Dinámicas comunitarias y gubernamentales sobre la malaria en Guaviare-Colombia / Community and governmental dynamics related to malaria in Guaviare-Colombia

OBJETIVO: El objetivo del estudio fue describir las dinámicas comunitarias y gubernamentales en torno a la malaria, su control y prevención en el Municipio de San José del Guaviare, en el departamento de Guaviare (Colombia). MÉTODOS: Se realizó un estudio de métodos mixtos utilizando una encuesta que constaba de 45 preguntas sobre conocimientos, actitudes y prácticas y entrevistas semiestructuradas con personal médico y trabajadores del gobierno. RESULTADOS: Aceptaron realizar la encuesta 103 personas, el 72% fueron mujeres, edad promedio de 40,8 años, tiene acueducto el 60% y alcantarillado 53,4%. El 59% reportó haber tenido malaria, 76% reconoció un mosquito como el vector de la enfermedad, 6% reconoce al Anopheles como el vector. El 16,5% de los encuestados asegura que la malaria no es un problema de salud para ellos y sus familias. El uso de toldillos (74%) es considerado una eficaz protección. CONCLUSIONES: Se evidencia un buen conocimiento de la malaria después de los acuerdos de paz, sin embargo, los determinantes relacionados con suministro de agua, alcantarillado, difícil atención en zona rural y las escasas acciones interdisciplinarias son posibles elementos de riesgo para esta población.

The objective of the study was to describe the community and government dynamics around malaria, especially its control and prevention, in the Municipality of San José del Guaviare, in the sector of Guaviare (Colombia). METHODS: We conducted a mixed methods study using a survey consisting of 45 questions on knowledge, attitudes, and practices, and semi-structured interviews with medical personnel and government workers. RESULTS: 103 people responded to the survey. 72% were women, and the average age was 40.8 years. 60% had an aqueduct and 53.4% had sewers. 59% reported having had malaria, 76% recognized a mosquito as the vector of the disease, and 6% recognized Anopheles as the vector. 16.5% of those surveyed said that malaria was not a health problem for them and their families. 74% considered the use of mosquito nets an effective protection. CONCLUSIONS: While there is a good knowledge of malaria, difficulties related to water supply, sewage, care in rural areas and lack of interdisciplinary solutions pose possible risk factors for this population.

Achievements of the national malaria control and elimination program in the People's Republic of China: the Atlas of Malaria Transmission in China / 医学前沿

In 2017, China achieved the target of zero indigenous malaria case for the first time, and has been certified as malaria free by World Health Organization in 2021. To further summarize the historical achievements and technical experiences of the elimination program, a project on the Roadmap Analysis and Verification for Malaria Elimination in China was carried out. Results of the project were compiled and published as the Atlas of Malaria Transmission in China (The Atlas). The Atlas using modern digital information technologies, has been supported by various data from 24 malaria endemic provinces of China since 1950, to assess the changes in malaria epidemic patterns from 1950 to 2019 at national and provincial levels. The Atlas is designed as two volumes, including a total of 1850 thematic maps and more than 130 charts, consisting of introductory maps, thematic maps of malaria epidemic and control at national and provincial levels. It objectively and directly shows the epidemic history, evolution process, and great achievements of the national malaria control and elimination program in China. The Atlas has important reference value for summing up historical experience in the national malaria elimination program of China, and malaria control and elimination in other endemic countries in the world.

Laboratory diagnosis for malaria in the elimination phase in China: efforts and challenges / 医学前沿

Malaria remains a global health challenge, although an increasing number of countries will enter pre-elimination and elimination stages. The prompt and precise diagnosis of symptomatic and asymptomatic carriers of Plasmodium parasites is the key aspect of malaria elimination. Since the launch of the China Malaria Elimination Action Plan in 2010, China has formulated clear goals for malaria diagnosis and has established a network of malaria diagnostic laboratories within medical and health institutions at all levels. Various external quality assessments were implemented, and a national malaria diagnosis reference laboratory network was established to strengthen the quality assurance in malaria diagnosis. Notably, no indigenous malaria cases have been reported since 2017, but the risk of re-establishment of malaria transmission cannot be ignored. This review summarizes the lessons about malaria diagnosis in the elimination phase, primarily including the establishments of laboratory networks and quality control in China, to better improve malaria diagnosis and maintain a malaria-free status. A reference is also provided for countries experiencing malaria elimination.

