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


Executive Summary
List of Participants

Full Text & Country Reports (Spanish, 134 pages, PDF: see report in Spanish for links to chapter headings translated below)

Cover and contents
Executive Summary

Chapters I-III
I. Inaugural Session
II. Election of the Chair and Reporter
III. Introduction and Objectives: The Purpose of the Network

IV. Working Groups
4.1 Present Priorities of the Networks and How They Work: Needs and Proposed Modifications
4.2 Opinion of the Participating Countries
4.2.1 Southern Cone Network
Commitment of the Countries Making Up the Southern Cone Network
4.2.2 Amazon Regional Network
4.2.3 Central American Network

V. Symptomatic Focus
5.1 Symptomatic Focus in Surveillance in Bolivia
5.2 Pros and Cons of the the Use of Symptomatic Focus for Surveillance in Peru
5.3 Surveillance of Icteric Febrile Syndrome

VI. Bioterrorism
6.1 Response to the "Anthrax Threat"
6.2 Project to Increase Surveillance

VII. Viral Diseases
7.1 Influenza: Activities Carried Out within the Surveillance Framework
7.2 Surveillance of Yellow Fever (YF) and Dengue: Perspectives for Control
7.3 Update on Hantavirus Pulmonary Syndrome (HPS)

VIII. Drug-Resistant Malaria
8.1 Resistance to Antimalarial Drugs
8.2 Monitoring the Resistance to Antimalarial Drugs in the Americas

IX. Resistance to Antibiotics
9.1 Surveillance of Antimicrobial Resistance in the Southern Cone Network
9.2 Performance Evaluation
9.3 Multiresistant Tuberculosis Mycobacterium: The Problem in Latin America
9.4 Tuberculosis Control in the United States

X. Enteropathogens
10.1 Global Surveillance of Salmonella: Epidemiology of Foodborne Diseases (FBD) and Hemolytic Uremic Syndrome (HUS)
10.2 Studies on Risk Factors for Hemolytic Uremic Syndrome and Toxic Shiga-producing E. coli Infection in Argentina

XI. Detecting Outbreaks
11.1 Outbreak Detection and Response in the Caribbean
11.2 Contingency Plan for Dengue Control in Suriname

XII. New Opportunities for Collaboration
12.1 Use of Applied Molecular Tools to Study Rubella and Varicella
12.2 Molecular Toolkits for Studying Rubella

XIII. Country Reports

Argentina
Brazil
Chile
Colombia
Paraguay
Uruguay
Venezuela

XIV: Recommendations

XV: Compliance of the Recommendations Made at the Network Meetings in 2001

XVI. List of Participants

2nd Meeting of the Surveillance Network for Emerging Diseases in the Amazon and Southern Cone Regions

photo collage, emerging infectious diiseases

(Atlanta, Georgia, 23-24 March 2002)

Focus  |   Achievements  |   Commitments

Rapidly transmitted emerging and reemerging diseases require surveillance systems of great sensitivity that make it possible to act immediately to impede the spread of an outbreak or to control epidemics. In this context, a new paradigm of global collaboration has been established: teamwork through the establishment of surveillance networks.

Networks constitute a democratic consensual organization where coordination is carried out multilaterally and where each part contributes to the total effort by contributing the resources it has at its disposal. The objective is to meet common goals, work as a team, maintain a single channel of constant communication, and develop the ability to detect what is abnormal. Thus, the network in its entirely is much more than the sum of its parts.

Whenever there exist common challenges, common strategies are needed to solve common problems. It becomes necessary to share information in order to respond in an integrated way using evidence-based data. Thus, networks become indisponsable in their ability to strengthen individual responses.

The surveillance network for emerging and reemerging diseases is an initiative developed in 1996 with the capacity to integrate laboratories and epidemiology centers. Activities are carried out through a network composed of different technical groups from the participating countries. To date, two networks have been established; the Amazon and Southern Cone Networks. The incorporation of a third Central American Network is expected for the near future.

