Dog Population Rabies Immunity before a Mass Vaccination Campaign in Lima, Peru: Vulnerabilities for Virus Reestablishment.

Lima, Peru, has not had a case of canine rabies since 1999. However, Lima remains at risk of rabies reintroduction due to the free movement of dogs from nearby rabies-endemic areas. In Latin America, rabies vaccination campaigns must reach 80% of dogs to halt transmission, but estimates of vaccine coverage are often unavailable, unreliable, or inaccurate. Quantifying virus neutralizing antibodies (VNA) allows monitoring of the immunological status of the canine population, evaluation of the degree of humoral protection to the virus, and assessing, partially, the population response to vaccination. We evaluated the dog population's immunity level against the rabies virus before a mass vaccination campaign in Lima. We collected 141 canine blood samples in the district of Surquillo and quantified rabies virus neutralizing antibody titers using the fluorescent antibody virus neutralization test). We surveyed dogs owners to reconstruct canine vaccination histories. Among dogs previously vaccinated, 73.9% exceeded the seroconversion threshold of > 0.5 IU/mL. Among all dogs, only 58.2% reached the titer limit for seroconversion. Dogs ≤ 1 year old constituted 26.2% of the total canine population and had lower levels of VNA than dogs > 1 year old (χ2 = 9.071; P = 0.028). Importantly, dogs vaccinated with single-pathogen vaccines had higher levels of VNA than those who received combined-pathogen vaccines (χ2 = 7.721; P = 0.005). We provide an important and timely glimpse to the immunity status of the dog population in urban areas of Lima, a metropolis near a dog rabies-endemic region.

The Amazonian Tropical Bites Research Initiative, a hope for resolving zoonotic neglected tropical diseases in the One Health era.

BACKGROUND: Neglected tropical diseases (NTDs) disproportionately affect populations living in resource-limited settings. In the Amazon basin, substantial numbers of NTDs are zoonotic, transmitted by vertebrate (dogs, bats, snakes) and invertebrate species (sand flies and triatomine insects). However, no dedicated consortia exist to find commonalities in the risk factors for or mitigations against bite-associated NTDs such as rabies, snake envenoming, Chagas disease and leishmaniasis in the region. The rapid expansion of COVID-19 has further reduced resources for NTDs, exacerbated health inequality and reiterated the need to raise awareness of NTDs related to bites. METHODS: The nine countries that make up the Amazon basin have been considered (Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Peru, Surinam and Venezuela) in the formation of a new network. RESULTS: The Amazonian Tropical Bites Research Initiative (ATBRI) has been created, with the aim of creating transdisciplinary solutions to the problem of animal bites leading to disease in Amazonian communities. The ATBRI seeks to unify the currently disjointed approach to the control of bite-related neglected zoonoses across Latin America. CONCLUSIONS: The coordination of different sectors and inclusion of all stakeholders will advance this field and generate evidence for policy-making, promoting governance and linkage across a One Health arena.

Sustaining communicable disease elimination efforts in the Americas in the wake of COVID-19.

The COVID-19 pandemic has disrupted implementation of health interventions and set back priority programs aiming to control and eliminate communicable diseases. At the same time, the pandemic has opened up opportunities to expedite innovations in health service delivery to increase effectiveness and position health on the development and political agendas of leaders and policy makers. In this context, we present an integrated, sustainable approach to accelerate elimination of more than 35 communicable diseases and related conditions in the region of the Americas. The Elimination Initiative promotes a life-course, person-centred approach based on four dimensions - preventing new infections, ending mortality and morbidity, and preventing disability - and four critical lines of action including strengthening health systems integration and service delivery, strengthening health surveillance and information systems, addressing environmental and social determinants of health, and furthering governance, stewardship, and finance. We present key actions and operational considerations according to each line of action that countries can take advantage of to further advance disease elimination in the region.

Every Dog Has Its Data: Evaluation of a Technology-Aided Canine Rabies Vaccination Campaign to Implement a Microplanning Approach.

