Sin t

1
INFECTIOUS AND TROPICAL DISEASES CONTROL IN
CUBA A NECESSARY INTRODUCTION
PROF. G. KOURI INSTITUTO DE MEDICINA TROPICAL
PEDRO KOURÍ
2
THE WORLDS BURDEN OF INFECTIOUS
DISEASES INFECTIOUS DISEASES ARE NOW THE WORLDS
BIGGEST KILLER OF CHILDREN AND YOUNG ADULTS.
MORE THAN 13 MILLION DEATHS A YEAR (221/100 0000
INHABITANTS) - ONE IN TWO DEATHS IN THE THIRD
WORLD.
WHO REPORT ON INF. DIS.
3
(II) OVER THE NEXT HOUR ALONE 1 500 PEOPLE WILL
DIE OF AN INFECTIOUS DISEASE OVER HALF OF THEM
CHILDREN UNDER FIVE YEARS.
WHO REPORT ON INF. DIS./
4

• INFECTIOUS DISEASES REPRESENTS
• 45 OF DEATHS IN LOW INCOME COUNTRIES (ASIA AND
  AFRICA).
• 63 OF DEATHS IN CHILDREN
• (0-4 YEARS) WORLDWIDE.
• 48 OF PREMATURE DEATHS
• (0 - 44 YEARS), WORLDWIDE

WHO REPORT ON INF. DIS.
5

• LEADING INFECTIOUS KILLERS
• MILLIONS OF DEATHS WORLWIDE
• ALL AGES
• ACUTE RESPIRATORY INFECTIONS 3.5
• AIDS 2.3
• DIARROEHAL DISEASES 2.2
• TUBERCULOSIS 1.5
• MALARIA 1.3
• MEASLES 0.9

WHO REPORT ON INF. DIS,
6
IT IS ESTIMATED THAT THE MAJORITY OF DEATHS FROM
INFECTIOUS DISEASES CAN BE PREVENTED WITH
EXISTING COST-EFFECTIVE STRATEGIES


WHO REPORT ON INFEC. DIS.
7
IN THE WORLD, ONE THIRD OF THE POPULATION LACKS
ACCESS TO THE ESSENTIAL DRUGS
WHO REPORT ON INFECTIOUS DISEASES
8
TODAY THE POOREST COUNTRIES ARE PAYING A HEAVY
PRICE FOR THE WORLDS COMPLACENCY AND NEGLECT
WHO REPORT ON INFECTIOUS DISEASES
9

• 20 OF THE WORLD POPULATION (1 300 MILL.) LIVE
  IN ABSOLUTE POVERTY
• (LESS THAN 1 USD/DAY)
• SURVIVING WITH LESS THAN 2 USD/DAY IS A REALITY
  FOR ALMOST HALF THE PEOPLE ON THE PLANET .
• THESE FIGURES ARE STILL RISING

WHO DIRECTOR GENERAL REPORT DEC/99
10
A VICIOUS CICLE OF POVERTY DIEASE AND DEATH
Poverty
Low Productivity
Disease
Death and Disability
KOURI G, LLOP A, ROGES G
11
INCIDENCE AND CONTROL OF TROPICAL DISEASES IN
CUBA
INSTITUTE OF TROPICAL MEDICINE PEDRO
Kourí HAVANA - CUBA YEAR 2004
12
THE SO-CALLED TROPICAL DISEASES ARE NOT A
HEALTH PROBLEM IN CUBA IN THE YEAR 2005
13
FACTS AND FIGURES 1959 - 2004
14
11.2 MILLON INHABITANTS gt70 000 M.D. WELL
DEVELOPED PRIMARY HEALTH CARE SUB - SYSTEM
15
FROM 1959 THE CUBAN NATIONAL HEALTH SYSTEM WAS
STABLISHED ACCESIBLE UNIVERSAL FREE 100 OF
URBAN AND RURAL POPULATION IS PROTECTED
16

• MAIN MORTALITY CAUSES IN CUBA
• HEART DISEASES
• CANCER
• CEREBROVASCULAR DISEASES
• INFLUENZA AND PNEUMONIA
• ACCIDENTS

17
IMMUNIZATION PROGRAME IN CUBA(100),
YEAR 2003 BCG
POLIO
MEASLES
MENINGO B RUBELLA
MENINGO C
MUMPS DIPHTERIA
HEMOPHILUS B
TETANUS
HEPATITIS B PERTUSIS
LEPTOSPIROSIS
CURRENTLY THE VACCINATION AGAINST INFLUENZA IS
LIMITED TO THE ELDERLY IN THE WORLD ONE IN
FIVE CHILDREN ARE NOT FULLY INMUNIZED BY THEIR
FIRST BIRTHDAY (WHO REPORT ON INF. DIS..)

