RESUMO
Lima, Peru, has not had a case of canine rabies since 1999. However, Lima remains at risk of rabies reintroduction due to the free movement of dogs from nearby rabies-endemic areas. In Latin America, rabies vaccination campaigns must reach 80% of dogs to halt transmission, but estimates of vaccine coverage are often unavailable, unreliable, or inaccurate. Quantifying virus neutralizing antibodies (VNA) allows monitoring of the immunological status of the canine population, evaluation of the degree of humoral protection to the virus, and assessing, partially, the population response to vaccination. We evaluated the dog population's immunity level against the rabies virus before a mass vaccination campaign in Lima. We collected 141 canine blood samples in the district of Surquillo and quantified rabies virus neutralizing antibody titers using the fluorescent antibody virus neutralization test). We surveyed dogs owners to reconstruct canine vaccination histories. Among dogs previously vaccinated, 73.9% exceeded the seroconversion threshold of > 0.5 IU/mL. Among all dogs, only 58.2% reached the titer limit for seroconversion. Dogs ≤ 1 year old constituted 26.2% of the total canine population and had lower levels of VNA than dogs > 1 year old (χ2 = 9.071; P = 0.028). Importantly, dogs vaccinated with single-pathogen vaccines had higher levels of VNA than those who received combined-pathogen vaccines (χ2 = 7.721; P = 0.005). We provide an important and timely glimpse to the immunity status of the dog population in urban areas of Lima, a metropolis near a dog rabies-endemic region.
Assuntos
Doenças do Cão , Vacina Antirrábica , Vírus da Raiva , Raiva , Animais , Cães , Anticorpos Antivirais , Doenças do Cão/epidemiologia , Doenças do Cão/prevenção & controle , Programas de Imunização , Vacinação em Massa/veterinária , Peru/epidemiologia , Raiva/epidemiologia , Raiva/prevenção & controle , Raiva/veterinária , Vacinação/veterináriaRESUMO
Elimination of dog-transmitted human rabies worldwide will require large-scale dog vaccination campaigns. However, this places participating vaccinators at increased risk. Data from the 2016-2017 Haitian mass rabies vaccination campaign was analyzed to determine dog bite incidence among vaccinators. A survey was then developed for completion by all identifiable bitten vaccinators covering demographics; experience and training; bite episode details; attitudes toward dogs and rabies; and medical care. A parallel group of unbitten vaccinators was also surveyed. Dog bite incidence was 0.03% (43/127,000) of all dogs vaccinated. The capture, vaccinate, and release method of vaccination carried a significantly higher risk of dog bite (0.35%, 6/1,739 vaccinations) than other methods (P < 0.001). Twenty-seven bitten vaccinators, and 54 control vaccinators were included in the survey analysis. No differences were found between groups in demographics, experience, or training. However, bitten vaccinators were significantly more likely than the control group to have experienced a dog bite before the study period (P < 0.001). This may be associated with a lesser appreciation of dogs, and/or a poorer ability to interpret dog behavioral signals within this group. Although 98% of the control group indicated they would seek medical care for a dog bite, only 35% of bitten vaccinators sought such care. On a yearly basis, for the Haitian campaign, a full series of postexposure rabies vaccinations for all bite victims would prove more cost-effective than preexposure vaccination of all vaccinators. These findings may prove useful for the planning and safety of future mass dog vaccination campaigns.
Assuntos
Técnicos em Manejo de Animais , Mordeduras e Picadas/epidemiologia , Doenças do Cão/prevenção & controle , Vacinação em Massa , Raiva/veterinária , Médicos Veterinários , Adulto , Idoso , Animais , Cães , Feminino , Haiti/epidemiologia , Humanos , Programas de Imunização , Incidência , Masculino , Pessoa de Meia-Idade , Raiva/prevenção & controle , Vacina Antirrábica/uso terapêutico , Inquéritos e Questionários , Adulto JovemRESUMO
One of the 4 pillars of the World Health Organization (WHO) strategy for the prevention and control of snake bite envenomings is to ensure safe and effective pharmacotherapeutic treatments [1]. The mainstay in the pharmacotherapy of these envenomings, as well as of envenomings by scorpions and spiders, is the timely administration of safe and effective antivenoms [2,3]. Antivenoms are composed of immunoglobulins, or immunoglobulin fragments, purified from the plasma of animals, usually horses, immunized with venoms. Currently, there is an urgent need to improve antivenom availability, accessibility, and affordability on a global basis, particularly for use in sub-Saharan Africa, Asia, and Latin America [1]. There is a long tradition in snake, scorpion, spider, and, more recently, caterpillar antivenoms production in Latin America, especially centered in public manufacturing laboratories in Argentina, Brazil, Peru, Bolivia, Ecuador, Colombia, Venezuela, Costa Rica, and Mexico [4–6]. A network of public laboratories devoted to the production and quality control of antivenoms was established in this region in the last decade [4,5], which has recently led to the creation of the Latin American Network of Public Antivenom Manufacturing Laboratories (RELAPA, Red Latinoamericana de Laboratorios Públicos Productores de Antivenenos) [6]. RELAPA aims at consolidating governance mechanisms within a regional platform for technical cooperation, technology transfer, research, and training for the regional improvement of antivenom availability, under the coordination of the Pan American Health Organization (PAHO) and its office Centro Panamericano de Fiebre Aftosa (Panaftosa). As part of the ongoing activities of RELAPA, a survey was sent by PAHO/Panaftosa to the institutions integrating this network to assess the situation of antivenom manufacture in these laboratories during the period January 2020 to July 2020, with the goal of analyzing in which ways has antivenom production been affected in this extraordinary year, especially regarding the impact of the Coronavirus Disease 2019 (COVID-19) pandemic, which has profoundly stricken Latin America [7]. The survey was sent to the directors of the institutions of RELAPA (the list of institutions is detailed in Fan and colleagues [6]). The survey included the following aspects: (a) What was the demand and the production of antivenoms (including snake, scorpion, spider, and caterpillar antivenoms) during the period January 2020 to July 2020? (b) What was the effect of the COVID-19 pandemic in (i) the number of professional and technical staff working to manufacture antivenom, (ii) acquisitions of consumables and laboratory equipment, (iii) overall budget devoted to antivenom manufacture, and (iv) attention to the COVID-19 crisis in terms of development of therapeutic equine preparations against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), preparation of diagnostic reagents, quality control activities, or assignment of staff to attend other pandemic issues? (c) Which are the priorities of the laboratories in the near future regarding regional cooperation in the field of antivenom manufacture and quality control? The survey was carried out between October 1 and October 19, 2020, using the platform Qualtrics (Qualtrics XM Platform, Seattle, Washington, United States of America).