Background: Robust dog vaccination coverage is the primary way to eliminate canine rabies. Haiti conducts annual canine mass vaccination campaigns, but still has the most human deaths in the Latin American and Caribbean region. We conducted an evaluation of dog vaccination methods in Haiti to determine if more intensive, data-driven vaccination methods, using smartphones for data reporting and geo-communication, could increase vaccination coverage to a level capable of disrupting rabies virus transmission. Methods: Two cities were designated into "Traditional" and "Technology-aided" vaccination areas. Traditional areas utilized historical methods of vaccination staff management, whereas Technology-aided areas used smartphone-supported spatial coordination and management of vaccination teams. Smartphones enabled real time two-way geo-communication between campaign managers and vaccinators. Campaign managers provided geographic instruction to vaccinators by assigning mapped daily vaccination boundaries displayed on phone handsets, whilst vaccinators uploaded spatial data of dogs vaccinated for review by the campaign manager to inform assignment of subsequent vaccination zones. The methods were evaluated for vaccination effort, coverage, and cost. Results: A total of 11,420 dogs were vaccinated during the 14-day campaign. The technology-aided approach achieved 80% estimated vaccination coverage as compared to 44% in traditional areas. Daily vaccination rate was higher in Traditional areas (41.7 vaccinations per team-day) compared to in technology-aided areas (26.8) but resulted in significantly lower vaccination coverages. The cost per dog vaccinated increased exponentially with the associated vaccination coverage, with a cost of $1.86 to achieve 25%, $2.51 for 50% coverage, and $3.19 for 70% coverage. Conclusions: Traditional vaccination methods failed to achieve sufficiently high vaccination coverages needed to interrupt sustained rabies virus transmission, whilst the technology-aided approach increased coverage above this critical threshold. Over successive campaigns, this difference is likely to represent the success or failure of the intervention in eliminating the rabies virus. Technology-aided vaccination should be considered in resource limited settings where rabies has not been controlled by Traditional vaccination methods. The use of technology to direct health care workers based on near-real-time spatial data from the field has myriad potential applications in other vaccination and public health initiatives.

Bite Injuries among Vaccination Staff Participating in a Mass Canine Rabies Vaccination Campaign, Haiti 2016-2017.

Elimination of dog-transmitted human rabies worldwide will require large-scale dog vaccination campaigns. However, this places participating vaccinators at increased risk. Data from the 2016-2017 Haitian mass rabies vaccination campaign was analyzed to determine dog bite incidence among vaccinators. A survey was then developed for completion by all identifiable bitten vaccinators covering demographics; experience and training; bite episode details; attitudes toward dogs and rabies; and medical care. A parallel group of unbitten vaccinators was also surveyed. Dog bite incidence was 0.03% (43/127,000) of all dogs vaccinated. The capture, vaccinate, and release method of vaccination carried a significantly higher risk of dog bite (0.35%, 6/1,739 vaccinations) than other methods (P < 0.001). Twenty-seven bitten vaccinators, and 54 control vaccinators were included in the survey analysis. No differences were found between groups in demographics, experience, or training. However, bitten vaccinators were significantly more likely than the control group to have experienced a dog bite before the study period (P < 0.001). This may be associated with a lesser appreciation of dogs, and/or a poorer ability to interpret dog behavioral signals within this group. Although 98% of the control group indicated they would seek medical care for a dog bite, only 35% of bitten vaccinators sought such care. On a yearly basis, for the Haitian campaign, a full series of postexposure rabies vaccinations for all bite victims would prove more cost-effective than preexposure vaccination of all vaccinators. These findings may prove useful for the planning and safety of future mass dog vaccination campaigns.

One Health for neglected tropical diseases.

The forthcoming World Health Organization road map for neglected tropical diseases (NTDs) 2021-2030 recognises the complexity surrounding control and elimination of these 20 diseases of poverty. It emphasises the need for a paradigm shift from disease-specific interventions to holistic cross-cutting approaches coordinating with adjacent disciplines. The One Health approach exemplifies this shift, extending beyond a conventional model of zoonotic disease control to consider the interactions of human and animal health systems within their shared environment and the wider social and economic context. This approach can also promote sustainability and resilience within these systems. To achieve the global ambition on NTD elimination and control, political will, along with contextualised innovative scientific strategies, is required.

