Zoonoses in a changing world.

Animals are continuously exposed to pathogens but rarely get infected, because pathogens must overcome barriers to establish successful infections. Ongoing planetary changes affect factors relevant for such infections, such as pathogen pressure and pathogen exposure. The replacement of wildlife with domestic animals shrinks the original host reservoirs, whereas expanding agricultural frontiers lead to increased contact between natural and altered ecosystems, increasing pathogen exposure and reducing the area where the original hosts can live. Climate change alters species' distributions and phenology, pathogens included, resulting in exposure to pathogens that have colonized or recolonized new areas. Globalization leads to unwilling movement of and exposure to pathogens. Because people and domestic animals are overdominant planetwide, there is increased selective pressure for pathogens to infect them. Nature conservation measures can slow down but not fully prevent spillovers. Additional and enhanced surveillance methods in potential spillover hotspots should improve early detection and allow swifter responses to emerging outbreaks.

Epidemiology of measles in Angola: Results from routine surveillance from 2015 to 2021.

Background: Measles, an acute infectious disease of extremely contagious viral aetiology, has been eliminated in some parts of the world. To the best of the authors' knowledge, this is the first study on the epidemiological pattern of the measles virus in Angola, and it was carried out through a review of 7 years of observational retrospective data from the national measles laboratory surveillance programme. Methods: A retrospective study using national databases on the laboratory surveillance of measles was performed. Patients of all ages with suspected measles from all provinces of Angola were included. Serum samples were used to detect IgM-type measles-virus-specific antibodies by enzyme-linked immunosorbent assay. Findings: In total, 3690 suspected measles samples were sent to the Instituto Nacional de Investigação em Saúde. There were 962 (26.1%) laboratory-confirmed cases, and the most affected age group was children aged 1-4 years. The highest incidence rate per 100,000 population was found in Benguela (17.9%), followed by Huambo (16.7%) and Cuanza Sul (13.6%). Of the study years, the incidence rate per 1,000,000 population was highest in 2020 (11.9%). The most common complication was diarrhoea (n=406, 42.2%). Of the confirmed cases, 209 (21.7%) were vaccinated, 633 (65.8%) were unvaccinated, and 120 (12.5%) had unknown vaccination status. For all study years, vaccination coverage was <70%. Interpretation: Measles continues to be a serious problem in Angola, and more efforts are needed to increase measles surveillance and achieve a high percentage of vaccination coverage.

First description of Candida haemulonii infecting a snake Boa constrictor: Molecular, pathological and antifungal sensitivity characteristics.

Candida haemulonii is an emergent infectious pathogen that affects human presenting comorbidities and/or immunodepression. Little is known about other possible hosts. For the first time, this fungus was found causing a cutaneous infection in a snake, Boa constrictor, characterized by scale opacity and several ulcerative lesions. This C. haemulonii was isolated, identified using molecular techniques and a phylogenetic study, and had its growth totally inhibited by all the drugs tested; however, no fungicide effect was seen for fluconazole and itraconazole. The B. constrictor clinical signals subsided after a treatment using a biogenic silver nanoparticle-based ointment. These findings, along with the B. constrictor presence near human habitats, warn for the necessity of wildlife health monitoring for emergent and opportunistic diseases in peri-urban environments.

Water Pollution Increases the Risk of Chytridiomycosis in Mexican Amphibians.

Chytridiomycosis is affecting amphibians worldwide, causing the decline and extinction of several amphibian populations. The disease is caused by the fungus Batrachochytrium dendrobatidis (Bd), a multihost pathogen living in freshwater habitats. While several environmental factors have been associated with the prevalence of Bd and its virulence, the effects of water quality on the pathogen are not clear yet. Some evidence suggests that water pollution may reduce amphibians' immune response and increase prevalence of Bd. To explore this hypothesis, we analyzed the relationship between water quality and the presence of Bd by using spatial data mining of 150 geolocations of Bd in amphibians from 9 families where Bd positive specimens have been previously reported, and water quality in 4,202 lentic and lotic water bodies in Mexico from 2010 to 2021. Our model showed that in the 3 main families where Bd was recorded, its presence is high in locations with low water quality, i.e., water polluted likely contaminated with urban and industrial waste. Using this model, we inferred areas suitable for Bd in Mexico; mainly in poorly studied areas along the gulf and on the pacific slope. We further argue that actions to reduce water pollution should become an integral part of public policies to prevent the spread of Bd and protect amphibians from this deadly pathogen.

