Direccion General de Epidemiologia

Lima, Peru

Direccion General de Epidemiologia

Lima, Peru
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Campbell K.M.,San Diego State University | Haldeman K.,San Diego State University | Lehnig C.,San Diego State University | Munayco C.V.,Uniformed Services University of the Health Sciences | And 7 more authors.
PLoS Neglected Tropical Diseases | Year: 2015

Background Dengue is one of the most aggressively expanding mosquito-transmitted viruses. The human burden approaches 400 million infections annually. Complex transmission dynamics pose challenges for predicting location, timing, and magnitude of risk; thus, models are needed to guide prevention strategies and policy development locally and globally. Weather regulates transmission-potential via its effects on vector dynamics. An important gap in understanding risk and roadblock in model development is an empirical perspective clarifying how weather impacts transmission in diverse ecological settings. We sought to determine if location, timing, and potential-intensity of transmission are systematically defined by weather. Methodology/Principal Findings We developed a high-resolution empirical profile of the local weather-disease connection across Peru, a country with considerable ecological diversity. Applying 2-dimensional weather-space that pairs temperature versus humidity, we mapped local transmissionpotential in weather-space by week during 1994-2012. A binary classification-tree was developed to test whether weather data could classify 1828 Peruvian districts as positive/ negative for transmission and into ranks of transmission-potential with respect to observed disease. We show that transmission-potential is regulated by temperature-humidity coupling, enabling epidemics in a limited area of weather-space. Duration within a specific temperature range defines transmission-potential that is amplified exponentially in higher humidity. Dengue-positive districts were identified by mean temperature >22°C for 7+ weeks and minimum temperature >14°C for 33+ weeks annually with 95% sensitivity and specificity. In elevated-risk locations, seasonal peak-incidence occurred when mean temperature was 26-29°C, coincident with humidity at its local maximum; highest incidence when humidity >80%. We profile transmission-potential in weather-space for temperaturehumidity ranging 0-38°C and 5-100% at 1°C x 2% resolution. Conclusions/Significance Local duration in limited areas of temperature-humidity weather-space identifies potential locations, timing, and magnitude of transmission. The weather-space profile of transmissionpotential provides needed data that define a systematic and highly-sensitive weather-disease connection, demonstrating separate but coupled roles of temperature and humidity. New insights regarding natural regulation of human-mosquito transmission across diverse ecological settings advance our understanding of risk locally and globally for dengue and other mosquito-borne diseases and support advances in public health policy/operations, providing an evidence-base for modeling, predicting risk, and surveillance-prevention planning. © 2015, PLOS Neglected Tropical Diseases. All rights reserved.


Tong S.,Centers for Disease Control and Prevention | Zhu X.,Scripps Research Institute | Li Y.,Centers for Disease Control and Prevention | Shi M.,University of Sydney | And 25 more authors.
PLoS Pathogens | Year: 2013

Aquatic birds harbor diverse influenza A viruses and are a major viral reservoir in nature. The recent discovery of influenza viruses of a new H17N10 subtype in Central American fruit bats suggests that other New World species may similarly carry divergent influenza viruses. Using consensus degenerate RT-PCR, we identified a novel influenza A virus, designated as H18N11, in a flat-faced fruit bat (Artibeus planirostris) from Peru. Serologic studies with the recombinant H18 protein indicated that several Peruvian bat species were infected by this virus. Phylogenetic analyses demonstrate that, in some gene segments, New World bats harbor more influenza virus genetic diversity than all other mammalian and avian species combined, indicative of a long-standing host-virus association. Structural and functional analyses of the hemagglutinin and neuraminidase indicate that sialic acid is not a ligand for virus attachment nor a substrate for release, suggesting a unique mode of influenza A virus attachment and activation of membrane fusion for entry into host cells. Taken together, these findings indicate that bats constitute a potentially important and likely ancient reservoir for a diverse pool of influenza viruses.


Bai Y.,Centers for Disease Control and Prevention | Recuenco S.,Centers for Disease Control and Prevention | Gilbert A.T.,Centers for Disease Control and Prevention | Osikowicz L.M.,Centers for Disease Control and Prevention | And 3 more authors.
American Journal of Tropical Medicine and Hygiene | Year: 2012

Bartonella infections were investigated in bats in the Amazon part of Peru. A total of 112 bats belonging to 19 species were surveyed. Bartonella bacteria were cultured from 24.1% of the bats (27/112). Infection rates ranged from 0% to 100% per bat species. Phylogenetic analyses of gltA of the Bartonella isolates revealed 21 genetic variants clustering into 13 divergent phylogroups. Some Bartonella strains were shared by bats of multiple species, and bats of some species were infected with multiple Bartonella strains, showing no evident specific Bartonella sp.-bat relationships. Rarely found in other bat species, the Bartonella strains of phylogroups I and III discovered from the common vampire bats (Desmodus rotundus) were more specific to the host bat species, suggesting some level of host specificity. Copyright © 2012 by The American Society of Tropical Medicine and Hygiene.


