Triquinosis: el impacto sanitario de una patología emergente / Trichinosis: the health impact of an emerging pathology

La triquinosis es una zoonosis que afecta a los animales y al hombre, y es ocasionada por la ingestión de la larva Trichinella spiralis que habita en el músculo de los animales hospedadores y, tras ser ingerida por el hombre, pasa a la pared intestinal de éste donde se multiplica y sus embriones emigran a los músculos. De 1990 a 1999 se reportaron 5.217 casos y en otro posterior de 2014 a 2018 fueron 5.211 casos. Con un promedio anual de 579 casos y de 1302 casos. Como resultado del cambio climático, la triquinosis se traslada de climas fríos a templados, lo que la torna una enfermedad emergente. El cuadro clínico puede presentarse en forma benigna o aguda, y su evolución abarca un período de un año; en ocasiones provoca la muerte por complicaciones. El hombre es responsable de la crianza, la alimentación y el control sanitario del cerdo y de sus productos para consumo. Consideramos a esta zoonosis, un indicador del desarrollo de los pueblos. Con educación, cambios de conducta y cumplimiento de las normas sanitarias, se actuará en beneficio de la salud y el bienestar de la población. (AU)

Trichinosis is a zoonosis that affects animals and humans. It is caused by the ingestion of a larva called Trichinella spiralis which lives in the muscle of host animals. After being ingested by humans, the larva passes to the intestinal wall where it multiplies, and its embryos migrate to the muscles. From 1990 to 1999, 5.217 cases were reported, and in a later period from 2014 to 2018, there were 5.211 cases. With an annual average of 579 cases and 1.302 cases, respectively. As a result of climate change, trichinosis moves from cold to temperate climates making it an emerging disease. The clinical presentation can range from benign to acute, with an evolution period of 1 year; and sometimes it causes death due to complications. Humans are responsible for raising, feeding, and ensuring sanitary control of pigs and their products for consumption. We consider this zoonosis an indicator of the development of communities. Through education, behavioral changes, and compliance with sanitary regulations, actions can be taken to promote the health and welfare of the population. (AU)

Thinking about development of multi-channel surveillance and multi-dimensional early warning system of emerging respiratory communicable diseases / 中华流行病学杂志

The world has paid a heavy price for the pandemic of the emerging respiratory communicable disease, so more concern about communicable disease surveillance and early warning has been aroused. This paper briefly reviews the establishment of the surveillance and early warning system of respiratory communicable diseases in China, discusses its future development and introduces the novel surveillance methods and early warning models for the purpose of establishment of a multi-channel surveillance and multi-dimensional early warning system of communicable diseases in the future and the improvement of the prevention and control of emerging respiratory communicable diseases in China.

Strategy and measures in response to highly uncertain emerging infectious disease / 中华流行病学杂志

The incidence and spread of emerging infectious diseases are highly uncertain. This paper summarizes the uncertainty and complexity of emerging infectious disease, and suggests that for the response to the varied emerging infectious diseases in the future, it is still necessary for human to take the strategy of constantly strengthening the prevention and control capability and improving various preparedness protocols. For the better response to emerging infectious diseases and protection of people's health and life, the following measures can be taken, paying more attention to the layout of the infectious disease surveillance network, establishing and maintaining the laboratory surveillance network of infectious diseases, establishing and improving a "wartime-peacetime" transition mechanism or system of medical treatment and response, developing and improving the prevention and control plan for emerging infectious diseases, strengthening the training and rehearsal of emerging infectious disease treatment and response, establishing and improving the system for the grading, classification and stockpile of medical supplies for public health emergency response and establishing and maintaining the system of early warning of emerging infectious diseases and technical platform regulations.

Progress in prevention and control of Nipah virus disease / 中华流行病学杂志

Nipah virus disease (NVD) is a newly emerged zoonosis with a case fatality rate of 40%-75%. NVD is a severe threat to human health and the development of livestock farming. NVD has become one of the emerging infectious diseases with great concern globally during more than 20 years. Nipah virus (NiV) is a pathogen for NVD, the natural host of which is Fruit bats of the Pteropodidae family. The clinical spectrum of NiV infection is broad, including asymptomatic infection, acute respiratory infection, fatal encephalitis, and even death. Since NiV was first identified in Malaysia in 1999, it has been prevalent mainly in Southeast Asia and South Asia. NiV is primarily transmitted to humans through bat-pig-human, contaminated food. Currently, there are no specific therapeutic drugs and vaccines for NVD. Although there are no cases of NVD reported in China, which has close personnel and trade exchanges with major NVD-endemic countries, and NiV antibody has also been detected in relevant bats. There is a potential risk of importing NVD and domestic outbreaks in the future in this country. This paper provides a systematic review of the research progress in the prevention and control of NVD etiology, epidemiology, clinical manifestations and laboratory diagnosis to help relevant staff to understand NVD more comprehensively and systematically.