RESUMO
BACKGROUND: International organizations advocate for the elimination of dog-mediated rabies, but there is only limited guidance on interpreting surveillance data for managing elimination programmes. With the regional programme in Latin America approaching elimination of dog-mediated rabies, we aimed to develop a tool to evaluate the programme's performance and generate locally-tailored rabies control programme management guidance to overcome remaining obstacles. METHODS: We developed and validated a robust algorithm to classify progress towards rabies elimination within sub-national administrative units, which we applied to surveillance data from Brazil and Mexico. The method combines criteria that are easy to understand, including logistic regression analysis of case detection time series, assessment of rabies virus variants, and of incursion risk. Subjecting the algorithm to robustness testing, we further employed simulated data sub-sampled at differing levels of case detection to assess the algorithm's performance and sensitivity to surveillance quality. RESULTS: Our tool demonstrated clear epidemiological transitions in Mexico and Brazil: most states progressed rapidly towards elimination, but a few regressed due to incursions and control lapses. In 2015, dog-mediated rabies continued to circulate in the poorest states, with foci remaining in only 1 of 32 states in Mexico, and 2 of 27 in Brazil, posing incursion risks to the wider region. The classification tool was robust in determining epidemiological status irrespective of most levels of surveillance quality. In endemic settings, surveillance would need to detect less than 2.5% of all circulating cases to result in misclassification, whereas in settings where incursions become the main source of cases the threshold detection level for correct classification should not be less than 5%. CONCLUSION: Our tool provides guidance on how to progress effectively towards elimination targets and tailor strategies to local epidemiological situations, while revealing insights into rabies dynamics. Post-campaign assessments of dog vaccination coverage in endemic states, and enhanced surveillance to verify and maintain freedom in states threatened by incursions were identified as priorities to catalyze progress towards elimination. Our finding suggests genomic surveillance should become increasingly valuable during the endgame for discriminating circulating variants and pinpointing sources of incursions.
Assuntos
Erradicação de Doenças/métodos , Doenças do Cão/epidemiologia , Doenças do Cão/prevenção & controle , Controle de Infecções/métodos , Vírus da Raiva/genética , Raiva/epidemiologia , Raiva/prevenção & controle , Algoritmos , Animais , Brasil/epidemiologia , Cães , Genômica/métodos , Humanos , América Latina/epidemiologia , Vacinação em Massa , México/epidemiologia , Raiva/transmissão , Raiva/virologia , Estudos Retrospectivos , Cobertura VacinalRESUMO
Rabies transmitted by common vampire bats (Desmodus rotundus) has been known since the early 1900s but continues to expand geographically and in the range of species and environments affected. In this review, we present current knowledge of the epidemiology and management of rabies in D. rotundus and argue that it can be reasonably considered an emerging public health threat. We identify knowledge gaps related to the landscape determinants of the bat reservoir, reduction in bites on humans and livestock, and social barriers to prevention. We discuss how new technologies including autonomously-spreading vaccines and reproductive suppressants targeting bats might manage both rabies and undesirable growth of D. rotundus populations. Finally, we highlight widespread under-reporting of human and animal mortality and the scarcity of studies that quantify the efficacy of control measures such as bat culling. Collaborations between researchers and managers will be crucial to implement the next generation of rabies management in Latin America.
Assuntos
Quirópteros/virologia , Reservatórios de Doenças/virologia , Vírus da Raiva/fisiologia , Raiva/virologia , Animais , Quirópteros/crescimento & desenvolvimento , Humanos , América Latina , Raiva/transmissão , Vírus da Raiva/genéticaRESUMO
The analysis of zoonotic disease risk requires the consideration of both human and animal geo-referenced disease incidence data. Here we show an application of joint Bayesian analyses to the study of echinococcosis granulosus (EG) in the province of Rio Negro, Argentina. We focus on merging passive and active surveillance data sources of animal and human EG cases using joint Bayesian spatial and spatio-temporal models. While similar spatial clustering and temporal trending was apparent, there appears to be limited lagged dependence between animal and human outcomes. Beyond the data quality issues relating to missingness at different times, we were able to identify relations between dog and human data and the highest 'at risk' areas for echinococcosis within the province.
