Initiative for the elimination of trachoma in the Americas: First year of implementation. Annual report 2023-2024
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Initiative for the elimination of trachoma in the Americas: First year of implementation. Annual report 2023-2024. (2024). [Technical reports]. PAHO. https://iris.paho.org/handle/10665.2/61974
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English; 5 pages
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2024-10-28
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OPS/CDE/VT/24-0016
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The Annual Report 2023-2024 of the Initiative for the Elimination of Trachoma in the Americas presents the key advances made by participating countries. In the region, trachoma remains endemic in Brazil, Colombia, Guatemala, and Peru, affecting approximately 5.6 million people, especially in rural and remote areas, with a disproportionate impact on women and children. Among the most significant outcomes, endemic countries have made progress in implementing the SAFE Strategy (Surgery, Antibiotics, Facial Hygiene, and Environmental Sanitation). Notably, surgical campaigns for the treatment of trachomatous trichiasis have been highlighted. In Mexico, two surgical campaigns were conducted in Chiapas, while in Guatemala and other countries, health personnel were trained in the recommended surgical techniques for trachoma. In the surveillance component, Bolivia, Ecuador, and El Salvador completed their rapid assessment protocols for trachoma. In Brazil, a population-based prevalence survey for trachoma was conducted, which included the assessment of over 3,000 individuals. These surveillance activities were supported by training for disease recognition, allowing for the determination of trachoma presence in various areas. Actions with a focus on cultural diversity and gender were promoted in Guatemala and Bolivia, including training sessions aimed at intercultural dialogues to increase acceptance of interventions. The WASH (Water, Sanitation, and Hygiene) component was fundamental, emphasizing community education and the development of tailored materials to improve hygiene practices. Finally, the report highlights efforts in communication and visibility, which include the implementation of workshops on communication with a gender and intercultural focus, the production of promotional materials, and the creation of a communication plan that integrates actions to be implemented at the country and regional levels. A commitment to effective communication is essential for raising community awareness and promoting behavioral changes that favor the elimination of trachoma. This report reflects the ongoing work and collaboration among countries in the region, non-governmental organizations, and civil society to address the challenge of trachoma. Together, we continue to make strides toward eliminating this disease, promoting health, dignity, and equality for all.
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Item Initiative for the Elimination of Trachoma in the Americas. Second year of implementation: Annual report 2024–2025(PAHO, 2025-11-13)Trachoma is the leading infectious cause of blindness worldwide. In the Americas, PAHO and the Government of Canada are driving its elimination through the Initiative for the Elimination of Trachoma in the Americas, a five-year effort (2023–2027) supported by a CAD$15 million investment benefiting ten countries in the Region. In addition to accelerating progress toward elimination, the Initiative provides comprehensive health care to historically underserved populations. During its second year, epidemiological surveillance was strengthened, and implementation of WHO’s SAFE strategy (Surgery, Antibiotics, Facial cleanliness, and Environmental improvement) advanced. The period from April 2024 to March 2025 saw key progress in gender equity, cultural diversity, water, sanitation and hygiene (WASH) interventions, and health communication efforts. Surgical campaigns were conducted in Colombia, Guatemala, and Mexico, benefiting over 40 individuals with trachomatous trichiasis. In Colombia, a mass drug administration campaign achieved coverage rates above 90% in Indigenous communities in Vaupés. Technical teams were trained in five countries, and rapid assessments and prevalence surveys were carried out in seven nations, strengthening the evidence base for decision-making. The Initiative also integrated broader health services such as cataract surgeries, immunizations, vector control, and telehealth. Gender and intercultural approaches were reinforced through knowledge-sharing dialogues and meetings with community leaders, promoting active participation of women and recognition of traditional practices. Finally, WASH actions and the production of materials in Indigenous languages alongside more than 50 audiovisual and digital resources, enhanced prevention, community engagement, and regional visibility. The Initiative reaffirms its contribution to trachoma elimination and to strengthening public health and equity across the Region.Item Neglected Infectious Diseases Safety Program — delivering community benefits while minimizing harm: Experiences and lessons learned from the Americas(PAHO, 2024-10-18)Neglected infectious diseases (NIDs) affect more than 1 billion people globally, causing serious long-term health effects on the most vulnerable populations. In 2020 the World Health Assembly endorsed a global road map 2021–2030 for tackling neglected tropical diseases that sets targets and milestones as well as cross-cutting targets aligned with the Sustainable Development Goals. To