CONICET | Buscador de Institutos y Recursos Humanos

Emerging and reemerging diseases: the situation in Argentina. Susana Fink.IMEX-CONICET/Academia Nacional de Medicina. Buenos Aires, Argentina. Emerging and reemerging infectiousdiseases are a public health problem worldwide. World travel, increased globalinterdependence, people migration to urban areas, climate change andinappropriate use of antibiotics all contribute to this situation. Diseasesconsidered to be emerging or re-emerging include, among others, Chikungunyavirus(CHKV), dengue, avian influenza, Ebolavirus infections, Middle East respiratory syndrome (MERS), West Nile virus, andLyme Disease. Vector-borne diseases are considered a public health threat incountries throughout the Americas and Caribbean region. Chikungunya, firstreported in the Caribbean in December 2013 took less than three months to reach10 Caribbean countries, and caused more than a million casesof chikungunya fever within 12 months of its introduction, according to PanAmerican Health Organization (PAHO)/World Health Organization (WHO). West Nile virus, imported into New York in 1999, hadby 2005 spread across the U.S. and to other countries of the Americas, fromCanada to Argentina.During the current year outbreaks of dengueand Saint Louis encephalitis were identified in our country. As of July 2015, dengue has been confirmed in 175 ofthe 2343 notified autochthonous cases, and in 69 imported cases. From the 1201studied cases of Saint Louis virus, 5 were confirmed, and 921 remain underinvestigation.As part of the surveillance program fordengue and other arbovirus, 63 cases were investigated for yellow fever, beingone of them considered probable, and 1115 reported cases of West Nile virus,most of them in Córdoba, none of them confirmed so far; some may be related totravel. CHKV was confirmed in 15 imported cases so far this year. Diagnosticmethods and organization of care and treatment for patients have been set upfor CHKV and Zika virus (another arbovirus present in the region). As mentionedabove, several imported cases of CHKV have been reported but no autochthonous caseshave yet occurred, although the vectors Aedesaegypti and Aedes albopictus arepresent in our territory and are responsible for dengue infections and yellowfever. Hantavirus is endemic in several regions ofour country. Ninety cases have been confirmed so far in 2015, mostly in thecentral and northwestern areas of the country. For the Argentinean hemorrhagic fever, causedby Junin virus, no cases have been confirmed in 2015, while in 2014 13 caseswere confirmed. This means a reduction of almost 57% compared to 2014.Although no cases were reported in ourcountry, labs prepared for the diagnostics of SARS, MERS and Ebola, andhospitals were assigned and organized for the possible event. A few suspectedsamples were studied with negative results. In collaboration with the PAHO,Argentina also gives support to other countries with less complex laboratoriesinfrastructure.Endemic cases of measles were last confirmed in Argentina in 2000.Isolated imported cases have been reported since. Argentina is not a high burden country fortuberculosis (TB), and it hosts one of WHO?s Supranational ReferenceLaboratories. Our country reported a total of 9018 cases of tuberculosis in2013, decreasing by an annual 3% the total of new cases. Deaths due totuberculosis went down 64,6% from 1980 to 2012, well below the objective set upin 1990 by the PAHO. Globally, an estimated 3.5%of new cases and 20.5% of previously treated cases have multidrug resistant (MDR)-TB.In the Tuberculosis annual report 2014, Argentina is in third place togetherwith Mexico (both with 480 cases) and after Peru and Brazil in the Americas forMDR-TB. Whooping cough, due to Bordetella pertussis infection,continues to be a serious public health problem throughout the world, even incountries with good vaccination coverage. In Argentina a significant increasein cases occurred in 2011. Thisinfection has 4 to 5 year cycles, making surveillance necessary. So far in 2015, 2706 cases were suspected,with 365 confirmed.Argentinais the country with the highest incidence of haemolytic uraemic syndrome, being the most common agent theshiga toxin producing Escherichia coli.Comparing the last ten years, a tendency towards lower number of cases can beobserved, with a mild increase in 2014. So far 181 cases have been reported in2015.Other bacterial infections includeleptospirosis. As ofend of July 2015, 136 cases have been confirmed, while 101 were confirmed in2014. The main affected area was the central area of the country, with 50confirmed cases of leptospirosis in the Santa Fe province during the firstquarter of 2015.Parasitic infections like Chagas andleishmaniasis are also present. For leishmaniasis: a total of 74cases (61 in 2014) of cutaneous leishmaniasis, 6 cases (7 in 2014) withthe visceral form and 4 (10 in 2014) ofmucous leishmaniasis have been confirmed so far in 2015. Fungi are alsoresponsible for some emerging diseases. It is estimated that about 10 million people are infectedwith paracoccidioidomycosis (PCM) in South America. It was previouslythought that the only causative agent of PCM was Paracoccidioides brasiliensis,but several species and genotypes have been described for Paracoccidioides.This may explain the emergence of new clinical forms. Precisely, an increase incases of a new clinical form of this fungal disease, with a rapid,progressive and severe evolution, has triggered a ?state of alert? innortheastern Argentina.In a globalized world everycountry has to be prepared and ready to avoid major consequences from theseemerging and reemerging infectious diseases. Regional, as well asinternational, collaboration is of extreme importance in this fight.