[Association between cutaneous leishmaniasis incidence and the human development index and its components in four endemic states of Venezuela]. / Asociación entre la incidencia de leishmaniosis cutánea y el índice de desarrollo humano y sus componentes en cuatro estados endémicos de Venezuela.

OBJECTIVES: Assess potential relationships between the Human Development Index (HDI) and its components and the incidence of cutaneous leishmaniasis (CL) in four endemic States of Venezuela (Mérida, Trujillo, Lara and Sucre) in the period 1994-2003. MATERIAL AND METHODS: Socioeconomical data (classified according the World Bank) was obtained from the National Institute of Statistics, and the epidemiological data from the Ministry of Health, both from Venezuela. For this ecological study the annual variation of the variables was assessed and also regression models were done. RESULTS: The HDI varied in the period from 0.6746 in 1994 to 0.8144 in 2003 (p=0.90). During this time an increase in the cumulative incidence of Leishmaniasis was observed, particularly from 1998 (7.3 cases/100,000 pop) to 1999 (11.3 cases/100,000 pop). Analyzing the linear regression models, it was observed that the relationship between epidemiological and social variables was different at States levels. For Mérida and Trujillo it was observed a significant decrease in the CL regard to the increase of literacy (p<0.05), of the gross combined enrollment (p<0.05), life expectancy (p<0.05), money income (p<0.05) and the HDI (p<0.05). CONCLUSION: This information reflects the significant influence of socioeconomical indicators on the CL incidence at Trujillo and Merida, being an inverse relationship between both types of variables; with an increase or improvement in the socioeconomical indicators, the disease incidence rate decreased.

Asociación entre la incidencia de leishmaniosis cutánea y el índice de desarrollo humano y sus componentes en cuatro estados endémicos de Venezuela / Association between cutaneous leishmaniasis incidence and the human development index and its components in four endemic states of Venezuela

Objetivos. Evaluar las posibles asociaciones entre el índice de desarrollo humano (IDH) y sus componentes, y la incidencia de Leishmaniosis cutánea (LC) en cuatro estados endémicos de Venezuela (Mérida, Trujillo, Lara y Sucre) en el período 1994 al 2003. Materiales y métodos. La data socioeconómica (clasificada de acuerdo al Banco Mundial) se obtuvo del Instituto Nacional de Estadística y la epidemiológica del Ministerio de Salud, ambos de Venezuela. Para este estudio ecológico se evaluó la variación anual de las variables y se realizó modelos de regresión. Resultados. El IDH varió en el período, de 0,6746 en 1994 a 0,8144 en 2003 (p=0,90), asimismo, se observó un aumento de la incidencia acumulada de Leishmaniosis, en especial del año 1998 (7,3 casos/100 000 hab) a 1999 (11,3 casos/100 000 hab). Al analizar con los modelos de regresión lineal, se observó que la relación entre las variables epidemiológicas y sociales era diferente a nivel de los Estados evaluados. Para Mérida y Trujillo se observó un descenso significativo de la incidencia de LC con relación al aumento del porcentaje de alfabetización (p menor que 0,05), de estudiantes matriculados (p menor que 0,05), la esperanza de vida (p menor que 0,05), su ingreso en USD per cápita por año (p menor que 0,05) e IDH (p minor that 0,05). Conclusión. Esta información refleja la influencia significativa de los indicadores socioeconómicos sobre la incidencia de la LC en los Estados Trujillo y Mérida, siendo inversa entre ambos tipos de variables; con el incremento o mejoría de los indicadores socioeconómicos, la incidencia acumulada de la enfermedad disminuyó.

Objectives. Assess potential relationships between the Human Development Index (HDI) and its components and the incidence of cutaneous leishmaniasis (CL) in four endemic States of Venezuela (Mérida, Trujillo, Lara and Sucre) in the period 1994-2003. Material and methods. Socioeconomical data (classified according the World Bank) wasobtained from the National Institute of Statistics, and the epidemiological data from the Ministry of Health, both fromVenezuela. For this ecological study the annual variation of the variables was assessed and also regression modelswere done. Results. The HDI varied in the period from 0.6746 in 1994 to 0.8144 in 2003 (p=0.90). During this time an increase in the cumulative incidence of Leishmaniasis was observed, particularly from 1998 (7.3 cases/100,000 pop) to 1999 (11.3 cases/100,000 pop). Analyzing the linear regression models, it was observed that the relationship betweenepidemiological and social variables was different at States levels. For Mérida and Trujillo it was observed a significantdecrease in the CL regard to the increase of literacy (p minor that 0.05), of the gross combined enrollment (p minor that 0.05), life expectancy (p minor that 0.05), money income (p minor that 0.05) and the HDI (p minor that 0.05). Conclusion. This information reflects the significant influence of socioeconomical indicators on the CL incidence at Trujillo and Merida, being an inverse relationship between both types of variables; with an increase or improvement in the socioeconomical indicators, the disease incidence rate decreased.

Burden of zoonotic diseases in Venezuela during 2004 and 2005.

Emerging zoonotic diseases have increased in importance in human and animal health during the last 10 years. Each of these diseases has emerged from an unsuspected quarter and has caused severe problems. In countries, such as Venezuela, the burden of these zoonoses has been understudied. In this report we analyze the status of such diseases in Venezuela for the period 2004-2005. During this period a significant number of animal and human cases of these diseases have been found, particularly for rabies, encephalitis, leishmaniasis, and cysticercosis among others. Surveillance needs to be reinforced for these zoonoses.

