Capacidad de respuesta y desafíos del sistema de salud cubano frente a las enfermedades transmisibles

Corcho, Denis Verdasquera; Valle, Isora Ramos; Gutiérrez, Susana Borroto; Castillo, R; Ávila, Lorenzo Jorge Pérez; Berrio, Lázara Alfonso; Cabrera, Pablo León; Parra, Susett Pérez; García, Francisco Alberto Durán

doi:10.26633/rpsp.2018.30

Cited by 6 publications

(7 citation statements)

References 7 publications

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“…All provinces in Cuba shared this same achievement equally by 2003. Despite this achievement, every year there are many reports to the NLCP of leprosy in children [15].…”

Section: Introductionmentioning

confidence: 99%

Leprosy in children in Cuba: Epidemiological and clinical description of 50 cases from 2012–2019

et al. 2021

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Introduction In 1993, Cuba achieved leprosy elimination according to the World Health Organization’s (WHO) indicator of less than one case per 10,000 population. Despite this achievement, detection of new cases occurs every year among all age groups including children. Detection of new cases in children reveals persistent transmission of the infection. Objective To describe the clinical and epidemiological features of leprosy in individuals younger than 15 years (childhood leprosy) reported to the Cuban National Leprosy Control Program (NLCP) between 2012 and 2019. Methods We conducted a retrospective descriptive study between 2012 and 2019 to assess the clinical and epidemiologic features of individuals under the age of 15 years with a confirmed diagnosis of leprosy reported to the NLCP. We reviewed the NLCP database and collected data to better define the total number of cases of leprosy in adults, children (younger than 15 years). We assessed socio-demographic variables (age, gender, and province of residence) as well as variables of clinical interest including operational classification and staging at diagnosis, bacillary index, grade of disability by WHO staging. Additionally, we evaluated epidemiological variables including passive versus active surveillance of cases, contact investigation focusing specifically in household transmission, and the degree of kinship as well as standing of the child within the focus of transmission when there were additional cases. Results We identified fifty children during the study period corresponding to 3% of the overall cases of leprosy comprising all age groups in Cuba. In the age group younger than 15 years, the majorities of cases was from the Granma province and most were between the ages of 10 and 14 years. Clinically, multibacillary/lepromatous forms were the most common type identified with positive bacillary index. The majority of children diagnosed with leprosy during our study period had a history of a relative with a confirmed diagnosis of leprosy. Conclusions Detection of cases of leprosy in individuals younger than 15 years of age in Cuba demonstrates ongoing transmission of M. leprae in specific geographic hotspots. Its frequency in the early adolescence, the predominant clinical forms, and the mode of detection associated with sources of suspected familiar infection demonstrated that there is a need for further efforts by the NLCP to conduct active surveillance activities among affected communities to identify cases of leprosy earlier with the goal of preventing further household and community transmission.

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“…All provinces in Cuba shared this same achievement equally by 2003. Despite this achievement, every year there are many reports to the NLCP of leprosy in children [15].…”

Section: Introductionmentioning

confidence: 99%

Leprosy in children in Cuba: Epidemiological and clinical description of 50 cases from 2012–2019

et al. 2021

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“…This was supported by the use of an epidemiological surveillance system (which tracks the location and contacts of potential vectors of communicable diseases) in place throughout the country for many years before the appearance of COVID-19. [7,16] This explains why 54% of confi rmed cases were either in asymptomatic or presymptomatic stages at the time of their confi rmation, and the share of asymptomatic cases continued to increase as the epidemic evolved, reaching close to 70% in the fi nal weeks of the 110-day period.…”

