Headlines in Cuban Health

Beefed-Up Measures Aim to Prevent Dengue

By Conner Gorry

A vector-control worker readies to fire up his fumigation bazooka.

 Friends and neighbors expressed surprise when light aircraft started buzzing around Havana recently. “I haven’t seen one of those for awhile,” said a young man. “They must be spraying,” he continued, hitting the nail on the head regarding the latest offensive in Cuba’s battle against dengue.

In an effort to control the multiplication of the Aedes aegypti mosquito that transmits the disease, Cuban health authorities recently instituted a series of stepped-up preventative measures including aerial spraying over coastal areas, more frequent fumigation of houses with weapons of mass mosquito destruction known locally as ‘bazookas’ for their resemblance to those big guns, and community education programs about the dengue vector.

Recognized worldwide as an effective epidemic-controlling strategy, the Cuban dengue model recently incorporated more aggressive preventative measures since the ongoing drought and abnormally high temperatures on the island promote multiplication of the mosquito that carries the disease. Monthly door-to-door visits by specialized health workers to kill mosquito larvae have been augmented to every twelve days in some Havana neighborhoods and to every week where the illness focus has been identified.

Department of Health and Epidemiology workers and public service announcements implore citizens to tightly cover water kept in tanks or buckets – increasingly common in a country where water reserves are dangerously low (see MEDICC Review Vol. VII (6), June 2005). Complicating the fight against Aedes aegypti are rolling blackouts that cuts electricity for six-hours almost daily in the capital, preventing the use of fans and air conditioning, allowing the mosquitoes to enter homes and multiply more easily.

Furthermore, citizens are being advised to visit their family doctors at the first sign of symptoms that could signal dengue including aches and pains, a spiking fever, or rash. People who have previously suffered from dengue are being monitored especially closely as they are at a higher risk of contracting the more serious hemorrhagic dengue fever (DHF) than the general population. Dr Orlando Frómeta, Provincial Director of the Vector Surveillance & Eradication Campaign added that preventative measures are also being instituted at airports, since Cuba’s proximity to countries where the disease has reached epidemic proportions presents a contagion risk to the island.

Following an outbreak in 2001, Cuba launched an aggressive dengue program that has already been replicated internationally in countries as disparate as Honduras and Sri Lanka. Health officials in those countries point to Cuba’s public awareness campaign and the overwhelming participation of the population as factors contributing to the success of the island’s program. Whether such participation can be engendered outside of Cuba - where local customs and culture will dictate acceptance of such measures as monthly door-to-door visits by health workers - remains to be seen.

Another Cuban contribution to the fight against dengue being adopted internationally is the application of bacteria to kill mosquito larvae. In Brazil, for example, Bactivec, the Cuban-produced Bacillus thuringien (BT) bacteria, has shown good results in controlling the Aedes aegypti mosquito in Rio de Janeiro, with infection rates falling from 1.8% to 0.4% in the nine municipalities tested, according to reports in Prensa Latina. This is below the WHO’s minimum recommended infection rate of 1%.

Cuban Cholera Vaccine Headed for Clinical Trials

By MEDICC Review Staff

Cuba ’s Finlay Institute recently announced it will implement a range of international field trials for its vaccine against cholera. Mozambique, South Africa and Equatorial Guinea topped the list of possible trial locales.

The vaccine, presented recently at Havana’s Health for All Fair, is based on living strains of genetically attenuated cholera-transmitting bacillus, and has already been successfully tested on 100 volunteers in lab tests carried out on the island ( MR Interview with Professor Gustavo Kourí). Since cholera is not present in Cuba – vaccine volunteers were induced with cholera to test the effectiveness of the vaccine - the next step is to administer immunizations in countries with high incidences of the disease. These are also the countries where people suffer from additional problems and illnesses like malnutrition, malaria and AIDS.

Although cholera vaccines are already commercially available, these are immunologically effective in only 30% to 60% of inoculated individuals, and do not work on the remainder, according to WHO reports. Nor are they effective during epidemics because of the time the body needs to generate antibodies (two to three weeks).

Present-day vaccines are based on disactivated bacteria (with heat or chemical substances), or dead bacteria, to generate antibodies. The Cuban vaccine, however, is based on modifying the bacteria’s genetic makeup to attenuate its effect, and to use it as a short-term (two- or three-day) antibody generator.