Appraisal of antivenom production in public laboratories in Latin America during the first semester of 2020: the impact of COVID-19

One of the 4 pillars of the World Health Organization (WHO) strategy for the prevention and control of snake bite envenomings is to ensure safe and effective pharmacotherapeutic treatments [1]. The mainstay in the pharmacotherapy of these envenomings, as well as of envenomings by scorpions and spiders, is the timely administration of safe and effective antivenoms [2,3]. Antivenoms are composed of immunoglobulins, or immunoglobulin fragments, purified from the plasma of animals, usually horses, immunized with venoms. Currently, there is an urgent need to improve antivenom availability, accessibility, and affordability on a global basis, particularly for use in sub-Saharan Africa, Asia, and Latin America [1]. There is a long tradition in snake, scorpion, spider, and, more recently, caterpillar antivenoms production in Latin America, especially centered in public manufacturing laboratories in Argentina, Brazil, Peru, Bolivia, Ecuador, Colombia, Venezuela, Costa Rica, and Mexico [4–6]. A network of public laboratories devoted to the production and quality control of antivenoms was established in this region in the last decade [4,5], which has recently led to the creation of the Latin American Network of Public Antivenom Manufacturing Laboratories (RELAPA, Red Latinoamericana de Laboratorios Públicos Productores de Antivenenos) [6]. RELAPA aims at consolidating governance mechanisms within a regional platform for technical cooperation, technology transfer, research, and training for the regional improvement of antivenom availability, under the coordination of the Pan American Health Organization (PAHO) and its office Centro Panamericano de Fiebre Aftosa (Panaftosa). As part of the ongoing activities of RELAPA, a survey was sent by PAHO/Panaftosa to the institutions integrating this network to assess the situation of antivenom manufacture in these laboratories during the period January 2020 to July 2020, with the goal of analyzing in which ways has antivenom production been affected in this extraordinary year, especially regarding the impact of the Coronavirus Disease 2019 (COVID-19) pandemic, which has profoundly stricken Latin America [7]. The survey was sent to the directors of the institutions of RELAPA (the list of institutions is detailed in Fan and colleagues [6]). The survey included the following aspects: (a) What was the demand and the production of antivenoms (including snake, scorpion, spider, and caterpillar antivenoms) during the period January 2020 to July 2020? (b) What was the effect of the COVID-19 pandemic in (i) the number of professional and technical staff working to manufacture antivenom, (ii) acquisitions of consumables and laboratory equipment, (iii) overall budget devoted to antivenom manufacture, and (iv) attention to the COVID-19 crisis in terms of development of therapeutic equine preparations against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), preparation of diagnostic reagents, quality control activities, or assignment of staff to attend other pandemic issues? (c) Which are the priorities of the laboratories in the near future regarding regional cooperation in the field of antivenom manufacture and quality control? The survey was carried out between October 1 and October 19, 2020, using the platform Qualtrics (Qualtrics XM Platform, Seattle, Washington, United States of America).

Role of Oral Rabies Vaccines in the Elimination of Dog-Mediated Human Rabies Deaths.

Domestic dogs are responsible for nearly all the ¼59,000 global human rabies deaths that occur annually. Numerous control measures have been successful at eliminating dog-mediated human rabies deaths in upper-income countries, including dog population management, parenteral dog vaccination programs, access to human rabies vaccines, and education programs for bite prevention and wound treatment. Implementing these techniques in resource-poor settings can be challenging; perhaps the greatest challenge is maintaining adequate herd immunity in free-roaming dog populations. Oral rabies vaccines have been a cornerstone in rabies virus elimination from wildlife populations; however, oral vaccines have never been effectively used to control dog-mediated rabies. Here, we convey the perspectives of the World Organisation for Animal Health Rabies Reference Laboratory Directors, the World Organisation for Animal Health expert committee on dog rabies control, and World Health Organization regarding the role of oral vaccines for dogs. We also issue recommendations for overcoming hesitations to expedited field use of appropriate oral vaccines.

