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Objective. To compare the performance of polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) tests for diagnosing Echinococcus granulosus in dog feces among national reference laboratories in Argentina, Chile, Peru, and Uruguay. Methods. National laboratories affiliated with the Ministry of Health/Agriculture of each country exchanged panels of 10 positive/negative samples obtained from their regular national surveillance programs in November 2015 – November 2016. All laboratories applied PCR; two also applied ELISA techniques. Sensitivity and specificity were determined for each laboratory and concordance of results among the laboratories was evaluated by Cohen Kappa coefficient. Results. Poor concordance (3 of 10 paired comparisons had values of Kappa > 0.4), low sensitivity and specificity across all laboratories, and poor performance of both techniques in detecting E. granulosus in canine feces was demonstrated in this study. An ex-post comparison of the laboratories’ test protocols showed substantial heterogeneity that could partially explain poor concordance of results. Conclusion. The results underscore the heterogeneity of canine echinococcosis diagnosis across the region and indicate possible sources of variability. Efforts to standardize canine echinococcosis testing must be included in the plan of action for the Regional Initiative for the Control of Cystic Echinococcosis. Future comparisons with fecal samples of known parasite load are needed.

This study investigates the historical temporal trend and geographical distribution of the foot-and-mouth disease virus (FMDv) serotype C in South America; discussing the findings within the context of the actions and strategies carried out for the elimination of foot-and-mouth disease (FMD). This is the first time that such a comprehensive historical compilation has been carried out in the Region; hence, the study is intended as a reference and source of evidence about the presence/absence of FMDv serotype C in South America. Data on the occurrence of FMD were sourced from the Weekly Epidemiological Reports submitted by the countries to Pan American Foot-and-Mouth Disease Center (PANAFTOSA-PAHO/WHO) since 1972, and complemented with other sources of information from the 1968-1971 period. The temporal distribution was examined with local weighted regression (LOESS) to identify two temporal trends, that is, "smoothed" and "over-adjusted", utilising the time-series with the total number of cases per year, at Regional level. Thereafter the outbreaks were aggregated by decades and mapped by the first subnational administrative level. As a result, two major peaks of occurrence were identified, one in the 70s, with up to 1,193 outbreaks, and another in the 80s, with 380. Overall, the investigations show a clear regressive trend in the occurrence of serotype C, with a reduction in the number of outbreaks over-time, and with the subsequent reduction of affected locations. This study illustrates the contrast between the very limited presence over the last 20 years - with only one event in 2004 - and the epidemic situation in the 1970s and 1980s, and suggests that serotype C of FMDv is no longer present in the Region.

