Binational Health week. Public Health Priority Issues

Size: px

Start display at page:

Download "Binational Health week. Public Health Priority Issues"

Stephanie Sparks
5 years ago
Views:

1 Binational Health week Public Health Priority Issues Dr. Jesús Felipe González Roldán Director General Centro Nacional de Programas Preventivos y Control de Enfermedades. October 6, 2014

2 Food On the Street In the air At Home At Work Risk Transition Smoking Stress Sedentary life style Inadequate Diet Inadequate Sanitation Unemployment Education, Poverty and Migration Gender Behavior Alcoholism and other Addictions Sexual Behavior

3 Non-Communicable Diseases

In 2012, 25% of the 6.6 million Mexican adults known with diabetes, was in metabolic control.

Previous diagnosis with complications Adequate metabolic control. There are 22.

4 million Mexican adults who have been diagnosed by a doctor and receive treatment, 25% showed evidence of adequate

4 In 2012, 25% of the 6.6 million Mexican adults known with diabetes, was in metabolic control. If trend had maintained, today 5.4 million more people would be overweight or have obesity. Previous diagnosis with complications Adequate metabolic control. There are 22.4 million Mexican adults with hypertension and 5.7 million are controlled. Regarding diabetes, 6.4 million Mexican adults who have been diagnosed by a doctor and receive treatment, 25% showed evidence of adequate metabolic control. This figure indicates a major challenge for the health sector, while showing the progress between 2006 and 2012: in 2006, only 5.3% of individuals with diabetes showed evidence of adequate metabolic control.

5 National Strategy for Prevention and Control of Overweight, Obesity and Diabetes In October 31, 2013, the President of the Republic announced the launch of the National Strategy for Prevention and Control of Overweight, Obesity and Diabetes. To meet the presidential statement, the SSA designed a comprehensive strategy based on three pillars: (1) Public Health, (2) Health Care and (3) Health Regulation. The aim of the Strategy is to improve the welfare levels of the Mexican population, stabilize and reduce the incidence of obesity in order to reverse the epidemic of Noncommunicable diseases, particularly cardiovascular diseases, diabetes and related diseases.

6 Guide Axes Research and Scientific Evidence Stewardship Mainstreaming intersectoral Evaluation public accountability National Strategy Pillars and Strategic Axes 1 Public Health Epidemiological Surveillance Health Promotion and Educational Communication Increase public and individual awareness of obesity and its association with the NCDs Prevention 2 Health Care Quality and Effective Access Direct the National Health System towards early detection 3 Health Regulatory and Fiscal Policy Labelling Solve and control at first contact Advertising Fiscal actions Health in All Policies Social Determinants of Health Slowing the increase in the prevalence of overweight, obesity and NCDs

7 Regulatory Actions As part of this strategy, COFEPRIS participated in the design of the third pillar: Health Legislation. In this regard, it was proposed to update our regulations according to international best practices in food advertising and labeling: 1 Advertising Standards for advertising child audience 2 Food labelling Inclusion of Nutritional Labelling 3 Taxes.- Beverages and Higher callories food

8 Medical Specialties units that offer an outpatient health care quality model, comprehensive and interdisciplinary based on scientific evidence and best clinical practice, focus in Chronic Non Communicable Diseases: Obesity, Diabetes, Hypertension and Cardiovascular Disease. Aim: Medical Specialities Unit for Chronic Diseases (UNEME EC) Advances in Health Care Improve control of these diseases. Prevent and reduce complications. Promoting and maintaining adherence to long-term treatment. Educating patients relatives and people at risk. Currently in operation 101 UNEMES EC, in 29 federal states of Mexico

9 Mutual Aid Groups of Chronic Disease (GAM EC) Advances in Health Care Educational strategy which includes the organization of the patients by themselves with health services staff support, developing their potential to acquire knowledge of their diseases and abilities to improve their control. In July 2014 the GAM-EC network consists of 6,792 groups, serving a total of 159,605 patients.