Towards the elimination of dog-mediated rabies: development and application of an evidence-based management tool.

BACKGROUND: International organizations advocate for the elimination of dog-mediated rabies, but there is only limited guidance on interpreting surveillance data for managing elimination programmes. With the regional programme in Latin America approaching elimination of dog-mediated rabies, we aimed to develop a tool to evaluate the programme's performance and generate locally-tailored rabies control programme management guidance to overcome remaining obstacles. METHODS: We developed and validated a robust algorithm to classify progress towards rabies elimination within sub-national administrative units, which we applied to surveillance data from Brazil and Mexico. The method combines criteria that are easy to understand, including logistic regression analysis of case detection time series, assessment of rabies virus variants, and of incursion risk. Subjecting the algorithm to robustness testing, we further employed simulated data sub-sampled at differing levels of case detection to assess the algorithm's performance and sensitivity to surveillance quality. RESULTS: Our tool demonstrated clear epidemiological transitions in Mexico and Brazil: most states progressed rapidly towards elimination, but a few regressed due to incursions and control lapses. In 2015, dog-mediated rabies continued to circulate in the poorest states, with foci remaining in only 1 of 32 states in Mexico, and 2 of 27 in Brazil, posing incursion risks to the wider region. The classification tool was robust in determining epidemiological status irrespective of most levels of surveillance quality. In endemic settings, surveillance would need to detect less than 2.5% of all circulating cases to result in misclassification, whereas in settings where incursions become the main source of cases the threshold detection level for correct classification should not be less than 5%. CONCLUSION: Our tool provides guidance on how to progress effectively towards elimination targets and tailor strategies to local epidemiological situations, while revealing insights into rabies dynamics. Post-campaign assessments of dog vaccination coverage in endemic states, and enhanced surveillance to verify and maintain freedom in states threatened by incursions were identified as priorities to catalyze progress towards elimination. Our finding suggests genomic surveillance should become increasingly valuable during the endgame for discriminating circulating variants and pinpointing sources of incursions.

Defining New Pathways to Manage the Ongoing Emergence of Bat Rabies in Latin America.

Rabies transmitted by common vampire bats (Desmodus rotundus) has been known since the early 1900s but continues to expand geographically and in the range of species and environments affected. In this review, we present current knowledge of the epidemiology and management of rabies in D. rotundus and argue that it can be reasonably considered an emerging public health threat. We identify knowledge gaps related to the landscape determinants of the bat reservoir, reduction in bites on humans and livestock, and social barriers to prevention. We discuss how new technologies including autonomously-spreading vaccines and reproductive suppressants targeting bats might manage both rabies and undesirable growth of D. rotundus populations. Finally, we highlight widespread under-reporting of human and animal mortality and the scarcity of studies that quantify the efficacy of control measures such as bat culling. Collaborations between researchers and managers will be crucial to implement the next generation of rabies management in Latin America.

Integration of animal health and public health surveillance sources to exhaustively inform the risk of zoonosis: An application to echinococcosis in Rio Negro, Argentina.

The analysis of zoonotic disease risk requires the consideration of both human and animal geo-referenced disease incidence data. Here we show an application of joint Bayesian analyses to the study of echinococcosis granulosus (EG) in the province of Rio Negro, Argentina. We focus on merging passive and active surveillance data sources of animal and human EG cases using joint Bayesian spatial and spatio-temporal models. While similar spatial clustering and temporal trending was apparent, there appears to be limited lagged dependence between animal and human outcomes. Beyond the data quality issues relating to missingness at different times, we were able to identify relations between dog and human data and the highest 'at risk' areas for echinococcosis within the province.

