TRACING INFECTIOUS DISEASES IN SOUTH AMERICA
Abstract
Biological Weapon (BW) agents are pathogens present in the nature that were included in weapons programs, but at the end, they are just microorganisms that cause diseases around the globe.
In this paper, we will show the aspects we consider are involved in the biological agents’ epidemiology in South America and with special focus in Argentina, using open sources information, from an Information Quality (IQ) perspective.
In this sense, and after study the data obtained, we found out several IQ problems, such as, several IQ dimensions are affected and cultural and organizational aspects deeply affect the disease reporting process.
This is a research in progress; there is a long way ahead in this journey that tries to understand both the epidemiology of certain diseases and the disease reporting schema.
Given the fact that in this research we deal with national and supranational organizations information, we propose some recommendations to them in order to improve their situation.
Key Words: infectious diseases, South America, information quality
Introduction
Biological weapon agents are just pathogens present in the nature that were included in weapons programs, but at the end, they are just microorganisms that cause diseases around the globe. [1]
In this context, is important to point out that to know when and where the biological agents were and are, we could be able to predict a will be and future distribution. This is valid not just for biological weapons agents but also to common diseases spread. In this given situation, the analysis of pathogens distribution gains great importance.
Now in the biological weapons arena, to know and understand the epidemiological situation of the diseases caused by biological weapons agents will provide critical information in cases of alleged attacks investigations and possible agent sources, among others.
Because of the complexity of the world epidemiological situation, we narrow our study to South America, the region where we live.
Background
The understanding of the regional epidemiological situation will allow us not just know which listed agents are present in the area and their history (background information) but also to have useful information for health plans elaboration and response systems organization, and at the same time, to have key elements in the attribution process in case of a biological attack.
Talking about the importance of knowing the epidemiological background information, Anne L. Clunan [2] clearly establishes its role in the Conclusion Chapter of her book, where she (like the other authors which also participated on the book) pointed out the role and importance of the background information not just in case of biological attacks but in health care topics.
In this context, is relevant to point out that there is no information or information sources 100% trustable, and because of this situation, is important to consider and use state of the art techniques to obtain the maximum profit of the raw elements used to build the research.
Taking into account this situation, we apply Information Quality and Total Data Quality Management techniques and tools in order to perform our research in a more complete and deep way. This new approach applied to the building of epidemiological information databases, allow us to count with a better quality product and to discover the problems with the traditional information sources in this field (WHO, PAHO, Promed, CDC, Health Ministries, etc.).
Due to the scope of this paper, the deep study of the different information sources wasn’t included, that will be objective of future research.
Rationale & Purpose
This research combines two areas: biological weapons agents’ situation in South America and information quality, meaning we use IQ tools to understand the diseases under study distribution.
The purpose of this research is the understanding of the geographical distribution regarding some specific diseases (BW agent caused diseases).
As a secondary objective is the identification of failures on the disease reporting system, as a first step to elaborate recommendations to the health care system.
Methodology
In order to fulfill the objectives of this research we analyze the open sources available. To do that, we used Google as a search engine and also the search engines from each website belonging to organizations considered, such as WHO, PAHO, CDC.
We also made consultations to experts and access to relevant books from the fields included in this study.
Regarding to the specific study about BW agents in the region and Argentina, we took as starting point the Australia Group Core list of Human Pathogens, updated in 2009, because we consider it the broader and more comprehensive list. From there, we first look through Internet in order to find which agents and diseases are present in South America1.
We considered a temporal frame of 10 years (from 1998 to 2008) for our analysis and also we registered the source of the more relevant information (from supranational to local levels) in order to qualify them and categorize them using information quality methodology.
Results
Disease Surveillance and BW agents present in South America
Taking the Australia Group Core List for Human Pathogens [6], the section about virus, we identify the listed BW agents presents in South America through a search of relevant information in the web.
It was possible to determine the presence of the following agents, both like as an endemic disease and occasional outbreaks.
It is important to point out that the information showed in the Table 1 was built considering more than one information source in each case and taking the smallest indicator of presence as an affirmative answer. The last concept is based on, first, the complications if the determination of the presence of a specific disease due to the geographic situation, the characteristics of the labs involved, the health care politics, control regulations and the difficulties inherent to the diseases and etiologic agents under consideration.
At this stage it was not possible to identify the number of cases, death ratio, etc. due to the figures complexity found.
Disease Surveillance and BW agents present in Argentina
In this specific point we want not just to identify which agents are present in Argentina naturally, but also include where they are because of humans activities, such as research programs.
BW agents present in Argentina
Following the previous logic, and considering as starting point the Core List for Human Pathogens from the Australia Group, after a search through Internet it was possible to establish the presence of the next BW agents in Argentina: Dengue fever virus, Eastern equine encephalitis virus, Hantaan virus, Junin virus, Lymphocytic choriomeningitis virus, Venezuelan equine encephalitis, Western equine encephalitis, Yellow fever virus, St Louis virus, Oropuche virus, Rocio virus, and West Nile virus.
Projects which involve BW agents
Through the search made to determine the presence of BW agents in South America and Argentina, it was possible to detect the existence of diverse research teams along the argentine territory. Those groups work with the virus previously mentioned and the diseases that they generate, in pure and applied science research, vaccine development, sanitary control and monitor activities, etc.
Next is showed a list with the more relevant Institutions2 and the agents they work with:
National Administration of Laboratories and Health Institutes (ANLIS) "Dr. Carlos G. Malbrán", Health Ministry.
• Nacional Institute of Human Viral Diseases (INEVH): Lymphocytic choriomeningitis virus; Dengue virus; Hantaan virus; and Junin virus.
• National Center for Diagnosis and Research in Endemoepidemics: Hantaan virus.
• Chagas National Institute "Dr. Mario Fatala Chaben," Buenos Aires: Hantaan virus.
• Comahue Nacional University: Hantaan virus.
• Virology Laboratory, Exact and Natural Sciences Faculty, Buenos Aires University: Hantaan virus.
• Veterinary Sciences Faculty, La Pampa National University: Hantaan virus.
• Virology Institute “Dr. J. M. Vanella”, Medical Sciences Faculty, Cordoba National University: St Louis encephalitis virus; VEE virus; WN virus
In some of the research activities also participated National Hospitals, especially in activities related with the patient control and local diseases surveys.
BLS 3 Laboratories
In July 2006, where the Malbran Institute is located, it was inaugurated the first BSL3 internationally certified laboratory in Argentina, called Operative Unit “Biological Containment Center” (UOCCB). It also has BSL2 facilities.
The SENASA (Agro-alimentary Health and Quality National Service) also has a high level of containment lab, which could be considered as BSL33 since the end of the 09’s.
Information Analysis: Information Quality
During the last 15 years, we witnessed the Information Technology revolution and it consequences in our daily life and work dynamic.
Even when we are immersed in an information sea, it is possible to identify different levels (Figure 1) of where the information is and how it relates to each other. In this case the broader context is the enterprise environment, which in our case could be considered like the human health situation in South America and how it is converted into statistics. The level 2 could be the information inside the health organizations and how it is processed and showed. And finally the level 3 could be considered like the small amount of information that a decision maker need to plan and establish a health strategy.
So in the Figure we can see not just the relations between the different levels but the amount of information in each case.