting target populations and diseases, laboratory capacities, anticipating the capacities to analyze and interpret complex data, and how to use it are key.

[RESUMEN]. Objetivo. Sistematizar la experiencia y determinar los desafíos y las enseñanzas obtenidas durante la apli- cación de una iniciativa de serovigilancia integrada de enfermedades transmisibles mediante un ensayo de perlas múltiples en países de la Región de las Américas. Métodos. Se recopilaron y revisaron los documentos generados en el marco de la iniciativa. Estos incluían notas conceptuales, documentos de trabajo internos, informes de reuniones regionales y protocolos de encuesta de los tres países participantes (Brasil, México y Paraguay) y otros dos países (Guatemala y Guyana) donde en las encuestas sobre enfermedades tropicales desatendidas también se incluía la serología para varias enfermedades transmisibles. Se recabó y resumió la información para describir tanto la experiencia como los desafíos y las enseñanzas de mayor relevancia. Resultados. La realización de encuestas serológicas integradas requiere equipos de trabajo interprogramáti- cos e interdisciplinarios para la elaboración de protocolos de encuesta que permitan responder a cuestiones programáticas fundamentales y ajustadas a las necesidades de los países. Es imprescindible contar con resultados de laboratorio válidos, para lo que es preciso que sus técnicas e instalaciones estén estandariza- das. Para que los equipos de campo puedan ejecutar correctamente los procedimientos de la encuesta, deben contar con una formación y supervisión adecuadas. El análisis y la interpretación de los resultados de las encuestas serológicas deben ser específicos para cada antígeno, situar las respuestas en el contexto de cada enfermedad y triangularse con los datos programáticos y epidemiológicos para tomar decisiones adaptadas a los contextos socioeconómicos y ecológicos específicos de la población. Conclusiones. Es uso de la vigilancia serológica integrada como una herramienta complementaria en los sistemas funcionales de vigilancia epidemiológica es algo posible; para esto deben tenerse en cuenta ciertos elementos fundamentales: el compromiso político, el compromiso técnico y la planificación integrada. A tal efecto, son fundamentales ciertos elementos como el diseño del protocolo, la selección de los grupos pobla- cionales y las enfermedades objetivo, la capacidad de los laboratorios, y la previsión de las capacidades de análisis e interpretación de datos complejos y la forma de utilizarlos.

[RESUMO]. Objetivo. Sistematizar a experiência e identificar desafios e lições aprendidas na implementação de uma iniciativa de vigilância sorológica integrada de doenças transmissíveis, usando ensaio de micro-esferas multiplex em países das Américas. Métodos. Os documentos produzidos na iniciativa foram compilados e examinados, e incluíram notas con- ceituais, documentos internos de trabalho, relatórios de reuniões regionais e protocolos de pesquisa dos três países participantes (México, Paraguai e Brasil) e de dois países adicionais (Guiana e Guatemala), onde a vigilância sorológica de várias doenças transmissíveis foi incluída em pesquisas sobre doenças tropicais negligenciadas. As informações foram extraídas e resumidas para descrever a experiência e os desafios e as lições aprendidas mais relevantes. Resultados. A implementação de inquéritos sorológicos integrados requer equipes de trabalho interpro- gramáticas e interdisciplinares para o delineamento de protocolos que respondam a questões programáticas chave, alinhadas com as necessidades dos países. Resultados laboratoriais válidos são essenciais, e depen- dem da instalação e implantação padronizadas de técnicas laboratoriais. As equipes de campo precisam de treinamento e supervisão apropriados para implementar adequadamente os procedimentos de pesquisa. A análise e a interpretação dos resultados dos inquéritos sorológicos devem ser antígeno-específicas, con- textualizando as respostas para cada doença, e trianguladas com dados programáticos e epidemiológicos para a tomada de decisões adaptadas aos contextos socioeconômicos e ecológicos específicos de cada população. Conclusões. A vigilância sorológica integrada como ferramenta complementar para sistemas de vigilância epidemiológica funcionais é viável. Os componentes-chave a seguir devem ser considerados: engajamento político, engajamento técnico e planejamento integrado. Aspectos como o delineamento do protocolo, a seleção de populações-alvo e doenças-alvo, a capacidade laboratorial, a previsão das capacidades para análise e interpretação de dados complexos e como usá-los são fundamentais.

Current status of the knowledge on the epidemiology of tungiasis in the Americas.

Objectives: To present the state-of-the-knowledge on the epidemiology of tungiasis in the Region of the Americas. Methods: A search of publications on the epidemiology of tungiasis in the Americas was performed in PubMed and LILACS databases from January 2007 to June 2021. In addition, a manual literature search on articles on the epidemiology of tungiasis was performed. Results: A total of 83 articles were analyzed which contained relevant information on tungiasis cases and their geographical distribution, prevalence and risk factors, life cycle, sites where transmission takes place, and zoonotic aspects. The on-host and off-host life cycles have been researched in detail. In certain contexts, the whole life cycle is completed indoors enabling transmission around the whole year. Cases were reported from 10 countries; 71% of them were from Brazil. In the general population, the prevalence varied between 1.0% and 82.6% according to the settings. Age-specific prevalence indicated that children and the elderly bear the highest disease burden. Risk factor studies indicate that tungiasis is associated with severe poverty. Conclusions: In the Americas, there are important gaps in information and knowledge of tungiasis. Understanding the burden, epidemiology, distribution, magnitude, related risk factors, and reservoirs, among others, is needed to develop and implement integrated control measures tailored to the context and patterns of transmission in the affected communities.