Assuntos
Doenças do Cão/epidemiologia , Equinococose/epidemiologia , Vigilância em Saúde Pública/métodos , Zoonoses/epidemiologia , Adolescente , Animais , Argentina/epidemiologia , Teorema de Bayes , Criança , Cães , Echinococcus granulosus , Humanos , Modelos BiológicosRESUMO
[ABSTRACT]. Objective. To compare the performance of polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) tests for diagnosing Echinococcus granulosus in dog feces among national reference laboratories in Argentina, Chile, Peru, and Uruguay. Methods. National laboratories affiliated with the Ministry of Health/Agriculture of each country exchanged panels of 10 positive/negative samples obtained from their regular national surveillance programs in November 2015 – November 2016. All laboratories applied PCR; two also applied ELISA techniques. Sensitivity and specificity were determined for each laboratory and concordance of results among the laboratories was evaluated by Cohen Kappa coefficient. Results. Poor concordance (3 of 10 paired comparisons had values of Kappa > 0.4), low sensitivity and specificity across all laboratories, and poor performance of both techniques in detecting E. granulosus in canine feces was demonstrated in this study. An ex-post comparison of the laboratories’ test protocols showed substantial heterogeneity that could partially explain poor concordance of results. Conclusion. The results underscore the heterogeneity of canine echinococcosis diagnosis across the region and indicate possible sources of variability. Efforts to standardize canine echinococcosis testing must be included in the plan of action for the Regional Initiative for the Control of Cystic Echinococcosis. Future comparisons with fecal samples of known parasite load are needed.
[RESUMEN]. Objetivo. Comparar el rendimiento de los ensayos de la reacción en cadena de la polimerasa y el enzimoinmunoanálisis de adsorción en fase sólida (o ELISA, por su sigla en inglés) para diagnosticar Echinococcus granulosus en heces caninas en los laboratorios de referencia nacionales de Argentina, Chile, Perú y Uruguay. Métodos. Los laboratorios nacionales, afiliados a los ministerios de salud y agricultura y ganadería de cada país, intercambiaron paneles de diez muestras positivas y negativas obtenidas de sus respectivos programas nacionales de vigilancia desde el mes de noviembre del año 2015 hasta el mismo mes del año siguiente. Todos los laboratorios emplearon la reacción en cadena de la polimerasa y dos emplearon también técnicas de ensayo inmunoenzimático (ELISA). Se determinó la sensibilidad y la especificidad de cada laboratorio y se evaluó la concordancia entre los resultados de los laboratorios mediante el coeficiente kappa de Cohen. Resultados. Este estudio descubrió una escasa concordancia (3 de 10 comparaciones de pares obtuvieron valores de kappa > 0,4), una sensibilidad y especificidad bajas en todos los laboratorios y un rendimiento deficiente de ambas técnicas de diagnóstico de Echinococcus granulosus en heces caninas. La comparación ex post de los protocolos de ensayo de los laboratorios mostró una heterogeneidad sustancial que podría explicar parcialmente la escasa concordancia de los resultados. Conclusiones. Los resultados subrayan la heterogeneidad del diagnóstico de equinococosis canina en toda la región e indican posibles fuentes de esta variabilidad. Deben incluirse medidas para estandarizar la prueba de equinococosis canina en el plan de acción de la Iniciativa Sudamericana para el Control de la Equinococosis Quística. En el futuro serán necesarias comparaciones adicionales con muestras fecales con una carga de parásitos conocida.
[RESUMO]. Objetivo. Comparar o desempenho dos métodos de reação em cadeia da polimerase (PCR) e ensaio imunoenzimático (ELISA) no diagnóstico de infecção pelo Echinococcus granulosus em fezes de cães entre laboratórios de referência nacional na Argentina, Chile, Peru e Uruguai. Métodos. Laboratórios nacionais conveniados ao Ministério da Saúde/Agricultura de cada país participante intercambiaram grupos de 10 amostras positivas/negativas coletadas rotineiramente pelos programas nacionais de vigilância no período de novembro de 2015 a novembro de 2016. Todos os laboratórios empregaram o método de PCR e dois empregaram também o método de ELISA. A sensibilidade e a especificidade dos métodos foram determinadas em cada laboratório, e a concordância dos resultados entre os laboratórios participantes foi avaliada com o coeficiente kappa de Cohen. Resultados. Observou-se fraca concordância (3 de 10 comparações pareadas com kappa >0,4), baixa sensibilidade e especificidade e fraco desempenho de ambos os métodos na identificação do E. granulosus em amostras fecais de cães nos laboratórios participantes do estudo. Uma comparação retroativa revelou considerável heterogeneidade dos protocolos de análise laboratorial, o que poderia em parte explicar a fraca concordância entre os resultados. Conclusões. Os resultados deste estudo apontam para a falta de uniformidade no diagnóstico de equinococose canina em toda a Região e indicam possíveis causas para variabilidade. A padronização da análise laboratorial da equinococose canina deve constar do plano de ação para a Iniciativa Regional para Controle da Hidatidose. Outras comparações de amostras fecais de parasitas conhecidos devem ser realizadas.
