On June 14-15, 1995, a conference on "Combating Emerging Infectious
diseases: Challenges for the Americas" was held at the Pan American
Health Organization (PAHO) Headquarters in Washington, D.C. The
meeting was designed to shape a regional strategy for preventing
and controlling emerging infectious diseases that could pose
serious threats to the peoples of the Americas.
Participants, convened by PAHO, included top officials and
infectious disease experts from that organization as well as the
World Health Organization, the U.S. Centers for Disease Control and
Prevention, the Canadian Laboratory Center for Disease Control, the
U.S. Department of Defense, and several Latin American and
Caribbean countries.
This international group of experts noted that an increasing number
of new, emerging, and reemerging infectious diseases have been
identified in both developed and developing nations and that these
diseases threaten to increase in the near future. They include
human immunodeficiency virus/acquired immunodeficiency syndrome,
which emerged in the l980s and now affects some 16 million people
worldwide; and cholera, which returned to the Western Hemisphere
for the first time this century in 1991 and has caused more than 1
million cases and 9,000 deaths in the Americas. PAHO estimates that
it will take more than a decade and over $200 billion to control
the current pandemic of this disease.
The experts concluded that both early warnings of, and rapid
responses to, infectious disease threats are needed. The group made
several major recommendations to PAHO and its member states to
improve surveillance, research, and communications in developing
countries. They also issued more detailed recommendations in the
areas of antimicrobial resistance, outbreak control, and
information and communication. In addition, a plan of action is
forthcoming.
The group made the following recommendations for PAHO and its
member countries:
General Recommendations
Develop and frequently update prioritized disease-specific
guidelines for the prevention and control of diseases that are
emerging or reemerging, both at the public health and individual
levels. This should include biologic and behavioral change measures
and will require groups of experts for each disease as well as
communications experts. Diseases of interest include yellow fever,
dengue, antimicrobial-resistant organisms (malaria, tuberculosis,
and enteric diseases), measles, polio, cholera and other foodborne
and waterborne diseases, viral hemorrhagic fevers, plague, rabies
and other zoonoses, and trypanosomiasis and other vector-borne
diseases.
Identify points of contact in the field to receive and transmit
information in countries. These contacts should include
organizations and individuals outside the government.
Develop plans to distribute accurate and timely information to the
general public.
Develop plans to improve and make more efficient two-way
communication on reporting, control, and modification measures.
This may require contracting information management specialists to
identify and implement the most efficient means.
Make efficient use of the press, including radio, television and
newspapers, fliers, and other methods to educate the public and the
medical community, with an eye toward social mobilization of
communities to fight emerging diseases. This will require expertise
in communications and support to the countries in developing
information dissemination plans. Countries should define
populations at greatest risk and focus the information and control
measures in these populations.
Define different approaches for educating the public and the
medical community.
Focus efforts on intersectorial action, including education of
policy makers outside the health community.
Antimicrobial Resistance
The expert group recommended that both PAHO and its member
countries, where applicable, do the following:
Seek ways to reduce availability of over-the-counter antimicrobial
agents, including those used in veterinary medicine; this will
require efforts beyond the health care community and involve
education and dissemination of information to all sectors.
Intensify assistance to the countries in developing rational drug
policies.
Monitor sensitivity to antibiotics in each country to allow for
optimum antibiotic use for individual cases and to eliminate
antibiotics with little therapeutic value. Employ mechanisms such
as WHONET and PHLIS to centralize, analyze, and distribute
antimicrobial sensitivity data.
Develop and distribute specific recommendations to extend the
useful life of antimicrobial drugs.
Frequently revise the list of essential antimicrobials based on
sensitivity data.
Initiate educational campaigns on the cost-effectiveness of
rational drug use in hospitals.
Initiate collaboration with the pharmaceutical industry on rational
drug use, standardized labels and warnings, and ethical marketing
strategies.
Outbreak Control
The expert group endorsed the leadership role of PAHO in developing
and disseminating guidelines for outbreak evaluation and control
and recommended that PAHO
Make timely recommendations to coordinate response to outbreaks or
threats, including issues related to travel advice, quarantine, and
commerce.
Develop policies and standard operating plans for response to
outbreaks at the regional and country levels. Assist countries in
developing national outbreak response plans and assist in training
teams.
Identify and list individuals and groups with disease-specific
expertise, laboratories with disease-specific diagnostic
capabilities, and products, including diagnostic reagents, drugs,
and vaccines (both licensed and investigational products).
Frequently update these lists.
Establish a standard system for rapid procurement of vaccines,
reagents, insecticides and antimicrobial drugs for prompt response
to outbreaks.
Establish information management and dissemination procedures for
use during outbreaks, including accurate and frequent release of
information to the press and public.
Conduct formal evaluations of responses to each outbreak and use
the lessons learned to improve responses to subsequent outbreaks.
Information and Communication
The experts recommended communicating with high-level government
officials and emphasizing to them the importance of a basic public
health infrastructure including improvements in water, sanitation,
and social and economic conditions in preventing diseases. The
group suggested disseminating more information about public health
implications of development (such as deforestation, dam
construction, urbanization, and other measures) and seeking
effective interaction with other sectors.
Other Recommendations
PAHO should
Create interagency task forces for emerging diseases at regional
and country levels.
Inform regional governments, other organizations, and the public
about the emerging disease initiative and strive for the highest
level of political support.
Solicit and allocate specific resources to deal with the emerging
diseases initiative, both at the regional and country levels. A
portion of these funds should be immediately available when
outbreaks are recognized.
For more information on these recommendations, the conference, or
its plan of action, contact PAHO.
Daniel B. Epstein
Office of Information & Public Affairs
Pan American Health Organization
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