Factores de riesgo asociados a la transmisión de malaria en zona endemica de Córdoba, Colombia / Risk factors associated with the transmission of malaria in the endemic zone of Córdoba, Colombia

El objetivo del trabajo fue determinar factores de riesgo asociados a la transmisión de la malaria en el municipio de Puerto Libertador, Córdoba. Se realizó un estudio observacional analítico transversal, retrospectivo, con enfoque cuantitativo de casos de malaria de zonas rurales del municipio. La información se organizó en Excel, se describieron variables sociodemográficas, aspectos clínicos de los pacientes, de vivienda y ambientales y se realizó un análisis de riesgo para establecer asociación entre las variables y la malaria, además se clasificaron especies de anofelinos vectores y se utilizaron los softwares SatScan y QGis para identificar puntos calientes de malaria en la zona de estudio. Se incluyeron 170 casos de malaria, se identificó que 92% de los individuos carecen de servicio de recolección de basuras, 86,5% sin acueducto, más del 90% no utilizan angeos, repelentes, insecticidas o fumigaciones, se encontró asociación estadística significativa (OR>1) con las aguas estancadas, la falta de acueducto y agua continua como factores de riesgo de malaria; además se clasificaron cinco especies de mosquitos que estarían involucradas en la transmisión y se identificó un punto caliente compuesto por seis veredas del municipio. La malaria en el municipio de Puerto Libertador está asociada principalmente a problemáticas sociales, que se constituyen en factores de riesgo que favorecen la incidencia de esta enfermedad. En la zona de estudio la identificación de los mosquitos Anopheles y del punto caliente, permitirán orientar las medidas de control del vector y dirigir las intervenciones a las localidades focalizadas con mayor riesgo de malaria(AU)

The objective of the work was to determine risk factors associated with the transmission of malaria in the municipality of Puerto Libertador, Córdoba. A retrospective, cross-sectional analytical observational study was carried out, with a quantitative approach to malaria cases in rural areas of the municipality. The information was organized in Excel, sociodemographic variables, clinical aspects of the patients, housing and environmental variables were described, and a risk analysis was carried out to establish an association between the variables and malaria.In addition, vector anopheline species were classified and the SatScan and QGis software to identify malaria hot spots in the study area. 170 cases of malaria were included, it was identified that 92% of the individuals lack garbage collection service, 86.5% without aqueduct, more than 90% do not use angeos, repellents, insecticides or fumigations, a significant statistical association was found ( OR> 1) with stagnant water, lack of aqueduct and continuous water as risk factors for malaria; In addition, five species of mosquitoes that would be involved in the transmission were classified and a hotspot made up of six villages in the municipality was identified. Malaria in the municipality of Puerto Libertador is mainly associated with social problems, which constitute risk factors that favor the incidence of this disease. In the study area, the identification of Anopheles mosquitoes and the hotspot will make it possible to orient vector control measures and direct interventions to targeted localities with the highest risk of malaria(AU)

Hacia un mundo libre de malaria: Utopía o realidad / Towards a malaria-free world: Utopia or reality

La Malaria es una enfermedad causada por un parásito que se transmite a los humanos a través de la picadura de mosquito hembra Anophele. Reportando la WHO en el 2019, 229 millones de casos y 409.000 muertes por la enfermedad en 87 paises del mundo, Existen seis especies de este párasito: Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale wallickeri, Plasmodium ovale curtisi, Plasmodium malariae y Plasmodium knowlesi. Siendo la especie P. falciparum la causante de mayor morbilidad, con tasa entre 10 y 50% de mortalidad por malaria complicada. Alrededor de 108 países han declarado la malaria como enfermedad endémica, pudiendo padecer la enfermedad en cualquier época del año. Sin embargo, en el caso de América Latina hoy en día se vive un estancamiento de la enfermedad, reportándose en países menos de 100 casos autóctonos entre el 2000 y 2019, con algunas excepciones. Esta situación de vulnerabilidad de países como Brasil, Colombia, la frontera Perú-Ecuador, Venezuela, se incrementan ante la presencia activa de la pandemia producto del Covid -19 aunado a restricciones económicas, incremento de la actividad minera, o políticas públicas que ponen en riesgo la sostenibilidad del programa de control de la enfermedad. Para el 2021 la OMS corrobora que existen 87 países con malaria a nivel mundial, de los cuales 24 de ellos habían interrumpido su transmisión autóctona por 3 años. Realidad que consolidad la propuesta tras la experiencia adquirida, que cualquiera que sea la situación epidemiológica de entrada, el trabajo hacia la erradicación de la malaria debe entenderse y atenderse como un proceso continuo donde los propios Estados deben desde su realidad y estrategias propias se articulen con el Plan Estratégico Técnico Mundial Contra la Malaria 2016-2030 propuesto por la OMS(AU)