First inter-laboratory comparison of Echinococcus granulosus sensu lato diagnosis in Latin America

[ABSTRACT]. Objective. To compare the performance of polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) tests for diagnosing Echinococcus granulosus in dog feces among national reference laboratories in Argentina, Chile, Peru, and Uruguay. Methods. National laboratories affiliated with the Ministry of Health/Agriculture of each country exchanged panels of 10 positive/negative samples obtained from their regular national surveillance programs in November 2015 – November 2016. All laboratories applied PCR; two also applied ELISA techniques. Sensitivity and specificity were determined for each laboratory and concordance of results among the laboratories was evaluated by Cohen Kappa coefficient. Results. Poor concordance (3 of 10 paired comparisons had values of Kappa > 0.4), low sensitivity and specificity across all laboratories, and poor performance of both techniques in detecting E. granulosus in canine feces was demonstrated in this study. An ex-post comparison of the laboratories’ test protocols showed substantial heterogeneity that could partially explain poor concordance of results. Conclusion. The results underscore the heterogeneity of canine echinococcosis diagnosis across the region and indicate possible sources of variability. Efforts to standardize canine echinococcosis testing must be included in the plan of action for the Regional Initiative for the Control of Cystic Echinococcosis. Future comparisons with fecal samples of known parasite load are needed.

[RESUMEN]. Objetivo. Comparar el rendimiento de los ensayos de la reacción en cadena de la polimerasa y el enzimoinmunoanálisis de adsorción en fase sólida (o ELISA, por su sigla en inglés) para diagnosticar Echinococcus granulosus en heces caninas en los laboratorios de referencia nacionales de Argentina, Chile, Perú y Uruguay. Métodos. Los laboratorios nacionales, afiliados a los ministerios de salud y agricultura y ganadería de cada país, intercambiaron paneles de diez muestras positivas y negativas obtenidas de sus respectivos programas nacionales de vigilancia desde el mes de noviembre del año 2015 hasta el mismo mes del año siguiente. Todos los laboratorios emplearon la reacción en cadena de la polimerasa y dos emplearon también técnicas de ensayo inmunoenzimático (ELISA). Se determinó la sensibilidad y la especificidad de cada laboratorio y se evaluó la concordancia entre los resultados de los laboratorios mediante el coeficiente kappa de Cohen. Resultados. Este estudio descubrió una escasa concordancia (3 de 10 comparaciones de pares obtuvieron valores de kappa > 0,4), una sensibilidad y especificidad bajas en todos los laboratorios y un rendimiento deficiente de ambas técnicas de diagnóstico de Echinococcus granulosus en heces caninas. La comparación ex post de los protocolos de ensayo de los laboratorios mostró una heterogeneidad sustancial que podría explicar parcialmente la escasa concordancia de los resultados. Conclusiones. Los resultados subrayan la heterogeneidad del diagnóstico de equinococosis canina en toda la región e indican posibles fuentes de esta variabilidad. Deben incluirse medidas para estandarizar la prueba de equinococosis canina en el plan de acción de la Iniciativa Sudamericana para el Control de la Equinococosis Quística. En el futuro serán necesarias comparaciones adicionales con muestras fecales con una carga de parásitos conocida.

[RESUMO]. Objetivo. Comparar o desempenho dos métodos de reação em cadeia da polimerase (PCR) e ensaio imunoenzimático (ELISA) no diagnóstico de infecção pelo Echinococcus granulosus em fezes de cães entre laboratórios de referência nacional na Argentina, Chile, Peru e Uruguai. Métodos. Laboratórios nacionais conveniados ao Ministério da Saúde/Agricultura de cada país participante intercambiaram grupos de 10 amostras positivas/negativas coletadas rotineiramente pelos programas nacionais de vigilância no período de novembro de 2015 a novembro de 2016. Todos os laboratórios empregaram o método de PCR e dois empregaram também o método de ELISA. A sensibilidade e a especificidade dos métodos foram determinadas em cada laboratório, e a concordância dos resultados entre os laboratórios participantes foi avaliada com o coeficiente kappa de Cohen. Resultados. Observou-se fraca concordância (3 de 10 comparações pareadas com kappa >0,4), baixa sensibilidade e especificidade e fraco desempenho de ambos os métodos na identificação do E. granulosus em amostras fecais de cães nos laboratórios participantes do estudo. Uma comparação retroativa revelou considerável heterogeneidade dos protocolos de análise laboratorial, o que poderia em parte explicar a fraca concordância entre os resultados. Conclusões. Os resultados deste estudo apontam para a falta de uniformidade no diagnóstico de equinococose canina em toda a Região e indicam possíveis causas para variabilidade. A padronização da análise laboratorial da equinococose canina deve constar do plano de ação para a Iniciativa Regional para Controle da Hidatidose. Outras comparações de amostras fecais de parasitas conhecidos devem ser realizadas.

