Dr. Esteban A Morales m.d; mph; msc
GROWING PUBLIC HEALTH PROBLEM




climate change - such as global
warming, phenomena of the child/of the
Southern Oscillation (ENSO) and the girl
(AEN...




VECTOR
HABITS
HUMAN
BEING




Last year, in Panama, the largest number of
deaths from dengue hemorrhagic fever since
the last reinfestation by Aed...
BACK AT THE
MACROFACTORES





Two megaprojects of the time
1850 The Panamá railroad
discovery of gold in California in the latter
part of 1848
...
What happened two
centuries ago

FERDINAND DE LESSEPS





The French started to build the
canal in 1850 until they fell...
but the health aspects were
especially important. Death
and suffering and disease
were the principal
characteristics in th...


The workers were
constantly attacked with
fever and
malaria, and, though the
whole working party was
changed every week...
It was the prospective home
of M. Jules Dingler directorgeneral of the first French
company
he never occupied it.
cost inc...
It was the era of the
megaconstruction of
the Panama canal
The great
transformation
faced deteriorated
due to rapid
immigr...
HOSPITAL ANCÓN. PANAMÁ. 1900

NICE
HOSPITALS
ARE NOT
ALWAYS
THE
ANSWER
But... the French
failed in its mission.
What happened
then?

 But... the

hospitals are also
needed


When the United
States started into
build the Panama
Canal, the first duty
was the sanitation of
the area. Col.
William...


He was fresh from his successes in
Cuba, where he had, applied the lessons of
sanitation that had been learned by Dr.
C...





he was assisted by a number of
experienced surgeons, as well as by Major
Roland Ross, the man who had proven the
m...
Distribution of the workers for 1913 :
Antillanos

29667

Chinos

15000

Españoles

8722

Italianos

1941

Colombianos

14...
WHEN IT MOVED FROM THIS…

AND GRADUALLY CAME TO
THIS…
THE RAPID POPULATION
GROWTH WAS FACED

WITH REORGANISATION
MEASURES, WHICH WAS INNOVATIVE


they are repeated, but magnified
tremendously, events of that first Republic.
We are living in an era with similar
char...
The extension works, initiated since
September 2007, with a value of
5,250 million dollars of which 3.2
billion are aimed ...
EL CONTEXTO GEOGRÁFICO
cuentan con la mayoría de los recursos naturales y
ambientales disponibles en el territorio naciona...
PANAMA ESTE, PARTE DE
LA CUENCA DEL CANAL
AEDES AEGYPTI Y
DENGUE
Is the main vector - trypanosoma cruzi
in Panama and the single triatomineo
transimisor Trypanosoma rangeli here
in Panama...
Main reservoirs are the
mammals (90%), mainly
zariguellas.
 47% Collected triatomine
were positive by
trypanosomes of whi...
Captación activa
Leishmaniasis
The regions most
affected are
Colon, Bocas del
Toro, Coclé, Darie
n, Panama. East
and Western
Panama recorde...
The presence of livestock in the
basin has left deep marks on its
natural resources. Firstly, it has
caused the Eliminatio...
PEOPLE MOVEMENT

DEFORESTATION
Concept and importance
Probably the first formal
discussion about ND was
held in 1977, with the
Rockefeller Foundation,
establishing the “Great
N...









a changing world where borders between countries
are disappearing
Global communication and technology make...
There is a great variety of diseases
considered as NTD´s depending of the
region of the world, history and resources
(Week...












Dengue. A mosquito-borne viral
disease.
Rabies. A viral zoonotic disease.
Trachoma. A bacterial infecti...
other author (N. Akritidis )
Although prions cannot strictly
considers Parasitic, fungal be considered to be infectious
an...






high financial burden to the individual, the
family, the community, the country and even
the region – impairing i...


causes significantly more accumulated
morbidity (anemia, chronic diarrhea and
pain, undernutrition from protein
loss, e...




affect the most vulnerable people (women,
children, eldest, migrant, inmuno supressed,
indigenous population, minori...


Are responsible of 27% of lost disabilityadjusted life years. According to WHO
(2006) ranked sixth among the ten leadin...


Hotez et.al(2010) consider that such diseases
are not confined to developing nations. He
estimates that millions of Ame...


CHAGAS DISEASE afflicts an estimated
300,000 people in the U.S. Screening of
donated blood, started in 2007, finds that...