Section: Confronting Covid-19: Cuban Strategies and Resultsmentioning

confidence: 99%

COVID-19 in Cuba: Assessing the National Response

2020

MEDICC Review

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The COVID-19 pandemic exhibits different characteristics in each country, related to the extent of SARS-CoV-2 local transmission, as well as the speed and effectiveness of epidemic response implemented by authorities. This study presents a descriptive epidemiological analysis of the daily and cumulative incidence of confi rmed cases and deaths in Cuba from COVID-19 in the fi rst 110 days after fi rst-case confi rmation on March 11, 2020. During this period, 2340 cases (20.7 x 100,000 population) were confi rmed, of which 86 patients died (case fatality 3.67%; 52 men and 34 women). Mean age of the deceased was 73.6 years (with a minimum of 35 years and a maximum of 101), with the average age of men lower than that of women. More than 70% of all deceased had associated noncommunicable diseases. The incidence curve ascended for fi ve weeks and then descended steadily. The average number of confi rmed cases and deaths for the last week included (June 23-28, 2020) were 25 and 1 respectively; the curve always moved within the most favorable forecast zone of available mathematical models and the effective reproductive number fell below 1 after the fi fth week following the onset of the epidemic.We present the prevention and control measures implemented during this period-some unique to Cuba-and assess their effectiveness using two analytical tools: comparison of observed deaths and confi rmed cases with those predicted by mathematical models; and estimation of the effective reproductive rate of SARS-CoV-2. Some distinctive features of this strategy include nationwide door-to-door active screening for individuals with fever and/or symptoms of respiratory distress, isolation of cases and quarantine of contacts of confi rmed cases and of persons suspected of having the virus. During this period, Cuba's response to the epidemic was successful in fl attening the curve and limiting transmission, resulting in fewer cases and a lower number of subsequent deaths.

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“…Cuba's approach adheres to these principles, although the multisector comprehensive intervention strategy still needs reinforcement. [17,18] Limitations associated with an antiquated housing stock deteriorated by extreme weather events; population growth and aging; internal migration to urban areas; and other local problems still need to be addressed. [16,17] Pillar 1 The ¿ rst pillar of the End TB Strategy is patient-centered prevention and care with these key components: early diagnosis; treatment of all people with TB; treatment of people at risk and vaccination against TB; and collaboration between TB and HIV programs, aimed at simultaneously addressing the risks of both diseases.…”

Section: Perspective Peer Reviewedmentioning

confidence: 99%

“…[4,27] Elimination of vertical transmission of HIV in Cuba was WHO-certi¿ ed in 2015. [18] In 1986-2016, fewer than 200 childhood cases were reported [28] with 8 children aged <15 years of a total of 692 cases nationwide (1.2%). No cases of coinfection in children aged <15 years have been reported since 1999.…”

Section: Perspective Peer Reviewedmentioning

confidence: 99%

“…[35] When a person with latent or active infection is identi-¿ ed, the health team determines and prescribes full treatment, adjusting the dose to that person's needs, and the family doctor takes charge of administering and monitoring the prescribed treatment. [4] Engagement of communities, civil society organizations During the 2009-2013 PNCT enhancement project, ¿ nanced by the Global Fund to Fight AIDS, Tuberculosis and Malaria, [6,18] special attention was given to training facilitators and engaging the public in activities aimed at TB prevention and early detection. Student…”

Section: Perspective Peer Reviewedmentioning

confidence: 99%

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The Challenge of Eliminating Childhood Tuberculosis in Cuba

Abreu-Suárez¹,

González-Valdés²,

E³

et al. 2019

MEDICC Rev

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WHO's 2015 End Tuberculosis Strategy can succeed only through universal health coverage, social protection, poverty alleviation and effective multisector actions to tackle social determinants in general. The pediatric age group is particularly vulnerable to tuberculosis and historically neglected worldwide. However, this group is a priority within Cuba's National Tuberculosis Control Program that has functioned since 1970, and Cuba is considered a low-incidence country with rates <7 per 100,000 population since 2011. Tuberculosis incidence in children aged <15 years is <1 per 100,000, similar to that reported in high-income countries and representing less than 2% of total cases in Cuba. Since 1999, no deaths from tuberculosis, coinfection with HIV or resistance to the two first-line TB drugs have been reported in affected children, and most diagnosed cases correspond to early, primary forms of the disease. These results place Cuba among the countries on track to eliminate TB by 2050. This article reviews the pillars and components of the 2015 End TB Strategy and the strategies developed by the National Tuberculosis Control Program that enabled Cuba to bring incidence below the 2035 targets of WHO's End TB strategy. The article also proposes other actions Cuba can take, despite limited resources, to eliminate TB, particularly in the pediatric age group. KEYWORDS Tuberculosis, communicable disease control, disease control programs, preventive health services, child health, World Health Organization, Cuba THE AUTHORS

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Capacidad de respuesta y desafíos del sistema de salud cubano frente a las enfermedades transmisibles

Cited by 6 publications

References 7 publications

Leprosy in children in Cuba: Epidemiological and clinical description of 50 cases from 2012–2019

Leprosy in children in Cuba: Epidemiological and clinical description of 50 cases from 2012–2019

COVID-19 in Cuba: Assessing the National Response

The Challenge of Eliminating Childhood Tuberculosis in Cuba

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