Talks have been held with health officials from Mozambique, Equatorial Guinea and South Africa to undertake field trials that will make it possible to pursue studies on the candidate vaccine.

Foreign Affairs and Cooperation Minister of the Republic of Mozambique, Alcinda Antonio de Abreu, made a three-day trip to Cuba in April, during which she visited the Finlay Institute. The minister announced Mozambique’s intention to participate in the clinical trials, noting that she looks forward to considering use of other products from the Cuban scientific center.

The Finlay Institute, one of Cuba’s most technologically advanced medical laboratories, is responsible for the development, manufacture and export of six vaccines which immunize against typhus and tetanus, among other diseases. Its flagship export is the only effective vaccine against type-B meningitis, distributed to several countries around the world.

UN Proposes Havana-Based Disaster Prevention Network

By Conner Gorry

This 2004 hurricane snapped palm trees in Cuba like toothpicks.

Cuba ’s hurricane season - predicted to be worse even than last year’s devastating storms - kicked off June 1 with heavy downpours and a three-day workshop designed to more effectively prepare for, confront, and recover from natural disasters. Jointly convened by the Association of Caribbean States, the Cuban Civil Defense, the United Nations Development Program (UNDP) and the Office for the Coordination of Humanitarian Affairs (OCHA), Cuba, with its proven and hopefully replicable, natural disaster response program, was a logical location for the meeting.

Held from June 1st through 3rd, the purpose of the “Seminar Workshop for National Authorities: Risk Management Policies, Systems and Experiences in the Caribbean,” was to define a regional plan of action within the larger goals for international disaster preparedness and risk reduction. Such a plan is long overdue.

Following the deadly hurricanes that ripped through the Caribbean in late 2004 and the December 26 tsunami in Asia, experts from all over the world convened in Japan in January 2005 to draft the Hyogo Framework of Action (HFA; http://www.unisdr.org/wcdr/intergover/official-doc/L-docs/Hyogo-framework-for-action-english.pdf). The Framework calls for worldwide strategies to minimize risk and loss due to natural disasters, which is critical as these become both more frequent and more powerful.

According to UN Under Secretary General for Humanitarian Affairs, Jan Egeland, Cuba is a leader in the field, with one of the world’s best systems for protecting its citizens and a demonstrated ability to minimize and manage the impact of natural disasters. The meeting highlighted the opportunity for Cuba to transfer its best practices in disaster management to other countries of the Caribbean. Specific areas in which Cuba could help include organizing workshops, sending disaster specialists to countries in need and knowledge sharing about early warning systems, elaborated Egeland.

During the proceedings, a plan was outlined to develop an integrated regional network allowing nations to augment their capacity to confront and mitigate the effects of natural disasters. Proposed by the UNDP and agreed upon by consensus, the Havana-based network - known as the Cross Cultural Network for Disaster Risk Reduction - would have the support of various UN agencies, underscoring the importance of a multilateral, interdisciplinary model to resolve inequalities that exacerbate losses. Improving the social and economic conditions of the poor, who are the most adversely effected by natural disasters, is integral to establishing sustainable systems in the Caribbean.

The final declaration, “The Havana Consensus on Disaster Risk Reduction in the Greater Caribbean,” (http://www.onu.org.cu/uunn/noticias/consensus.html), calls on governments to improve cooperation and exchanges with regional and international actors, primarily by strengthening alliances and augmenting information flow. According to the document, “the key factor to reduc[ing] vulnerability and enhanc[ing] disaster preparedness and response is the level of national political commitment and allocation of national resources.”

Unfortunately, some countries are better equipped to do so than others. In his opening remarks, Undersecretary Egeland singled out Haiti as particularly vulnerable, even while myriad factors render the country unable to manage and reduce that vulnerability.

The declaration went further, calling on “the international community to support activities geared toward strengthening the resilience and coping mechanisms of vulnerable communities through the development of effective people-centered early warning systems, [and] integrated public health measures.”

