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The Colombian program to end trachoma implements the component F of the SAFE strategy in the Vaupés department of the Amazon rainforest. Cultural, linguistic, and geographical barriers and the coexistence of an ancestral medical system demand the technical and sociocultural adaptation of this component. A cross-sectional survey combined with focus-group discussions to understand the knowledge, attitudes, and practices of the indigenous population related to trachoma was conducted in 2015. Of the 357 heads of households that participated, 45.1% associated trachoma with a lack of hygiene, and 94.7% associated the concept of hygiene with taking one or more body baths per day, using commercial or handcrafted soap. In total, 93% reported cleaning their children’s faces and eyes more often when they have conjunctivitis, but 66.1% also did this with clothes or towels in use, and 52.7% of people shared towels; in total, 32.8% indicated that they would use ancestral medicine to prevent and treat trachoma. The SAFE strategy in Vaupés requires an intercultural approach to facilitate stakeholder support and participation to promote general and facial hygiene, washing clothes with soap, and not sharing towels and clothes to dry and clean children’s faces for effective and sustainable elimination of trachoma as a public health problem. This qualitative assessment facilitated an intercultural approach locally and in other Amazonian locations.

Introduction. COVID-19 is a pathology caused by the SARS-CoV-2 virus. The World Health Organization (WHO) has reported more than 225 million cases and 4.5 million deaths worldwide. Objective: To describe the seropositivity, spatial distribution, and clinical and sociodemographic variables of SARS-CoV-2 in a community of the Colombian Amazon region. Methods. In December 2020, a cross-sectional observational study was carried out in a population located in the Colombian Amazon in the municipality of Mitú. Sociodemographic and clinical data were taken. Besides, 589 blood samples were taken, and an antibody detection was carried out with an ELISA and a recombinant protein N antigen of SARS-CoV-2. Results. A seropositivity of 57.6% was observed. The highest proportion of the infection is located in inter-municipal transport zones. The bivariate analysis did not show differences in the SARS-CoV-2 infection rate concerning the variables sex, age range, and the presence of comorbidities (p &gt, 0.05). The bivariate and multivariate analysis showed that being symptomatic and presenting neurological manifestations of the upper respiratory tract are clinical variables associated with SARS-CoV-2 infection (p &lt, 0.05). One of the causes of this virus’s high spread in this community could be that 53.3% of the people were asymptomatic. Conclusions. Our data showed a high burden and transmission of SARS-CoV-2 in the indigenous community. This could be linked to cultural behaviors and the high infection rate in asymptomatic patients.

Introduction. COVID-19 is a pathology caused by the SARS-CoV2 virus. The World Health Organization has reported more than 94 million cases and two million deaths worldwide. Objective: To describe the seroprevalence, spatial distribution, and clinical and sociodemographic variables of SARS-CoV2 in a community of the Colombian Amazon region. Methods. In December 2020, a cross-sectional observational study was carried out in a population located in the Colombian Amazon in the municipality of Mitú. Sociodemographic and clinical data were taken. Besides, 590 blood samples were taken, and an antibody detection was carried out with an ELISA and a recombinant protein N antigen of SARS-CoV2. Results. A seroprevalence of 57.6% was observed. The highest proportion of the infection is located in inter-municipal transport zones. The bivariate analysis did not show differences in the SARS-CoV2 infection rate concerning the variables sex, age-range, and the presence of comorbidities (P> 0.05). The bivariate and multivariate analysis showed that being symptomatic and presenting neurological manifestations of the upper respiratory tract are clinical variables associated with SARS-CoV2 infection (P

The 2021–2030 Neglected Tropical Diseases road map calls for intensified cross-cutting approaches. By moving away from vertical programming, the integration of platforms and intervention delivery aims to improve efficiency, cost-effectiveness and programme coverage. Drawing on the direct experiences of the authors, this article outlines key elements for successful integrated surveys, the challenges encountered, as well as future opportunities and threats to such surveys. There are multiple advantages. Careful planning should ensure that integration does not result in a process that is less efficient, more expensive or that generates data driving less reliable decisions than conducting multiple disease-specific surveys.