Focus

At this meeting, topic of discussion were those related to differences in network growth as well as their potential, expectations, and mechanisms utilized for strengthening them. During the meeting, proposals were formulated that are aimed system improvement, especially with regard to the capacity of the countries to predict epidemics and act accordingly. Presentations focused on the surveillance of influenza, yellow fever, dengue, foodborne diseases (FBD), Salmonellas, Hemolytic Uremic Syndrome (HUS), toxic Shiga-producing E coli infection, surveillance of resistance to antibiotics and the corresponding quality assurance, and the use of molecular tools to diagnose rubella and chickenpox (varicella).

A special topic was the recent threat of anthrax in the United States and the opportunity that this represents to test the response capacity of the different countries, not to mention the need to develop emergency plans to respond to this and other threats. In the United States, the Laboratory Response Network for Bioterrorism has recently been created as a multilevel system designed to unite local and state public-health laboratories with their clinical, military, veterinary, and agricultural counterparts, as well as those evaluating water and food.

New problems emerging since September 11 call for new networking proposals in the countries. A bioterrorism attack to any country should have a global response consisting of the rapid case identification, vaccination, contact identification, and contact vaccination, to assure quick control and erradication.

Achievements

Among the achievements of the networks operating in the Southern Cone and Amazon subregions, current noteworthy activities include effective annual contact enabling information exchange and updates, strengthening communication among countries, and generating information. Annual reports are currently available that contribute information on each country; however, one area in need of strengthening is that which pertains to producing information in a regular and timely manner. The information generated should provide an integrated overview of the region for each priority area. The countries propose constructing a platform that integrates subregional and regional information on the priority diseases, with periodic updating and publication of national reports.

The countries recognize several contributions made by the network:

  • Facilitation of better communication.
  • Incentive to develop themes.
  • On-site evaluation visits and quality assurance.
  • Incentives for coordinated work between laboratories and epidemiologists.
  • Training and human-resource development, especially in laboratories.
  • Support for rapid response.

However, new challenges come up constantly, as is the case with West Nile Virus. Within each network, various areas in need of strengthening have been identified:

  • Southern Cone Network: There is a need to strengthen research capacity in the field, as well as in the shipment of samples. Another area to be strengthened is clinical staff training on how to watch for and detect unusual or abnormal phenomena.
  • Amazon Network: Some difficulties have been detected, such as the distance from national or regional reference centers for sample shipment; absence of externally financed support; lack of communication between clinicians, epidemiologists, and laboratory workers; and the need to establish sentinel sites and a greater number of common protocols.

In theSouthern Cone, the is a general consensus to continue to place a high priority on the surveillance of influenza, Hantavirus, and antimicrobial resistance. Argentina, Bolivia, Chile, Paraguay, and Uruguay agree that Hemolytic Uremic Syndrome (HUS) and toxic Shiga-producing E. coli infection are also priority topics. The countries propose incorporating such new priorities as leptospirosis, FBD outbreaks, Salmonella and death by unknown causes. With regard to designing prevention and control strategies, they will initiate the development of response plans that place emphasis on influenza.

Commitments

Southern Cone Network

  1. Working on joint prevention plans.
  2. Forming multidisciplinary teams.
  3. Incorporating clinical and environmental areas into surveillance activities.
  4. Strengthening laboratory and field epidemiology.
  5. Training clinicians by stimulating their ability to suspect and detect abnormal phenomena.

Amazon Network
The Network intends to continue to place priority on the surveillance of influenza, Hantavirus, and resistance of Plasmodium to malarial drugs. To improve its annual meetings, it intends to focus more on establishing research priorities; communicating and disseminating information; and establishing a workplan.

Central American Network
The Network proposes setting up cooperative efforts between countries, to prevent and control those communicable diseases that represent a common threat to the subregion, and better utilizing the available human and material resources.

The recommendations are summarized by disease and topic in the Executive Summary.