RESUMEN
The countries of the Americas have made a commitment to eliminate syphilis and congenital syphilis as a public health problem by 2030. This goal translates into reducing the incidence of congenital syphilis to less than 0.5 cases per 1000 live births and a 90 percent reduction in the number of syphilis cases (as compared to 2018). However, incident cases of syphilis are increasing in the Americas. This trend has accelerated in recent years and is reflected in higher prevalence of syphilis in pregnant women and, consequently, an increase on the rate of congenital syphilis that is far from the target set for 2030. Besides of reaching the impact target, elimination of congenital syphilis requires meeting the following programmatic targets: 95 percent of pregnant women receive prenatal care; 95 percent of pregnant women are tested for syphilis; and 95 percent of pregnant women with syphilis receive appropriate treatment. However, in settings with a high prevalence of syphilis, meeting these programmatic targets may not guarantee the elimination of congenital syphilis. Therefore, in addition to actions framed around quality antenatal care, implementing a syphilis response aimed at reducing the prevalence of the disease in pregnant women and their partners may help reduce the incidence of congenital syphilis. This technical note consolidates World Health Organization (WHO) recommendations for the prevention and control of syphilis and congenital syphilis. It shares best practices from different countries in the Americas to implement these recommendations. It also provides WHO recommendations for surveillance and monitoring of syphilis and congenital syphilis. Finally, it details the supplies for the diagnosis and treatment of the disease, available through the Strategic Fund of the Pan American Health Organization.
Asunto(s)
Sífilis , Sífilis Congénita , Enfermedades Virales de Transmisión Sexual , Erradicación de la Enfermedad , Enfermedades Transmisibles , AméricasRESUMEN
The Pan American Health Organization (PAHO/WHO) has published Health in the Americas (HIA) since 1954, focusing on one of the Organization's main mandates related to collecting and disseminating information on health conditions and trends in the countries and territories of the Americas and the Caribbean. The proposed topic for the 2024 Health in the Americas is to highlight the advances the Americas Region has made with the Elimination Initiative 30+, a policy for an integrated sustainable approach committed to eliminating more than 30 communicable diseases and related conditions by 2030.
Asunto(s)
Erradicación de la Enfermedad , Neoplasias del Cuello Uterino , Cólera , Factores de Riesgo , Transmisión Vertical de Enfermedad Infecciosa , VIH , Tuberculosis , Enfermedades Transmitidas por Vectores , Inequidades en Salud , Américas , Región del CaribeRESUMEN
L'Organisation panaméricaine de la santé publie La santé dans les Amériques depuis 1954, en se concentrant sur l'un des principaux mandats de l'Organisation lié à la collecte et à la diffusion d'informations sur les conditions et les tendances sanitaires dans les pays et territoires des Amériques et les Caraïbes. Le thème proposé pour la Santé dans les Amériques en 2024 est de mettre en lumière les progrès réalisés par la Région des Amériques avec l'Initiative d'élimination 30+, une politique pour une approche durable intégrée engagée à éliminer plus de 30 maladies transmissibles et affections associées d'ici 2030.
Asunto(s)
Erradicación de la Enfermedad , Neoplasias del Cuello Uterino , Cólera , Factores de Riesgo , Transmisión Vertical de Enfermedad Infecciosa , VIH , Tuberculosis , Enfermedades Transmitidas por Vectores , Inequidades en Salud , Américas , Región del CaribeRESUMEN
A Organização Pan-Americana da Saúde publica Saúde nas Américas desde 1954, concentrando-se em um dos principais mandatos da Organização relacionado à coleta e divulgação de informações sobre condições e tendências de saúde nos países e territórios das Américas e o Caribe. O tema proposto para o Saúde nas Américas 2024 é destacar os avanços que a Região das Américas obteve com a Iniciativa de Eliminação 30+, uma política para uma abordagem sustentável integrada comprometida em eliminar mais de 30 doenças transmissíveis e condições relacionadas até 2030.