Assuntos
Equinococose , Doenças do Cão , Ensaio de Proficiência Laboratorial , América do Sul , Equinococose , Doenças do Cão , Ensaio de Proficiência Laboratorial , América do Sul , Equinococose , Doenças do Cão , Ensaio de Proficiência Laboratorial , América do SulRESUMO
[RESUMEN]. Se analiza la situación de los laboratorios públicos productores de antivenenos en América Latina, con base a los resultados de en un taller coordinado por el Centro Panamericano de Fiebre Aftosa (PANAFTOSA) de la Organización Panamericana de la Salud (OPS). Nueve países en la región poseen doce laboratorios públicos que producen y distribuyen antivenenos contra venenos de diferentes animales ponzoñosos. Se discutió la situación de cada laboratorio, se analizó el escenario actual caracterizado por las crecientes demandas regulatorias y la heterogeneidad de estos en términos de infraestructura y capacidad productiva y se planteó la necesidad de concertar procesos de cooperación regional dirigidos a mejorar la disponibilidad de antivenenos, incluyendo proyectos de investigación y desarrollo para el mejoramiento de los procesos y las tecnologías; estudios del perfil de la capacidad neutralizante de los antivenenos contra diferentes venenos, y programas de capacitación técnica de profesionales y personal técnico. En el contexto actual, en el que la Organización Mundial de la Salud elaboró una estrategia global para la prevención y el control de los envenenamientos ofídicos, el Centro PANAFTOSA de la OPS ha asumido la coordinación de estas acciones en las Américas, mejorar la disponibilidad de antivenenos es prioritaria. Como resultado de ese taller, se creó la Red de Laboratorios Públicos Productores de Antivenenos de América Latina (RELAPA), con el objetivo de fortalecer estos laboratorios y de aumentar la disponibilidad y accesibilidad de antivenenos eficaces y seguros a toda América Latina.
[ABSTRACT]. The situation of public laboratories manufacturing antivenoms in Latin America was analyzed, based on the results of a workshop coordinated by the Pan American Foot-and-Mouth Disease Center (PANAFTOSA) of the Pan American Health Organization (PAHO). Nine countries in the region have 12 public laboratories that produce and distribute antivenoms for use against different venomous animals. The situation of each laboratory was discussed, and an analysis was conducted of the current scenario, which is characterized by increasing regulatory requirements that vary in terms of infrastructure and production capacity. The authors identified a need to organize regional cooperation processes to improve the availability of antivenoms, including: research and development projects to improve processes and technologies; studies of the capacity of antivenoms to neutralize different poisons; and technical training programs for professionals and technical personnel. In the current context, in which the World Health Organization has prepared a global strategy for the prevention and control of snakebite envenoming, PANAFTOSA has taken on coordination of this initiative in the Americas. Improving the availability of antivenoms is the priority. As a result of the workshop, the RELAPA network was created, bringing together public laboratories that manufacture antivenoms in Latin America, in order to strengthen these laboratories and increase the availability of, and access to effective and safe antivenoms throughout Latin America.
[RESUMO]. A situação dos laboratórios públicos produtores de soros antivenenos na América Latina foi analisada com base nas conclusões de um seminário coordenado pelo Centro Pan-Americano de Febre Aftosa (PANAFTOSA) da Organização Pan-Americana da Saúde (OPAS). Em nove países da Região, encontram-se 12 laboratórios públicos que produzem e distribuem soros contra venenos de diferentes animais peçonhentos. Examinou-se a situação de cada laboratório, analisou-se o panorama atual marcado por crescentes demandas de regulação e pela heterogeneidade da infraestrutura e capacidade produtiva dos laboratórios e destacou-se a necessidade de um esforço concertado de cooperação regional com vistas a aumentar a disponibilidade de soros antivenenos, englobando projetos de pesquisa e desenvolvimento para o avanço dos processos e tecnologias, estudos do perfil da capacidade de neutralização dos soros contra diversos venenos e programas de capacitação técnica de profissionais e pessoal técnico. No contexto atual, em que uma estratégia mundial de prevenção e controle de acidentes ofídicos foi elaborada pela Organização Mundial da Saúde e que a coordenação das ações relacionadas na Região das Américas foi assumida pelo PANAFTOSA, melhorar a disponibilidade de soros antivenenos é prioridade. Como resultado deste seminário, a Rede de Laboratórios Públicos Produtores de Soros Antivenenos da América Latina (RELAPA) foi formada com o objetivo de fortalecer os laboratórios e aumentar a disponibilidade e a acessibilidade de soros antivenenos eficazes e seguros em toda América Latina.
