	The Pan American Health Organization Promoting Health in the Americas

Disease Prevention and Control / Communicable Diseases / Chagas

VI^th Meeting of the Andean Initiative to Control Chagas Disease (IPA) (Bogotá, Colombia, 5–6 May 2005)

Final Report (in Spanish, PDF, via the CDIA/EC * website; headings translated below for user orientation): - Table of Contents I. I^st International Workshop on Chagas Disease Control (190 pp) II. Course on the Diagnostics, Management and Treatment of Chagas Disease (37 pp) III. VI^th Meeting of the Andean Initiative to Control Chagas Disease (201 pp) Other Subregional Initiatives - INCOSUR (Southern Cone) - IPCA (Central America) - AMCHA (Amazon) - PAHO Chagas Page - PAHO/TDR - WHO/TDR		Recommendations and Decisions The Initiative has recognized that two of its member countries lack defined programming structures in the areas of for surveillance and control and thus recommends the formation and development of such structures. It also recommends that the countries that do have national control programs strengthen them and provide them with the best possible conditions for their sustainability. Based on the priorities set by the Initiative for the vector control per country, there is recommended immediately defining the areas of interest and the physical goals of the intervention, as well as the necessary resources. For the exercise in 2006, the Technical Secretariat will provide electronic formats in order to collect standardized data from the member countries (entomological data, information on coverage and blood banks, seroepidemiological data, information on costs, etc.) prior to each annual meeting. The Technical Secretariat will prepare a survey directed at the countries, for collecting information on the insecticides utilized, their characteristics and costs, and spraying equipment, prior to each subregional meeting. The component of morbidity and medical care to those ill with Chagas will be initiated, in coordination with the national health system of each country. The Initiative expresses its concern regarding the irregular provision or total absence of medication for the etiological treatment of Chagas, requesting the following: Renewal of the production of Nufuritimox. The supply of Benznidazole. Registry and inclusion of these drugs in the list of essential drugs for all the countries. Preparation and availability of pediatric presentations. Research and development of new drugs. Commitment from the countries to help PAHO obtain an annual needs assessment estimating the need of both of the above drugs, with a view to arranging for donations and production of the same. Looking at the epidemiological and control situation in Arequipa, Peru, would the Initiative would be interested in the following: Intensifying the control measures of intensify and carrying these out with the greatest urgency and with the greatest possible coverage in preserving the health of the population at risk. Other subregional Initiatives cooperating in the control effort, should Peru require it. Offering a complete diagnostic profile through its next evaluation, to be executed by PAHO and CIDA-Canada, to help mobilize resources and carry out the necessary control measures. The Initiative recognizes community participation as a priority measure for the epidemiological surveillance and control of Chagas, meaning that it recommends that the member countries, among other measures, make appropriate arrangements with the Ministry of Education to incorporate elementary-school programs basic information on this topic aimed at recognizing local vectors and Chagas disease in general. The Initiative recommends making a request at the Meeting of the Ministers of Health of the Andean Area, to be held this year in Bogotá, that it recognize the Intergovernmental Commission of the Andean Initiative as a subregional advisory body on the topic, and that it include among its priorities the development of bilateral and multilateral projects for the surveillance and control of Chagas disease. The Andean Initiative for Control of Chagas Disease recognizes and salutes the creation of the Amazon Initiative for the Surveillance and Control of Chagas Disease (AMCHA), with which is hopes to work in a coordinated and complementary manner. The Initiative recommends that prior to each annual subregional meeting, each country hold its own annual national meeting to evaluate its own exercise, plan accordingly, and prepare its own national presentation to the Andean area. The countries express their interest in implementing a revolving fund for international cooperation to help procure supplies, insecticides, equipment, and drugs to serve the needs of the control programs. The Initiative emphasizes the importance of the plans to improve housing as a complementary strategy for Chagas disease control and social development. Regarding the use of geographical information systems, the Initiative recommends their adoption by the national control programs with a view to organizing their information and optimizing its management and use (see Annex 2 of the report). The country representatives will make contact with the Andean Health Office to make better use of its international Chagas surveillance system. The initiative considers it a priority to incorporate the morphobiometric and molecular tool into the Triatominae study, with the objective of making epidemiological characterizations (on reinfestation, residuality, determining factors) and supporting operational surveillance and control strategies. The Initiative proposed developing and implementing a human-resource training plan (for operational staff, technicians and professionals) in the area of medical entomology, to support program strengthening, in national and international centers of excellence and with support from PAHO TCC projects, ECLAT, CDIA-EC and WHO/TDR. The Initiative recommends implementing, in the next three months, a triannual electronic bulletin published by the Technical Secretariat, with monthly contributions from the national programs in the countries. Decisions* The great diversity of epidemiological situations in the subregion creates a need for distinguishing different goals for the Andean initiative. There are vectors of recognized importance with different control vulnerability, even in areas within the territory of the same country. This calls the adoption of the following general measures against vector-borne transmission: eliminating household colonies of indigenous vectors as well populations of introduced vectors, according to the situation in each country. As a proposal of the Intergovernmental Commission, the Initiative proposes that the National Delegate of Venezuela consult with the national authorities concerning the possibility of holding the VII^th Meeting of the Andean Initiative in Venezuela. Delegates by Country Dr. Jorge A. Monroy Nicola, Ecuador Dr. César Náquira Velarde, Peru Dr. Julio César Padilla Rodríguez, Colombia Dr. Jesús A. Benítez, Venezuela Abbreviations: TCC* = PAHO Technical Cooperation in the Countries. ECLAT = European Community Latin American Network for Research on the Biology and Control of Triatominae. CDIA-EC = Chagas Disease Intervention Activities, European Community. TDR/WHO = Special Programme for Research and Training in Tropical Diseases (Tropical Disease Research / TDR, coordinated at WHO).