Executive Summary

Full Text (68 pp, PDF)
(Available in Spanish only, chapter headings translated below)

Cover |  Contents |  Summary (Spanish)

Session I
Antimalarial Drug Policy in the Amazon Countries
(Introduction, overview, surveillance and containment, challenges, USAID presentation)

Country Reports and Comments

French Guiana

Session II
Surveillance of Other Emerging and Reemerging Diseases
Bolivia   |   Colombia   |   Venezuela
Results and Conclusions

Surveillance of Resistance to Antibiotics

Epidemiological Surveillance: The Importance of Standardization of Reactives and Quality Control
Brazil   |   Colombia, Conclusions


List of Participants
Situation Report on Regional Malaria Programs

More information on
Project Proposal and Workplans

Third Meeting of the Surveillance Network for
Emerging Infectious Diseases in the Amazon Countries—

Monitoring Resistance to Antimalarial Drugs: Treatment Policies

RAVREDA meeting, Bahia

(Salvador, Bahia, Brazil; 9-11 March 2001)

Recommendations |  List of Participants

The Third Meeting of the Network for Surveillance of Emerging Infectious Diseases in the Amazon Countries took place in Salvador, Bahia, Brazil, from 9 to 11 March 2001. Public health professionals, representatives of international institutions and governmental cooperation agencies participated in the meeting.

During the first session, antimalarial drug policy and the current state of resistance to the drugs in the respective countries were analysed.

Within the framework of the Roll Back Malaria initiative, the importance of early diagnosis and the timely treatment of the disease; the need for strategies and implementation of multiple preventive activities based on local requirements; and the need for coordination among distinct groups and organizations involved in prevention and control activities against the disease were emphasized. Additionally, the importance of conducting operational research in order to solve bottlenecks observed in several of the national programs was stressed.

A summary was made of the epidemiological malaria situation in the Americas, which is included in Annex 1. Malaria transmission occurs in 21 countries of the Region. All of them have programs to control the disease.

Due to the importance of the monitoring antimalarial drug resistance in the Region, information on the experiences about the subject in other continents was considered useful. Information was shared on activities in the East African countries and USAID supported activities in the Mekong, Southeast Asia Region.

The countries of the Amazon region presented reports on their respective national situations with regard to antimalarial drug resistance and to its drug treatment policies. In turn, each country committed to joint efforts to undertake monitoring of the resistance and to use acquired information as the basis for rational malaria treatment policies. The 'U.S. Agency for International Development', the World Health Organization, and PAHO were committed to supporting the efforts.

During the second session, different aspects of syndromic surveillance were discussed, both as a way of implementing surveillance of the emerging/reemerging diseases, as well as its importance in regulation of reagents and quality control of same in order to confirm suspected clinical cases. Both Brazil and Colombia described the existing national experience in this regard. Subsequently, the activities carried out by the countries of the Region and PAHO in promoting surveillance of antibiotic resistance and of potential for contention of that resistance were described.


The participants made the following recommendations to countries and agencies represented at the meeting:

Session I
Malarial drug policy in the Amazon countries: Monitoring of drug resistance

To the countries: Each country will have a national coordinator for monitoring drug resistance; a common protocol developed by PAHO/WHO and adapted to the Region of the Americas will be used in carrying out the monitoring of the resistance to the drugs by Plasmodium vivax and Plasmodium falciparum. The databases for the studies of resistance will be shared between all the countries and its structure will be discussed among them (Brazil already has a database and should send it all the countries for its analysis and potential use); a Steering Committee at the national and subregional level will be created in order to supervise the studies and sentinel sites and Dr. Ruebush will act as monitor of the tests in order to establish the efficacy of the antimalarial drugs.

To PAHO and WHO (Roll Back Malaria): That they support the organization of the national and subregional networks for monitoring resistance.

To the United States Agency for International Development (USAID): That it provide financial support so that the activities of the network can be undertaken.

Session II
Surveillance of other emerging/reemerging infectious diseases

To the countries: That they carry out monitoring of antibiotic resistance to antibiotics in specimens isolated in the community and in nosocomial infections, following the standards of quality assurance and analyze and periodically disseminate results of such surveillance.

To PAHO: That a system of evaluation be established to measure performance of institutions from countries that participate in the network for laboratory diagnosis of emerging/reemerging diseases, and that two topics to be included in future meetings be:
i. National surveillance systems for antimicrobial resistance, and
ii. Viral emerging/reemerging diseases