Ecologies of violence in urban peripheries during health emergencies / Ecología de violencias en las periferias urbanas durante emergencias sanitarias / Ecologia de violências nas periferias urbanas em tempos de emergências sanitárias

Violence is a health problem and a determinant of health emergencies, with structural dimensions going beyond interpersonal physical aggression. In the present text, we outline the ecologies of violence and relate them to pandemic experiences in a favela of São Paulo city, taking the perspective of One Health of Peripheries. We show how imposed precariousness, exploitation, persecution, territorial expulsions, incarceration practices, and household aggressions harm peripheral subjects and find in health emergencies the possibility of elevating themselves to the condition of a syndemic of violences. This has happened in the Covid-19 pandemic, in recent epidemics, and it is expected to happen in the next health emergency. Through de ecologies of violence, we hope to give more visibility to the entanglement that frustrates prevention and protection efforts in the face of health emergencies. Entanglement between marginalizing apparatuses, modalities of violence, and health emergencies, materialized in multispecies collectives.

La violencia es un problema de salud y un determinante de emergencias sanitarias, con dimensiones estructurales que van más allá de las agresiones físicas interpersonales. En el presente texto esbozamos la ecología de violencias y la relacionamos con vivencias de la pandemia en una favela de la ciudad de São Paulo, bajo la perspectiva de Una Salud de las Periferias. Mostromaos como precariedad impuesta, exploración, persecución, expulsiones territoriales, prácticas de encarcelamiento y agresiones intradomiciliares violentan sujetos periféricos y encuentran en las emergencias sanitarias posibilidades de convertirse en sindemia de violencias. Eso sucedió en la pandemia de Covid-19, en epidemias recientes y se espera que suceda en la próxima emergencia sanitaria. Por medio de la ecología de violencias le damos más visibilidad a la imbricación que frustra tentativas de prevención y protección frente a emergencias sanitarias. Imbricación entre dispositivos marginalizantes, modalidades de violencia e emergencias sanitarias, materializada en colectivos multiespécies.

A violência é um problema de saúde e um determinante das emergências sanitárias, com dimensões estruturais que vão além das agressões físicas interpessoais. No presente texto esboçamos a noção de ecologia de violências e a relacionamos com vivências da pandemia em uma favela paulistana, na perspectiva da Saúde Única em Periferias. Mostramos como marginalização, precariedade imposta, exploração, perseguição, expulsões territoriais, práticas de encarceramento e agressões no ambiente domiciliar violentam sujeitos periféricos e encontram nas emergências sanitárias possibilidades de se elevar à condição de sindemia de violências. Isso aconteceu na pandemia de Covid-19, em epidemias anteriores, e espera-se que aconteça na próxima emergência sanitária. Por meio da ecologia de violência damos mais visibilidade à imbricação que frustra tentativas de prevenção e proteção frente a emergências sanitárias. Imbricação entre dispositivos marginalizantes, modalidades de violência e emergências sanitárias, materializada em coletivos multiespécies.

Begomoviruses: what is the secret(s) of their success?

Begomoviruses constitute an extremely successful group of emerging plant viruses transmitted by whiteflies of the Bemisia tabaci complex. Hosts include important vegetable, root, and fiber crops grown in the tropics and subtropics. Factors contributing to the ever-increasing diversity and success of begomoviruses include their predisposition to recombine their genomes, interaction with DNA satellites recruited throughout their evolution, presence of wild plants as a virus reservoir and a source of speciation, and extreme polyphagia and continuous movement of the insect vectors to temperate regions. These features as well as some controversial issues (replication in the insect vector, putative seed transmission, transmission by insects other than B. tabaci, and expansion of the host range to monocotyledonous plants) will be analyzed in this review.

The Role of Extensive Recombination in the Evolution of Geminiviruses.

