Interestingly this year in Peru influenza B was isolated

A 28 day study of chloroquine efficacy against P.

more frequently than influenza A (44 type B isolations

vivax at two sites in the Amazon region of Peru and

vs. 32 for type A).  

one on the north coast of Peru clearly suggested the

presence of resistance.  This is the first report of

A particularly strong element of the NMRCD program

chloroquine resistant P. vivax in Peru.  Other innovative

is surveillance for antimalarial drug resistance.

malaria resistance related activities in Peru include

Ensuring that this initiative is well integrated with

initiation of P. falciparium resistance mutation map 

host country public health policy development has

ping at about 20 sites where in vivo studies have not

been greatly favored by the long term presence of a

been feasible and the establishment of a formal sur 

Public Health Service physician from CDC. The

veillance system for adverse drug reactions to SP 

Amazon Basin is the second most drug resistant area of

artesunate along the north coast.  As a result of

the world and up to date information on Plasmodium

these ongoing collaborations, Peru's antimalaria

falciparium drug resistance in the nine countries

drug resistance surveillance data is the most current

making up the Amazon Basin is very limited.  What

and accurate in the Americas.

data are available has often been difficult to interpret

In the Bolivian Amazon, a 28 day study comparing

because methods have not been standardized.

MQ with MQ plus artesunate showed 100% efficacy

Chloroquine resistant P. vivax is an even less defined

with both regimens.  The Bolivian Ministry of Health

issue.  Again the long term goal is to build capacity

is planning to use these data to recommend a com 

in the region so that ministries of health can monitor

bination therapy policy.  Surveillance in Suriname

antimalarial drug resistance in a standardized manner

is affected by the fact that economic problems in

and make evidence based decisions. Evidence of the

that country preclude use of expensive drugs like

progress along these lines has been that Peruvian

MQ.  An efficacy study of quinine for 5 days in

Ministry of Health staff with experience from earlier

cases of P. falciparium showed a 56% parasitemia

studies have helped with the training in Ecuador and

recurrence rate.  Also in Suriname, a 28 day study

Bolivia.  The surveillance method used by the

of a 3 day quinine clindamycin regimen showed a

NMRCD GEIS program is the standardized

32% recurrence rate.  

WHO/PAHO 14  or 28 day in vivo drug efficacy

protocol.  During FY 2001, a 28 day study in Iquitos,

Surveillance for antibiotic resistant enteric agents in

Peru, compared mefloquine (MQ) alone with MQ

Peru continues to be justified based on the broad

plus artesunate.  Efficacy against P. falciparium was

increases in resistance seen during the 1990s.

100% with both regimens.  In Sullana, on the north

Surveillance for antibiotic susceptibility was conducted

coast of Peru, a 28 day comparison of sulfa 

during FY 2001 at four sites in Peru (including two

pyrimethamine (SP) monotherapy with SP plus arte 

new sites in Iquitos and Cuzco) and two in Bolivia;

sunate showed the combination was 99% effective

1,018 enteric bacterial isolates were evaluated.

while SP alone had an efficacy of 97%.  As a result of

Shigella species constituted almost 50% of the isolates.

these studies the Peruvian Ministry of Health officially

Of note has been a reported overall increase in the

instituted MQ artesunate as the first line treatment

resistance of salmonella to a wide range of antibiotics.

for uncomplicated P. falciparium in the Amazon

Among seven drugs (chloramphenicol, cephalothin,

ciprofloxacin, erythromycin, gentamycin, tetracycline,

Basin and SP artesunate as the first line for uncom 

trimethoprim sulfa) for which there were substantial

plicated P. falciparium on the north Pacific coast.

FY 2000 and FY 2001 data, salmonella resistance

It is now the first country in the world to use two

rates in FY 2001 for all surveillance sites were higher

different combination regimens in different regions

(resistance to erythromycin was 100% both years).

of the country. 

Fortunately 99% of the isolates remained susceptible

21