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Peru Rebuilds Health Services Affected by the 2007 Earthquake
PAHO/WHO, with the support of the Spanish Agency for International Cooperation (AECID) and the Swedish International Development Cooperation Agency (SIDA), are supporting Peru's Ministry of Health and regional authorities with the health needs resulting from the earthquake of 15 August 2007 in Ica.
The project encompasses the construction of a maternal and child center in Pisco; recovery of services in the primary health network of Ica and Huancavelica; strengthening technical capacity for the epidemiologic surveillance system; improving the regional public health laboratory; and increasing coordination for disaster and emergency response among different sectors at the national, regional, and local levels by setting up Emergency Operations Centers and developing technical capacity.
The 7.9 magnitude earthquake, which affected several provinces, killing 519 people, injuring 1,366, and affecting 863,597 people. The public and social security health networks suffered considerable damage. According to official reports, 11 facilities were completely destroyed and 111 suffered different levels of damage. The 110-bed San Juan de Dios hospital was the most severely impacted. In addition to the health services, Pisco's water and sewerage systems were severely affected. There are major diffi culties in the process of latrine construction and supply of safe water, both in terms of quantity and quality. The management of solid waste, surveillance of food management, and proliferation of harmful fauna continue to be matters of concern.
For more information on progress in restoring health services in this area, contact Dr. José Luis Zeballos,at jzeballo@per.ops-oms.org.
Yellow Fever Outbreaks in the Americas
Yellow fever, commonly found in the tropical regions of South America and Africa, has two epidemiological cycles: jungle and urban. In the jungle cycle, the virus circulates in the primate population and humans are infected when they enter the jungle and are bitten by infected mosquitoes. Urban yellow fever was eradicated from the Americas (the last cases occurred in 1942 in Brazil). In mid-January of this year, Paraguayan health authorities detected an outbreak of jungle yellow fever.
The clinical manifestations of yellow fever virus infection are acute fever and jaundice (yellowing of the skin and eyes), followed by hemorrhage in 15% to 25% of infected patients. Case fatality can reach 50%.
Since the 1970s jungle yellow fever cases were limited to the northern region of South America. Between 1985 and December 2007, a total of 3,837 cases of jungle yellow fever and 2,229 deaths were reported.
In 2007 and at the beginning of 2008, six states in Brazil (Goias, Federal District, Mato Grosso do Sul, Minas Gerais, Tocantins, and São Paulo) recorded an intense and extensive increase in epizootic yellow fever. These outbreaks of the disease in animal populations were confirmed by laboratory and/or by clinical-epidemiological criteria through the State Health Secretariats. In January and February 2008, human cases were reported in three states (Goias, Mato Grosso do Sul, and the Federal District); of the 26 confirmed cases, there were 13 deaths. While the affected areas have high vaccination coverage, health authorities intensified vaccination campaigns for individuals over six months of age who had not been immunized previously and/or reside in/or frequent affected areas.
As of 21 February 2008, seven cases of yellow fever had been confirmed in Paraguay, all inthe rural area of San Pedro Department, about 300 km northeast of Asunción, the capital. Five other suspected cases were reported in Central Department, which neighbors Asunción; four of these cases died with signs and symptoms highly suggestive of yellow fever. If these cases are confirmed, it would validate the circulation of the virus in urban areas.
In response to these outbreaks, the authorities have expanded epidemiologic surveillance for the detection and testing of suspected cases. Yellow fever vaccination has been intensified in Asunción, Central and San Pedro departments, and in border areas in order to protect the population living in high-risk areas.
To achieve this level of coverage, approximately 3 million doses of vaccine are needed. Thanks to the support of PAHO/WHO, 850,000 doses are being sent from Brazil, 144,000 from Peru, and 2 million doses from the WHO Global Fund. With the support of the Spanish Agency for International Cooperation (AECID), the U.S. Office of Foreign Disaster Assistance (OFDA/USAID), and the Government of Italy, PAHO/ WHO has been able to implement emergency projects to intensify epidemiologic surveillance and vector control, increase laboratory diagnosis, expand communications about the risk, and carry out vaccinations in at-risk areas.
In Argentina, authorities reported that on 17 January 2008 dead monkeys were found in Piñalito park, in the department of San Pedro, province of Misiones. In February, yellow fever was confirmed in one of the primates through molecular techniques. Despite the high vaccination coverage in the area, authorities have intensified vaccination activities for previously unimmunized individuals who reside in or travel to the area.
Currently, the recommended yellow fever vaccination strategy is to direct efforts at the population that lives in, or is traveling to the areas where epizootics or human cases were recently registered and where risk of transmission exists. This approach avoids indiscriminate mass vaccination or revaccination.
PAHO/WHO is providing technical support through advisers from country offices and headquarters, in accordance with requests from the countries.
For more information, write to ugarteci@paho.org. In addition, the publications Control of Yellow Fever-Field Guide and Zoonoses and Communicable Diseases Common to Man and Animal, 3rd edition, can be consulted at http://publications.paho.org.
Floods: History Repeats Itself in Bolivia
The heavy rains produced by the La Niña phenomenon have left nine Bolivian departments under water. Flooding in Beni, Chuquisaca, Cochabamba, La Paz, Oruro, Pando, Potosí, Santa Cruz, and Tarija have affected 73,776 families and caused 63 deaths. The most affected areas are Trinidad, capital of the department of Beni (with 20,000 affected families) and the department of Santa Cruz (19,818 affected).
The floods reveal once more how vulnerable the population is to chronic hydrometeorologic disasters. There continue to be deficiencies in managing nutritional requirements and shelters and in gathering health information in remote areas.
Since November 2007, Bolivia has suffered from climatological phenomena that, according to experts, are more severe than those caused by El Niño at the beginning of 2007. The World Food Program (WFP) has reported that 80% of the people who suffered from floods in early 2007, suffered again with the recent heavy rains. The flooding has increased the risk of epidemics and there have been reports of cases of dengue, yellow fever, hemorrhagic dengue, hanta virus, malaria, conjunctivitis, diarrheal diseases, leptospirosis, and respiratory diseases.
PAHO/WHO has concentrated its efforts on coordinating disaster response in the areas of international cooperation, epidemiologic surveillance, vector control, mental health care, logistical support, and resource mobilization.
For more information, write to cgarzon@ecu.ops-oms.org.