An Integrated One Health Approach to Detect and Respond to Emerging Disease Threats in High-Risk Regions of Central America

总结。新出现的病原体是全球公共卫生威胁，中低收入国家位于中部 由于庞大的人口中心、极端的地区，美国的传播风险极高 贫穷和热带气候。在伯利兹和萨尔瓦多，超过670万人处于危险之中，其中230万人 生活在贫困之中。病媒传播的病原体、呼吸道病原体和肠道病原体在这些易受感染的人群中受到高度关注 人口。自20世纪70年代S以来，该地区发生了登革热病毒的暴发，并成为世界上第一例 2014年和2015年报告了基孔肯雅病毒(CHIKV)和寨卡病毒(ZIKV)的本土病例， 分别进行了分析。由于埃及伊蚊在整个地区建立了种群，而且缺乏资源 在病媒监测和控制方面，这些病原体的传播将继续保持下去。原生的 寄生虫和细菌传播的疾病也会发生；然而，真实的发病率和 这些感染的流行情况尚不清楚。在缺乏公共卫生的深度贫困社区 基础设施、一般健康状况可能较差，营养不良普遍存在，从而导致较高的不良风险 呼吸道和肠道病原体的结果。疫情可能使公共卫生系统不堪重负，并严重 在地方一级加强目前的诊断和病例管理能力。总体而言，地方病和 新出现的病原体继续影响中美洲。考虑到每年有130万游客访问伯利兹 仅此一项，引入美国的风险就很高。为了抗击这些疾病威胁，我们召集了一支强大的、 多学科国际小组创建急性发热病(AFI)监测网络，以检测 并在两家高危哨兵医院内诊断病媒传播、呼吸道和肠道病原体 伯利兹(伯利兹市)和萨尔瓦多(桑索纳特)地区。这些哨所设在三级医疗中心。 贝勒医学院(BCM)目前正在进行项目的医院。所服务的总人口 这些医院大约有829,000家。这个AFI哨兵监视系统将与 病媒和动物宿主监测创建一种统一健康的方法来检测和抗击 疾病威胁。我们将利用拥有世界知名专业知识的美国机构的学术优势 热带医学、昆虫学、兽医公共卫生和信息学：BCM，德克萨斯A&M，南方大学 卡罗莱纳大学和约翰·霍普金斯大学。我们将协力扩展我们的临床、教育和研究 特派团，与各自卫生部、当地大学、医院的利益攸关方合作 网络、疾控中心、泛美卫生组织和其他美国和中美洲的合作伙伴。这一协作网络将 向中美洲提供能力建设、培训、应用研究、诊断、 以及对新出现的病原体进行综合实时监测。我们的总体目标是最大限度地提高 了解、检测和应对高危地区的传染病威胁。我们的One Health-集成 设在中美洲的监测系统将加强我们对疾病威胁的地区防御。

Summary. Emerging pathogens are global public health threats, with low to middle income countries in Central America having disproportionately high risks for transmission due to large population centers, areas of extreme poverty, and tropical climates. In Belize and El Salvador, more than 6.7 million people are at risk, with 2.3 million living in poverty. Vector-borne, respiratory, and enteric pathogens are of high concern in these vulnerable populations. Outbreaks of dengue virus (DENV) have occurred in this region since the 1970's, and the first autochthonous cases of chikungunya virus (CHIKV) and Zika virus (ZIKV) were reported in 2014 and 2015, respectively. With Aedes aegypti mosquito populations established throughout the region and lack of resources for vector surveillance and control, transmission of these pathogens will continue to be sustained. Autochthonous transmission of parasitic and bacterial vector-borne diseases also occur; however, the true incidence and prevalence of these infections are not known. In deeply impoverished communities that lack public health infrastructure, general health can be poor and malnutrition prevalent, leading to a higher risk of adverse outcomes from respiratory and enteric pathogens. Outbreaks can overwhelm public health systems and severely strain the current diagnostic and case management capacities at the local level. Collectively, endemic and emerging pathogens continue to impact Central America. Considering 1.3 million tourists visit Belize each year alone, the risk of introduction to the US is high. To combat these disease threats, we have convened a strong, multi-disciplinary international team to create an acute febrile illness (AFI) surveillance network to detect and diagnose vector-borne, respiratory, and enteric pathogens within sentinel hospitals in two high-risk areas of Belize (Belize City) and El Salvador (Sonsonate). These sentinel sites are based in tertiary-care hospitals where Baylor College of Medicine (BCM) has current, ongoing projects. The total population served by these hospitals is approximately 829,000. This AFI sentinel surveillance system will work in tandem with vector and animal reservoir surveillance to create a One Health approach to detecting and combating disease threats. We will leverage the academic strengths of US institutions with world-renowned expertise in tropical medicine, entomology, veterinary public health, and informatics: BCM, Texas A&M, University of South Carolina, and Johns Hopkins University. We will collaboratively expand our clinical, education, and research missions, working in tandem with stakeholders from the respective Ministries of Health, local universities, hospital networks, CDC, PAHO, and other US- and Central America-based partners. This collaborative network will provide a preeminent resource to Central America for capacity building, training, applied research, diagnostics, and integrated real-time surveillance for emerging pathogens. Our overall goal is to maximize the ability to understand, detect, and respond to infectious disease threats in a high-risk region. Our One Health-integrated surveillance system based in Central America will strengthen our regional defenses against disease threats.