At the International Congress of Parasitology (ICOPA XIII) held in Mexico City earlier this month, we learned of a very serious and dangerous tropical disease situation now unfolding in Venezuela. The most glaring public health failure has been a sharp rise in malaria. As also reported in Lancet last week Rodriguez-Morales and Paniz-Mondolfi found more than a doubling of the number of malaria cases in Venezuela since 2008, with almost 1,500 weekly cases reported on average this year. Whereas the Americas overall have seen a 58 percent decrease in malaria over the last decade, Venezuela joins Guyana and Haiti as the only three countries with an increase. However, Venezuela has a substantially higher human development index and gross national income per head than Guyana and Haiti, suggesting that factors other than extreme poverty partly account for this situation. They include a health system in disarray (as reported recently in Science), and the unavailability of antimalarial drugs. According to Rodriguez-Morales, who presented at ICOPA XIII, malaria is now hyperendemic in areas surrounding Venezuela’s gold mines, which has been linked to a rise in illegal mining and mismanagement.
Malaria is not the only tropical disease to re-emerge in Venezuela. Dengue cases are increasing and there are serious concerns about chikungunya spreading from the Caribbean. Moreover, there have been shortages in the national stockpile of antimonial drugs for treating leishmaniasis, and we learned of an unresolved problem with urban schistosomiasis caused by Schistosoma mansoni. In 2010, Dr. Belkisyole Alarcon de Noya and her colleagues from the Instituto de Medicine Tropical, Universidad Central de Venezuela, reported on a large urban outbreak of orally acquired acute Chagas disease at a school comprised of mostly middle-class schoolchildren in Caracas. More than 100 of 1,000 exposed individuals became infected with Trypanosoma cruzi when they ingested contaminated guava juice. More than one-half of the confirmed cases exhibited abnormalities on their ECG recordings, while 20 percent required hospitalization. There was also one death – a five-year-old child who died of acute Chagasic myocarditis. Subsequent T. cruzi genotyping confirmed a common source of infection.
We have used the term blue marble health to highlight the unexpectedly high prevalence and incidence rates of neglected tropical diseases in the G20 and other wealthy economies. The term mostly applies to diseases striking concentrated areas of intense poverty in these countries. The concepts of blue marble health certainly apply to Venezuela but we may now also be seeing a significant re-emergence of tropical infections in recent years. In stark contrast to previous decades, when Venezuela was a leader of public health efforts in Latin America, the country now appears to be experiencing a dire public health crisis. We need a better understanding of the basis for this rise in disease prevalence and incidence, and to what extent they reflect changes in government policies versus other forces. In the meantime, neglected tropical diseases represent a public health and humanitarian emergency in the nation of Venezuela that may require external assistance from the Pan American Health Organization and other international agencies.
Peter Hotez MD PhD and Jennifer Herricks PhD are at the National School of Tropical Medicine at Baylor College of Medicine and James A Baker III Institute for Public Policy at Rice University. Prof. Hotez is also Co-Editor-in-Chief of PLOS Neglected Tropical Diseases.