Border Binational Infectious Disease Conference

Transcription

2012
Proceedings Report of the United States-México
Border Binational Infectious Disease Conference
May 22-24, 2012
Austin, Texas
Providing international leadership
to optimize health and quality of
life along the United States-México
border
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For additional information, please visit the BHC website at www.borderhealth.org.
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ACKNOWLEDGEMENTS
Special thanks is extended to the following entities and individuals for the invaluable time, expertise, and
assistance provided to the United States-México Border Binational Infectious Disease Conference, sponsored by
the U.S.-México Border Health Commission (BHC) and coordinated through the Texas Department of State
Health Services’ (DSHS) Office of Border Health in partnership with the BHC Chihuahua Regional Office.
Technical Organizing Committee: Dr. Allison Banicki (Chair), Dr. Elisa Aguilar, Dr. Ricardo Cortés Alcalá,
Dr. Karen Ferran, Omar Contreras, Lori Navarrete, Katharine Perez-Lockett, Raul Sotomayor, Dr. Steve
Waterman, and Dr. Enrique Flores-Pérez.
Administrative and Logistics Planning: Kathie Martinez, Susan Ayala, Jorge Bacelis, Jose Moreira, Dr.
Banicki, Dr. Aguilar, Carlos Ramón Arriaga Rangel, Fabiola Elena de la Torre, Rogelio Sánchez, and Eduardo
Rangel.
Conference Support:
•
Dr. Aguilar and Dr. Ronald J. Dutton, Masters of Ceremony.
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All speakers, panelists, and poster presenters who provided technical content and stimulated discussion.
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The following subject matter experts, facilitators, scribes, and note takers who assisted with registration,
timekeeping, translations, and technical support: Lupita Mata, Lupita Guerrero, Ivonne Mendez, C.
Arriaga, F. de la Torre, Aldo Carrasco, Edith de la Fuente, J. Bacelis, Elvia Ledezma, J. Moreira, Adriana
Corona-Luevanos, Calixto Seca, K. Martinez, Linda Willer, S. Ayala, L. Navarrete, Avelina Acosta,
Herminia Alva, O. Contreras, Maureen Fonseca-Ford, Orion McCotter, Dr. Aguilar, Dr. Miguel
Escobedo, Dr. Norma Irene Luna Guzmán, Lupe González, Dr. Leticia Wong López, Dr. David Padilla,
Dr. Max Zarate-Bermudez, Dr. Rachael Joseph, Irma Hernández Monroy, Dr. Lumumba Arriaga, Micaela
Tapia, Andy Thornton, Alba Phippard, Dr. Eduardo Azziz-Baumgartner, Dr. Cortéz Alcalá, Irma López
Martínez, K. Pérez-Lockett, Dr. José Luis Alomía, Jennifer Smith, Dr. Fernando González, Dr. Liz
Hunsperger, Dr. Paul Cantey, Dr. Daniel Marquez Uscanga, Mauricio Gómez-Sierra, Veronica Bejarano,
Laura Alvarez, Dr. Waterman, Dr. Banicki, Andres Velasco-Villa, Belinda Medrano, Dr. María
Guadalupe González Martínez, Catherine Golenko, Sonia Montiel, Ricardo Morales Monroy, Dr. Dutton,
Dr. Martha Alicia Bueno, Dr. K. Ferran, Dr. Alfonso Rodriguez-Lainz, Dr. Gudelia Rangel, Dr. María
Teresa Zorrilla, Jorge Navarro, and Michael Welton.
SharePoint Conference Site: Pan American Health Organization–U.S.-México Border Office
Resource Provisions: The Center for Global Health, Centers for Disease Control and Prevention
Contracted Support:
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Venue—Sheraton Austin Hotel at the Capitol
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Audio/Visual Support—Swank Audio Visuals
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Interpretation Services—Maya Interpreting
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Written Conference Recording and Draft Proceeding Report—The Global Good
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Training in Epidemiology and Surveillance Data Visualization—The University of North Texas, School
of Public Health, Department of Epidemiology, Health Science Center for Early Warning Infectious
Disease
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Finally, special thanks are extended to Luanne Southern, Deputy Commissioner, Texas DSHS, who hosted the
Conference together with Dr. Beatriz A. Díaz Torres, Delegate to Dr. Sergio Piña Marshall, Chihuahua Secretariat
of Health and BHC-Chihuahua Member.
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TABLE OF CONTENTS
ACKNOWLEDGEMENTS ........................................................................................................................ i
EXECUTIVE SUMMARY ........................................................................................................................ 1
OVERVIEW OF EVENT .......................................................................................................................... 3
Purpose .................................................................................................................................................. 3
Objectives and Methodology .............................................................................................................. 3
Conference Structure ........................................................................................................................... 3
OPENING REMARKS ............................................................................................................................. 4
Review of 2011 Meeting and Objectives for the 2012 BBID Conference .................................... 5
DAY 1: PANELS AND PRESENTATIONS .......................................................................................... 5
Panel–Federal Updates on Border and Binational Preparedness, Surveillance, and
Epidemiology ......................................................................................................................................... 5
Panel–State Updates on Border and Binational Preparedness, Surveillance, and
Epidemiology ......................................................................................................................................... 6
Panel–Local Updates on Border and Binational Preparedness, Surveillance, and
Epidemiology ......................................................................................................................................... 6
Panel–Cross-Border Sharing of Public Health Items...................................................................... 6
Binational Technical Work Group and Sub-Groups’ Reports ........................................................ 7
Plenary–Best Practices in Border Binational Surveillance ................................................................ 8
Questions & Answers......................................................................................................................... 10
DAY 2: BREAKOUT GROUPS AND LIGHTENING TALKS ........................................................... 10
Disease Breakout Group Reports .................................................................................................... 10
TB, HIV, STDs, Hepatitis ............................................................................................................... 11
Foodborne and Diarrheal Diseases ............................................................................................. 12
Respiratory Diseases, including Pandemic Influenza and Coccidioidomycosis ................... 12
Emerging Infectious Threats, including Vector-Borne Diseases ............................................. 13
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Thematic Breakout Group Reports .................................................................................................. 13
Laboratory Integration with Surveillance Systems .................................................................... 14
Migrant Health ................................................................................................................................. 14
Binational Communication and the Implementation of the Guidelines................................... 15
Cross-Border Sharing of Items for Public Health Purposes..................................................... 15
DAY 2 & 3: CONCURRENT TRACK SESSIONS ............................................................................. 16
Best Practices and Lessons Learned from BIDS and EWIDS Projects..................................... 16
HPV, Cervical Cancer, and HIV: Epidemiology and Control Measures..................................... 16
Binational Outbreak Investigations .................................................................................................. 17
Respiratory Conditions in the Border Region: Tuberculosis and Influenza............................... 17
International Health Regulations and Their Impact on U.S.-México Bilateral Relations ......... 17
Effective Methods for Outreach, including Innovative Film Documentary and Social Media
Techniques .......................................................................................................................................... 18
Training in Data Visualization for Epidemiology and Surveillance ............................................. 18
CLOSING REMARKS............................................................................................................................ 18
SUMMARY OF PRIORITY ISSUES, OBJECTIVES, AND NEXT STEPS .................................... 19
Priority Issues and Objectives .......................................................................................................... 19
Recommendations and Next Steps ................................................................................................. 20
APPENDIX A: PARTICIPANT DIRECTORY ................................................................................... A-1
APPENDIX B: MEETING AGENDA .................................................................................................. B-1
APPENDIX C: LIST OF POSTER PRESENTERS AND TITLES ................................................. C-1
APPENDIX D: PANEL SUMMARIES................................................................................................ D-1
Epidemiology ..................................................................................................................................... D-1
Epidemiology ..................................................................................................................................... D-3
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Epidemiology ..................................................................................................................................... D-4
Panel–Cross-Border Sharing of Public Health Items.................................................................. D-6
APPENDIX E: CONCURRENT TRACK SESSION SUMMARIES ................................................E-1
Best Practices and Lessons Learned from BIDS and EWIDS Projects....................................E-1
HPV, Cervical Cancer, and HIV: Epidemiology and Control Measures....................................E-2
Binational Outbreak Investigations .................................................................................................E-4
Respiratory Conditions in the Border Region: Tuberculosis and Influenza..............................E-7
International Health Regulations and Their Impact on U.S.-México Bilateral Relations ........E-9
Effective Methods for Outreach, including Innovative Film Documentary and Social Media
Techniques .......................................................................................................................................E-12
APPENDIX F: LIST OF ACRONYMS ................................................................................................ F-1
APPENDIX G: LIGHTNING TALK SUMMARIES............................................................................ G-1
APPENDIX H: BREAKOUT GROUP PARTICIPANTS .................................................................. H-1
APPENDIX I: BREAKOUT GROUP SUMMARY SLIDES ............................................................... I-1
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EXECUTIVE SUMMARY
The U.S.-México Border Health Commission (BHC) sponsored the United States-México Border Binational
Infectious Disease (BBID) Conference, hosted by the Texas Department of State Health Services’ (DSHS) Office
of Border Health (OBH) in partnership with the BHC Chihuahua Regional Office, on May 22-24, 2012, in Austin,
Texas.