Objetivo. Determinar y caracterizar áreas de riesgo potencial de la ocurrencia de leishmaniasis cutánea (LC) en América Latina (AL).Método. Estudio observacional ecológico con unidades de observación definidas por municipios con transmisión de LC entre 2014-2018. Se utilizaron variables medioambientales y socioeconómicas disponibles para al menos 85% de los municipios, combinados en una sola base de datos, a través del software R. Se combinó la metodología de análisis de componentes principales con un análisis de conglomerados jerárquicos parala formación de conglomerados de municipios en función de su similitud. Se estimó el V-test para definir la asociación positiva o negativa de las variables con los conglomerados y separación por divisiones naturales para determinar cuáles contribuyeron más a cada conglomerado. Se incorporaron los casos para atribuir el riesgo de LC para cada conglomerado.Resultados. Se incluyeron en el estudio 4 951 municipios con transmisión de LC (36,5% del total en AL) y se definieron siete conglomerados por su asociación con 18 variables medioambientales y socioeconómicas. El riesgo histórico de LC se asocia de manera positiva y en forma decreciente con los conglomerados Amazónico, Andino y Sabana; y de manera negativa con los conglomerados Boscoso/perenne, Boscoso/cultivo y Boscoso/poblado. El conglomerado Agrícola no reveló ninguna asociación con los casos de LC.Conclusiones. El estudio permitió identificar y caracterizar el riesgo de LC por conglomerados de municipios y conocer el patrón propio epidemiológico de distribución de la transmisión, lo que proporciona a los gestores una mejor información para las intervenciones intersectoriales para el control de la LC. Objective. Determine and characterize areas at potential risk for the occurrence of cutaneous leishmaniasis (CL) in Latin America. Method. Ecological observational study with observation units defined by municipalities with CL transmission during 2014-2018. Environmental and socioeconomic variables available for at least 85% of municipalities were combined in a single database, using R software. Principal component analysis was combined with hierarchical cluster analysis for the formation of clusters of municipalities according to their similarity. The V-test was used to define positive or negative association of variables with clusters and separation by natural divisions to determine which contributed more to each cluster. Cases were included to attribute CL risk for each cluster. Results. The study included 4 951 municipalities with CL transmission (36.5% of municipalities in Latin America); seven clusters were defined by their association with 18 environmental and socioeconomic variables. Historical risk of CL is associated positively and in descending order with the Amazonian, Andean, and Savanna clusters; and negatively with the Forest/perennial, Forest/cultivated, and Forest/populated clusters. The Agricultural cluster showed no association with CL cases. Conclusions. The study made it possible to identify and characterize CL risk by clusters of municipalities and to understand the characteristic epidemiological distribution patterns of transmission, providing program managers with better information for intersectoral interventions to control CL. Objetivo. Determinar e caracterizar as áreas de risco de ocorrência de leishmaniose cutânea na América Latina. Método. Estudo observacional ecológico com unidades de observação definidas por municípios com transmissão de leishmaniose cutânea entre 2014 e 2018. Foram usadas as variáveis ambientais e socioeconômicas disponíveis em 85% ou mais dos municípios, reunidas em uma única base de dados com o uso do software R. A metodologia de análise de componentes principais foi combinada a uma análise de conglomerados com agrupamento hierárquico para formar conglomerados de municípios por semelhança. O teste V foi usado para estabelecer a associação (positiva ou negativa) das variáveis com os conglomerados e uma separação por divisões naturais foi usada para determinar as variáveis que mais contribuíram em cada conglomerado. Os casos foram incluídos para avaliar o risco de leishmaniose cutânea em cada conglomerado. Resultados. A amostra do estudo compreendeu 4.951 municípios com transmissão de leishmaniose cutânea (36,5% do total na América Latina). Foram definidos sete conglomerados por apresentarem associação com 18 variáveis ambientais e socioeconômicas. Foi observada associação positiva e decrescente do risco histórico de leishmaniose cutânea com os conglomerados Amazônico, Andino e Savana e negativa com os conglomerados Mata/perene, Mata/cultivo e Mata/povoado. O conglomerado Agrícola não demonstrou associação com casos de leishmaniose cutânea. Conclusões. Este estudo permitiu identificar e caracterizar o risco de leishmaniose cutânea por conglomerados de municípios e conhecer o padrão epidemiológico de distribuição da transmissão da doença, oferecendo às autoridades dados melhores para subsidiar as intervenções intersetoriais para o controle da leishmaniose cutânea. Fil: Maia Elkhoury, Ana Nilce S.. Organización Panamericana de la Salud; Estados Unidos Fil: Magalhães Lima, Daniel. Centro Panamericano de Fiebre Aftosa; Brasil Fil: Salomón, Oscar Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste; Argentina. Administración Nacional de Laboratorios e Institutos de Salud "Dr. Carlos G. Malbrán". Instituto Nacional de Medicina Tropical; Argentina Fil: Buzanovsky, Lia Puppim. Centro Panamericano de Fiebre Aftosa; Brasil Fil: Saboyá Díaz, Martha Idalí. Organización Panamericana de la Salud; Estados Unidos Fil: Valadas, Samantha Y.O.B.. Organización Panamericana de la Salud (ops); Estados Unidos Fil: Sanchez Vazquez, Manuel J.. Centro Panamericano de Fiebre Aftosa; Brasil

The Region of Central and South America represents an eclectic scenery with regards to its economic and social indicators and its ecological and geographical range. This is a Region with a vast wildlife diversity, which also holds the largest livestock producing and exporting countries. In this context, many opportunities for interaction at the wildlife–livestock interface arise, enabling the occurrence of important infectious diseases.

Cutaneous leishmaniasis (CL) is a zoonotic disease with complex transmission cycle. Some environmental and socioeconomic factors are known to be the major determinants of the transmission process, which are involved in configuring the spatiotemporal patterns and thus can be delimiting. However, the relevance of these socioeconomic and environmental determinants is still not well understood. In this study, we aimed to identify the major environmental and socioeconomic determinants of CL in Brazil by articulating a systematic literature review of studies that are based on this subject. The methodology included a search for studies according to a structured protocol using the scientific platforms, such as Scielo and PubMed. The references of each identified article were who referred to CL determinants were further screened, and so on. We extracted information from 41 articles and the determinants were grouped accordingly. Two measures were evaluated as follows: a) the frequency of citations of the determinants; and b) the proportion of determinants identified as having "significant association in analytical studies" with respect to the total number of determinants analyzed in other analytical studies using the same concept. The analyzed articles covered most of the regions of Brazil and 7 other countries bordering Brazil. We found 43 concepts of determinants. However, the final selection resulted in the identification of 14 major determinants. These results therefore contribute in the identification of major CL determinants and this information can be used to establish strategies for identifying risk prone areas for disease surveillance.