Introduction. Currently, more than 1.8 billion doses of SARS-CoV-2 vaccines have been applied worldwide. However, some developing countries are still a long way from achieving herd immunity through vaccination. In some territories, such as the Colombian Amazon, mass immunization strategies have been implemented with the CoronaVac® vaccine. Due to its proximity to Brazil, where one of the variants of interest of SARS-CoV-2 circulates. Objective. To determine the efficacy of the CoronaVac® vaccine in a population of the Colombian Amazon. Methods. Between February 24, 2021, and May 19, 2021, a descriptive observational study was carried out in which a population of individuals over 18 years of age immunized with two doses of the CoronaVac® vaccine was evaluated. The study site was in the municipality of Mitú, Vaupés, in southeastern Colombia, a region located in the Amazon bordering Brazil. Results. 87% of the urban population of the Mitú municipality were vaccinated with CoronaVac®. To date, 2.1% of vaccinated individuals have become ill, and only 0.1% of these require hospitalization. No deaths attributable to COVID-19 have been reported among vaccinated individuals, and the vaccine has shown 97% efficacy against mild disease and 100% against severe infection. Conclusions. The herd immunity achieved through mass vaccination in this population has made it possible to reduce the rate of complicated cases and mortality from COVID-19 in this region of the Colombian Amazon.

Epidermal parasitic skin diseases encompass scabies, pediculosis, cutaneous larva migrans, myiasis, and tungiasis. Tungiasis is probably the most neglected of all Neglected Tropical Diseases (NTD). It occurs in South America, the Caribbean and Sub-Saharan Africa and affects marginalized populations where people live in extreme poverty. In endemic communities the prevalence can be up to 30% in general population and 85% in children. Over time, chronic pathology develops characterized by hyperkeratosis, edema around the nail rim, fissures, ulcers, deformation and loss of nails. This leads to a pattern of disabilities, eventually resulting in impairment of mobility.Dimeticones are a family of silicon oils with a potential to kill parasites located on top or inside the epidermis by a physical mode of action. They are considered the treatment of choice for pediculosis capitis and pediculosis pubis. With regard to tungiasis, the so called rear abdominal cone of the parasites has been identified as a target for treatment with dimeticones. NYDA®, a mixture of two dimeticones with different viscosity, is the only dimeticone product for which data on the mode of action, efficacy and safety with regard to tungiasis exists. The product has been shown highly effective against embedded sand fleas, even in very intense infection with more than 500 parasites situated on top of each other. A randomized controlled trial showed that seven days after a targeted application of NYDA® 97% (95% CI 94-99%) of the embedded sand fleas had lost all signs of viability.Comprehensive toxicological investigations on the dimeticones contained in NYDA® showed that there is practically no risk of embryotoxicity, fetotoxicity, teratogenicity, and other toxicity. The safety of dimeticones was also demonstrated in clinical trials with a total of 106 participants with tungiasis, in which not a single adverse event was observed.

Objectives The objectives of the study were to estimate the prevalence of different clinical signs of trachoma and identify possible factors associated with TF. Methodology Following the approval of the study protocol by the ethics committee, a cross-sectional study was conducted in Vaupes, a department of the Colombian Amazon, between the years 2012 and 2013 in two districts. Based on the records obtained from a standardized format for the clinical evaluation of the participants and the factors associated with follicular trachoma, an excel database was built and debugged, which was analyzed using IBM SPSS, Statistics Version 23 and Stata STATA (Version 14, 2015, StataCorp LLC, Texas, USA). Results The records of 13,091 individuals was collected from 216 rural indigenous communities, of which 12,080 were examined (92.3%); 7,274 in the Western and 4,806 in the Eastern districts. A prevalence of trachomatous inflammation–follicular (TF) of 21.7% (n = 599; 95% CI 20.2–23.3) in the Western and 24.9% (n = 483; 95% CI 23.1–26.9) in the Eastern district was found in children aged 1 to 9 years. Regarding trachomatous trichiasis (TT), 77 cases were found, of which 14 belonged to the Western district (prevalence 0.3%, CI 95% 0.2–0.5) and 63 to the Eastern district (1.8%, CI 95% 1.4–2.4). Children aged between 1 to 9 years were significantly more likely to have TF when there was the presence of secretions on the face (OR: 3.2; 95% CI: 2.6–3.9). Conclusions Trachoma is a public health problem in Vaupes that requires the implementation of the SAFE strategy (S = Surgery, A = Antibiotics, F = Face Washing, E = Environment) in the Eastern and Western districts, for at least 3 consecutive years, in accordance with WHO recommendations.