Malaria is a disease caused by a parasite that is transmitted to humans through the bite of the female Anophele mosquito. Reporting the WHO in 2019, 229 million cases and 409,000 deaths from the disease in 87 countries of the world, There are six species of this parasite: Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale wallickeri, Plasmodium ovale curtisi, Plasmodium malariae and Plasmodium knowlesi. The species P. falciparum is the cause of greatest morbidity, with a rate between 10 and 50% of mortality from complicated malaria. About 108 countries have declared malaria as an endemic disease, and the disease can occur at any time of the year. However, in the case of Latin America today there is a stagnation of the disease, with fewer than 100 indigenous cases reported in countries between 2000 and 2019, with some exceptions. This situation of vulnerability of countries such as Brazil, Colombia, the Peru-Ecuador border, Venezuela, increases in the face of the active presence of the pandemic product of the Covid -19 coupled with economic restrictions, increased mining activity, or public policies that put at risk the sustainability of the disease control programme. By 2021, WHO confirms that there are 87 countries with malaria worldwide, of which 24 had interrupted their indigenous transmission for 3 years. Reality that consolidates the proposal after the experience acquired, that whatever the epidemiological situation of entry, The work towards the eradication of malaria must be understood and addressed as a continuous process where the States themselves must from their own reality and strategies articulate with the Global Technical Strategic Plan Against Malaria 2016-2030 proposed by the WHO(AU)

Signos de alarma en pacientes con paludismo importado por Plasmodium falciparum / Warning signs in patients with imported Plasmodium falciparum malaria

Introducción: El paludismo es una enfermedad febril aguda potencialmente mortal causada por parásitos que se transmiten al ser humano por la picadura de mosquitos del género Anopheles. De los 214 millones de casos de paludismo registrados en 2016, la mayoría de ellos se producen en niños menores de cinco años en África subsahariana. La mortalidad está dada por la presencia de sus complicaciones que deben ser detectadas y tratadas precozmente. Objetivo: Identificar la presencia de signos de alarma, y determinar su relación con otras variables clínicas y de laboratorio. Métodos: Se realizó un estudio descriptivo de 47 pacientes adultos con paludismo por Plasmodium falciparum importado, ingresados en el Departamento de Medicina del Instituto de Medicina Tropical Pedro Kourí, desde enero de 2016 a diciembre de 2018. Los datos fueron procesados en una base de datos en Microsoft Excel y luego analizados en el programa estadístico SPSS 11,5. Resultados: Predominaron los pacientes del sexo masculino, con una media de edad de 35,9 años. Fue significativa la relación existente entre los signos de alarma y la severidad del cuadro clínico, la hiperparasitemia, el supuesto estado no inmune de los pacientes, trombocitopenia y la demora en el ingreso. La respuesta al tratamiento es excelente con los esquemas combinados utilizados a base de quinina. Conclusiones: Los signos de alarma, dentro de los cuales podemos incluir la trombocitopenia, constituyen elementos importantes para poder prevenir futuras complicaciones(AU)

Introduction: Malaria is an acute potentially fatal febrile disease caused by parasites transmitted to humans through the bite of mosquitoes from the genus Anopheles. Most of the 214 million malaria cases reported in the year 2016 were children aged under five years from Sub-Saharan Africa. Mortality is due to the presence of complications which should be detected and treated timely. Objective: Identify the presence of warning signs and determine their relationship to other clinical and laboratory variables. Methods: A descriptive study was conducted of 47 adult patients with imported Plasmodium falciparum malaria admitted to the Medicine Department of Pedro Kourí Tropical Medicine Institute from January 2016 to December 2018. The data obtained were processed in a Microsoft Excel database and then analyzed with the statistical software SPSS 11.5. Results: Male patients prevailed, with a mean age of 35.9 years. A significant relationship was found between warning signs and severity of the clinical status, hyperparasitemia, the supposed non-immune status of patients, thrombocytopenia and admission delay. An excellent response was obtained to treatment with combined quinine-based schemes. Conclusions: Warning signs, among them thrombocytopenia, are important to prevent future complications(AU)

Enfoque terapéutico profiláctico para reducir la morbilidad por paludismo en la mujer embarazada / Prophylactic therapeutic approach to reduce malaria morbidity among pregnant women

