INFECTIOUS AND

TROPICAL DISEASES

CONTROL IN CUBA

A NECESSARY INTRODUCTION

PROF. G. KOURI

INSTITUTO DE MEDICINA TROPICAL “PEDRO KOURÍ”

THE WORLD´S BURDEN OF

INFECTIOUS DISEASESINFECTIOUS DISEASES ARE NOW

THE WORLD´S 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.

(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./

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.

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,

IT IS ESTIMATED THAT THE MAJORITY OF

DEATHS FROM INFECTIOUS DISEASES

CAN BE PREVENTED WITH EXISTING COST-

EFFECTIVE STRATEGIES

WHO REPORT ON INFEC. DIS.

IN THE WORLD, ONE THIRD OF THE

POPULATION LACKS ACCESS TO THE

ESSENTIAL DRUGS

WHO REPORT ON INFECTIOUS DISEASES

TODAY THE POOREST

COUNTRIES ARE PAYING A HEAVY PRICE FOR THE

WORLD´S COMPLACENCY AND

NEGLECTWHO REPORT ON INFECTIOUS DISEASES

•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

PovertyPoverty

Disease

Death Death and and DisabilitDisabilityy

Low Productivity

A VICIOUS

CICLE OF POVERTY

DIEASE AND DEATH

KOURI G, LLOP A, ROGES G

INSTITUTE OF TROPICAL MEDICINE “PEDRO Kourí”HAVANA - CUBA YEAR 2004

THE SO-CALLED

TROPICAL DISEASES

ARE NOT A HEALTH PROBLEM IN CUBA IN THE

YEAR 2005

FACTS AND FIGURES

1959 - 2004

11.2 MILLON INHABITANTS

>70 000 M.D.

WELL DEVELOPED

PRIMARY HEALTH CARE

SUB - SYSTEM

FROM 1959THE CUBAN NATIONAL HEALTH

SYSTEM WAS STABLISHED

ACCESIBLE

UNIVERSAL

FREE

100% OF URBAN AND RURAL POPULATION IS PROTECTED

MAIN MORTALITY CAUSES IN CUBA

HEART DISEASES

CANCER

CEREBROVASCULAR DISEASES

INFLUENZA AND PNEUMONIA

ACCIDENTS

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..)

NATION-WIDE, LABORATORY BASED

SURVEILLANCE SYSTEM FOR MOST

IMPORTANT INFECTIOUS AND

PARASITIC DISEASES

CONTROL ELIMINATION

ERADICATION 2004

CUBA, HAS A LONG TRADITION IN THE CONTROL OF INFECTIOUS DISEASES

DURING THE SPANISH COLONYCHOLERA 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

ELIMINATED AND CONTROLLED INFECTIOUS

DISEASE AFTER 1959

IN 1962 POLIO WAS ERADICATED

•IN 1967MALARIA WAS ERADICATED

•IN 1972 NEO-NATORUM TETANUS WAS ELIMINATED

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

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)

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

DIARRHEAL DISEASES ARE PREVALENT

ALTHOUGH

ITS MORTALITY RATE WAS REDUCED MORE THAN 95% BETWEEN

1962 AND 2004

NO HUMAN CASES OF RABIES AND TETANUS THIS

YEAR

CUBA IS NOT A DENGUE

ENDEMCIC COUNTRY

HIV/AIDS

TOTAL HIV-AIDS PATIENTS:

6025 (1985-04)- (0.07%)

AMONG THEM

AIDS PATIENTS : 4724

AIDS DEATHS: 1222

HIV CARRIERS: 3424

MAIN HEALTH INDEXESIN CUBA

INFANT MORTALITY:

5.8 / 1000 NEWBORNSMATERNAL 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.

LIFE EXPECTANCY:

77 YEARS

MEN: 75 YEARS

WOMEN:79 YEARS

INFECTIOUS AND PARASITIC DISEASES

MORTALITY RATE - CUBA

GENERAL

MORTALITY RATE: 60.3

(IN THE WORLD: 221X100 000)

IN CUBA THE % OF MORTALITY DUE TO INFECTIOUS

DISEASES IS

ONLY 6.5%

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%)

MAIN CHALLENGES FOR CUBA

•ACUTE RESPIRATORY INFECTIONS

•HIV/AIDS

•OTHER STIs

•PREVENT ANTIMICROBIAL RESISTANCE

INSTITUTE OF TROPICAL MEDICINE

“PEDRO KOURI”(IPK)

MINISTRY OF PUBLIC HEALTHHAVANA CUBA

PROF GUSTAVO KOURI MD, PhD ,DrScVICEPRESIDENT CUBAN ACADEMY OF SCIENCES

DIRECTOR GENERAL IPK

IPK

PABELLÓN DOMINGO CUBAS, PABELLÓN DOMINGO CUBAS, HOSPITAL CALIXTO GARCÍAHOSPITAL CALIXTO GARCÍA

SEDE DE LA CÁTEDRA DE PARASITOLOGÍA # 20 Y SEDE DE LA CÁTEDRA DE PARASITOLOGÍA # 20 Y DEL INSTITUTO DE MEDICINA TROPICAL 1937DEL INSTITUTO DE MEDICINA TROPICAL 1937