treat infected persons and reduce disease transmission, the World Health Organization (WHO) advocates for a rapid impact intervention: preventive chemotherapy (PC). PC is the administration of safe and effective treatment to a defined population at regular time intervals, regardless of infection status. In the Americas, more than 100 million people suffer from one or more NIDs. Of the people at risk of NIDs in Latin America and the Caribbean, many are receiving safe and effective treatment through mass administration of medications for five diseases: lymphatic filariasis, onchocerciasis, blinding trachoma, soil-transmitted helminthiasis (STH), and schistosomiasis. These medications are donated, while others are procured through the Strategic Fund of the Pan American Health Organization (PAHO) or through the Global Fund to Fight AIDS, Tuberculosis and Malaria. Safety should be assured at every step of the process, from the manufacture of the drugs and assuring their quality and regulatory standards, to shipment and management of drugs in the supply chain, to their administration in the community. A critical condition to success when implementing PC is to “do no harm” while delivering the health services, which relies largely on careful planning, communication, training, monitoring and prompt investigation of serious adverse events (SAEs), and supervision at all levels. In 2021 WHO updated the guidelines and developed training modules for community drug distributors, health workers, and other front-line workers and partners. The modules address key aspects of drug safety, which include management, storage, and packaging of medicines; safe administration of medicines to ensure safety and prevent choking; identification, management, and reporting of adverse events (AEs); and effective communication with communities and health staff. The Fred Hollows Foundation and IZUMI Foundation funded PAHO to implement a two-year project to strengthen safety in administration of medications to eliminate NIDs in the countries of the Americas. Planning and tailoring the educational materials to train different audiences were conducted as a joint effort with the participation of partners from RTI international, Task Force for Global Health, and The Fred Hollows Foundation. This report describes the experience and lessons learned for strengthening regional and national capacities to plan, prepare, and monitor the safe administration of medicines for treatment of NIDs in the endemic countries of the Americas.Item Methodology for Evaluating National Arboviral Disease Prevention and Control Strategies in the Americas(PAHO, 2022)The IMS-Arbovirus is a model that provides a methodological framework for arboviral disease prevention and control. It divides the compendium of actions to be taken into the following components, which are not listed in their order of importance: management, epidemiology (with emphasis on health surveillance), laboratory, patient care (clinical), integrated vector management (IVM), and environment (with emphasis on water, sanitation, and hygiene). It also proposes common crosscutting themes for each component: operations research and health communication and promotion for behavioral change. Each component and crosscutting theme is overseen and executed by personnel trained for this purpose. The Integrated Management Strategy for Arbovirus Disease Prevention and Control in the Americas contains a group of indicators selected by the countries, and a trained professional regularly conducts an informal evaluation of the strategy. This evaluation may be based on what the coordinator for each component or the participants in the process report, often based only on their own experiences. Generically, this methodology attempts to organize ideas and the methodologies that should be followed for best performance in an evaluation. The IMS-Arbovirus currently includes monitoring and evaluation from the outset, thus systematically coordinating its planning, monitoring, and evaluation. The main objective is for monitoring and evaluation to serve as a good mechanism for management, course correction, and accountability to advance and improve the quality and impact of management with the preparation of the IMS Arbovirus. The specific objectives are as follows: determine the progress made and barriers implementing the IMS-Arbovirus, formulate recommendations to improve the IMS-Arbovirus Implementation process, and create a monitoring plan based on the evaluation's results.Item Trachoma elimination in Latin America: prioritization of municipalities for surveillance activities(2019)[ABSTRACT]. Objective. To identify and prioritize municipalities in 22 countries of Latin America for trachoma surveillance activities, to measure the absence or prevalence of trachoma, and to support validation and trachoma elimination efforts in the Region of the Americas. Methods. A prioritization scale was developed in 2017 to rank each municipality by considering a combination of three characteristics: (a) its trachoma vulnerability index, derived from three socioeconomic factors known to be risks for trachoma—lack of access to improved sanitation, to clean drinking water, and to adequate education, according to housing census data from early 2017; (b) its history of trachoma in countries where the disease was not a known public health problem in 2016; and (c) whether or not it shares a border with a municipality where trachoma was a known public health problem in 2016. Municipalities in 22 countries were classified as either very high, high, medium, or low priority for trachoma surveillance. From the Caribbean, only Trinidad and Tobago met inclusion