[Situation of public laboratories manufacturing antivenoms in Latin AmericaA situação dos laboratórios públicos produtores de soros antivenenos na América Latina]. / Situación de los laboratorios públicos productores de antivenenos en América Latina.

The situation of public laboratories manufacturing antivenoms in Latin America was analyzed, based on the results of a workshop coordinated by the Pan American Foot-and-Mouth Disease Center (PANAFTOSA) of the Pan American Health Organization (PAHO). Nine countries in the region have 12 public laboratories that produce and distribute antivenoms for use against different venomous animals. The situation of each laboratory was discussed, and an analysis was conducted of the current scenario, which is characterized by increasing regulatory requirements that vary in terms of infrastructure and production capacity. The authors identified a need to organize regional cooperation processes to improve the availability of antivenoms, including: research and development projects to improve processes and technologies; studies of the capacity of antivenoms to neutralize different poisons; and technical training programs for professionals and technical personnel. In the current context, in which the World Health Organization has prepared a global strategy for the prevention and control of snakebite envenoming, PANAFTOSA has taken on coordination of this initiative in the Americas. Improving the availability of antivenoms is the priority. As a result of the workshop, the RELAPA network was created, bringing together public laboratories that manufacture antivenoms in Latin America, in order to strengthen these laboratories and increase the availability of, and access to effective and safe antivenoms throughout Latin America.

A situação dos laboratórios públicos produtores de soros antivenenos na América Latina foi analisada com base nas conclusões de um seminário coordenado pelo Centro Pan-Americano de Febre Aftosa (PANAFTOSA) da Organização Pan-Americana da Saúde (OPAS). Em nove países da Região, encontram-se 12 laboratórios públicos que produzem e distribuem soros contra venenos de diferentes animais peçonhentos. Examinou-se a situação de cada laboratório, analisou-se o panorama atual marcado por crescentes demandas de regulação e pela heterogeneidade da infraestrutura e capacidade produtiva dos laboratórios e destacou-se a necessidade de um esforço concertado de cooperação regional com vistas a aumentar a disponibilidade de soros antivenenos, englobando projetos de pesquisa e desenvolvimento para o avanço dos processos e tecnologias, estudos do perfil da capacidade de neutralização dos soros contra diversos venenos e programas de capacitação técnica de profissionais e pessoal técnico. No contexto atual, em que uma estratégia mundial de prevenção e controle de acidentes ofídicos foi elaborada pela Organização Mundial da Saúde e que a coordenação das ações relacionadas na Região das Américas foi assumida pelo PANAFTOSA, melhorar a disponibilidade de soros antivenenos é prioridade. Como resultado deste seminário, a Rede de Laboratórios Públicos Produtores de Soros Antivenenos da América Latina (RELAPA) foi formada com o objetivo de fortalecer os laboratórios e aumentar a disponibilidade e a acessibilidade de soros antivenenos eficazes e seguros em toda América Latina.

