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      Elimination of Neglected Diseases in Latin America and the Caribbean: A Mapping of Selected Diseases

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          Abstract

          In Latin America and the Caribbean, around 195 million people live in poverty, a situation that increases the burden of some infectious diseases. Neglected diseases, in particular, are often restricted to poor, marginalized sections of the population. Tools exist to combat these diseases, making it imperative to work towards their elimination. In 2009, the Pan American Health Organization (PAHO) received a mandate to support the countries in the Region in eliminating neglected diseases and other poverty-related infections. The objective of this study is to analyze the presence of selected diseases using geo-processing techniques. Five diseases with information available at the first sub-national level (states) were mapped, showing the presence of the disease (“hotspots”) and overlap of diseases (“major hotspots”). In the 45 countries/territories (approximately 570 states) of the Region, there is: lymphatic filariasis in four countries (29 states), onchocerciasis in six countries (25 states), schistosomiasis in four countries (39 states), trachoma in three countries (29 states), and human rabies transmitted by dogs in ten countries (20 states). Of the 108 states with one or more of the selected diseases, 36 states present the diseases in overlapping areas (“major hotspots”). Additional information about soil-transmitted helminths was included. The analysis suggests a majority of the selected diseases are not widespread and can be considered part of an unfinished agenda with elimination as a goal. Integrated plans and a comprehensive approach, ensuring access to existing diagnostic and treatment methods, and establishing a multi-sectoral agenda that addresses social determinants, including access to adequate water and sanitation, are required. Future studies can include additional diseases, socio-economic and environmental variables.

          Author Summary

          Neglected diseases are often restricted to poor, marginalized sections of the population. Tools exist to combat these diseases, making it imperative to work towards their elimination. In 2009, the Pan American Health Organization received a mandate to support the countries in the Region in eliminating neglected diseases and other poverty-related infections. This study analyzed the presence of selected diseases using geo-processing techniques. Five diseases (lymphatic filariasis, onchocerciasis, schistosomiasis, trachoma and human rabies transmitted by dogs) were mapped by state, showing the presence of the disease (“hotspots”) and overlap of diseases (“major hotspots”). Additional information about soil-transmitted helminths was included. In the 45 countries/territories (approximately 570 states) of the Region, there are 108 states with one or more of the selected diseases, and 36 states present the diseases in overlapping areas (“major hotspots”). Integrated plans and a comprehensive approach, ensuring access to existing diagnostic and treatment methods, and establishing a multi-sectoral agenda that addresses social determinants, are required.

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          Most cited references7

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          Overview of rabies in the Americas.

          Between 1993 and 2002, the number of human and canine rabies cases in the Americas Region fell by approximately 80%. There were 39 human cases in 2002, 63% of them transmitted by dogs. Furthermore, human rabies transmitted by wildlife, mostly by bats is a risk to inhabitants in many countries in the Region. The objective of this study is to describe this epidemiological situation based in the information received from the countries of the Americas Region in Regional Rabies Surveillance System in the Americas (SIRVERA) administrated by the Pan American Health Organization. This sharp reduction is attributable mainly to the control measures implemented by the countries of the Region, such as the mass vaccination of dogs and prophylactic treatment for people who have been exposed.
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            Neglected diseases of neglected populations: Thinking to reshape the determinants of health in Latin America and the Caribbean

            Background People living in poverty throughout the developing world are heavily burdened with neglected communicable diseases and often marginalized by the health sector. These diseases are currently referred to as Neglected Diseases of Neglected Populations. The neglected diseases create social and financial burdens to the individual, the family, the community, and the nation. Discussion Numerous studies of successful individual interventions to manage communicable disease determinants in various types of communities have been published, but few have applied multiple interventions in an integrated, coordinated manner. We have identified a series of successful interventions and developed three hypothetical scenarios where such interventions could be applied in an integrated, multi-disease, inter-programmatic, and/or inter-sectoral approach for prevention and control of neglected diseases in three different populations: a slum, an indigenous community, and a city with a mix of populations. Summary The objective of this paper is to identify new opportunities to address neglected diseases, improve community health and promote sustainable development in neglected populations by highlighting examples of key risk and protective factors for neglected diseases which can be managed and implemented through multi-disease-based, integrated, inter-programmatic, and/or inter-sectoral approaches. Based on a literature review, analysis and development of scenarios we visualize how multiple interventions could manage multiple disease problems and propose these as possible strategies to be tested. We seek to stimulate intra- and inter-sectoral dialogue which will help in the construction of new strategies for neglected diseases (particularly for the parasitic diseases) which could benefit the poor and marginalized based on the principle of sustainability and understanding of key determinants of health, and lead to the establishment of pilot projects and activities which can contribute to the achievement of the Millennium Development Goals.
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              Hepatitis E among U.S. travelers, 1989-1992.

              (1993)
              Outbreaks of hepatitis E (i.e., enterically transmitted non-A, non-B hepatitis) have occurred in some parts of the world and have generally been related to contaminated water supplies. Until recently, when research-based serologic tests (1,2) were developed to test for antibody to hepatitis E virus (anti-HEV), no serologic test was available to identify HEV infection, and diagnosis depended on a history of exposure in an appropriate epidemiologic setting and the exclusion of other causes of viral hepatitis. During 1989-1992, acute HEV infection was documented among six persons in the United States who had returned from international travel. This report summarizes CDC's serologic documentation of acute HEV infection--presumed to have been acquired during international travel--in four of these persons.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS Negl Trop Dis
                plos
                plosntds
                PLoS Neglected Tropical Diseases
                Public Library of Science (San Francisco, USA )
                1935-2727
                1935-2735
                February 2011
                15 February 2011
                : 5
                : 2
                : e964
                Affiliations
                [1]Pan American Health Organization, Washington, D.C., United States of America
                London School of Hygiene & Tropical Medicine, United Kingdom
                Author notes

                Conceived and designed the experiments: MCS XPA JBdSJ SKA RR ZY MRP. Performed the experiments: MCS SKA PN JM JCS LFL. Analyzed the data: MCS XPA JBdSJ PN JM RSN JCS. Wrote the paper: MCS JM. Supported on lymphatic filariasis and schistosomiasis aspects: SKA. Supported on onchocerciasis aspects: RSN. Supported on diseases strategies and future directions: ZY. Supported on trachoma aspects: JCS. Supported on rabies aspects: LFL. Formulated original question of this study: MRP. Created GIS maps: PN. Defined goals and strategies: RR. Reviewed the paper: RR RSN ZY JCS LFL MRP.

                Article
                10-PNTD-RA-1200R3
                10.1371/journal.pntd.0000964
                3039687
                21358810
                94a63b5e-a97b-47cb-97e0-696068987462
                Schneider et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                : 22 June 2010
                : 12 January 2011
                Page count
                Pages: 13
                Categories
                Research Article
                Infectious Diseases/Epidemiology and Control of Infectious Diseases
                Infectious Diseases/Neglected Tropical Diseases

                Infectious disease & Microbiology
                Infectious disease & Microbiology

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