Background Visceral Leishmaniasis (VL) is the most severe form of leishmaniasis because it can lead to death. In the Americas, 96% of cases are in Brazil, and despite efforts, the fatality rate has increased in the past years. We analyzed deaths associated to VL in Brazil and investigated the factors that could influence on the timeliness of fatal outcome with emphasis on time (tStoD). Methodology The registered deaths by VL were sourced from the Brazilian National Notification System from 2007–2014. Through a retrospective cohort study, univariate and multivariable Cox proportional hazards model analysis were performed and investigated the factors that could influence the time (tStoD). These factors were analyzed through survival models. Results Out of the 1,589 reported deaths, the median for onset of the symptoms and the case notification date (tStoN) is 25 days (10–61), and for date of case notification and death (tNotD) is 9 days (4–17). The time (tStoN) to event investigation for HIV non-infected individuals was 1.4 (1.16–1.68) greater than the HIV positive group. At the same time peri-urban and urban area were 0.83 (0.47–1.44) and 1.33 (1.16–1.52), respectively. The explorations revealed apparent differences between the time to event investigation (both for tStoN and tNotD) and the age at the onset of the symptoms. According to the tStoN the rate of notification is 1.73 times greater in patients under 5 years old at the onset of the clinical symptoms compared to older patients. Conclusion VL patients under 5 years old were diagnosed earlier and had shorter survival. It could mean that in younger population, although properly diagnosed, the fatality pattern might be related to the severity of the disease. Main host characteristics were evaluated, and age and co-infections seem to have an impact in the disease progression., Author summary Visceral Leishmaniasis (VL) is present worldwide, affecting mainly economically vulnerable populations in over 80 countries. In the Americas, Brazil accounts for approximately 96% of the cases. VL as one of the most relevant endemic neglected diseases in the world, due to its incidence and high fatality, which is generally reported among untreated individuals, and its emerging pattern in human immunodeficiency virus (HIV) infected individuals. Despite the increasing knowledge on prognostic factors, incorporation of new diagnostic tools and increasing access to new treatments, case fatality rate remains high in Brazil. The analysis revealed differences in the time to event investigation according to HIV status, being greater for HIV infected individuals, particularly for the period between case notification and death. The time between onset of the symptoms and case notification appears to be greater in peri-urban and rural areas compared to the urban areas. Also, differences in the time to event investigation according to patient’s age at the onset of symptoms was evident, being longer for 5 years old or older patients. Our findings identified that children under 5 years old are at higher risk of premature death being relevant for planning interventions aimed at reduction of VL lethality in Brazil.