It consists of a group of parasitic
diseases, caused by different species of
Leishmania
It is a zoonosis
Discove...
VISION TO SMEAR MICROSCOPY

In the host
vertebrate
intracellular
amastigotes
(aflagelado))
promastigota
(flagellate)) found
in digestive tract
of thr flies





Leishmaniasis Visceral
Leishmaniasis Cutánea del Viejo Mundo
Leishmaniasis Cutánea del Nuevo Mundo
(América)
Leis...
Delicate and
tiny flies only
about 2-4 mm
long, these flies
belong to the
subfamily
phlebotominae,
family
Psychodidae







Luztomia panamensis.
Luztomia trapidoi.
Luztomia Gomezi
Luztomia ylephileptor.
Luztomia sanguinarialis
Luztom...
“perezoso
colorado”
of two nails
(choloepus
hoffmanni)
 pentavalent antimony

compounds have remained the
principal solution for nearly 75
years
Globalization, Population movements, as
crucial factors related to neglected
tropical diseases




Globalization has led to massive migratory
movements; unplanned urbanization and the fast
conexion between massive t...




Migration, poverty and disease is many times
a funest triangle that leads to more disease,
more poverty and more und...






Since the focus is given to the international heath, then
the strategies derived from it suggest a strong
interna...
Reemergence of old neglected tropical diseases related to the Panama Canal
Reemergence of old neglected tropical diseases related to the Panama Canal
Reemergence of old neglected tropical diseases related to the Panama Canal
Reemergence of old neglected tropical diseases related to the Panama Canal
Reemergence of old neglected tropical diseases related to the Panama Canal
Reemergence of old neglected tropical diseases related to the Panama Canal
Reemergence of old neglected tropical diseases related to the Panama Canal
Reemergence of old neglected tropical diseases related to the Panama Canal
Reemergence of old neglected tropical diseases related to the Panama Canal
Reemergence of old neglected tropical diseases related to the Panama Canal
Reemergence of old neglected tropical diseases related to the Panama Canal
Reemergence of old neglected tropical diseases related to the Panama Canal
Reemergence of old neglected tropical diseases related to the Panama Canal
Reemergence of old neglected tropical diseases related to the Panama Canal
Reemergence of old neglected tropical diseases related to the Panama Canal
Reemergence of old neglected tropical diseases related to the Panama Canal
Reemergence of old neglected tropical diseases related to the Panama Canal
Reemergence of old neglected tropical diseases related to the Panama Canal
Reemergence of old neglected tropical diseases related to the Panama Canal
Reemergence of old neglected tropical diseases related to the Panama Canal
Reemergence of old neglected tropical diseases related to the Panama Canal
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Reemergence of old neglected tropical diseases related to the Panama Canal

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New appearances of old neglected tropical diseases and its control

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Reemergence of old neglected tropical diseases related to the Panama Canal