1000 MTS1000 MTS22

LABORATORIO DE INVESTIGACIONES

KOURÍ Y COLS. TRABAJANDO EN EL LABORATORIO

ASCARIASISASCARIASIS

OBSTRUCCIÓN OBSTRUCCIÓN

INTESTINALINTESTINAL

esto ya no esto ya no

existe en Cubaexiste en Cuba

ASCARIASISASCARIASIS

VIASVIAS

BILIARESBILIARES

ULTIMOS CASOSULTIMOS CASOS

DE FILARIASISDE FILARIASIS

BANCROFTIBANCROFTI

EN CUBAEN CUBA

ULTIMOS CASOS ULTIMOS CASOS DE FILARIASISDE FILARIASIS

BANCROFTIBANCROFTI

EN CUBAEN CUBA

Amebiasis cutáneaSE CONFUNDÍA CON CANCER APORTE DE

KOURI

Antes del tratamientoAntes del tratamientoSE CONFUNDÍA CON CANCERSE CONFUNDÍA CON CANCER Después del tratamiento

PROPOSAL FOR A NEW BUILDING FOR THE PROPOSAL FOR A NEW BUILDING FOR THE INSTITUTE April / 1939INSTITUTE April / 1939

IT WAS NOT ACCEPTED . LACK OF FUNDSIT WAS NOT ACCEPTED . LACK OF FUNDS

A NEW PHASE, A NEW PHASE, 1979 - 20041979 - 2004

NEWNEW

CHALLENGESCHALLENGES

A NEW PHASE, A NEW PHASE, 1979 - 20041979 - 2004

NEWNEW

CHALLENGESCHALLENGES

¿WHAT IS ¿WHAT IS THE IPKTHE IPK

TODAY?TODAY?

Instituto Pedro Kourí

NEW FACILITIES : 10 BUILDINGS

52 000 SQUARE METERS (1993)

June 2004

• 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

HOSPITAL EPIDEMIOLOGY

ADMINISTRATION

TEACHING

ECONOMYATELIER

MANTEINENCE

BACTERIOLOGY -

VIROLOGY

MICOLOGY

PARASITOLOGY

VECTOR CONTROL

FUNCTIONS

• RESEARCH• HOSPITALIZATION• EPIDEMIOLOGICAL

SURVEILLANCE• UNDER AND POST-GRADUATE

PROGRAMMES• INTERNATIONAL ACIVITIES

4 WHO - PAHO COLLABORATING 4 WHO - PAHO COLLABORATING CENTERSCENTERS

•BIOLOGICAL VECTOR

CONTROL AND MEDICAL

MALACOLOGY

• STUDY OF VIRAL DISEASES.

• TUBERCULOSIS AND OTHER

MYCOBACTERIA

• DENGUE

Research StaffResearch StaffRESEARCHERS FULL TIME 148

PROFESORS 60

TOTAL STAFF 700

STUDENTS (UNDER AND POST GRADUATE) MORE THAN 1000

CUBANS AND FOREIGNERS YEARLY

TECHNICIANS 130

ALL REFERENCE LABS. FOR HUMAN

PATHOGENS

WITHIN THE CUBAN PUBLIC HEALTH

SYSTEM ARE AT IPK

JUNE 2002

FUNCTIONS:

• RESEARCH:Basic 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

• 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

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

Epidemiological Unit• CENTRALIZES THE EPIDEMIOLOGICAL CENTRALIZES THE EPIDEMIOLOGICAL

SURVEILLANCE SYSTEMS AND THE USE SURVEILLANCE SYSTEMS AND THE USE OF SOFTWARE SPECIALLY DESIGNED BY OF SOFTWARE SPECIALLY DESIGNED BY IPK.IPK.

• VACCINE EVALUATIONVACCINE EVALUATION

JUNE 2002

Clinical Areas

• 140 beds hospital140 beds hospital• Medical Services specialized in Medical Services specialized in

infectious diseases. infectious diseases. • Screening of exotic diseases Screening of exotic diseases

among travelers from endemic among travelers from endemic areas.areas.

• Advisory in Infectology to all the Advisory in Infectology to all the medical units of the country.medical units of the country.

• CLINICAL trials . National Unit for CLINICAL trials . National Unit for the clinical management of AIDS the clinical management of AIDS patients. and evaluation of cuban patients. and evaluation of cuban vaccinesvaccines

JUNE 2002

Teaching Unit

• PhD PhD • 6 Master degree courses, 6 Master degree courses, • workshops workshops • customary training in:customary training in:

Tropical Medicine , Infectology, Tropical Medicine , Infectology, Bacteriology, Mycology, Virology or Bacteriology, Mycology, Virology or Parasitology as well as Epidemiology, Parasitology as well as Epidemiology, Entomology or Vector Control.Entomology or Vector Control.

JUNE 2002

Teaching activities at IPK (1980 - 2004)

229 000 UNDERGRADUATED 9 000 UNDERGRADUATED AND POST-GRADUATED AND POST-GRADUATED STUDENTS SINCE 1982STUDENTS SINCE 1982

AMONG THEM 2 400 FROM AMONG THEM 2 400 FROM 72 COUNTRIES OF THE 5 72 COUNTRIES OF THE 5

CONTINENTSCONTINENTS

June 2002

International Cooperation and

Funding • PAHOPAHO• TDRTDR• IDRC CanadaIDRC Canada• Wellcome TrustWellcome Trust• European UnionEuropean Union• Joint venture IPK/UNESCOJoint venture IPK/UNESCO• Carlos III Institute, SpainCarlos III Institute, Spain• Tropical Medicine Institute , Antwerp.Tropical Medicine Institute , Antwerp.• KITS, AmsterdamKITS, Amsterdam

JUME 2002

National Awards·

•From 1990 to 2004 , IPK From 1990 to 2004 , IPK has been granted with has been granted with more than 70 “National more than 70 “National Awards of Science and Awards of Science and Technology” from the Technology” from the

Cuban Academy of Cuban Academy of Sciences.Sciences.

JUNE 2002

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

THANKS