Asunto(s)
Erradicación de la Enfermedad , Neoplasias del Cuello Uterino , Cólera , Factores de Riesgo , Transmisión Vertical de Enfermedad Infecciosa , VIH , Tuberculosis , Enfermedades Transmitidas por Vectores , Inequidades en Salud , Américas , Región del CaribeRESUMEN
La Organización Panamericana de la Salud publica Salud en las Américas desde 1954, centrándose en uno de los principales mandatos de la Organización relacionado con la recopilación y difusión de información sobre las condiciones y tendencias de salud en los países y territorios de las Américas y el caribe. El tema propuesto para Salud en las Américas 2024 es resaltar los avances que la Región de las Américas ha logrado con la Iniciativa de Eliminación 30+, una política para un enfoque integrado sostenible comprometido a eliminar más de 30 enfermedades transmisibles y condiciones relacionadas para 2030.
Asunto(s)
Erradicación de la Enfermedad , Neoplasias del Cuello Uterino , Cólera , Factores de Riesgo , Transmisión Vertical de Enfermedad Infecciosa , VIH , Tuberculosis , Enfermedades Transmitidas por Vectores , Inequidades en Salud , Américas , Región del CaribeRESUMEN
Los países de las Américas han adoptado el compromiso de eliminar la sífilis congénita como problema de salud pública para el 2030. Esta meta se traduce en reducir la incidencia de sífilis congénita a menos de 0,5 casos por 1000 nacidos vivos. Además de alcanzar la meta de impacto, la eliminación de la sífilis congénita pasa por cumplir con las siguientes metas programáticas: que el 95% de las embarazadas reciba atención prenatal; que, de estas, el 95% se someta a una prueba de sífilis, y que el 95% de las embarazadas y con sífilis reciba tratamiento adecuado. Sin embargo, en entornos con alta prevalencia de sífilis, cumplir estas metas programáticas puede no garantizar la eliminación de la sífilis congénita. Por ello, además de las acciones enmarcadas en una atención prenatal de calidad, implementar una respuesta a la sífilis dirigida a reducir la prevalencia de la enfermedad en las embarazadas y sus parejas puede ayudar a disminuir la incidencia de la sífilis congénita. La presente nota técnica recoge, de forma consolidada, las recomendaciones de la Organización Mundial de la Salud (OMS) para la prevención y el control de la sífilis y la sífilis congénita. En ella se comparten diversas buenas prácticas de distintos países de las Américas, a fin de implementar dichas recomendaciones. Además, se facilitan las recomendaciones de la OMS para la vigilancia y el monitoreo de la sífilis y la sífilis congénita. Por último, se detallan los insumos para el diagnóstico y el tratamiento de la enfermedad, disponibles a través del Fondo Estratégico de la Organización Panamericana de la Salud.
Asunto(s)
Sífilis , Sífilis Congénita , Enfermedades de Transmisión Sexual , Erradicación de la Enfermedad , Enfermedades Transmisibles , AméricasRESUMEN
The Pan American Health Organization (PAHO) has published Health in the Americas (HIA) since 1954, focusing on one of the Organization's main mandates related to collecting and disseminating information on health conditions and trends in the countries and territories of the Americas and the Caribbean. The proposed topic for the 2024 Health in the Americas is to highlight the advances the Americas Region has made with the Elimination Initiative 30+, a policy for an integrated sustainable approach committed to eliminating more than 30 communicable diseases and related conditions by 2030.
Asunto(s)
Erradicación de la Enfermedad , Neoplasias del Cuello Uterino , Cólera , Factores de Riesgo , Transmisión Vertical de Enfermedad Infecciosa , VIH , Tuberculosis , Enfermedades Transmitidas por Vectores , Inequidades en Salud , Américas , Región del CaribeRESUMEN
Several countries of the Guiana Shield are aiming at the control and elimination of malaria in areas where Artisanal and Small-scale Gold Mining (ASGM) activities predominate, raising questions about how to strengthen community engagement to improve the effectiveness of health programs. The Curema project focuses its intervention on the mobile and hard-to-reach ASGM population, complementing the efforts of national programs in the Guiana Shield. The Curema intervention combines targeted drug administration for suspected Plasmodium vivax asymptomatic carriers, the Malakit distribution, and health education activities. The primary goals of this manuscript are to outline a pathway to foster community participation in the Curema project aimed at eliminating malaria. Thus, it presents a vision of the challenges that the AGSM community poses in terms of community participation for an asymptomatic problem; and highlights the community-based model and the Information, Education and Communication (IEC) components as foundations for participation. In addition, it also presents culturally sensitive IEC strategies designed through iterative and collaborative consultative processes and other bottom-up outreach activities. The community engagement approach facilitates adaptability and responsiveness in a complex, evolving context increasing the effectiveness of interventions.
