Infectious Disease, Health Inequities Among Top Health Stories for 1999

Originally published
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Washington, DC (PAHO), December 30, 1999--At the end of the century, new diseases and old diseases which have reappeared, along with the Venezuela disaster, continuing inequities in health care, and the emergence of smoking as the leading preventable cause of death were among the top health stories of 1999, according to experts at the Pan American Health Organization (PAHO).

A series of new viruses, bacteria and parasites have emerged in recent years as threats to health of both residents and tourists in the Americas, and antimicrobial and drug resistance have spread among organisms, according to Dr. Gabriel Schmunis, Coordinator of PAHOs Communicable Disease Program. Tuberculosis, cholera, malaria and other diseases once thought almost eradicated have developed drug-resistant strains and threaten millions of persons, according to Dr. George Alleyne, Director of PAHO.

Inequities in health, with millions of poor people still lacking access to health in the Americas, also continued to be a severe problem in 1999, said Dr. David Brandling-Bennett, PAHOs Deputy Director. One advance during the year was a new initiative, backed by health ministers of the Americas, to save an additional 100,000 lives of children by the year 2002, through intensified training of health workers and communities to recognize danger signs of potentially lethal diarrhea and respiratory infections. The Integrated Management of Childhood Illness strategy relies on simple public health interventions, preventive measures taken at home, early diagnoses, effective treatment and strengthening health systems to reduce risks and consequences of childhood diseases, he said.

The natural disaster caused by flooding in Venezuela, which killed thousands and left thousands more homeless, prompted a strong, integrated response from PAHO, which has been providing technical cooperation to the countrys Ministry of Health and Social Development in epidemiological surveillance, water, and environmental sanitation, mental health, health services, and management of humanitarian supplies, Dr. Brandling-Bennett added.

Smoking has emerged as the leading preventable cause of death in the Americas, with diseases linked to tobacco claiming some 600,000 lives a year ---more than AIDS, accidents, and suicide, according to Dr. Alleyne. PAHO studies show that one in every three people over 15 years old smoke, and that youths 15 and under are increasingly taking up the habit, he said.

The global advances in the effort to eradicate polio, which has been absent from the Americas since 1991, were paralleled by regional advances in the plan to eliminate measles from the continent, with only 2,803 cases of measles confirmed in 199, compared with over 14,000 cases in 1998. Most of the 1999 cases resulted from an outbreak in Bolivia, where 1,420 cases were confirmed.

But there were also 689 measles cases in Brazil, 251 in Argentina, 206 in the Dominican Republic, and 83 in the United States, PAHO figures show. Twelve countries reported no measles cases in 1999, compared with eight countries with no cases in 1998.

Dengue and dengue hemorrhagic fever, which are transmitted by mosquitoes, have continued to cause health problems in the Americas, with almost 300,000 cases reported in 1999, including cases in Texas and Florida, said Dr. Schmunis. Dengue is a threat to tourism and Aedes aegypti mosquitoes have reinfested every country in the Americas except Canada and Chile, he said.

Malaria, once the target of a global eradication campaign that ended in failure in the 1960s, is still an important health problem in many countries, where more than 308 million people live in areas where the ecology favors malaria transmission.

Even as 21 countries in the Americas report active malaria transmission and more than 354,000 cases of the more severe form, falciparum malaria, were notified, new strategies for malaria control at the community level are rapidly reducing the number of cases, said Dr. Renato Gusmao, PAHOs Regional Advisor on Malaria. Considering the large expansion of areas where malaria is endemic in South America, the fact that deaths were reduced by 60 percent is proof that the new strategies are working well, he said. Early diagnosis and immediate treatment of malaria by health workers and expansion of health service coverage are the best ways to combat malaria, Dr. Gusmao said.

Diagnosing malaria is fairly easy. If you have alternating high fevers and chills, headaches and vomiting, you very likely have malaria. This can be confirmed with a rapid test that costs about $1, and the first-line drugs like chloroquine and primaquine are still effective in 70 per cent of cases, Dr. Gusmao added.

While previous efforts to control malaria focused on killing mosquitoes that carry the disease, new strategies target the mosquitoes only where transmission is known to occur, and concentrate on reducing the incidence through early diagnosis and rapid treatment, he said. The 21 countries where malaria is prevalent have adopted new strategies to control malaria, incorporating them into regular health services. The new Roll Back Malaria strategy is crucial because each year between 300 and 500 million episodes of malaria illness worldwide result in more than one million deaths, and massive loss of earnings. Brazil, for example, which has over 100,000 cases of severe malaria each year, has set a goal of cutting cases in half by 2002, and is increasing its investment in malaria control by 150 percent, Dr. Gusmao said.

More political and financial support for malaria control strategies are necessary, Dr. Gusmao said, especially in the light of health sector challenges such as decentralization and the need to improve socioeconomic development in the many poverty-stricken zones where malaria remains a problem.

Due to the widespread geographical distribution of these infectious diseases in the Americas, and an increasing number of travelers, there are many opportunities to contract an infection when traveling in developed or undeveloped countries, Dr. Schmunis said. But, he added, we must end the misconception that only travel to poor countries carries a risk of acquiring an infection.

Disease in travelers is not a trivial matter, he said, and can have an impact on countries that derive income from tourism. But one problem is that many physicians lack information about diseases relevant to travelers and how to treat them, he said.