The purpose of this three-day binational conference was to convene federal, state, and local partners from both
sides of the U.S.-México border to address critical infectious disease and emergency preparedness issues
impacting the region and to discuss potential solutions to those problems.
To improve binational preparedness, surveillance, and epidemiology in border health, conference participants
discussed several areas of concern, including the enhancement of cross-border and global partnerships, global
health security, and international communication on public health events that address binational and/or
international concerns.
The conference addressed the following strategic objectives:
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Enhance processes for cross-border epidemiologic information sharing.
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Improve communication protocols for immediate, cross-border notification regarding public health events
of binational and/or international concern.
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Improve electronic information sharing and data exchange.
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Establish enhanced regional surveillance networks.
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Encourage binational surveillance, epidemiology, and preparedness training and exercises.
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Assess the impact of migration on U.S. and México health systems.
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Review insights and best practices gained from migrant experiences to better inform border and nonborder states.
The following recommendations were identified:
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Prioritize the implementation of the Guidelines for 2012-2014, including standardization where possible
and protocol implementation for cross-border communication and collaboration.
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Identify alternate funding sources and communicate the value of border health actions and initiatives to
local, state, and federal policy- and decision-makers.
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Increase cross-border data and information sharing, possibly leveraging enhanced electronic surveillance
systems.
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Include migrant populations in public health surveillance, prevention and control, and outreach activities.
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Revise policies and practices that hinder the cross-border sharing of public health items; convene a small
work group to advance specific action items proposed during the corresponding panel discussion.
•
Continue building relationships and strategic alliances that facilitate binational collaboration on infectious
disease and emergency preparedness issues affecting the United States and México.
In total, 150 participants attended the conference. Participants represented federal, state, and local health agencies
and laboratories from all ten U.S. and Mexican border states—Arizona, Baja California, California, Chihuahua,
Coahuila, New Mexico, Nuevo León, Sonora, Tamaulipas, and Texas. Also present were representatives from the
BHC; Pan American Health Organization/World Health Organization; México Ministry of Health; México’s
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National Institute of Epidemiological Diagnosis and Referral; México’s General Directorate of Epidemiology;
U.S. Department of Health and Human Services; Centers for Disease Control and Prevention; Department of
Global Migration and Quarantine; Assistant Secretary for Preparedness and Response; U.S. Customs and Border
Protection; Texas A&M University; University of California, Los Angeles; University of California, San Diego;
Texas Tech University; National Polytechnic Institute; and National Autonomous University of Tamaulipas.
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OVERVIEW OF EVENT
Purpose
The purpose of the third annual United States-México Border Binational Infectious Disease (BBID) Conference
was to convene federal, state, and local partners from both sides of the U.S.-México border to address critical
infectious disease and emergency preparedness issues impacting the border region. This meeting built on
outcomes of the 2011 BBID Conference held in El Paso, Texas.
Objectives and Methodology
Improved preparedness, surveillance, epidemiology, and cross-border information sharing were identified as key
areas that lead to an enhanced binational public health emergency response. As such, the conference provided a
forum for local, state, and federal stakeholders to address the following binational strategic objectives:
•
Enhance processes for cross-border epidemiologic information sharing.
•
Improve communication protocols for immediate, cross-border notification regarding public health events
of binational and/or international concern.
•
Improve electronic information sharing and data exchange.
•
Establish enhanced regional and binational surveillance networks.
•
Encourage binational surveillance, epidemiology, and preparedness training/exercises.
•
Assess the impact of migration on U.S. and México health systems.
•
Review insights and best practices gained from migrant experiences to better inform border and nonborder states.
Conference Structure
Dr. Ronald J. Dutton, Director, Office of Border Health (OBH), Texas Department of State Health Services
(DSHS), and Dr. Elisa Aguilar, Coordinator, BHC Chihuahua Regional Office, acted as masters of ceremony.
The conference agenda (see Appendix B—note: some individuals referenced herein may not be listed on the
agenda) was organized under the following structure:
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Panels for federal, state, and local updates on border and binational preparedness, surveillance, and
epidemiology. A fourth panel addressed the cross-border sharing of public health items (see Appendix D
for summaries).
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A presentation on the Binational Technical Work Group and sub-groups.
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A plenary session on best practices for border binational surveillance.
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Breakout groups organized by disease or thematic area (see Appendix H for participants and Appendix I
for summary slides).
 Disease breakout groups:
1. Tuberculosis (TB), HIV, STDs, and hepatitis.
2. Foodborne and diarrheal diseases.
3. Respiratory diseases, including pandemic influenza and coccidioidomycosis.
4. Emerging infectious threats, including vector-borne diseases.
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 Thematic breakout groups:
1. Laboratory integration with surveillance systems.
2. Migrant health.
3. Binational communication and implementation of the Technical Guidelines for United
States-México Coordination on Public Health Events of Mutual Interest (Guidelines).
4. Cross-border sharing of items for public health purposes.
•
Concurrent sessions with panel presentations organized by topic (see Appendix E for summaries).
 Concurrent Session I:
1. Best practices and lessons learned from Border Infectious Disease Surveillance (BIDS)
and Early Warning Infectious Disease Surveillance (EWIDS) projects.
2. Human papillomavirus (HPV), cervical cancer, and Human Immunodeficiency Virus
(HIV): epidemiology and control measures.
3. Binational outbreak investigations.
4. Respiratory conditions in the border region: TB and influenza.
 Concurrent Session II:
1. International health regulations and their impact on U.S.-México bilateral relations.
2. Effective methods for outreach, including innovative film documentary and social media
techniques.