Current status of the knowledge on the epidemiology of tungiasis in the Americas

[ABSTRACT]. Objectives. To present the state-of-the-knowledge on the epidemiology of tungiasis in the Region of the Americas. Methods. A search of publications on the epidemiology of tungiasis in the Americas was performed in PubMed and LILACS databases from January 2007 to June 2021. In addition, a manual literature search on articles on the epidemiology of tungiasis was performed. Results. A total of 83 articles were analyzed which contained relevant information on tungiasis cases and their geographical distribution, prevalence and risk factors, life cycle, sites where transmission takes place, and zoonotic aspects. The on-host and off-host life cycles have been researched in detail. In certain contexts, the whole life cycle is completed indoors enabling transmission around the whole year. Cases were reported from 10 countries; 71% of them were from Brazil. In the general population, the prevalence varied between 1.0% and 82.6% according to the settings. Age-specific prevalence indicated that children and the elderly bear the highest disease burden. Risk factor studies indicate that tungiasis is associated with severe poverty. Conclusions. In the Americas, there are important gaps in information and knowledge of tungiasis. Understanding the burden, epidemiology, distribution, magnitude, related risk factors, and reservoirs, among others, is needed to develop and implement integrated control measures tailored to the context and patterns of transmission in the affected communities.

[RESUMEN]. Objetivos. Presentar el estado del conocimiento sobre las características epidemiológicas de la tungiasis en la Región de las Américas. Métodos. Se hizo una búsqueda de publicaciones sobre las características epidemiológicas de la tungiasis en la Región en las bases de datos PubMed y LILACS en el período comprendido entre enero del 2007 y junio del 2021. Además, se realizó una búsqueda bibliográfica manual de artículos sobre las características epidemiológicas de la tungiasis. Resultados. Se analizaron en total 83 artículos que contenían información pertinente sobre casos de tungiasis y su distribución geográfica, prevalencia y factores de riesgo, ciclo de vida, lugares donde se produce la transmisión y aspectos zoonóticos. Se investigaron en detalle los ciclos de vida dentro y fuera del huésped. En ciertos contextos, la totalidad del ciclo de vida se completa en espacios cerrados, lo que permite la transmisión durante todo el año. Se notificaron casos en 10 países, con 71% de los casos notificados en Brasil. En la población general, la prevalencia varió entre 1,0% y 82,6% según el entorno. La prevalencia específica por edad indica que la población infantil y las personas mayores tienen la mayor carga de morbilidad. Los estudios relativos a los factores de riesgo indican que la tungiasis está relacionada con la pobreza extrema. Conclusiones. En la Región, hay lagunas importantes en la información y el conocimiento sobre la tungiasis. Es necesario comprender la carga, las características epidemiológicas, la distribución, la magnitud, los factores de riesgo relacionados y los reservorios, entre otros factores, para elaborar y aplicar medidas de control integradas adaptadas al contexto y los patrones de transmisión en las comunidades afectadas.

[RESUMO]. Objetivos. Apresentar o estado do conhecimento sobre a epidemiologia da tungíase na Região das Américas. Métodos. Realizou-se uma pesquisa de estudos publicados de janeiro de 2007 a junho de 2021 sobre a epidemiologia da tungíase nas Américas nas bases de dados PubMed e LILACS, bem como uma pesquisa bibliográfica manual de artigos sobre a epidemiologia da tungíase. Resultados. Analisou-se um total de 83 artigos com informações de interesse sobre casos de tungíase e sua distribuição geográfica, prevalência e fatores de risco, ciclo vital, locais de transmissão e aspectos zoonóticos. Os ciclos vitais dentro e fora do hospedeiro foram pesquisados em detalhes. Em determinados contextos, todo o ciclo vital ocorre em ambientes fechados, o que possibilita a transmissão durante todo o ano. Relataram-se casos de 10 países; 71% deles no Brasil. Na população em geral, a prevalência variou de 1,0% a 82,6%, de acordo com o local. A prevalência específica por idade mostrou que a maior carga de doença ocorre em crianças e pessoas idosas. Estudos dos fatores de risco indicam que a tungíase está associada à extrema pobreza. Conclusões. Nas Américas, existem importantes lacunas de informação e conhecimento sobre a tungíase. É necessário compreender fatores como carga, epidemiologia, distribuição, magnitude, fatores de risco relacionados e reservatórios, entre outros, para desenvolver e implementar medidas integradas de controle adequadas ao contexto e aos padrões de transmissão nas comunidades afetadas.

Current status of the knowledge on the epidemiology of tungiasis in the Americas / Estado actual del conocimiento sobre las características epidemiológicas de la tungiasis en la Región de las Américas / Situação atual do conhecimento sobre a epidemiologia da tungíase nas Américas

ABSTRACT Objectives. To present the state-of-the-knowledge on the epidemiology of tungiasis in the Region of the Americas. Methods. A search of publications on the epidemiology of tungiasis in the Americas was performed in PubMed and LILACS databases from January 2007 to June 2021. In addition, a manual literature search on articles on the epidemiology of tungiasis was performed. Results. A total of 83 articles were analyzed which contained relevant information on tungiasis cases and their geographical distribution, prevalence and risk factors, life cycle, sites where transmission takes place, and zoonotic aspects. The on-host and off-host life cycles have been researched in detail. In certain contexts, the whole life cycle is completed indoors enabling transmission around the whole year. Cases were reported from 10 countries; 71% of them were from Brazil. In the general population, the prevalence varied between 1.0% and 82.6% according to the settings. Age-specific prevalence indicated that children and the elderly bear the highest disease burden. Risk factor studies indicate that tungiasis is associated with severe poverty. Conclusions. In the Americas, there are important gaps in information and knowledge of tungiasis. Understanding the burden, epidemiology, distribution, magnitude, related risk factors, and reservoirs, among others, is needed to develop and implement integrated control measures tailored to the context and patterns of transmission in the affected communities.