Malaria mortality in Venezuela: focus on deaths due to Plasmodium vivax in children.

Morbidity and mortality burden of malaria in the childhood represents a public health threat not only in countries with high levels of transmission, but also in those, such as Venezuela and others in Latin America, with moderate to low transmission. Usually its mortality has been attributed just to Plasmodium falciparum malaria, but the changing patterns of increase in Plasmodium vivax malaria morbidity and mortality are now causing concern. We studied malaria mortality by analyzing different epidemiological variables during a 10-year period in Venezuela, finding mortality rates ranging 0.10-0.36 deaths/100,000 population, with almost a third of deaths in children (<10 years old), corresponding 270 deaths to P. falciparum cases and 30 to P. vivax; but along the period with a decrease trend for P. falciparum and an increase trend for P. vivax.

Trends in fatal snakebites in Venezuela, 1995-2002.

OBJECTIVE: There have been few studies evaluating snakebite mortality in Venezuela and South America. In this study we evaluate trends in fatal snakebites occurring in Venezuela between 1995 and 2002. METHODS: Epidemiological data for this study were retrieved from the records of the Ministry of Health of Venezuela. Using these data, we analyzed the impact of snakebites in Venezuela during the study period. RESULTS: During the study period, there were 266 reports of death due to snakebite; 79.7% were males, and 20.3% were females (P < .01). Annual mean deaths numbered 33 per year. Of total deaths, 24.1% occurred in victims 55-70 years old. Deaths in young children (<5 years old) accounted for 7.1% of the total. Mortality rate by age showed an age-dependent rate, with higher rates in older ages (P = .038). CONCLUSION: Snake envenomations are an important cause of injury and deaths in Venezuela as in many American countries. Surveillance of envenomations is essential for establishing guidelines, planning therapeutic supplies, and training medical staff on snakebite treatment, as well as assessing risk zones for travelers.

Epizootics of yellow fever in Venezuela (2004-2005): an emerging zoonotic disease.

Epidemics and epizootics of yellow fever (YF) have been occurring in the border area of eastern Colombia and western Venezuela since 2003; for this reason many epidemiological control measures were adopted by the Ministry of Health (MOH) trying to prevent their spreading. These activities included monkey deaths surveillance as well as immunization of susceptible individuals with YF vaccine. In this setting, we analyzed epidemiological and epizootical issues related to YF in Venezuela during 2004-2005. In this period, YF epizootics occurred initially without geographical links to the 2003 outbreaks (which occurred at the Southern Maracaibo lake epizootic wave), but in relation with the Guayana epizootic wave; beginning in Monagas state and then affecting Anzoátegui, Guárico, and Sucre states. Just months later, Apure was also affected. Mérida and Táchira also report epizootics for the end of 2004. This year concluded with 15 human deaths due to YF and more than 100 howler monkey deaths. In the same year, 715 suspected cases were investigated confirming YF in 0.7% of them. For these reasons, between 2002 and 2004, Venezuela's MOH has vaccinated approximately 1.9 million people in areas considered to be enzootic. The country's goal for 2006 is to have 7 million people residing in high-risk cities and towns vaccinated, and in this way, preventing and controlling this emerging zoonotic disease.

Ecoepidemiological and Social Factors Related to Rabies Incidence in Venezuela during 2002-2004.

Rabies in Venezuela has been important in last years, affecting dogs, cats, and human, among other animals, being a reportable disease. In Zulia state, it is considered a major public health concern. Recently, a considerable increase in the incidence of rabies has been occurring, involving many epidemiological but also ecoepidemiological and social factors. These factors are analyzed in this report. During 2002-2004, 416 rabies cases were recorded. Incidence has been increasingly significantly, affecting mainly dogs (88.94%). Given this epidemiology we associated ecoepidemiological and social factors with rabies incidence in the most affected state, Zulia. In this period 411 rabies cases were recorded. Zulia has varied environmental conditions. It is composed mostly of lowlands bordered in the west by mountain system and in the south by the Andes. The mean is temperature 27.8°C, and mean yearly rainfall is 750 mm. Climatologically, 2002 corresponded with El Niño (drought), middle 2003 evolved to a Neutral period, and 2004 corresponded to La Niña (rainy); this change may have affected many diseases, including rabies. Ecological analysis showed that most cases occurred in lowland area of the state and during rainy season (p<0.05). Additionally, there is an important social problem due to educational deficiencies in the native population. Many ethnic groups live un Zulia, many myths about rabies are in circulation, and the importance of the disease is not widely realized. The full scale of the rabies burden is unknown, owing to inadequate disease surveillance. Although there have been important advances in our knowledge and ability to diagnose and prevent it, enormous challenges remain in animal rabies control and provision of accessible-appropriate human prophylaxis worldwide. Human and animal surveillance including ecological and social factors is needed.

Lepidopterism due to exposure to the moth Hylesia metabus in northeastern Venezuela.

Lepidopterism refers to a spectrum of medical conditions in humans that usually involves the skin and results from contact with the adult or larval forms of certain butterflies and moths. We analyzed the epidemiologic and clinical features associated with exposure to the moth Hylesia metabus between 1970 and 2002 in the Cajigal district, Sucre, Venezuela. Fifty cases of lepidopterism mostly affecting individuals under 18 years of age were identified during this period and manifested as pruritic dermatitis with or without associated respiratory symptoms. With increased travel to endemic areas of lepidopterism, travel and tropical medicine practitioners should be aware of the clinical spectrum of this condition.