Comportamiento de la vigilancia de síndrome febril inespecífico / Behavior of the surveillance of the unspecific febrile syndrome

Introducción: La vigilancia del síndrome febril inespecífico es objeto de especial atención, frecuente expresión de la ocurrencia de enfermedades emergentes y reemergentes; su detección oportuna permite formular medidas de intervención adecuadas. Objetivo: Evaluar el comportamiento de la vigilancia del síndrome febril inespecífico. Métodos: Se realizó una investigación observacional descriptiva de corte transversal, mediante la vigilancia activa y pasiva. La población objeto de estudio se determinó por los 384 pacientes detectados con síndrome febril inespecífico en las tres áreas de salud: Juan M. Páez Inchausti, Leonilda Tamayo Matos y Oreste Falls Oñate en la Isla de la Juventud, durante el período de enero a junio de 2017. Se utilizó como fuente primaria de datos la encuesta epidemiológica de cada caso. Para el análisis se emplearon frecuencias absolutas, relativas y tasas. Se evaluaron dos atributos del sistema (oportunidad y valor predictivo positivo). Resultados: La mayor notificación se produjo en las últimas semanas estadísticas, con predominio del área de salud Juan M. Páez Inchausti, que mostró una tasa de 61,8 x 104 hab. Al sexo masculino se atribuyeron 207 casos (48,6 x 10 4 hab.) y la mayor incidencia se evidenció en los menores de 1 año con 48 casos (497,9 x 104 hab). La frecuencia de síntomas presentó el 95,8 por ciento (368) para la fiebre, seguido de la cefalea 47,1 por ciento (181). El atributo de oportunidad se evaluó de medianamente suficiente y el valor predictivo positivo se consideró bajo. Conclusiones: La vigilancia mostró su mayor efectividad en las últimas semanas. Según características demográficas predominó el sexo masculino y la mayor incidencia fue en los menores de 1 año. Existen algunas insuficiencias en el cumplimiento de los atributos esenciales, sin embargo, no afecta el resultado del sistema en su conjunto(AU)

Introduction: The surveillance of the unspecific febrile syndrome is a subject of special attention because it is the most common expression of the occurrence of emerging and re-emerging diseases. Its timely detection allows the formulation of adequate intervention measures. Objective: To evaluate the behavior of the surveillance of the unspecific febrile syndrome. Methods: A descriptive, cross-sectional, observational investigation was carried out through active and passive surveillance. The population studied was determined by 384 patients detected having unspecific febrile syndrome, in three health areas: Juan M. Páez Inchausti, Leonilda Tamayo Matos y Orestes Falls Oñate, located in Isla de la Juventud special municipality , from January to June 2017 . The epidemiological survey of each case was used as the primary source of data. For the analysis, absolute frequencies, relative frequencies and rates were used. Two attributes of the system were evaluated (opportunity and positive predictive value). Results: The highest notification occurred in the last weeks being predominant Juan M. Páez Inchausti health area, which showed the highest rate (61.8 x 104 inhab.). 207 cases were of the male sex (48.6 x 10 4 inhab.) and the highest incidence was evidenced in those younger than 1 year, with 48 cases (497.9 x 104 inhab). The frequency of symptoms was of 95.8 percent (368) for fever, followed by headache 47.1 percent (181). The opportunity attribute was evaluated as medium enough and the PPV was low. Conclusions: The surveillance showed its greatest effectiveness in the last weeks. According to the socio-demographic characteristics, the male sex predominated and the incidence was greater in the ages from 1 to 4 years old. There are some deficiencies in the fulfillment of the essential attributes; however, it does not affect the result of the system as a whole(AU)

