Peter Maes-Enfermedades transmitidas por vectores
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El 12 de mayo de 2017 celebramos en la Fundación Ramó Areces una jornada con IS Global y Unitaid sobre enfermedades transmitidas por vectores, como la malaria, entre otras.
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Peter Maes-Enfermedades transmitidas por vectores
- 1. Unique challenges of Vector Control for populations in precarious situations Presented by Peter Maes, Madrid, May 2017 Louise Annaud
- 2. War and persecution have driven more people from their homes than at any time since records began, with over 65million persons, half of them children , now displaced worldwide If the world’s forcibly displaced were a country it would be the size of the United Kingdom in 2015 and counting since given the urbanisation and ecological migration
- 3. Urban slum Detainees Flooded Camp Jo Kuper Migrants Francesco Zizola POPULATIONS IN PRECARIOUS SITUATIONS - POPULATIONS IN PRECARIOUS SITUATIONS - POPULATIONS IN - -
- 4. MSF & VC • Malaria • Dengue • Yellow fever • Zika • Chikungunya • Chagas disease • Leishmaniasis • Trypanosomiasis • Plague • Typhus • Lassa fever … Yellow Fever 2016 Democratic Republic of Congo Dieter Telemans
- 5. These new VC-tools must be: • Safe but effective ! • Ready-to-use & stockpiled • Fit-for-purpose & easy to use • Require little behavioral change among users & implementers • Place little burden on implementers The impact of new validation scheme on introduction of new VC products ? Insecticide resistance necessitates the development of products incorporating non-pyrethroids guidelines, protocols and technical support required to build evidence base for evaluation and recommendation
- 6. Main Operational Challenges: • Vector friendly environment • Late night sleeping patterns • Wash and sun dry ITN’s • Resistance to Pyrethroids • Low impact conventional VC New Insecticides for IRS Doro camp, South Sudan: high malaria transmission context a.i. Pirimiphos Methyl by MENTOR
- 7. Main Operational Challenges: • Cold at night ( ∆ 10 °C) • Resistance to Pyrethroids • IRS impractical: instability leads to constant mobility of population • ITN’s impractical: large family in small shelter , insufficient usage ITN’s (e.g. 50,9 % ) Masisi, DRC: Highland Malaria Context Insecticide treated blankets
- 8. Main Operational Challenges: • Non-immune refugees moving from highland areas to high transmission setting • Very poor mass shelters filled with blood fed vectors • Resistant malaria vectors • Presence of made man breeding sites Ntuta Refugee Camp, Tanzania ITPS Impregnated tents
- 9. Effective application of appropriate larvicides Main operational challenges: Multiple a-typical Aedes breeding sites after typhoon Hayan : PHILIPPINES - Guiuan, Eastern Samar, 2013
- 10. COCONUTS HERE, COCONUTS THERE, COCONUTS EVERYWHERE
- 11. SUGAR BAITED TRAPS ZOOPROPHYLAXIS SPATIAL REPELLENTS MOSQUITOES OTHER VECTORS: Other priority VC tools for re-development IVERMECTIN – LOUSE ?
- 12. The unique challenges of Vector Control for populations in precarious situations require: • New VC tools for these specific context acknowledging that some products may also be more generally appropriate for outdoor transmission • Swift deployment of these products and strategies should be achievable • Clarify responsibility to actively address the VC needs of these specific populations • A dedicated platform to meet regularly and exchange focused experiences. RECOMMENDATIONS
- 13. DEDICATED PLATFORM TO FACILITATE: Improve use of current Vector Control tools (LLINs, IRS, LSM) Improve learning around supplemental tools Provision of field platform for evaluation of new tools Cross-agency learning, entomological surveillance, LLINs, IRS, LSM. Guides for implementing supplementary tools (ITPS, treated blankets, etc.) Engage industry to develop Target Product Profile for Humanitarian Emergencies Technical support through interagency exchange M&E templates to standardize data collection Develop and implement Operational Research Protocols Technical support for dissemination Collation and dissemination of field data to expand operational evidence- base; interface with WHO to develop norms Offer platforms to pilot and develop new tools
- 14. CONTRIBUTIONS Corey Leclair Konstantina Boutsika Martin De Smet Michael B Macdonald Natacha Protopopoff Peter Maes Rafael Van Den Bergh Ian Berry, Magnum
Editor's Notes
- War and persecution have driven over 65 million men, women and children displaced worldwide -50 % of them are children. If the world’s forcibly displaced were a country it would be about the size of the United Kingdom in 2015 not counting the urbanisation and associated slums and ecological migration. Despite the immensity of this human suffering, searching for safety and protection is increasingly perilous.
