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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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New appearances of old neglected tropical diseases and its control

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 Reemergence of old neglected tropical diseases related to the Panama Canal Presentation Transcript

    • 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 (AENOS), population growth unprecedented in the region and not always with an appropriate health infrastructure (not controlled or planned urbanization)),
    •    VECTOR HABITS HUMAN BEING
    •   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
    • BACK AT THE MACROFACTORES
    •     Two megaprojects of the time 1850 The Panamá railroad discovery of gold in California in the latter part of 1848 1914. the Panama Canal.
    • 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.
    • but the health aspects were especially important. Death and suffering and disease were the principal characteristics in this period of time
    •  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.
    • 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
    • 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
    • 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 Gorgas was in charge of it
    •  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.
    •    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
    • 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
    • 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 characteristics
    • 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%
    • 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
    • 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  It is a hematophagous insect of the order diptera, family Reduviidae, subfamily Triatominae  great ability to invade and colonize human habitation.
    • 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
    • Captación activa
    • 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.
    • 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.
    • PEOPLE MOVEMENT DEFORESTATION
    • Concept and importance
    • 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.
    •        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.
    • 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)
    •        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.
    • 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.
    •    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.
    •  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
    •   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.
    •  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
    •  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
    •  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)
    •     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.
    • 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) Leishmaniasis mucocutánea.
    • 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 Luztomia olmeca.
    • “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 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).
    •   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)
    •    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.