Se confirman los primeros dos casos de transmisión autóctona del virus de chikungunya en las Américas.

Fuente: Alerta Epidemiológica OPS/OMS.

El 6 de diciembre del corriente año la OPS/OMS recibió la notificación de la confirmación de dos casos de transmisión autóctona del virus de chikungunya (en la isla de Saint Martin / Sint Maarten). Ya en las Américas, se habían registrado casos importados en Estados Unidos, Canadá, Guyana Francesa, Martinica, Guadalupe y Brasil. Esta enfermedad fue detectada por primera vez en Tanzania en 1952. A partir del 2004, se han reportado brotes intensos y extensos en África, las islas del océano Índico, la región del Pacífico, incluyendo Australia y Asia (India, Indonesia, Myanmar, Maldivas, Sri Lanka y Tailandia). En 2007 el virus se extendió a Italia, donde produjo un brote trasmitido por Aedes albopictus en la región de Emilia-Romagna. Los recientes brotes de fiebre por chikungunya han demostrado impactos importantes en la salud pública, principalmente en los servicios de salud. Fiebre por chikungunya (CIE-10 A 92.0) Es una enfermedad causada por el virus de chikungunya (CHIKV). El CHIKV pertenece al género alphavirus (familia Togaviridae). Este virus es transmitido por la picadura del mosquito del género Aedes, particularmente Aedes aegypti y Aedes albopictus. En los humanos picados por un mosquito infectado, los síntomas de enfermedad aparecen generalmente después de un periodo de incubación de tres a siete días (rango: 1−12 días). El CHIKV puede causar enfermedad aguda, subaguda y crónica. Para acceder a más detalles entre aquí: http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=23808+&Itemid=999999&lang=es

Treatment ends for Chagas patients

Médecins Sans Frontières MSF (Doctors Without Borders) stops diagnosing Chagas disease in Paraguay due to treatment shortage. In Bolivia, new projects in endemic areas are suspended. Thousands of people with Chagas disease will go untreated in coming months due to a shortage of benznidazole, the first-line drug used in most endemic countries.

As a number of countries are actively seeking to reverse the long neglect of Chagas disease, the supply of this treatment threatens to run out.

Therefore, the medical-humanitarian organisation MSF is urging the Brazilian Ministry of Health, which is responsible for the only laboratory in the world manufacturing benznidazole, to respect its commitment to Chagas patients and take immediate measures to make the drug available.

Chagas treatment

Chagas treatment currently depends wholly on a single pharmaceutical company to produce benznidazole tablets, the Brazilian State laboratory LAFEPE (Laboratorio Farmaceutico do Estado de Pernambuco). Responsibility for producing the active pharmaceutical ingredient (API) used by this laboratory was recently transferred to one sole private company, Nortec Química.

There is not enough API at present to produce the tablets needed, and Nortec has yet to validate production. In addition, LAFEPE has breached its promise to publish and fulfil a manufacturing schedule that would ensure availability of the drug.

As a result, various national Chagas programmes in Latin America are already struggling to meet the demand for new treatment and are expected to run out of stock in the next few months.

Future availibility unknown

No information has been provided by the Brazilian Ministry of Health on what is happening, and the World Health Organization (WHO) and the Pan American Health Organization (PAHO) have not put a contingency plan in place to maintain stocks of this drug for acute cases of Chagas.

Future availability of the drug is not currently known, although according to various estimations it is unlikely to be before mid-2012.

“This situation is unacceptable. In Boquerón, an area with one of the highest rates of Chagas in Paraguay, we are forced to stop diagnosing patients because we simply don’t have the drugs to treat them,” explains Dr Henry Rodríguez, MSF’s head of mission in Bolivia and Paraguay.

“For decades Chagas was a completely neglected disease and just when diagnosis and treatment were finally being made a priority, we’ve run out of medication. We must not allow this to continue; an urgent solution must be found for our patients.”

MSF forced to delay treatment

In recent years, demand for treatment has increased significantly because adults are now being treated as well as children. Besides, the WHO and the PAHO have strongly endorsed diagnosis and treatment at the primary healthcare level. However, all progress made to date is now jeopardised by the shortage of benznidazole.

“Although we know that current treatment is more effective and more likely to prevent complications the sooner a patient is treated, we will be forced to delay it,” says Dr Unni Karunakara, MSF's international president.

Alerta Epidemiológica | Epidemiological Alert

Síndrome hemolítico urémico e infección por E. coli productora de toxina Shiga (STEC) o E. coli enterohemorrágica (EHEC) Haemolytic uraemic syndrome (HUS) and infection by Shigatoxin-producing E. coli (STEC) or enterohaemorrhagic E. coli (EHEC)

El objetivo de esta alerta es informar sobre la ocurrencia de Síndrome Hemolítico Urémico (SHU) y de infección por Escherichia coli productora de toxina shiga (STEC) o E. coli enterohemorrágica (ECEH) en Alemania y otros países.

Se incluye además, las recomendaciones que la Organización Panamericana de la Salud (OPS) realiza a los Estados Miembros en relación a este tema.

The objective of this alert is to provide an update on cases of Haemolityc uraemic syndrome (HUS) and on cases of infection by Shigatoxin-producing E. coli (STEC) or enterohaemorrhagic E. coli (EHEC) in Germany and other countries.

Included are the Pan American Health Organization (PAHO) recommendations to Member States in relation to this theme.

Recomendaciones | Recomendations

La Organización no ha realizado nuevas recomendaciones para el tratamiento de los casos relacionadas a este brote en particular3.

Se recomienda especialmente observar las medidas de higiene como el lavado de manos después de usar el baño y antes de tocar alimentos, dado que la bacteria puede transmitirse de persona a persona, así como a través de los alimentos, el agua y el contacto directo con animales. La cocción de los alimentos hasta que alcancen una temperatura de 70°C destruye estas bacterias.

Cualquier persona que ha desarrollado diarrea sanguinolenta y dolor abdominal, y que ha tenido contacto recientemente con el norte de Alemania, debe buscar atención médica urgente. El SHU es una complicación que puede producir insuficiencia renal aguda y aparecer después de que la diarrea se haya resuelto. En general no se recomienda el tratamiento con antidiarreicos ni antibióticos, pues pueden empeorar la situación.

The Organization is not making any new recommendations for treatment.3

Normal hygiene measures should be observed. Hand washing after toilet use and before touching food, are highly recommended, as the bacterium can be passed from person to person, as well as through food, water and direct contact with animals. The bacteria is destroyed by thorough cooking of foods until all parts reach a temperature of 70 °C or higher.

Anyone who has developed bloody diarrhoea and abdominal pain and who has recently had contact with northern Germany should seek medical advice urgently. The HUS complications can cause acute kidney failure and can develop after the diarrhoea has resolved. Treatment with anti-diarrhoeal products or antibiotics is not recommended, as these may worsen the situation.

[Press Release OPS] español

[Press Release PAHO] english