Venezuela’s public health woes are poised to become South America’s

Map of Venezuela and South America

Three EPI investigators are coauthors to published research on Venezuela’s public health crisis and how it is affecting bordering South American countries. Vaccine-preventable diseases and insect-borne diseases are increasing as mosquito-control measures subside and public health infrastructure crumbles.

Three researchers from UF’s Emerging Pathogens Institute have contributed to two high-profile original research papers that synthesize key components of the growing public health threat posed by infectious diseases in Venezuela. The research was split into twin papers due to the volume of data being examined: one paper reviewed vaccine-preventable diseases (Emerging Infectious Diseases, published Jan 30.) and the other reviewed vector-borne diseases and was published in The Lancet Infectious Diseases on Thursday.

UF-EPI coauthors include: EPI director Glenn Morris, EPI investigator John Lednicky and post-doctoral fellow Gabriela Blohm. All three EPI researchers were coauthors to both papers. The study published in The Lancet Infectious Diseases focused on Zika virus, malaria, dengue, chikungunya and Chagas disease. The earlier study published in Emerging Infectious Diseases focused on measles, diphtheria and poliomyelitis.

“These papers reflect two sides of the same coin,” said EPI director Glenn Morris. “Both provide 30,000 foot views on the scope of the health problems in Venezuela. This is the first time that someone has pulled all these disparate bits and pieces together to make a wide-angle snapshot of what Venezuelan public health looks like while the country is in free fall.”

UF has engaged in multiple components of work with Venezuelan investigators who remain in the country in a desperate attempt to both maintain an adequate health care system, and to document the effects of its collapse. Morris said that outbreaks of disease are occurring in neighboring Brazil and Colombia that appear to be triggered by the movement of people fleeing coupled with the collapse of Venezuelan healthcare infrastructure.

“It gets back to this idea that a key element of global public health is that everyone needs to be part of it,” Morris said.

Mosquito-control efforts appear to have collapsed which would explain a spike in insect-borne diseases. Writing in The Lancet Infectious Diseases, the researchers said: “Between 2000 and 2015, Venezuela witnessed a 359 percent increase in malaria cases, followed by a 71 percent increase in 2017 (411,586 cases) compared with 2016 (240,613). Neighboring countries, such as Brazil, have reported an escalating trend of imported malaria cases from Venezuela, from 1,538 in 2014 to 3,129 in 2017… Dengue incidence increased by more than four times between 1990 and 2016. The estimated incidence of chikungunya during its epidemic peak is 6,975 cases per 100,000 people and that of Zika virus is 2,057 cases per 100,000 people.” The infectious spillover threatens to erode mosquito-borne illness control and infection rates in the bordering countries of Colombia, Guyana and Brazil as well as non-bordering South America countries.

Likewise, crumbling public health infrastructure means that vaccines for easily preventable diseases such as measles have gone undelivered. According to the findings, published in Emerging Infectious Diseases, measles was under control in Venezuela until 2010, when the nationwide immunization program began to fail alongside a collapsing economy. The authors write: “The return of measles and other vaccine-preventable childhood infections in Venezuela, as well as the potential for expansion of outbreaks beyond Venezuela’s borders, has been recognized by the World Health Organization and the Pan American Health Organization…As of October 23, 2018, Venezuela had contributed 68 percent (5,525 out of 8,091 cases) of the measles cases reported in the Americas and most of the measles-related deaths (73 out of 85).”

Gabriela Blohm, a Venezuelan post-doctoral fellow working with the EPI was key in establishing a relationship between UF and Venezuelan researchers. She noted that while many media stories have focused either on the diseases spreading to other countries with the millions of people who have fled, or the role of the Maduro government in facilitating the public health crisis, few have focused on the doctors, students and public health workers who remain in the country to try and alleviate the crisis.

“Several of our co-authors are still working in Venezuela, including UF’s key collaborator in the country,” said Blohm, who is also affiliated with UF’s College of Health and Health Professions in the department of environmental and global health. “We have the unique opportunity to talk about the courage and persistence it has taken our collaborators to continue working on the ground.”

By: DeLene Beeland