Scabies is a neglected tropical disease associated with important morbidity. The disease occurs worldwide and is particularly common in resource-poor communities in the Global South. A validated technique for the diagnosis of scabies in resource-poor settings does not exist. The objective of the study was to determine the practicability and accuracy of handheld digital microscopy in three indigenous communities in the Amazon lowland of Colombia, where scabies is the most common parasitic skin disease. One-hundred-and-eleven children and adults from three indigenous communities with a presumptive diagnosis of scabies were examined clinically by using a handheld digital microscope placed directly on the skin. The microscopical identification of a mite was verified by an &ldquo, experienced mother&rdquo, a woman who had acquired the skills to diagnose scabies as part of traditional Amerindian medicine. The &ldquo, removed the parasite with a fine needle and placed it on a flat surface in order to enable its direct examination with the digital microscope. Using digital microscopy, scabies was diagnosed in 24 out of 111 participants and confirmed by the extraction of a Sarcoptes mites from the acarine eminence. A characteristic tunnel (burrow) with or without mite could be clearly identified irrespective of the degree of pigmentation of the skin. Besides, digital microscopy revealed pathological characteristics of scabies hitherto unknown and impossible to be seen in dermoscopy, such as partially or totally obliterated tunnels, tunnels with multiple entry or exit points, circumscribed hyperpigmentation around obliterated tunnels and mites secluded in a nodule. This proof-of-principle study demonstrated the accurate diagnosis of scabies by handheld digital microscopy in patients with pigmented skin and the feasibility of this technique in resource-poor settings.

Introduction: Trachoma is the leading cause of infectious blindness in the world. In 2008 there were 1,300,000 persons with blindness caused by trachoma and 8 million with trichiasis, which might eventually lead to blindness. In Latin America it has been documented in Brazil, Guatemala and Mexico. Objective: To inform the presence of trachoma for the first time in Colombia, amongst Amerindians of the Department of Vaupes. Materials and methods: In 2003 and 2006 the Amerindian Maku communities of San Joaquin and Santa Catalina, located 5 km from the border with Brazil, were visited. From 2007 to 2009, San Gerardo, San Gabriel and Nuevo Pueblo, at a 35 km distance from San Joaquin were visited. Results: In 2006 114 people were examined in Santa Catalina and San Joaquin; 21 patients were clinically diagnosed with trachoma (18.4%), 15 (13.2%) of them children under 15 years old. All trachoma phases were observed. Three women had corneal opacity with poor vision. In the remaining three communities, three women with advanced trachoma with corneal opacity and blindness were detected. The poor quality of living conditions without fresh water and adequate sanitary disposal systems, and the abundance of flies identified as Hippelates sp., are risk factors for the transmission of the disease. Discussion: Trachoma exists in Colombia, and it is frequent among the studied communities. Its focalized distribution makes it amenable to elimination. It is advisable to search for trachoma in other indigenous communities in Vaupes with similar living conditions.