10 Advances in Health Care Chronic disease information system (SIC) The National Health Council, determined the creation of the Chronic disease information system (SIC). Electronic platform that will replace the Chronic Diseases card used in first contact medical units over the country. Aim: Develop a nominal census record. Develop a technological tool that optimizes first contact health services performance. Valuable health information source on the control and treatment of patients. Simplifying processes for planning and timely drugs supply.

11 Advances in Health Care Excellence Networks in Obesity and Diabetes 12 entities 60 First contact health centers 339 Medical offices 11 UNEMES 1,764 health Personnel In the geographic area of influence of the 60 health centers: Total resident population: 3,874,316 Total resident population affiliated to Seguro Popular : 1,380,186 Strengthening the referral and counter-referral of patients Population 20 years and over affiliated to Seguro Popular 554,350 Source:

12 Advances in Health Care Access and care quality of patients with NCDs in health services. Comprehensive detections Training health personnel serving NCDs Compliance in 65% of the target detection of chronic diseases like diabetes, hypertension, dyslipidemia, overweight and obesity. Training on Chronic Diseases to health care givers by 75.9% Drug Supply Drug Supply in 81% of the health units. Souce:

13 Following Steps Sectoral Specific Action Programs Extending the Excellence Networks in Obesity and Diabetes to all states. Continue training medical and paramedical first contact staff on chronic diseases issues. Improving adequate drug supply in health units. Implementation of SIC.

14 Influenza Prevention and Control

15 Introduction Underministry of Health Prevention and Promotion Influenza Prevention and Control General Direction of Epidemiology National Center for Preventive Programs and Diseases Control General Direction of Health Promotion Network of Highly Specialized Hospitals

16 Objectives of the Especific Action Program Implementation of the Respiratory Diseases and Influenza National Program. 2.- Evaluation of the infrastructure of health services to suit the program needs. 3.- Development of the Official Mexican Normativity Standard for Influenza and Respiratory Diseases Control and Prevention.

17 Objectives of the Especific Action Program Promotion and training focused on prevention and control of influenza. 5.-Strengthen the information system for epidemiological surveillance of influenza (SISVEFLU). 6.- Strengthen operational research as the main tool for continuous quality improvement program.

18 Action lines for influenza prevention and control To develop a standardized policy, giving priority to influenza prevention and control in the first and second level of health attention. To increase influenza vaccination coverage, focused on risk groups. To develop promotional and educational materials for influenza prevention and control, according to the cultural and educational environment of the population. To continue updating health staff on influenza prevention and control.

19 Binational collaboration CENAPRECE CDC To implement a binational coordination on epidemiological surveillance and influenza laboratory in the region. To strength the influenza surveillance system for increasing response efficiency to any eventuality that may arise during the season of disease onset.

20 Tb control

21 Cases 2191 Rate: %. Cases: 211 Rate: % Cases: 40 Rate: 1,9 0,4 Tuberculosis on the border states of Mexico and the USA, 2013 Cases 1233 Rate: % USA (2012): Total Cases: 9,945 Borderline cases : 3,675 36,8% from the National total Source: MMWR CDC Cases:1839 Rate: % Cases:854 Rate: % Cases: 696 Rate: %. Cases:609 Rate: % Mexico (2013): Cases: 19,703 * Rate per 100,000 Cases:1233 Rate: % Cases:,1108 Rate:32 5.6% Borderline cases: 6,339 32% from the National Total Source: DGE/SS

Migratory Routes Migration patrons in Mexico Kind of Migration Regional Swallow Grand scale Intl from Center -South Am-Mex to USA Migration patrons in México and USA.

22 Migratory Routes Migration patrons in Mexico Kind of Migration Regional Swallow Grand scale Intl from Center -South Am-Mex to USA Migration patrons in México and USA.. Migration in Mexico is quite complex Mexico is the only country in the region that is origin, transit and destiny of migrants Guatemala El Salvador Costa Rica Honduras Nicaragua Panama Source: PNT-Mexico, MMWR-CDC, DGE-SSa. *

23 Outbreaks and Epidemiological Emergencies Attention

Threats Mexico, is not only one of the countries with the greatest risks of suffering a disaster caused by a natural phenomena, but also its social and

24 Threats Mexico, is not only one of the countries with the greatest risks of suffering a disaster caused by a natural phenomena, but also its social and economical conditions favour the presence of diseases outbreaks such as chickenpox, hepatitis A, poisoning food, dengue and diarrhea, among other ailments.