18
NATION-WIDE, LABORATORY BASED SURVEILLANCE SYSTEM
FOR MOST IMPORTANT INFECTIOUS AND PARASITIC
DISEASES
19
CONTROL ELIMINATION ERADICATION 2004
20

• CUBA, HAS A LONG TRADITION IN THE CONTROL OF
  INFECTIOUS DISEASES
• DURING THE SPANISH COLONY
• CHOLERA APPEARD IN CUBA IN 1834, IT WAS
  ELIMINATED IN 1871
• AT THE BEGINING OF THIS CENTURY
• YELLOW FEVER WAS ERADICATED IN 1902
• IN 1915 BUBÓNIC PLAGUE WAS ERADICATED
• IN 1923 SMALLPOX WAS ERADICATED
• IN 1947 LAST CASE OF BANCROTI FILARIASIS

21

• ELIMINATED AND CONTROLLED INFECTIOUS DISEASE
  AFTER 1959
• IN 1962 POLIO WAS ERADICATED
• IN 1967MALARIA WAS ERADICATED
• IN 1972 NEO-NATORUM TETANUS WAS ELIMINATED

22
ELIMINATED AND CONTROLLED INFECTIOUS DISEASES
(II) IN 1979 DIPHTERIA WAS ELIMINATED IN
1993MEASLES WAS ELIMINATED IN 1995 RUBELLA WAS
ELIMINATED IN 1995 MUMPS WAS ELIMINATED
23
NO MORE CONSIDERED A HEALTH PROBLEM IN
CUBA TETANUS, WHOOPING COUGH (LESS THAN 0.1 X
100 000) MENINGOCCOCAL DISEASE DECLINED ITS
MORBIDITY IN 93 AND ITS MORTALITY IN
98 HEPATITIS B MORBIDITY IN CHILDREN, LESS THAN
15 YEARS, WAS REDUCED IN 97 HUMAN LEPTOSPIROSIS
DECLINED (CUBAN VACCINE)
24
THE TUBERCULOSIS RATE IS 6.6 X 100 000 AT
PRESENT WE ARE PREPARING A PROGRAMME TO ELIMINATE
Tb IN CUBA LEPROSY IS NOT A HEALTH PROBLEM
25
DIARRHEAL DISEASES ARE PREVALENT ALTHOUGH ITS
MORTALITY RATE WAS REDUCED MORE THAN 95
BETWEEN 1962 AND 2004
26
NO HUMAN CASES OF RABIES AND TETANUS THIS
YEAR
27
CUBA IS NOT A DENGUE ENDEMCIC COUNTRY
28
HIV/AIDS
29
TOTAL HIV-AIDS PATIENTS 6025 (1985-04)-
(0.07) AMONG THEM AIDS PATIENTS 4724 AIDS
DEATHS 1222 HIV CARRIERS 3424
30
MAIN HEALTH INDEXES IN CUBA
31
INFANT MORTALITY 5.8 / 1000 NEWBORNS MATERNAL
MORTALITY 3.8 /10 000 NEWBORNS TOTAL 2.12 /10
000 NEWBORNS (DIRECT) 1.73 / 10 000
NEWBORNS (INDIRECT) INFEC. DISEAS. 0.08 / 10
000NEWB.
32
LIFE EXPECTANCY 77 YEARS MEN 75 YEARS WOMEN79
YEARS
33
INFECTIOUS AND PARASITIC DISEASES MORTALITY RATE
- CUBA GENERAL MORTALITY RATE 60.3 (IN THE
WORLD 221X100 000)
34
IN CUBA THE OF MORTALITY DUE TO INFECTIOUS
DISEASES IS ONLY 6.5
35
THE NUMBER OF FATAL CASES IN 2004 EXCLUDING
INFLUENZA AND PNEUMONIA FOR ALL THE REST OF INF.
DIS. WHAS 742 FATALITIES WHICH REPRESENTS
0.9 OF THE TOTAL MORTALITY IN CUBA (IN 1970
7,2)
36
(No Transcript)
37

• MAIN CHALLENGES FOR CUBA
• ACUTE RESPIRATORY INFECTIONS
• HIV/AIDS
• OTHER STIs
• PREVENT ANTIMICROBIAL RESISTANCE

38
INSTITUTE OF TROPICAL MEDICINE PEDRO
KOURI(IPK) MINISTRY OF PUBLIC HEALTH HAVANA CUBA
PROF GUSTAVO KOURI MD, PhD ,DrSc VICEPRESIDENT
CUBAN ACADEMY OF SCIENCES DIRECTOR GENERAL IPK
39
IPK
40
PABELLÓN DOMINGO CUBAS, HOSPITAL CALIXTO GARCÍA
SEDE DE LA CÁTEDRA DE PARASITOLOGÍA 20 Y DEL
INSTITUTO DE MEDICINA TROPICAL 1937 1000 MTS2
41
LABORATORIO DE INVESTIGACIONES
42
KOURÍ Y COLS. TRABAJANDO EN EL LABORATORIO
43
(No Transcript)
44
ASCARIASIS OBSTRUCCIÓN INTESTINAL esto ya no
existe en Cuba
45
ASCARIASIS VIAS BILIARES
46
ULTIMOS CASOS DE FILARIASIS BANCROFTI EN CUBA
47
ULTIMOS CASOS DE FILARIASIS BANCROFTI EN CUBA
48
Amebiasis cutánea SE CONFUNDÍA CON CANCER APORTE
DE KOURI
Antes del tratamiento SE CONFUNDÍA CON CANCER
Después del tratamiento
49
PROPOSAL FOR A NEW BUILDING FOR THE INSTITUTE
April / 1939 IT WAS NOT ACCEPTED . LACK OF FUNDS
50
A NEW PHASE, 1979 - 2004 NEW CHALLENGES
51
WHAT IS THE IPK TODAY?
52
NEW FACILITIES 10 BUILDINGS 52 000 SQUARE
METERS (1993)
Instituto Pedro Kourí
53