criteria. Results. The prioritization scale identified 1 053 municipalities in Brazil, Colombia, and Guatemala as very high priority for trachoma surveillance. In Ecuador, El Salvador, Guyana, Paraguay, Peru, Suriname, and Venezuela, 183 municipalities were ranked as high priority, and in Argentina, Belize, Bolivia, Chile, Dominican Republic, Honduras, Nicaragua, Panama, and Uruguay, 677 municipalities were designated a medium priority for trachoma surveillance. Conclusions. This prioritization scale will be useful to countries in Latin America that still need to ascertain their current trachoma situation. The absence or prevalence of trachoma in countries designated as very high and high priority for trachoma surveillance activities must be studied to determine the extent of the disease in Latin America.Item Cholera Outbreak in Haiti and Dominican Republic. Situation Report, n.10 (22 December 2022)(PAHO, 2022)In Haiti, as of 20 December 2022, the Department of Epidemiology, Laboratories, and Research (DELR) reports 18,469 suspected cholera cases in all 10 departments of the country since the first cases were reported on 2 October. Of these, 1,380 cases have been confirmed in nine departments, of which 1,024 (74.2%) of were reported in the Ouest Department, followed by 157 in Centre, 60 in Sud Est, and 54 in Artibonite. In Haiti, high levels of insecurity and limited access to populations continue to be major challenges in the response to the cholera outbreak. In Haiti, PAHO/WHO continues to support the Ministry of Health (Ministère de la Santé Publique et de la Population – MSPP) and partners, including: Strategic and technical support for the implementation of the first phase of the cholera vaccination campaign with more than 1,170,000 doses, which began on 18 December in Ouest and Centre Departments. Technical and logistical support to field investigations in all departments, strengthening completeness and quality of data and transportation of samples. Distribution of cholera kits and other essential supplies by air and land to ensure quality management of cases at Cholera Treatment Centers (CTCs) and Oral Rehydration Points (ORPs) in 9 departments. In the Dominican Republic, 6 new cholera cases (all male between 4-49 years old) have been confirmed in Santo Domingo in addition to the 2 imported cases from Haiti reported in October and November, bringing the total number of confirmed cases to 8. PAHO/WHO is providing technical and logistic support to the Ministry of Health in monitoring, investigating, and responding to cholera alerts, including prevention activities through risk communication and community engagement. In Haiti, as of 20 December, a total of 18,469 suspected cholera cases were reported in nine of the ten departments in Haiti, including cases reported in the Civil Prison in Port-au- Prince. Of these, 1,380 were confirmed by the national laboratory, including 324 deaths. To date, nine out of the ten departments that reported suspected cases have confirmed cases (54 in Artibonite, 157 in Centre, 60 in Sud-Est and 1,024 in Ouest). There has been an increase of 22.06% in overall suspected cases and a 6.98% increase in confirmed cases since 15 December (Figure 1). The case fatality rate among suspected cases is 2%. Regarding the 324 deaths reported as of 20 December, there is a 6.58% increase compared to 15 December 2022. The Ouest Department reported a 6.37% increase in suspected cases and a 6.44% increase in confirmed cases since 15 December 2022. However, the other 9 departments reported an average increase of 117.4% in suspected cases and 8.5% in confirmed cases in the same period (Figure 1). The most affected communes in the Ouest Department continue to be Port-au-Prince, Delmas, Cité Soleil, Carrefour, and Pétion-Ville, where the majority of suspected and confirmed cases are reported. Based on MSPP information from 20 December, 57.97% of reported suspected cases are male, 42.03% female and (Figure 2). Among the 1,380 confirmed cases, age groups 1-4 (19.4%) and 30-39 (14.42%) are the most affected. In Haiti, the complex humanitarian and socio-political crisis, with high levels of insecurity, fuel shortages and economic instability continue to impact response capacity. These are some of the main drivers of the cholera epidemic as they limit access to health and basic water and sanitation services, and food and water supplies as well: o Although fuel distribution has restarted in the Ouest Department, availability continues to be limited in other departments, hindering basic water and sanitation services (garbage collection), hindering the response and the distribution of life-saving medicines and supplies. o Lack of access to affected areas due to insecurity continue to hamper epidemiological surveillance, the installation of Oral Rehydration Points (ORP) and Cholera Treatment Centers (CTCs), the transport of patients to CTCs, and health promotion, as well as water, hygiene and sanitation activities at the community level. In the Dominican Republic, the 6 new confirmed cholera cases are all reported from the la Zurza neighborhood in Santo Domingo, which is an area with limited access to safe water in addition to poor hygiene and sanitation conditions. A large proportion of the population in that sector uses water from the river for cooking and bathing, which is one of the factors that increases the risk of cholera transmission among the most vulnerable populations living in these locations. Global cholera crisis generates a high demand for medical and non-medical supplies, including the oral vaccine, resulting in limited cholera commodities for immediate distribution in all affected countries.