Assuntos
Antivenenos , Serviços Laboratoriais de Saúde Pública , Animais Peçonhentos , América Latina , Antivenenos , Serviços Laboratoriais de Saúde Pública , Animais , Animais Peçonhentos , América Latina , Animais PeçonhentosRESUMO
An effective surveillance system is critical for the elimination of canine rabies in Latin America. Brazil has made substantial progress towards canine rabies elimination, but outbreaks still occurred in the last decade in two states. Brazil uses a health information system (SINAN) to record patients seeking post-exposure prophylaxis (PEP) following contact with an animal suspected of having rabies. This study evaluated: (i) whether SINAN can be reliably used for rabies surveillance; (ii) if patients in Brazil are receiving appropriate PEP and (iii) the benefits of implementing the latest World Health Organization (WHO) recommendations on PEP. Analysing SINAN records from 2008 to 2017 reveals an average of 506,148 bite-injury patients/year [range: 437k-545k] in the country, equivalent to an incidence of 255 bite-injuries/100,000 people/year [range: 231-280]. The number of reports of bites from suspect rabid dogs generally increased over time. In most states, records from SINAN indicating a suspect rabid dog do not correlate with confirmed dog rabies cases reported to the Regional Information System for Epidemiological Surveillance of Rabies (SIRVERA) maintained by the Pan American Health Organization (PAHO). Analyses showed that in 2017, only 45% of patients received appropriate PEP as indicated by the Brazilian Ministry of Health guidance. Implementation of the latest WHO guidance using an abridged intradermal post-exposure vaccination regimen including one precautionary dose for dog bites prior to observation would reduce the volume of vaccine required by up to 64%, with potential for annual savings of over USD 6 million from reduced vaccine use. Our results highlight the need to improve the implementation of SINAN, including training of health workers responsible for delivering PEP using an Integrated Bite Case Management approach so that SINAN can serve as a reliable surveillance tool for canine rabies elimination.
Assuntos
Profilaxia Pós-Exposição/métodos , Raiva/tratamento farmacológico , Raiva/epidemiologia , Animais , Mordeduras e Picadas/epidemiologia , Brasil , Erradicação de Doenças , Doenças do Cão , Cães , Pessoal de Saúde , Humanos , Organização Mundial da SaúdeRESUMO
OBJECTIVE: To compare the performance of polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) tests for diagnosing Echinococcus granulosus in dog feces among national reference laboratories in Argentina, Chile, Peru, and Uruguay. METHODS: National laboratories affiliated with the Ministry of Health/Agriculture of each country exchanged panels of 10 positive/negative samples obtained from their regular national surveillance programs in November 2015 - November 2016. All laboratories applied PCR; two also applied ELISA techniques. Sensitivity and specificity were determined for each laboratory and concordance of results among the laboratories was evaluated by Cohen Kappa coefficient. RESULTS: Poor concordance (3 of 10 paired comparisons had values of Kappa > 0.4), low sensitivity and specificity across all laboratories, and poor performance of both techniques in detecting E. granulosus in canine feces was demonstrated in this study. An ex-post comparison of the laboratories' test protocols showed substantial heterogeneity that could partially explain poor concordance of results. CONCLUSION: The results underscore the heterogeneity of canine echinococcosis diagnosis across the region and indicate possible sources of variability. Efforts to standardize canine echinococcosis testing must be included in the plan of action for the Regional Initiative for the Control of Cystic Echinococcosis. Future comparisons with fecal samples of known parasite load are needed.
RESUMO
The situation of public laboratories manufacturing antivenoms in Latin America was analyzed, based on the results of a workshop coordinated by the Pan American Foot-and-Mouth Disease Center (PANAFTOSA) of the Pan American Health Organization (PAHO). Nine countries in the region have 12 public laboratories that produce and distribute antivenoms for use against different venomous animals. The situation of each laboratory was discussed, and an analysis was conducted of the current scenario, which is characterized by increasing regulatory requirements that vary in terms of infrastructure and production capacity. The authors identified a need to organize regional cooperation processes to improve the availability of antivenoms, including: research and development projects to improve processes and technologies; studies of the capacity of antivenoms to neutralize different poisons; and technical training programs for professionals and technical personnel. In the current context, in which the World Health Organization has prepared a global strategy for the prevention and control of snakebite envenoming, PANAFTOSA has taken on coordination of this initiative in the Americas. Improving the availability of antivenoms is the priority. As a result of the workshop, the RELAPA network was created, bringing together public laboratories that manufacture antivenoms in Latin America, in order to strengthen these laboratories and increase the availability of, and access to effective and safe antivenoms throughout Latin America.
RESUMO
Rabies virus is the only Lyssavirus species found in the Americas. In discussions about rabies, Latin America and the Caribbean are often grouped together. Our study aimed to independently analyse the rabies situation in the Caribbean and examine changes in rabies spatiotemporal epidemiology. A questionnaire was administered to the 33 member countries and territories of the Caribbean Animal Health Network (CaribVET) to collect current data, which was collated with a literature review. Rabies was endemic in ten Caribbean localities, with the dog, mongoose, and vampire bat identified as enzootic reservoirs. The majority of animal cases occurred in Puerto Rico, the Dominican Republic, and Haiti, while human cases only consistently occurred in the latter two areas. Rabies vaccination was conducted for high-risk animal populations with variable coverage, and rabies diagnostic capacities varied widely throughout the region. Illegal importation and natural migration of animals may facilitate the introduction of rabies virus variants into virus-naïve areas. Passive surveillance, together with enhanced methods and serological screening techniques, can therefore be of value. The insularity of the Caribbean makes it ideal for conducting pilot studies on reservoir host population management. Best practice guidelines developed for these reservoir hosts can be individually modified to the epidemiological status and available resources within each locality.
