At Havana meeting, PAHO director urges consensus on prevention and control of arboviruses through integrated surveillance, laboratory networks, clinical case management and vector controlWashington, D.C., 21 October 2016 (PAHO/WHO) - Health leaders from countries of the Americas are expected to agree on a series of actions to monitor, diagnose, treat and control arboviruses, a group of mosquito-borne viruses that includes Zika, dengue, and chikungunya. The actions are being discussed at an international meeting organized by the Pan American Health Organization/World Health Organization (PAHO/WHO) and the Ministry of Public Health of Cuba in Havana this week.
"Dengue, chikungunya, yellow fever, and Zika-with its unfortunate complications like microcephaly, neurological syndromes, and its social and economic impact-take an especially heavy toll on our region's most vulnerable populations," said PAHO/WHO Director Carissa F. Etienne in opening the meeting.
"The incidence of these arboviruses puts pressure on the region's health systems and presents a challenge that we need to address in an integrated way, combining resources and sharing experiences and best practices developed by each country to confront them," said Etienne. She urged delegates to reach a consensus on a road map for the region to follow in the coming months for integrated prevention and control of these mosquito-borne diseases.
A framework for these actions is presented in a regional strategy on arboviruses that was approved last month by ministers of health from throughout the Americas during the 55th PAHO Directing Council in Washington, D.C. There are currently very few vaccines available to prevent arboviruses. The strategy therefore recommends a series of prevention and control measures aimed at reducing mosquito populations, ensuring timely and accurate clinical diagnosis, and strengthening epidemiological surveillance and laboratory networks. It also emphasizes active involvement of communities in the elimination of mosquito breeding sites.
Arboviruses in the Americas
"In the Americas, we have more than 500 million people living in areas at risk of Zika, dengue, or chikungunya, because of the presence of the Aedes aegypti, the mosquito that carries these diseases," said Sylvain Aldighieri, acting deputy director of PAHO's Health Emergencies department.
Among the challenges this presents, Aldighieri said, is the potential reintroduction of "old enemies" such as yellow fever in urban areas where the mosquito is present. Moreover, dengue continues to infect nearly 2 million people every year, with life-threatening consequences if the disease is not detected on time. Many questions remain about chikungunya's long-term consequences as well as its potential to cause death in a small number of patients.
In the case of Zika, Aldighieri explained that all subregions of the Americas are currently reporting cases of microcephaly or other defects associated with congenital Zika syndrome. However, much remains to be learned about the full consequences of the syndrome, what proportion of babies in infected women are affected, and what its relationship is with other arboviruses circulating in the same area. Based on the experience with Zika, said Aldighieri, the region's countries need to remain alert to other circulating arboviruses, including Mayaro and Oropouche viruses, which could present new challenges.
Ministers share experiences
Cuba's Minister of Health, Roberto Morales Ojeda, said the Havana meeting "demonstrates the concern about confronting" arboviruses in a joint manner, as well as the importance of "strengthening fraternal ties in the area of health, in a context of growing differences between rich and poor countries...where arboviruses have become a threat." He described his country's experience in fighting dengue since the 1980s, with a strategy that integrated vector control with health care, and which has been useful in facing other viruses, such as Zika.
U.S. Secretary of Health and Human Services Sylvia Mathews Burwell said "there is no higher priority" than controlling Zika and other arboviruses. She added that "inaction is not an option" and described actions the United States has taken to confront Zika, ranging from communicating its risks to the population and promoting research toward a new vaccine, to providing resources to affected states, especially Florida, and to Puerto Rico. Burwell's visit to Cuba is her first since her government renewed diplomatic relations with the island country.
Minister of Health of Honduras Yolani Batres advocated "formulating a plan that integrates us" to confront arboviruses, but allows for differences among countries. Barbados Minister of Health John Boyce outlined how his country followed up Zika cases and intensified control of mosquitoes in the areas where those patients were identified. Guyana's Health Minister, George Norton, discussed the challenges Guyana faced in Zika, and representatives from Brazil, Colombia, El Salvador and other countries also shared their countries' experiences.
All told, delegates from more than 30 countries in this meeting are looking for consensus in actions to improve epidemiological surveillance for Zika and other arboviruses, as well as clinical management of patients infected by various arboviruses.
They are also exchanging experiences and approaches on control and elimination of mosquitoes, and working to strengthen laboratory networks that can quickly detect and diagnose arboviruses.