25 Health Emergencies All extraordinary event that constitutes a health harm and/or risk and requieres immediate and coordinated response. Epidemiological emergency Health damages caused by the presence of microbiological, chemical or toxic agents, that bring about outbreaks or epidemies, including emerging and reemerging diseases. Disaster Any event, caused by natural phenomena or produce by man, that causes damage, ecological disruption, loss of human life, deterioration of health and health services, on a scale sufficient to require and extraordinary response from outside assistance. Source: PAHO/WHO

Coordination Scientific Advisory Committee UNAM, IPN, PAHO/WHO, CDC, Academies SCT DGP DGMM SECTUR National Comittee for Health Security National Council for

SEMARNAT- SAGARPA Civil Aviation SEDENA SEMAR Jurisdictional Committee for Health Security Municipal Council for Civil Protection SSA, SEP, CFE, SCT, PFP,

26 Coordination Scientific Advisory Committee UNAM, IPN, PAHO/WHO, CDC, Academies SCT DGP DGMM SECTUR National Comittee for Health Security National Council for Civil Protection SEGOB PC CISEN PFP SER PGR CENAPRECE COFEPRIS DGE DGCS IMSS ISSSTE State Committee for Health Security State Council for Civil Protection SEMARNAT- SAGARPA Civil Aviation SEDENA SEMAR Jurisdictional Committee for Health Security Municipal Council for Civil Protection SSA, SEP, CFE, SCT, PFP, SEDENA, SEMAR, SEDESOL, CONAGUA, TELMEX, RED CROSS, MUNICIPAL SERVICES, ETC. SSA IMSS ISSSTE SEDENA SEMAR PEMEX DIF CR Operative Command for Health Security (OCHS) Affected Area

27 Action Component for Emergencies Attention 1. Coordination 2. Medical Attention 3. Psychological Attention 4. Epidemiological Surveillance 5. Health Risks Control (food and water) 6. Basic Sanitation 7. Health Promotion 8. Laboratory 9. Vector Control 10. Public Health Actions (if applicable) Vaccination Condom Distribution 11. Social Communication Health Units Modules Temporary Shelters Community

28 Lines of action of the different phases Before Develop Program and Intervention Plans. Set the Coalition and Coordination intra and extra- Institutions Assignment of responsibilities Training Institutional Staff During Activate present intervention plans After Medical Attention Evaluation of damage to health infastructure Epidemiological Surveillance Health Surveillance Supervision of assigned duties Compilation, tabulation and analysis of information Information to the public and media

29 Events Hospital Outbreaks Community Outbreaks Bioterrorism Disasters Accident or radiological, chemical and nuclear attacks

30 Response to outbreaks Outbreaks Investigation and Control Evaluation of the previous epidemic activity in the risk area. Evaluation of the endemic level of major diseases under surveillance in risk areas. Evaluation of risk factors for preexisting conditions in risk areas Evaluation of quality of life conditions after emergency (shelter, access to clean water, proper sewage disposal, mosquito protection) Arising Risks Outbreak Detection Selection of diseases subject to surveillance (tracers) Diseases Prevention and Control Epidemiological Surveillance BEFORE Disaster Sentinel surveillance Epidemiological surveillance after disaster

31 Dengue: Integrated Strategy

IVM (Integrated Vector Management) Surveillance, diagnosis,

infection surveillance Epidemiological and virological

Hospital Case Management Enabling Integrated Vector Management

32 IVM (Integrated Vector Management) Surveillance, diagnosis, and case management Entomological and mosquitoes viral infection surveillance Epidemiological and virological surveillance Early diagnosis and circulating serotypes Hospital Case Management Enabling Integrated Vector Management (IVM) from the entomological risk or as an immediate response to the appearance of cases