3. Optional training in data visualization for epidemiology and surveillance.
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Lightening talks (short talks) on infectious disease issues affecting the U.S.-México border region (see
Appendix G for summaries).
•
Poster session on various U.S.-México border binational infectious diseases (see Appendix C for titles
and presenters).
OPENING REMARKS
Luanne Southern, M.S.W., Deputy Commissioner, Texas DSHS
Dr. Beatriz A. Díaz Torres, Delegate to Dr. Sergio Piña Marshall, Chihuahua Secretary of Health and BHCChihuahua Member
L. Southern welcomed conference participants to Austin on behalf of Dr. David Lakey, Texas DSHS
Commissioner and BHC-Texas Member, and acknowledged the BHC’s conference sponsorship as well as the
Texas DSHS OBH in planning the event. In addition, L. Southern noted the attendance and support of BHC U.S.
Section representatives—Dr. Dutton, Texas; Robert Guerrero, Arizona; Mauricio Leiva, California—and BHC
México Section representatives—Dr. María Teresa Zorilla, Executive Secretary, and Dr. Gudelia Rangel,
Delegate to the México Secretary of Health. L. Southern recognized the participation of the federal delegations
led by Dr. Katrin Kohl, Office of the Director, Department of Global Migration and Quarantine (DGMQ), Centers
for Disease Control and Prevention (CDC); and Dr. Ricardo Cortés Alcalá, Director, Inter-Institutional Liaison
Office, General Directorate of Epidemiology (DGE), México Ministry of Health.
L. Southern extended a special recognition to the universities and nongovernmental organizations, including the
Pan American Health Organization (PAHO)-U.S.-México Border Office, for attending the 2012 BBID
Conference.
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L. Southern reiterated the conference objectives and concluded by acknowledging the BHC’s support of
binational strategies impacting border health by providing a venue for discussion and action.
Dr. Díaz reviewed Chihuahua’s demographics and provided a brief history of cross-border collaboration,
emphasizing the need to address border health through coordinated local, state, and national actions.
Dr. Díaz reviewed binational projects in Chihuahua, including BIDS, EWIDS, and pilots for TB and
coccidioidomycosis prevention and control in collaboration with Texas and New Mexico. She noted Chihuahua’s
ongoing commitments to border health include strengthening communication, coordination, and collaboration in
surveillance; maintaining disease prevention and control; participating in laboratory trainings; and sharing
epidemiological information with Texas, New Mexico, and Arizona to support cross-border decision making.
Dr. Díaz concluded by asserting it was essential that the United States and México continue their collaboration to
safeguard the health of border populations, as illnesses do not recognize political borders.
Review of 2011 Meeting and Objectives for the 2012 BBID Conference
Dr. Allison Abell Banicki, Epidemiologist, Texas DSHS OBH
Dr. Banicki informed participants all 2012 BBID Conference documents were accessible in English and Spanish
on the PAHO-U.S.-México Border Office SharePoint site (The site would remain active for a limited time).
Dr. Banicki reviewed the 2011 BBID Conference outcomes and presented the 2012 meeting objectives. She
encouraged BBID participants to focus on sustaining border and binational initiatives under severe funding
restrictions brought about, in part, by the cessation of EWIDS funding in August 2012. She also reviewed the
conference agenda, noting conference planners incorporated an optional, three-part data visualization training
intended to help participants effectively prepare graphs and figures to communicate epidemiological and
surveillance data. The training topic resulted from an EWIDS survey that identified epidemiology and
surveillance needs in Texas, New Mexico, Chihuahua, Nuevo León, and Tamaulipas.
Dr. Banicki announced the BHC would sponsor the first Border Obesity Prevention Summit in 2013 as well as a
fourth BBID Conference in 2014. She concluded by thanking all conference participants for attending.
DAY 1: PANELS AND PRESENTATIONS
Federal, state, and local partners provided panel updates on border and binational preparedness; surveillance;
epidemiology perspectives; and the cross-border sharing of specimens, reagents, supplies, and other items for
public health use. Panel discussion abstracts are provided below (see Appendix D for more details on panel
presentations).
Epidemiology
Dr. Ricardo Cortés Alcalá, Director, Inter-Institutional Liaison Office, DGE, México Ministry of Health
Dr. Katrin Kohl, Ph.D., M.P.H., Deputy Director, DGMQ, CDC
Dr. Jose Fernandez, Deputy Director, Division of International Health Security, Office of the Assistant
Secretary for Preparedness and Response (ASPR), U.S. Department of Health and Human Services (HHS)
The three panelists reviewed major global, trilateral, and binational health initiatives, such as the North American
Plan for Pandemic and Animal Influenza (NAPAPI), the Global Health Security Initiative (GHSI), the
International Health Regulations (IHR), EWIDS, and BIDS. They emphasized the recently signed Guidelines lay
the framework for meaningful binational engagement, including notification of epidemiologic events.
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Epidemiology
Dr. Francisco Javier Navarro Gálvez, General Director, Community Health Services, Sonora Secretariat of
Public Health
David Selvage, M.H.S., PA-C, Epidemiologist, Infectious Disease Epidemiology Bureau, New Mexico
Department of Health (NM DOH)
Dr. Navarro Gálvez and D. Selvage described significant accomplishments in binational cooperation at the state
level, including Sonora’s Epidemiologic Intelligence Unit for Health Emergencies (UIEES) and several enhanced
surveillance projects.
Epidemiology
Dr. José Luis Aranda Lozano, Epidemiologist, Institute of Public Health Services for Baja California-Health
Jurisdiction II, Tijuana
Dr. Benito Lopez, Epidemiologist, Yuma County Public Health Services District
Belinda Medrano, M.P.H., Epidemiologist, Hidalgo County Health and Human Services Department
(HCHD)
The three panelists described the challenges of disease surveillance and control in border communities with high
levels of migration. Recommendations included improving routine vital statistics surveillance, using existing
infrastructure to improve communication and collaboration, and maintaining frequent communication with
colleagues in neighboring communities across the border.
Panel–Cross-Border Sharing of Public Health Items
Moderator: Sonia Montiel, BIDS Laboratory Coordinator, DGMQ, CDC
Dr. Elisa Aguilar Jiménez, Coordinator, BHC Chihuahua Regional Office, “Evaluation of Transportation
Procedures for Materials Used in Public Health on the U.S.-México Border”
Trinidad Barreras, Supervisory Consumer Safety Officer, U.S. Food and Drug Administration (FDA),
“Import Operations”
Norman Bebon, Assistant Port Director-El Paso, U.S. Customs and Border Protection (CBP), “U.S.-México
Transport of Public Health Material”
Dr. Miguel Escobedo, Quarantine Medical Officer, DGMQ, CDC, “Evaluation of Pilot Procedures for
Importing Public Health Specimens through Southern Land Border Ports of Entry”
Dr. Aguilar presented recent survey results that evaluated transportation procedures for border public health
materials. She noted respondents identified multiple challenges and barriers to compliance with import/export
regulations and recognized cost as the most frequently identified barrier. Several recommendations emerged from
the evaluation, most notably the development and implementation of a uniform, efficient import/export process.
T. Barreras provided an overview of FDA import operations, including those implemented along the U.S.México border.
N. Bebon presented an evaluation of the Border Health Pilot Project for Cross-Border Transport of Public
Health Material, in operation from September 30, 2009, to January 1, 2010. He concluded the pilot was unable to
facilitate the movement of items for public health purposes and noted lessons learned can improve the process.
