Volume 1, Number 3—July 1995
News and Notes
Recommendations for a Regional Strategy for the Prevention and Control of Emerging Infectious Diseases in the Americas
On June 14-15, 1995, a conference on "Combating Emerging Infectious diseases: Challenges for the Americas" was held at the Pan American Health Organization (PAHO) Headquarters in Washington, D.C. The meeting was designed to shape a regional strategy for preventing and controlling emerging infectious diseases that could pose serious threats to the peoples of the Americas.
Participants, convened by PAHO, included top officials and infectious disease experts from that organization as well as the World Health Organization, the U.S. Centers for Disease Control and Prevention, the Canadian Laboratory Center for Disease Control, the U.S. Department of Defense, and several Latin American and Caribbean countries.
This international group of experts noted that an increasing number of new, emerging, and reemerging infectious diseases have been identified in both developed and developing nations and that these diseases threaten to increase in the near future. They include human immunodeficiency virus/acquired immunodeficiency syndrome, which emerged in the l980s and now affects some 16 million people worldwide; and cholera, which returned to the Western Hemisphere for the first time this century in 1991 and has caused more than 1 million cases and 9,000 deaths in the Americas. PAHO estimates that it will take more than a decade and over $200 billion to control the current pandemic of this disease.
The experts concluded that both early warnings of, and rapid responses to, infectious disease threats are needed. The group made several major recommendations to PAHO and its member states to improve surveillance, research, and communications in developing countries. They also issued more detailed recommendations in the areas of antimicrobial resistance, outbreak control, and information and communication. In addition, a plan of action is forthcoming.
The group made the following recommendations for PAHO and its member countries:
Develop and frequently update prioritized disease-specific guidelines for the prevention and control of diseases that are emerging or reemerging, both at the public health and individual levels. This should include biologic and behavioral change measures and will require groups of experts for each disease as well as communications experts. Diseases of interest include yellow fever, dengue, antimicrobial-resistant organisms (malaria, tuberculosis, and enteric diseases), measles, polio, cholera and other foodborne and waterborne diseases, viral hemorrhagic fevers, plague, rabies and other zoonoses, and trypanosomiasis and other vector-borne diseases.
Identify points of contact in the field to receive and transmit information in countries. These contacts should include organizations and individuals outside the government.
Develop plans to distribute accurate and timely information to the general public.
Develop plans to improve and make more efficient two-way communication on reporting, control, and modification measures. This may require contracting information management specialists to identify and implement the most efficient means.
Make efficient use of the press, including radio, television and newspapers, fliers, and other methods to educate the public and the medical community, with an eye toward social mobilization of communities to fight emerging diseases. This will require expertise in communications and support to the countries in developing information dissemination plans. Countries should define populations at greatest risk and focus the information and control measures in these populations.
Define different approaches for educating the public and the medical community.
Focus efforts on intersectorial action, including education of policy makers outside the health community.
The expert group recommended that both PAHO and its member countries, where applicable, do the following:
Seek ways to reduce availability of over-the-counter antimicrobial agents, including those used in veterinary medicine; this will require efforts beyond the health care community and involve education and dissemination of information to all sectors.
Intensify assistance to the countries in developing rational drug policies.
Monitor sensitivity to antibiotics in each country to allow for optimum antibiotic use for individual cases and to eliminate antibiotics with little therapeutic value. Employ mechanisms such as WHONET and PHLIS to centralize, analyze, and distribute antimicrobial sensitivity data.
Develop and distribute specific recommendations to extend the useful life of antimicrobial drugs.
Frequently revise the list of essential antimicrobials based on sensitivity data.
Initiate educational campaigns on the cost-effectiveness of rational drug use in hospitals.
Initiate collaboration with the pharmaceutical industry on rational drug use, standardized labels and warnings, and ethical marketing strategies.
The expert group endorsed the leadership role of PAHO in developing and disseminating guidelines for outbreak evaluation and control and recommended that PAHO
Make timely recommendations to coordinate response to outbreaks or threats, including issues related to travel advice, quarantine, and commerce.
Develop policies and standard operating plans for response to outbreaks at the regional and country levels. Assist countries in developing national outbreak response plans and assist in training teams.
Identify and list individuals and groups with disease-specific expertise, laboratories with disease-specific diagnostic capabilities, and products, including diagnostic reagents, drugs, and vaccines (both licensed and investigational products). Frequently update these lists.
Establish a standard system for rapid procurement of vaccines, reagents, insecticides and antimicrobial drugs for prompt response to outbreaks.
Establish information management and dissemination procedures for use during outbreaks, including accurate and frequent release of information to the press and public.
Conduct formal evaluations of responses to each outbreak and use the lessons learned to improve responses to subsequent outbreaks.
The experts recommended communicating with high-level government officials and emphasizing to them the importance of a basic public health infrastructure including improvements in water, sanitation, and social and economic conditions in preventing diseases. The group suggested disseminating more information about public health implications of development (such as deforestation, dam construction, urbanization, and other measures) and seeking effective interaction with other sectors.
Create interagency task forces for emerging diseases at regional and country levels.
Inform regional governments, other organizations, and the public about the emerging disease initiative and strive for the highest level of political support.
Solicit and allocate specific resources to deal with the emerging diseases initiative, both at the regional and country levels. A portion of these funds should be immediately available when outbreaks are recognized.
For more information on these recommendations, the conference, or its plan of action, contact PAHO.