• EXTENSION OF THE INSTITUTIONAL OBJECTIVES 1979
• To protect the population from infectious and
  parasitic diseases existing in Cuba and to
  detect and avoid the propagation of exotic ones.
• To collaborate with other institutions,
  mainly in the developing world.
• To contribute to the development of Medical
  Sciences, particularly Microbiology,
  Parasitology, Epidemiology and Tropical
  Medicine.
• National reference center for HIV-AIDS

June 2004
54

BACTERIOLOGY - VIROLOGY MICOLOGY
PARASITOLOGY VECTOR CONTROL
HOSPITAL
EPIDEMIOLOGY
TEACHING
ATELIER MANTEINENCE
ADMINISTRATION
ECONOMY
55
FUNCTIONS

• RESEARCH
• HOSPITALIZATION
• EPIDEMIOLOGICAL SURVEILLANCE
• UNDER AND POST-GRADUATE PROGRAMMES
• INTERNATIONAL ACIVITIES

56
(No Transcript)
57
Research Staff
RESEARCHERS FULL TIME 148


PROFESORS 60
TECHNICIANS 130

TOTAL STAFF 700
STUDENTS (UNDER AND POST GRADUATE) MORE THAN 1000
CUBANS AND FOREIGNERS YEARLY
58
ALL REFERENCE LABS. FOR HUMAN PATHOGENS WITHIN
THE CUBAN PUBLIC HEALTH SYSTEM ARE AT IPK
59
FUNCTIONS

• RESEARCHBasic and applied research
• Transfer or original design of new technologies
  and extension to National network
• Clinical trials, vaccines, new drugs, vaccines,
  etc........
• Specialized laboratory diagnosis

JUNE 2002
60

• EPIDEMIOLOGY
• DESIGN AND OPERATION OF THE NATIONAL
  EPIDEMIOLOGICAL SURVEILLANCE SYSTEM. PLANNING,
  EXECUTION AND CONTROL OF THE NATIONAL CONTROL
  PROGRAMS FOR TRANSMISSIBLE DISEASES.
• TEACHING
• NATIONAL AND INTERNATIONAL POSTGRADUATE
  COURSES.

JUNE 2002
61
National Reference Laboratories for Microbiology
and Parasitology.Epidemiological surveillance
with laboratory support

• Virology
• Molecular Biology
• Mycology
• Neisseriae
• Tuberculosis Leptospira
• Malaria
• Hemoparasites Intestinal Parasitism

JuNe 2002
62
Epidemiological Unit

• CENTRALIZES THE EPIDEMIOLOGICAL SURVEILLANCE
  SYSTEMS AND THE USE OF SOFTWARE SPECIALLY
  DESIGNED BY IPK.
• VACCINE EVALUATION

JUNE 2002
63
Clinical Areas

• 140 beds hospital
• Medical Services specialized in infectious
  diseases.
• Screening of exotic diseases among travelers from
  endemic areas.
• Advisory in Infectology to all the medical units
  of the country.
• CLINICAL trials . National Unit for the clinical
  management of AIDS patients. and evaluation of
  cuban vaccines

JUNE 2002
64
Teaching Unit

• PhD
• 6 Master degree courses,
• workshops
• customary training in
• Tropical Medicine , Infectology, Bacteriology,
  Mycology, Virology or Parasitology as well as
  Epidemiology, Entomology or Vector Control.

JUNE 2002
65
Teaching activities at IPK (1980 - 2004)

• 29 000 UNDERGRADUATED AND POST-GRADUATED STUDENTS
  SINCE 1982
• AMONG THEM 2 400 FROM 72 COUNTRIES OF THE 5
  CONTINENTS

JUNE 2002
66
International Cooperation and Funding

• PAHO
• TDR
• IDRC Canada
• Wellcome Trust
• European Union
• Joint venture IPK/UNESCO
• Carlos III Institute, Spain
• Tropical Medicine Institute , Antwerp.
• KITS, Amsterdam

June 2002
67
National Awards

• From 1990 to 2004 , IPK has been granted with
  more than 70 National Awards of Science and
  Technology from the Cuban Academy of Sciences.

JUME 2002
68

• ...quiero decirles que siempre estaremos
  dispuestos a la colaboración con nuestros
  hermanos de América Latina y con los países de
  todo el mundo y les ruego que no consideren esa
  institución que inauguramos hoy solo como una
  institución cubana, sino como una institución de
  la humanidad..."Dr. Fidel Castro Ruz, OCTUBRE
  1993.

JUNE 2002
69
THANKS