Mutation, recombination and pseudo-recombination are the major forces driving the evolution of viruses by the generation of variants upon which natural selection, genetic drift and gene flow can act to shape the genetic structure of viral populations. Recombination between related virus genomes co-infecting the same cell usually occurs via template swapping during the replication process and produces a chimeric genome. The family Geminiviridae shows the highest evolutionary success among plant virus families, and the common presence of recombination signatures in their genomes reveals a key role in their evolution. This review describes the general characteristics of members of the family Geminiviridae and associated DNA satellites, as well as the extensive occurrence of recombination at all taxonomic levels, from strain to family. The review also presents an overview of the recombination patterns observed in nature that provide some clues regarding the mechanisms involved in the generation and emergence of recombinant genomes. Moreover, the results of experimental evolution studies that support some of the conclusions obtained in descriptive or in silico works are summarized. Finally, the review uses a number of case studies to illustrate those recombination events with evolutionary and pathological implications as well as recombination events in which DNA satellites are involved.

The Impatiens Downy Mildew Epidemic in the United States Is Caused by New, Introgressed Lineages of Plasmopara destructor with Prominent Genotypic Diversity and High Evolutionary Potential.

Impatiens downy mildew (IDM) caused by Plasmopara destructor is currently the primary constraint on the production and use of impatiens (Impatiens walleriana) as bedding plants worldwide. Downy mildew has been documented since the 1880s from wild-grown Impatiens spp. but epidemic outbreaks of the disease affecting the commercially grown, ornamental I. walleriana were only reported for the first time in 2003 in the United Kingdom and in 2004 in the United States. Here, we assess the genetic diversity, level of differentiation, and population structure from 623 samples associated with current and preepidemic IDM outbreaks, by genotyping the samples with simple sequence repeat markers. P. destructor population structure following the emergence of IDM in the United States is subdivided into four genetic lineages characterized by high genetic diversity, mixed reproduction mode, inbreeding, and an excess of heterozygosity. P. destructor genotypes are significantly differentiated from preepidemic IDM samples from hosts other than I. walleriana but no geographical or temporal subdivision is evident. P. destructor samples from different Impatiens spp. show significant but very low levels of differentiation in the analysis of molecular variance test that did not hold in discriminant analysis of principal components analyses. The same was observed between samples of P. destructor and P. velutina recovered from I. walleriana. The finding of shared genotypes in samples from different countries and lack of differentiation among U.S. and Costa Rican samples indicate the occurrence of international movement of the pathogen. Our study provides the first high-resolution analysis of the diversity of P. destructor populations and the IDM epidemic that may be instrumental for disease management and breeding efforts.

First report: Co-infection of Sarcococca hookeriana (sweetbox) by Coccinonectria pachysandricola and Calonectria pseudonaviculata causes a foliar disease of sweetbox in Pennsylvania.

Sweetbox (Sarcococca hookeriana) are high value ornamental shrubs susceptible to disease caused by Calonectria pseudonaviculata (Cps) and Coccinonectria pachysandricola (Cpa) (Malapi-Wight et al. 2016; Salgado-Salazar et al. 2019). In July 2018, 18-month old sweetbox with leaf spots and defoliation were observed in a residential landscape in Lancaster County, Pennsylvania. Small tan leaf spots grew to cover half of the leaf, developing a concentric banding with dark brown rings and a yellow halo (Sup. Doc. 1: Sup. Fig. 1). The symptoms agreed with those of Cpa disease of sweetbox reported from Washington D.C. (Salgado-Salazar et al. 2019). Diseased plants were located ~1.5 m from Buxus sempervirens with boxwood blight. Morphological and genetic characterization of isolated fungi and pathogenicity tests followed Salgado-Salazar et al. (2019) (Sup. Doc. 2). White to salmon pink spore masses developed on the abaxial leaf surface after humid chamber incubation. Two distinct fungal cultures were recovered (JAC 18-61, JAC 18-79) on potato dextrose agar (Fisher Scientific, Pittsburg, PA). JAC 18-61 presented cultural and morphological characteristics as described for Cps (Crous et al. 2002). JAC 18-79 produced flat, filamentous, light salmon colonies with tan centers and white filiform borders containing pale pink sporodochia, verticillate and simple conidiophores (x̄: 61.8 ± 20.12 µm, N = 20) with lateral, cylindrical phialides (x̄ = 18.1 ± 5.83 x 2.4 ± 0.7 µm, N = 20), and ellipsoid, hyaline conidia without septa (x̄ = 15.2 ± 1.9 x 3.3 ± 0.7 µm, N = 20). Sexual structures and chlamydospores were not observed. The characteristics of JAC 18-79 agree with those reported for Cpa (Salgado-Salazar et al. 2019). Bidirectional sequencing of the ITS, beta-TUB, and RPB1 and RPB2 regions was performed as described (Salgado-Salazar et al. 2019). BLASTn comparisons against NCBI GenBank revealed JAC 18-61 sequences (MT318150 and MT328399) shared 100% identity with Cps sequences (JX535321 and JX535307 from isolate CB002). Sequences from JAC 18-79 (MT318151, MT341237 to MT341239) were 100% identical to Cpa sequences (MH892596, MH936775, MH936703 from isolate JAC 16-20 and JF832909, isolate CBS 128674). The genome of JAC 18-79 was sequenced and yielded an assembly of 26.3 Mb (204 contigs > 1000 bases, N50 = 264.3 kb, 92x coverage, JABAHV0000000000) that contained the MAT1-2 mating-type idiomorph and shared 98.9% similarity with Cpa BPI910731. Isolate JAC 18-61 (Cps) caused lesions on wounded and unwounded sweetbox and boxwood leaves (Sup. Table 1). In general, JAC 18-79 (Cpa) infected only wounded leaves of both hosts; however, in one trial, one unwounded sweetbox and two unwounded boxwood plants developed lesions, possibly due to the presence of natural wounds. Control plants did not develop symptoms. These results diverge to some degree from previous reports of Cpa infecting unwounded sweetbox and not infecting wounded boxwood (Salgado-Salazar et al. 2019). These results indicate that virulence variation among Cpa isolates might occur. Plating of symptomatic tissue and examination of spores fulfilled Koch's postulates for both pathogens. To our knowledge, this is the first report of Cpa blight on sweetbox in Pennsylvania, and the second U.S. report of the disease. This is also the first report of co-infection of Cpa and Cps on diseased sweetbox foliage. Given the capacity of Cpa to infect both sweetbox and boxwood, inspection for Cpa on both hosts is advisable.