Introducción: La infección por malaria durante el embarazo es un importante problema de salud en la mayoría de las regiones tropicales. Esta condición puede tener incidencia negativa tanto en la gestante como en el feto. Objetivo: Indagar en el impacto del tratamento preventivo intermitente con el medicamento antimalárico sulfadoxina-pirimetamina en la mujer embarazada. Métodos: Se realizó una revisión bibliográfica en la base de datos Medline/Pub Med y en artículos relevantes relacionados al tema de los últimos cinco años. Además, se tomó como referencia las guías para el tratamiento de malaria de la Organización Mundial de la Salud, verisón 2016-2017. Análisis y síntesis de los resultados: Durante el período 2015-2017 no se lograron avances significativos en la reducción del número de enfermos palúdicos. No obstante, se señala la anemia como causa de mortalidad en el curso de la malaria. También, se destacan los nuevos enfoques y compromisos para reducir la morbilidad atribuible al paludismo en la mujer embarazada en sus tres vertientes: tratamiento eficaz de los casos de paludismo, el uso de mosquiteros tratados con insecticidas, y la utilización del tratamiento preventivo intermitente con el antimalárico sulfadoxina-pirimetamina a partir del segundo trimestre del embarazo. La indicación de este tratamiento inlcuye mínimo dos dosis del fármaco antipalúdico, con un intervalo de un mes entre cada dosis, con independencia de que las embarazadas muestren o no síntomas de la enfermedad. Conclusiones: Esta intervención para prevenir el paludismo en el embarazo es una cuestión prioritaria en la iniciativa de salud materna, infantil y reproductiva; además, ayuda a mejorar y aumentar la cobertura de las medidas de control de esta enfermedad durante la gestación(AU)

Introduction: Malaria infection during pregnancy is an important health problem in most tropical regions. This condition may have a negative incidence on pregnant women and fetuses. Objective: Inquire into the effect of the intermittent preventive treatment with the malarial sulfadoxine / pyrimethamine in pregnant women. Methods: A bibliographic review was conducted in the database Medline / PubMed and in relevant papers about the topic published in the last five years. The Guidelines for the Treatment of Malaria 2016-2017 of the World Health Organization were also used as reference. Analysis and synthesis of results: Significant progress was not achieved in reducing the number of malaria patients in the period 2015-2017. However, anemia is reported as the cause of mortality during the course of malaria. New approaches and commitments are proposed to reduce malaria-related morbidity among pregnant women, namely effective treatment of malaria cases, use of insecticide-treated mosquito nets, and intermittent preventive treatment with the antimalarial sulfadoxine / pyrimethamine as of the second quarter of pregnancy. Indication of this treatment includes at least two doses of the malarial, with a separation of one month between the doses, regardless of whether the pregnant women have symptoms of the disease. Conclusions: The intervention to prevent malaria during pregnancy is a first-priority aspect of the mother, child, reproductive health initiative. It also helps improve and broaden the coverage of measures for the control of this disease during pregnancy(AU)

The World Health Organizations changing goals and expectations concerning malaria, 1948-2019 / As mudanças nos objetivos e expectativas da Organização Mundial da Saúde com relação à malária, 1948-2019

Abstract From its inception, in 1948, the World Health Organization made control of malaria a high priority. Early successes led many to believe that eradication was possible, although there were serious doubts concerning the continent of Africa. As evidence mounted that eradicating malaria was not a simple matter, the malaria eradication programme was downgraded to a unit in 1980. Revived interest in malaria followed the Roll Back Malaria Initiative adopted in 1998. This article presents an historical account of the globally changing ideas on control and elimination of the disease and argues that insufficient attention was paid to strengthening health services and specialized human resources.

Resumo Desde sua origem, em 1948, a Organização Mundial da Saúde priorizou o controle da malária. Os primeiros êxitos induziram à crença na viabilidade da erradicação, apesar de sérias dúvidas quanto ao continente africano. À medida que se somavam comprovações de que a erradicação da malária não seria simples, o projeto com essa finalidade foi rebaixado a uma unidade em 1980. O reavivamento do interesse na malária ocorreu após a iniciativa Roll Back Malaria, criada em 1998. Este artigo apresenta um panorama histórico das mudanças nas ideias, em âmbito global, ligadas ao controle e à eliminação da doença e defende a tese de que a atenção dada ao fortalecimento dos serviços de saúde e a recursos humanos especializados foi insuficiente.