  1. 1. Dr. Esteban A Morales m.d; mph; msc
  2. 2. GROWING PUBLIC HEALTH PROBLEM
  3. 3.   climate change - such as global warming, phenomena of the child/of the Southern Oscillation (ENSO) and the girl (AENOS), population growth unprecedented in the region and not always with an appropriate health infrastructure (not controlled or planned urbanization)),
  4. 4.    VECTOR HABITS HUMAN BEING
  5. 5.   Last year, in Panama, the largest number of deaths from dengue hemorrhagic fever since the last reinfestation by Aedes mosquito aegypti in 1985. Around 2000 cases of classic dengue
  6. 6. BACK AT THE MACROFACTORES
  7. 7.     Two megaprojects of the time 1850 The Panamá railroad discovery of gold in California in the latter part of 1848 1914. the Panama Canal.
  8. 8. What happened two centuries ago FERDINAND DE LESSEPS   The French started to build the canal in 1850 until they fell into the historical financial disaster that led into bankruptcy in 1885; after a second attempt with another French company started in 1989, they decided to sell the rights for the building of the canal to the United States, for 40 million dollars in 1902.
  9. 9. but the health aspects were especially important. Death and suffering and disease were the principal characteristics in this period of time
  10. 10.  The workers were constantly attacked with fever and malaria, and, though the whole working party was changed every week, it was necessary to keep constantly importing others to take the places of those who fell sick or died.
  11. 11. It was the prospective home of M. Jules Dingler directorgeneral of the first French company he never occupied it. cost including the grounds is said to have been about $50,000. one of the saddest incidents in French canal history. he is credited with having said, "I am going to show them, that only drunkards and the dissipated contract yellow fever and die." Afterwards his son, daughter and wife died of yellow fever. Then he relinquished his post and went back to France
  12. 12. It was the era of the megaconstruction of the Panama canal The great transformation faced deteriorated due to rapid immigration, the But the process concentration of itself, also produced this population in risk situations, such as the cities. The the proliferation of excavations and large response of the ditches, which were institutions of the important under the State were not at epidemiological point the same speed. of view
  13. 13. HOSPITAL ANCÓN. PANAMÁ. 1900 NICE HOSPITALS ARE NOT ALWAYS THE ANSWER
  14. 14. But... the French failed in its mission. What happened then?  But... the hospitals are also needed
  15. 15.  When the United States started into build the Panama Canal, the first duty was the sanitation of the area. Col. William Gorgas was in charge of it
  16. 16.  He was fresh from his successes in Cuba, where he had, applied the lessons of sanitation that had been learned by Dr. Carlos Finlay in their remarkable series of experiments with yellow fever, who found out that a mosquito was the transmitter of this disease.
  17. 17.    he was assisted by a number of experienced surgeons, as well as by Major Roland Ross, the man who had proven the mosquito theory of the causation of malaria Gorgas bases his strategy on a mass sanitation. He proposes the construction of 10 clinics (outpatient) along all the waterway, between Panama and Colon
  18. 18. Distribution of the workers for 1913 : Antillanos 29667 Chinos 15000 Españoles 8722 Italianos 1941 Colombianos 1403 Panameños 357 Ticos 244 Franceses 19 Armenios 14 No Clasificados 69
  19. 19. WHEN IT MOVED FROM THIS… AND GRADUALLY CAME TO THIS…
  20. 20. THE RAPID POPULATION GROWTH WAS FACED WITH REORGANISATION MEASURES, WHICH WAS INNOVATIVE
  21. 21.  they are repeated, but magnified tremendously, events of that first Republic. We are living in an era with similar characteristics
  22. 22. The extension works, initiated since September 2007, with a value of 5,250 million dollars of which 3.2 billion are aimed at the design and construction of a third set of locks, work that has advanced 22%
  23. 23. EL CONTEXTO GEOGRÁFICO cuentan con la mayoría de los recursos naturales y ambientales disponibles en el territorio nacional. Climate Intertropical Region high rainy season precipitation temperatures Tropical diseases: Malaria. Dengue. Leishmaniasis. Enf. de Chagas
  24. 24. PANAMA ESTE, PARTE DE LA CUENCA DEL CANAL
  25. 25. AEDES AEGYPTI Y DENGUE
  26. 26. Is the main vector - trypanosoma cruzi in Panama and the single triatomineo transimisor Trypanosoma rangeli here in Panama  It is a hematophagous insect of the order diptera, family Reduviidae, subfamily Triatominae  great ability to invade and colonize human habitation.
  27. 27. Main reservoirs are the mammals (90%), mainly zariguellas.  47% Collected triatomine were positive by trypanosomes of which 85% corresponded to T. cruzi and the rest to T. rangeli.  Héctor Paz
  28. 28. Captación activa
  29. 29. Leishmaniasis The regions most affected are Colon, Bocas del Toro, Coclé, Darie n, Panama. East and Western Panama recorded incidence rates, during all the period, rates higher than the national rate.
  30. 30. The presence of livestock in the basin has left deep marks on its natural resources. Firstly, it has caused the Elimination of important forest areas. The loss of plant cover, in turn, increases levels of sediment entering the Lakes of the channel, influencing the quality of its waters. Studies on water quality in different points of the basin indicate that direct animal contact with bodies of water affects the concentration of micro-organisms harmful to human health.
  31. 31. PEOPLE MOVEMENT DEFORESTATION
  32. 32. Concept and importance
  33. 33. Probably the first formal discussion about ND was held in 1977, with the Rockefeller Foundation, establishing the “Great Neglected Diseases of Man Kind Program”, focusing in collaborative researches on malaria in poor countries. One of the first authors that defined the criteria for NTD was Ehrenberg (Ehrenberg & Ault 2005). They pose a major challenge to the fulfillment of the Millennium Development Goals; hence, there is involved an ethical and strategic component in the control of these diseases. In general terms the so called ND are those related to the also called, neglecte d population. are communicable diseases from the tropical areas of the world.