Criptosporidiosis y una salud / Cryptosporidiosis and one health

RESUMEN Criptosporidiosis es una enfermedad diarreica (zoonótica) causada por el parásito Cryptosporidium, el cual infecta al intestino. Se producen tanto en el ser humano como en diferentes animales de granja, mascotas y animales silvestres. Se subestima su papel y poco se conoce sobre su epidemiología, debido al escaso interés que suscita y la limitada disponibilidad de métodos de diagnóstico. La salud de las poblaciones tanto humana como animal, están relacionadas con una estrecha interacción de tres factores: el ambiente, los agentes patógenos, y las poblaciones, lo cual determina el estado de salud y enfermedad. El enfoque, conocido como «Una Salud¼, es una estrategia global en crecimiento que se está adoptando por una diversidad de organizaciones y responsables de las políticas en respuesta a la necesidad de enfoques integrados. Este enfoque puede ser relevante para una amplia gama de objetivos mundiales de desarrollo. Cada vez se habla más de salud integral, de salud holística. Parece que somos más conscientes de que la salud no se reduce a algo puramente biológico, sino que afecta a toda la persona. No es sólo ver al enfermo globalmente, es partir de la complejidad del ser humano y del mundo entero atravesado por la vulnerabilidad e interaccionar con la totalidad de los sujetos.(AU)

ABSTRACT Cryptosporidiosis is a diarrheal disease (zoonotic) caused by the parasite Cryptosporidium, which infects the intestine. It occurs in humans and in different pets, farm and wild animals. Its role is underestimated and little is known about its epidemiology, due to the low interest it draws and the limited availability of diagnostic methods. The population health, both human and animal, is related to a close interaction of three factors: the environment, pathogens, and population, which determines the state of health and disease; some of the diseases considered as emerging, that appeared in the last years. The approach, known as "One Health", is a growing global strategy being adopted by a diversity of organizations and policy makers in response to the need for integrated approaches. This approach may be relevant to a wide range of global development goals. There is more and more talk about holistic health. It seems that we are more aware that health is not reduced to something purely biological, but affects the whole person. It is not only seeing the patient globally, it is starting from the complexity of the human being and the whole world crossed by vulnerability and interacting with the totality of the subjects.(AU)

Zika virus outbreak in 19 English- and Dutch-speaking Caribbean countries and territories, 2015-2016 / Brote epidémico del virus del Zika en 19 países y territorios del Caribe de habla inglesa y holandesa en el período 2015-2016 / Surto causado pelo vírus zika em 19 países e territórios do Caribe de língua inglesa e holandesa, 2015-2016

ABSTRACT Surveillance for Zika virus was enhanced in the English- and Dutch-speaking Caribbean following emergence of the virus in Brazil in May 2015. The first autochthonous case of Zika in the Caribbean was reported by Suriname in November 2015, and the virus subsequently spread rapidly throughout the region. Caribbean Public Health Agency (CARPHA) member states (CMS) reported clinically suspected cases of Zika and submitted serum specimens to the agency for laboratory investigation. A patient was considered a confirmed case if Zika virus was detected by real-time reverse transcription-polymerase chain reaction (RT-PCR) assay or serological test. Due to the documented link between 1) Zika virus and congenital syndrome, and 2) Zika virus and Guillain-Barré syndrome (GBS), data on both of these disease outcomes were extracted from country and regional reports. This special report describes the epidemiology of laboratory-confirmed Zika cases reported to CARPHA, including links with both congenital syndrome and GBS, for 19 English- and Dutch-speaking Caribbean countries during the epidemic period (1 October 2015-29 December 2016).

RESUMEN Tras la aparición del virus del Zika en Brasil en mayo del 2015, los países de habla inglesa y holandesa reforzaron la vigilancia de este virus. El primer caso autóctono de infección por el virus del Zika en el Caribe fue notificado por Suriname en noviembre del 2015 y desde entonces el virus se ha propagado rápidamente en toda el área. Los Estados Miembros del Organismo de Salud Pública del Caribe (CARPHA, por su sigla en inglés) notificaron casos presuntos de infección por el virus detectados clínicamente y entregaron al Organismo muestras de suero para que se llevaran a cabo las pruebas de laboratorio. Se consideró que un paciente era un caso confirmado si se detectaba el virus del Zika mediante la prueba serológica de la reacción en cadena de la polimerasa con retrotranscriptasa en tiempo real. Habida cuenta de la relación documentada entre 1) el virus del Zika y el síndrome congénito y 2) el virus del Zika y el síndrome de Guillain Barré, se buscaron datos sobre los resultados relativos a ambas enfermedades en los informes nacionales y regionales. En este informe especial se describen las características epidemiológicas de los casos de infección por el virus del Zika notificados al CARPHA, confirmados mediante pruebas de laboratorio, incluidos los vínculos con el síndrome congénito y el síndrome de Guillain Barré, en 19 países del Caribe de habla inglesa y holandesa en el período de la epidemia (del 1 de octubre del 2015 al 29 de diciembre del 2016).