Determine and characterize potential risk areas for the occurrence of cutaneous leishmaniasis (CL) in Latin America (LA).Ecological observational study with observation units defined by municipalities with CL transmission between 2014-2018. Environmental and socioeconomic variables available for at least 85% of the municipalities were used, combined in a single database, utilizing the R software. The principal component analysis methodology was combined with a hierarchical cluster analysis to group clusters of municipalities based on their similarity. The V-test was estimated to define the positive or negative association of the variables with the clusters and separation by natural breaks was used to determine which ones contributed the most to each cluster. Information on cases was also incorporated in the analyses to attribute CL risk for each cluster.This study included 4,951 municipalities with CL transmission (36.5% of the total in LA) and seven clusters were defined by their association with 18 environmental and socioeconomic variables. The historical risk of CL is positively associated with the Amazonian, Andean and Savannah clusters in a decreasingly manner; and negatively associated with the Forest evergreen, Forest/crop and Forest/populated clusters. The Agricultural cluster did not reveal any association with the CL cases.The study made it possible to identify and characterize the CL risk by clusters of municipalities and to recognize the epidemiological distribution pattern of transmission, which provides managers with better information for intersectoral interventions to control CL.Determinar y caracterizar áreas de riesgo potencial de la ocurrencia de leishmaniasis cutánea (LC) en América Latina (AL).Estudio observacional ecológico con unidades de observación definidas por municipios con transmisión de LC entre 2014-2018. Se utilizaron variables medioambientales y socioeconómicas disponibles para al menos 85% de los municipios, combinados en una sola base de datos, a través del software R. Se combinó la metodología de análisis de componentes principales con un análisis de conglomerados jerárquicos para la formación de conglomerados de municipios en función de su similitud. Se estimó el V-test para definir la asociación positiva o negativa de las variables con los conglomerados y separación por divisiones naturales para determinar cuáles contribuyeron más a cada conglomerado. Se incorporaron los casos para atribuir el riesgo de LC para cada conglomerado.Se incluyeron en el estudio 4 951 municipios con transmisión de LC (36,5% del total en AL) y se definieron siete conglomerados por su asociación con 18 variables medioambientales y socioeconómicas. El riesgo histórico de LC se asocia de manera positiva y en forma decreciente con los conglomerados Amazónico, Andino y Sabana; y de manera negativa con los conglomerados Boscoso/perenne, Boscoso/cultivo y Boscoso/poblado. El conglomerado Agrícola no reveló ninguna asociación con los casos de LC.El estudio permitió identificar y caracterizar el riesgo de LC por conglomerados de municipios y conocer el patrón propio epidemiológico de distribución de la transmisión, lo que proporciona a los gestores una mejor información para las intervenciones intersectoriales para el control de la LC.Determinar e caracterizar as áreas de risco de ocorrência de leishmaniose cutânea na América Latina.Estudo observacional ecológico com unidades de observação definidas por municípios com transmissão de leishmaniose cutânea entre 2014 e 2018. Foram usadas as variáveis ambientais e socioeconômicas disponíveis em 85% ou mais dos municípios, reunidas em uma única base de dados com o uso do software R. A metodologia de análise de componentes principais foi combinada a uma análise de conglomerados com agrupamento hierárquico para formar conglomerados de municípios por semelhança. O teste V foi usado para estabelecer a associação (positiva ou negativa) das variáveis com os conglomerados e uma separação por divisões naturais foi usada para determinar as variáveis que mais contribuíram em cada conglomerado. Os casos foram incluídos para avaliar o risco de leishmaniose cutânea em cada conglomerado.A amostra do estudo compreendeu 4.951 municípios com transmissão de leishmaniose cutânea (36,5% do total na América Latina). Foram definidos sete conglomerados por apresentarem associação com 18 variáveis ambientais e socioeconômicas. Foi observada associação positiva e decrescente do risco histórico de leishmaniose cutânea com os conglomerados Amazônico, Andino e Savana e negativa com os conglomerados Mata/perene, Mata/cultivo e Mata/povoado. O conglomerado Agrícola não demonstrou associação com casos de leishmaniose cutânea.Este estudo permitiu identificar e caracterizar o risco de leishmaniose cutânea por conglomerados de municípios e conhecer o padrão epidemiológico de distribuição da transmissão da doença, oferecendo às autoridades dados melhores para subsidiar as intervenções intersetoriais para o controle da leishmaniose cutânea.