  34. 34.        a changing world where borders between countries are disappearing Global communication and technology make global communities migratory movements have increased Typology of population movement according to the characteristics of onset, cause, direction and motivation. Lechat (1976); Shears (1991); and others mega projects need the contribution of human resources from many different part of the globe new transport infrastructure allows parasites and vectors to travel greater distances population resettlement may introduce parasite carriers to receptive areas or to those who are not immune to pathogens transmitted by vectors.
  35. 35. There is a great variety of diseases considered as NTD´s depending of the region of the world, history and resources (Weekly epidemiological record, No. 13, 25 march 2011)
  36. 36.        Dengue. A mosquito-borne viral disease. Rabies. A viral zoonotic disease. Trachoma. A bacterial infection of the eye caused by Chlamydia trachomatis. Buruli ulcer. A severe sken disorder caused by the bacterium Mycobacterium. Endemic treponematoses. (yaws, endemic syphilis and pinta. Leprosy. A chronic bacterial infection caused by the bacillus Mycobacterium. Chagas disease (American trypanosomiasis) .          Human African trypanosomiasis (sleeping sickness). Leismaniasis Cysticercosis. A severe helmint infection. Dracunculiasis. (guinea-worm disease) A helminth infection. Food borne trematode infections. A group of parasitic worm infection. Lymfatic filariasis. Onchocerciasis. (river blindness) Shistosomiasis (bilharziasis) Soil transmited helminthiases.
  37. 37. other author (N. Akritidis ) Although prions cannot strictly considers Parasitic, fungal be considered to be infectious and prion zoonoses as other agents, as they are not less classic ND. a list that is pathogens as such, BSE likely to expand in the future possesses all the typical characteristics of a zoonotic as novel human immune infection. the disease induced in compromised humans, variant Creutzfeldt– Jakob disease behave as a typical zoonosis.
  38. 38.    high financial burden to the individual, the family, the community, the country and even the region – impairing its development. Since most are zoonosis, they represent a serious menace to food security, and adversely affect opportunities for income generation. long-lasting sequels' and cause persisting symptoms if the infestation remains untreated.
  39. 39.  causes significantly more accumulated morbidity (anemia, chronic diarrhea and pain, undernutrition from protein loss, exercise intolerance, infertility, poor school performance) than previously thought (King CH, Dickman K, Tisch DJ
  40. 40.   affect the most vulnerable people (women, children, eldest, migrant, inmuno supressed, indigenous population, minority ethnic groups, refugees. This confers the attention of NTD an ethical component When all the NTD are put together in a single rate, these represent the second cause of death after HIV.
  41. 41.  Are responsible of 27% of lost disabilityadjusted life years. According to WHO (2006) ranked sixth among the ten leading causes of Disability Adjusted Life Years (DALYS) is the aggregated measure of 11 of the NTDs
  42. 42.  Hotez et.al(2010) consider that such diseases are not confined to developing nations. He estimates that millions of Americans living in poverty also suffer from NTD-like infections. Parasitic diseases such as cysticercosis, Chagas disease, trichomoniasis and toxocariasis occur with high frequency in our inner cities, post-Katrina Louisiana, other parts of the Mississippi Delta, the border region with Mexico, and Appalachia
  43. 43.  CHAGAS DISEASE afflicts an estimated 300,000 people in the U.S. Screening of donated blood, started in 2007, finds that cases are concentrated in areas with large numbers of immigrants from Latin America living in substandard housing.(Hotez et.al 2010)
  44. 44.     It consists of a group of parasitic diseases, caused by different species of Leishmania It is a zoonosis Discovered by Brazilian scientists in 1909 In Panama the first indigenous case was reported by Dr. S. T. Darling in 1910.
  45. 45. VISION TO SMEAR MICROSCOPY In the host vertebrate intracellular amastigotes (aflagelado))
  46. 46. promastigota (flagellate)) found in digestive tract of thr flies
  47. 47.     Leishmaniasis Visceral Leishmaniasis Cutánea del Viejo Mundo Leishmaniasis Cutánea del Nuevo Mundo (América) Leishmaniasis mucocutánea.
  48. 48. Delicate and tiny flies only about 2-4 mm long, these flies belong to the subfamily phlebotominae, family Psychodidae
  49. 49.       Luztomia panamensis. Luztomia trapidoi. Luztomia Gomezi Luztomia ylephileptor. Luztomia sanguinarialis Luztomia olmeca.
  50. 50. “perezoso colorado” of two nails (choloepus hoffmanni)
  51. 51.  pentavalent antimony compounds have remained the principal solution for nearly 75 years
  52. 52. Globalization, Population movements, as crucial factors related to neglected tropical diseases
  53. 53.   Globalization has led to massive migratory movements; unplanned urbanization and the fast conexion between massive transport media have made more dangerous these diseases since many of them are zoonosis and vector transmitted diseases. According to the International Organization for Migration (IOM) (2009), more than 200 million people are estimated to be international migrants; another 26 million are internally displaced in at least 52 countries as a result of conflict. Overall migrants comprise 3% of the world’s population (IOM 2009).
  54. 54.   Migration, poverty and disease is many times a funest triangle that leads to more disease, more poverty and more under develope. For example, some authors found that leismaniasis is four times more frequent among people with protein-energy malnutrition (Machado-Coelho et al. 2005)
  55. 55.    Since the focus is given to the international heath, then the strategies derived from it suggest a strong international cooperation. Following the initative proposed in the first Universities allied for esential medicines neglected diseases and innovation symposium. Finally, I consider that one of the main issues related to the problem of NTDs in general and to leishmaniasis in particular is the one related to vaccination and medication.

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