Debordering public health: the changing patterns of health border in modern Europe / Tirando as fronteiras da saúde pública: mudanças nos padrões de fronteira sanitária na Europa moderna

Abstract According to David Fidler, the governance of infectious diseases evolved from the mid-nineteenth to the twenty-first century as a series of institutional arrangements: the International Sanitary Regulations (non-interference and disease control at borders), the World Health Organization vertical programs (malaria and smallpox eradication campaigns), and a post-Westphalian regime standing beyond state-centrism and national interest. But can international public health be reduced to such a Westphalian image? We scrutinize three strategies that brought health borders into prominence: pre-empting weak states (eastern Mediterranean in the nineteenth century); preventing the spread of disease through nation-building (Macedonian public health system in the 1920s); and debordering the fight against epidemics (1920-1921 Russian-Polish war and the Warsaw 1922 Sanitary Conference).

Resumo Segundo David Fidler, a gestão de doenças infecciosas entre meados do século XIX e e o XXI guiou-se por uma série de acordos institucionais: Regulamento Sanitário Internacional (não interferência e controle de doenças em fronteiras), programas verticais da OMS (campanhas de erradicação da malária e varíola), e posicionamento pós-vestefaliano além do estado-centrismo e interesse nacional. Mas pode a saúde pública internacional ser reduzida à tal imagem vestefaliana? Examinamos três estratégias que destacaram as fronteiras sanitárias: prevenção em estados vulneráveis (Mediterrâneo oriental, século XIX); prevenção à disseminação de doenças via construção nacional (sistema público de saúde macedônico, anos 1920); remoção de fronteiras no combate às epidemias (guerra polaco-soviética, 1920-1921 e Conferência Sanitária de Varsóvia, 1922).

Historical epidemiology and global health history / Epidemiologia histórica e história global da saúde

Abstract The subdiscipline of historical epidemiology holds the promise of creating a more robust and more nuanced foundation for global public health decision-making by deepening the empirical record from which we draw lessons about past interventions. This essay draws upon historical epidemiological research on three global public health campaigns to illustrate this promise: the Rockefeller Foundation's efforts to control hookworm disease (1909-c.1930), the World Health Organization's pilot projects for malaria eradication in tropical Africa (1950s-1960s), and the international efforts to shut down the transmission of Ebola virus disease during outbreaks in tropical Africa (1974-2019).

Resumo A subdisciplina epidemiologia histórica se propõe a criar um alicerce robusto e refinado para o processo de tomada de decisões em saúde pública global, aprofundando registros empíricos que nos ensinam sobre intervenções passadas. Este artigo se baseia na pesquisa epidemiológica histórica de três campanhas globais de saúde pública para ilustrar essa proposta: os esforços da Fundação Rockefeller para controle da ancilostomose (1909-c.1930), os projetos-piloto da Organização Mundial da Saúde para erradicação da malária na África tropical (décadas de 1950-1960), e os esforços internacionais de interrupção da transmissão do vírus Ebola durante surtos na África tropical (1974-2019).

Establecimiento de una línea de base entomológica de malaria en la parroquia San Isidro del municipio Sifontes del estado Bolívar, Venezuela / Establishment of an entomological malaria baseline in the San Isidro parish of the Sifontes municipality of Bolívar state, Venezuela

La malaria en Venezuela es altamente heterogénea y focalizada. En 2016 se reportaron más de 242 mil casos nuevos en el país, de los cuales 73% provenían del estado Bolívar, 42% del municipio Sifontes y 29% de la parroquia San Isidro. Entre octubre 2016 y mayo 2017 se realizó en la parroquia San Isidro un estudio exploratorio, con el fin de establecer una línea basal entomológica en malaria que permitiera la evaluación posterior de Rociamientos Intradomiciliarios de Insecticida y Mosquiteros Tratados con insecticida de Larga Duracion.Las capturas de mosquitos adultos con Trampas Mosquito Magnet Independence™, atrayente humano y en reposo pre-hematofágico, permitieron determinar que en esta parroquia, hay por lo menos tres especies de anofelinos con actividad hematofágica antropofílica, An. darlingi, An. albitarsis s.l. y An. nuneztovari s.l., cuyos hábitos de reposo y actividad de picada fueron descritos. Asimismo, el muestreo de hábitats larvales permitió determinar que las lagunas residuales de la actividad minera son los más importantes y que An. albitarsis s.l. y An. triannulatus s.l. son las especies de mayor prevalencia en estos hábitats. Estos hallazgos permiten actualizar la data entomológica de este foco caliente de malaria y sientan las bases para la evaluación y seguimiento de las medidas de control de vectores implementadas(AU)