To compare the performance of polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) tests for diagnosingNational laboratories affiliated with the Ministry of Health/Agriculture of each country exchanged panels of 10 positive/negative samples obtained from their regular national surveillance programs in November 2015 - November 2016. All laboratories applied PCR; two also applied ELISA techniques. Sensitivity and specificity were determined for each laboratory and concordance of results among the laboratories was evaluated by Cohen Kappa coefficient.Poor concordance (3 of 10 paired comparisons had values of Kappa0.4), low sensitivity and specificity across all laboratories, and poor performance of both techniques in detectingThe results underscore the heterogeneity of canine echinococcosis diagnosis across the region and indicate possible sources of variability. Efforts to standardize canine echinococcosis testing must be included in the plan of action for the Regional Initiative for the Control of Cystic Echinococcosis. Future comparisons with fecal samples of known parasite load are needed.Comparar el rendimiento de los ensayos de la reacción en cadena de la polimerasa y el enzimoinmunoanálisis de adsorción en fase sólida (o ELISA, por su sigla en inglés) para diagnosticarLos laboratorios nacionales, afiliados a los ministerios de salud y agricultura y ganadería de cada país, intercambiaron paneles de diez muestras positivas y negativas obtenidas de sus respectivos programas nacionales de vigilancia desde el mes de noviembre del año 2015 hasta el mismo mes del año siguiente. Todos los laboratorios emplearon la reacción en cadena de la polimerasa y dos emplearon también técnicas de ensayo inmunoenzimático (ELISA). Se determinó la sensibilidad y la especificidad de cada laboratorio y se evaluó la concordancia entre los resultados de los laboratorios mediante el coeficiente kappa de Cohen.Este estudio descubrió una escasa concordancia (3 de 10 comparaciones de pares obtuvieron valores de kappa0,4), una sensibilidad y especificidad bajas en todos los laboratorios y un rendimiento deficiente de ambas técnicas de diagnóstico deLos resultados subrayan la heterogeneidad del diagnóstico de equinococosis canina en toda la región e indican posibles fuentes de esta variabilidad. Deben incluirse medidas para estandarizar la prueba de equinococosis canina en el plan de acción de la Iniciativa Sudamericana para el Control de la Equinococosis Quística. En el futuro serán necesarias comparaciones adicionales con muestras fecales con una carga de parásitos conocida.Comparar o desempenho dos métodos de reação em cadeia da polimerase (PCR) e ensaio imunoenzimático (ELISA) no diagnóstico de infecção peloLaboratórios nacionais conveniados ao Ministério da Saúde/Agricultura de cada país participante intercambiaram grupos de 10 amostras positivas/negativas coletadas rotineiramente pelos programas nacionais de vigilância no período de novembro de 2015 a novembro de 2016. Todos os laboratórios empregaram o método de PCR e dois empregaram também o método de ELISA. A sensibilidade e a especificidade dos métodos foram determinadas em cada laboratório, e a concordância dos resultados entre os laboratórios participantes foi avaliada com o coeficiente kappa de Cohen.Observou-se fraca concordância (3 de 10 comparações pareadas com kappa0,4), baixa sensibilidade e especificidade e fraco desempenho de ambos os métodos na identificação doOs resultados deste estudo apontam para a falta de uniformidade no diagnóstico de equinococose canina em toda a Região e indicam possíveis causas para variabilidade. A padronização da análise laboratorial da equinococose canina deve constar do plano de ação para a Iniciativa Regional para Controle da Hidatidose. Outras comparações de amostras fecais de parasitas conhecidos devem ser realizadas.

Rabies virus (RABV) is the only lyssavirus known to be present within the Caribbean. The island of Trinidad, is richly diverse in chiropteran fauna and endemic for bat-transmitted rabies with low RABV isolation rates observed in this population. We aimed to determine the seroprevalence of rabies virus neutralizing antibodies (RVNA) in light of spatio-temporal and bat demographic factors to infer the extent of natural exposure to RABV in the Trinidadian bat population. RVNA titers were determined by the RABV micro-neutralization test on 383 bat samples representing 21 species, comprising 30.9% of local bat diversity, from 31 locations across the island over 5 years. RVNA was positively detected in 33 samples (8.6%) representing 6 bat species (mainly frugivorous) with titers ranging from 0.1 to 19 IU/mL (mean 1.66 IU/mL). The analyses based on a multivariable binomial generalised linear mixed-effects model showed that bat age and year of capture were significant predictors of seropositivity. Thus, juvenile bats were more likely to be seropositive when compared to adults (estimate 1.13, p = 0.04) which may suggest early exposure to the RABV with possible implications for viral amplification in this population. Temporal variation in rabies seropositivity, 2012&ndash, 2014 versus 2015&ndash, 2017 (estimate 1.07, p = 0.03) may have been related to the prevailing rabies epizootic situation. Regarding other factors investigated, RVNA was found in bats from both rural and non-rural areas, as well as in both hematophagous and non-hematophagous bat species. The most common seropositive species, Artibeus jamaicensis planirostris is ubiquitous throughout the island which may potentially facilitate human exposure. The findings of this study should be factored into public health assessments on the potential for rabies transmission by non-hematophagous bats in Trinidad.

Vampire bat-transmitted human rabies was first recognized in Trinidad during a major outbreak during the first half of the 20th century. To date, Trinidad is the only Caribbean island with vampire bat-transmitted rabies. Herein, we summarized the epidemiological situation of rabies in Trinidad during the period 1971–2015 through the analysis of field and laboratory records. During the study period, 259 domestic and wild animal rabies cases were laboratory confirmed with an annual median of 2 animal rabies cases. Over the 45 years, five significant epizootic events occurred (in 1974, 1997–1998, 2000, 2010 and 2012–2013) over which there was a significant increasing trend for the occurrence of rabies cases. The highest number of cases (87 cases) occurred during the 1997–1998 event, and the rabies positive proportion, was highest (0.7, 95% CI 0.52-0.84) for the year 2000. Rabies risk was highest for cattle (negative binomial parameter estimate 4.84, 95% CI 3.45–6.76), although numerous rabies cases were seen in the caprine population during the study period. In light of this finding, consideration should be given to including the small ruminant population in the national rabies vaccination program. Outbreaks affected mainly the counties of St. Patrick and St. George East, with epidemic progression outwards, and these areas should be prioritized for prevention and control efforts.

