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1. Welcoming Remarks
A. Summary of the Previous Recommendations
B. Description of Participating Institutions (by country)
C. Current Status of Emerging Disease Surveillance (by country)
D. Regional System for Epidemiological Surveillance
E. Antimicrobial Resistance
F. Unexplained Deaths and Critical Illness due to Possible Infectious Causes
G. Review of Manaus Meeting Recommendations
4. Plan of Action
A. Surveillance Team and Tasks
B. Disease Syndromes
C. Infectious Agents
E. Reagents and Diagnostic Tests
F. Quality Control
H. Project Management
I. Financial Support
J. Associated Institutions and Supporting Roles
K. Study Sites and Populations
L. Number of Subjects
N. Disease Questionnaires
O. Banking of Specimens
R. Transfer of Funds
T. Integration of Network to the National Surveillance Systems
V. Drug Resistance
1. Members of the Table of Honor
2. List of Participants
3. Participating Country Reports
Second Meeting to Establish a
Surveillance Network for Emerging Infectious Diseases (EID)
in the Amazon Region
(Tarapoto, Peru, 14-16 April 1999)
The overall objective was to review ongoing efforts to establish a functional network of laboratories within the greater Amazon Region, with the capability to obtain accurate, high-quality surveillance results on emerging and reemerging infections.
The specific objectives were to
- review and/or modify the Manaus action plan,
- describe the current status of emerging infections in the participating countries, and
- review and discuss ongoing surveillance activities, and
- discuss possibilities for cooperation among participating countries and international reference laboratories.
In order to achieve these objectives/aims, the surveillance network will need to be integrated into the existing national surveillance programs, and not to be a separate program on its own. In addition, a close link needs to be established between laboratories and epidemiology, and between surveillance and prevention and control actions, bearing in mind three concepts:
- We used to say that surveillance was information for action; now we say timely information for timely action. Or even better, timely, quality information for timely, quality action.
- Practice a type of public health surveillance that integrates the surveillance of syndromes and diseases with the surveillance of agents and the surveillance of risk in order to get there before the epidemic curve or as early as possible.
- The bell of emerging diseases rings at the local level, and it is necessary to strengthen the base of the surveillance at the level of the technical, operational teams and the community.
Other requirements needed to strengthen and sustain a functional surveillance network are
- research and collaborative studies,
- horizontal cooperation between countries in the Amazon Region,
- actions to link with international reference laboratories,
- matching actions with those of other projects in search of complementing or improving resources and results,
- actions to link with other sectors for surveillance, prevention and control actions, especially in high risk and poverty areas, and
- exchange of epidemiological information and studies for collective appropriation of the knowledge.
The original plan of action was modified slightly to include minor changes such as a revision of definitions of disease syndromes and endorsed.
The syndromes selected for initial surveillance were the same recommended previously, with the possibility of subsequently including neurologic and enteric disease syndromes:
- Undifferentiated febrile syndrome: A fever, (axillary temperature > 38º C) that has no obvious etiology and has no more than 7 days evolution in a previously healthy person 5 years of age and older.
- Hemorrhagic fever syndrome: An acute febrile (axillary temperature > 38º C) hemorrhagic illness with or without evidence of capillary fragility in a person of any age.
- Febrile icteric syndrome: Febrile patients (> 38º C) more than one year of age with acute or insidious onset of icterus in whom there is no detectable cholelithiasis or biliary obstruction or maligancy.
- Acute respiratory distress syndrome: Febrile patients (> 38º C) more than 5 years of age, 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.
- Sudden unexplained death syndrome: Previously healthy person, 5–49 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.
The list of possible disease pathogens for diagnostic testing for each disease syndrome was revised, including testing algorithms. The participants recommended that testing should emphasize the most common and/or important disease agents in each country, which included the following: malaria, dengue, viral hepatitis, yellow fever, leptospirosis and influenza.
Since surveillance programs were already established for anti-malarial and anti-tuberculosis drugs and for antibiotic resistance in the participating countries, these were not included under the Amazon network program.
All participants agreed that for the surveillance network to be effective, it must be integrated with existing national and regional health surveillance program, and there must be close interaction among clinicians, and staff of the diagnostic laboratory and the epidemiology programs.
The associated institutions that intend to help support the Amazon network by providing reference services, multilateral agreements, and training and reagents are as follows:
- Pan American Health Organization / World Health Organization (PAHO/WHO),
- Ministry of Health of Brazil,
- Oswaldo Cruz Foundation (FIOCRUZ),
- Brazilian Army Institute of Biology,
- Amazon Center for Investigation and Control of Tropical Diseases "Simon Bolivar",
- US Naval Medical Research Institute Detachment (Lima, Peru),
- Centers for Disease Control and Prevention (CDC, Atlanta), and
- University of Texas Medical Branch, Galveston.
Several potential funding sources were discussed for supporting the surveillance network, including PAHO (limited), CDC, and US Department of Defense.
The participants recommended that the next meeting be held in Atlanta Georgia just before the International Conference on Emerging Infectious Diseases, July, 2000.