Marcos A. Espinal is with Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization, Washington, DC. Jon K. Andrus is with the Department of Global Health, George Washington University Milken Institute of Public Health, Washington, DC, and the Division of Vaccines and Immunization, Center for Global Health, University of Colorado, Boulder. Barbara Jauregui is with the Department of Global Health, Milken Institute of Public Health, George Washington University. Stephen Hull Waterman is with the Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. David Michael Morens is with the Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD. Jose Ignacio Santos is with the Experimental Medicine Research Unit, Medical School, National Autonomous University of Mexico, Mexico City, Mexico. Olaf Horstick is with the Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany. Lorraine Ayana Francis is with Communicable Diseases & Emergency Response, Caribbean Public Health Agency, Port-of-Spain, Trinidad. Daniel Olson is with the Pediatric Infectious Disease Department, University of Colorado School of Medicine, and Epidemiology Department, Colorado School of Public Health, Aurora.
Am J Public Health. 2019 Mar;109(3):387-392. doi: 10.2105/AJPH.2018.304849. Epub 2019 Jan 24.
The increasing geographical spread and disease incidence of arboviral infections are among the greatest public health concerns in the Americas. The region has observed an increasing trend in dengue incidence in the last decades, evolving from low to hyperendemicity. Yellow fever incidence has also intensified in this period, expanding from sylvatic-restricted activity to urban outbreaks. Chikungunya started spreading pandemically in 2005 at an unprecedented pace, reaching the Americas in 2013. The following year, Zika also emerged in the region with an explosive outbreak, carrying devastating congenital abnormalities and neurologic disorders and becoming one of the greatest global health crises in years. The inadequate arbovirus surveillance in the region and the lack of serologic tests to differentiate among viruses poses substantial challenges. The evidence for vector control interventions remains weak. Clinical management remains the mainstay of arboviral disease control. Currently, only yellow fever and dengue vaccines are licensed in the Americas, with several candidate vaccines in clinical trials. The Global Arbovirus Group of Experts provides in this article an overview of progress, challenges, and recommendations on arboviral prevention and control for countries of the Americas.
虫媒病毒感染的地理传播范围不断扩大和发病率不断上升，是美洲地区最受关注的重大公共卫生问题之一。过去几十年，该地区登革热发病率呈上升趋势，已从低流行区发展为高度流行区。黄热病的发病率在这一时期也有所加剧，其活动范围已从森林局限型扩展为城市暴发。基孔肯雅热也于 2005 年开始以空前的速度大流行，并于 2013 年蔓延至美洲。次年，寨卡病毒也在该地区爆发，造成严重的先天畸形和神经疾病，成为多年来最严重的全球卫生危机之一。该地区虫媒病毒监测不足，且缺乏用于区分病毒的血清学检测方法，这构成了重大挑战。关于病媒控制干预的证据仍然薄弱。临床管理仍然是控制虫媒病毒病的主要手段。目前，只有黄热病和登革热疫苗在美洲获得许可，还有几种候选疫苗正在临床试验中。全球虫媒病毒专家组在本文中概述了美洲国家在虫媒病毒预防和控制方面的进展、挑战和建议。
