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26/03/2019

Venezuela crisis affects its neighboring countries


Marlúcia Seixas de Almeida (Fiocruz Amazônia)

More than a political and economic crisis, Venezuela is facing other problems that have an impact, not only in the country, but also in the public health of neighboring countries, especially regarding vector-borne diseases.

In Brazil, an increase in imported cases of malaria from Venezuela has already been seen, rising from 1,538 (in 2014) to 3,129 (in 2017). In addition to malaria, Chagas disease, dengue, Chikungunya and Zika, among others transmitted by vectors, represent a public health crisis, not only in Venezuela, but which has already reached neighboring countries and has seriously affected their efforts to eliminate these diseases.

A study published on February in the scientific journal The Lancet Infectious Diseases, entitled Venezuela's humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region, emphasizes the need for measures to address epidemics and strategically prevent the spread of vector-borne and infectious diseases beyond borders.

Another point that has been affected by the Venezuelan crisis is the work of collecting data by that country's health surveillance, which, last year, resulted in the closure of the Epidemiology and Vital Statistics Division of the Venezuelan Center for Disease Classification, which provided the Pan American Health Organization (PAHO/WHO) with updated indicators on morbidity and mortality.

According to Sérgio Luz, a researcher at the Instituto Leônidas & Maria Deane (ILMD/Fiocruz Amazônia) and one of the authors of the study, the report published exemplifies what has already been identified by researchers at Fiocruz Amazônia: the need to create an epidemiological surveillance system, with a network of reference laboratories supported to deal with these situations.

"Aedes aegypti was reintroduced into Brazil on the Roraima border in the late 1960s, after Brazil received the WHO certificate for mosquito eradication in 1958. Similarly, some dengue serotypes appeared in this region. In addition, we have now seen the reappearance of measles, diphtheria, and an exponential increase in malaria. In another region, in the municipality of Tabatinga (AM), on the three-way border with Peru and Colombia, we saw cholera enter, which had a great epidemic power in Brazil. Now, with the confirmation of the crisis in Venezuela, which has affected the health service in that country, we are sure that an organized epidemiological surveillance system needs to be created to respond to all these problems”, the researcher said.

Malaria and other diseases

Venezuela was the leader in vector control and public health policies in Latin America in 1961, and was the first country certified by the World Health Organization for eliminating malaria in most of its territory. However, in 2016, the country accounted for 34.4% of total reported cases worldwide (240,613). That number rose 71% in 2017.

The incidence of malaria in Venezuela has increased since 2000 but has intensified since 2010. The causes for this increase are also due to the deforestation and illegal mining activities that expose human populations that migrate from different regions of the country to mining areas in search of economic opportunities.

It is worth mentioning that this sharp increase in the burden that malaria has on Venezuela and the mass exit of its citizens directly affect neighboring countries, particularly Brazil and Colombia. In addition to malaria, Chagas disease, caused by Trypanosoma cruzi, that is in many Venezuelan states and in the Andes, has not been receiving attention from the authorities since 2012, when surveillance and control of the transmission of Chagas disease were abandoned in the country.

Investigators are also concerned about Leishmaniasis (Leishmania spp, transmitted by the bite of infected sandflies), viruses transmitted by arthropod vectors (arbovirus) such as Dengue, Chikungunya and Zika, and the return of measles and other infectious diseases that are preventable by vaccination.

Researchers suggest collaboration at an operational level, strengthening surveillance, training staff, and effective educational measures to prevent these diseases from spreading and causing damage across borders.

The study also had repercussions in The Telegraph News, in the article entitled Venezuela compared to war zone as number of malaria cases rocket, and in The Guardian, saying Venezuela crisis threatens disease epidemic across continent.

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