Asunto(s)
Participación de la Comunidad , Humanos , Educación en Salud/métodos , Guyana , Malaria Vivax/prevención & control , Erradicación de la Enfermedad , Malaria/prevención & control , Minería , Antimaláricos/uso terapéutico , OroRESUMEN
The Pan American Health Organization´s initiative to eliminate communicable diseases, known as the Elimination Initiative (EI), aims to eradicate more than 30 communicable diseases and related conditions across the Americas by 2030. The EI spans a wide range of diseases including vaccine preventable, neglected infectious, vector-borne, sexually transmitted, mother-to-child transmitted, and zoonotic diseases, as well as tuberculosis, cervical cancer, and environmental risk factors (open defecation and polluting fuels in the household). The purpose of the EI is not just to eliminate and sustain the elimination targets, but to save and improve the quality of people’s lives through guaranteeing equitable access to integrated health services, addressing mechanisms of vulnerability and social and environmental determinants of health, and empowering communities.
Asunto(s)
Enfermedades Transmisibles , Erradicación de la Enfermedad , Acontecimientos que Cambian la Vida , AméricasRESUMEN
The meeting with PAHO/WHO Collaborating Centres in Canada as part of the Official Visit of Dr. Jarbas Barbosa da Silva Jr (Ottawa, Canada, 9 April 2024) represented a significant step in the technical cooperation in the region of the Americas, focusing on enhancing cooperation and resilience in health systems. Discussions centered on strategic pandemic response, regulatory capacity building, particularly in pharmaceuticals, and leveraging PAHO/WHO as an information hub. Key topics included Digital Transformation, One Health, and the Elimination Initiative for communicable diseases, emphasizing ethical use of artificial intelligence, generation of evidence, innovation, and tailored strategies. The meeting highlighted the need for innovative health workforce development, transparent algorithms for equity, and integrating new priorities for stronger health systems and outcomes. The commitment to technical cooperation and support for Member States aims to address various health challenges and promote universal health coverage. PAHO/WHO express its appreciation to the efforts and commitment of the twenty-eight PAHO/WHO Collaborating Centres in Canada (May 2024).
Asunto(s)
Cooperación Técnica , Salud Pública , Resiliéncia de los Sistemas de la Salud , Creación de Capacidad , Erradicación de la Enfermedad , Enfermedades no Transmisibles , Salud Única , Colaboración Intersectorial , Organización Panamericana de la Salud , AméricasRESUMEN
The single onchocerciasis-endemic focus in the remote Amazon rainforest is shared by Brazil and Venezuela and affects primarily the indigenous Yanomami people. Regional elimination of onchocerciasis is challenged by the magnitude and inaccessibility of this area. In Brazil, 272 onchocerciasis-endemic communities are operationally organized through 21 health centers ("polos bases"). Mass drug administration of ivermectin began in 1995, with 36 effective biannual rounds (≥85% coverage of the eligible population) through 2022. The national on chocerciasis program maintains community-level monitoring to prioritize treatment activities and epidemiological surveys. The Onchocerciasis Elimination Program for the Americas and the WHO onchocerciasis elimination guidelines have helped Brazil move toward its goal of stopping ivermectin treatment by 2025 and verifying transmission elimination by 2030. Additional challenges to the Brazilian onchocerciasis program include cross-border movements and insecurity due to illegal mining and inter-community conflicts. The new government in Brazil offers hope given its commitment to the equity of indigenous people and preservation of the Amazon environment.
