Filariasis Bancrofti en Costa Rica

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COSTA RICA
Presented by Dr. José Luis Garcés F.Office of
Health Monitoring
Lymphatic Filariasis Elimination in the Americas,
6th Regional Program Managers Meeting (San José,
Costa Rica, October 2005)
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Demographic Indicators at the National
Level Costa Rica

• Total Population (2004) 4,248,508
• Male Population 2,160,670
• Female Population 2,087,838
• Urban Population 71.3
• Increase In Population 2.8

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Demographic Indicators 2004

• Life Expectancy at Birth
• General 78.4
• Men 76.2
• Women 81.0

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Demographic Indicators 2004

• General Mortality Rate (per 1,000 inhabitants)
  3.7
• Maternal Mortality Rate (per 10,000 births)
  3.0
• Infant Mortality Rate (per 1,000 births)
  9.2
• Birth Rate (per 1,000 inhabitants) 17.0

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Socioeconomic Indicators

• Population with Access to Potable Water Service
  95
• Urban 99.6
• Rural 91.5
• Population with Access to Sewage Network
• Total 93.5
• Urban 88.5
• Rural 97.13
• Average Number of Persons per Household
  4.1
• Housing with Household Sewage Connection
  89.5

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Socioeconomic Indicators

• Population with Electricity Services 96.7
  
• Population with Sanitation Services 89.5
• Unemployment Rate (2001) 6.1
• Births to Adolescent Mothers 21.2
• Hospital Births 99.3

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Education Characteristics

• of population that is literate 95.2
• of population that is illiterate 4.8
• of population that has attended
  school 92.7
• Net rate of secondary school education
  59

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SISTEMA DE SALUD COSTA RICA

• Ministry of Health
• Costa Rican Social Security
• Water and Sanitation Systems
• Private Health-Care System
• National Insurance Institute
• Universities

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HUETAR NORTE
CHOROTEGA
CENTRAL NORTE
C.OCCIDENTE
HUETAR ATLANTICA
CENTRAL SUR
CENTRAL ESTE
PACIFICO CENTRAL
BRUNCA
Ministry of Health Regions
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FUNCIONES RECTORAS MINISTERIO SALUD

• Management and Administration
• Health Monitoring
• Regulation of Health-Care Development
• Research and Technical Development

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System of Health and Social Security
Health Regions (CCSS) 7 Health Areas
93 Primary Health-Care Units (EBAIs)
(approx.) 845 Hospitals 29
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Network of Health Services in Costa Rica
San José3 high-level centers and 6 specialized
centers
8 regional hospitals
Network of 12 peripheral hospitals
Regional Hospital Peripheral Hospital
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Interruption of Transmission of Filariasis
bancrofti in the City of Puerto Limón
Costa Rica
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Previous Studies on Filaria bancrofti Conducted
In Puerto Limón, Costa Rica
Year Author Site No. of persons Examined Positive No.
1946 Butts DCA Cieneguita 706 56 7.9
_ Roosevelt 300 45 15
Bataan 100 3 3
Quepos 100 1 1
Cahulta 100 2 2
1951 Paez H. Limon 1 1 _
1954 Lieske H. Limon 137 21 15.3
1962 Brenes R. Roosevelt 119 21 17.6
1974 Brenes R. Hosp. Mexico 1 1
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Epidemiological Studies19741983
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Objectives

• Determine prevalence of W. bancrofti
• Determine vectors and study their characteristics
• Determine frequency of microfilaria
• Identify and localize clinical cases

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Distribution by Age and Sex of 17 Cases of
Elephantiasis Detected in Puerto Limón
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Distribution by Area of 6,155 Persons from the
City of Puerto Limón (Costa Rica, 19761980)
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Distribution by Age of 4,021 Persons Examined,
including 78 with Microfilaria from the City of
Limón
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70.0 of the carriers present less than 6 mf per
20 microliters of blood (Dmf 50 3.5). It has
been determined that the frequency of W.
bancrofti was strictly nocturnal.
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Results of Entomological Studies
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Persons Examined in 13 Rural Localities

• The 3 positives came from the City of Limón

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Treatment of Positive Cases

• 100 of cases
• Dose 6mg DEC/kg of weight for 12 days
• Follow-up and control

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Follow-Up

• In one study conducted in 1987, 727 persons from
  Cristóbal Colón were examined by the Knott
  technique and none presented microfilaria.

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Vector Control Project inCristóbal
Colón,19861989
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Environmental Conditions, Cristóbal Colón
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Sanitation Activities
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Achievements

• Paving of roads
• Filling in of swampy areas
• Installation of recreational areas
• Initiation of construction of coastal boulevard

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Mapping of Antigenemia for W. bancrofti in the
City of Puerto Limón, Costa Rica, 20022003
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Problem of Filariasis (W. bancrofti) Limited to
the City of Puerto Limón
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• Selection of schools
• Determination of sample size
• Workplan
• Informed consent, resulting report

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Technical assessment /Training (CENCET)
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Distribution by School of Persons Examined for
Antigenemia (W. bancrofti),City of Puerto Limón,
20022003
School Area Persons examined No. Results
Balvanero Vargas Cieneguita 349 11 Negative
Tomas Guardia Limón centro 486 16 Negative
Rafael Iglesias Limón centro 434 14 Negative
San Marcos Limón centro 248 8 Negative
Olimpia Trejos Bo Trinidad 145 5 Negative
Atilia Mata Bo San Juan 447 15 Negative
Limoncito Limoncito 665 22 Negative
Santa Eduviges Santa Eduviges 180 6 Negative
Los Lirios Los Lirios 90 3 Negative
Total 3,044 100 Negative
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Distribution by Residential Area

• 9 schools
• 47 areas

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Persons examined for antigenemia of W. bancrofti
by Age and Sex (City of Puerto Limón, 20022003)
Age Group Sex Male Female No. No. Total No.
45 47.0 68 53.0 128 4.2
69 779 47.0 874 53.0 1653 54.3
1014 593 48.0 641 52.0 1234 40.5
1518 19 66.0 10 34.0 29 1.0
Total 1451 47.7 1593 52.3 3044 100.0
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Persons examined for antigenemia of W.
bancrofti by race (City of Puerto Limón,
2002-2003)
Race Persons examined No.
White 2113 69.4
Black 895 29.4
Asian 36 1.2
Total 3044 100.0
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• Morbidity Study
• Rapid survey among key informants from
  EBAIs-CCSS.
• Interviews with professionals from Urology and
  Dermatology services at Tony Facio Hospital

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Morbidity Survey

• Residual morbidity is limited to older adults.

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Structure and Functioningof the National
Epidemiological Monitoring System

• Filariasis present in Group D of the Subsystem
  for Mandatory Notification

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Network of Laboratories for Public Health
Monitoring
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Conclusions
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• Samples of 3,044 students from all areas of
  the City of Puerto Limón were negative for
  antigenemia.

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• Results of epidemiological studies (1974-1983)
  and of those for antigenemia (2002-2003) indicate
  a low probability that sufficient sources of
  infection exist to maintain an active
  transmission.

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The program expresses appreciation to

• The Limón community and local institutions
  participating in this study
• Health authorities
• CENCET, Dominican Republic
• Regional Program for the Elimination of
  Lymphatic Filariasis
• PAHO/WHO Representation in Costa Rica

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Thank you very much!