Brote de dengue en el distrito Puente Piedra, Lima Peru 2012

-Brote de dengue en el distrito Puente Piedra, Lima Peru 2012.
- Caso fatal Sx Febril Hemorrágico pulmonar 15/04/2012, Iquitos, Loreto.
- Brotes de DEngue en Junin, Jaen, Tarapoto, Iquitos.


      
Ver Mapa de Alertas y Brotes de Enfermedades Infecciosas y Tropicales - Perú en un mapa más grande

Dengue — NEJM

Dengue — NEJM

Mapa Global de Vectores predominantes de Malaria

A global map of dominant malaria vectors
Parasites & Vectors 2012, 5:69 (Free)

Global malaria vector maps, by necessity, must simplify a complex diversity of numerous interacting and sympatric anopheline species. Such simplification refines the information down to a minimum, indicating only the primary vector(s) at each location and provides users, such as public health officials, modellers and opinion formers, with a global and regional picture that is easy to digest and utilise for scientific, operational and advocacy 

purposes.

Global maps have long been used to aid in visualising the malaria problem. These include the vector species map of May [1] and the 12 zones of malaria epidemiology described by Macdonald [2], determined using broad climatic ranges and physical land features, as well as consideration of the known distribution of the major anopheline vectors at the time. More recently Mouch et al. [3] updated Macdonald’s map, reassigning the 12 zones into more conventional biogeographical regions. This history of malaria vector (or vector-associated) visualisation indicates a past appetite for such maps, continuing more recently with Kiszewski et al.[4] publishing a global distribution map for the major malaria vectors in 2004. Their map was created to aid the authors in the development of a malaria transmission ‘stability’ map, but has since been adopted widely within the malaria research community and reproduced in many publications (their paper is listed as being cited 81 times in Web of Science and 37 times in PubMED). There is, therefore, a substantial and continuing demand for global maps of the major vectors of malaria.

Amazonian malaria: Asymptomatic human reservoirs, diagnostic challenges, environmentally driven changes in mosquito vector populations, and the mandate for sustainable control strategies

06 April 2012

Acta Tropica, Volume 121, Issue 3, March 2012, Pages 281-291

Mônica da Silva-Nunes, Marta Moreno, Jan E Conn, Dionicia Gamboa, Shira Abeles, Joseph M Vinetz, Marcelo U Ferreira.

Across the Americas and the Caribbean, nearly 561,000 slide-confirmed malaria infections were reported officially in 2008. The nine Amazonian countries accounted for 89% of these infections; Brazil and Peru alone contributed 56% and 7% of them, respectively. Local populations of the relatively neglected parasite Plasmodium vivax, which currently accounts for 77% of the regional malaria burden, are extremely diverse genetically and geographically structured. At a time when malaria elimination is placed on the public health agenda of several endemic countries, it remains unclear why malaria proved so difficult to control in areas of relatively low levels of transmission such as the Amazon Basin. We hypothesize that asymptomatic parasite carriage and massive environmental changes that affect vector abundance and behavior are major contributors to malaria transmission in epidemiologically diverse areas across the Amazon Basin. Here we review available data supporting this hypothesis and discuss their implications for current and future malaria intervention policies in the region. Given that locally generated scientific evidence is urgently required to support malaria control interventions in Amazonia, we briefly describe the aims of our current field-oriented malaria research in rural villages and gold-mining enclaves in Peru and a recently opened agricultural settlement in Brazil.

Presentaciones del I° módulo de la Maestria en Salud Pública 2012 INS Perú- FioCruz Brasil