33 IVM (Integrated Vector Management) Management of personal and environmental risks (integrated approach with intersectoral and community participation) Larviciding Space sprays Indoor fast residual spraying with residual insecticide

34 Cases DATA % of variation FHD confirmed 9,264 4, FD confirmed 21,515 9, Confirmed 30,779 13, Ratio FD:FHD 2.2:1 2.4:1 % Sampling % Positivity Deaths Lethality Decrease in the total number of confirmed cases Dengue (-54.8%) from baseline dengue Transmission is concentrated in the Southeast region states (55%). The state of Veracruz recorded 12.7% and 8.9% Sinaloa. Deaths occur in the states: (5) Veracruz (3) Chiapas, (3) Guerrero, (2) Sinaloa, (2) Yucatan (2) Oaxaca (1) Campeche (1) Nuevo Leon (1) Quintana Roo (1) and Tabasco (1) Sonora. Circulation of the four serotypes in the country is reported. Updated to September 14, Source: Plataforma Única SINAVE Módulo Dengue, DGE National Dengue * Suspects y Confirmed Week Probables 2013 Confirmados 2013 Probables 2014 Confirmados 2014

35 Updated to September 14, Source : Plataforma Única SINAVE Módulo Dengue, DGE NS1 IgM IgG DIAGNOSIS TEST RAPID TEST AIS PCR** TOTAL POSITIVE 3,752 6,910 3, ,055 14,084 NEGATIVE 27,753 19,275 28, ,212 TOTAL 31,505 26,185 31, ,469 89,296 % OF POSITIVE STATE Circulating Serotypes TOTAL BAJA CALIFORNIA SUR CAMPECHE COAHUILA COLIMA CHIAPAS GUANAJUATO DURANGO GUERRERO HIDALGO JALISCO MEXICO MICHOACAN MORELOS NAYARIT NUEVO LEON OAXACA PUEBLA QUERETARO QUINTANA ROO SAN LUIS POTOSI SINALOA SONORA TABASCO TAMAULIPAS TLAXCALA VERACRUZ YUCATAN TOTAL ,057 Incidence, test positivity and circulating denguevirus serotypes isolated by state, Mexico 2014 * 1,2 1, , ,2,4 1,2,4 1,2,4 1,2,3 1 1,2,4 1,2 1,2 1,2 1,2,3,4 1,2,4 BCS reported the highest incidence rate of confirmed cases X 100,000. Serotypes DNV1 (56%) and DNV2 (36.1%) predominate in relation to serotypes DENV3 (5%) and DNV4 (2.9%). Veracruz has reported the highest number of cases so far ,2,3,4 1,2 1,2,4 1,2,3,4

36 Spatial distribution of reported cases of Dengue, Mexico 2014 * In 2014, transmission of dengue in the first weeks has been concentrated in the south-southeast (> 54%). Updated to Week No Source: Panorama Epidemiological Dengue, DGE

37 Strategy to define the incorporation of dengue vaccine in Mexico Main Objective: Create a proposal supported by scientific evidence and field experience for the application of dengue vaccine (to the Mexican population) when available. For this a group of experts were integrated.

38 Dengue Expert Group v v

39 Chikungunya, Surveillance, Prevention and Control

40 Geographical distribution in the world Countries and territories have been reported Chikungunya indigenous cases (September 16, 2014)

41 Geographical distribution in America Countries and territories have been reported Chikungunya indigenous cases (September 16, 2014)

42 Domestic and imported cases to Epidemiological Week 36 (September 12, 2014) Domestic cases Epidemiological situation in America Number Confirmed cases 8,651 Deaths 113 Imported cases Number United States 926 Venezuela 70 Brazil 12 Mexico 3 Source: OPS/OMS * Note: July, 17, United States reported the first two cases of indigenous transmission in Florida state

43 Operational Definitions Suspect Case: Any person with fever and arthritis of acute onset or severe arthralgia, resident or visiting areas with transmission of Chikungunya virus during the two weeks preceding the onset of symptoms, or contact of a confirmed case or that any epidemiological link is found with transmission areas.

