The changing view of the priority of dengue disease as seen by WHO and its regional office

Transcription

1 The changing view of the priority of dengue disease as seen by WHO and its regional office Organización Panamericana De la Salud Dr. José Luis San Martin Regional advisor of dengue program. OPS/OMS America s Dengue Prevention Board Brasilia, Brazil. August 22nd-23th, 2011

2 Areas or countries at risk Source: Countries report PAHO/WHO

3 Incidence evolution of dengue since 1980 Source: Countries report PAHO/WHO

4 Morbility of dengue in four subregions of America Source: Countries report PAHO/WHO *2011: 31st epidemiolofy week.

5 Percentual distribution of the Morbility by countries of greater notification in the America s, % 90% Resto México 19.2% 80% 70% 60% Honduras Costa Rica Venezuela 50% Colombia 80.8% 40% 30% Brasil 20% 10% 0% Brasil Colombia Venezuela Costa Rica Honduras México Resto Source: Country report to OPS/OMS

6 By the end of december 2010, over 36 countries had reported dengue cases, severe dengue cases and fatalities: case fatality rate (cfr): 2,3. Outbreaks in sourh hemisphere during the first semester of 2011: Peru, Bolivia, Brazil and Paraguay. Current outbraks: Bahamas, Panama, St. Lucia. All four serotipes of dengue are active and circulating. Till 31st EW, 2011, dengue cases, severe dengue cases and 488 fatalities (cfr: 4,5) have been reported. Current situation in our Region

7 Circulation of dengue serotypes in the Americas MEXICO DEN 1,2,3,4 EL SALVADOR DEN 1,2,3,4 DEN 1,2,3,4 HONDURAS DEN 1,2,3,4 DEN 1, 2,3 NICARAGUA DEN 1,2,3 COLOMBIA DEN 1,2,3,4 ECUADOR DEN1,3 PERÚ DEN 1,2,3,4 DEN 1,2,4 BOLIVIA: DEN 2,3 PARAGUAY: DEN1,2, 3 REP. DOMINICANA: DEN 1,2,4 MARTINICA: DEN 1,2, 4 VENEZUELA DEN 1,2,3,4 ARGENTINA DEN 1, 2,3 GUYANA FRANCESA: DEN 1,2,3 BRASIL: DEN 1,2,3 DEN ISLAS PASCUA: DEN 1 DEN 1 Fuente: Boletines de país.

8 Countries with greater mortality and case fatality rate by dengue in the Americas (Period ) and 2010 Countries Deaths Percentage Percentage accumulated Case fatality rate Cases in 2010 Brasil República Dominicana Colombia México Hondura Nicaragua El Salvador Guatemala Venezuela n/d Ecuador Puerto Rico Total 2, , Countries concentrates 95 % of the deaths by dengue in the region was the total number of deaths by dengue in this period. The region reported in 2010: 1,174 deaths for dengue (57% Brasil and 18% Colombia). The case fatality rate in 2010 was 2,61% Country with greater case fatality rate.

9 Determinants of dengue transmission Unprecedented population growth (megacities) Uncontrolled and unplanned Urbanization; Inadequate environmental management; Migration and tourism; Climate change Poverty and extreme Poverty

10 Dengue en las Américas , la Respuesta de los países. OPS/OMS ERADICATION of Aedes ae. OPS CD1.R1 Comunicac ión Social Laboratórí o Vigilancia Epidemiológ ica EGI- Dengue Atención al paciente Manejo Integrado de Vectores Ambiente 2001 CD43.R4 Nueva generación de Programas 2003: CD44.R9 OPS La Estrategia de Gestión Integrada (EGI Dengue) 2. GT Dengue 2007 Entrada en vigencia RSI (2005) 2007 CSP27.R Nueva Guía diagnóstico, tratamiento, prevención y control del dengue 2010 Nueva Guía de atención a enfermos de dengue

11 Integrated Management Strategy for dengue prevention and control (IMS-Dengue) Epidemiologic Surveillance Social communication Integrated Vector control Integrated Management Strategy Laboratory Environment Patient care Countries with IMS-dengue 21 countries and 4 sub-regions (Central America, MERCOSUR, Andean and Caribbean have the IMS- Dengue.

12 Event Management system (EMS)

13 Brotes en hemisferio Sur, 2011 Perú, Iquitos enero 2011 Bolivia, Beni enero 2011 Casos sospechosos, confirmados y fallecidos por dengue Bolivia 9 de febrero de 2011

14 Intervenciones: Perú, Iquitos febrero 2011

15 LABORATORY SURVEILLANCE RELDA: Laboratory network of dengue in the Americas Network of WHO collaborating centers and national laboratories of dengue references in the Americas WHO Collaborating Centers Argentina Brasil Caribe inglés Cuba Puerto Rico National Laboratories of dengue reference Colombia El Salvador Guayana francesa México Nicaragua Paraguay

16 Resolution CSP27.R15 Integrated Vector Management (IVM) DENGUE YELLOW FEVER MALARIA CHAGAS LEISHMANIASIS WEST NILE VIRUS FILARIASIS SAN LUIS ENCEPHALITIS HANTAVIRUS Aedes aegypti Anopheles Triatoma Lutzonia Culex Roedores HORIZONTAL LINES OF ACTION Strengthen epidemiological and entomological surveillance. Promote advocacy, social movillizations and synergies for primary attentions in health. Integrated Vector Management (IVM) Rational use of pesticides. Strengthen legislation and public policy Organización Panamericana De la Salud

17 Dengue in the Americas Support Requested Better Outbreak Responses Increase Clinical and patient care capacities to avoid deaths. New Entomology and Vector control strategies. Laboratory Diagnostics training/resources support New interventions on Social Communications Strengthen the environmental management and legislative aspects Extrasectorial partnerships (Industry, City Majors) Vaccine, Research and development Dengue control in Megacities Tires/plastics/solid waste disposition and recycling

18 Ideas to remember The dengue problem goes beyond Health Sector and the current response of prevention and control must not be sectorial, but global. The presence of macrofactors as determinants of disease transmission make necessary to promote and strengthen public policies that effectively operate on them. A strategy that integrates key disciplines in the prevention and control have the greatest impact on the disease and is necessary to put the vector in the center of this strategy. Even with the advent of a vaccine is needed to continue a vector control strategy, who may also transmit other diseases.

19 Áreas con riesgo de importación Programa Regional de Dengue-2011

20 Our challenges

21 Our challenges

22 Our challenges Cementerio infestado de Aedes aegypti

23 Backyard housing

24 Backyard housing in front of a health center

25 Epidemiologic Surveillance Social communication Integrated control Vector Laboratory Environment Patient care Thank you