RESUMEN Objetivos. Presentar el estado del conocimiento sobre las características epidemiológicas de la tungiasis en la Región de las Américas. Métodos. Se hizo una búsqueda de publicaciones sobre las características epidemiológicas de la tungiasis en la Región en las bases de datos PubMed y LILACS en el período comprendido entre enero del 2007 y junio del 2021. Además, se realizó una búsqueda bibliográfica manual de artículos sobre las características epidemiológicas de la tungiasis. Resultados. Se analizaron en total 83 artículos que contenían información pertinente sobre casos de tungiasis y su distribución geográfica, prevalencia y factores de riesgo, ciclo de vida, lugares donde se produce la transmisión y aspectos zoonóticos. Se investigaron en detalle los ciclos de vida dentro y fuera del huésped. En ciertos contextos, la totalidad del ciclo de vida se completa en espacios cerrados, lo que permite la transmisión durante todo el año. Se notificaron casos en 10 países, con 71% de los casos notificados en Brasil. En la población general, la prevalencia varió entre 1,0% y 82,6% según el entorno. La prevalencia específica por edad indica que la población infantil y las personas mayores tienen la mayor carga de morbilidad. Los estudios relativos a los factores de riesgo indican que la tungiasis está relacionada con la pobreza extrema. Conclusiones. En la Región, hay lagunas importantes en la información y el conocimiento sobre la tungiasis. Es necesario comprender la carga, las características epidemiológicas, la distribución, la magnitud, los factores de riesgo relacionados y los reservorios, entre otros factores, para elaborar y aplicar medidas de control integradas adaptadas al contexto y los patrones de transmisión en las comunidades afectadas.

RESUMO Objetivos. Apresentar o estado do conhecimento sobre a epidemiologia da tungíase na Região das Américas. Métodos. Realizou-se uma pesquisa de estudos publicados de janeiro de 2007 a junho de 2021 sobre a epidemiologia da tungíase nas Américas nas bases de dados PubMed e LILACS, bem como uma pesquisa bibliográfica manual de artigos sobre a epidemiologia da tungíase. Resultados. Analisou-se um total de 83 artigos com informações de interesse sobre casos de tungíase e sua distribuição geográfica, prevalência e fatores de risco, ciclo vital, locais de transmissão e aspectos zoonóticos. Os ciclos vitais dentro e fora do hospedeiro foram pesquisados em detalhes. Em determinados contextos, todo o ciclo vital ocorre em ambientes fechados, o que possibilita a transmissão durante todo o ano. Relataram-se casos de 10 países; 71% deles no Brasil. Na população em geral, a prevalência variou de 1,0% a 82,6%, de acordo com o local. A prevalência específica por idade mostrou que a maior carga de doença ocorre em crianças e pessoas idosas. Estudos dos fatores de risco indicam que a tungíase está associada à extrema pobreza. Conclusões. Nas Américas, existem importantes lacunas de informação e conhecimento sobre a tungíase. É necessário compreender fatores como carga, epidemiologia, distribuição, magnitude, fatores de risco relacionados e reservatórios, entre outros, para desenvolver e implementar medidas integradas de controle adequadas ao contexto e aos padrões de transmissão nas comunidades afetadas.

Trachoma elimination in Latin America: prioritization of municipalities for surveillance activities

[ABSTRACT]. Objective. To identify and prioritize municipalities in 22 countries of Latin America for trachoma surveillance activities, to measure the absence or prevalence of trachoma, and to support validation and trachoma elimination efforts in the Region of the Americas. Methods. A prioritization scale was developed in 2017 to rank each municipality by considering a combination of three characteristics: (a) its trachoma vulnerability index, derived from three socioeconomic factors known to be risks for trachoma—lack of access to improved sanitation, to clean drinking water, and to adequate education, according to housing census data from early 2017; (b) its history of trachoma in countries where the disease was not a known public health problem in 2016; and (c) whether or not it shares a border with a municipality where trachoma was a known public health problem in 2016. Municipalities in 22 countries were classified as either very high, high, medium, or low priority for trachoma surveillance. From the Caribbean, only Trinidad and Tobago met inclusion criteria. Results. The prioritization scale identified 1 053 municipalities in Brazil, Colombia, and Guatemala as very high priority for trachoma surveillance. In Ecuador, El Salvador, Guyana, Paraguay, Peru, Suriname, and Venezuela, 183 municipalities were ranked as high priority, and in Argentina, Belize, Bolivia, Chile, Dominican Republic, Honduras, Nicaragua, Panama, and Uruguay, 677 municipalities were designated a medium priority for trachoma surveillance. Conclusions. This prioritization scale will be useful to countries in Latin America that still need to ascertain their current trachoma situation. The absence or prevalence of trachoma in countries designated as very high and high priority for trachoma surveillance activities must be studied to determine the extent of the disease in Latin America.

[RESUMEN]. Objetivo. Establecer y priorizar los municipios en 22 países de América Latina para desempeñar actividades de vigilancia del tracoma, medir la ausencia o la prevalencia del tracoma, y brindar apoyo a la validación y las iniciativas de eliminación del tracoma en la Región de las Américas. Métodos. En el 2017, se creó una escala de asignación de prioridades con el fin de clasificar cada municipio teniendo presente una combinación de tres características: a) el índice de vulnerabilidad al tracoma, derivado de los tres factores socioeconómicos conocidos por ser factores de riesgos para el tracoma (falta de acceso del municipio a mejores instalaciones sanitarias, agua potable limpia y educación adecuada), según los datos del censo de vivienda de principios del 2017; b) los antecedentes de tracoma en los países en que la enfermedad no se conocía como problema de salud pública en el año 2016, y c) si el municipio comparte frontera con otro donde el tracoma supuso un problema de salud pública en el 2016. Se clasificaron municipios de 22 países según un criterio de prioridad muy alta, alta, media o baja de vigilancia del tracoma. En el Caribe, únicamente Trinidad y Tabago cumplieron los criterios de inclusión. Resultados. Mediante la escala de asignación de prioridades se establecieron 1 053 municipios en Brasil, Colombia y Guatemala con prioridad muy alta de vigilancia del tracoma. En Ecuador, El Salvador, Guyana, Paraguay, Perú, Suriname y Venezuela, 183 municipios se clasificaron con prioridad alta y en Argentina, Belice, Bolivia, Chile, República Dominicana, Honduras, Nicaragua, Panamá y Uruguay, se asignó a 677 municipios una prioridad media de vigilancia del tracoma. Conclusiones. Esta escala de asignación de prioridades será una herramienta útil para los países en América Latina que todavía necesitan evaluar su actual situación de tracoma. Debe estudiarse la ausencia o prevalencia del tracoma en los países designados con prioridades muy alta y alta para las actividades de vigilancia de tracoma con el fin de determinar la magnitud de la enfermedad en América Latina.