44 Operational Definitions Confirmed case Every suspected case with a positive result to chikungunya virus by any of the following specific laboratory tests: Detection of viral RNA by RT-PCR in serum samples taken in the first five days of onset of fever. Serum IgM from 6th day the onset of fever. Detection of IgG antibodies in paired serum samples, with a difference of at least a week in the making. Increase of at least 4-fold antibody titer CHIKV.

45 Algorithm key actions for suspected cases Patient with fever, arthritis or arthralgia with visiting or resident in area transmisison Entomological risk assessment Vector Control Serum sampling Immediate reporting to Jurisdiction Capture Database Sending sample LESP Immediate reporting to state Sending sample InDRE Immediate reporting to DGE * En las primeras 24 horas de conocimiento por los servicios de salud

46 Analytical framework for CHIKV in InDRE Mexico has installed capacity for laboratoryconfirmed cases of CHIKV Virological VIRAL INSULATION C6 / 36 cells BHK21 Vero MOLECULAR Real-time RT-PCR (Strains African and Asian strains) sequencing Serologic MAC-ELISA GAC-ELISA microneutralisation Commercial kits (SD

47 Health Promotion

48 CHIKV and Dengue Vectors Aedes aegypti Aedes albopictus

Identify the presence, distribution and density vector (Aedes aegypti and Aedes albopictus) Entomovirológica surveillance to identify the presence of CHIKV and

49 Identify the presence, distribution and density vector (Aedes aegypti and Aedes albopictus) Entomovirológica surveillance to identify the presence of CHIKV and Dengue virus Uniform sampling in the whole town (cover) Weekly readings throughout the year, over 85% Seasonal fixed observation sites Entomological surveillance ovitraps

50 National Meeting of Chikungunya

51 Brucellosis

52 Situation CASOS DE BRUCELA POR ENTIDAD In XXI century, 35,700 cases accumulate, 51.5% in the states of Coahuila, Guanajuato, Jalisco, Michoacán, Nuevo León and Sinaloa AGUASCALIENTES CHIHUAHUA MEXICO QUERETARO TLAXCALA Six states have reported cases of brucellosis in 2013 and Reporte de casos en SUIVE/SSA de enero a julio 2013 N N JURISDICCI UNIDADES TOTAL DE ESTADO ONES DE DE CASOS OCURREN OCURREN CIA CIA Reporte de casos en SUIVE/SSA de enero a julio 2014 N N JURISDICCI UNIDADES TOTAL D ESTADO ONES DE DE CASOS OCURREN OCURREN CIA CIA Guanajuat o Puebla Michoacá n Sinaloa Puebla Michoacán Guanajuat Sinaloa o Zacatecas Coahuila Sonora Zacatecas Morelos México Nuevo Tlaxcala León

53 Brucellosis Programme of Action Challenges Promote the nominal registry of case at State Health Services that have a higher incidence. Corroborate laboratory studies establishing regulations in patients suspected brucellosis. Ensure that the State Health Services to provide treatment confirmed by SAT / 2ME patients. And to follow up on the health sector institutions to patients treated brucellosis.

54 Brucellosis Programme of Action Objectives, strategies, action lines and indicators Objective: To improve the care of patients with brucellosis in health sector institutions to provide early diagnosis and treatment. Strategy: To verify compliance with standards in reported cases of these zoonoses. Action Line: To apply current regulations in patients with brucellosis Indicator: To apply appropriate treatment to 100% of confirmed patients with brucellosis.

55 Brucellosis Programme of Action Nominal Registration Cases In the process of programming the "Collaborative Communication Network" (RCC) platform ecolls admistrada by the company. Each SESA has a username and password to feed the platform with information on diagnosis, treatment and monitoring of patients with brucellosis to their high health. It will be in September all states register their cases of brucellosis in that platform.

