The intersectoral and multidisciplinary strategies to prevent and respond to communicable diseases include the early identification and high-risk case management, to reduce additional pressure on the health system, focused on the COVID-19 response.
-Dengue: As of 5 September, 5,110 cases were reported (which amounts to an incidence rate of 15.78 cases per 100,000 inhabitants), as well as 209 laboratory-confirmed cases, 20 severe cases, and 9 deaths (a fatality rate of 0.176 per cent). There was a 46.1 per cent decrease in reported cases (9,475) and a 18.9 per cent increase in the fatality rate compared to the same period in 2019 (0.148 per cent) and to the fatality rate in the Andean subregion (0.056 per cent) and in the Americas (0.037 per cent).
-Chikungunya: As of 5 September, there were 52 cumulative probable cases, with two confirmed cases, a decrease of 57.7 per cent compared to the same period in 2019 (123 cases).
-Zika: As of 5 September, there were 21 cumulative probable cases, with zero confirmed cases, a decrease of 62.5 per cent compared to the same period in 2019 (56 cases).
-Measles and Rubella: As of 19 September, there were 515 suspected cases of measles, rubella and congenital rubella syndrome (CRS) with zero confirmed cases. There are 13,092 reporting units for these pathologies that reported 100 per cent of cases with adequate investigation and 96 per cent of blood samples adequate for case study, but only 13 per cent of blood samples arrive at the laboratory in less than five days. In the last 52 epidemiological weeks (EW 39 2019 to EW 38 2020) a rate of 0.8 suspected measles and rubella cases per 100,000 inhabitants and a rate of 0.3 suspected CRS cases per 100,000 live births was reported.
-Diphtheria: As of 22 August, 54 suspected cases were reported, with 5 confirmed cases (3 by laboratory and 2 by clinical criteria or epidemiological link) including 2 deaths. The confirmed cases corresponded to patients between 2 and 14 years old in Anzoátegui (municipality of José Gregorio Monagas), Miranda (municipality of Brion) and Yaracuy (municipality of Bruzual) states. Since the beginning of the 2018 outbreak, there was a sustained increase in cases, which dropped in 2019 and is expected to continue decreasing in 2020. PAHO/WHO recommends strengthening surveillance systems and laboratory diagnostic capacity; maintaining a supply of diphtheria antitoxin for timely use and reduction of the fatality rate; vaccination to prevent cases and outbreaks; and adequate clinical management that decreases complications and deaths.
-COVID-19: From 13 March to 10 November, 95,445 PCR-confirmed COVID-19 cases have been reported, which represents an incidence rate of 329 cases per 100,000 inhabitants. To date, 834 deaths have been reported, representing a mortality rate of 28.7 deaths per million inhabitants and a lethality rate of 0.87 per cent, one of the lowest in the region. As of 8 November, 88.4 per cent of confirmed cases are a result of community transmission (83,943 cases) and 11.5 per cent are imported (10,940 cases). A comparison of the total number of reported cases in September (75,122 cases) with cases reported as of 10 November (95,445 cases) shows an increase of 27 per cent. As of 22 August 22, 184 confirmed COVID-19 cases have been reported in the Pemón, Kurripaco, Yeral, Yanomami, and Warao indigenous communities, representing a 3 per cent increase over the number reported as of 2 August (179 cases).
Needed activities include increasing PCR diagnostic tests among the population (including health workers and at-risk groups such as migrants and indigenous people) as well as continuing the reorganization of health services to manage the impact of increased cases and deaths, considering the high likelihood of underreporting of cases and delays in surveillance and contact tracing. The provision of personal protective equipment (PPE) for workers in health facilities, PASIs, home visit workers, etc. should be ensured.
In September, Health Cluster partners trained 466 health workers across 24 states. In Bolivar, Carabobo and Zulia, the training focused on COVID-19 response. In addition, in Carabobo, the capacity for clinical management of sexual violence was strengthened.
Health Cluster partners provided equipment, supplies and medicines, including for sexual and reproductive health, benefiting 49,665 people in over 28 outpatient clinics, 11 community clinics, 8 maternity hospitals and 42 hospitals across 24 states. In the context of COVID-19, 979 diagnostic tests were delivered to the Instituto Nacional de Higiene Rafael Rangel, Ministry of Popular Power for Health and the Regional Laboratory of Yaracuy. In addition, 606 people benefited from the provision of personal protection equipment in more than five health facilities and 2 PASIs in three states.
Health Partners have improved access to health services for 39,664 vulnerable people (children, adolescents, pregnant women, indigenous people, people with disabilities) in 171 health facilities (including 3 PASIs) and 17 communities in 14 states. In addition, 8,995 people benefited from access to health services in 11 health facilities (including 3 PASIs) and four communities in five states, as part of the COVID-19 response.
Community capacities on disease prevention and health promotion (Sexual and Reproductive Health, Non-Communicable Diseases, Emergency and Trauma, Maternal Health, and psychosocial) were strengthened through awareness and information on COVID-19 prevention, sexual and reproductive health, delivery of contraceptive methods, warning signs and COVID-19, reaching a total of 6,854 people in 41 health facilities (including 3 PASIs) and 15 communities in 5 states.
At the Center for Comprehensive Assistance to Children, Adolescents and Women (CAINNAM), 2,878 people benefited from strengthening of information and epidemiological surveillance systems, including community health actors in 7 states. In Tachira, 636 people benefited from delivery and distribution of information on COVID-19 prevention and control, at the Center for Integral Attention to Children, Adolescents and Women (CAINNAM).
The Health Cluster held regular virtual meetings on 24 September, with emphasis on telemedicine and child pornography and the Zulia sub-national Health Cluster meeting on 29 September.
For the COVID-19 response, the following actions are needed: accelerate efforts to increase health services and maintain a supply of health services for priority pathologies, avoid overcrowding and provide personal protective equipment for health workers.
Monitoring health workers, indigenous populations and people on the move is needed. In the context of COVID-19, these vulnerable populations face particular risks and may be predisposed other outbreaks. For the Mako ethnic group, located south of Piaroa, the nearest hospital with an Intensive Care Unit is more than 500 km away. The distance between the patient and the health facility is correlated to the risk of death in COVID-19 cases.
Fuel shortages are a challenge to humanitarian operations and to access to health services, including vaccination.