[RESUMO]. Objetivo. Identificar e priorizar os municípios em 22 países da América Latina para realizar atividades de vigilância epidemiológica do tracoma, determinar a ausência ou a prevalência do tracoma e dar apoio à validação e aos esforços de eliminação da doença na Região das Américas. Métodos. Uma escala de priorização foi elaborada em 2017 para classificar cada município segundo três critérios combinados: (a) índice de vulnerabilidade ao tracoma, estimado com base em três fatores socioeconômicos conhecidos como riscos à doença – falta de acesso a um melhor saneamento básico, à água para consumo e a uma educação adequada, segundo dados do censo habitacional realizado no início de 2017; (b) antecedentes do tracoma nos países onde a doença não era um problema conhecido de saúde pública em 2016 e (c) fazer divisa ou não com um município onde o tracoma era um problema conhecido de saúde pública em 2016. Os municípios de 22 países foram classificados como de prioridade muito alta, alta, média ou baixa para a vigilância do tracoma. No Caribe, apenas Trinidad e Tobago satisfez os critérios de inclusão. Resultados. De acordo com a escala de priorização, 1.053 municípios no Brasil, Colômbia e Guatemala foram classificados como de prioridade muito alta; 183 municípios no Equador, El Salvador, Guiana, Paraguai, Peru, Suriname e Venezuela como de prioridade alta, e 677 municípios na Argentina, Belize, Bolívia, Chile, República Dominicana, Honduras, Nicarágua, Panamá e Uruguai foram qualificados como de prioridade média para a vigilância do tracoma. Conclusões. A escala de priorização será um instrumento útil aos países na América Latina que ainda precisam determinar sua situação atual em relação ao tracoma. A ausência ou a prevalência da doença deve ser pesquisada nos países classificados como de prioridade muito alta e alta para as atividades de vigilância para que se possa conhecer a extensão do tracoma na América Latina.

Epidemiological situation of yaws in the Americas: A systematic review in the context of a regional elimination goal.

BACKGROUND: Yaws is targeted for eradication by 2020 in the WHA66.12 resolution of the World Health Assembly. The objective of this study was to describe the occurrence of yaws in the Americas and to contribute to the compilation of evidence based on published data to undertake the certification of yaws eradication. METHODOLOGY: A systematic review of the epidemiological situation of yaws in the Americas was performed by searching in MEDLINE, Embase, LILACS, SCOPUS, Web of Science, DARE and Cochrane Database of Systematic Reviews. Experts on the topic were consulted, and institutional WHO/PAHO library databases were reviewed. PRINCIPAL FINDINGS: Seventy-five full-text articles published between 1839 and 2012 met the inclusion criteria. Haiti and Jamaica were the two countries with the highest number of papers (14.7% and 12.0%, respectively). Three-quarters of the studies were conducted before 1970. Thirty-three countries reported yaws case count or prevalence data. The largest foci in the history were described in Brazil and Haiti. The most recent cases reported were recorded in eight countries: Suriname, Guyana, Colombia, Haiti, Martinique, Dominica, Trinidad and Tobago, and Brazil. Gaps in information and heterogeneity were detected in the methodologies used and outcome reporting, making cross-national and chronological comparisons difficult. CONCLUSIONS: The lack of recent yaws publications may reflect, in the best-case scenario, the interruption of yaws transmission. It should be possible to reach the eradication goal in the region of the Americas, but it is necessary to collect more information. We suggest updating the epidemiological status of yaws, especially in two countries that need to assess ongoing transmission. Twenty-four countries need to demonstrate the interruption of transmission and declare its status of yaws endemicity, and sixteen countries should declare if they are yaws-free. It is necessary to formally verify the achievement of this goal in Ecuador.

The decline of dengue in the Americas in 2017: discussion of multiple hypotheses.

OBJECTIVE: Since the 1980s, dengue incidence has increased 30-fold. However, in 2017, there was a noticeable reduction in reported dengue incidence cases within the Americas, including severe and fatal cases. Understanding the mechanism underlying dengue's incidence and decline in the Americas is vital for public health planning. We aimed to provide plausible explanations for the decline in 2017. METHODS: An expert panel of representatives from scientific and academic institutions, Ministry of Health officials from Latin America and PAHO/WHO staff met in October 2017 to propose hypotheses. The meeting employed six moderated plenary discussions in which participants reviewed epidemiological evidence, suggested explanatory hypotheses, offered their expert opinions on each and developed a consensus. RESULTS: The expert group established that in 2017, there was a generalised decreased incidence, severity and number of deaths due to dengue in the Americas, accompanied by a reduction in reported cases of both Zika and chikungunya virus infections, with no change in distribution among age groups affected. This decline was determined to be unlikely due to changes in epidemiological surveillance systems, as similar designs of surveillance systems exist across the region. Although sudden surveillance disruption is possible at a country or regional level, it is unlikely to occur in all countries simultaneously. Retrospective modelling with epidemiological, immunological and entomological information is needed. Host or immunological factors may have influenced the decline in dengue cases at the population level through immunity; however, herd protection requires additional evidence. Uncertainty remains regarding the effect on the outcome of sequential infections of different dengue virus (DENV) types and Zika virus (ZIKV), and vice versa. Future studies were recommended that examine the epidemiological effect of prior DENV infection on Zika incidence and severity, the epidemiological effect of prior Zika virus infection on dengue incidence and severity, immune correlates based on new-generation ELISA assays, and impact of prior DENV/other arbovirus infection on ZIKV immune response in relation to number of infections and the duration of antibodies in relation to interval of protection. Follow-up studies should also investigate whether increased vector control intensification activities contributed to the decline in transmission of one or more of these arboviruses. Additionally, proposed studies should focus on the potential role of vector competence when simultaneously exposed to various arboviruses, and on entomological surveillance and its impact on circulating vector species, with a goal of applying specific measures that mitigate seasonal occurrence or outbreaks. CONCLUSIONS: Multifactorial events may have accounted for the decline in dengue seen in 2017. Differing elements might explain the reduction in dengue including elements of immunity, increased vector control, and even vector and\or viruses changes or adaptations. Most of the results of this expert consensus group meeting are hypothetical and based on limited evidence. Further studies are needed.

