[Vibrio parahaemolyticus infections and algal intoxications as emergent public health problems in Chile]. / Infecciones por Vibrio parahaemolyticus e intoxicaciones por algas: problemas emergentes de salud pública en Chile.

There is interest in the paradigm that relates environmental sea changes to the emergence of diseases that affect both aquatic organisms in the sea and human beings. The emergence of Vibrio parahaemolyticus as an important cause of epidemic summer diarrhea in 2004 and 2005, confined mainly to the tenth region in Chile, could be a manifestation of this trend. This and other areas of the country have also experienced several outbreaks of paralytic shellfish poisoning (PSP), diarrheal shellfish poisoning (DSP) and amnesic shellfish poisoning (ASP) caused by harmful algal blooms (HAB) of Alexandrium catenella, Dinophysis acuta and Pseudonitzchia species, respectively. The short historical record of these pathological phenomena in Chile suggests that they are increasing in frequency and expanding their geographical range. The V parahaemolyticus isolates responsible for the Chilean outbreaks correspond mainly to the pandemic strain O3:K6. HAB found in Chile and the intoxications caused by them have similar biological characteristics to those described in other areas of the world. The tenth region, the area where these problems are emerging, produces approximately 80-90% of the shellfish consumed in Chile and a large proportion of the shellfish that is exported. Prevention of these public health problems can be attained by developing policies that increase environmental surveillance for Vibrios and toxic algae, improve the epidemiological surveillance of acute diarrhea and algal intoxications after the ingestion of raw bivalves, and educate the population on the mode of transmission of these diseases. Scientific capacity and laboratories need to be developed to widen the limited knowledge of the biology of Vibrio and toxic algae and the environmental factors that favor their emergence as public health and economic problems in Chile.

Hantavirus pulmonary syndrome, southern Chile.

We analyzed data from 25 consecutive patients with hantavirus pulmonary syndrome (HPS) admitted to the Puerto Montt and Osorno Regional Hospitals, southern Chile, from 1997 to 2001, emphasizing epidemiologic, clinical, radiographic, treatment, and laboratory aspects. Hemorrhage was frequent (64%), and 48% of patients showed alterations in renal function. Ten patients died (40%). We identified three groups of patients, which included the following: 1) those with the least severe form who had prodromic symptoms without pulmonary involvement; 2) those with moderate illness who had interstitial pulmonary infiltrates, usually needed supplemental nasal oxygen, were hemodynamically stable, and had an APACHE II <12 (none of whom died); and 3) those with the severe form who required mechanical ventilation, frequently had hemodynamic instability (93%), experienced a high mortality rate (77%), and had an APACHE II >12. Mild forms of HPS also exist, which are poorly known; the symptoms could be confounded with those of other viral diseases, leading to underdiagnosis.

Reglamento Sanitario Internacional (RSI) / International Health Regulations

El conocimiento de la historia de la salud pública permite entenderla en su contexto social, económico y político, estar alerta ante situaciones ya vividas y aprender de los éxitos y fracasos previos. El conocer los elementos que han intervenido en su devenir puede ayudarnos en el presente a comprender los factores que inciden en las decisiones adoptadas. La salud pública internacional ha evolucionado desde la cuarentena como respuesta a epidemias hasta el logro de la cooperación sanitaria internacional. En ese camino, hay hitos como las conferencias sanitarias internacionales, el Código Sanitario Panamericano y el Reglamento Sanitario Internacional. La salud pública internacional debe resolver un conflicto permanente entre la mirada sanitaria y los puntos de vista políticos y económicos, requiriendo un gran compromiso para lograr consensos, lo que se ha conseguido y cuyo fruto es esta normativa. Este artículo presenta la historia del Reglamento Sanitario Internacional y el cambio del enfoque en la salud internacional en el contexto de la modificación del Reglamento Sanitario Internacional...