A review of plant leaf fungal diseases and its environment speciation.

There is increasing difficulty in identifying new plant leaf diseases as a result of environmental change. There is a need to identify the factors influencing the emergence and the increasing incidences of these diseases. Here, we present emerging fungal plant leaf diseases and describe their environmental speciation. We considered the factors controlling for local adaptation associated with environmental speciation. We determined that the advent of emergent fungal leaf diseases is closely connected to environmental speciation. Fungal pathogens targeting the leaves may adversely affect the entire plant body. To mitigate the injury caused by these pathogens, it is necessary to be able to detect and identify them early in the infection process. In this way, their distribution, virulence, incidence, and severity could be attenuated.

Tomato chlorosis virus, an emergent plant virus still expanding its geographical and host ranges.

Tomato chlorosis virus (ToCV) causes an important disease that primarily affects tomato, although it has been found infecting other economically important vegetable crops and a wide range of wild plants. First described in Florida (USA) and associated with a 'yellow leaf disorder' in the mid-1990s, ToCV has been found in 35 countries and territories to date, constituting a paradigmatic example of an emergent plant pathogen. ToCV is transmitted semipersistently by whiteflies (Hemiptera: Aleyrodidae) belonging to the genera Bemisia and Trialeurodes. Whitefly transmission is highly efficient and cases of 100% infection are frequently observed in the field. To date, no resistant or tolerant tomato plants are commercially available and the control of the disease relies primarily on the control of the insect vector. TAXONOMY: Tomato chlorosis virus is one of the 14 accepted species in the genus Crinivirus, one of the four genera in the family Closteroviridae of plant viruses. VIRION AND GENOME PROPERTIES: The genome of ToCV is composed of two molecules of single-stranded positive-sense RNA, named RNA1 and RNA2, separately encapsidated in long, flexuous, rod-like virions. As has been shown for other closterovirids, ToCV virions are believed to have a bipolar structure. RNA1 contains four open reading frames (ORFs) encoding proteins associated with virus replication and suppression of gene silencing, whereas RNA2 contains nine ORFs encoding proteins putatively involved in encapsidation, cell-to-cell movement, gene silencing suppression and whitefly transmission. HOST RANGE: In addition to tomato, ToCV has been found to infect 84 dicot plant species belonging to 25 botanical families, including economically important crops. TRANSMISSION: Like all species within the genus Crinivirus, ToCV is semipersistently transmitted by whiteflies, being one of only two criniviruses transmitted by members of the genera Bemisia and Trialeurodes. DISEASE SYMPTOMS: Tomato 'yellow leaf disorder' syndrome includes interveinal yellowing and thickening of leaves. Symptoms first develop on lower leaves and then advance towards the upper part of the plant. Bronzing and necrosis of the older leaves are accompanied by a decline in vigour and reduction in fruit yield. In other hosts the most common symptoms include interveinal chlorosis and mild yellowing on older leaves. CONTROL: Control of the disease caused by ToCV is based on the use of healthy seedlings for transplanting, limiting accessibility of alternate host plants that can serve as virus reservoirs and the spraying of insecticides for vector control. Although several wild tomato species have been shown to contain genotypes resistant to ToCV, there are no commercially available resistant or tolerant tomato varieties to date.