56 New tests for the diagnosis of brucellosis Research collaboration with the CDC Participation CENAPRECE: promote the identification of patients and sampling. Contemplate realize two states Michoacan and Nuevo Leon (200 patients and 200 control patients). Medical personnel (3) and laboratory (1) was hired to implement the study. Objective: To compare the results of conventional tests with new tests (rapid assay life, Brucellacapt and Elisa) for InDRE. Preview: medical staff in outpatient tested methodology, CS La Piedad Michoacan and Nuevo León. InDRE indications are expected to start taking samples.

57 Rickettsiosis

Rickettsiosis: They are zoonosis caused by obligate intracellular

lice and fleas to wild or domestic animals and man accidentally.

Rickettsia prowazekii y Rickettsia typhi.. R. rickettsii R. prowazekii R.

58 Rickettsiosis: They are zoonosis caused by obligate intracellular gram-negative bacteria, transmitted by ticks and other ectoparasites such as lice and fleas to wild or domestic animals and man accidentally. In Mexico the most comun cases presented are result of Rickettsia rickettsii, Rickettsia prowazekii y Rickettsia typhi.. R. rickettsii R. prowazekii R. typhi The most common is the spotted fever of the Rocky Mountains, althought 16.0% are mixed infections.

59 Mexico Background They are existing Rickettsiosis records since 1920; by 1940 s, the cases where reported in several states in Mexico. In the 90 s, they where Spotted Fever cases registered in Mexico City and Yucatan. In late 2008 and early 2009 Mexico reported the biggest outbreak of Rockettsiosi in Los Santorales, located in the metropolitan area of Mexicali, Baja California. Since 2010, the epidemiological surveillance reported cases in Baja California Sur, Coahuila, Sonora, Durango and Nuevo León. According to InDRE in 2012, positive serology to Rickettsia rickettsii was registered in 28 states of Mexico. Evolution and current situation Mapa 1. Prevalencia de casos confirmados de rickettsiosis por Laboratorio, InDRE, México 2012 Prevalencia/100,000 habitantes < a a a a 4.9 Prevalencia Nacional /100,00 habitantes Fuente: Secretaría de Salud/DGE/InDRE/Deptos. Virología y Bacteriología/Base de datos Rick fecha de corte 29 de abril de 2013 de las 10:58 hrs In 2014 there has been 199 registered Rickettsiosis cases. Coahuila accounts for 36 % of cases in the country until epidemiological week 36.

60 Cases Rickettsiosis cases Mexico * * From 2005 to 2014 a total of 9,295 cases where registered in Mexico Source: SUIVE/DGE/ SS/Vigilancia Epidemiológica de Rickettsiosis.*Al corte de la semana epidemiológica 28

61 Cases per Rickettsiosis type México * Year Spotted Fever Recurrent Fever*** *At 28th epidemiological week ** The notifications began in 2014 *** The notifications stopped in 2014 Source: SUIVE/DGE/Secretaría de Salud/Estados Unidos Mexicanos Other types of Rickettsiosis* * Epidemic Tifo Murine Tifo sd sd sd sd sd sd sd sd sd * 123 sd

62 Vector integral Management Simultaneous actions; Entomológical Surveillance Enviromental Control Ecto canine Deworming Rickettsiosis prevention and control program Vector Program Zoonosis program

63 Ebola

64 Filoviridae RNA. There are five different subtypes: Bundibugyo, Côte d'ivoire, Reston, Sudan and Zaire. Reston has not caused disease in humans. It was first detected in 1976 in two simultaneous outbreaks occurred in Nzara, Yambuku Sudan and Democratic Republic of Congo. The village where the second outbreak occurred is located near the Ebola River, which gives its name to the virus. It has been found that the natural hosts of the virus are fruit bats. Before this outbreak (2014), outbreaks were recorded in the year 2012 in Uganda and Democratic Republic of Congo.

65 Collaboration Between Countries. Need to Identify new cases in time

66 GRACIAS Dr. Jesús Felipe González Roldán CENAPRECE

Regional Economic Report January March 2015

Regional Economic Report January March 2015 June 11, 2015 Outline I. Regional Economic Report II. Results January March 2015 A. Economic Activity B. Inflation C. Economic Outlook III. Final Remarks Regional