Situación de los laboratorios públicos productores de antivenenos en América Latina

[RESUMEN]. Se analiza la situación de los laboratorios públicos productores de antivenenos en América Latina, con base a los resultados de en un taller coordinado por el Centro Panamericano de Fiebre Aftosa (PANAFTOSA) de la Organización Panamericana de la Salud (OPS). Nueve países en la región poseen doce laboratorios públicos que producen y distribuyen antivenenos contra venenos de diferentes animales ponzoñosos. Se discutió la situación de cada laboratorio, se analizó el escenario actual caracterizado por las crecientes demandas regulatorias y la heterogeneidad de estos en términos de infraestructura y capacidad productiva y se planteó la necesidad de concertar procesos de cooperación regional dirigidos a mejorar la disponibilidad de antivenenos, incluyendo proyectos de investigación y desarrollo para el mejoramiento de los procesos y las tecnologías; estudios del perfil de la capacidad neutralizante de los antivenenos contra diferentes venenos, y programas de capacitación técnica de profesionales y personal técnico. En el contexto actual, en el que la Organización Mundial de la Salud elaboró una estrategia global para la prevención y el control de los envenenamientos ofídicos, el Centro PANAFTOSA de la OPS ha asumido la coordinación de estas acciones en las Américas, mejorar la disponibilidad de antivenenos es prioritaria. Como resultado de ese taller, se creó la Red de Laboratorios Públicos Productores de Antivenenos de América Latina (RELAPA), con el objetivo de fortalecer estos laboratorios y de aumentar la disponibilidad y accesibilidad de antivenenos eficaces y seguros a toda América Latina.

[ABSTRACT]. The situation of public laboratories manufacturing antivenoms in Latin America was analyzed, based on the results of a workshop coordinated by the Pan American Foot-and-Mouth Disease Center (PANAFTOSA) of the Pan American Health Organization (PAHO). Nine countries in the region have 12 public laboratories that produce and distribute antivenoms for use against different venomous animals. The situation of each laboratory was discussed, and an analysis was conducted of the current scenario, which is characterized by increasing regulatory requirements that vary in terms of infrastructure and production capacity. The authors identified a need to organize regional cooperation processes to improve the availability of antivenoms, including: research and development projects to improve processes and technologies; studies of the capacity of antivenoms to neutralize different poisons; and technical training programs for professionals and technical personnel. In the current context, in which the World Health Organization has prepared a global strategy for the prevention and control of snakebite envenoming, PANAFTOSA has taken on coordination of this initiative in the Americas. Improving the availability of antivenoms is the priority. As a result of the workshop, the RELAPA network was created, bringing together public laboratories that manufacture antivenoms in Latin America, in order to strengthen these laboratories and increase the availability of, and access to effective and safe antivenoms throughout Latin America.

[RESUMO]. A situação dos laboratórios públicos produtores de soros antivenenos na América Latina foi analisada com base nas conclusões de um seminário coordenado pelo Centro Pan-Americano de Febre Aftosa (PANAFTOSA) da Organização Pan-Americana da Saúde (OPAS). Em nove países da Região, encontram-se 12 laboratórios públicos que produzem e distribuem soros contra venenos de diferentes animais peçonhentos. Examinou-se a situação de cada laboratório, analisou-se o panorama atual marcado por crescentes demandas de regulação e pela heterogeneidade da infraestrutura e capacidade produtiva dos laboratórios e destacou-se a necessidade de um esforço concertado de cooperação regional com vistas a aumentar a disponibilidade de soros antivenenos, englobando projetos de pesquisa e desenvolvimento para o avanço dos processos e tecnologias, estudos do perfil da capacidade de neutralização dos soros contra diversos venenos e programas de capacitação técnica de profissionais e pessoal técnico. No contexto atual, em que uma estratégia mundial de prevenção e controle de acidentes ofídicos foi elaborada pela Organização Mundial da Saúde e que a coordenação das ações relacionadas na Região das Américas foi assumida pelo PANAFTOSA, melhorar a disponibilidade de soros antivenenos é prioridade. Como resultado deste seminário, a Rede de Laboratórios Públicos Produtores de Soros Antivenenos da América Latina (RELAPA) foi formada com o objetivo de fortalecer os laboratórios e aumentar a disponibilidade e a acessibilidade de soros antivenenos eficazes e seguros em toda América Latina.

An evaluation of Brazil's surveillance and prophylaxis of canine rabies between 2008 and 2017.

