Disease Prevention and Control / Communicable Diseases / Leprosy
Successful Experiences en Disease Control in Brazil Presented at Expoepi (Brasilia, 23–26 November 2004)
Agência Saúde, Brasilia, 25 November 2004: The day before yesterday, 23 November, in Brasilia, Minister of Health Humberto Costa and Secretary of Health Surveillance Jarbas Barbosa inaugurated the 4th National Exhibition of Successful Experiences in Epidemiology and Disease Prevention and Control (Expoepi). The objectives of the event, the most important in its area in all of Brazil, are to bring to light and reward actions implemented in states and cities that had a positive impact on the prevention and control of diseases of importance to public health by improving the quality of epidemiological surveillance.
In the competitive exhibit, 27 experiences are being presented, in nine categories:
The best work from each area will be chosen by popular vote and will receive a prize. The non-competitive sample is composed of 13 posters.
As in the previous events, homage was paid in the opening ceremony to professionals who made an outstanding contribution to public health in Brazil. Some examples are Dr. José Rosemberg, at the forefront of the fight against tuberculosis, and Dr. Lair Guerra de Macedo, who for Brazil symbolizes the struggle against AIDS. Among those so honored, two were posthumous: Doctors Frederico Simões Barbosa, from the field of surveys, and Walter Sidney Pereira Laser, one of those responsible for the eradication of smallpox and poliomyelitis in the country.
Over time, Expoepi has consolidated itself to become the main event for epidemiology applied to the service of health; nearly 1,000 people participated in the 3rd Expoepi held last year in the city of Salvador, Bahia. According to this year's registration, 1,246 are expected to attend the 4th Expoepi. Along with the displays on successful experiences, other areas covered at this year's activity include working groups, roundtable discussions, talks, and conferences. By the time it ends on 26 November, it will commemorate 100 years of disease prevention and control in Brazil.
Challenges: Scheduled events included the International Seminar on Uses and Prospects of Epidemiology-20 Years Later: Updating Buenos Aires, opened by SVS Secretary Jarbas Barbosa on Monday, 26 November. Also participating in the opening ceremony were Stephen Corber and Horácio Toro, both representing PAHO/WHO, as well as former PAHO Director Carlyle Guerra de Macedo and Oscar Velázquez Monroy of the National Center for Epidemiological Surveillance and Disease Control in Mexico.
The seminar conducted an inventory of progress achieved in epidemiology over the last two decades up to the last event in Buenos Aires, where the objective was to discuss and propose actions in the area of disease prevention and control in the Americas. To date, the event has marked the definition of new directives for the development of epidemiology throughout the Region.
According to Dr. Stephen Corber, in the last 25 years nearly 30 new diseases have been identified and have required adaptations in epidemiological monitoring to adjust to such a scenario. AIDS, hantavirus, and SARS (the form of 'atypical pneumonia' identified in Asian countries) are but a few examples.
Dr. Corber presented a general overview of health surveillance in the world. During his talk, he emphasized the importance of using epidemiological information for governmental decision-making. While recognizing the advances made by the countries of the Americas in epidemiological surveillance, he stressed their need to increase their capacity to deal with new situations of risk to human health, given that the future perspective is one where new infectious diseases are bound to appear.
One of the priorities of the Ministry of the Health is the elimination of Hansen's disease in the country by the end of 2005. Yesterday (24 November), as one of the scheduled Expoepi activities, the SVS eight working groups, one of them in the area "Hansen's Disease: The Challenge to Integrate Diagnosic and Treatment Activities into Basic Care."
During the opening ceremony for Expoepi, Minister of the Health Humberto Costa reaffirmed the federal government's commitment to do whatever it takes to eliminate the disease. One of those honored by the Ministry of Health on opening night was Dr. Vladimir Araújo Opromolla, renowned worldwide as a symbol of the struggle against Hansen's disease.
Also present at the event were Dennis Daumerie, Chief of Leprosy Elimination at the World Health Organization (WHO), who spoke yesterday (24 November) on the situation of Hansen's disease in the world, and Dr. S.K. Nordeen of the International Leprosy Association (ILA).
Today, successful experiences were presented in the areas of surveillance and control of Hansen's disease. These efforts have been spearheaded by Dr. Rosa Castália, Coordinator of the National Program for Elimination of Hansen's disease at the SVS.
A total of 3 Brazilian states and 12 cities received certification yesterday from the Ministry of the Health as to the quality of the services provided to people with Hansen's disease. These localities were successful in increasing the patient cure rate as well as reducing the index of people acquiring disabilities as a result of the disease. The certificates were awarded during the official opening ceremony of the 4th Expoepi in the presence of Minister of Health Humberto Costa and of Secretary of Health Surveillance Jarbas Barbosa, accompanied by other government officials.
The states receiving certification were Amazonas, Rio Grande do Sul, and Espírito Santo. The cities were Pajeú do Piauí and Parnaíba (Piauí); Paragominas and Garrafão do Norte (Pará); Barreira and Sobral (Ceará); Vitória da Conquista and Vereda (Bahia), Jerônimo Monteiro (Espírito Santo), São Bernardo (Maranhão), Centralina (Minas Gerais) and Florianópolis (Santa Catarina).
On 11 November in Brasília, Secretary of Health Surveillance Jarbas Barbosa launched a task force to strengthen leprosy-elimination monitoring in the Brazilian states. The objective is to expand the diagnosis of new cases of the disease as well as adequate treatment offers for those affected. The Ministry of Health has already contracted 25 health professionals and is contracting another 10 to help strengthen teams in the state health departments (SESs).
The formation of task forces to strengthen state-level surveillance has demonstrated its usefulness as an efficient tool in disease prevention and control-as in the case of dengue, for example. Along with training on leprosy control, technicians will receive orientation on how to better monitor the disease. These specialists will then make monthly reports on the epidemiological situation in the priority cities of their respective states, as well as progress made towards the goals established.
Hansen's disease is curable and has no lasting impact when detected early and treated adequately. Any clear or reddish spot accompanied by loss of sensitivity on the skin should be considered as a possible sign of Hansen's disease, and any person showing these symptoms should immediately be directed to a public-health unit.
According to data from the Secretary of Health Surveillance (SVS), Brazil currently shows a leprosy prevalence rate of 4.5 patients per every 10,000 inhabitants. The World Health Organization considers the disease eliminated as a public-health problem when the prevalence is less than 1 case per 10,000.
Recently, the SVS launched a new instrument for monitoring the epidemiological situation of Hansen's disease in the states: the Charters of Elimination. Their objective is twofold: to show the extent of the problem and to increase managerial performance so Brazil can reach its national goal of leprosy elimination.
The Charters of Elimination of Hansen's Disease contain summary information on the decentralization of diagnosis and treatment of that disease, its epidemiological profile with 2003 data, and a map with the location of micro-regions in the states with their respective prevalence coefficients, i.e. number of cases for each group of 10,000 inhabitants.
By the end of 2005, another three editions of the Charters will be send every trimester to program managers, so as to maintain monitoring efforts and to orient the strategic actions necessary for the success of the National Plan to Eliminate Hansen's Disease.