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CURRENT PUBLIC HEALTH PANORAMA IN THE CONTEXT OF REGIONAL MASS MIGRATIONS

CURRENT PUBLIC HEALTH PANORAMA IN THE CONTEXT OF REGIONAL MASS MIGRATIONS. HEALTH. EMERGENCIES. Health Challenges. Reduction in the burden of communicable diseases. With re-emerging of some diseases.

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CURRENT PUBLIC HEALTH PANORAMA IN THE CONTEXT OF REGIONAL MASS MIGRATIONS

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  1. CURRENT PUBLIC HEALTH PANORAMA IN THE CONTEXT OF REGIONAL MASS MIGRATIONS HEALTH EMERGENCIES

  2. Health Challenges • Reduction in the burden of communicable diseases. With re-emerging of some diseases. • Unprecedented socioeconomic and demographic changes that have led to a surge in non-communicable diseases. Chronic diseases are also increasing. • High levels of migration existing in the Americas, with irregular and forced migration, driven by economic factors, but also by conflicts and violence.

  3. Communicable diseases • The persistence, emergence, and reemergence of infectious diseases associated with poverty and with changes in the physical (ecosystems) and social context. • There has been a reemergence of measles in the Region, as well as recent outbreaks of dengue and other arbovirus

  4. Regional trends in selected health topics Measlescoverageevolutionover time Declining measles-containing-vaccine first-dose (MCV1) immunization coverage among 1-year-olds in the region of the Americas. 2008 - 2017 2017 2008 2013 Source: WHO Global Health Observatory (GHO) data

  5. Regional trends in selected health topics Measlescoverageevolutionover time Declining measles-containing-vaccine second-dose (MCV2) immunization coverage by the nationally recommended age in the region of the Americas. 2008 - 2017 2013 2008 2017 Source: WHO Global Health Observatory (GHO) data

  6. Measles regional epidemic, July 2017 to date

  7. CONFIRMED MEASLES CASES - REGIONAL

  8. MEASLES – REGION OF THE AMERICAS *As of 17 May 2019 ** 25 May, 2019: https://www.canada.ca/en/public-health/services/publications/diseases-conditions *** 6 June, 2019: https://www.cdc.gov/measles

  9. YELLOW FEVER – BRAZIL • Current monitoring period: July 18-June 19: • As of 26 March 2019 • Confirmed cases: 71 • Fatalities: 13 • Under investigation: 134 • 3 states: SP, PR, SC • Previous monitoring periods: • December 2016 – June 2017 • 778 confirmed cases • 262 fatalities [CFR: 34.6%] • 4 states: SP, MG, RJ, ES • July 2017- June 2018 • 1376 confirmed cases • 483 fatalities [CFR: 32.8%] • 5 states: SP, MG, RJ, ES, DF Distribution of notified human yellow fever cases by epidemiological week of occurrence and classification. (EW 27 of 2018 – EW 9 of 2019). Brazil. Monitoring Period Jul/2018 – Jun/2019. (n=1240) Source: Brazil Ministry of Health Epidemiological Bulletin. #8, 2018 /2019

  10. DENGUE in the AMERICAS • Signals of increased dengue severity for 2019 • Increased circulation currently: • COL, FDA, JAM, NIC report dengue epidemics • BRA, ELS, GUT, HON, DOR report dengue alert (increased circulation that has not yet crossed epidemic threshold) • PAHO monitoring indicators of Intensity, Geographic dispersion, Severity • PAHO technical cooperation on risk assessment and preparedness, clinical management, vector control, epidemiological surveillance, laboratory diagnosis, and risk communication • PAHO internal task force Annual dengue cases and proportion of severe dengue in the Americas, 1999-2019* Dengue case fatality rate (CFR) in the Americas, 2013-2019* Target CFR: <0.049% *EW 10 Source: epidemiological data sent to PLISA by the countries

  11. Regional trends in selected health topics Confirmed malaria cases per 1000 population in 2017 MALARIA TRENDS • The Amazon basinisthemostaffectedarea. • Countrieslocated in thisgeographicalarea, haveseensteadilyincreasingtrends in thepast 10 years. Source: WHO World Malaria Report 2018

  12. Regional trends in selected health topics MALARIA TRENDS Source: Regional profile: Region of the Americas for Malaria World Malaria Report 2018

  13. MALARIA – VENEZUELA 2019 Transmission remain very high in main foci in Bolivar Population movements continue due to mining activity Increase in cases in other municipalities in Bolivar state. States with the highest burden of cases : Bolívar, Sucre, and Amazonas. States with significate increase in cases: compared to the same period in 2018 Barinas, Guárico, Mérida, Miranda, Táchira and Yaracuy Malaria cases Venezuela. 2000- 2018 (EW 50) Total cases in 2018 (without relapses): 401.365 (EW 50) In 8 years malaria increased by 900% and local transmission extended from 12 to 17 federal entities Source: MoH VEN