*Este trabajo es un resumen de la versión original, que se publica en Biomédica 32 (2): junio, 2010. Se publica aquí con la autorización de los editores de Biomédica.ResumenIntroducción: La tungiasis o infestación cutánea por la pulga Tunga penetrans ocurre en comunidades muy pobres. Las pulgas penetran la piel (usualmente de los pies), produciendo rasquiña y luego dolor. La mayoría de las veces la enfermedad se resuelve sola pero en casos severos pueden presentarse deformidades que llevan a infección secundaria y a tétanos.Objetivo: Estudiar la entidad en indígenas del Vaupés.Métodos: 1. Revisar el tema. 2. Describir el área y la vivienda. 3. Detectar animales con la zoonosis. 4. Ilustrar la clínica y las complicaciones. 5. Tratar los pacientes y los animales con creolina. 6. Modificar el piso de las malocas en dos comunidades, con humectación y arcillado de piso. 7. Educación comunitaria.Resultados: 95 % de los 33.000 habitantes del Vaupés son indígenas. Algunos moran en viviendas de piso arenoso, seco, con detritos alimenticios y perros con tungiasis. Entre 1996-2007 confirmamos 942 casos del parasitismo o 3-8/1000 de los indígenas estudiados; y un 62 % de los perros presentaron tungiasis. Los pies se afectaron en el 98 % de los pacientes. Casos graves con más de 20 lesiones ocurrieron en niños y ancianos. Complicaciones: infección secundaria, dolor, anoniquia, artejos deformados, amputados e imposibilidad para la marcha. Hubo sepsis mortal en tres pacientes. Los baños con creolina y la extracción del parásito fueron curativos, en hombres y animales. La modificación de los pisos redujo a cero la enfermedad en una comunidad.Conclusiones: 1. La enfermedad es intra-domiciliaria. El piso de la vivienda y la convivencia con perros infestados son ideales para adquirirla. 2. La creolina, humectar el piso y arcillarlo controlaron un foco de la enfermedad, actividad que podría generalizarse. 3. Esta es la primera investigación colombiana sobre tungiasis, conocida desde que afectó a los soldados de Gonzalo Jiménez de Quesada.Palabras clave: Tungiasis, Tunga penetrans , pulgas, zoonosis, ectoparasitosis, anoniquia, sepsis, pobreza, indígenas, Colombia, Vaupés.TUNGIASIS IN NATIVE AMERINDIANS IN VAUPÉS PROVINCE: EPIDEMIOLOGY, CLINICAL ASPECTS, TREATMENT, AND PREVENTION.AbstractIntroduction: Tungiasis is a skin disease caused by a parasitic jigger flea called Tunga penetrans which is found in depressed tropical communities. The female fleas are embedded into the skin (usually in the feet) and cause localized itching and then pain. In most cases the condition resolves itself but severe infestation can cause deformity, existing the risk of secondary infection and tetanus.Objective: To study tungiasis seen in Vaupes native indians.Methods: To review the subject, to describe areas and housing conditions where this happens, to screen for sick animals suffering from these zoonoses, to describe clinical findings and complications of the disease, to treat both patients and animals with creolin; to modify the ground in houses (“malocas”) of two communities, humidifying and placing clay in floors; and to educate the community.Results: 95 % of 33.000 people living in Vaupes are native indians. Some live in houses with sandy ground, dry, with food waste spilled throughout the floor and sheltering infected dogs. Between 1996-2007 we were able to confirm 942 cases of this parasitic disease. Tungiasis was present in 3-8/1000 of studied native indians and 62 % of dogs. 98% of patients feet had lesions. Serious cases with more than 20 lesions occurred in children and elderly patients. Complications observed were secondary infection, pain, anonychia, deformed or amputated toefingers, inability to walk. Three patients had fatal sepsis. Spilling creoline in restrooms and pulling out parasite from both sick human and domestic animals was curative. Community incidence of disease went down to zero once floors were modified.Conclusions: 1. This is an in-house condition. Housing floors and living with infected dogs are main risk factors to acquire this condition. 2. Creolin and floor humidification –claying it afterwards- were strategies able to control a source of disease, action that could be expanded. 3. This study is the very first one about tungiasis carried out in Colombia; thecondition is known here after infection spreaded out among spanish soldiers serving under commander Gonzalo Jiménez de Quesada.Key words: Tungiasis, Tunga penetrans , jigger fleas, zoonoses, ectoparasitosis, anonychia, sepsis, poverty, native indians, Colombia, Vaupes.