PROGRAMA DE LA MAESTRÍA EN SALUD PÚBLICA

2012	MODULOS	HORAS	ARCHIVOS
05 marzo	Determinantes de la salud (8 horas) Paulo Buss	08	Ponencia Dr. Buss: Determinantes Sociales de la Salud  descargar archivo
06 a 09 marzo	Metodología de investigación I (4 hs) Willer Baumgarten El sentido común y la actitud científica. ¿Qué es la ciencia?¿Cuáles son sus ideas principales y consecuencias? Ética y acciones de carácter científico.  El enfoque cualitativo. La relación entre la teoría sociológica y la metodología de la investigación social sobre la salud. Metodología de Investigación II (28 hs) Willen Baumgarten  Tema: Temática, tema/ objeto/ problema a ser analizado en la investigación, hipótesis y presupuestos, justificativa, objetivos, conceptos centrales y abordajes metodológicas.	32	I Modulo: Metodología de laInvestigación Peofesor :Willer Baumgarten Marcodes Programa del I Módulo  descargar archivo Ponencias del I Modulo:1. Clase de apertura descargar archivo 2.Mapa Conceptual Maxwell descargar archivo 3. Un ejemplo de Mapa Conceptual 4.Desarrollo de un Trabajo Científico descargar archivo EjercicioQuestões Iniciais : Ejercicio propuesto para la clase del día 06/03/2012 descargar archivo Documentos1. Bruno José Barcellos Fontanella: Amostragem por saturação em pesquisas qualitativas em saúde: contribuições teóricas. descargar documento 2. Celia Ramos: Un Proyecto de Investigación Social en Salud. descargar documento 3. Everardo Nunes: La Salud Colectiva como práctica Científica. descargar documento 4. Marilena Chaui: Convite a filosofía. descargar documento 5.Minayo: Parte I Conceptos Básicos sobre metodología y abordajes cualitativos. descargar documento 6. Minayo: Capitulo 13 Acerca de la validez y la verificación en la investigación cualitativa.descargar documento 7. Minayo: Bibliografía descargar documento

Tropical Lymphedemas — Control and Prevention — NEJM

Tropical Lymphedemas — Control and Prevention — NEJM
There are two principal causes of elephantiasis, or lymphedema, in the tropics. The most common cause and a significant public health problem is lymphatic filariasis due to the parasitic nematodeWuchereria bancrofti (and, in Asia, Brugia malayi and B. timori), which is transmitted by mosquitoes. The second principal cause is podoconiosis.

WHO | Population-based active surveillance cohort studies for influenza: lessons from Peru

WHO | Population-based active surveillance cohort studies for influenza: lessons from Peru

Bulletin of the World Health Organization 2012;90:318-320

Peru population-based cohort study

In 2009, the United States Naval Medical Research Unit 6 in Lima, Peru, with support from the Peruvian Ministry of Health, the Centers for Disease Control and Prevention in Atlanta, and the Armed Forces Health Surveillance Center in Silver Springs, implemented and has since maintained an active population-based household cohort study for ILI as a complement to the country’s routine passive surveillance system.⁶ The project is driven by the need to collect detailed epidemiological data to elucidate the complex transmission dynamics of influenza and other ILIs, which are major causes of morbidity and mortality in Peru. Five geographically distinct regions of Peru were selected to represent the country’s diverse ecological niches (urban coastal desert, northern and southern tropical rainforest, dry tropical forest, and Andean highlands). Over 2500 households comprising more than 10 000 people were then selected randomly from a community geo-referenced census. The study protocol was approved by the Institutional Review Board of the United States Naval Medical Research Unit 6 in compliance with all applicable federal regulations of the United States and Peru governing the protection of human subjects. Each site is under the supervision of a physician or nurse with a small team of experienced field workers who visit each household as frequently as three times a week to screen household members using WHO’s case definition of ILI.⁴ Nasopharyngeal swabs are collected from identified cases and tested for influenza A and B virus by the rapid influenza test and real-time reverse transcriptase polymerase chain reaction (RT–PCR) with sequencing of amplification products. Detailed data on household characteristics and demographics – socioeconomic status, household crowding, ventilation systems, sanitation, contact with animals and comorbid health conditions, etc. – are collected. Clinical data are also recorded and participants are followed for 15 days to monitor and record the course of the illness. Project supervisors monitor the field team’s work by conducting weekly confirmatory visits to randomly-chosen study households.

To the extent possible, cohort study activities are integrated into the regular functions of the staff of Peru’s Ministry of Health to avoid duplication of effort. The incidences of ILI and confirmed influenza are reported weekly to the health ministry to help guide prevention and mitigation policies. Furthermore, the cohort study has the potential to actively promote healthy behaviours. For example, study team members readily counsel study participants in areas such as nutrition, vaccination and the proper use of antibiotics, and by doing so they encourage their adherence to the study. By performing these collateral duties, the team also improves overall health awareness and promotes good health practices in the study population and surrounding community.

