Descargar Control And Surveillance Of African Trypanosomiasis: Report Of A Who Expert Committee por World Health Organization(who) Epub y PDF
This book provides a state-of-the-art review of what is currently known about African Trypanosomiasis and the measures available for its treatment surveillance and control. Reflecting the consensus reached by an international group of experts the report responds to the many obstacles confronting efforts to control a disease which is confined to sub-Saharan Africa and thus afflicts some of the poorest countries in the world. Problems discussed include the difficulty of detecting cases at an early stage the need for laboratory confirmation of diagnosis the reliance on drugs developed empirically before 1950 the high cost and toxic effects of these drugs lack of commercial interest in the development of new drugs and characteristics of the parasite that preclude the development of a vaccine. Control efforts are further hampered by the tsetse fly's great capacity for dispersal the inaccessibility of transmission sites and the dwindling resources for disease control in virtually all endemic countries. With these difficulties in mind the report gives particular attention to new knowledge that can lead to the better use of existing tools whether involving treatment schedules with lower drug doses and shorter duration the construction of cheaper traps or the use of geographical information systems to target control measures precisely. Throughout the report an effort is also made to identify the specific lines of experimental and operational research needed to improve control at the least possible cost. The report opens with information about the clinical features of Trypanosoma brucei gambiense and T. b. rhodesiense including characteristic signs and symptoms pathology and pathogenesis tools for diagnosis in both mass screening and individual cases and current recommendations for treatment in the first and second stages of disease. Section two on the parasite concentrates on recent research at the biological biochemical and molecular level that can be exploited to improve diagnosis and treatment including the development of new drugs. A section devoted to the Glossina species reviews current knowledge about the vector's bioecology life cycle and behavior including response to odors and colors and outlines the information needed to define risk factors for transmission and identify high-risk zones. Drugs for the treatment of sleeping sickness are discussed in the next section which gives detailed information on the mode of action pharmacokinetics adverse reactions and efficacy of pentamidine suramin sodium melarsoprol eflornithine and nifurtimox a drug traditionally used to treat Chagas disease. Subsequent sections cover the epidemiology of transmission human factors influencing the spread of disease and strategies for control and surveillance. The remaining sections offer advice on tools for the implementation and evaluation of control programs and discuss training and research needs. Further practical information is set out in a series of nine annexes which include examples of treatment schedules advice on the use of geographical information systems drawings of traps and screens and examples of their use in control operations. To help decision-makers find the most cost-effective way of accomplishing their objectives additional annexes provide examples of cost calculations for the comparative analysis of different detection and treatment strategies and explain the use of decision analysis as a powerful tool for an integrated analytical approach to control.
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