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A discussion following the panel presentations allowed participants to share additional challenges they
encountered with exporting and importing items for public health purposes.
Dr. Cortés Alcalá suggested convening a small work group to analyze the situation and submit specific
recommendations to the Mexican Federal Commission for Protection against Health Risks with a letter requesting
a response.
Raul Sotomayor, M.P.H., M.S.A., International Health Analyst, ASPR, HHS, recommended using the NAPAPI to
support requests for further study and action, as the highest levels of all three North American nations approved it
and requested protocols for rapidly sharing specimens be developed.
Dr. Steve Waterman, Team Lead, U.S.-México Unit, DGMQ, CDC, and S. Montiel emphasized the need to
consider globally-developed best practices, such as the Chinese electronic platform.
Binational Technical Work Group and Sub-Groups’ Reports
Dr. Steve Waterman, Team Lead, U.S.-México Unit, DGMQ, CDC
Dr. Waterman explained the Binational Technical Work Group (BTWG) in Public Health met four times in
plenary, most recently in December 2011. Established in 2010 to facilitate discussion on technical matters, the
BTWG involved technical sections that addressed issues on (1) infectious diseases (an active section), (2) noncommunicable diseases (an envisioned section), and (3) health communication (in planning). In addition, a crosscutting team was identified to initiate the Guidelines implementation.
Over 50 public health agency representatives participated in the fourth BTWG plenary meeting videoconference,
including representation from the CDC, DGE, México’s National Institute of Epidemiological Diagnosis and
Referral (InDRE), and the binational border states. The infectious disease section focused on science, data, and
public health practice; addressed laboratory issues, including CDC-InDRE shipment protocol development; and
provided updates on México’s National Epidemiological Surveillance System (SINAVE), as well as ongoing
programs, infectious diseases, and event-based surveillance. Specific updates on surveillance activities included
the following:
•
The CDC’s Global Disease Detection Program developed and strengthened global capacity to rapidly
detect, identify, and contain international, emerging infectious disease and bioterrorist threats.
•
The European Commission, as part of the Global Health Security Action Group, funded a project for early
alerting and reporting that utilized a single portal consisting of 40 languages, 10,000 informational
sources, and 1.5 million scanned web pages.
•
BIDS expanded binational surveillance into a more comprehensive system that included event-based
surveillance and connected with sentinel surveillance sites via SINAVE to form an epidemiologic
intelligence network for risk detection and assessment. Although the border was a priority, surveillance
was not limited to the region.
As per the letter of intent to implement the Guidelines, Dr. Waterman affirmed the BTWG was tasked to oversee
the development of protocols outlined within the Guidelines within 12 months of their signing and to provide
periodic reviews and updates.
Potential BTWG collaborations included partnerships with PAHO and HHS on HPV vaccination and cervical
cancer prevention; affiliations concerning hepatitis C and cross-cutting health promotions; and the formation of a
BTWG non-communicable diseases section.
Dr. Waterman concluded by emphasizing the key roles border stakeholders play in the U.S.-México collaboration
on public health and encouraged the continued cross-border convergence of public health activities.
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Plenary–Best Practices in Border Binational Surveillance
Dr. Nubia Astrid Hernández Santillan, Binational Epidemiological Surveillance Coordinator, Sonora
Secretariat of Public Health, “Binational System for Real-Time Epidemiological Alerts”
Omar A. Contreras, M.P.H., Epidemiologist, Arizona Department of Health Services (ADHS),
“Campylobacter and Guillain-Barré Syndrome (GBS): A Multi-jurisdictional Approach to the First Binational
Outbreak along the Arizona-México Border”
Dr. Bertha P. Armendariz, Border Health Specialist, Migrant Clinicians Network, “Binational Tuberculosis
Surveillance and Control Pilot Project in the New Mexico and Chihuahua Region”
Orion McCotter, M.P.H., BIDS Epidemiologist, ADHS OBH, and Dr. José Alomía Zegarra, Epidemiologist,
Sonora Secretariat of Public Health, “The Binational Project Improving the Diagnosis, Surveillance, and
Treatment of Coccidioidomycosis in the Border Region of ‘Four Corners’ Arizona-Sonora and New MexicoChihuahua”
Dr. Daniel Carmona Aguirre, Department of Epidemiology and Communicable Diseases, Tamaulipas
Secretariat of Health, “Sustainability of Binational Epidemiological Surveillance”
Dr. Hernández and her colleague, Marco Cázares, discussed the Four Corners Pilot Project: Binational Early
Epidemiological Alert System. Focused on the binational Four Corners region of Arizona, Sonora, California, and
Baja California, the pilot aimed to develop a binational platform based on an Early Epidemiologic Alert System
that would standardize methods, processes, and technical tools for identification and early warning of public
health events of binational interest.
Dr. Hernández and M. Cázares defined binational cases, provided a list of diseases of binational interest, and
developed a flow chart illustrating binational communication. In addition, they affirmed the pertinent state
jurisdiction was notified when binational cases were confirmed in México, as only state-level authorities were
authorized to disseminate information to other states.
Dr. Hernández and M. Cázares reported the Binational Epidemiologic Network members’ objective was to
collaborate, strengthen, and maintain epidemiologic surveillance under the Four Corners project. Furthermore,
the Early Epidemiologic Alert System established an automatic communication channel that provided immediate
notification.
M. Cázares noted the system’s software monitored the database every fifteen minutes to identify probable cases
and immediately alert the appropriate physicians to emerging cases by e-mail, etc. He noted doctors can alert the
system by text or through an online portal and added the system also maintains videoconferencing capabilities.
Dr. Hernández and M. Cázares affirmed the use of information technologies allowed for improved U.S.-México
communication, better decision-making, and stronger responses to binational health cases.
O. Contreras described the multi-jurisdictional approach to the first binational outbreak along the ArizonaMéxico border, which occurred in June 2011 after Sonora and Baja California health authorities notified the
ADHS and the California Department of Public Health (CDPH) that they detected cases of Acute Flaccid
Paralysis (AFP)/suspected GBS.
O. Contreras reported the Arizona criteria for reporting a binational case applies to Arizona residents diagnosed
with reportable diseases in Sonora or Sonora residents who (1) recently travelled to Arizona or other U.S. states,
(2) possibly contracted the illness from or shared it with Arizona residents or residents from other U.S. states, (3)
and/or were part of a suspected binational outbreak.
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In addition, O. Contreras shared information on Arizona’s Health Services Portal. Managed by the ADHS Bureau
of Emergency Preparedness and Response, the portal allows for the exchange of secured information and houses
the Medical Electronic Disease Surveillance Intelligence System (MEDSIS), a secured, web-based disease
surveillance system that captures all reportable diseases, excluding HIV infection, sexually transmitted diseases,
and TB. He noted the Sonora Secretary of Health retains access to the Health Services Portal as well.
O. Contreras reported the AFP/GBS investigation was completed with the support of ADHS, CDC, DGMQ,
Yuma County Public Health Services District, CDPH, Imperial County Health Department, San Luis Rio
Colorado General Hospital, Sonora Secretary of Health, DGE, and InDRE. He affirmed a robust binational
collaboration and multi-jurisdictional approach was essential to address the outbreak and noted the efforts also
enhanced communication among the ADHS Office of Infectious Disease Services, the ADHS OBH, and the
Sonora Secretary of Health.
