Las epidemias en La Pampa (Argentina), en perspectiva histórica* / The epidemics in La Pampa (Argentina), from a historical perspective

Resumen Este artículo describe el inicio de las preocupaciones sanitarias vinculadas a las epidemias ocurridas durante el siglo XX en La Pampa, provincia argentina. Las epidemias, como las de la viruela, fueron un estímulo para estas políticas que frecuentemente tuvieron origen en Buenos Aires, la capital del país. El contagio de muchas epidemias dependía de carencias de infraestructura: agua, desagüe y desecho adecuado de basuras, de la ausencia de un número suficiente de trabajadores de salud, de la presencia de vectores transmisores de enfermedades como los mosquitos y, en última instancia, de la pobreza. La experiencia histórica descrita en este texto resalta la importancia de analizar el impacto del SARS-CoV-2 más allá de las grandes ciudades.

Abstract This article describes the emergence of health concerns relating to the epidemics that occurred during the twentieth century in La Pampa, a province in Argentina. Epidemics such as smallpox drove such policies, which frequently originated in Buenos Aires, the country's capital. The spread of many epidemics was due to shortages: water, sewage and adequate refuse disposal, an insufficient number of health care workers, the presence of disease transmission vectors such as mosquitos, and, ultimately, poverty. The historical experience described in this text highlights the importance of analyzing the impact of SARS-CoV-2 beyond the big cities.

[The epidemics in La Pampa (Argentina), from a historical perspective]. / Las epidemias en La Pampa (Argentina), en perspectiva histórica.

This article describes the emergence of health concerns relating to the epidemics that occurred during the twentieth century in La Pampa, a province in Argentina. Epidemics such as smallpox drove such policies, which frequently originated in Buenos Aires, the country's capital. The spread of many epidemics was due to shortages: water, sewage and adequate refuse disposal, an insufficient number of health care workers, the presence of disease transmission vectors such as mosquitos, and, ultimately, poverty. The historical experience described in this text highlights the importance of analyzing the impact of SARS-CoV-2 beyond the big cities.

Este artículo describe el inicio de las preocupaciones sanitarias vinculadas a las epidemias ocurridas durante el siglo XX en La Pampa, provincia argentina. Las epidemias, como las de la viruela, fueron un estímulo para estas políticas que frecuentemente tuvieron origen en Buenos Aires, la capital del país. El contagio de muchas epidemias dependía de carencias de infraestructura: agua, desagüe y desecho adecuado de basuras, de la ausencia de un número suficiente de trabajadores de salud, de la presencia de vectores transmisores de enfermedades como los mosquitos y, en última instancia, de la pobreza. La experiencia histórica descrita en este texto resalta la importancia de analizar el impacto del SARS-CoV-2 más allá de las grandes ciudades.

Lymphatic filariasis elimination in the Dominican Republic: History, progress, and remaining steps.

Lymphatic filariasis (LF) is a mosquito-transmitted parasitic disease that is a leading cause of disability globally. The island of Hispaniola, which the Dominican Republic shares with Haiti, accounts for approximately 90% of LF cases in the Americas region. In 1998, the Dominican Ministry of Public Health created the Program to Eliminate Lymphatic Filariasis (PELF) with the goal of eliminating LF transmission by 2020. Baseline mapping revealed 19 (12% of total) endemic municipalities clustered into three geographic foci (Southwest, La Ciénaga and East), with a total at-risk population of 262,395 people. Beginning in 2002, PELF sequentially implemented mass drug administration (MDA) in these foci using albendazole and diethylcarbamazine (DEC). In total, 1,174,050 treatments were given over three to five annual rounds of house-to-house MDA per focus with a median coverage of 81.7% (range 67.4%-92.2%). By 2018, LF antigen prevalence was less than 2% in all foci, thus meeting criteria to stop MDA and begin post-treatment surveillance (PTS). This success has been achieved against a shifting landscape of limited domestic funding, competing domestic public health priorities, and sporadic external donor support. Remaining steps include the need to scale-up morbidity management and disability prevention services for LF and to continue PTS until LF transmission is interrupted across Hispaniola.

Seven decades towards malaria elimination in Yunnan, China.