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Through national efforts and regional cooperation under the umbrella of the Regional Program for the Elimination of Rabies, dog and human rabies have decreased significantly in Latin America and Caribbean (LAC) countries over the last three decades. To achieve this decline, LAC countries had to develop national plans, and consolidate capabilities such as regular mass dog vaccination, opportune post-exposure prophylaxis and sensitive surveillance. This paper presents longitudinal data for 21 LAC countries on dog vaccination, PEP and rabies surveillance collected from the biannual regional meeting for rabies directors from 1998-2014 and from the Regional Epidemiologic Surveillance System for Rabies (SIRVERA). Differences in human and dog rabies incidence rates and dog vaccination rates were shown between low, middle and high-income countries. At the peak, over 50 million dogs were vaccinated annually in national campaigns in the countries represented. The reported number of animal exposures remained fairly stable during the study period with an incidence rate ranging from 123 to 191 reported exposures per 100,000 people. On average, over 2 million doses of human vaccine were applied annually. In the most recent survey, only 37% of countries reported that they had sufficient financial resources to meet the program objectives. The data show a sufficient and sustained effort of the LAC countries in the area of dog vaccination and provide understanding of the baseline effort required to reduce dog-mediated rabies incidence.
Assuntos
Doenças do Cão/prevenção & controle , Vacina Antirrábica , Raiva/epidemiologia , Animais , Região do Caribe/epidemiologia , Doenças do Cão/epidemiologia , Doenças do Cão/virologia , Cães , Humanos , América Latina/epidemiologia , Vacinação em Massa/veterinária , Profilaxia Pós-Exposição , Raiva/transmissão , Raiva/veterinária , Raiva/virologia , Vacina Antirrábica/administração & dosagem , Vacina Antirrábica/economia , Inquéritos e Questionários , Vacinação/economia , Vacinação/estatística & dados numéricos , Vacinação/veterináriaRESUMO
Haiti has historically vaccinated between 100,000 and 300,000 dogs annually against rabies, however national authorities have not been able to reach and maintain the 70% coverage required to eliminate the canine rabies virus variant. Haiti conducts massive dog vaccination campaigns on an annual basis and utilizes both central point and door-to-door methods. These methods require that dog owners are aware of the dates and locations of the campaign. To improve this awareness among dog owners, 600,000 text messages were sent to phones in two Haitian communes (Gonaives and Saint-Marc) to remind dog owners to attend the campaign. Text messages were delivered on the second day and at the mid-point of the campaign. A post-campaign household survey was conducted to assess dog owner's perception of the text messages and the impact on their participation in the vaccination campaign. Overall, 147 of 160 (91.9%) text-receiving dog owners indicated the text was helpful, and 162 of 187 (86.6%) responding dog owners said they would like to receive text reminders during future rabies vaccination campaigns. In areas hosting one-day central point campaigns, dog owners who received the text were 2.0 (95% CI 1.1, 3.6) times more likely to have participated in the campaign (73.1% attendance among those who received the text vs 36.4% among those who did not). In areas incorporating door-to-door vaccination over multiple days there was no significant difference in participation between dog owners who did and did not receive a text. Text message reminders were well-received and significantly improved campaign attendance, indicating that short message service (SMS) alerts may be a successful strategy in low resource areas with large free roaming dog populations.
Assuntos
Doenças do Cão/imunologia , Doenças do Cão/prevenção & controle , Vacina Antirrábica/imunologia , Vírus da Raiva/imunologia , Raiva/imunologia , Raiva/prevenção & controle , Animais , Cães , Haiti , Humanos , Programas de Imunização/métodos , Vacinação em Massa/métodos , Propriedade , Inquéritos e Questionários , Envio de Mensagens de Texto , Vacinação/métodosRESUMO
Haiti, a Caribbean country of 10.5 million people, is estimated to have the highest burden of canine-mediated human rabies deaths in the Western Hemisphere, and one of the highest rates of human rabies deaths in the world. Haiti is also the poorest country in the Western Hemisphere and has numerous economic and health priorities that compete for rabies-control resources. As a result, primary rabies-control actions, including canine vaccination programs, surveillance systems for human and animal rabies, and appropriate postbite treatment, have not been fully implemented at a national scale. After the 2010 earthquake that further hindered the development of public health program infrastructure and services, the U.S. Centers for Disease Control and Prevention worked with the Ministry of Public Health and Population and key health development partners (including the Pan-American Health Organization) to provide technical expertise and funding for general disease surveillance systems, laboratory capacity, and selected disease control programs; including rabies. In 2011, a cross-ministerial rabies consortium was convened with participation from multiple international rabies experts to develop a strategy for successful rabies control in Haiti. The consortium focused on seven pillars: 1) enhancement of laboratory diagnostic capacity, 2) development of comprehensive animal surveillance system, 3) development of comprehensive human rabies surveillance system, 4) educational outreach, 5) sustainable human rabies biologics supply, 6) achievement of sustained canine vaccination rates of ≥ 70%, and 7) finalization of a national rabies control strategy. From 2010 until 2015, Haiti has seen improvements in the program infrastructure for canine rabies control. The greatest improvements were seen in the area of animal rabies surveillance, in support of which an internationally recognized rabies laboratory was developed thereby leading to an 18-fold increase in the detection of rabid animals. Canine rabies vaccination practices also improved, from a 2010 level of approximately 12% to a 2015 dog population coverage level estimated to be 45%. Rabies vaccine coverage is still below the goal of 70%, however, the positive trend is encouraging. Gaps exist in the capacity to conduct national surveillance for human rabies cases and access to human rabies vaccine is lacking in many parts of the country. However, control has improved over the past 5 years as a result of the efforts of Haiti's health and agriculture sectors with assistance from multiple international organizations. Haiti is well situated to eliminate canine-mediated human rabies deaths in the near future and should serve as a great example to many developing countries struggling with similar barriers and limitations.