An effective surveillance system is critical for the elimination of canine rabies in Latin America. Brazil has made substantial progress towards canine rabies elimination, but outbreaks still occurred in the last decade in two states. Brazil uses a health information system (SINAN) to record patients seeking post-exposure prophylaxis (PEP) following contact with an animal suspected of having rabies. This study evaluated: (i) whether SINAN can be reliably used for rabies surveillance; (ii) if patients in Brazil are receiving appropriate PEP and (iii) the benefits of implementing the latest World Health Organization (WHO) recommendations on PEP. Analysing SINAN records from 2008 to 2017 reveals an average of 506,148 bite-injury patients/year [range: 437k-545k] in the country, equivalent to an incidence of 255 bite-injuries/100,000 people/year [range: 231-280]. The number of reports of bites from suspect rabid dogs generally increased over time. In most states, records from SINAN indicating a suspect rabid dog do not correlate with confirmed dog rabies cases reported to the Regional Information System for Epidemiological Surveillance of Rabies (SIRVERA) maintained by the Pan American Health Organization (PAHO). Analyses showed that in 2017, only 45% of patients received appropriate PEP as indicated by the Brazilian Ministry of Health guidance. Implementation of the latest WHO guidance using an abridged intradermal post-exposure vaccination regimen including one precautionary dose for dog bites prior to observation would reduce the volume of vaccine required by up to 64%, with potential for annual savings of over USD 6 million from reduced vaccine use. Our results highlight the need to improve the implementation of SINAN, including training of health workers responsible for delivering PEP using an Integrated Bite Case Management approach so that SINAN can serve as a reliable surveillance tool for canine rabies elimination.

First inter-laboratory comparison of Echinococcus granulosus sensu lato diagnosis in Latin America.

OBJECTIVE: To compare the performance of polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) tests for diagnosing Echinococcus granulosus in dog feces among national reference laboratories in Argentina, Chile, Peru, and Uruguay. METHODS: National laboratories affiliated with the Ministry of Health/Agriculture of each country exchanged panels of 10 positive/negative samples obtained from their regular national surveillance programs in November 2015 - November 2016. All laboratories applied PCR; two also applied ELISA techniques. Sensitivity and specificity were determined for each laboratory and concordance of results among the laboratories was evaluated by Cohen Kappa coefficient. RESULTS: Poor concordance (3 of 10 paired comparisons had values of Kappa > 0.4), low sensitivity and specificity across all laboratories, and poor performance of both techniques in detecting E. granulosus in canine feces was demonstrated in this study. An ex-post comparison of the laboratories' test protocols showed substantial heterogeneity that could partially explain poor concordance of results. CONCLUSION: The results underscore the heterogeneity of canine echinococcosis diagnosis across the region and indicate possible sources of variability. Efforts to standardize canine echinococcosis testing must be included in the plan of action for the Regional Initiative for the Control of Cystic Echinococcosis. Future comparisons with fecal samples of known parasite load are needed.

Situación de los laboratorios públicos productores de antivenenos en América Latina / Situation of public laboratories manufacturing antivenoms in Latin America

The situation of public laboratories manufacturing antivenoms in Latin America was analyzed, based on the results of a workshop coordinated by the Pan American Foot-and-Mouth Disease Center (PANAFTOSA) of the Pan American Health Organization (PAHO). Nine countries in the region have 12 public laboratories that produce and distribute antivenoms for use against different venomous animals. The situation of each laboratory was discussed, and an analysis was conducted of the current scenario, which is characterized by increasing regulatory requirements that vary in terms of infrastructure and production capacity. The authors identified a need to organize regional cooperation processes to improve the availability of antivenoms, including: research and development projects to improve processes and technologies; studies of the capacity of antivenoms to neutralize different poisons; and technical training programs for professionals and technical personnel. In the current context, in which the World Health Organization has prepared a global strategy for the prevention and control of snakebite envenoming, PANAFTOSA has taken on coordination of this initiative in the Americas. Improving the availability of antivenoms is the priority. As a result of the workshop, the RELAPA network was created, bringing together public laboratories that manufacture antivenoms in Latin America, in order to strengthen these laboratories and increase the availability of, and access to effective and safe antivenoms throughout Latin America.