Specific measures designed to reduce risk and improve prevention and recovery responses expressed in The Havana Consensus include:

• Implement the earthquake and hurricane building codes as defined by the Association of Caribbean States;
• Install Early Warning Systems in the most vulnerable areas;
• Create risk-management centers;
• Promote public education and awareness as regards risk and natural disasters;
• Insert risk reduction measures into the recovery phase;
• Launch sustainable socio-economic programs that aim to reduce future risk;
• Strengthen disaster response mechanisms so that simultaneous natural events can be managed;
• Develop a regional network of recovery specialists who can respond to disasters and aid in integrating recovery and reduction efforts across nations, international agencies and donor organizations;
• Integrate risk reduction and climate change considerations into development strategies; and
• Focus on the UN Millennium Development Goals relating specifically to disaster response and recovery

Undoubtedly, the progress of these actions will be scrutinized, evaluated and analysed during the VII International Congress on Disaster Reduction, to be held in Havana in June 2006.

“The key factor to reduce vulnerability and enhance disaster preparedness and response is the level of national political commitment and allocation of national resources.”

The Havana Consensus, June 2005

Another First: Cuba Hosts IERASG 2005

By Michele Frank, MD

Some 150 delegates from 25 countries gathered in Havana from June 12-16 for the 19th Biennial Symposium of the International Evoked Response Audiometry Study Group: IERASG 2005 http://www.ausp.memphis.edu/ierasg/index1.html . This is the first time the prestigious Symposium has been held in the developing South. Another first for IERASG, this year’s event was organized and chaired by a woman - Cuban neuroscientist María Cecilia Pérez-Abalo of the Cuban Neuroscience Center.

The IERASG is a neuroscience professional society organized to provide an open forum for the discussion of physiologic signals generated within the auditory system, according to its mission statement. The 2005 meeting’s topics included electrically evoked auditory response, cochlear implant evaluations, auditory neuropathy, technology and instrumentation, auditory steady-state responses, and screening for hearing impairment in newborns.

IERASG 2005 Chairwoman: María Cecilia Pérez-Abalo, MD, PhD

“From a scientific standpoint,” Dr. Peréz-Abalo told MEDICC Review, “this has been a great success. There was even a significant U.S. presence despite severe restrictions currently imposed by the U.S. on U.S.-Cuba scientific interchange.” Dr. Peréz-Abalo also pointed to the contributions of top specialists Dr. Adrian Davis and Dr. Martin Hyde of the United Kingdom and Canada, respectively, who spearheaded national screening programs for the early detection of hearing impairment in their countries.

Dr. Davis of the University of Manchester told MEDICC Review: “We wanted to hold this Symposium in Cuba because Cuba has played an essential and ongoing role in the development of Cognitive Neuroscience, particularly its relevance to children with hearing impairment. Cuban scientists have made quite a substantial contribution to the discussion of how we should screen babies for hearing loss.”

Several companies promoted their products during the Symposium, including Cuba’s Neuronic SA (an ISO 9001-approved company), which exhibited AUDIX, the first commercially available electro-audiometer system with Multiple Steady State Responses (MSSR). Already widely used in clinical practice, this electro-physiological system is designed to facilitate objective hearing assessment in infants and other difficult-to-test patients by including both Transient Auditory Evoked Potentials and MSSR.

Cuba ’s Information Center
for Medical Sciences Turns 40

By MEDICC Review Staff

Havana , June 8, 2005 - Presided over by Cuba’s Public Health Minister, José Ramón Balaguer, the 40th anniversary of the National Information Center for Medical Sciences (CNICM according to its acronym in Spanish) was commemorated today at Calixto García Hospital. Another cause for celebration was the Center’s recent recognition as a WHO and PAHO collaborator.

Since its founding in April 1965, CNICM has provided scientific and technical information to health professionals across the country. It is the leading center in a network of specialized institutions that together make up Cuba’s National Health Information System, a nexus comprised of provincial and municipal information centers, national reference sub-centers, and more than 800 libraries located at research centers, hospitals, polyclinics, and other health units throughout Cuba.

In order to provide the electronic tools necessary to support, promote and enhance the work of various Cuban health-related information entities, CNICM developed a nationwide computer information network ten years ago. This network has been internationally recognized, with its web page Infomed www.sld.cu/), receiving the Stockholm Challenge Award in 2002 in the health field.

Among other projects and institutions, CNICM oversees the National Medical Library, offering traditional and digital library services, and the Medical Sciences Publishing House, in charge of editing most of Cuba’s 28 medical journals, textbooks and other medical and public health books.

Good humor abounded at the ceremony, especially as colleagues and co-workers remembered hard work captured in a laugh-out-loud video produced with archive material. The video, together with a few songs performed by the Cuban pop duo Buena Fe, wrapped up an enjoyable commemoration.