Presentación de PowerPoint - Dengue Vaccine Initiative

Presentación de PowerPoint - Dengue Vaccine Initiative

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
Areas or countries at risk
Source:
Countries report PAHO/WHO
Incidence evolution of dengue since 1980
Source:
Countries report PAHO/WHO
Morbility of dengue in four subregions of America
Source: Countries report PAHO/WHO
*2011: 31st epidemiolofy week.
Percentual distribution of the Morbility by countries of
greater notification in the America’s, 2003-2010
100%
Resto
90%
19.2%
México
80%
70%
Honduras
Costa Rica
Venezuela
60%
Colombia
50%
80.8%
40%
Brasil
30%
20%
10%
0%
2003
Brasil
2004
Colombia
2005
2006
Venezuela
2007
Costa Rica
2008
Honduras
2009
México
2010
Resto
Source: Country report to OPS/OMS
Current situation in our Region
 By the end of december 2010,
over 36 countries had reported
1.699.379 dengue cases, 50.235
severe dengue cases and 1.185
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, 890.756
dengue cases, 10.816 severe
dengue cases and 488 fatalities
(cfr: 4,5) have been reported.
Circulation of dengue serotypes in the
Americas 2006-2010
MEXICO
DEN 1,2,3,4
DEN 1,2,4
HONDURAS
DEN 1,2,3,4
NICARAGUA
EL SALVADOR
DEN 1,2,3
DEN 1,2,3,4
REP. DOMINICANA:
DEN 1,2,4
MARTINICA:
DEN 1,2, 4
VENEZUELA GUYANA FRANCESA:
COLOMBIA
DEN 1,2,3,4 DEN 1,2,3
DEN 1,2,3,4
DEN 1,2,3,4
ECUADOR
DEN1,3
BRASIL:
DEN 1,2,3
DEN 4
2010
PERÚ
DEN 1,2,3,4
DEN 1, 2,3
BOLIVIA:
DEN 2,3
PARAGUAY:
DEN1,2, 3
ARGENTINA
DEN 1, 2,3
ISLAS PASCUA:
DEN 1
DEN 1
Fuente: Boletines de país.
Countries with greater mortality and case fatality rate
by dengue in the Americas (Period 2000-2009) and 2010
Deaths
Percentage
Percentage
accumulated
Case
fatality
rate
Cases in
2010
Brasil
996
46.2
46.2
4.0
673
República
Dominicana
316
14.7
60.9
14.1
51
Colombia
300
13.9
74.8
0.7
217
México
150
7.0
81.8
0.3
20
Hondura
85
3.9
85.7
0.5
83
Nicaragua
84
3.9
89.6
4.0
3
El Salvador
64
3.0
92.6
3.4
2
Guatemala
58
2.7
95.3
12.7
41
Venezuela
37
1.7
97.0
0.1
n/d
Ecuador
33
1.5
98.5
2.0
2
Puerto Rico
32
1.5
100.0
12.2
33
2,155
100.0
4.9
1,125
Countries
Total
• 11 Countries concentrates 95 % of the deaths by dengue in the region.
• 2155 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.
Determinants of dengue transmission
 Unprecedented population growth
(megacities)
 Uncontrolled and unplanned
Urbanization;
 Inadequate environmental
management;
 Migration and tourism;
 Climate change
 Poverty and extreme Poverty
Dengue en las Américas 2000-2009, la Respuesta de los
países. OPS/OMS
1947-1970 ERADICATION of Aedes ae. OPS – CD1.R1
Comunicac
ión Social
Vigilancia
Epidemiológ
ica
Manejo
Integrado
de Vectores
EGIDengue
Atención
al
paciente
2010
Nueva Guía
de atención a
enfermos de
dengue
2009
2008
2007
2007
CSP27.R15
2005
2004
2009
Nueva Guía
diagnóstico,
tratamiento,
prevención y
control del
dengue
2010
2007
Entrada en
vigencia RSI
(2005)
2003: CD44.R9 OPS
La Estrategia de
Gestión
Integrada
(EGI – Dengue)
2. GT – Dengue
2003
2002
2001
2001
CD43.R4
Nueva
generación de
Programas
Ambiente
2006
Laboratórí
o
Integrated Management Strategy for dengue prevention and
control (IMS-Dengue)
Epidemiologic
Surveillance
Integrated
Vector
Social
communication
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 IMSDengue.
Event Management system (EMS)
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
Intervenciones: Perú, Iquitos
febrero 2011
LABORATORY SURVEILLANCE
RELDA: Laboratory network of dengue in the Americas
http://www.paho.org/Spanish/AD/DPC/CD/den-cc.htm
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
Resolution CSP27.R15
 Integrated Vector Management (IVM)
DENGUE
YELLOW FEVER
Aedes aegypti
MALARIA
CHAGAS
Anopheles
LEISHMANIASIS
Triatoma
WEST NILE VIRUS
FILARIASIS
SAN LUIS ENCEPHALITIS
Lutzonia
HANTAVIRUS
Culex
HORIZONTAL LINES OF ACTION
•
Strengthen epidemiological and
entomological surveillance.
•
Promote advocacy, social
movillizations and synergies for
primary attentions in health.
•
Rational use of pesticides.
•
Strengthen legislation and public policy
Organización
Panamericana
De la Salud
Integrated
Vector
Management (IVM)
Roedores
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
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.
Áreas con riesgo de importación
Programa Regional de Dengue-2011
Our challenges
Our challenges
Our challenges
Cementerio infestado de Aedes aegypti
• Backyard housing
• Backyard housing in front of a health center
Epidemiologic
Surveillance
Integrated
Vector
control
Social communication
Environment
Laboratory
Patient care
Thank you