Dr. Armendariz reviewed the Binational Pilot Project: Tuberculosis Surveillance and Control in the New
Mexico-Chihuahua Border Region, a three-year binational project established to decrease TB in the New MexicoChihuahua border region through enhanced surveillance and control. She explained that in 2007, the NM DOH
OBH utilized BHC funding to develop a three-year public health plan for Luna County, New Mexico, and
Palomas, Chihuahua, that specified nine priority health areas, including TB. This effort resulted in a bilateral
agreement for health cooperation signed by the New Mexico and Chihuahua state governors and health
authorities.
Dr. Armendariz stated a binational TB committee composed of U.S. and México health administrators was
created to develop the binational TB pilot project in the border region. Funded by the BHC through the Migrant
Clinicians Network (MCN), the pilot objectives were to (1) improve TB surveillance; (2) train non-medical
personnel on preventative measures; (3) diminish Multi-drug Resistant (MDR) TB; (4) establish a binational
patient registry and functional patient database for use by participating health care providers on both sides of the
border; and (5) implement protocols that improved binational communication.
Dr. Armendariz reported pilot participants conducted an intensive investigation to identify active TB cases and
continue treatment for existing cases, which included providing treatment during home visits. She noted access to
rural communities and a lack of public health materials posed significant challenges, as did communication
between the corresponding binational health, social security, and defense agencies with respect to these TB cases.
Future goals included introducing TB education into prison systems, increasing access to rural areas, and securing
further project funding.
O. McCotter and Dr. Alomía presented their experience with an ongoing pilot project launched in February 2010
entitled Four Corners: Improved Diagnosis, Surveillance and Treatment of Coccidioidomycosis in the Binational
Border Region of Arizona-Sonora-New Mexico-Chihuahua. O. McCotter and Dr. Alomía explained the pilot’s
goals were to improve the diagnostics, surveillance, and treatment of coccidioidomycosis, which is caused by the
inhalation of spores endemic to the border region and often mis- or undiagnosed.
O. McCotter noted that increased coccidioidomycosis cases declared in Arizona could be attributed to several
factors, including changes in laboratory reporting and increased awareness among doctors. He also illustrated the
rate of reported cases across borders, comparing 11,888 Arizona cases in 2010 to only 63 cases reported in Sonora
over nine years. Possible causes for the variation included underreporting and a lack of specific processes for
coccidioidomycosis detection and treatment in México. O. McCotter asserted the pilot project was developed as a
collaborative, binational effort to acutely understand the burden of coccidioidomycosis in the border region.
To enhance clinical awareness and laboratory capacity in México, O. McCotter and Dr. Alomía affirmed that in
September 2011, project participants conducted laboratory trainings with Sonora and Chihuahua personnel to
facilitate the exchange of InDRE and CDC technologies and provided financial support for laboratory equipment.
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The pilot project also sponsored binational continuing medical education sessions in New Mexico and Arizona,
providing translated educational materials for medical personnel in addition to public education campaign
materials.
The presenters asserted U.S. and Mexican pilot participants learned to adapt existing resources for use by
individual states. They concluded by emphasizing the declaration of cooperation signed at the Arizona-Sonora
Commission meeting in June 2010 helped further advance the project.
Dr. Carmona addressed the sustainability of binational epidemiologic surveillance and reported current
challenges included the need for greater investment, training, and efficient strategies. He asserted stronger
international alliances and permanent binational collaboration were necessary to sustain efforts and affirmed
surveillance needed to become analytical, preventative, and accompanied by university research.
Strengths in binational surveillance included existing strategic alliances, the Guidelines, information systems, the
BHC, binational health councils, and other health institutions and organizations. Strategies for sustaining
epidemiological surveillance potentially involved stronger political cohesion and project prioritization as well as a
broader legal basis for collaboration.
Questions & Answers
O. Contreras elaborated on the GBS outbreak detection timeline and explained the first diarrheal illness case
occurred in May. Cases increased in both Yuma and San Luis by June, and after an epidemiologic investigation,
GBS was determined to be the cause of the one reported fatality.
In response to a question regarding the Early Epidemiologic Alert System’s development costs, M. Cázares stated
costs were attributed to software development, as the software was the property of Sonora and not intended to
substitute other platforms.
Dr. Cortés Alcalá reported the Sonora-Arizona collaboration regarding the health portal was a positive experience
and could be utilized in other states, although it is important to clarify objectives. According to Dr. Cortés Alcalá,
an outbreak study was not justifiable based on a single case or even a few. He noted GBS surveillance continued
due to remaining cases.
In response to Dr. Waterman’s question regarding the potential for the Guidelines to affect local communications,
a Four Corners participant responded that the Guidelines could help build on existing relationships.
DAY 2: BREAKOUT GROUPS AND LIGHTENING TALKS
Conference attendees participated in breakout groups of their choice, all designed to facilitate further discussion
on specific diseases and other thematically organized information (see Appendix H for a complete list of breakout
group participants).
Each breakout group also included up to three 5-minute lightening talks presented by subject matter experts (see
Appendix G for lightning talk summaries). The breakout group reports below begin with a list of the lightning
talks presented during each session.
Disease Breakout Group Reports
Within each of the four disease-specific breakout groups, participants received a one-page summary of
discussions and conclusions reached by their respective 2011 BBID Conference breakout groups as well as a list
of questions for discussion during the current session.
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Disease-specific breakout groups were asked to complete the following:
•
Review 2011 BBID Conference breakout group information i to address follow-up items.
•
Discuss the ways surveillance data are currently shared.
•
Identify ways to improve the exchange of surveillance information.
•
Identify ways to improve cooperation on disease control measures related to binational cases or
outbreaks.
•
Develop a Group Activity Plan for 2012-14.
Breakout group representatives reported the group discussion results on conference day three (see Appendix H for
breakout group report slides). Summaries of the group reports are provided below, following the list of lightning
talks within each session.
TB, HIV, STDs, Hepatitis
Dr. Miguel Escobedo, Quarantine Medical Officer, DGMQ, CDC, “Descriptive Analysis of Mexican
Immigrants with Overseas Tuberculosis Conditions, October 1, 2010–September 30, 2011”
Dr. Haoquan Wu, Assistant Professor, Center of Excellence for Infectious Diseases, Texas Tech University
Health Sciences Center (TTUHSC), Paul L. Foster School of Medicine, “Design miRNA-based shRNA to
Suppress HIV Infection”
Dr. Escobedo reported TB work groups were formed to address specific issues per the established 2011-2012
activity plan, especially binational case management, and worked in close coordination with other binational TB
initiatives involving the BHC, CDC Division of TB Elimination, DGMQ, and Immigration and Customs
Enforcement (ICE). The work groups planned to pursue better outreach and coordination with these groups.
In addition, Dr. Escobedo affirmed the TB Work Groups established an HIV Continuity of Care Work Group, and
a work plan regarding migrants in the United States was in development. As binational TB projects, such as
Grupo Sin Fronteras (Group without Borders), encountered HIV and TB coinfection, the group indentified this
issue as a priority in the forthcoming years.
The group also recognized the lack of coordination regarding binational referrals and continuity of care for
patients in U.S. federal custody as a gap in the process, noting these patients are continually repatriated to México
without advance notification provided to U.S. and Mexican public health authorities.
