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

摘要新出现的病原体是全球公共卫生威胁，中低收入国家在中部非洲， 美国由于人口众多的中心，极端贫困地区， 贫穷和热带气候。在伯利兹和萨尔瓦多，超过670万人面临风险，其中230万人 生活在贫困之中在这些易受感染的人群中， 人口。自20世纪70年代以来，该地区发生了登革热病毒（DENV）的爆发， 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， 分别随着埃及伊蚊在整个地区的蚊子种群的建立和资源的缺乏 就病媒监测和控制而言，这些病原体的传播将继续存在。原地 寄生虫和细菌媒介传播疾病的传播也会发生;然而， 这些感染的流行率尚不清楚。在极度贫困的社区， 由于基础设施不足，一般健康状况可能很差，营养不良普遍存在，导致不良风险增加。 呼吸道和肠道病原体的结果。暴发可使公共卫生系统不堪重负， 地方一级目前的诊断和病例管理能力捉襟见肘。集体性、地方性和 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， 单独来看，传入美国的风险很高。为了应对这些疾病的威胁，我们召集了一个强大的， 一个多学科的国际小组，以建立一个急性发热性疾病（AFI）监测网络， 并在两个高风险地区的哨点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（萨尔瓦多）（松索纳特）地区。这些监测点设在三级保健中心， 贝勒医学院（Baylor College of Medicine）目前正在进行项目的医院。服务的总人口 这些医院大约有829 000家。这个AFI哨兵监测系统将与 病媒和动物宿主监测，以创建一个健康方法， 疾病威胁。我们将利用美国院校的学术优势，在以下方面拥有世界知名的专业知识： 热带医学，昆虫学，兽医公共卫生和信息学：德克萨斯A & M大学，南 卡罗莱纳和约翰霍普金斯大学。我们将合作扩大我们的临床、教育和研究 特派团，与来自卫生部、当地大学、医院 网络、疾病预防控制中心、泛美卫生组织和其他美国和中美洲的合作伙伴。该合作网络将 为中美洲提供卓越的资源，用于能力建设、培训、应用研究、诊断， 并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、检测和应对高风险地区的传染病威胁。我们的一体化健康 建立一个以中美洲为基地的监测系统将加强我们对疾病威胁的区域防御。

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.