Guatemala

The first autochthonous case of Zika infection in Guatemala, confirmed by CDC, was reported in the Department of Zacapa in November 2015.[1]  Since then, and as reported in the December 2016 MSPAS Epidemiological Update, Guatemala has reported over 3,149  cases of Zika[2].  So far the MSPAS data shows that most cases are in people between 25 and 39 years of age, and 67% of cases are reported in women.   Additionally, as of Epidemiological Week 45 of 2016, the Guatemala Ministry of Public Health and Social Assistance has reported:

  • 965 pregnant women with suspected Zika virus disease, including 275 confirmed cases.
  • 54 cases of Guillain-Barré syndrome (GBS) have been reported, including 13 cases confirmed for Zika virus. The incidence rate of GBS in 2016 (as of EW 40) is higher than the rates of GBS reported between 2011 and 2015.
  • 15 confirmed cases of congenital syndrome associated with Zika virus infection have been reported by the Guatemala health authorities.[3]

Overall, MSPAS epidemiological reports show a consistently high prevalence in 6-7 departments which represent over 75% of cases reported nationwide (Table below).

 

In response to the growing number of cases, the MSPAS has initiated a response which includes surveillance, clinical care, vector control and community-based prevention.  However, the Government of Guatemala faces significant challenges to overcome structural and budgetary deficiencies that limit their capacity to respond and/or consistently implement their Zika plans. These challenges include among others, the lack of stakeholder coordination, lack of human resources at the MSPAS (both national and sub-national level), a limited capacity to design and consistently implement protocols for entomological monitoring, vector control interventions, and environmental management. Additionally, the initial assessment of the MSPAS’s capacity to respond to Zika indicates the need to strengthen national procedures such as pesticide warehouse management and pesticide and equipment supply chain (particularly procurement). Finally, there is a need to improve the data collection systems and data analysis for decision-making to ensure an efficient and cost-effective implementation of MSPS’ Zika plans.

Overall, the main goal of the ZAP Guatemala project is to support the MSPAS efforts to control the Zika outbreak in Guatemala.  To this end, ZAP Guatemala will implement vector control (VC) activities and establish routine entomological surveillance in eleven (11) municipalities located in El Progreso, Zacapa and Chiquimula departments. Additionally, in close coordination with the USAID-funded Engaging communities in responding to Zika in Guatemala and El Salvador (ZICORE) Project (implemented by MCDI in partnership with the Guatemalan Red Cross),  ZAP Guatemala will implement an integrated model in four (4) municipalities in Chiquimula out of  the 11 mentioned above, where households will receive both ZAP and ZICORE interventions. See section 6.1 for a more detailed explanation.

While implementing field activities, ZAP Guatemala will support the GoG by establishing best practices in managing Zika-related environmental health risks, and safe inventory and warehouse management.  Additionally, in close coordination with the MSPAS and PAHO, ZAP Guatemala will also implement an Indoor Residual Spraying (IRS) pilot in a cluster of prioritized municipalities covering approximately 15,000 households. The objective of the pilot is to assess the effectiveness of “dengue-style” IRS on the Aedes aegypti population in target municipalities.

Finally, ZAP Guatemala will work with GoG, CDC and other partners to strengthen insecticide resistance (IR) management policies and establish a comprehensive domain of bionomic data on Aedes vectors to ensure data-driven decisions in any forthcoming arbovirus control efforts.

ZAP Specific Objectives

ZAP Guatemala will work with partners at national and departmental levels to achieve the following specific objectives:

  1. Implementation of high quality VC management to protect 70,000 vulnerable households (approximately 352,000 people at risk) in the departments of Zacapa, El Progreso and Chiquimula from Zika virus transmission. The proposed integrated VC model includes using a knowledge, attitude and practice (KAP) approach for the elimination of mosquito breeding sites, larviciding, and pilots of new VC approaches for Aedes
  2. In approximately 38,000 households out of the 70,000 indicated in specific objective #1 (above), the ZAP Guatemala will join efforts with the ZICORE project resulting in an integrated intervention model. This joint intervention will take place in the Department of Chiquimula and will benefit approximately 187,000 people at risk.
  3. Conduct an IRS pilot covering 15,000 households in one of the priority departments as recommended by USAID/MSPAS.
  4. In close coordination with the MSPAS, CDC and PAHO, implement entomological surveillance best practices through the establishment of five sentinel sites located in target municipalities, and two control sites. Sentinel sites will conduct vector bionomic studies, routine monitoring and data reporting to inform optimal cost-effective VC interventions.
  5. In coordination with CDC, PAHO and other USAID implementing agencies, contribute to strengthening the capacity and skills of GoG (at national, and sub-national level ) and other local counterparts, in VC and entomology in order to establish in-country resources to implement activities aimed to reduce Zika and other arbovirus transmission.

 

[1] Epidemiological week 45-2015 – MSPAS/PAHO

[2] MSPAS: Direccion de Epidemiologia

[3] Pan American Health Organization / World Health Organization. Zika – Epidemiological Report Guatemala. December 2016. Washington, D.C.: PAHO/WHO; 2016

[4] Epidemiological Update #43 –Nov 2016 – MSPAS