OBJECTIF: Depuis les années 1980, l'incidence de la dengue a été multipliée par 30. Cependant, en 2017, il y a eu une réduction notable du nombre de cas d'incidence de dengue rapportés dans les Amériques. Nous voulions fournir des explications plausibles à la baisse en 2017. MÉTHODES: Un groupe d'experts constitué de représentants d'institutions scientifiques et académiques, d'officiels des Ministères de la Santé d'Amérique Latine et de membres du personnel de l'OPS/OMS s'est réuni en octobre 2017 pour proposer et évaluer des hypothèses. RÉSULTATS: En 2017, il y a eu une baisse généralisée de l'incidence, de la sévérité et du nombre de décès dus à la dengue dans les Amériques, accompagnée d'une réduction des cas rapportés d'infections par le virus Zika et par le virus du chikungunya, sans modification dans la répartition entre les groupes d'âge affectés. Il a été déterminé que ce déclin était peu probablement dû aux changements dans les systèmes de surveillance épidémiologique, étant donné que des systèmes de surveillance similaires existaient dans toute la région. Bien que des perturbations soudaines dans la surveillance soient possibles au niveau national ou régional, il est peu probable que cela se produise simultanément dans tous les pays. Une modélisation rétrospective avec des informations épidémiologiques, immunologiques et entomologiques est nécessaire. Des facteurs liés à l'hôte ou immunologiques peuvent avoir influencé le déclin des cas de dengue au niveau de la population par le biais de l'immunité; cependant, l'évidence d'une protection conférée par l'effet du troupeau nécessite des données supplémentaires. Une incertitude subsiste quant à l'effet sur le résultat des infections séquentielles de différents types du virus de la dengue (DENV) et du virus Zika (ZIKV), et vice-versa. Les études à venir devraient examiner (1) l'effet épidémiologique d'une infection antérieure par le DENV sur l'incidence et la sévérité du virus Zika, (2) l'effet épidémiologique d'une infection antérieure par le virus Zika sur l'incidence et la sévérité de la dengue, (3) les corrélats immunitaires basés sur des tests ELISA de nouvelle génération, (4) l' impact d'une infection antérieure à DENV/autres arbovirus sur la réponse immunitaire au ZIKV en fonction du nombre d'infections et de la durée des anticorps en fonction de l'intervalle de protection, (5) si des activités d'intensification de la lutte antivectorielle ont contribué à la diminution de la transmission d'un ou plusieurs de ces arbovirus, (6) le rôle potentiel de la compétence vectorielle lorsqu'ils sont exposés simultanément à différents arbovirus, (7) la surveillance entomologique et son impact sur la circulation d'espèces de vecteurs, dans le but d'appliquer des mesures spécifiques qui réduisent l'occurrence saisonnière d'épidémies. CONCLUSIONS: Des événements multifactoriels pourraient expliquer le déclin observé de la dengue en 2017. La plupart des résultats de cette réunion du groupe de consensus d'experts sont hypothétiques, reposent sur des données limitées et requièrent des investigations supplémentaires.

Trachoma elimination in Latin America: prioritization of municipalities for surveillance activities.

OBJECTIVE: To identify and prioritize municipalities in 22 countries of Latin America for trachoma surveillance activities, to measure the absence or prevalence of trachoma, and to support validation and trachoma elimination efforts in the Region of the Americas. METHODS: A prioritization scale was developed in 2017 to rank each municipality by considering a combination of three characteristics: (a) its trachoma vulnerability index, derived from three socioeconomic factors known to be risks for trachoma-lack of access to improved sanitation, to clean drinking water, and to adequate education, according to housing census data from early 2017; (b) its history of trachoma in countries where the disease was not a known public health problem in 2016; and (c) whether or not it shares a border with a municipality where trachoma was a known public health problem in 2016. Municipalities in 22 countries were classified as either very high, high, medium, or low priority for trachoma surveillance. From the Caribbean, only Trinidad and Tobago met inclusion criteria. RESULTS: The prioritization scale identified 1 053 municipalities in Brazil, Colombia, and Guatemala as very high priority for trachoma surveillance. In Ecuador, El Salvador, Guyana, Paraguay, Peru, Suriname, and Venezuela, 183 municipalities were ranked as high priority, and in Argentina, Belize, Bolivia, Chile, Dominican Republic, Honduras, Nicaragua, Panama, and Uruguay, 677 municipalities were designated a medium priority for trachoma surveillance. CONCLUSIONS: This prioritization scale will be useful to countries in Latin America that still need to ascertain their current trachoma situation. The absence or prevalence of trachoma in countries designated as very high and high priority for trachoma surveillance activities must be studied to determine the extent of the disease in Latin America.

Experiencia del desarrollo de herramientas para el monitoreo de coberturas de vacunación y quimioterapia preventiva

[RESUMEN]. Objetivo. Describir la experiencia y las lecciones aprendidas en el desarrollo de herramientas para el monitoreo de las coberturas de vacunación y de quimioterapia preventiva en las Américas. Métodos. Se compiló y revisó la documentación disponible en los programas regionales de inmunización integral de la familia y de las enfermedades infecciosas desatendidas de la Organización Panamericana de la Salud/Organización Mundial de la Salud producida durante el proceso de desarrollo de las herramientas entre 2012 y 2017 incluidos: búsqueda sistemática de literatura, reportes técnicos, informes de reuniones internas, reporte de la prueba piloto e informes y resultados de las evaluaciones de los talleres de entrenamiento en doce países de las Américas. La documentación se organizó, se extrajo la información más relevante sobre el desarrollo de las herramientas y se consensuaron las principales lecciones aprendidas en el proceso. Resultados. El proceso facilitó la organización y sistematización de las herramientas aplicadas durante las últimas dos décadas en los programas de vacunación en las Américas para el análisis y monitoreo de las coberturas y su rápida adaptación para el monitoreo de las coberturas de la quimioterapia preventiva. Se integró un conjunto de herramientas cuya aplicación se define con un algoritmo de decisiones y pueden ser utilizadas por los países. Conclusiones. Las lecciones aprendidas pueden aplicarse para desarrollos similares y para promover el trabajo interprogramático en salud pública. El trabajo integrado aceleró el desarrollo de herramientas útiles para los países.