The group recognized the Tijuana Compañeros (Tijuana Partners) program as a best practice for using remote
video and mobile phones to track patients. They recommended developing procedures to ensure prompt reporting
to Mexican consulates throughout the United States and noted operational consular staff training would be
required to assist with health repatriations.
Dr. Escobedo reported a reliable information system that ensures prompt reporting of case referrals to U.S and
México federal public health authorities does not exist. As such, the group made the following recommendations:
(1) utilize established TB referral systems, such as TB-Net, to coordinate the flow of clinical information required
to follow-up on referred patients; (2) identify uniform reporting procedures for México’s national TB program
and the international relations section of México’s consular service to assist with patient and family relocations;
and (3) establish clinical case follow-up calls, especially to address MDR patients.
Dr. Escobedo indicated an established system to coordinate follow-up and response to difficult cases and
outbreaks also does not exist. The group recommended expanding existing regional systems and developing
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protocols to define roles, responsibilities, and points of contact as well as developing a resource directory with
contact information to include Mexican consular resources.
Foodborne and Diarrheal Diseases
Dr. Rachael Joseph, Epidemic Intelligence Service (EIS) Officer, CDC, “Investigation of a Shigella Sonnei
Outbreak among U.S. Travelers to México, November 2011”
Dr. Max Zarate-Bermudez, CDC epidemiologist, indicated InDRE continued to pursue Pulsed Field Gel
Electrophoresis certification for various macro-organisms and bionumerics analysis training. Several binational
training sessions were completed in 2011, including GBS Campylobacter training and coccidioidomycosis
continuing education for healthcare providers as well as dust modeling training for coccidioidomycosis in New
Mexico and Chihuahua. The binational notification pilot project also advanced the Guidelines implementation.
Collaboration challenges included the loss of EWIDS funding, which presented obstacles to continuing
surveillance activities. The group also surmised that public health workers utilized informal methods to convey
binational surveillance information, rather than formal channels. Another challenge concerned the varying U.S.
and México definitions for binational cases. With respect to these challenges, the group recommended binational
partners take steps to clearly understand specific U.S. and Mexican public health interventions for enteric disease
cases or outbreak reports.
Dr. Joseph presented the group recommendations for 2012-2014 activities, including activities intended to
increase the understanding of U.S. and México surveillance system attributes, such as varying case definitions and
health interventions. The group recommended integrating environmental assessments into epidemiologic
investigations and identifying strategies to link U.S. and Mexican information systems. As formal implementation
of the Guidelines would improve the sustainability and stability of binational surveillance systems and
communication, the group recommended increased pilot participation by Mexican border states and U.S. and
Mexican non-border states as well as the development of criteria to guide time and resource investment in
binational investigations.
Respiratory Diseases, including Pandemic Influenza and Coccidioidomycosis
Dr. Alberto Martínez Vázquez, Professor, Autonomous University of Ciudad Juárez, “Clinical Disorders and
Risk Factors for the Development of Acute Respiratory Distress Syndrome in the Intensive Care Unit”
Dr. Mingtao Zeng, Assistant Professor, Center of Excellence for Infectious Diseases, TTUHSC, Paul L.
Foster School of Medicine, “New Mucosal Vaccine for Cross-Strain Protection against Influenza”
Dr. Beatriz A. Díaz Torres, Delegate to Dr. Sergio Piña Marshall, Chihuahua Secretary of Health and BHCChihuahua Member, “Risk Factors Associated with Acquired Pneumonia in a Pediatric Patient at Ciudad
Juárez General Hospital”
Dr. Eduardo Azziz-Baumgartner, EIS Officer, CDC, reported NAPAPI was launched in 2011. The group
planned to circulate annual reports on respiratory diseases and determined further migrant population outreach
was required.
Moreover, the group concluded additional measures to implement NAPAPI were necessary, including essential
relationship building at the local, state, and federal levels. They identified the joint use of MEDSIS by Sonora,
México, and Arizona, United States, as a best practice case for local collaboration due to the mutual trust and
respect developed among binational partners.
Dr. Azziz-Baumgartner noted the following as promising directions for binational collaborations: (1) use of a
SharePoint website as a forum/receptacle for binational data; (2) the potential binational access to U.S and
México surveillance systems; (3) development of linguistically and culturally appropriate health education
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materials for vulnerable populations; and (4) the proposal of a standardized border city report to facilitate a
borderwide analysis of data.
The group determined 2012-2014 activities would include formalizing binational communication protocols and
disseminating the Guidelines. Members planned to continue building relationships while respecting differences in
legal and cultural norms among stakeholders.
Emerging Infectious Threats, including Vector-Borne Diseases
Orion McCotter, M.P.H., BIDS Epidemiologist, ADHS OBH, “Establishing a System for Dengue Surveillance
along the Arizona-Sonora Border”
Omar Contreras, M.P.H., Epidemiologist, ADHS, “Detection of Rocky Mountain Spotted Fever (RMSF)
Activity in Southern Arizona”
Dr. Benjamin Park, Medical Officer, Mycotic Diseases Branch, CDC, “The Re-emergence and Changing
Epidemiology of Coccidioidomycosis, United States, 1998–2010”
Lieutenant (LTJG) David Cruz, Environmental Health Division Officer, Preventive Medicine, Naval Medical
Center San Diego, reported on an electronic system for rabies surveillance, developed by CDC following the 2011
BBID Conference. Additionally, CDC and PAHO/ World Health Organization (WHO) are also planning a March
2013 training session on dengue, and the CDC and American Association of Public Health Labs developed and
disseminated dengue testing guidelines. With respect to México, LTJG. Cruz affirmed that InDRE continued to
the build capacity in laboratory immunohistochemistry within Mexican border states and held training sessions on
coccidioidomycosis. He also asserted funding for border dengue surveillance required attention.
LTJG Cruz emphasized the importance of a OneHealth perspective in helping improve communications.
Improvements in the communication process may potentially require those involved in surveillance on both sides
of the border to convene regular meetings and phone conferences as well as exchange contact information. The
group plans to utilize lessons learned and standardize protocols for communication and cooperation on disease
control measures related to binational cases and outbreaks.
The 2012-2014 activity plan included continued monthly meetings. The group indicated they would solicit the
CDC and the U.S. and México offices of border heath to facilitate meetings. They also anticipated their pilot
program participation would improve binational communication and information sharing.
Thematic Breakout Group Reports
Conference participants pre-registered for two of eight thematic breakout groups according to their areas of
expertise and professional interests. Themes identified for discussion included ongoing issues or new areas of
interest raised during the 2011 BBID Conference.
Thematic breakout group objectives included the following:
•
Review 2011 BBID Conference recommendations and action items.
•
Describe the current status of binational collaboration.
•
Identify promising future directions for binational collaboration.
•
Identify key areas not currently being addressed, i.e., the gaps.
•
Develop 2012-2014 Group Activity Plan.
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Laboratory Integration with Surveillance Systems
No presentations were scheduled for this session. Discussion began immediately.
Irma Hernández Monroy, InDRE, reported important advances in diagnostics occurred in México since 2011,
including expanded laboratory capacity, increased training, and progress toward ensuring more timely
surveillance by decentralizing diagnostics to the local level. She also highlighted examples of the strong federal
and state-level collaboration that existed between the two countries and affirmed InDRE sought to continue
reinforcing binational communication.
