Region of the Americas

Centers for Disease Control and Prevention Regional Office of Central America and Panama
Field Epidemiology and Training Programs:  Website
 
Canada Field Epidemiology and Training Program:  Website
 
Activities From the Field - Region of the Americas
by Dr. Roberto Flores Reyna
 
The region is diverse. The United States’ program, which serves as the model for so many, began in 1951, followed by Canada in 1975. The first program to follow suit in Latin America was Mexico in 1984. In the late 80’s and early 90’s Peru and Colombia joined the fold. Since 2000, programs have begun in Argentina, Brazil and Central America.
Approximately 140 trainees are expected to graduate from these programs in 2005, most of those being graduates of the United States Epidemic Intelligence Service (EIS.)
Program trainees have served on teams that have responded to outbreaks, where the interventions have thwarted epidemics. Recent examples of such interventions include the following:
  • In 2003, trainees of the Brazilian FETP, Programa de Treinamento em Epidemiologia Aplicada aos Serviços do Sistema Único de Saúde investigated an outbreak of Shigella Sonnei associated with drinking water, in Mina Gerais state, Brazil
  • In 2002, trainees of the Costa Rican FETP, Programa de Epidemiologia de Campo Aplicada al Nivel Local, responded to an episode of food poisoning by clostridium perfringens in the Cocori Central Penitentiary, Cartago, Costa Rica
Many improvements in policies and practices are adopted as a direct result of recommendations following these interventions, to prevent recurrence. Recent examples include recommendations which were made as a result of the following investigations:
  • trainees of the Brazilian FETP, Programa de Treinamento em Epidemiologia Aplicada aos Serviços do Sistema Único de Saúde
    • investigated an outbreak of gastroenteritis, with isolation of norovirus (2003)
    • investigated an outbreak of diarrhea with isolation of toxigenic vibrio cholerae O1 Ogawa in a rural area of northeast Brazil (2004)
    • studied sylvatic yellow fever in Minas Gerais State, Brazil, during the period 2002-2003
    • conducted an investigation of a human rabies outbreak due to vampire bat exposure Portel Municipality, Par State, Brazil (2004)
    • conducted an investigation of increased deaths in a hemodialysis centre, in Caruaru – Pernambuco State, Brazil (2003)
    • investigated wide-spread Vibrio Parahaemolyticus O3:K6 Gastroenteritis following consumption of raw crab meat, Ceara State Brazil (2002)
 
  • trainees of the Canadian Field Epidemiology Program
    • investigated the connection between cochlear implants and bacterial meningitis in Canada (2002)
    • conducted an investigation of an acupuncture-associated mycobacterium abscessus outbreak in Canada (2002)
 
  • In 2002, trainees of the Argentine FETP, Programa de Residencia en Epidemiología de Campo investigated an outbreak of tegumentary leishmaniasis in Argentina
  • trainees of the Peruvian FETP, Programa de Especialización en Epidemiologia de Campo (PREC)
    • conducted an Investigation of a spotted fever group typhus and leptospirosis outbreak in northern highlands of Peru (2002)
    • Identified the factors associated to an outbreak of gastroenteritis in the national police technical school Pucuto, Cusco-Peru (2001)
Research and investigations conducted by FETP trainees contribute to the general understanding of the epidemiology of certain diseases and conditions, methods of combating epidemics and so forth. Recent examples include knowledge gained from the following studies and investigations:
  • Trainees of the Colombian FETP, Servicio de Epidemiogia Aplicada (SEA) conducted a comparison of the response to three-dose and four-dose Hepatitis B vaccination series in health-care personnel in Columbia (2001)
  • trainees of the Brazilian FETP, Programa de Treinamento em Epidemiologia Aplicada aos Serviços do Sistema Único de Saúde
    • Conducted a study of the Incidence, clinical features and estimated costs of congenital rubella syndrome Brazil
    • Conducted an investigation of an outbreak of spotted fever-group rickettsios, Espiritu Santo State, Brazil (2003)
    • Undertook a study of human deaths due to hemorrhagic fever of unknown etiology occurring during an epizootic among sylvatic monkey population in a periurban park – Rio Grande do Norte State, Brazil (2004)
  • trainees of the Costa Rican FETP, Programa de Epidemiologia de Campo Aplicada al Nivel Loca
    • conducted a study of the risk of rubella vaccine virus infection in inadvertently vaccinated pregnant women Costa Rica (2001)
    • carried out a study of mortality and morbidity by diarrhea in Costa Rica, 1970 – 2000
    • conducted a study of the Incidence of congenital rubella syndrome in Costa Rica 1996 – 2001
    • carried out a serological and entomological survey regarding an acute case of Chagas disease in Bajo Los Anonos, Escazu, Costa Rica (2003)
  • In 2004, trainees of the Mexican FETP, Residencia en Epidemiologià investigated a measles outbreak in Mexico
  • In 2004, trainees of the Canadian Field Epidemiology Program conducted an investigation of norovirus in oysters, in British Columbia
  • trainees of the Peruvian FETP, Programa de Especialización en Epidemiologia de Campo (PREC)
    • performed a study of the clinical features of acute bartonellosis in an endemic area of the northeastern highlands of Peru (2002-03)
    • conducted an investigation of bartonella bacilliformis bacteremia in relatives of febrile patients, Jaen-Ancash, Peru, May-June 2004
    • undertook a study of a community surveillance system of maternal risks associated with improvements to maternal health care: lessons learned from a community intervention, Urinsaya-Cusco, Peru 2001-2003
Program trainees have contributed a great deal to the improvement of surveillance systems within their countries. Recent examples include improvements resulting from the following studies and investigations:
  • In 2002, trainees of the Brazilian FETP, Programa de Treinamento em Epidemiologia Aplicada aos Serviços do Sistema Único de Saúde, conducted an evaluation of the dengue fever surveillance system in Brazil
  • In 2002, a trainee of the Costa Rican FETP, Programa de Epidemiologia de Campo Aplicada al Nivel Loca, conducted a study of reported cases of Hansen’s disease, with a view to reasserting the health authorities strategies to eradicate the disease.
  • trainees of the Peruvian FETP, Programa de Especialización en Epidemiologia de Campo (PREC)
    • evaluated the suitability of PAP smear and Visual Inspection with Ascetic Acid as the most practical method of mass screening methods for cervical cancer in the highland communities of the Andes (2002)
    • conducted a study of the most efficient means of diagnosing human bartonellosis in Peru (2003)
  • In 2003, trainees of the Argentine FETP, Programa de Residencia en Epidemiología de Campo, assessed that country’s surveillance system for diphtheria
  • Recently, trainees of the U.S. Epidemic Intelligences Service studied the use of a hospital emergency department based syndromic surveillance system implemented during a high-profile event

 
Dr. Roberto Flores Reyna
 

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