Avila J.,Direccion General de Epidemiologia | Tavera M.,UNICEF | Carrasco M.,Hospital Regional Of Cusco
Revista Peruana de Medicina Experimental y Salud Publica | Year: 2015

Objectives. Describe the epidemiological characteristics of neonatal deaths in Peru. Materials and methods. Descriptive study based on notifications to the Perinatal and Neonatal National Epidemiological Surveillance Subsystem (PNNESS) made in 2011-2012. The capture-recapture method was used to calculate the registration of the notification and estimate the neonatal mortality rate (NMR) nationally and by regions. Responses were made to the questions: where, when, who and why the newborns died. Results. 6,748 neonatal deaths were reported to PNNESS, underreport 52.9%. A national NMR of 12.8 deaths/1,000 live births was estimated. 16% of deaths occurred at home and 74.2% of these were in the highlands region, predominantly in rural areas and poor districts. 30% died in the first 24 hours and 42% between 1 and 7 days of life. 60.6% were preterm infants and 39.4% were term infants. 37% had normal weight, 29.4% low weight, and 33.6% very low weight. Preventable neonatal mortality was 33%, being higher in urban and highland areas. 25.1% died of causes related with prematurity-immaturity; 23.5% by infections; 14.1% by asphyxiation and causes related to care during childbirth and 11% by lethal congenital malformation. Conclusions. Neonatal mortality in Peru is differentiated by setting; harms related to prematurity-immaturity dominated on the coast, while the highlands and jungle recorded more preventable neonatal mortality with a predominance of asphyxia and infections. © 2015, Instituto Nacional de Salud. All rights reserved.


Ormaeche M.,Direccion General de Epidemiologia | Whittembury A.,Direccion General de Epidemiologia | Whittembury A.,National Major San Marcos University | Pun M.,Direccion General de Epidemiologia | And 2 more authors.
International Journal of Infectious Diseases | Year: 2012

Objective: To assess the seroprevalence of hepatitis B virus (HBV), syphilis, and HIV and associated risk factors in pregnant women and their male partners from six indigenous populations of the Peruvian Amazon Basin. Methods: A cross-sectional study was performed in six indigenous populations from the Peruvian Amazon Basin. Blood samples were obtained and tested for HBV (antibodies to the hepatitis B core antigen (anti-HBc) and hepatitis B surface antigen (HBsAg)), for syphilis (rapid plasma reagin and microhemagglutination assay for Treponema pallidum antibodies), and for HIV (ELISA and indirect immunofluorescence test). A survey was also performed to identify associated risk factors. Results: One thousand two hundred and fifty-one pregnant women and 778 male partners were enrolled in the study. The seroprevalence of anti-HBc in pregnant women was 42.06% (95% confidence interval (CI) 39.28-44.85%) and in their male partners was 54.09% (95% CI 50.32-57.86%). The seroprevalence of HBsAg in pregnant women was 2.11% (95% CI 0.78-3.44%) and in their male partners was 3.98% (95% CI 1.87-6.08%). The seroprevalence of syphilis in pregnant women was 1.60% (95% CI 0.86-2.33%) and in their male partners was 2.44% (95% CI 1.22-3.66%). HIV seroprevalence in pregnant women was 0.16% (95% CI 0.02-0.58%) and in their male partners was 0.29% (95% CI 0.04-1.03%). Sexual risk factors were strongly related to blood markers of syphilis and HBV. Conclusions: Hepatitis B was found to be hyperendemic and strongly related to sexual factors, suggesting an important sexual component in the transmission of the disease in the populations studied. Syphilis was found to have an endemicity in pregnant women above the national level and this may be indicative of high mother-to-child transmission. HIV has started to show its presence in indigenous populations of the Amazon Basin and the results suggest the epidemic is concentrated. © 2012 International Society for Infectious Diseases.


Moya J.,Organizacion Panamericana de la Salud | Pimentel R.,Direccion General de Epidemiologia | Puello J.,Centro Nacional Para El Control Of Enfermedades Tropicales Cencet
Revista Panamericana de Salud Publica/Pan American Journal of Public Health | Year: 2014

The Region of the Americas has been affected since December 2013 by a chikungunya epidemic for the first time. Although the first cases were recorded in the French Caribbean, the epidemic quickly spread to the Dominican Republic due to trade and people movements. The Dominican Republic, which shares the island of Hispaniola with Haiti, has a population of 10 million. This article contains information from a range of different publications and official documents about the chikungunya virus infection and epidemic. These papers were extremely helpful for guiding the response to the epidemic in the Dominican Republic and may also be useful for enhancing knowledge of the virus and responses among health workers elsewhere in the region. Particular attention is drawn to the important research undertaken in countries and territories affected by the epidemic in the Indian Ocean area. This is the case, for example, of the island of La Réunion, where the epidemic had an attack rate of more than 30% between 2005 and 2007. Researchers were able to identify risk groups, severe and atypical forms of the infection, cases of vertical transmission, chronic disease causing recurrent pain over three years, and directly- or indirectly-related deaths from the virus. Given its high attack rate, the chikungunya virus has emerged as an exceptional challenge for health ministries and calls for appropriate organized responses from the health services, prioritization of care for risk groups and patients exhibiting severe forms of the disease, and effective social communication and intersectoral actions.