[ABSTRACT]. Objective. Describe the experience and lessons learned in the development of tools to monitor vaccination coverage and preventive chemotherapy coverage in the Americas. Methods. The available documentation on Pan American Health Organization/ World Health Organization regional programs for comprehensive family immunization and neglected infectious diseases––produced during the process of tool development from 2012 to 2017––was compiled and reviewed, including: systematic literature search, technical reports, internal meeting reports, pilot study report, and reports and results from evaluations of training workshops in 12 countries of the Americas. The documentation was organized, gleaning the most relevant information on tool development, and consensus was reached on the principal lessons learned in the process. Results. The process facilitated the organization and dissemination of tools used to analyze and monitor vaccination coverage during the last two decades in vaccination programs in the Americas, and the rapid adaptation of these tools for monitoring preventive chemotherapy coverage. A toolkit was put together, accompanied by a decision tree to aid in its application, which countries can use.

[RESUMO]. Objetivo. Descrever a experiência e as lições aprendidas no desenvolvimento de ferramentas para o monitoramento da cobertura vacinal e quimioprofilaxia nas Américas. Métodos. Foi coletada e revisada a documentação disponível nos programas regionais de imunização integral da família e doenças infecciosas negligenciadas da Organização Pan-Americana da Saúde/Organização Mundial da Saúde, produzida no processo de desenvolvimento de ferramentas entre 2012 e 2017. Os arquivos englobavam resultados de busca sistemática da literatura, relatórios técnicos, atas de reuniões internas, informe de teste-piloto e relatórios e resultados das avaliações dos seminários de capacitação em 12 países das Américas. A documentação foi organizada e foram extraídos os dados mais relevantes sobre o desenvolvimento das ferramentas. As principais lições aprendidas no processo foram decididas por consenso. Resultados. O processo facilitou a organização e a sistematização das ferramentas empregadas nas últimas duas décadas nos programas de vacinação nas Américas para avaliação e monitoramento da cobertura vacinal e sua rápida adaptação para o monitoramento da cobertura da quimioprofilaxia. Foi integrado um conjunto de ferramentas cuja aplicação é definida com um algoritmo de decisões e que pode ser utilizado pelos países. Conclusões. As lições aprendidas podem ser aplicadas em processos semelhantes de desenvolvimento e para promover o trabalho interprogramático em saúde pública. O trabalho integrado acelerou o desenvolvimento de ferramentas úteis para os países.

[Experience with development of tools to monitor vaccination coverage and preventive chemotherapy coverageExperiência do desenvolvimento de ferramentas para o monitoramento da cobertura vacinal e quimioprofilaxia]. / Experiencia del desarrollo de herramientas para el monitoreo de coberturas de vacunación y quimioterapia preventiva.

OBJETIVO: Describir la experiencia y las lecciones aprendidas en el desarrollo de herramientas para el monitoreo de las coberturas de vacunación y de quimioterapia preventiva en las Américas. MÉTODOS: Se compiló y revisó la documentación disponible en los programas regionales de inmunización integral de la familia y de las enfermedades infecciosas desatendidas de la Organización Panamericana de la Salud/Organización Mundial de la Salud producida durante el proceso de desarrollo de las herramientas entre 2012 y 2017 incluidos: búsqueda sistemática de literatura, reportes técnicos, informes de reuniones internas, reporte de la prueba piloto e informes y resultados de las evaluaciones de los talleres de entrenamiento en doce países de las Américas. La documentación se organizó, se extrajo la información más relevante sobre el desarrollo de las herramientas y se consensuaron las principales lecciones aprendidas en el proceso. RESULTADOS: El proceso facilitó la organización y sistematización de las herramientas aplicadas durante las últimas dos décadas en los programas de vacunación en las Américas para el análisis y monitoreo de las coberturas y su rápida adaptación para el monitoreo de las coberturas de la quimioterapia preventiva. Se integró un conjunto de herramientas cuya aplicación se define con un algoritmo de decisiones y pueden ser utilizadas por los países. CONCLUSIONES: Las lecciones aprendidas pueden aplicarse para desarrollos similares y para promover el trabajo interprogramático en salud pública. El trabajo integrado aceleró el desarrollo de herramientas útiles para los países.

OBJETIVO: Descrever a experiência e as lições aprendidas no desenvolvimento de ferramentas para o monitoramento da cobertura vacinal e quimioprofilaxia nas Américas. MÉTODOS: Foi coletada e revisada a documentação disponível nos programas regionais de imunização integral da família e doenças infecciosas negligenciadas da Organização Pan-Americana da Saúde/Organização Mundial da Saúde, produzida no processo de desenvolvimento de ferramentas entre 2012 e 2017. Os arquivos englobavam resultados de busca sistemática da literatura, relatórios técnicos, atas de reuniões internas, informe de teste-piloto e relatórios e resultados das avaliações dos seminários de capacitação em 12 países das Américas. A documentação foi organizada e foram extraídos os dados mais relevantes sobre o desenvolvimento das ferramentas. As principais lições aprendidas no processo foram decididas por consenso. RESULTADOS: O processo facilitou a organização e a sistematização das ferramentas empregadas nas últimas duas décadas nos programas de vacinação nas Américas para avaliação e monitoramento da cobertura vacinal e sua rápida adaptação para o monitoramento da cobertura da quimioprofilaxia. Foi integrado um conjunto de ferramentas cuja aplicação é definida com um algoritmo de decisões e que pode ser utilizado pelos países. CONCLUSÕES: As lições aprendidas podem ser aplicadas em processos semelhantes de desenvolvimento e para promover o trabalho interprogramático em saúde pública. O trabalho integrado acelerou o desenvolvimento de ferramentas úteis para os países.