Assuntos
Erradicação de Doenças , Doenças do Cão/prevenção & controle , Vacina Antirrábica/uso terapêutico , Raiva/prevenção & controle , Animais , Países em Desenvolvimento , Vetores de Doenças , Doenças do Cão/transmissão , Cães , Haiti , Humanos , Cooperação Internacional , Vigilância em Saúde Pública , Raiva/diagnóstico , Raiva/transmissão , Raiva/veterináriaRESUMO
Cystic echinococcosis (CE) or hydatidosis, a parasitic zoonosis caused by a cestode of the family Taeniidae, species Echinococcus granulosus, is endemic in Argentina, Chile, Peru, Uruguay, and southern Brazil. This report presents CE figures for these five countries in 2009 - 2014 and proposes indicators to measure national control programs. Nearly 5 000 new CE cases were diagnosed annually in the five countries during the study period. The average case fatality rate was 2.9%, which suggests that CE led to approximately 880 deaths in these countries during the 6-year period. CE cases that required secondary or tertiary health care had average hospital stays of 10.6 days, causing a significant burden to health systems. The proportion of new cases (15%) in children less than 15 years of age suggests ongoing transmission. Despite figures showing that CE is not under control in South America, the long-standing implementation of national and local control programs in three of the five countries has achieved reductions in some of the indicators. The Regional Initiative for the Control of CE, which includes the five countries and provides a framework for networking and collaboration, must intensify its efforts.
Assuntos
Equinococose/epidemiologia , Equinococose/prevenção & controle , Humanos , Incidência , Prevalência , América do Sul/epidemiologia , Fatores de TempoRESUMO
Cystic echinococcosis (CE) or hydatidosis, a parasitic zoonosis caused by a cestode of the family Taeniidae, species Echinococcus granulosus, is endemic in Argentina, Chile, Peru, Uruguay, and southern Brazil. This report presents CE figures for these five countries in 2009 – 2014 and proposes indicators to measure national control programs. Nearly 5 000 new CE cases were diagnosed annually in the five countries during the study period. The average case fatality rate was 2.9%, which suggests that CE led to approximately 880 deaths in these countries during the 6-year period. CE cases that required secondary or tertiary health care had average hospital stays of 10.6 days, causing a significant burden to health systems. The proportion of new cases (15%) in children less than 15 years of age suggests ongoing transmission. Despite figures showing that CE is not under control in South America, the long-standing implementation of national and local control programs in three of the five countries has achieved reductions in some of the indicators. The Regional Initiative for the Control of CE, which includes the five countries and provides a framework for networking and collaboration, must intensify its efforts.
La equinococosis quística o hidatidosis, zoonosis parasitaria causada por un cestodo de la especie Echinococcus granulosus, familia Taeniidae, es endémica en Argentina, Chile, Perú, Uruguay y el sur del Brasil. En este informe se presentan datos sobre la equinococosis quística registrados en estos cinco países entre los años 2009 y 2014, y se proponen indicadores para medir el desempeño de los programas nacionales de control. Durante el período de estudio, en los cinco países se diagnosticaron casi 5 000 casos nuevos por año. La tasa de letalidad promedio fue del 2,9 %, lo que indica que la equinococosis quística causó aproximadamente 880 defunciones en estos países en el período de 6 años estudiado. Los casos que debieron recibir atención de salud secundaria o terciaria tuvieron una estadía hospitalaria promedio de 10,6 días, lo que ha generado una carga significativa para los sistemas de salud. La proporción de casos nuevos de niños menores de 15 años (15 %) indica que la transmisión no se ha interrumpido. A pesar de que los datos muestran que la enfermedad no está controlada en América del Sur, tres de los cinco países disponen de programas nacionales y locales de control desde hace muchos años, los que han logrado reducir algunos de los indicadores. Es preciso que la Iniciativa Sudamericana para el Control de la Equinococosis Quística, que incluye a los cinco países y contribuye con un marco para la formación de redes y la colaboración, redoble sus esfuerzos para lograr el control de la enfermedad.