BACKGROUND: Yunnan Province was considered the most difficult place in China for malaria elimination because of its complex malaria epidemiology, heterogeneous ecological features, relatively modest economic development, and long, porous border with three malaria endemic countries: Lao People's Democratic Republic, Myanmar, and Viet Nam. METHODS: Academic publications and grey literature relevant to malaria elimination in Yunnan covering the period from 1950 until 2020 inclusive were considered. The following academic indexes were searched: China Science Periodical Database, China National Knowledge Infrastructure Database, and MEDLINE. Grey literature sources were mainly available from the National Institute of Parasitic Diseases (NIPD), the Chinese Center for Diseases Control and Prevention, and the Yunnan Institute of Parasitic Diseases (YIPD). RESULTS: A malaria elimination campaign in the 1950-1960s, based mainly on mass administration of antimalarial drugs and large-scale vector control, reduced morbidity and mortality from malaria and interrupted transmission in some areas, although elimination was not achieved. Similar strategies were used to contain outbreaks and a resurgence of disease during the 1970s, when malaria services were discontinued. From the 1980s, malaria incidence declined, despite the challenges of large numbers of mobile and migrant populations and an unstable primary health care system in rural areas following economic transformation. Launch of the national malaria elimination programme in 2010 led to adoption of the '1-3-7' surveillance and response strategy specifying timely detection of and response for every case, supported by the establishment of a real-time web-based disease surveillance system and a new primary health care system in rural areas. Border malaria was addressed in Yunnan by strengthening the surveillance system down to the lowest level, cross-border collaboration with neighbouring countries and non-governmental organizations, and the involvement of other sectors. CONCLUSIONS: Seven decades of work to eliminate malaria in Yunnan have shown the importance of political commitment, technically sound strategies with high quality implementation, a robust surveillance and response system at all levels, community participation and effective management of border malaria. The experiences and lessons learned from elimination remain important for prevention re-establishment of malaria transmission in the Province.

Paradigm shift in efforts to end TB by 2025.

TB is a deadly infectious disease, in existence since time immemorial. This article traces the journey of TB developments in the last few decades and the path breaking moments that have accelerated the efforts towards Ending TB from National Tuberculosis Control Program (NTCP 1962-1992) to Revised National Tuberculosis Control Program (RNTCP - 1992-2019) and to National Tuberculosis Elimination Program (NTEP) as per the vision of Honorable Prime Minister of India. From increased funding for TB, the discovery of newer drugs and diagnostics, increased access to health facilities, greater investment in research and expanded reach of public health education, seasoned with TB activism and media's proactive role, private sector participation to political advocacy and community engagement, coupled with vaccine trials has renewed the hope of finding the elusive and miraculous breakthrough to END TB and it seems the goal is within the realms of the possibility. The recent paradigm shift in the policy and the drive of several states & UTs to move towards TB free status through rigorous population-based vulnerability mapping and screening coupled with active case finding is expected to act as the driving force to lead the country towards Ending TB by 2025. Continued investments in research, innovations and availability of more effective drugs and the vaccines will add to existing armamentarium towards Ending TB.

Prevention of re-establishment of malaria: historical perspective and future prospects.

Prevention of re-establishment (POR) refers to the prevention of malaria outbreak/epidemic occurrence or preventing re-establishment of indigenous malaria in a malaria-free country. Understanding the effectiveness of the various strategies used for POR is, therefore, of vital importance to countries certified as "malaria-free" or to the countries to be thus certified in the near future. This review is based on extensive review of literature on both the POR strategies and elimination schemes of countries, (i) that have reached malaria-free status (e.g. Armenia, Mauritius, Sri Lanka), (ii) those that are reaching pre-elimination stage (e.g. South Korea), and (iii) countries at the control phase (e.g. India). History has clearly shown that poorly implemented POR programmes can result in deadly consequences (e.g. Sri Lanka); conversely, there are examples of robust POR programmes that have sustained malaria free status that can serve as examples to countries working toward elimination. Countries awaiting malaria elimination status should pre-plan their POR strategies. Malaria-free countries face the risk of resurgence mostly due to imported malaria cases; thus, a robust passenger screening programme and cross border collaborations are crucial in a POR setting. In addition, sustained vigilance, and continued funding for the national anti-malarial campaign programme and for related research is of vital importance for POR. With distinct intrinsic potential for malaria in each country, tailor-made POR programmes are built through continuous and robust epidemiological and entomological surveillance, particularly in countries such as Sri Lanka with increased receptivity and vulnerability for malaria transmission. In summary, across all five countries under scrutiny, common strengths of the POR programmes are (i) a multipronged approach, (ii) strong passive, active, and activated passive case detection, (iii) Indoor residual spraying (IRS), and (iv) health education/awareness programmes.