Asunto(s)
Erradicación de la Enfermedad , Ivermectina , Oncocercosis , Humanos , Brasil/epidemiología , Oncocercosis/prevención & control , Oncocercosis/epidemiología , Oncocercosis/tratamiento farmacológico , Erradicación de la Enfermedad/métodos , Ivermectina/uso terapéutico , Administración Masiva de Medicamentos , Filaricidas/uso terapéuticoRESUMEN
In the Americas, onchocerciasis has been eliminated in 11 of 13 endemic foci by mass administration of ivermectin. The remaining at-risk population resides in a contiguous cross-border transmission zone located in the Amazon jungle in northwest Brazil and southern Venezuela, known as the Yanomami Focus Area. Here, we describe the development and implementation of a data-driven tool, called the Scorecard Approach (SCA), for the 393 communities that comprise the Venezuela South Focus. The SCA was first applied in 2018 and is reassessed on an annual basis. This operational strategy seeks to prioritize communities with low ivermectin coverage while taking into account the nature and variation of other epidemiological and logistical variables. Numeric scores are assigned for each factor and added together to yield a composite score for each community that is categorized as high, medium, or low priority. In this way, the SCA serves as a valuable and comprehensive strategy for planning, monitoring, and maximizing programmatic efficiency. In addition, it has allowed the country to face the main challenges of this endemic area: its remoteness, its large areas of territory to cover, the semi-nomadic nature of the Yanomami people, and their continuous cross-border movements. For 2022, the SCA categorized 54 (13.7%), 108 (27.5%), and 231 (58.8%) communities as high, medium, and low priority, respectively. The results presented here show that prioritizing communities at risk and with greatest needs increases the feasibility of interrupting the transmission of onchocerciasis by 2025 in the last endemic focus in the Americas.
Asunto(s)
Ivermectina , Oncocercosis , Venezuela/epidemiología , Oncocercosis/prevención & control , Oncocercosis/epidemiología , Oncocercosis/transmisión , Oncocercosis/tratamiento farmacológico , Humanos , Ivermectina/uso terapéutico , Erradicación de la Enfermedad/métodos , Administración Masiva de MedicamentosRESUMEN
To eliminate malaria, all populations must be included. For those who are not reached by the health care system, specific interventions must be tailor-made. An innovative Malakit strategy, based on the distribution of self-diagnosis and self-treatment kits, has been evaluated in the Suriname-French Guiana- Amapá (Brazil) region. The results showed effectiveness and good acceptability. The Malakit intervention is complex and has many components. Its transferability requires adaptation to other populations and regions, while retaining the main features of the intervention. This article provides the keys to adapting, implementing and evaluating it in other contexts facing residual malaria in hard-to-reach and/or mobile populations. The process of transferring this intervention includes: diagnosis of the situation (malaria epidemiology, characteristics of the population affected) to define the relevance of the strategy; determination of the stakeholders and the framework of the intervention (research project or public health intervention); adaptation modalities (adaptation of the kit, training, distribution strategy); the role of community health workers and their need for training and supervision. Finally, evaluation needs are specified in relation to prospects for geographical or temporal extension. Malaria elimination is likely to increasingly involve marginalized people due to climate change and displacement of populations. Evaluation of the transferability and effectiveness of the Malakit strategy in new contexts will be essential to increase and refine the evidence of its value, and to decide whether it could be an additional tool in the arsenal recommended in future WHO guidelines.
Asunto(s)
Malaria , Malaria/prevención & control , Humanos , Brasil , Suriname , Guyana Francesa , Erradicación de la Enfermedad/métodosRESUMEN
BACKGROUND: Health information systems (HIS) are a pivotal element in epidemiological surveillance. In Brazil, malaria persists as a public health challenge, with 99% of its occurrences concentrated in the Amazon region, where cases are reported through the HIS Sivep-Malaria. Recent technological advancements indicate that case notifications can be expedited through more efficient systems with broader coverage. The objective of this study is to analyse opportunities for notification within Sivep-Malaria and explore the implementation of mobile electronic devices and applications to enhance the performance of malaria case notifications and use. METHODS: This descriptive study analyses data on malaria-positive cases in the Brazilian Amazon from 2004 to 2022. Malaria Epidemiological Surveillance System (Sivep-Malaria) data were used. The Brazilian Amazon region area is approximately 5 million km2 across nine different states in Brazil. Data entry opportunities were assessed by considering the time difference between the 'date of data entry' and the 'date of notification.' Descriptive statistics, including analyses of means and medians, were conducted across the entire Amazon region, and for indigenous population villages and gold mining areas. RESULTS: Between 2004 and 2022, 6,176,878 new malaria cases were recorded in Brazil. The average data entry opportunity throughout the period was 17.9 days, with a median of 8 days. The most frequently occurring value was 1 day, and 99% of all notifications were entered within 138 days, with 75.0% entered within 20 days after notification. The states with the poorest data entry opportunities were Roraima and Tocantins, with averages of 31.3 and 31.0 days, respectively. For indigenous population villages and gold mining areas, the median data entry opportunities were 23 and 15 days, respectively. CONCLUSIONS: In malaria elimination, where surveillance is a primary strategy for evaluating each reported case, reducing notification time, enhancing data quality and being able to follow-up cases through computerized reports offer significant benefits for cases investigation. Technological improvements in Sivep-Malaria could yield substantial benefits for malaria control in Brazil, aiding the country in achieving disease elimination and fulfilling the Sustainable Development Goals.
