The Pan American Health Organization
Promoting Health in the Americas

 Safe Hospitals

Health Surveillance & Disease Prevention & Control — Communicable Diseases: 
Acute Respiratory Infections - Anthrax - Antimicrobial Resistance - Campylobacter - Chagas -
Cholera - Dengue - Diarrheal/Enteric Diseases - Disease Outbreak News -
Emerging/Reemerging Diseases - Filariasis - Hantavirus - InfluenzaAvian |  Pandemic |  Seasonal - International Health Regulations - Leishmaniasis - Leprosy - Malaria -
Neglected Diseases - Parasitic Diseases - Rabies - Research - Salmonella - Shigella - Smallpox -
Tuberculosis - West Nile Virus  - Yellow Fever  -
Health Analysis & Statistics - Chronic Diseases - Veterinary Public Health


Full Text: 48 pp, PDF,
213 KB

Executive Summary
1. Welcoming Remarks
2. Objectives of the Meeting
3. Background
4. Summary Description of Participating Laboratories

Argentina
Bolivia
Brazil
Chile
Paraguay
Uruguay

5. Surveillance Activities Already Underway
6. Plan of Action
7. Reagents and Diagnostic Tests
8. Conclusions

Annexes
1. List of Principal Publications
2. Diseases and Agents for which Reporting in Brazil is Mandatory
3. List of Participants

laboratory

Meeting to Establish a Network of Laboratories for the Surveillance of Emerging Infectious Diseases (EID) in the Southern Cone Region:

Buenos Aires, Argentina, 17–19 April 1998

Goal |  Objectives |  Plan of Action |  Conclusions

Goal: To create a functional network of laboratories within the greater Southern Cone Region—Argentina, Bolivia, Brazil, Chile, Paraguay and Uruguay—able to obtain accurate, high-quality laboratory results on new, emerging and re-emerging infections found in the Region.

Objectives

  1. Enhance capacity for early detection and monitoring of EID in the Southern Cone Region.
  2. Begin implementation of common survey protocols to identify specific pathogens of significance.
  3. Strengthen laboratory capacity for surveillance of EID.
  4. Begin implementation of common protocols to address specific diseases, using identical or comparable laboratory procedures with good quality control to ensure accuracy of results obtained.
  5. Create a forum for rapid technology transfer.
  6. Encourage research to develop new methodologies for the identification of pathogens important to the region.
  7. Facilitate prompt information sharing.
  8. Establish strategies to alert clinicians and epidemiologists for outbreak investigation and identification as well as strengthening linkages between epidemiological and laboratory studies.

Plan of Action

A Plan of Action was prepared for surveillance of:

  1. Disease syndromes.
  2. Specific pathologies.
  3. Antimicrobial resistance.

The following syndrome and diseases were selected for initial surveillance:

  • Influenza.
  • Antimicrobial resistance, especially for tuberculosis.
  • Acute diarrhea, especially bloody diarrhea leading to hemolytic uremic syndrome.
  • Hantavirus pulmonary syndrome and hantaviral disease.

Seven disease syndromes were selected for inclusion in the proposed surveillance program. A definition of each syndrome is given below:

  1. Undifferentiated febrile syndrome: Fever > 38.3º C that has no obvious etiology and has no more than 7 days evolution in a previously healthy person 5 years of age or older.
  2. Hemorrhagic fever syndrome: An acute febrile hemorrhagic illness.
  3. Febrile icteric syndrome: Febrile patients > 1 year of age with acute or insidious onset of icterus in whom there is no detectable cholelithiasis or biliary obstruction.
  4. Acute respiratory distress syndrome: A febrile illness (temp. > 38.3º C) characterized by bilateral diffuse interstitial edema, with respiratory compromise requiring supplemental oxygen, developing within 72 hours of hospitalization, and occurring in a previously healthy person.
  5. Unexpected death syndrome: Previously healthy persons, 1-49 years of age, who are hospitalized (or admitted to an emergency room) with a life threatening illness with hallmarks of an infectious disease for which no cause is identified.
  6. Infectious neurologic syndrome: Febrile neurologic symptoms with clear CSF in a nonimmunodepressed patient.
  7. Enteric syndrome: Bloody or non bloody, acute diarrhea, with fever or not, in children or adults.

A list of possible diseases that will be tested for was prepared for each disease syndrome.

In addition to the above syndromes, the participants agreed to include the following specific pathologies to be under surveillance: Hemolytic uremic syndrome (HUS), Muco-cutaneous and visceral leishmaniasis, and plague.

The Surveillance for Antimicrobial Resistance was agreed for the following:
  1. Resistance of Streptococcus pneumoniae and Haemophilus influenzae to penicillin.
  2. Resistance of Salmonella and Shigella to one or more drugs.
  3. Vancomycin-resistant Enterococcus.
  4. Yeast and filamentous fungi.

Conclusions

  • Participants agreed to form a network of laboratories to carry out surveillance and to share information on the incidence and prevalence of emerging infectious disease in the Region. The network will collaborate in conducting studies carried out to define better the infectious etiology of human disease in the Region, to share laboratory techniques and reagents, and to participate actively in a Regional quality control and proficiency-testing program.
  • Participants agreed that initially the surveillance activities should focus in the following health problems:
    1. Influenza.
    2. Antimicrobial resistance, including tuberculosis.
    3. Acute diarrhea, including E. coli 0157 (HUS).
    4. HPS/Hantavirus disease.
  • Participants agreed to create an executive committee that will meet annually to discuss progress in implementing common projects and protocols, to share results and to define strategies to address Regional problems. The next meeting will be held in Brazil, and subsequent annual meetings will rotate among all collaborating laboratories as appropriate. A goal will be to obtain funding for the network including support for the participation of at least two representatives from each collaborating laboratory at each meeting.
  • Participants agreed to joint presentation and publication of findings resulting from collaboration undertaken by laboratories of the network in appropriate scientific journals and meetings. All formal publications will share authorship. This agreement is, however, not meant to exclude publication of their own results separately by workers in individual laboratories.