The World Health Organization's changing goals and expectations concerning malaria, 1948-2019.

From its inception, in 1948, the World Health Organization made control of malaria a high priority. Early successes led many to believe that eradication was possible, although there were serious doubts concerning the continent of Africa. As evidence mounted that eradicating malaria was not a simple matter, the malaria eradication programme was downgraded to a unit in 1980. Revived interest in malaria followed the Roll Back Malaria Initiative adopted in 1998. This article presents an historical account of the globally changing ideas on control and elimination of the disease and argues that insufficient attention was paid to strengthening health services and specialized human resources.

The World Health Organizations changing goals and expectations concerning malaria, 1948-2019 / As mudanças nos objetivos e expectativas da Organização Mundial da Saúde com relação à malária, 1948-2019

Abstract From its inception, in 1948, the World Health Organization made control of malaria a high priority. Early successes led many to believe that eradication was possible, although there were serious doubts concerning the continent of Africa. As evidence mounted that eradicating malaria was not a simple matter, the malaria eradication programme was downgraded to a unit in 1980. Revived interest in malaria followed the Roll Back Malaria Initiative adopted in 1998. This article presents an historical account of the globally changing ideas on control and elimination of the disease and argues that insufficient attention was paid to strengthening health services and specialized human resources.

Resumo Desde sua origem, em 1948, a Organização Mundial da Saúde priorizou o controle da malária. Os primeiros êxitos induziram à crença na viabilidade da erradicação, apesar de sérias dúvidas quanto ao continente africano. À medida que se somavam comprovações de que a erradicação da malária não seria simples, o projeto com essa finalidade foi rebaixado a uma unidade em 1980. O reavivamento do interesse na malária ocorreu após a iniciativa Roll Back Malaria, criada em 1998. Este artigo apresenta um panorama histórico das mudanças nas ideias, em âmbito global, ligadas ao controle e à eliminação da doença e defende a tese de que a atenção dada ao fortalecimento dos serviços de saúde e a recursos humanos especializados foi insuficiente.

Narrativas vacunales y políticas de vacunación contra la poliomielitis en el contexto de la provincia de Alicante (1963-1978) / Vaccine narratives and polio vaccination policies in the context of the province of Alicante (1963-1978)

El análisis a pequeña escala es una vía de abordaje historiográfico que abrió, en su momento, nuevos caminos en la investigación. La proximidad del objeto de estudio, permite profundizar en los determinantes propios y específicos y en las realidades y prácticas, por ejemplo, de las campañas de inmunización masiva contra la poliomielitis diseñada a nivel nacional pero implementadas localmente, como en el estudio de caso que abordamos. Utilizando como modelo el ámbito sanitario provincial de Alicante, el trabajo añade datos para completar la información de proximidad sobre estas campañas y de ese modo, completar una visión de conjunto y un análisis comparado tanto en un ámbito externo como en un ámbito interno interterritorial, nacional y provincial, así como el seguimiento de las directrices dadas por los organismos nacionales e internacionales. En segundo término, dotar de significado al conjunto de actividades llevadas a cabo por diferentes actores, instituciones y medios de comunicación, implicados en el proceso de implantación, cobertura y seguimiento de las campañas de vacunación contra la polio en el ámbito provincial alicantino. El uso de narrativas de personas afectadas por la enfermedad permite añadir elementos relevantes sobre experiencias personales en el contexto de las campañas vacunales