Objective. To confirm the microbiological presence of C. trachomatis in indigenous communities of Colombia found to have cases of active trachoma. Method: An ophthalmic evaluation was performed in order to identify the active forms of the disease. Ocular swabs were taken from the conjunctiva and analyzed by real time PCR “in house” for the detection of C. trachomatis. Positive samples, were confirmed by a commercial real time PCR and DNA sequencing. Design: Descriptive study Subjects: Children with active trachoma from different indigenous communities in Vaupés, Colombia. Main outcome measures: Presence of C. trachomatis in conjunctival swab samples Results. Fifteen clinical cases of active trachoma were identified in children between one and 12 years old. A major proportion of TI was observed, compared with TF and greater bilateral commitment of the disease. Patients were from the indigenous communities of Santa Catalina (73.3%), Pacuativa (20%) and Piramirí (6.7%). The presence of C. trachomatis was confirmed in 3 (20%) patients, by real time PCR technique “in house” and confirmatory, and validated with sequencing. Conclusion. This study confirms the presence of C. trachomatis in cases of active trachoma in indigenous communities of the department of Vaupés, Colombia.

Trachoma is the leading cause of infectious blindness in the world. In 2008 there were 1,300,000 persons with blindness caused by trachoma and 8 million with trichiasis, which might eventually lead to blindness. In Latin America it has been documented in Brazil, Guatemala and México.To inform the presence of trachoma for the first time in Colombia, amongst Amerindians of the Department of Vaupés.In 2003 and 2006 the Amerindian Makú communities of San Joaquín and Santa Catalina, located 5 km from the border with Brazil, were visited. From 2007 to 2009, San Gerardo, San Gabriel and Nuevo Pueblo, at a 35 km distance from San Joaquín were visited.In 2006 114 people were examined in Santa Catalina and San Joaquin; 21 patients were clinically diagnosed with trachoma (18.4%), 15 (13.2%) of them children under 15 years old. All trachoma phases were observed. Three women had corneal opacity with poor vision. In the remaining three communities, three women with advanced trachoma with corneal opacity and blindness were detected. The poor quality of living conditions without fresh water and adequate sanitary disposal systems, and the abundance of flies identified as Hippelates sp., are risk factors for the transmission of the disease.Trachoma exists in Colombia, and it is frequent among the studied communities. Its focalized distribution makes it amenable to elimination. It is advisable to search for trachoma in other indigenous communities in Vaupés with similar living conditions.

Tungiasis, the skin infestation with the flea Tunga penetrans, occurs in poor communities. Objective. To present a study of this condition among native Amerindians from Vaupés (Colombia).After reviewing this topic, we present a description of the geographic area and the housing of the affected subjects; animal carriers infected with this zoonosis were also detected. We illustrate the clinical aspects and complications. Patients were treated with creolin (liquid cresol). We modified the floor of malocas in two communities using wet clay, and we educated the community on this parasite.About 95% of the 33,000 inhabitants of Vaupés are native Amerindians. Some households have dry sandy floors, where food leftovers attract dogs infested with tungiasis. From 1996 to 2007 we confirmed 942 human cases of this parasitic disease. Among the native communities, 3 to 8 per 1,000 persons and 62% of the dogs have tungiasis. Feet were affected in 98% of the patients. Severe cases, with more than 20 lesions, occurred among children and the elderly. Complications included secondary infections, pain, anonychia (loss of toenails), toe deformities, amputation of toes and walking problems. Three patients died as a result of sepsis originating from toe infections. Topic use of liquid creolin and extraction of the parasite cured the problem in humans and dogs. Floor modifications eradicated the problem in one community.Tungiasis is an intradomiciliary disease. Favorable conditions for infestations include dry sandy floors and infected dogs. Treatment of the floors with creolin and wet clay resulted in control of one focus of the disease; this method could be applied more widely. This is the first known research study on tungiasis in Colombia, a disease that affected the soldiers of the Spanish Conquistador Gonzalo Jiménez de Quesada in the 1500s.