In addition, I. Hernández Monroy reported that InDRE identified several opportunities for future collaboration,
including a border region course on dengue in August/September 2012 and an international bilingual course on
diagnostics for dengue in March 2013. Arizona, New Mexico, Chihuahua, and Sonora were also developing a
working protocol for the diagnostics of coccidioidomycosis.
With respect to challenges, I. Hernández Monroy affirmed the need to improve the process for cross-border
sharing of public health materials and the communications between local laboratories with that of state and federal
laboratories. She also noted funding for research and diagnostics implementation remained a concern.
I. Hernández Monroy stated the InDRE 2012-2014 Activity Plan aimed to increase (1) communication among
binational federal, state, and local laboratories; (2) diagnostics capacity and implementation protocols; and (3)
regional laboratory resources. She reported InDRE planned to exchange diagnostic algorithms with the United
States to detect illnesses transmitted between both countries, collaboratively define border-related diagnostic
priorities, and integrate binational teams, including laboratories intended to rapidly respond to infectious disease
outbreaks.
Migrant Health
Dr. Alfonso Rodriguez-Lainz, Epidemiologist, CDC, “Migration-related Information in U.S. National Data
Sources”
Dr. Gudelia Rangel, Coordinator, Comprehensive Strategy for Migrant Health, México Ministry of Health;
BHC Delegate to Salomón Chertorivski Woldenberg, México Secretary of Health, “Comprehensive Strategy
for Migrant Health”
This was the first meeting of a thematic group on migrant health during a BBID Conference, as the topic was
identified as an area of interest in 2011.
Dr. Rodríguez reported the Ventanillas de Salud ([VDS]—Windows to Health) program, established in the 50
Mexican consulates in the United States, increased the capacity to provide health information to vulnerable
Hispanic communities living in the United States. He indicated a forthcoming telemedicine pilot would be
implemented in certain VDS locations and a call center designed to provide health information to migrants was
slated for June 2012. He also noted the increased collaboration between HHS and community health centers.
Dr. Rodríguez reported México’s ongoing Northern Border Migration Survey provided information on migrant
health issues and affirmed this data was shared with U.S. researchers.
With respect to the United States, Dr. Rodríguez reported CDC was scheduled to release an HIV/AIDS
surveillance guidance report for U.S. border states as well as an influenza health communication plan for
migrants, both in 2012. He discussed improvements related to the addition of migration variables to surveillance
systems and the increased emphasis on health communication with migrants in the United States.
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Opportunities for binational collaboration included (1) enhancing VDS services; (2) utilizing resources pledged
for mobile health units serving migrants in the United States; (3) advancing a Mexican health communication
campaign for migrants in the United States; and (4) increasing collaboration between México and CDC on
migrant health surveillance and education.
Priority areas of concern included (1) immigrants deported with health conditions that call for prior notification
and continuity of care; (2) lack of insurance; (3) the need for better borderwide surveillance data, especially
regarding HIV, to address deported persons with health conditions; and (4) the enrollment of more migrant
workers into México’s Seguro Popular.
The VDS 2012-2014 Activity Plan outlined efforts to enhance cross-border communication and disseminate
migrant health information. VDS also intended to establish a binational work group to develop a collaborative
work plan on migrant health communication and to jointly develop linguistically and culturally appropriate health
education materials. In conclusion, VDS acknowledged the need to better educate U.S. healthcare providers on
services available to migrants on both sides of the border, i.e., educating U.S. health workers on HIV resources
available in México.
Binational Communication and the Implementation of the Guidelines
Dr. Steve Waterman, Team Lead, U.S.-México Unit, DGMQ, CDC, “Overview of Pilot Project to Implement
the Technical Guidelines for United States-México Coordination on Public Health Events of Mutual Interest”
Dr. Allison Abell Banicki, Epidemiologist, Texas DSHS OBH, "Pilot Project to Implement the Technical
Guidelines for United States-México Coordination on Public Health Events of Mutual Interest: Perspectives
from the U.S. Border States"
D. Selvage stressed the importance of maintaining a strong presence in border health offices and highlighted the
improved data exchange with policy makers since 2011. He affirmed the necessity for public health workers to
effectively inform policy makers about the value of work along the border (i.e., information regarding the GBS
outbreak) to continue to receive funding and maintain their presence.
D. Selvage reported surveillance data was shared through various formats and forms, including during national
and binational meetings and within standardized reports. He commended Arizona and Sonora’s ability to integrate
for data exchange and identified web-based tracking systems, face-to-face meetings, and standardized
communication, such as through binational case definitions, as opportunities to improve data exchange.
The group affirmed that promising future directions for binational collaboration included implementation of the
Guidelines and indicated the need to share pilot project results and information regarding noteworthy
communication tools. They also emphasized the need to creatively identify different federal and state funding
opportunities to offset the cessation of EWIDS funding. In addition, the group suggested they pursue uniformity
in reporting across states when performing border region analyses and noted that a mechanism, such as
SharePoint, could be established to make data available for inclusion in an annual report.
Cross-Border Sharing of Items for Public Health Purposes
No presentations were scheduled for this session. Discussion began immediately.
Dr. Esteban Vlasich, Coordinator, Project JUNTOS, Texas DSHS, explained each port of entry encountered
difficulties with importing medicines into México due to the process with México’s Federal Commission for the
Protection against Sanitary Risks (COFEPRIS). As a result, permission to import/export needed materials was not
always provided during emergency cases. Dr. Vlasich asserted a federal-level meeting between COFEPRIS, CDC,
and the FDA was necessary to identify and implement solutions, such as offering a single permit to import/export
public health materials.
15
Dr. Aguilar emphasized the need for resolution and indicated a special permit for the importation of public health
material into México was a possible solution. The group encouraged the BHC to convene a meeting to address the
topic with federal agencies.
DAY 2 & 3: CONCURRENT TRACK SESSIONS
Participants took part in concurrent track sessions that focused on border health topics of interest, each containing
up to six fifteen-minute presentations offered by area experts. A 30-minute question/discussion period succeeded
each panel (see Appendix E for summaries of concurrent track session presentations).
Best Practices and Lessons Learned from BIDS and EWIDS Projects
Moderator: Jorge Bacelis
Dr. Martha Alicia Bueno Rosas, Chief, Epidemiology Surveillance, Chihuahua Secretariat of Health,
“Seroprevalence of Coccidioidomycosis in Chihuahua”
Katharine Perez-Lockett, M.P.H., BIDS Officer-Epidemiologist, NM DOH, “Development and Dissemination
of the Borderwide Regional Influenza Surveillance Network Report”
Catherine Golenko, M.P.H., BIDS Epidemiologist, ADHS, “Enhancing Respiratory Infection Surveillance on
the Arizona-Sonora Border–BIDS Program Sentinel Surveillance Data”
Dr. Ricardo Cortés Alcalá, Director, Inter-Institutional Liaison Office, DGE, México Ministry of Health,
“Epidemiologic Surveillance of Influenza in México, its Impact on the Northern Border, and the HHSGeneral Directorate of Epidemiology Cooperative Agreement”
Dr. Steve Waterman, Team Lead, U.S.-México Unit, DGMQ, CDC, “U.S. Perspective on BIDS Best Practices
and Lessons Learned”
Raul Sotomayor, M.P.H., M.S.A., International Health Analyst, ASPR, HHS, “EWIDS Best Practices and
Lessons Learned”
Speakers described ways the BIDS and EWIDS projects have enhanced surveillance efforts along the U.S.México border.