- Refugees, Internal displaced, Migrants, Detainees or populations in urban slums often live in crowded and unsanitary conditions that result in a sharp increase in vectors exposure, and the spread of the associated communicable diseases. This may be exacerbated by a lack of sufficient water for personal and domestic hygiene, poor sanitation conditions, inadequate nutritional or failing health services. Responsibility to actively address these VC needs often falls in-between the table of WASH, HEALTH and SHELTER cluster under the supervision of MOH and the needs are rarely adequately addressed. The few actors that go beyond distribution of nets have no dedicated platform to meet regularly and exchange focused experiences.
- An organization like MSF has been involved on a community scale in the control of the following diseases all of them transmitted by mosquitoes, ticks, flies, lice, other arthropods and rats. For reasons of time the presentation will be mainly focused on diseases transmitted by mosquitoes.
- The VC response to populations in precarious situation is extremely challenging and needs context specific new tools. The interagency field handbook for Malaria Control in Humanitarian Emergencies published by who in 2013 acknowledged this gap. In emergency situations such as civil or political conflicts and natural disasters the conventional vector control measures become impractical for a population living in overcrowded make-shift housing. Refugee camps often lack appropriate substrates such as walls and ceilings for spraying with insecticides. Nets cannot be easily hung in overcrowded dwelling and get easily damaged as the shelters are often constructed from sharp or abrasive materials. The perfect tool would be safe but effective, ready to use & stockpiled, fit for purpose & easy to use, require little behavioural change amongst users & implementers and place little burden upon implementers. Products first require proof of effectiveness and recommendation by WHO as expected in the new prequalification scheme with its eligibility criteria. If this validation policy is implemented in an inflexible way these requirements could become a bottleneck in the operationalisation of these new products. Insecticide resistance necessitates the development of products incorporating non-pyrethroids. Guidelines, protocols and technical support are required to build evidence base for evaluation and recommendation Note that some of these nascent vector control tools may also be applicable for malaria “outdoor and residual” transmission, for the gold miner in Amazonia or the woodcutter in the Mekong, or for Aedes in the displaced persons camps in Yemen or the barrios of Brazil. Currently it seems the market seems too fragmented and unstable to encourage investment in what seems to be “niche” products and the relevant question is what the conditions would be for a company to invest in this segment.
- In this operational context the timely IRS with a new insecticide could have made all the difference on its own or in synergy with other new tools. The IRS in 2016 came rather late in the season in week 32 with Pirimiphos Methyl by MENTOR because of availability of the product and registration and importation issues
- In this operational context insecticide treated blankets have the potential to make a big difference on its own or in synergy with other new tool. Incorporation of non-pyrethroid insecticides/synergists in combination with safety however seems a challenge. The specifications of commercially available permethrine blankets and the usual humanitarian blankets currently do not match. Washfastedness and durability without sacrificing comfort seems crucial. It would be interesting to evaluate the personal protection versus potential community effect of coverage with insecticide treated blankets.
- In this operational context the availability of ITPS or Impregnated tents would have been interesting on the condition of incorporation of non-pyrethroid insecticides/synergists and residual persistence of insecticide deposit in these adverse conditions. Collaboration would also be required between HEALTH, WASH and SHELTER cluster to agree on acceptable specifications of the plastic sheeting and tents. Important in this context was also the reduction of made man breeding sites..
- The new larvicides and new application methods MSF currently uses in Martissant slum in Haiti would have been very welcome in this context of multiple a-typical breeding sites instead of the archaic manual approach that was implemented in this context.
- Paper submitted