Experiencia del desarrollo de herramientas para el monitoreo de coberturas de vacunación y quimioterapia preventiva / Experience with development of tools to monitor vaccination coverage and preventive chemotherapy coverage / Experiência do desenvolvimento de ferramentas para o monitoramento da cobertura vacinal e quimioprofilaxia

RESUMEN Objetivo Describir la experiencia y las lecciones aprendidas en el desarrollo de herramientas para el monitoreo de las coberturas de vacunación y de quimioterapia preventiva en las Américas. Métodos Se compiló y revisó la documentación disponible en los programas regionales de inmunización integral de la familia y de las enfermedades infecciosas desatendidas de la Organización Panamericana de la Salud/Organización Mundial de la Salud producida durante el proceso de desarrollo de las herramientas entre 2012 y 2017 incluidos: búsqueda sistemática de literatura, reportes técnicos, informes de reuniones internas, reporte de la prueba piloto e informes y resultados de las evaluaciones de los talleres de entrenamiento en doce países de las Américas. La documentación se organizó, se extrajo la información más relevante sobre el desarrollo de las herramientas y se consensuaron las principales lecciones aprendidas en el proceso. Resultados El proceso facilitó la organización y sistematización de las herramientas aplicadas durante las últimas dos décadas en los programas de vacunación en las Américas para el análisis y monitoreo de las coberturas y su rápida adaptación para el monitoreo de las coberturas de la quimioterapia preventiva. Se integró un conjunto de herramientas cuya aplicación se define con un algoritmo de decisiones y pueden ser utilizadas por los países. Conclusiones Las lecciones aprendidas pueden aplicarse para desarrollos similares y para promover el trabajo interprogramático en salud pública. El trabajo integrado aceleró el desarrollo de herramientas útiles para los países.

ABSTRACT Objective Describe the experience and lessons learned in the development of tools to monitor vaccination coverage and preventive chemotherapy coverage in the Americas. Methods The available documentation on Pan American Health Organization/World Health Organization regional programs for comprehensive family immunization and neglected infectious diseases--produced during the process of tool development from 2012 to 2017--was compiled and reviewed, including: systematic literature search, technical reports, internal meeting reports, pilot study report, and reports and results from evaluations of training workshops in 12 countries of the Americas. The documentation was organized, gleaning the most relevant information on tool development, and consensus was reached on the principal lessons learned in the process. Results The process facilitated the organization and dissemination of tools used to analyze and monitor vaccination coverage during the last two decades in vaccination programs in the Americas, and the rapid adaptation of these tools for monitoring preventive chemotherapy coverage. A toolkit was put together, accompanied by a decision tree to aid in its application, which countries can use.

RESUMO Objetivo Descrever a experiência e as lições aprendidas no desenvolvimento de ferramentas para o monitoramento da cobertura vacinal e quimioprofilaxia nas Américas. Métodos Foi coletada e revisada a documentação disponível nos programas regionais de imunização integral da família e doenças infecciosas negligenciadas da Organização Pan-Americana da Saúde/Organização Mundial da Saúde, produzida no processo de desenvolvimento de ferramentas entre 2012 e 2017. Os arquivos englobavam resultados de busca sistemática da literatura, relatórios técnicos, atas de reuniões internas, informe de teste-piloto e relatórios e resultados das avaliações dos seminários de capacitação em 12 países das Américas. A documentação foi organizada e foram extraídos os dados mais relevantes sobre o desenvolvimento das ferramentas. As principais lições aprendidas no processo foram decididas por consenso. Resultados O processo facilitou a organização e a sistematização das ferramentas empregadas nas últimas duas décadas nos programas de vacinação nas Américas para avaliação e monitoramento da cobertura vacinal e sua rápida adaptação para o monitoramento da cobertura da quimioprofilaxia. Foi integrado um conjunto de ferramentas cuja aplicação é definida com um algoritmo de decisões e que pode ser utilizado pelos países. Conclusões As lições aprendidas podem ser aplicadas em processos semelhantes de desenvolvimento e para promover o trabalho interprogramático em saúde pública. O trabalho integrado acelerou o desenvolvimento de ferramentas úteis para os países.

Malaria in the Americas: trends from 1959 to 2011.

Malaria has declined in recent years in countries of the American continents. In 2011, 12 of 21 endemic countries had already met their 2015 Millennium Development Goal. However, this declining trend has not been adequately evaluated. An analysis of the number of cases per 100,000 people (annual parasite index [API]) and the percentage of positive blood slides (slide positivity rate [SPR]) during the period of 1959-2011 in 21 endemic countries was done using the joinpoint regression methodology. During 1960-1979, API and SPR increased significantly and peaked in the 1980s. Since the 1990s, there have been significant declining trends in both API and SPR. Additionally, both Plasmodium vivax and P. falciparum species-specific incidence have declined. With the exception of two countries, such a collectively declining malaria trend was not observed in previous decades. This presents a unique opportunity for the Americas to seriously consider malaria elimination as a final goal.

[The road to elimination: an overview of neglected infectious diseases in Latin America and the Caribbean]. / El camino a la eliminación: un panorama de las enfermedades infecciosas desatendidas en América Latina y el Caribe.

Neglected infectious diseases (NID) affect mainly isolated populations living in isolation and in poor socioeconomic conditions. These diseases, by their chronic and silent nature, often affect communities with a weak political voice. This translates into very little attention or political priority; which is reflected in minimal and insufficient preventive measures, monitoring and control. However, there is evidence this situation is changing favorably in some countries of the Americas. In recent years, several resolutions (official agreement of the member countries of the Pan American Health Organization / World Health Organization-PAHO / WHO), regional and global agreements on public health; with a greater commitment from the pharmaceutical industry, and other donors and international partners in combination with the development and use of integrated action plans have allowed countries to intensify public interventions to control these diseases and thus achieve target elimination of NID. Onchocerciasis, lymphatic filariasis, Chagas disease, leprosy and trachoma blindness, among others, have been eliminated in several countries and endemic areas, regardless of the level of development of the country or geographical area where they are located. The political decision reflected in adequate financial resources in the next decade will be crucial to achieving the goals of elimination of NID (regional and national).