Prevalence of Guillain-Barré syndrome among Zika virus infected cases: a systematic review and meta-analysis.

Zika virus (ZIKV) is an emergent flavivirus transmitted mainly through Aedes spp. mosquitoes that is posing challenge to healthcare services in countries experiencing an outbreak. Usually ZIKV infection is mild, but in some cases it has been reported to progress into neurological diseases such as microcephaly in infants and Guillain-Barré syndrome (GBS) in adults. GBS is a debilitating autoimmune disorder that affects peripheral nerves. Since ZIKV caused massive outbreaks in South America in the past few years, we aimed to systematically review the literature and perform a meta-analysis to estimate the prevalence of GBS among ZIKV-infected individuals. We searched PubMed and Cochrane databases and selected three studies for a meta-analysis. We estimated the prevalence of ZIKV-associated GBS to be 1.23% (95% CI=1.17-1.29%). Limitations include paucity of data regarding previous flavivirus infections and ZIKV-infection confirmation issues. Our estimate seems to be low, but cannot be ignored, since ZIKV outbreaks affects an overwhelming number of individuals and GBS is a life-threatening debilitating condition, especially in pregnant women. ZIKV infection cases must be closely followed to assure prompt care to reduce the impact of GBS associated-sequelae on the quality of life of those affected.

Prevalence of Guillain-Barré syndrome among Zika virus infected cases: a systematic review and meta-analysis

ABSTRACT Zika virus (ZIKV) is an emergent flavivirus transmitted mainly through Aedes spp. mosquitoes that is posing challenge to healthcare services in countries experiencing an outbreak. Usually ZIKV infection is mild, but in some cases it has been reported to progress into neurological diseases such as microcephaly in infants and Guillain-Barré syndrome (GBS) in adults. GBS is a debilitating autoimmune disorder that affects peripheral nerves. Since ZIKV caused massive outbreaks in South America in the past few years, we aimed to systematically review the literature and perform a meta-analysis to estimate the prevalence of GBS among ZIKV-infected individuals. We searched PubMed and Cochrane databases and selected three studies for a meta-analysis. We estimated the prevalence of ZIKV-associated GBS to be 1.23% (95% CI = 1.17-1.29%). Limitations include paucity of data regarding previous flavivirus infections and ZIKV-infection confirmation issues. Our estimate seems to be low, but cannot be ignored, since ZIKV outbreaks affects an overwhelming number of individuals and GBS is a life-threatening debilitating condition, especially in pregnant women. ZIKV infection cases must be closely followed to assure prompt care to reduce the impact of GBS associated-sequelae on the quality of life of those affected.

[Emergent and reemergent infectious diseases]. / Maladies infectieuses émergentes et réémergentes.

Emergent and reemergent infectious diseases. The notion of emerging and re-emerging infection has been developed recently, even if it rests on an already former concept. The emergence is doubtless delicate to define but can globally be an infectious disease by which the real incidence increases for a population and a geographical zone given to a period of time. Numerous factors condition an emergence, very unknown or not mastered. They report the difficulty or the impossibility to plan in a reliable way a future phenomenon, which would be nevertheless desirable. Yet to assure a legitimate effective coverage, serious preliminary data is essential. The modern companies wish to get organized and to form themselves to fight at best. Diverse ways can be set up.