  14. Influenza in the Americas • Country activity (EW 14) • North America  Overall, influenza activity continued decreasing in the sub-region. A(H3N2) virus caused an increased amount of the activity in Canada and in the United States. In Mexico, influenza activity continued decreasing. • Caribbean  Influenza virus activity decreased throughout the sub-region. In Cuba, RSV detections continued increasing. • Central America  Influenza activity continued low across the sub-region. Guatemala reported moderate influenza activity. El Salvador reported increased RSV activity. • Andean Region Influenza activity decreased in the sub-region with influenza A(H3N2) predominance. Moderate RSV activity in Ecuador. • Brazil and Southern Cone  Overall, influenza remained at inter-seasonal levels throughout the subregion. Moderate RSV activity reported in Paraguay. • Prevention strategies • Southern Hemisphere seasonal influenza vaccine expected to arrive in countries in April on time

  15. CHOLERA – HAITI • In 2019, the MSPP reports: • 194 suspect cholera cases • 3 suspect cholera-related deaths • In 2018, there were: • 3,786 suspect cholera cases • 41 suspect cholera-related deaths • In 2017, there were: • 13,681 suspect cholera cases • 159 suspect cholera-related deaths • In January 2019, the Global Task Force for Cholera Control (GTFCC) accepted Haiti’s request for 3.6m oral cholera vaccine doses. • However, GTFCC also requested to revise the campaign plan for target population, details on WaSH component, surveillance strengthening, and M&E. Source: weekly cholera bulletin, MSPP Haiti, as of EW 9-2019

  16. DIPHTHERIA – HAITI • Situation in numbers: 2014-2019 • 794 notified cases • 109 Deaths • 17% CFR (among PCR confirmed) • 2019 up to EW 9 • 31 probable cases, 5 confirmed Haiti Diphtheria SitRep EW11, 2019 Source: Haiti MSPP, DELR

  17. 2019 (EW 10) • Incidence Rate: 0.13 cases per 100,000 population • 1-year-old : 0.19 cases per 100,000 population • 30 to 39-year-olds: 0.18 per 100,000 population • CFR by age-group • 5-9 year-olds: 75% • >50 year-olds: 50% • 30-29 year-olds: 22% • 10-15 year-olds: 20% • 16-29 year-olds” 8.3% • TD vaccination coverage among 7-15 year-olds at national level 100% • Of the 42 confirmed cases, 71.4% are aged >15 years, a population not included in the current vaccination campaign objective. DIPHTHERIA – VENEZUELA

  18. Migration and Health www.paho.org/emergencies

  19. Regional trends in selected health topics • Between 1990 and 2017, the prevalence of stunting among children less than 5 years of age in the Region decreased from 14.9% to 7.1%. • However, undernutrition in the form of stunting in young children continues to be highly prevalent in many countries, particularly in Central America and the Andes. • There are large differences within and among countries, with indigenous and Afro-descendant children and those living in rural areas especially affected. NUTRITION TRENDS Trends in undernutrition per subregión in the Americas (%) Source: Health in the Americas 2017 Source: Panorama seguridad alimentaria 2018 (FAO/PAHO/WHO/UNICEF/WFP) http://www.fao.org/3/CA2127ES/CA2127ES.pdf

  20. Indigenous populations are the most vulnerable • Warao communities in the Orinoco Delta; • Yanomami communities in the Venezuela / Brazil border area; • High mortality rates due to epidemic infectious diseases, particularly Measles • High incidence of HIV and TB, • Increase of Malaria Source: https://www.survivalinternational.org/news/11967

  21. How (well) prepared is the region to early detect events? (1) • IHR corecapacities – Implementation status 2018 • Compared to 2017, variations in the average regional scores for all core capacities are in the range of six percentage points for 2018 • Highest average regional score (92%), continues to be for events associated with zoonotic hazards • Lowest score was for human resources and capacity to respond to events associated with chemical hazards : 65% and 63%, respectively Source: WHO Global Health Observatory data repository

  22. How (well) prepared is the region to early detect events? (2) • IHR corecapacities – Implementation status 2010-2017 Source: WHO Global Health Observatory data repository

  23. TECHNICAL COOPERATION IN MASS MIGRATION * Ensure that emergency-affected populations have access to essential life-saving health services * Early Detection and Response to Outbreaks Establish comprehensive Incident Management Systems and coordinate actions with Health Emergency Response Partners on the ground

  24. Additional Technical Cooperation Actions • Activated focal points in all countries regarding risk of importation of Measles (July 2017). Renewed alert in the Plan of Action (September 2017) • Communications to all Member States to increase vaccine coverage of Measles and Diphtheria, and strengthen surveillance for measles, Diphtheria and Malaria • Daily summary of events that have (or could have) international public health implications in, or related to, the Region of the Americas. • Monthly Epidemiological updates on Measles and Diphtheria • Increased technical cooperation with countries through: technical missions, hiring consultants, periodic webinars, face to face and virtual capacity building training. • Provided laboratory equipment, reagents and supplies to selected national and subnational laboratories

  25. Migration and Health www.paho.org/emergencies

  26. Migration and Health Strengthen health surveillance, information management and monitoring Improve access to health services for the migrant and host population Improve communication and exchange of information to counter xenophobia stigma and discrimination Strengthen partnerships, networks, and multi-country frameworks to understand the status and promote and protect the health of migrants Adapt policies, programs, and legal frameworks to promote and protect the health and well-being of migrants

  27. CURRENT PUBLIC HEALTH PANORAMA IN THE CONTEXT OF REGIONAL MASS MIGRATIONS HEALTH EMERGENCIES

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