Summary South America has a favourable position with respect to foot-and-mouth disease (FMD) compared with other FMD-affected regions due to the elimination of endemic clinical presentation of the disease. South America has reached the final stage of control and aims to eradicate the disease in the region under the provisions of the Hemispheric Program for the Eradication of FMD 2011–2020 (PHEFA). This programme aims at bringing eradication to completion, thereby eliminating the pool of foot-and-mouth disease genotypes active in South America. This plan includes a regional political agreement that provides strategies and technical guidelines for the eradication of foot-and-mouth disease from South America. It incorporates knowledge and experience regarding the disease's history and its connection with the different production systems, animal movement and trade. The Pan American Foot and Mouth Disease Center has led the control and eradication programmes, providing the framework for designing national and subregional programmes that have led to significant progress in controlling the disease in South America. The current situation is the result of several factors, including the proper implementation of a national control programmes, good veterinary infrastructure in most countries and public–private participation in the process of eradicating the disease. Notwithstanding the favourable health status, there are significant challenges for the goal of eradication. At this stage, South American countries should enhance their surveillance strategies particularly through the use of target or risk-based surveys that contribute to increase the degree of sensitivity in the search for viral circulation in the context of absence of clinical occurrence of FMD.

Background In the Americas, leishmaniasis is endemic in 18 countries, and from 2001 through 2015, 17 countries reported 843,931 cases of cutaneous and mucocutaneous leishmaniasis, and 12 countries reported 52,176 cases of visceral leishmaniasis. A Regional Information System (SisLeish) was created in order to provide knowledge of the distribution and tendency of this disease to analyze and monitor the leishmaniasis status. This article analyses the performance and progress of SisLeish from 2012–2015. Methodology The performance of SisLeish was evaluated by country adhesion, data completeness and delay in entering the data, and also by the SWOT technique. Furthermore, we outlined the structure and modus operandi of the system and indicators utilized. Results In 2012, only 18% of the countries entered the data in SisLeish before the deadline, where 66.7% and 50% of the countries with autochthonous CL/ML and VL reported their cases to the system, respectively. Whereas in 2015, 59% of the countries reached the deadline, where 94.4% and 58.3% of the countries reported their CL/ML and VL data, respectively. Regarding data completeness, there was great progress for different variables since its launch, such as gender, which had an approximately 100% improvement from 2012 to 2015. The SWOT analysis of SisLeish showed 12 strengths, 11 opportunities, seven weaknesses and six threats. Conclusions From 2012–2015 there has been an improvement in the adhesion, quality and data completeness, showing the effort of the majority of the countries to enhance their national database. The SWOT analysis demonstrated that strengths and opportunities exceed weaknesses and threats; however, it highlighted the system frailties and challenges that need to be addressed. Furthermore, it has stimulated several National Programs to advance their surveillance system. Therefore, SisLeish has become an essential tool to prioritize areas, assist in decision-making processes, and to guide surveillance and control actions., Author summary Leishmaniasis is among the most neglected diseases and remains a challenge for surveillance and control programs. In response to this challenge, the Regional Program for Leishmaniasis (PAHO/WHO), with the support of advisors and representatives from endemic countries, have created a Regional Information System (SisLeish), based on epidemiological and operational indicators, to provide knowledge of the distribution and tendency of this disease to analyze and monitor the leishmaniasis status in the Americas. Since the implementation of SisLeish, there has been an improvement in the adhesion, quality and data completeness and the results show the effort of the majority of the countries to improve their national database in terms of completeness and availability. Furthermore, it has stimulated several programs to advance their surveillance system and program, and has been an alternative for countries that currently do not have a national information system available. SisLeish has become an essential tool to prioritize areas, where the occurrence of leishmaniasis requires additional attention, assist in the decision-making process, and to guide surveillance and control actions. This article analyses the performance and progress of SisLeish from 2012–2015.