Small-scale analysis is a path of historiographical approach that opened, at the time, new paths in research. The proximity of the study object allows us to delve into our own and specific determinants and the realities and practices of, for example, mass immunization campaigns against polio, designed at the national level but implemented locally, as in the case study that we discuss. Using as a model the provincial sanitary area of Alicante, the work adds data to complete the proximity information on these campaigns and thus, complete an overview and a comparative analysis both in an external and in an internal interterritorial, national scope and provincial level as well as the follow-up of the guidelines given by the national and international organisms. Secondly, to give meaning to the set of activities carried out by different actors, institutions and media, involved in the process of implementation, coverage and follow-up of polio vaccination campaigns in the province of Alicante. The use of narratives of people affected by the disease allows to add relevant elements about personal experiences in the context of the vaccine campaigns

Ioannis Kardamatis (1852-1942): Pioneer of the Anti-Malaria Battle in Greece.

Few scientists have contributed as much to medicine and society as Ioannis Kardamatis (1859-1942). Kardamatis was an important historical figure whose vast medical knowledge was recorded in a spectrum of medical publications, including monographs, bibliographic reviews, books, and experimental and statistical studies. His studies have been published in both Greek and foreign journals. He is most notably remembered for his contribution to the battle against malaria in Greece.

Chagas disease: Historic perspective.

This review is a perspective on the history of Chagas disease, and it adopts a novel approach from literary studies, historical documents and the science and epidemiology of the nature of the disease. From this analysis, comes the review's working definition of the Contact Zone (CZ): "the space in which geographically and historically separated people come into contact with each other and establish long-lasting relationships, which usually involve coercive conditions, radical inequality and intolerable conflict." In the Patient-Physician CZ, we verified the triple transition phenomena: the American trypanosomiasis shifted from a rural, acute, and vectorial transmitted disease to an urban, chronic and non-vectorial disease. In the Academic CZ, we describe the original disagreements which denied the existence of the disease and the current controversies about pathogenic mechanisms and etiological treatment. From the News from Latin America, and in the Original CZ, we will review the evolution of different forms of transmission. As in any good story, research across broad disciplines is necessary to reveal historical perspectives, scientific approaches, and the epidemiology of the disease, which has a prequel of 9000 years and an open ending: thus, we explore across the Global CZ, with its multiple and unexpected actors.

Re-assessing the Foundations: Worldwide Smallpox Eradication, 1957-67.

An expansive, worldwide smallpox eradication programme (SEP) was announced by the World Health Assembly in 1958, leading this decision-making body to instruct the World Health Organization Headquarters in Geneva to work with WHO regional offices to engage and draw in national governments to ensure success. Tabled by the Soviet Union's representative and passed by a majority vote by member states, the announcement was subject to intense diplomatic negotiations. This led to the formation, expansion and reshaping of an ambitious and complex campaign that cut across continents and countries. This article examines these inter-twining international, regional and national processes, and challenges long-standing historiographical assumptions about the fight against smallpox only gathering strength from the mid-1960s onwards, after the start of a US-supported programme in western Africa. The evidence presented here suggests a far more complex picture. It shows that although the SEP's structures grew slowly between 1958 and 1967, a worldwide eradication programme resulted from international negotiations made possible through gains during this period. Significant progress in limiting the incidence of smallpox sustained international collaboration, and justified the prolongation and expansion of activities. Indeed, all of this bore diplomatic and legal processes within the World Health Assembly and WHO that acted as the foundation of the so-called intensified phase of the SEP and the multi-faceted activities that led to the certification of smallpox eradication in 1980.

Missed vaccinations and critical care admission: all you may wish to know or rediscover-a narrative review.

Most vaccines are so effective that they could lead to the control/elimination of the diseases they target and directly impact on intensive care admissions or complications. This is best illustrated by the use of vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae, zoster, yellow fever, Ebola virus, influenza or measles-but also by third party strategies such as maternal, toddler and care-giver immunization. However, each of these vaccine-induced protection is threatened by insufficient vaccine uptake. Here, we briefly discuss how vaccine hesitancy has led to the resurgence of diseases that were considered as controlled and explore the effect of vaccine-hesitant healthcare workers on nosocomial infections. As intensive care physicians are in charge of polymorbid patients, we briefly summarize the current recommendations for vaccinations in high-risk patients. We finally give some perspective on ongoing research, and discuss how institutional policies and intensive care physicians could play a role in increasing the impact of vaccination, overall and in intensive care units.