The emergence of West Nile virus, with the detection of the first human cases in Mexico (2003) and circulation of the virus in some of the Caribbean and Central American countries, poses a challenge to the Region. Training workshops have been held for surveillance and diagnosis of this disease with participation of most countries of the Region. The difficulties encountered are related especially to diagnosis (referral of samples and purchase of the necessary reagents) and to the training of multidisciplinary teams, as key elements for coordinated surveillance and response.
With reference to dengue, the need for global surveillance was emphasized, in order to identify trends and forecast potentially risky situations. DengueNet was presented as a tool for global surveillance; its next steps include implementation of the software in a greater number of countries, accompanied by support for the national diagnostic laboratories, and the routine use of the information that the system produces. Several countries have shown deterioration of the epidemiological situation for dengue and dengue hemorrhagic fever. In order to improve the situation, Technical Groups have been set up to cooperate with the countries to jointly develop a national integrated strategy for dengue prevention and control. Such strategy must take into account patient care, social communication, entomological and laboratory aspects, and epidemiological surveillance, as well as any other factor that may influence the epidemiology of dengue.
Several countries presented their experiences in detection and response to epidemiological emergencies. Many of them using syndromic surveillance as a framework for early detection of etiologic agents. This type of surveillance has helped to improve sensitivity in the detection of diseases and etiological diagnosis in several countries of the subregions. The following difficulties were mentioned:
the limited capacity of the reference laboratories for differential diagnosis;
the need to establish criteria for selecting sentinel posts that ensure the use of representative population for the detection of diseases or etiologic agents;
the need to determine the timing for this type of surveillance, based on the epidemiological situation and priorities of the country; and
that this type of surveillance should be coordinated and integrated with existing surveillance activities to prevent overlapping of activities.
The current malaria situation in the Region of the Americas was presented; the trend is downward. Nevertheless, malaria continues to pose a threat in the Region due to the growing resistance to malaria drugs, which calls for the development of harmonized, integrated policies in the subregions to achieve standard systems of management. The overall strategy for malaria control advocates timely diagnosis and treatment, with plans of action in the event resistance appears. In this regard, securing greater cooperation among the countries of the different networks is key to information exchange.
The importance of promoting the rational use of antibiotics to prevent resistance from developing was emphasized with the presentation of results of surveillance of antimicrobial resistance in community and hospital isolates. The importance of surveillance of nosocomial infections as an indicator of the quality of care in hospitals was also pointed out as well as the burden that costs of hospital infections represent for the health care system. The need for quality assurance was also stressed, so that there is confidence in the laboratory results.
The last day of the meeting was devoted to evaluating the fulfillment of the commitments assumed by the countries and cooperating agencies at the previous meeting for each of the networks and to stating the new challenges. In introducing the plenary session, the Director of PAHO, Dr. Mirta Roses, thanked Drs. J. Hughes and J. Leduc, from CDC, for their efforts to set up the networks, and noted the importance of the commitment made by the countries and PAHO for continuous improvement of the technical and scientific quality in the surveillance and investigation of EID. With regard to future challenges to creating a safer and healthier Region, she stated that the EID surveillance networks must continue their efforts along these lines.