Leishmaniasis is an important health problem in several countries in the Americas and cases notification is limited and underreported. In 2008, the Pan American Health Organization (PAHO/WHO) met with endemic countries to discuss the status and need of improvement of systems region-wide. The objective is to describe the temporal and spatial distribution of cutaneous leishmaniasis (CL) cases reported to PAHO/WHO by the endemic countries between 2001 and 2011 in the Americas. Methods Cases reported in the period of 2001–2011 from 14/18 CL endemic countries were included in this study by using two spreadsheet to collect the data. Two indicators were analyzed: CL cases and incidence rate. The local regression method was used to analyze case trends and incidence rates for all the studied period, and for 2011 the spatial distribution of each indicator was analyzed by quartile and stratified into four groups. Results From 2001–2011, 636,683 CL cases were reported by 14 countries and with an increase of 30% of the reported cases. The average incidence rate in the Americas was 15.89/100,000 inhabitants. In 2011, 15 countries reported cases in 180 from a total of 292 units of first subnational level. The global incidence rate for all countries was 17.42 cases per 100,000 inhabitants; while in 180 administrative units at the first subnational level, the average incidence rate was 57.52/100,000 inhabitants. Nicaragua and Panama had the highest incidence but more cases occurred in Brazil and Colombia. Spatial distribution was heterogeneous for each indicator, and when analyzed in different administrative level. The results showed different distribution patterns, illustrating the limitation of the use of individual indicators and the need to classify higher-risk areas in order to prioritize the actions. This study shows the epidemiological patterns using secondary data and the importance of using multiple indicators to define and characterize smaller territorial units for surveillance and control of leishmaniasis., Author Summary In the Americas, cutaneous leishmaniasis (CL) cases are notified across a wide geographic area, extending from southern United States to northern Argentina. Currently, 70–75% of all estimated cases of CL worldwide occur in ten countries, including four in the Americas (Brazil, Colombia, Nicaragua, and Peru) and six countries from Africa and the Eastern Mediterranean. This study shows the epidemiological situation and geographical distribution of CL cases reported by passive surveillance system of endemic countries of the American Region from 2001 to 2011, collected and consolidated by the Pan American Health Organization (PAHO). Furthermore, it represents a joint effort of the National Programs of leishmaniases. Despite some limitations, the data were analyzed and discussed and this study represents the first step to understand the global epidemiological situation in this Region and it contributes to the improvement of the surveillance of leishmaniases in the Americas.

Liver fluke is a manifestation of bovine fasciolosis and its presence is compulsorily investigated as part of routine official abattoir inspections. It is known that the presence of fasciolosis negatively influences beef production, interfering with weight gain and fertility. Recent reports suggest increased occurrence of this parasite worldwide. This paper aims to investigate the impact of fasciolosis on beef cattle performance by examining the association of liver fluke with carcase characteristics and its value. Cattle slaughtered between 2005 and 2010 (328, 137 cattle (of which 12.6% were positive to liver fluke) sourced from 2278 farms) are analysed adjusting for the effect of gender, age, breed, season and year. Carcases with liver fluke have lower cold weight than those carcases free of fluke, estimated coefficient -0.63 kg (95% confidence intervals (CI) -0.93, -0.33). Carcases with liver fluke have lower price than those carcases free of fluke, estimated coefficient -£1.5 (95% CI -2.24, -0.74). The presence of liver fluke is associated with lower carcase conformation scores compared to carcases with fluke absence, proportional odds ratio (POR) 0.89 (95% CI 0.87-0.91). Similarly, the presence of liver fluke is associated with lower levels of fat in the carcase compared to carcases with fluke absence, POR 0.97 (95% CI 0.95-0.99). These results indicate a potential negative effect of the parasitism on carcase performance. The downgrading of the carcase impacts its value and therefore the price paid to the farmer. Both farmers and abattoir operators share a common interest in the control of fasciolosis in order to optimise the profitability of beef production. This study shows the utility of abattoir post-mortem inspection as a tool to monitoring animal health and production.