Asunto(s)
Malaria , Brasil/epidemiología , Malaria/prevención & control , Malaria/epidemiología , Humanos , Notificación de Enfermedades/estadística & datos numéricos , Notificación de Enfermedades/métodos , Erradicación de la Enfermedad/estadística & datos numéricos , Erradicación de la Enfermedad/métodos , Monitoreo Epidemiológico , Sistemas de Información en Salud/estadística & datos numéricosRESUMEN
BACKGROUND: The Global Programme to Eliminate Lymphatic Filariasis (GPELF) aims to reduce and maintain infection levels through mass drug administration (MDA), but there is evidence of ongoing transmission after MDA in areas where Culex mosquitoes are the main transmission vector, suggesting that a more stringent criterion is required for MDA decision making in these settings. METHODS: We use a transmission model to investigate how a lower prevalence threshold (<1% antigenemia [Ag] prevalence compared with <2% Ag prevalence) for MDA decision making would affect the probability of local elimination, health outcomes, the number of MDA rounds, including restarts, and program costs associated with MDA and surveys across different scenarios. To determine the cost-effectiveness of switching to a lower threshold, we simulated 65% and 80% MDA coverage of the total population for different willingness to pay per disability-adjusted life-year averted for India ($446.07), Tanzania ($389.83), and Haiti ($219.84). RESULTS: Our results suggest that with a lower Ag threshold, there is a small proportion of simulations where extra rounds are required to reach the target, but this also reduces the need to restart MDA later in the program. For 80% coverage, the lower threshold is cost-effective across all baseline prevalences for India, Tanzania, and Haiti. For 65% MDA coverage, the lower threshold is not cost-effective due to additional MDA rounds, although it increases the probability of local elimination. Valuing the benefits of elimination to align with the GPELF goals, we find that a willingness to pay per capita government expenditure of approximately $1000-$4000 for 1% increase in the probability of local elimination would be required to make a lower threshold cost-effective. CONCLUSIONS: Lower Ag thresholds for stopping MDAs generally mean a higher probability of local elimination, reducing long-term costs and health impacts. However, they may also lead to an increased number of MDA rounds required to reach the lower threshold and, therefore, increased short-term costs. Collectively, our analyses highlight that lower target Ag thresholds have the potential to assist programs in achieving lymphatic filariasis goals.
Asunto(s)
Análisis Costo-Beneficio , Filariasis Linfática , Administración Masiva de Medicamentos , Filariasis Linfática/prevención & control , Filariasis Linfática/epidemiología , Filariasis Linfática/economía , Humanos , Administración Masiva de Medicamentos/economía , Haití/epidemiología , Tanzanía/epidemiología , Prevalencia , India/epidemiología , Animales , Erradicación de la Enfermedad/economía , Erradicación de la Enfermedad/métodos , Filaricidas/uso terapéutico , Filaricidas/administración & dosificación , Filaricidas/economía , Antígenos Helmínticos/sangre , CulexRESUMEN
[Objetivo] Pasados más de 50 años de lucha, que los delegados de cada país miembro de la COSALFA y los expertos invitados traigan a la mesa una breve historia del combate a la enfermedad en sus países; el escenario presente y los desafíos que se imponen tanto para mantener o avanzar en el estatus reconocido de libre de fiebre aftosa, en el contexto actual y las diferentes estrategias, para cada situación. Que a través de las discusiones se presente la oportunidad para evaluar los desafíos actuales y futuros a fin de cumplir con los objetivos del Plan de Acción 2021-2025 del PHEFA.