Malaria in Venezuela is highly heterogeneous and focused. In 2016, more than 242,000 malaria cases were reported in the country, from which 73% came from Bolivar state, 42% from Sifontes municipality and 29% from the San Isidro parish. Between October 2016 and May 2017, an exploratory study was carried out in order to establishing an entomologic baseline that would allow posterior evaluations of indoors insecticide spraying and long lasting insecticidal nets. Adults captures with Mosquito Magnet Independence™ traps, human landing, and pre-feedingresting habits allowed to determine that in San Isidro there are at least three anopheline species with significant anthropophilic activity: An darlingi, An. albitarsis s.l. and An. nuneztovari s.l. Resting habits and biting activities were described for the three species. Likewise, larval sampling were carried out which allowed to identify that abandoned gold mine dugouts are the most important habitatsfor these species. Particularly, An. albitarsis s.l. and An. triannulatus s.l. were the most prevalent anophelines colonizing these breeding sites. Our results update entomologic data of this malaria hot spot area and establish the baseline for further evaluations ofthe vector control measures implemented(AU)

Medicina Traslacional en el Perú, generación de políticas y mejoras basadas en la evidencia / Translational medicine in Peru, policy making and evidence-based improvement

Introducción: la investigación traslacional es una rama de la ciencia de reciente creación, su objetivo principal es la aplicación del conocimiento que se genera de las investigaciones, que no quede formando parte de la literatura gris, en el papel o para unos pocos, sino que pueda servir a la mayor cantidad posible de individuos y/o poblaciones. Objetivo: determinar los avances que se han dado a lo largo de los últimos años en la aplicación de la medicina traslacional en Perú. Métodos: se realizó una búsqueda por conveniencia en bases de datos (Google Scholar, Pubmed). Se han brindado ejemplos de cómo la investigación traslacional en Perú puede aportar en gran medida a la mejora de realidades y problemáticas específicas, esto refuerza la necesidad de que las decisiones políticas deben basarse en la medicina basada en la evidencia. Resultados: la medicina traslacional en Perú enfrenta muchas dificultades, como lo son los recursos limitados, tiempo escaso para implementar la investigación formativa, carencia de modelos pedagógicos actualizados, docentes preparados en escuelas antiguas y con capacidad limitada para la educación médica continua; obstáculos que deben de superarse para poder asegurar que la ciencia -y por ende la sociedad- progresen. Conclusiones: en Perú, el avance de la medicina traslacional ha derivado en la generación de personal de salud más capacitado que ha proporcionado los medios para el desarrollo de múltiples políticas públicas. Dichas políticas en muchos casos han terminado plasmadas en normas, reglamentos y hasta leyes en el país(AU)

Introduction: translational research is a branch of science of recent creation. Its main aim is the application of the knowledge generated by research so that it will not become grey literature printed on paper or for the use of a chosen few, but serve as many people and/or populations as possible. Objective: determine the progress made in recent years in the application of translational medicine in Peru. Methods: a convenience search was conducted in the databases Google Scholar and PubMed. Examples are offered of the way in which translational research may greatly contribute to improve specific realities and problems in Peru. This reinforces the need that political decisions be based on evidence-based medicine. Results: translational medicine is faced with many difficulties in Peru, such as limited resources, scant time to implement training research, lack of updated pedagogical models, and teachers trained in old schools and with a limited capacity for continuing medical education. These hurdles should be overcome to ensure the progress of science and therefore of society as well. Conclusions: progress of translational medicine in Peru has resulted in the training of more skilled health personnel, providing the means for the development of multiple public policies. In many cases those policies have been included in standards, regulations and even laws in the country(AU)

Medidas para asegurar la continuidad de la respuesta a la malaria en las Américas durante la pandemia de COVID-19, 24 de abril de 2020 / Measures to ensure the continuity of the response to malaria in the Americas during the COVID-19 pandemic, 24 April 2020

El Programa Regional de Malaria de la OPS, consciente del inminente impacto negativo que la presente pandemia de COVID-19 está causando en los países y en sus sistemas de salud, y consecuentemente en la lucha contra la malaria en los países de las Américas, considera fundamental orientar a las autoridades nacionales y llamar la atención sobre medidas principales a tomar para mantener la continuidad de las acciones contra la malaria, protegiendo la salud de los trabajadores y en consonancia con las disposiciones nacionales de respuesta a la COVID-19. La OMS ha elaborado orientaciones específicas sobre malaria durante la respuesta a la COVID-19, que constituyen la referencia principal de este documento. Este material está sujeto a actualizaciones de la OMS y la OPS sobre malaria y sobre la respuesta a la COVID-19.