Palpan-Guerra A.,Direccion General de Epidemiologia | Munayco C.V.,Direccion General de Epidemiologia
Revista Peruana de Medicina Experimental y Salud Publica | Year: 2015

We analyzed the characteristics of news issued by communication media (CM) in Peru on H1N1 influenza in 2013, for which written, radio, television and internet CM were reviewed daily. The news were classified according to framing, estimation (educational, informative and with high perception of risk of contagion and death) and scope. A descriptive analysis of the main variables of the study was made. The framing of the news was focused on influenza cases (47.5%) and actions of the Ministry of Health and other institutions (29.0%). The highest percentage of news was informative (73.7%), and only 7.5% were news with high perception of risk of contagion and death; the latter was more frequent in newspapers (9.0%) and television (9.4%). During 2013, the CM, in general, was responsible at the time of reporting, although there were some that spread news that could have increased the perception of risk in the population. © 2015 Instituto Nacional de Salud. All rights reserved.


Reyes Pablo A.E.,Subdireccion de Gineco Obstetricia | Sierra Romero M.C.,Hospital General Dr Manuel Gea Gonzalez | Valdes Hernandez J.,Direccion General de Epidemiologia
Boletin Medico del Hospital Infantil de Mexico | Year: 2013

Background. Congenital malformations are a main cause of infant death, chronic illness and disability in several countries. The expected frequency is ~2-3% in live newborns and ~15-20% in stillbirths. In 2010 in Mexico, infant mortality ranked in second place with a rate of 336.3/100,000 births. In order to estimate prevalence and main causes of congenital malformations in live births and stillbirths, national base registries of newborns and stillbirths were evaluated for 2009-2010. Methods. Databases of neonatal live births and fetal deaths were combined. Results. From a total population of 4,123,531 certificates, 99.3% were live born and there were 0.7% fetal deaths. Congenital malformations were registered in 30,491 cases, 91.7% of live newborns and 8.3% of fetal deaths with a prevalence rate of congenital malformations of 73.9/10,000. Conclusions. The reported prevalence was lower than expected. It is necessary to enforce registry systems through system validation and training of personnel.


Objective: To determine trends of mortality from prostate cancer (PC) and years of potential life lost (YPLL) by federative entity and by socioeconomic region in the period 2000-2010. Methods: Records of mortality associated with PC 2000-2010 were obtained from the National Information System of the Secretariat of Health. This information is generated by the National Institute of Statistics and Geography through death certificates issued throughout the country. International Classification of Diseases, 10th revision, codes corresponding to the basic cause of death from PC were identified. Rates of mortality nationwide, by state, and by socioeconomic region were calculated. Rates of YPLL were calculated by federative entity and by socioeconomic region. The seven socioeconomic regions were elaborated by the National Institute of Statistics and Geography and include the 31 states and Mexico City according to indicators that are related to well-being such as education, occupation, health, housing, and employment. Results: Raw mortality rates per 100,000 inhabitants who died from PC increased from 7.8 to 9.8 between 2000-2010. The states and socioeconomic regions with the higher rates of mortality from PC were Sinaloa, Sonora, Baja California Sur, Nayarit, Colima and regions 6 and 3. The state and socioeconomic regions with higher rate of APVP from PC were Aguascalientes, Nuevo Leon, Campeche, Baja California Sur, Durango and regions 6, 5, 3, 1 and 2. Conclusions: Raw mortality rates per 100,000 inhabitants who died from PC increased from 7.8 to 9.8 between 2000-2010. The states and socioeconomic region with the higher mortality rates were Sinaloa, Sonora, Baja California Sur, Nayarit, Colima and regions 6 and 3. Mexico.


Pimentel R.,Direccion General de Epidemiologia | Skewes-Ramm R.,Direccion General de Epidemiologia | Moya J.,Organizacion Panamericana de la Salud
Revista Panamericana de Salud Publica/Pan American Journal of Public Health | Year: 2014

The chikungunya epidemic in the Dominican Republic began in February 2014. During the first six months 429 421 cases were recorded, representing 65% of all those notified to the Pan American Health Organization by 33 countries and territories of the Region of the Americas. This epidemic has spread quickly in the Dominican Republic, requiring a focused intersectoral response, led by the Ministry of Public Health and involving major efforts by the National Epidemiological System and the health services network. Given that the virus will affect thousands of people, this article seeks to describe the actions that have already been carried out, and to share the results and lessons learned during these first months with health ministries and professionals in the countries of the Region, in order to assist them to prepare an appropriate response to confront the epidemic effectively and efficiently.

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