Natalia Cediel

Setting priorities for surveillance, prevention, and control of zoonoses in Bogotá, Colombia

OBJECTIVE To establish priorities for zoonoses surveillance, prevention, and control in Bogotá, Colombia. METHODS A Delphi panel of experts in veterinary and human medicine was conducted using a validated prioritization method to assess the importance of 32 selected zoonoses. This exercise was complemented by a questionnaire survey, using the knowledge, attitudes, and practices (KAP) methodology, administered in 19 districts of Bogotá from September 2009 to April 2010 to an at-risk population (workers at veterinary clinics; pet shops; butcher shops; and traditional food markets that sell poultry, meat, cheese, and eggs). A risk indicator based on level of knowledge about zoonoses was constructed using categorical principal component and logistic regression analyses. RESULTS Twelve experts participated in the Delphi panel. The diseases scored as highest priority were: influenza A(H1N1), salmonellosis, Escherichia coli infection, leptospirosis, and rabies. The diseases scored as lowest priority were: ancylostomiasis, scabies, ringworm, and trichinellosis. A total of 535 questionnaires were collected and analyzed. Respondents claimed to have had scabies (21%), fungi (8%), brucellosis (8%), and pulicosis (8%). Workers with the most limited knowledge on zoonoses and therefore the highest health risk were those who 1) did not have a professional education, 2) had limited or no zoonoses prevention training, and 3) worked in Usme, Bosa, or Ciudad Bolívar districts. CONCLUSIONS According to the experts, influenza A(H1N1) was the most important zoonoses. Rabies, leptospirosis, brucellosis, and toxoplasmosis were identified as priority diseases by both the experts and the exposed workers. This is the first prioritization exercise focused on zoonoses surveillance, prevention, and control in Colombia. These results could be used to guide decision-making for resource allocation in public health.

Impacto epidemiológico y económico de la vacunación contra el tétanos en adultos de Colombia

OBJECTIVE Assess the potential epidemiological and economic impact of vaccinating the over-15 Colombian population against tetanus with a booster dose every 10 years. METHODS A cost-effectiveness analysis of tetanus vaccination with a booster dose every 10 years was conducted in Colombia and compared with the current strategy (2, 4, 6, 18, and 60 months). Estimates of the burden of disease were based on three official data sources. A Markov model from the perspective of the third party payer was developed. The time horizon was the lifetime of a person. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS In Colombia, 30 to 48 cases of tetanus resulting in 9.6 to 10.1 deaths are reported each year. Although booster vaccination for the entire population was cost-effective (the cost per disability-adjusted life year [DALY] avoided was US

The epidemiology of canine rabies in Colombia

11,314 in the entire population), gender-based differentiation of the results showed that it would not be cost-effective in women (cost per DALY avoided was US

Las redes SAPUVET y SPVet: un modelo de integración en materia de salud pública veterinaria entre Europa y América Latina

4,903 in men and US

Epidemiología de la rabia canina en Colombia

22,332 in women). CONCLUSIONS This is the first study that evaluates the cost-effectiveness of a tetanus vaccine booster dose every 10 years in a developing country. Use of this measure would be cost-effective in Colombia, especially for men. As a result of the gender-based differences in the results, any decision about its use in women of childbearing age should take current vaccination into account.

New Approaches for Education and Training in Veterinary Public Health: The SAPUVET Projects

Objetivo Se realizo un estudio epidemiologico ecologico para describir la tendencia de la rabia canina desde 1976-2006 y explorar posibles factores relacionados con su presentacion en Colombia. Metodologia Las variables fueron recolectadas mediante un cuestionario aplicado a los responsables del programa en cada departamento y mediante fuentes de informacion oficiales nacionales. Se calculo la incidencia de la rabia canina entre 2001-2006. Se emplearon razones de tasas de incidencia y pruebas de correlacion de Spearman. Resultados La tasa de incidencia de rabia canina estimada es de 0,4 casos de rabia por 100 000 perros-ano. El promedio de las coberturas de vacunacion nacionales 1994-2005 fluctuo entre 45 % y 63 %. Las principales asociaciones con rabia canina fueron: mayor porcentaje de la poblacion urbana, mayores coberturas de vacunacion, ausencia de red de frio propia, no participacion del coordinador en el Comite Vigilancia Epidemiologica, ausencia de mapa epidemiologico, ausencia de laboratorio diagnostico, ausencia de recurso humano adecuado, ausencia de centro de zoonosis, periodicidad del analisis de situacion epidemiologica, expulsion de poblacion humana por violencia. Conclusiones La rabia canina se ha controlado exitosamente, sin embargo es importante fortalecer el sistema de vigilancia epidemiologica activa para ratificar el descenso de la enfermedad. Los resultados encontrados permiten referir que en ausencia de las variables significativas encontradas se espera que ocurran casi la mitad de los casos en la poblacion. Se sugiere tambien que la situacion de violencia del pais puede estar influyendo en la relacion hombre-perro-reservorios silvestres y ocurrencia de la rabia.

Is Colombia reaching the goals on infant immunization coverage? A quantitative survey from 80 municipalities

This paper underscores the need for animal health professionals to play a more significant role in the sphere of public health, particularly during natural disasters and other emergency situations which can reduce the availability of safe foods from animal sources. In order to help readers understand the importance of the emerging field of veterinary public health (VPH), the authors review the importance and current status of VPH in different countries and assess the role that veterinarians can play in overcoming situations that threaten human health. The last section discusses the need for training veterinarians in VPH and the important role that veterinarians can play within international public health organizations and multidisciplinary groups, such as SAPUVET and SPVet networks.

