(Atlanta, Georgia, 23-24 March 2002)
Rapidly transmitted emerging and reemerging diseases require surveillance systems of great sensitivity that make it possible to act immediately to impede the spread of an outbreak or to control epidemics. In this context, a new paradigm of global collaboration has been established: teamwork through the establishment of surveillance networks.
Networks constitute a democratic consensual organization where coordination is carried out multilaterally and where each part contributes to the total effort by contributing the resources it has at its disposal. The objective is to meet common goals, work as a team, maintain a single channel of constant communication, and develop the ability to detect what is abnormal. Thus, the network in its entirely is much more than the sum of its parts.
Whenever there exist common challenges, common strategies are needed to solve common problems. It becomes necessary to share information in order to respond in an integrated way using evidence-based data. Thus, networks become indisponsable in their ability to strengthen individual responses.
The surveillance network for emerging and reemerging diseases is an initiative developed in 1996 with the capacity to integrate laboratories and epidemiology centers. Activities are carried out through a network composed of different technical groups from the participating countries. To date, two networks have been established; the Amazon and Southern Cone Networks. The incorporation of a third Central American Network is expected for the near future.
At this meeting, topic of discussion were those related to differences in network growth as well as their potential, expectations, and mechanisms utilized for strengthening them. During the meeting, proposals were formulated that are aimed system improvement, especially with regard to the capacity of the countries to predict epidemics and act accordingly. Presentations focused on the surveillance of influenza, yellow fever, dengue, foodborne diseases (FBD), Salmonellas, Hemolytic Uremic Syndrome (HUS), toxic Shiga-producing E coli infection, surveillance of resistance to antibiotics and the corresponding quality assurance, and the use of molecular tools to diagnose rubella and chickenpox (varicella).
A special topic was the recent threat of anthrax in the United States and the opportunity that this represents to test the response capacity of the different countries, not to mention the need to develop emergency plans to respond to this and other threats. In the United States, the Laboratory Response Network for Bioterrorism has recently been created as a multilevel system designed to unite local and state public-health laboratories with their clinical, military, veterinary, and agricultural counterparts, as well as those evaluating water and food.
New problems emerging since September 11 call for new networking proposals in the countries. A bioterrorism attack to any country should have a global response consisting of the rapid case identification, vaccination, contact identification, and contact vaccination, to assure quick control and erradication.
Among the achievements of the networks operating in the Southern Cone and Amazon subregions, current noteworthy activities include effective annual contact enabling information exchange and updates, strengthening communication among countries, and generating information. Annual reports are currently available that contribute information on each country; however, one area in need of strengthening is that which pertains to producing information in a regular and timely manner. The information generated should provide an integrated overview of the region for each priority area. The countries propose constructing a platform that integrates subregional and regional information on the priority diseases, with periodic updating and publication of national reports.
The countries recognize several contributions made by the network:
Facilitation of better communication.
Incentive to develop themes.
On-site evaluation visits and quality assurance.
Incentives for coordinated work between laboratories and epidemiologists.
Training and human-resource development, especially in laboratories.
Support for rapid response.
However, new challenges come up constantly, as is the case with West Nile Virus. Within each network, various areas in need of strengthening have been identified:
Southern Cone Network: There is a need to strengthen research capacity in the field, as well as in the shipment of samples. Another area to be strengthened is clinical staff training on how to watch for and detect unusual or abnormal phenomena.
Amazon Network: Some difficulties have been detected, such as the distance from national or regional reference centers for sample shipment; absence of externally financed support; lack of communication between clinicians, epidemiologists, and laboratory workers; and the need to establish sentinel sites and a greater number of common protocols.
In theSouthern Cone, the is a general consensus to continue to place a high priority on the surveillance of influenza, Hantavirus, and antimicrobial resistance. Argentina, Bolivia, Chile, Paraguay, and Uruguay agree that Hemolytic Uremic Syndrome (HUS) and toxic Shiga-producing E. coli infection are also priority topics. The countries propose incorporating such new priorities as leptospirosis, FBD outbreaks, Salmonella and death by unknown causes. With regard to designing prevention and control strategies, they will initiate the development of response plans that place emphasis on influenza.
Southern Cone Network
Working on joint prevention plans.
Forming multidisciplinary teams.
Incorporating clinical and environmental areas into surveillance activities.
Strengthening laboratory and field epidemiology.
Training clinicians by stimulating their ability to suspect and detect abnormal phenomena.
The Network intends to continue to place priority on the surveillance of influenza, Hantavirus, and resistance of Plasmodium to malarial drugs. To improve its annual meetings, it intends to focus more on establishing research priorities; communicating and disseminating information; and establishing a workplan.
Central American Network
The Network proposes setting up cooperative efforts between countries, to prevent and control those communicable diseases that represent a common threat to the subregion, and better utilizing the available human and material resources.
The recommendations are summarized by disease and topic in the Executive Summary.