In recent years Venezuela has faced a severe economic crisis precipitated by political instability and a significant reduction in oil revenue. Public health provision has suffered particularly. Long-term shortages of medicines and medical supplies and an exodus of trained personnel have occurred against the backdrop of a surge in vector-borne parasitic and arboviral infections. Herein, we aim to assess comprehensively the impact of Venezuela's healthcare crisis on vectorborne diseases and the spillover to neighbouring countries. Methods Alongside the ongoing challenges affecting the healthcare system, health-indicator statistics have become increasingly scarce. Official data from the Ministry of Health, for example, are no longer available. To provide and update on vector-borne disease in Venezuela, this study used individualized data from nongovernmental organizations, academic institutions and professional colleges, various local health authorities and epidemiological surveillance programs from neighbouring countries, as well as data available through international agencies. Findings Between 2000-2015 Venezuela witnessed a 365% increase malaria cases followed by a 68% increase (319,765 cases) in late 2017. Neighbouring countries such as Brazil have reported an escalating trend of imported cases from Venezuelan from 1,538 (2014) to 3,129 (2017). Active Chagas disease transmission is reported with seroprevalence in children (<10 years) as high as 12.5% in one community tested (N=64). There has been a nine-fold rise in the mean incidence of dengue between 1990 to 2016. Estimated rates of chikungunya and Zika are 6,975 and 2,057 cases per 100,000 population, respectively, during their epidemic peaks. Interpretation The re-emergence of many arthropod-borne endemic diseases has set in place an epidemic of unprecedented proportions, not only in Venezuela but in the region. Data presented here demonstrates the complex determinants of this situation. National, regional and global authorities must take action to address these worsening epidemics and prevent their expansion beyond Venezuelan borders.

IntroductionCommunity-wide administration of antibiotics is one arm of a four-pronged strategy in the global initiative to eliminate blindness due to trachoma. The potential impact of more efficient, targeted treatment of infected households depends on the relative contribution of community and household transmission of infection, which have not previously been estimated.MethodsA mathematical model of the household transmission of ocular Chlamydia trachomatis was fit to detailed demographic and prevalence data from four endemic populations in The Gambia and Tanzania. Maximum likelihood estimates of the household and community transmission coefficients were obtained.ResultsThe estimated household transmission coefficient exceeded both the community transmission coefficient and the rate of clearance of infection by individuals in three of the four populations, allowing persistent transmission of infection within households. In all populations, individuals in larger households contributed more to the incidence of infection than those in smaller households.DiscussionTransmission of ocular C. trachomatis infection within households is typically very efficient. Failure to treat all infected members of a household during mass administration of antibiotics is likely to result in rapid re-infection of that household, followed by more gradual spread across the community. The feasibility and effectiveness of household targeted strategies should be explored.

BackgroundMass drug administration (MDA) is part of the current trachoma control strategy, but it can be costly and results in many uninfected individuals receiving treatment. Here we explore whether alternative, targeted approaches are effective antibiotic-sparing strategies.Methodology/Principal FindingsWe analysed data on the prevalence of ocular infection with Chlamydia trachomatis and of active trachoma disease among 4,436 individuals from two communities in The Gambia (West Africa) and two communities in Tanzania (East Africa). An age- and household-structured mathematical model of transmission was fitted to these data using maximum likelihood. The presence of active inflammatory disease as a marker of infection in a household was, in general, significantly more sensitive (between 79% [95%CI: 60%–92%] and 86% [71%–95%] across the four communities) than as a marker of infection in an individual (24% [16%–33%]–66% [56%–76%]). Model simulations, under the best fit models for each community, showed that targeting treatment to households has the potential to be as effective as and significantly more cost-effective than mass treatment when antibiotics are not donated. The cost (2007US$) per incident infection averted ranged from 1.5 to 3.1 for MDA, from 1.0 to 1.7 for household-targeted treatment assuming equivalent coverage, and from 0.4 to 1.7 if household visits increased treatment coverage to 100% in selected households. Assuming antibiotics were donated, MDA was predicted to be more cost-effective unless opportunity costs incurred by individuals collecting antibiotics were included or household visits improved treatment uptake. Limiting MDA to children was not as effective in reducing infection as the other aforementioned distribution strategies.Conclusions/SignificanceOur model suggests that targeting antibiotics to households with active trachoma has the potential to be a cost-effective trachoma control measure, but further work is required to assess if costs can be reduced and to what extent the approach can increase the treatment coverage of infected individuals compared to MDA in different settings.

There is a multiplicity of journals originating in Spain and the Spanish-speaking countries of Latin America and the Caribbean (SSLAC) in the health sciences of relevance to the fields of epidemiology and public health. While the subject matter of epidemiology in Spain shares many features with its neighbours in Western Europe, many aspects of epidemiology in Latin America are particular to that region. There are also distinctive theoretical and philosophical approaches to the study of epidemiology and public health arising from traditions such as the Latin American social medicine movement, of which there may be limited awareness. A number of online bibliographic databases are available which focus primarily on health sciences literature arising in Spain and Latin America, the most prominent being Literatura Latinoamericana en Ciencias de la Salud (LILACS) and LATINDEX. Some such as LILACS also extensively index grey literature. As well as in Spanish, interfaces are provided in English and Portuguese. Abstracts of articles may also be provided in English with an increasing number of journals beginning to publish entire articles written in English. Free full text articles are becoming accessible, one of the most comprehensive sources being the Scientific Electronic Library Online (SciELO). There is thus an extensive range of literature originating in Spain and SSLAC freely identifiable and often accessible online, and with the potential to provide useful inputs to the study of epidemiology and public health provided that any reluctance to explore these resources can be overcome. In this article we provide an introduction to such resources.

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