RESUMO A vigilância do zika foi melhorada nos países e territórios do Caribe de língua inglesa e holandesa com a emergência da doença no Brasil em maio de 2015. O primeiro caso autóctone de zika no Caribe foi registrado no Suriname em novembro de 2015 e, desde então, o vírus tem se propagado rapidamente em toda a região. Os Estados Membros da Agência de Saúde Pública do Caribe (CARPHA) notificaram casos com suspeita clínica de zika e enviaram amostras séricas para análise laboratorial. Considerou-se caso confirmado quando houve a detecção do vírus zika com a técnica de reação em cadeia da polimerase da transcrição reversa em tempo real (PCR-RT) ou com teste sorológico. Devido à associação comprovada entre o vírus zika e a síndrome congênita e o vírus zika e a síndrome de Guillain-Barré (SGB), foram obtidos dados relativos a estes desfechos dos registros regionais e dos países. Este informe especial faz uma descrição da epidemiologia dos casos de zika com confirmação laboratorial notificados à CARPHA, incluindo casos associados à síndrome congênita e SGB, nos 19 países do Caribe de língua inglesa e holandesa no período epidêmico (de 1o de outubro de 2015 a 29 de dezembro de 2016).

Sistema de acciones de la Medicina General Integral para enfrentar la reemergencia de enfermedades / System of actions of the General Integral Medicine to confront the re-emerging diseases

Se presentan resultados parciales del Proyecto Institucional Evaluación del impacto de la metodología para el desarrollo del capital intelectual en los servicios de salud, en ejecución por la Universidad de Ciencias Médicas de Guantánamo desde el 2016. La investigación permitió fundamentar la necesidad de mejorar el nivel de conocimientos de profesionales y población en general acerca de la relación entre el deterioro en los ecosistemas y la emergencia y la reemergencia de enfermedades. Los métodos de investigación empleados aportaron la información primaria a partir de la cual pudo caracterizarse el estado actual del problema y el diseño de un sistema de acciones para el avance en ese aspecto, que, como objetivo cumplido, propician, según el criterio de expertos, lograr integralidad en el manejo de los ecosistemas en función de elevar el nivel de calidad de vida con una gestión ambiental sostenible y saludable(AU)

Partial results of the Institutional Project: Evaluation of the impact of the methodology for the development of the intellectual capital in the services of health, in execution by the University of Medical Sciences of Guantánamo from the 2016 was presented by the researchers. The investigation allowed to base the need to improve the level of knowledges of professionals and population in general about the relation between the degradation in the ecosystems and the emerging and re-emerging diseases. The research methods employed supplied the primary information from which could be characterized the current state of the problem and the design of a system of actions for the advance in this aim, this one fulfilled the criterion of experts, attain integral handle of the ecosystems in function to increase the level of quality of life with a sustainable environmental management and healthy(AU)

Reemergence of mumps in São Paulo, Brazil - the urgent need for booster shot campaign to prevent a serious infectious disease

Abstract INTRODUCTION: Neglected infectious diseases like mumps may be opportunistic in controlled areas with low vaccine coverage, particularly in developed and emerging countries. METHODS: A retrospective analysis of mumps-related data from 2001 to 2016 for São Paulo State, Brazil was conducted. RESULTS: From 2014 to 2015, there was an increase of 82% in reported mumps cases in São Paulo, with prevalence of n=49 and 297, respectively in young adults aged 15-29 years. CONCLUSIONS: A booster-shot campaign on MMR vaccination is recommended to prevent the spread of mumps in unvaccinated children and recipients of only the first dose.

Emerging arboviruses and public health challenges in Brazil / Arboviroses emergentes e novos desafios para a saúde pública no Brasil

ABSTRACT Environmental modification by anthropogenic actions, disordered urban growth, globalization of international exchange and climate change are some factors that help the emergence and dissemination of human infectious diseases transmitted by vectors. This review discusses the recent entry of three arboviruses in Brazil: Chikungunya, West Nile, and Zika virus, focusing on the challenges for the Country's public health. The Brazilian population is exposed to infections caused by these three arboviruses widely distributed on the national territory and associated with humans. Without effective vaccine and specific treatment, the maintainance and integration of a continuos entomological and epidemiological surveillance are important so we can set methods to control and prevent these arboviruses in the Country.