The Peru influenza cohort study was particularly informative during the 2009 A(H1N1) pandemic by providing key early data on the epidemic curve, clinical presentation and attack and incidence rates by age group and gender. The cohort study allowed us to demonstrate that A(H1N1)pdm09 was well established in the greater population of Lima at the time of the screening. We were also able to partially assess the efficacy of various mitigation measures and to demonstrate the likelihood that the seasonal influenza A(H1N1) virus would be replaced by A(H1N1)pdm09, as occurred later in many parts of the world.⁶ By adding serologic testing to the cohort study we were able to detect a huge number of influenza virus infections not captured by routine passive surveillance (Fig. 1). We are presently using the cumulative attack rates from the Peru cohort studies to model global influenza pandemic mortality.

Fig. 1. Cases of A(H1N1)pdm09 infection detected through a population-based active household surveillance cohort study in Lima, Peru, April 2009–December 2010

ILI, influenza-like illness.Note: Data are shown on a subset of 325 participants on whom serologic testing was performed using a haemagglutination inhibition test specific for antibodies against A(H1N1)pdm09, in addition to the surveillance described in the text employing reverse-transcriptase polymerase chain reaction. Approximately 10% of the population was vaccinated for A(H1N1)pdm09 over the course of the surveillance period.

The benefit of the cohort study extends beyond the epidemiological data collected on influenza; the presence of influenza virus has been confirmed in only 32% of the 4400 respiratory specimens collected from people with ILI up to the writing of this paper, in October 2011. Testing of the negative samples has revealed a host of other pathogens, including coronaviruses, human metapneumoviruses, adenoviruses, respiratory syncytial viruses, human bocaviruses, rhinoviruses, enteroviruses and parainfluenza viruses, as well as numerous viral coinfections. We are presently exploring multiplex diagnostic platforms to simultaneously detect a broad array of respiratory pathogens, which is essential given the importance of possible recombination events and the historical evidence of viral–bacterial coinfection as a major factor in mortality associated with influenza.⁷ As with the influenza virus data, incidence and attack rates, disease burden, seasonal trends and disaggregated risk factors can all be calculated. Finally, there is the potential to leverage the existing infrastructure of the influenza cohort study to monitor other syndromes. We are presently expanding our programme to include population-based surveillance of diarrhoeal illness as well as collateral studies on dengue fever.

Implementation of the Peru cohort project has taught us several important lessons:

• To assess risk factors, risk factor data must be collected from all individuals in the cohort as frequently as possible.
• Having well-trained, proactive field workers is extremely important, since study participants count on a regular and positive interaction with field workers to continue to enrol.
• Data management is by far the most challenging issue because an intensive cohort study generates huge amounts of information requiring a detailed and intensive data management plan.

Conclusion

We recognize that the large amount of work and money required to mount population-based active surveillance cohort studies – this study in Peru, for example, cost approximately 100 000 United States dollars annually per site – may prevent them from being carried out. To our knowledge, influenza surveillance efforts similar to the one described in this paper have been undertaken only in a few developing countries, including Bangladesh, Guatemala, India, Kenya and Nicaragua.^7–11 However, cohort studies with active household surveillance and specimen collection generate data that are critical to understanding the epidemiologic distribution and behaviour of respiratory pathogens, including influenza viruses, and to detect disease of all degrees of severity in the early stages of a pandemic. Mustering the resources to include this valuable complement to passive surveillance systems should be a priority. Collaboration between developing countries and those with greater resources to dedicate to public health research, as exemplified by our project in Peru, is probably the most viable strategy for achieving this.

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Acknowledgements

The authors thank all the participants of the Peru cohort study for their open collaboration and contribution to this work.

Funding:

The cohort studies discussed in the article were funded by the Centers for Disease Control and Prevention, the Armed Forces Health Surveillance Center-Division of GEIS Operation, and the National Institutes of Health Fogarty International Center.

Competing interests:

None declared.

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