Evaluación del impacto de la vacuna contra rotavirus en Colombia usando métodos rápidos de evaluación

Objetivo Se realizo un estudio epidemiologico ecologico para describir la tendencia de la rabia canina desde 1976-2006 y explorar posibles factores relacionados con su presentacion en Colombia. Metodologia Las variables fueron recolectadas mediante un cuestionario aplicado a los responsables del programa en cada departamento y mediante fuentes de informacion oficiales nacionales. Se calculo la incidencia de la rabia canina entre 2001-2006. Se emplearon razones de tasas de incidencia y pruebas de correlacion de Spearman. Resultados La tasa de incidencia de rabia canina estimada es de 0,4 casos de rabia por 100 000 perros-ano. El promedio de las coberturas de vacunacion nacionales 1994-2005 fluctuo entre 45 % y 63 %. Las principales asociaciones con rabia canina fueron: mayor porcentaje de la poblacion urbana, mayores coberturas de vacunacion, ausencia de red de frio propia, no participacion del coordinador en el Comite Vigilancia Epidemiologica, ausencia de mapa epidemiologico, ausencia de laboratorio diagnostico, ausencia de recurso humano adecuado, ausencia de centro de zoonosis, periodicidad del analisis de situacion epidemiologica, expulsion de poblacion humana por violencia. Conclusiones La rabia canina se ha controlado exitosamente, sin embargo es importante fortalecer el sistema de vigilancia epidemiologica activa para ratificar el descenso de la enfermedad. Los resultados encontrados permiten referir que en ausencia de las variables significativas encontradas se espera que ocurran casi la mitad de los casos en la poblacion. Se sugiere tambien que la situacion de violencia del pais puede estar influyendo en la relacion hombre-perro-reservorios silvestres y ocurrencia de la rabia.

Risk perception about zoonoses in immigrants and Italian workers in Northwestern Italy

Continued contact between humans and animals, in combination with the ever-increasing movement of human and animal populations that is one effect of globalization, contributes to the spread of diseases, often with detrimental effects on public health. This has led professionals involved in both animal health and public health to recognize veterinary public health (VPH) as a key area for their activities to address the human-animal interface. Veterinarians, a profession with major involvement in this field, are in need of specific knowledge and skills to prevent and control public-health problems. As a result, VPH must be directly integrated into veterinary educational programs. At present, only few veterinary schools have specific VPH programs; in most institutions, VPH does not feature as a specific subject in either undergraduate or post-graduate curricula. SAPUVET and SAPUVETNET II are network projects supported by the ALFA program of the European Union (EU). Their main objectives are to reach a common understanding between European and Latin American universities in the definition of the areas in which VPH is important in their respective countries, and to design a harmonized training program for veterinarians in VPH, by making use of new technological applications and innovative teaching methodologies. The elaboration of educational material in combination with case studies presenting real-life problems provides a basis to apply the knowledge acquired on VPH. It is envisaged that the material and modules developed during the two projects will be integrated into the veterinary curricula of the participating universities, as well as in other partner organizations.

Experiencias en la Enseñanza de la Salud Publica Veterinaria entre Latino América y Europa: el Proyecto SAPUVETNET II

OBJECTIVES This study aimed to evaluate the coverage of the Colombian Expanded Program on Immunization among children less than 6years old, to evaluate the timeliness of immunization, to assess the coverage of newly introduced vaccines, and to identify factors associated with lack of immunization. METHODS We conducted a cross-sectional survey in 80 municipalities of Colombia, using a two-stage cluster random sampling. We attempted to contact all children less than 6years old living in the sampled blocks, and asked their caregivers to provide immunization record cards. We also collected basic sociodemographic information. RESULTS We reached 81% of the attempted household contacts, identifying 18,232 children; of them, 14,805 (83%) had an immunization record card. Coverage for traditional vaccines was above 90%: BCG (tuberculosis) 95.7% (95%CI: 95.1-96.4), pentavalent vaccine 93.3% (92.4-94.3), MMR (measles, mumps, rubella) initial dose 94.5% (93.5-95.6); but it was lower for recently introduced vaccines: rotavirus 80% (77.8-82.1), influenza 48.4% (45.9-50.8). Results for timely vaccination were not equally successful: pentavalent vaccine 44.2% (41.4-47.1), MMR initial dose 71.2% (68.9-73.4). Mothers education was significantly associated with higher immunization odds. Older age, a greater number of siblings, low socioeconomic status, and not having health insurance were significantly associated with lower immunization odds. There was significant heterogeneity in immunization rates by municipality across the country. CONCLUSIONS Although absolute immunization coverage for traditional vaccines met the goal of 90% for the 80 municipalities combined, disparities in coverage across municipalities, delayed immunization, and decline of coverage with age, are common problems in Colombia that may result in reduced protection. Newly introduced vaccines require additional efforts to reach the goal. These results highlight the association of health inequities with low immunization coverage and delayed immunization. Identification of vulnerable populations and their missed opportunities for vaccination may help to improve the reach of immunization programs.