RESUMO A modificação do ambiente por ações antrópicas, o crescimento urbano desordenado, o processo de globalização do intercâmbio internacional e as mudanças climáticas são alguns fatores que vêm facilitando a emergência e disseminação de doenças infecciosas humanas transmitidas por vetores. Este comentário aborda a recente entrada de três arbovírus no Brasil, Chikungunya (CHIKV), West Nile (WNV) e Zika (ZIKV), com enfoque nos desafios para a Saúde Pública do País. Transmitidos por mosquitos vetores amplamente distribuídos no território nacional e associados ao homem, a população brasileira encontra-se exposta à infecção por esses três arbovírus. Na ausência de vacina eficaz e tratamento específico, são importantes a manutenção e integração de uma vigilância entomológica e epidemiológica contínua, a fim de direcionarmos métodos de controle e prevenção contra essas arboviroses no País.

Estratificación epidemiológica del riesgo de las enfermedades emergentes y reemergentes por áreas de salud. Provincia de Matanzas, 2002-2006 / Risk epidemiologic stratification of the emergent and re-emergent diseases per health areas. Province of Matanzas, 2002-2006

Las enfermedades emergentes y reemergentes constituyen un problema de salud que preocupa a los gobiernos y a las autoridades de salud pública, por los efectos económicos y sociales que pueden ocasionar. Se realizó un estudio observacional descriptivo en la población de la provincia de Matanzas, distribuida geográficamente en sus áreas de salud, con el propósito de estratificar el riesgo para las enfermedades emergentes y reemergentes, en el período 2002-2006. Un grupo de expertos seleccionaron las enfermedades a estudiar y los indicadores, quedando definidos así: para la tuberculosis y el VIH/sida, la tasa de prevalencia y de letalidad; para el dengue y el paludismo, los casos importados y el índice de infestación; para la influenza aviar y la fiebre del Oeste del Nilo Occidental (FNO), el asentamiento de aves migratorias, el arribo de viajeros de áreas endémicas, y también para esta última, el índice de infestación. Los datos fueron obtenidos de las tarjetas de Enfermedades de Declaración Obligatoria y certificados de defunción, de la Dirección Provincial de Salud, del Centro Provincial de Higiene y Epidemiología, del sistema de vigilancia vectorial de la Unidad Provincial de Vectores y de aves migratorias de la Dirección Provincial de Medicina Veterinaria y el Ministerio de Ciencia Tecnología y Medio Ambiente (CITMA). Se obtuvo como resultado que Playa, Varadero, Agramante y Jagüey Grande fueron las áreas de salud de mayor riesgo, lo que es de vital importancia para los cuadros a diferentes niveles del sistema, ya que posibilita con una base científica la reorientación de la vigilancia, la organizar los servicios de salud e intervención oportuna.

The emergent and re-emergent diseases are a health problem worrying governments and public health authorities because of the economic and social effects they can produce. We carried out a descriptive observational study in the population of the province of Matanzas, geographically distributed in their health area, with the purpose of stratifying the risk for the emergent and re-emergent diseases, in the period 2002-2006. A group of experts selected the diseases to study and the indicators, being defined this way: for the tuberculosis and HIV/AIDS, the prevalence rate and the lethality; for dengue and malaria, the imported cases and the infestation index; for the avian flu and the West Nile fever, the migratory birds settlement and the traveler arrival from the endemic areas, and for the last one also the infestation rate. The data were collected from the cards of Obligatory Declaration Diseases and the decease certifications, from the Provincial Direction of Health, the Provincial Center of Hygiene and Epidemiology, the vectorial surveillance system of the Provincial Unit of Vectors, the Provincial Center of Veterinary Medicine, and the Ministry of Sciences, Technology and Environment. As a result we obtained that Playa, Varadero, Agramonte and Jagüey Grande were the health areas at higher risk. This is of great importance for the executives at the different levels of the system, making possible the reorientation of the surveillance, the organization of the health services and te opportune intervention on a scientific basis.