A equinococose cística ou hidatidose, zoonose parasitária causada por um céstodo da família Taeniidae e espécie Echinococcus granulosus, é endêmica na Argentina, Chile, Peru, Uruguai e no sul do Brasil. Neste artigo são apresentadas as estimativas da hidatidose nos cinco países de 2009 a 2014 e propostos indicadores para avaliar os programas nacionais de controle. Cerca de 5 mil casos novos de hidatidose foram diagnosticados por ano nos cinco países no período de estudo. A taxa de letalidade média foi de 2,9%, o que indica que esta doença causou aproximadamente 880 mortes nestes países no período de 6 anos. Nos casos de hidatidose que precisaram de atenção de saúde secundária ou terciária, a duração média da internação hospitalar foi de 10,6 dias, representando uma sobrecarga considerável aos sistemas de saúde. O percentual de novos casos (15%) em indivíduos menores de 15 anos de idade indica transmissão contínua. Apesar de as estimativas mostrarem que a hidatidose não está controlada na América do Sul, a execução permanente de programas municipais e nacionais de controle em três dos cinco países tem redundado na redução de alguns dos indicadores. A Iniciativa Regional para Controle da Hidatidose, que integra os cinco países em uma estrutura para trabalho em conjunto e colaboração, deve redobrar os seus esforços.
Assuntos
Zoonoses , Equinococose , Echinococcus granulosus , América do Sul , ZoonosesRESUMO
The direct fluorescent antibody test (DFA), is performed in all rabies reference laboratories across Latin America and the Caribbean (LAC). Despite DFA being a critical capacity in the control of rabies, there is not a standardized protocol in the region. We describe the results of the first inter-laboratory proficiency exercise of national rabies laboratories in LAC countries as part of the regional efforts towards dog-maintained rabies elimination in the American region. Twenty three laboratories affiliated to the Ministries of Health and Ministries of Agriculture participated in this exercise. In addition, the laboratories completed an online questionnaire to assess laboratory practices. Answers to the online questionnaire indicated large variability in the laboratories throughput, equipment used, protocols availability, quality control standards and biosafety requirements. Our results will inform actions to improve and harmonize laboratory rabies capacities across LAC in support for the regional efforts towards elimination of dog-maintained rabies.
Assuntos
Doenças do Cão/diagnóstico , Ensaio de Proficiência Laboratorial/normas , Saúde Pública , Vírus da Raiva/imunologia , Raiva/diagnóstico , Animais , Encéfalo/virologia , Região do Caribe , Erradicação de Doenças , Doenças do Cão/prevenção & controle , Doenças do Cão/virologia , Cães , Técnica Direta de Fluorescência para Anticorpo , Humanos , Cooperação Internacional , Internet , América Latina , Controle de Qualidade , Raiva/prevenção & controle , Raiva/virologia , Vírus da Raiva/isolamento & purificação , Sensibilidade e Especificidade , Inquéritos e QuestionáriosRESUMO
BACKGROUND: In recent years, global public health security has been threatened by zoonotic disease emergence as exemplified by outbreaks of H5N1 and H1N1 influenza, SARS, and most recently Ebola and Zika. Additionally, endemic zoonoses, such as rabies, burden countries year after year, placing demands on limited finances and personnel. To survey the baseline status of the emerging and endemic zoonoses programmes of the Latin American and the Caribbean (LAC) countries, the Pan American Health Organization (PAHO) conducted a survey of priority emerging and endemic zoonoses, countries´ prioritization criteria and methodologies, and suggestions to strengthen countries capacities and regional approaches to zoonoses control. METHODS: A fillable online questionnaire was sent to the zoonoses programme managers of the Ministries of Health (MOH) and Ministries of Agriculture (MAg) of 33 LAC countries from January to April of 2015. The questionnaire comprised 36 single, multiple choice and open-ended questions to inform the objectives of the survey. A descriptive exploratory analysis was completed. RESULTS: Fifty-four ministries (26 MOH, 25 MAg, and 3 combined responses) in 31 LAC countries responded to the survey. Within the ministries, 22 (85%) MOH, 5 (20%) MAg, and 2 (67%) combined entities indicated they had specialized zoonoses units. For endemic zoonoses, 32 of 54 ministries responded that they conduct formal prioritization exercises, most of them annually (69%). The three priority endemic zoonoses for the MOHs were leptospirosis, rabies, and brucellosis while the three priorities for the MAgs were brucellosis, rabies, and tuberculosis. Diagnosis for rabies and leptospirosis were cited as the capacities most in need of development. The most needed cross-cutting capacity was coordination between stakeholders. For emerging zoonoses, 28 ministries performed formal prioritization exercises. The top prioritization criteria were probability of introduction into the country and impact. The three priority emerging zoonoses for the MOHs were Ebola viral disease, avian influenza, and Chikungunya while for the MAgs were avian influenza, bovine spongiform encephalopathy and West Nile virus disease. Surveillance for avian influenza and Ebola, and diagnosis for BSE were quoted as the capacities most needed. For all zoonoses, the majority of respondents (69%) ranked their relationship with the other Ministry as productive or very productive, and 31% minimally productive. Many countries requested a formal regional network, better regional communication and collaboration, and integrated surveillance. CONCLUSIONS: The survey is the first comprehensive effort to date to inform the status of zoonoses programmes in LAC. The information collected here will be used to develop a regional strategy for zoonoses (both endemic and emerging), increase efforts, advocacy, and promote prompt identification and management of EIDs and improvement of endemic programmes.