El camino a la eliminación: un panorama de las enfermedades infecciosas desatendidas en América Latina y el Caribe / The road to elimination: an overview of neglected infectious diseases in Latin America and the Caribbean

Las enfermedades infecciosas desatendidas (EID) afectan, principalmente, a las poblaciones que viven en condiciones aisladas y socioeconómicas de pobreza. Estas enfermedades, por su naturaleza crónica y silenciosa, aquejan con frecuencia a comunidades con voz política débil. Lo anterior se traduce en muy poca atención o prioridad política; lo que se refleja en mínimas e insuficientes acciones de prevención, vigilancia y control. Sin embargo, hay evidencia de que la situación está cambiando favorablemente en algunos países de las Américas. En los últimos años, varias resoluciones (acuerdos oficiales de los países miembros de la Organización Panamericana de la Salud/Organización Mundial de la Salud- OPS/OMS), convenios regionales y mundiales en materia de salud pública, junto a un mayor compromiso por parte de la industria farmacéutica, y otros donantes y socios internacionales, en combinación con el desarrollo y uso de los planes de acción integrados, han permitido que los países intensifiquen las intervenciones públicas hacia el control de estas enfermedades y así alcanzar los objetivos de eliminación de las EID. La oncocercosis, la filariasis linfática, la enfermedad de Chagas, la lepra y la ceguera por tracoma, entre otras, han sido eliminadas en varios países o zonas endémicas, sin importar el nivel de desarrollo del país o área geográfica donde se localizan. La voluntad política reflejada en los recursos financieros suficientes en la próxima década, serán determinantes para lograr los objetivos regionales y nacionales de eliminación de las EID...

Neglected infectious diseases (NID) affect mainly isolated populations living in isolation and in poor socioeconomic conditions. These diseases, by their chronic and silent nature, often affect communities with a weak political voice. This translates into very little attention or political priority; which is reflected in minimal and insufficient preventive measures, monitoring and control. However, there is evidence this situation is changing favorably in some countries of the Americas. In recent years, several resolutions (official agreement of the member countries of the Pan American Health Organization / World Health Organization-PAHO / WHO), regional and global agreements on public health; with a greater commitment from the pharmaceutical industry, and other donors and international partners in combination with the development and use of integrated action plans have allowed countries to intensify public interventions to control these diseases and thus achieve target elimination of NID. Onchocerciasis, lymphatic filariasis, Chagas disease, leprosy and trachoma blindness, among others, have been eliminated in several countries and endemic areas, regardless of the level of development of the country or geographical area where they are located. The political decision reflected in adequate financial resources in the next decade will be crucial to achieving the goals of elimination of NID (regional and national)...

Viral hepatitis in Latin America and the Caribbean: a public health challenge.

Viral hepatitis (VH) is an emergent concern in public health agendas worldwide. More than one million people die annually from hepatitis and 57% and 78% of global cirrhosis and hepatocellular carcinoma cases, respectively, are caused by VH. The burden of disease caused by hepatitis in Latin America and the Caribbean (LAC) is high. Data on hepatitis has been collected in several countries, but more accurate and comparable studies are needed. Hepatitis B vaccination and screening of donated blood are routine practices in the region. However, integrated policies covering prevention and control of disease caused by all types of hepatitis viruses are scarce. Existing preventive measures need to be reinforced. Attention must be paid to at-risk populations, awareness campaigns, and water and food safety. Affordable access to diagnosis and treatment, population screening, referral to health services and monitoring of positive cases are among the main challenges currently posed by VH in LAC. The World Health Organization framework and Pan American Health Organization regional strategy, defined in response to resolution WHA63.18 of the World Health Assembly, may help to overcome these difficulties. Successful experiences in the fight against hepatitis in some LAC countries may also provide very interesting solutions for the region.

Viral hepatitis in Latin America and the Caribbean: a public health challenge / Las hepatitis víricas en América Latina y el Caribe: un reto para la salud pública

Viral hepatitis (VH) is an emergent concern in public health agendas worldwide. More than one million people die annually from hepatitis and 57% and 78% of global cirrhosis and hepatocellular carcinoma cases, respectively, are caused by VH. The burden of disease caused by hepatitis in Latin America and the Caribbean (LAC) is high. Data on hepatitis has been collected in several countries, but more accurate and comparable studies are needed. Hepatitis B vaccination and screening of donated blood are routine practices in the region. However, integrated policies covering prevention and control of disease caused by all types of hepatitis viruses are scarce. Existing preventive measures need to be reinforced. Attention must be paid to at-risk populations, awareness campaigns, and water and food safety. Affordable access to diagnosis and treatment, population screening, referral to health services and monitoring of positive cases are among the main challenges currently posed by VH in LAC. The World Health Organization framework and Pan American Health Organization regional strategy, defined in response to resolution WHA63.18 of the World Health Assembly, may help to overcome these difficulties. Successful experiences in the fight against hepatitis in some LAC countries may also provide very interesting solutions for the region.

Las hepatitis víricas (HV) constituyen una preocupación emergente en los programas de salud pública a escala mundial. Más de un millón de personas mueren anualmente por hepatitis. Las HV causan el 57% de los casos de cirrosis y el 78% de los casos de carcinoma hepatocelular en el mundo. La carga de morbilidad causada por las hepatitis en América Latina y el Caribe (ALC) es alta. Se han recopilado datos sobre las hepatitis en varios países, pero se requieren estudios más minuciosos y comparables. La vacunación contra la hepatitis B y el tamizaje de la sangre donada son prácticas corrientes en la región. Sin embargo, son escasas las políticas integradas que abarquen la prevención y el control de las enfermedades ocasionadas por todos los tipos de virus causantes de hepatitis. Es preciso reforzar las medidas preventivas existentes y prestar atención a las poblaciones en situación de riesgo, a las campañas de sensibilización y a la inocuidad del agua y los alimentos. El acceso asequible al diagnóstico y el tratamiento, el tamizaje de la población, la derivación a los servicios de salud y la vigilancia de los casos positivos constituyen algunos de los principales retos planteados actualmente por las HV en ALC. El marco de la Organización Mundial de la Salud y la estrategia regional de la Organización Panamericana de la Salud, definidos en respuesta a la resolución WHA63.18 de la Asamblea Mundial de la Salud, pueden ayudar a superar estas dificultades. Las experiencias exitosas en la lucha contra las hepatitis en algunos países de ALC también pueden proporcionar soluciones muy interesantes para la región.