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Disease Prevention and Control / Communicable Diseases / Emerging and Reemerging Diseases

IVth Meeting of the Surveillance Network for Emerging and Reemerging Diseases in the Amazon Region

(Belém, Pará, Brazil, 15–18 March 2003)

EER, Amazonas

Final Report (in Spanish, 108 pp, PDF, 4237 KB; links in Table of Contents to chapters listed below, with headings translated for user orientation)

1. Executive Summary, Spanish
2. Executive Summary, English
(with recommendations)

3. Introduction

4. Priority Network Activities
- Malaria in the Americas
- EID Surveillance: Performance Evaluation for Laboratory Diagnostics
- Resistance to Antibiotics

5. Status of EIDs in the Amazon Countries



6. Compliance with the Recommendations from the IInd Joint Meeting of the EID Surveillance Network, Atlanta 2002

7. Recommendations for 2003–2004
- General Network Activities
- Syndromic Focus
- Influenza
- Performance Evaluation for Serological EID Diagnosis
- Antimicrobial Resistance
- Malaria, RAVREDA

8. List of Participants

The IVth Meeting of the Surveillance Network for Emerging and Reemerging Diseases was held in Belém, Pará, Brazil, from 15 to 18 March 2003. The participants included staff from the ministries of health and academic institutions of Bolivia, Brazil, Colombia, Ecuador, Guyana, Peru, Suriname, and Venezuela; the United States Agency for International Development (USAID); the Centers for Disease Control and Prevention (CDC); the US Naval Medical Research Center (NMRCD, Lima Peru); the World Health Organization (WHO); and the Pan American Health Organization.

Objective: To report on and discuss topics of special interest regarding surveillance of emerging and reemerging infectious diseases (EIDs) in the subregion. The participating countries also reported on the EID situation in 2002 and early 2003, and on the fulfillment of the commitments made at the joint meeting of the Southern Cone and Amazon Region countries held in Atlanta, Georgia, in July 2002. Participants also reviewed the EID events detected during the past year and issued recommendations for the period 2003–2004, based on identified needs and established priorities.

Recommendations for 2003–2004

I. General Network Activities

To the countries: That the EID surveillance network of the Amazon countries formally integrate its activities with those of the Amazon Cooperation Treaty (ACT) network; that multicountry border activities be carried out; and that the available epidemiological information be regularly and systematically at the disposal of the health services.

To PAHO/WHO: That information on outbreaks, epidemics, and other events that affect more than one country be furnished to the countries of the epidemiological surveillance network.

II. Syndromic Approach

To the countries: That during the coming year each country report on the use of the syndromic approach in epidemiological surveillance and the detection of outbreaks, providing specific examples; that countries indicate the manner in which physicians were involved in surveillance activities; and that they continue to strengthen surveillance of dengue, yellow fever, and leptospirosis.

III. Influenza

To the countries: That contingency plans be prepared for an eventual influenza pandemic and that at least two countries present these plans at the next meeting; that the national influenza reference centers strengthen the epidemiological surveillance network (including virological surveillance), report their findings regularly to FluNet, and send samples to the WHO Collaborating Center in the Americas for characterization.

IV. Performance Evaluation with respect to the Serological Diagnosis of EIDs

To the countries: That all countries participate in the performance evaluation of serological diagnosis of EIDs.

To the CDC: That it continue its support for this activity.

To PAHO/WHO: That it report the results of performance evaluation activities at the next meeting.

V. Antimicrobial Resistance

To the countries: That they expand the surveillance network; report the findings on the surveillance of resistance in community and hospital species and the operation of the quality assurance system, including an evaluation of antibiotic resistance surveillance; that hospitals produce and disseminate information on local resistance profiles; and that information, education, and communication (IEC) activities begin for the general population on the rational use of antibiotics.

To PAHO/WHO: That it distribute information on the results of the surveillance of antimicrobial resistance and on the rational use of antibiotics in the Amazon countries.

VI. Malaria, RAVREDA

Use of Antimalarial Drugs

To the countries: Plasmodium falciparum: That monotherapy or quinine in first-line treatment regimens not be used, nor drug dosages that are either higher or lower than those recommended by PAHO/WHO; in regimens with mefloquine, that a dosage of 25 mg/kg be used (15 mg/kg the first day and 10 mg/ kg the second day), and only in combination therapy; when amodiaquine is used, carefully monitoring of adverse effects (toxicity associated with frequent use) must take place; countries must ensure the appropriate prescription of second-line treatment. The recommended combination therapy regimens are: AQ + SP, SP + ACE, AQ + ACE, MQ + ACE, or artemether + lumefantrine.

Plasmodium vivax: That only CQ be used to detect resistance to chloroquine, and CQ+PQ to determine whether the policy is effective.

Protocols and Sentinel Sites

To the countries: That they evaluate the efficacy of antimalarials through the exclusive use of the standard protocols (WHO/PAHO), ensuring that be trained to assure the quality of the data and parasitological diagnosis and that the quality of the drugs to be used in the efficacy studies is guaranteed. That the efficacy of any drug not be evaluated at less than two-year intervals. That sentinel sites be selected as follows:

  1. the level of transmission should ensure a sufficient number of cases (at least 50 patients per study) and permit patient monitoring;
  2. sentinel sites should be operational for several years to evaluate changes in efficacy over time; and
  3. a single sentinel site can be selected if it is representative of a geographic-epidemiological area.

The use of in vitro studies and molecular markers can be considered for evaluating the drugs included in combination therapies, and specimens can be collected on filter paper and properly stored to facilitate the creation of strain banks for future studies.

To USAID: That it continue its support for these activities.

To PAHO/WHO: That it continue its support for these activities.

Policy on the Use of Antimalarials

To the countries: That they draft a specific policy for the treatment of malaria in pregnancy and, if there is evidence from the evaluation of the efficacy of the antimalarials, two different treatment regimens can be used in a single region or country.