LEISHMANIASIS is a vectorborne, protozoan disease caused by infection with Leishmania species transmitted by infected phlebotomine sandflies. This article focuses on visceral leishmaniasis, which results in the most severe clinical forms of the disease. It also focuses on Latin American and the Caribbean and Europe, where the zoonotic form of visceral leishmaniasis is prevalent. In the case of zoonotic visceral leishmaniasis, the role of the dog as the main vertebrate reservoir is well established (Dantas-Torres and others 2012), making visceral leishmaniasis a good example of the importance of embracing a One Health approach for efficient disease surveillance and control. In people, visceral leishmaniasis infections can be asymptomatic or develop into clinical forms comprising fever, weight loss, splenomegaly and hepatomegaly. If left untreated, visceral leishmaniasis results in death in 90 per cent of human cases. When treated, the fatality rate drops considerably, ranging from 1.5 to 8.4 per cent depending on the region. However, immunocompromised individuals are more prone to developing clinical disease and have higher case fatality rates (up to 20 per cent when treated) (WHO 2007, PAHO/WHO 2013, Alvar and others 2012). Clinical features of visceral leishmaniasis infection frequently reported in dogs include skin lesions, ocular inflammation or injury, weight loss, lethargy, inappetence and lymphadenomegaly. Leishmaniasis has been reported in 98 countries on five continents (WHO 2010). More than 90 per cent of the estimated 300,000 new cases per year of visceral leishmaniasis in humans occur in just six countries: India, Bangladesh, Sudan, South Sudan, Ethiopia and Brazil (WHO 2014a). In Europe, visceral leishmaniasis is caused by Leishmania infantum and transmitted by Phlebothomus perniciosus (WHO 2014b). Visceral leishmaniasis is endemic to 14 countries in southeastern and western Europe, with around 500 autochthonous new human cases reported annually; 73 per cent of these are in Albania, Italy …

Ascariosis is the most important internal parasitism present worldwide in farmed pigs. Milk spots are healing lesions occurring when Ascaris suum larvae migrate through the liver. This study aimed to identify current husbandry practices (e.g. wet/compound feeding, outdoors/indoors production, bedded/slatted floors) that influence the prevalence of milk spots in batches of slaughtered pigs, accounting for geographical locations and seasonality. Farm information was accessed through the British farm quality assurance programmes (QAPs) and information on milk spots was obtained from the pig abattoir based health schemes. Two working datasets were created. The first consisted of 505 farms recruited from the whole of Great Britain (GB). The second combined 338 farms from England and Wales (EW) with housing and feed category-specific information (e.g. for growers and finishers separately), which was not fully available for inclusion in the previous dataset. The variables were studied in multivariable beta-binomial models with the presence of milk spots being the response variable. Solid floor with bedding appeared as a risk factor, OR 1.52 (95% confidence intervals (CI) 1.26–1.85) for the GB sample, and OR 1.47 (CI 1.19–1.81) for the EW subset. Those GB herds that had all the stages of production indoors appeared to be at lower risk of milk spots (OR 0.4, CI 0.32–0.49). Changes were detected within year, with higher risk of milk spots in the second 6 months of the year OR 1.17 (CI 1.02–1.35) in the GB sample and 1.21 (95% CI 1.04–1.41) in EW farms. Overall this study suggests that those husbandry practices facilitating optimal levels of hygiene posed lower risk of milk spots in slaughtered pigs, potentially reflecting lower levels of ascariosis in the later stages of production.

Abattoir data collected from three British pig health monitoring schemes were combined to investigate the associations between Salmonella infection and the presence of gross lesions detected in slaughtered pigs. Each set of results was linked back to the farm from which the pigs were submitted, and the Salmonella results and lesions reports were connected at farm level. Salmonella infection was determined through meat juice ELISA (MJE), and the health conditions were assessed by postmortem inspection. The final dataset contained 873 slapmarks, with an average of 215 samples tested by MJE, and 355 pigs that were assessed for health conditions, per slapmark. Each of the health assessment conditions was individually analysed by regression models to investigate associations with the MJE results, accounting for clustering at the slapmark level and also for seasonality. A multivariable model was also used to estimate the strength of association with MJE results when all the health conditions were entered into the model. The results showed positive associations between Salmonella and enzootic pneumonia-like lesions, milk spots, peritonitis and pericarditis.

SIR, — In March 2006 two female cavalier King Charles spaniel puppies were presented at one day old due to problems suckling having been normal at birth. On admission they were found to feed well but no urine was produced. They became progressively unresponsive and began to head bob and shake when

Foot-and-Mouth Disease serotype O circulated endemically in Ecuador for many years, with an upsurge occurring in 2009. This manuscript describes retrospectively in vitro and in vivo laboratory studies to predict the field effectiveness of a commercial FMD vaccine to protect against the field strain, and explains the key actions and epidemiological strategies followed by the country to control the disease.The results established that the use of a good quality oil vaccine, manufactured with strains that were isolated long ago: O1 Campos Br/58 and A24 Cruzeiro Br/55; combined with the correct epidemiological strategies, are useful to control field strains when used in periodic biannual vaccination campaigns.