Biodiversidade e saúde: um estudo sobre a concordância entre a visão de especialistas em doenças transmitidas por artrópodes e as políticas nacionais em saúde / Biodiversity and health: a study on the correlation between vision specialists in diseases transmitted by arthropods and national policies on health

As mudanças ambientais causadas por ações antrópicas alteram a dinâmica e ocomportamento de hospedeiros, inclusive os humanos, patógenos e vetores resultando em arranjos ecossistêmicos diferenciados que potencializam a transmissão depatógenos. O Programa Institucional Biodiversidade & Saúde da Fiocruz realizou o workshop “Estado da Arte da Saúde Silvestre no Brasil”, em 2009, com o propósito de obter de especialistas convidados a identificação da importância dos parâmetrosclimáticos e bioecológicos para a promoção de doenças emergentes e reemergentes advindas da biodiversidade e recomendações para sua prevenção e controle. Utilizandoos resultados do trabalho participativo dos especialistas em artrópodes, mensurou-se a concordância entre os parâmetros analisados e as recomendações apontadas por elescom as políticas nacionais de saúde, além de hierarquizar os parâmetros em ordem de importância e identificar lacunas no conhecimento. Diversos índices foram criados de modo a gerar valores numéricos comparáveis entre as análises de conteúdo realizadaspara avaliação da concordância entre os resultados dos especialistas e os instrumentos jurídicos da saúde. As lacunas de conhecimento foram registradas apenas nos parâmetros físico-químicos do solo para os subgrupos dos flebotomíneos e sifonápteros, e nos parâmetros populacionais ou de comunidade somente para os flebotomíneos.

Estratificación epidemiológica del riesgo de las enfermedades emergentes y reemergentes por municipios, Matanzas, 2002-2006 / Epidemiologic stratification of the emergent and re-emergent diseases risk per municipalities, Matanzas, 2002-2006

Las enfermedades emergentes y reemergentes constituyen un problema de salud que preocupa a los gobiernos y a las autoridades de Salud Pública por los efectos económicos y sociales que pueden ocasionar. Se realizó un estudio observacional descriptivo en la población de la provincia de Matanzas, distribuida geográficamente en sus municipios, para estratificar el riesgo para las enfermedades emergentes y reemergentes en el período 2002-2006. Se seleccionaron las enfermedades a estudiar y los indicadores por un grupo de expertos: para la tuberculosis y el VIH/sida fueron la tasa de prevalencia y de letalidad, para el dengue y el paludismo los casos importados y el índice de infestación, para la influenza aviar y la fiebre del Oeste del Nilo Occidental el asentamiento de aves migratorias, el arribo de viajeros de áreas endémicas y para esta última también el índice de infestación. Los datos fueron obtenidos de las tarjetas de enfermedades de declaración obligatoria y certificados de defunción de la Dirección Provincial de Salud y del Centro Provincial de Higiene, Epidemiología y Microbiología, así como del sistema de vigilancia vectorial de la Unidad Provincial de Vectores y de aves migratorias de la Dirección Provincial de Medicina Veterinaria y el CITMA. Obteniéndose como resultado que Jagüey Grande, Matanzas y Varadero fueron los municipios de mayor riesgo, constituyendo una herramienta de trabajo para los cuadros a diferentes niveles del sistema, ya que brinda un grupo de elementos con base científica para reorientar la vigilancia de estas enfermedades, organizar los servicios de salud e intervenir oportunamente.

The emergent and re-emergent diseases are a health problem worrying the governments and the public health authorities because of the economic and social effects they can have. We carried out an observational descriptive study in the population of the province of Matanzas, geographically distributed in municipalities, to stratify the risk of the emergent and re-emergent diseases in the period 2002-2006. We selected the diseases and the indicators to study for a group of experts: for the tuberculosis and HIV/AIDS were choose the indicators prevalence rate and lethality; for the dengue and malaria, the imported cases and the infestation index; for the chicken influenza and the Western Nile fever, the population of the migratory birds, the arrival of passengers from endemic areas, and for the last one the infestation index. The data were obtained from the forms of the diseases of obligatory declaration and from the decease certificates in the Provincial Health Direction and the Provincial Center of Hygiene, Epidemiology and Microbiology, and also from the system of vectorial surveillance of the Provincial Unit of Vectors. The data about the migratory birds were gathered in the Provincial Directions of Veterinary Medicine and of Sciences, Technology and Environment. The municipalities of Jagüey Grande, Matanzas and Varadero were the ones with the highest risks. This is a working tool for the persons in charge in the different levels of the system giving elements on a scientific basement to re-orientate the surveillance of these diseases, organize the health care services and the intervention on time.