The PAHO Regional Malaria Program is aware of the imminent negative impact that the present COVID-19 pandemic is causing in the countries and their health systems, and consequently, in the fight against malaria in the countries of the Americas; considers that it is essential to guide national authorities; and draws attention to the main measures to be taken to maintain the continuity of actions against malaria, while protecting the health of healthcare workers and in line with national provisions for response to COVID-19. Malaria-specific guidance on the response to COVID-19 has been developed by WHO1 and is the main reference for this document. This material is subject to updates by WHO and PAHO on malaria and on the COVID-19 response.

Medidas para migrar los efectos de la respuesta en malaria, dado el contexto de la pandemia por covid-19 en las áreas endémicas de malaria en Honduras / Measures to migrate the effects of the malaria response, given the context of the covid-19 pandemic in malaria endemic areas in Honduras

Objetivo: Mantener los esfuerzos para prevenir, detectar y tratar los casos de malaria al mismo tiempo que se evita la propagación de COVID-19 y se garantiza la seguridad de quienes prestan los servicios. Medidas principales: Adaptar la detección de casos de malaria a la situación de la red de salud y flujos de atención del COVID-19 a nivel local, para asegurar el tratamiento temprano de la malaria. Simplificar las operaciones de vigilancia y control de malaria, según escenarios de situación local de COVID-19, para asegurar las acciones esenciales. Asegurar y optimizar el manejo de los insumos de malaria necesarios (medicamentos, PDR, MTILD e insecticidas para el RRI)...(AU)

Minería de oro y aumento de la malaria: ¿qué ocurre en Chocó? / Gold mining and increased malaria: what happens in Chocó?

La minería de oro a cielo abierto se ha asociado a diversos problemas de salud en la población, entre esos la proliferación de enfermedades infecciosas como la malaria. El departamento del Chocó, uno de los más importantes productores de oro del país, ha venido siendo afectado por un aumento en el número de casos y muertes por Malaria. Con el fin de poner a prueba si estos dos eventos se encuentran relacionados el ONS llevó a cabo un estudio para evaluar la asociación entre los niveles de producción de oro en los municipios del Chocó y los casos de malaria. El estudio encontró que los municipios con mayor producción de oro también presentan en promedio el mayor número de casos de malaria anualmente. De acuerdo con los hallazgos de este y otros estudios es importante para el control de la malaria abrir los espacios necesarios para discutir la minería de oro como un factor determinante en la propagación de la malaria en el departamento del Chocó y probablemente otras regiones mineras de Colombia.

Variabilidade dos casos de malária e sua relação com a precipitação e nível d'água dos rios no Estado do Amazonas, Brasil / Variabilidad de los casos de malaria y su relación con las precipitaciones y nivel del agua de los ríos en el estado del Amazonas, Brasil / Variability in malaria cases and the association with rainfall and rivers water levels in Amazonas State, Brazil

O entendimento das relações entre as variáveis de precipitação e nível d'água dos rios com os casos de malária podem fornecer indícios importantes da modulação da doença no contexto da variabilidade climática local. No intuito de demonstrar como essas relações variam no mesmo espaço endêmico, realizou-se a análise de coerência e fase de ondeletas entre as variáveis ambientais e epidemiológica no período de 2003 a 2010 para 8 municípios do Estado do Amazonas (Barcelos, Borba, Canutama, Carauari, Coari, Eirunepé, Humaitá e São Gabriel da Cachoeira). Os resultados indicam coerências significativas principalmente na escala de variabilidade anual, contudo, escalas menores que 1 ano e bienal também foram encontradas. As análises mostram que casos de malária apresentam pico com aproximadamente 1 mês e meio antes ou depois dos picos de chuva, e em média 1-4 meses após o pico dos rios para grande parte dos municípios estudados. Foi notado que cada variável ambiental apresentou atuação local distinta no tempo e no espaço, sugerindo que outras variáveis locais (a topografia é um exemplo) possam controlar as condições ambientais favorecendo uma atuação diferenciada em cada município, porém, quando as análises são feitas em conjunto é possível ver uma ordem não aleatória destas relações acontecerem. Embora os fatores ambientais e climáticos denotem certa influência sobre a dinâmica da malária, questões de vigilância, prevenção e controle não devem ser desprezadas, significando que as atuações governamentais de saúde podem mascarar possíveis relações com as condições hidrológicas e climáticas locais.