Maladies infectieuses émergentes et réémergentes. La notion d'infection émergente et réémergente s'est développé récemment, même si elle repose sur un concept déjà ancien. L'émergence est sans doute délicate à définir mais peut globalement être une maladie infectieuse dont l'incidence réelle augmente pour une population et une zone géographique données sur une période de temps. De nombreux facteurs conditionnent une émergence, beaucoup inconnus ou non maîtrisés. Ils rendent compte de la difficulté ou de l'impossibilité de prévoir de façon fiable un futur phénomène, ce qui serait pourtant souhaitable. Or, pour assurer une légitime prise en charge efficace, des données prévisionnelles sérieuses sont essentielles. Les sociétés modernes désirent s'organiser et se structurer pour lutter au mieux. Divers moyens peuvent être mis en place. Des plans correctement définis permettent de les mettre en oeuvre.

Microcephaly Prevalence in Infants Born to Zika Virus-Infected Women: A Systematic Review and Meta-Analysis.

Zika virus is an emergent flavivirus transmitted by Aedes genus mosquitoes that recently reached the Americas and was soon implicated in an increase of microcephaly incidence. The objective of the present study is to systematically review the published data and perform a meta-analysis to estimate the prevalence of microcephaly in babies born to Zika virus-infected women during pregnancy. We searched PubMed and Cochrane databases, included cohort studies, and excluded case reports and case series publications. We extracted sample sizes and the number of microcephaly cases from eight studies, which permitted a calculation of prevalence rates that are pooled in a random-effects model meta-analysis. We estimated the prevalence of microcephaly of 2.3% (95% CI = 1.0-5.3%) among all pregnancies. Limitations include mixed samples of women infected at different pregnancy times, since it is known that infection at the first trimester is associated with higher risk to congenital anomalies. The estimates are deceptively low, given the devastating impact the infection causes over children and their families. We hope our study contributes to public health knowledge to fight Zika virus epidemics to protect mothers and their newborns.

Henipavirus pathogenesis and antiviral approaches.

Hendra virus and Nipah virus are closely related, recently emerged zoonotic paramyxoviruses, belonging to the Henipavirus genus. Both viruses induce generalized vasculitis affecting particularly the respiratory tract and CNS. The exceptionally broad species tropism of Henipavirus, the high case fatality rate and person-to-person transmission associated with Nipah virus outbreaks emphasize the necessity of effective antiviral strategies for these intriguing threatening pathogens. Current therapeutic approaches, validated in animal models, target early steps in viral infection; they include the use of neutralizing virus-specific antibodies and blocking membrane fusion with peptides that bind the viral fusion protein. A better understanding of Henipavirus pathogenesis is critical for the further advancement of antiviral treatment, and we summarize here the recent progress in the field.

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.

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.

[Travelling epidemics]. / Infectiologie itinérante.

OBJECTIVES: We have to become aware of the current development of international travels which has contributed to amplify circulation of all sorts of infectious agents. We will describe the current situation. OBSERVATIONS: Infectious agents are carried by means of travellers, immigrants, as well as by animals, goods and merchandise. The distribution of infections potentially responsible for epidemics tends to become worldwide and some of them are emergent diseases. SOLUTIONS: Such a situation imposes enhancement of international surveillance and development of resources for control and response to alerts. Developed countries possess most advanced equipments and interventional structures: they are those which may intervene predominantly in the fight against epidemics. The necessary contribution of these industrialized countries is increasing in developing countries in which infectious epidemics are spreading and such intervention must be sustained. The content of the article is a review of major threatening infectious epidemic diseases with the contribution of personal experiences.

O desafio das doenças emergentes e a revalorização da epidemiologia descritiva / The defy of emergent diseases and epidemiological descriptive revalorization

Este artigo trata das doenças emergentes e re-emergentes apresentando seu conceito, as pincipais ocorrências nos últimos 25 anos, e os determinantes dessas ocorências.Trta também da epidemiologia descritiva e sua utilizacão na investigação desses problemas de saúde apontando a importância de sua recuperação pelos epidemiologistas. Finalmente, são mencionados os desafios que as doenças emergentes colocam para a prática em Saúde Coletiva e também para o desenvolvimento metodológico da epidemiologia descritiva

This paper focuses on emergent and re-emergent diseases, presenting their definition, patterns of ocurrence during the last 25 years, and the determinants of this ocurrence. It also emphasizes the importance of descriptive epidemiology and its use in the investigation of these health problems, especially in view of epidemiologists' tendency to give less attention to it. Finally, it mentions the challenges that emergent diseases bring to the practice of Public Health and also for the methodological development of descriptive epidemiology. These challenges are considered in three fields: biosecurity, surveillance systems and descriptive epidemiology techniques.