Asunto(s)
Fiebre Aftosa , Salud Pública Veterinaria , Erradicación de la Enfermedad , Congresos como AsuntoRESUMEN
It is acknowledged that the technical coordination and cooperation provided by PANAFTOSA/PAHO within the framework of the Hemispheric Program for the Eradication of Foot-and-Mouth Disease (PHEFA) has been decisive for the progress made and it is still necessary for the complete eradication of the disease in the continent, without jeopardizing the progress made. The PHEFA remains in effect although the region reflected its best historical record in 2023, consecutively, regarding areas recognized as free by the World Organization for Animal Health (WOAH). Additionally, the countries continue to be oriented toward the execution of the PHEFA Plan of Action 2021-2025 to complete the eradication of foot-and-mouth disease, while also seeking to strengthen prevention and the capacity of veterinary services of the countries of the continent to respond to a potential foot-and-mouth disease emergency. The funding modality of PANAFTOSA/PAHO’s technical cooperation for the PHEFA is based on PAHO’s contribution with international professionals responsible of the foot-and-mouth disease (FMD) area and the reference laboratory, as well as the resources obtained from the reference material supplied to the countries. Additionally, it includes a model of voluntary contributions linked to specific projects with the countries. Therefore, the aforementioned is reflected in the costs referred to for this Biennial Plan 2024-2025. The expected outcomes of the mentioned plan will contribute to the goals outlined in the PHEFA Plan of Action 2021-2025, with a priority vision from PANAFTOSA/PAHO that takes into account COSALFA resolutions, aiming to prepare the countries for the final stage of the PHEFA. Based on these guidelines, and considering the current situation, PANAFTOSA/PAHO has elaborated the present proposal of the Biennial Technical Cooperation Plan 2024-2025 to consolidate the PHEFA.
Asunto(s)
Salud Pública Veterinaria , Fiebre Aftosa , Erradicación de la EnfermedadRESUMEN
La modalidad de financiación para la cooperación técnica de PANAFTOSA/OPS para el PHEFA se basa en el aporte por parte de la OPS de los profesionales internacionales responsables del área de Fiebre Aftosa (FA) y del laboratorio de referencia y en los recursos obtenidos por el material de referencia suministrado a los países. Se incluye, además, un modelo de contribuciones voluntarias vinculadas a proyectos específicos con países. Por lo tanto, lo mencionado anteriormente se refleja en los costos referidos para este Plan Bienal 2024-2025. Los resultados esperados del mencionado plan contribuirán a las metas previstas en el Plan de Acción 2021-2025 del PHEFA, con una visión de prioridades por parte de PANAFTOSA/OPS que toma en cuenta las resoluciones de la COSALFA, que apunta a preparar a los países para la fase final del PHEFA. Con base en estas directrices, y considerando la situación actual, PANAFTOSA/OPS ha elaborado la presente propuesta de Plan Bienal 2024-2025 de cooperación técnica para consolidación del PHEFA.
Asunto(s)
Fiebre Aftosa , Erradicación de la Enfermedad , Centro Panamericano de Fiebre AftosaRESUMEN
Current WHO guidelines for onchocerciasis elimination provide requirements for stopping mass drug administration of ivermectin and the verification of elimination of transmission. These guidelines also recommend post-elimination surveillance (PES) based on entomological surveys. Serological markers in humans could complement entomological PES once the longevity of anti-OV-16 antibody responses is better understood. In 2014-2015 we evaluated ELISA anti-OV-16 IgG4 antibody persistence among previously seropositive people from the central endemic zone of Guatemala. The country stopped all onchocerciasis program interventions in 2012 and was verified by WHO as having eliminated transmission of onchocerciasis in 2016. A total of 246 participants with prior OV-16 ELISA results from 2003, 2006, 2007, or 2009 were enrolled in a follow-up study. Of these, 77 people were previously OV-16 seropositive and 169 were previously seronegative. By 2014 and 2015, 56 (72.7%) previously seropositive individuals had sero-reverted, whereas all previous negatives remained seronegative. The progression of antibody responses over time was estimated using a mixed-effects linear regression model, using data from seropositive participants who had sero-reverted. The temporal variation showed a mean activity unit decay of 0.20 per year (95% credible interval [CrI]: 0.17, 0.23), corresponding to an estimated antibody response half-life of 3.3 years (95% CrI: 2.7, 4.1). These findings indicate that the majority of seropositive people will sero-revert over time.