La comprensión de las relaciones entre las variables de precipitaciones y el nivel de agua de los ríos con los casos de malaria pueden proporcionar indicios importantes sobre la modulación de la enfermedad en el contexto de la variabilidad climática local. Con el fin de demonstrar cómo varían esas relaciones en el mismo espacio endémico, se realizó un análisis de coherencia y fase de ondeletas entre las variables ambientales y epidemiológicas, durante el período de 2003 a 2010, en 8 municipios del estado de Amazonas (Barcelos, Borba, Canutama, Carauari, Coari, Eirunepé, Humaitá y São Gabriel da Cachoeira). Los resultados indican coherencias significativas, principalmente en la escala de variabilidad anual, sin embargo, también se detectaron escalas menores de 1 año y bienal. Los análisis muestran que los casos de malaria presentan un pico con aproximadamente 1 mes y medio antes o después de la pluviosidad más alta, y de media 1-4 meses tras el pico de los ríos para gran parte de los municipios estudiados. Se observó que cada variable ambiental presentó una actuación local distinta en el tiempo y en el espacio, sugiriendo que otras variables locales (la topografía es un ejemplo) puedan controlar las condiciones ambientales, favoreciendo una actuación diferenciada en cada municipio, no obstante, cuando los análisis se realizan en conjunto es posible ver un orden no aleatorio de estas relaciones para que se produzcan. A pesar de que los factores ambientales y climáticos denoten una cierta influencia sobre la dinámica de la malaria, cuestiones de vigilancia, prevención y control no se deben despreciar, lo que significa que las actuaciones gubernamentales de salud pueden enmascarar posibles relaciones con las condiciones hidrológicas y climáticas locales.

Understanding the relations between rainfall and river water levels and malaria cases can provide important clues on modulation of the disease in the context of local climatic variability. In order to demonstrate how these relations can vary in the same endemic space, a coherence and wavelet phase analysis was performed between environmental and epidemiological variables from 2003 to 2010 for 8 municipalities (counties) in the state of Amazonas, Brazil (Barcelos, Borba, Canutama, Carauari, Coari, Eirunepé, Humaitá, and São Gabriel da Cachoeira). The results suggest significant coherences, mainly on the scale of annual variability, but scales of less than 1 year and of 2 years were also found. The analyses show that malaria cases display a peak at approximately 1 and a half months before or after peak rainfall and on average 1-4 months after peak river water levels in most of the municipalities studied. Each environmental variable displayed distinct local behavior in time and in space, suggesting that other local variables (e.g. topography) may control environmental conditions, favoring different patterns in each municipality. However, when the analyses were performed jointly it was possible to show a non-random order in these relations. Although environmental and climatic factors indicate a certain influence on malaria dynamics, surveillance, prevention, and control issues should not be overlooked, meaning that government public health interventions can mask possible relations with local hydrological and climatic conditions.

Analytical validation of real-time quantitative PCR assays for optimum diagnosis of vivax malaria

BACKGROUND The prompt diagnosis of plasmodial species for effective treatment prevents worsening of individual health and avoids transmission maintenance or even malaria reintroduction in areas where Plasmodium does not exist. Polymerase chain reaction (PCR) allows for the detection of parasites below the threshold of microscopic examination. OBJECTIVE Our aim was to develop a real-time PCR test to reduce diagnostic errors and increase efficacy. METHODS The lower limit of quantification and the linearity/analytical sensitivity to measure sensitivity or limit of detection (LoD) were determined. Intra-assay variations (repeatability) and alterations between assays, operators, and instruments (reproducibility) were also assessed to set precision. FINDINGS The linearity in SYBR™ Green and TaqMan™ systems was 106 and 102 copies and analytical sensitivity 1.13 and 1.17 copies/μL, respectively. Real-time PCR was more sensitive than conventional PCR, showing a LoD of 0.01 parasite (p)/μL. Reproducibility and repeatability (precision) were 100% for up to 0.1 p/μL in SYBR™ Green and 1 p/μL in TaqMan™ and conventional PCR. CONCLUSION Real-time PCR may replace conventional PCR in reference laboratories for P. vivax detection due to its rapidity. The TaqMan™ system is the most indicated when quantification assays are required. Performing tests in triplicate when diagnosing Plasmodium-infected-asymptomatic individuals is recommended to minimise diagnostic errors.