HPV, Cervical Cancer, and HIV: Epidemiology and Control Measures
Moderator: Dr. Allison Banicki
Dr. Mona Saraiya, M.P.H., Medical Officer, Epidemiology and Applied Research Branch, Division of Cancer
Prevention and Control, CDC, “Cervical Cancer Prevention”
Dr. Allison Banicki, Epidemiologist, Texas DSHS OBH, “HPV Vaccination in Texas, 2010”
Dr. Gudelia Rangel, Coordinator, Comprehensive Strategy for Migrant Health, México Ministry of Health;
BHC Delegate to Salomón Chertorivski Woldenberg, México Secretary of Health, “Current Overview of HIV
on the Northern Border of México”
Emilio J. German, M.S.H.S.A., Public Health Analyst-Coordinator for Hispanic or Latino Health Equity
Activities, CDC, “HIV and Health Equity among Hispanics/Latinos”
Dr. María Luisa Zúñiga, Associate Professor and Behavioral Epidemiologist, Division of Global Public
Health, University of California, San Diego (UCSD), “Gender Inequality and HIV Care Behavior among
HIV-positive Latinos in the U.S.-México Border Region”
Speakers reviewed recent work on HPV and HIV and identified areas for future collaborations between the United
States and México.
16
Binational Outbreak Investigations
Moderator: Omar Contreras
Maureen Fonseca-Ford, M.P.H., Public Health Prevention Specialist, DGMQ, CDC, “Cluster of GuillainBarré Syndrome due to a Waterborne Outbreak of Campylobacter Jejuni Infection—Sonora, México, and
Arizona, 2011”
Dr. Max Zarate-Bermudez, CDC Epidemiologist, “Environmental Assessment of the Waterborne Outbreak of
Campylobacter Infection in Sonora, México, and Arizona, United States, 2011”
Dr. Miguel Escobedo, Quarantine Medical Officer, DGMQ, CDC, “Coordinated Response to a Binational
Wound Botulism Outbreak”
Dr. Gerardo H. Flores-Gutiérrez, Professor, Autonomous University of Tamaulipas, “Epidemiologic
Surveillance on the U.S.-México Border from the Veterinary Perspective under the One Health Concept”
Dr. Andres Velasco-Villa, Associate Service Fellow, CDC, “Rabies across Borders: Finding Emerging and
Re-emerging RABV Variants with Public Health Impact”
Dr. Mauricio Gómez-Sierra, InDRE, “Expanded Panel of 20 Anti-nucleocapsid Monoclonal Antibody as a
Tool in the Differentiation of A-typical Antigenic of the Rabies Virus within the Mexican Territory”
Speakers and participants discussed outbreaks and clusters with binational implications.
Respiratory Conditions in the Border Region: Tuberculosis and Influenza
Moderator: Dr. Elisa Aguilar
Dr. Miguel Angel Reyes López, Professor/Researcher, Genomics and Biotechnology Center, National
Polytechnic Institute, “Detection of M. Tuberculosis Mutations in Tamaulipas Isolates”
Dr. Alberto Martínez Vázquez, Professor, Autonomous University of Ciudad Juárez, “Tuberculosis Analysis
in Juárez, 2011”
Dr. Roberto Alejandro Suárez Pérez, Epidemiologist, Juárez Jurisdictional Office, “Epidemiology of AH1N1 and the Identification of Risk Factors Associated with Confirmed Cases during the 2009 Pandemic in
Ciudad Juárez, Chihuahua, México”
Laura Alvarez, M.P.H., Disease Surveillance Specialist, EWIDS, El Paso Department of Public Health
(DPH), “Integrating Selected El Paso County School Districts into Public Health Surveillance”
Aldo Carrasco, Disease Surveillance Specialist, Texas DSHS OBH Region 9/10, “Sustaining Syndromic
Surveillance in Underserved Areas along the Border using Independent School Districts as Reporting Sites in
Health Service Region 9/10 with the Texas Department of State Health Services”
Dr. Eduardo Azziz-Baumgartner, EIS Officer, CDC, “Estimating the Disease and Economic Burden of Viral
Respiratory Diseases at Sentinel Sites on the U.S.-México Border during 2010-2012”
Speakers discussed recent research and innovations in surveillance of TB, influenza, and influenza-like illnesses
along the U.S.-México border.
International Health Regulations and Their Impact on U.S.-México Bilateral Relations
Moderator: Linda Willer
Dr. Katrin Kohl, Ph.D., M.P.H., Deputy Director, DGMQ, CDC, “Practical Aspects of the Binational
Implementation of the International Health Regulations”
17
“International Health Regulations and Their Impact on Binational and Border Relationships between México
and the United States”
Alicia Harvey Vera, M.P.H., Project Manager, Division of Global Public Health, Department of Medicine,
UCSD, “Biological Sample Transport across the U.S.-México Border: It Takes Two Villages”
Dr. Roberta Andraghetti, Adviser, International Health Regulations, PAHO/WHO, “Maximizing the Benefits
of the International Health Regulations: The Example of México and the United States”
Speakers discussed International Health Regulations as they pertained to bilateral relations.
Effective Methods for Outreach, including Innovative Film Documentary and Social
Media Techniques
Michael Welton, M.P.H., M.A., Epidemiologist, California Office of Binational Border Health (COBBH),
CDPH, “California Border Region Influenza-like Illness (ILI) Surveillance and Influenza Education in
Migrant Farmworker Populations”
Irma Ortiz Soto, Coordinator, BHC Baja California Regional Office, “Health Education for the Surveillance
of Vaccine Preventable Diseases within Communities in Tijuana during 2011”
Dr. Kimberly Shoaf, Associate Professor, UCLA School of Public Health; Assistant Director, UCLA Center
for Public Health and Disasters, “Cross-border Public Health Communication during the 2009 H1N1
Influenza Outbreak”
Dr. Jacob Rosales Velázquez, Quality and Health Education, Tamaulipas Secretariat of Health, “Dengue
Proof Hospital”
Speakers presented innovative methods for health communication, surveillance, and disease control regarding
influenza, influenza-like illness, TB, dengue, and other infectious diseases.
Training in Data Visualization for Epidemiology and Surveillance
In 2010, public health personnel in the Texas-México border region participated in a survey designed to assess
surveillance and epidemiology training needs. The results indicated several needs and identified a focus for future
trainings. As many primary training needs related to the visualization of epidemiologic and surveillance data,
Texas EWIDS sponsored training in free, readily available software, such as Epi Info™ 7, that enables data
collection, advanced statistical analyses, and geographic information system mapping capability.
CLOSING REMARKS
Dr. Gudelia Rangel, Coordinator, Comprehensive Strategy for Migrant Health, México Ministry of Health; BHC
Delegate to Salomón Chertorivski Woldenberg, México Secretary of Health
Dr. Craig Shapiro, Director, Office of the Americas, Office of Global Affairs; HHS Representative to the BHC
Dr. Rangel affirmed the BBID Conference provided a critical opportunity to share information and experiences in
advancement of improved collaborative binational efforts. To illustrate this, she noted her participation in the TB
breakout group informed her that not all Mexican consulates actively participated when patients were deported
from the United States. As a result, she planned to initiate consulate trainings through the BHC México Section.
Furthermore, she noted certain practices were more successful than others and affirmed the necessity for
improved procedures regarding the cross-border sharing of public health materials.
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Dr. Rangel commended the previous year’s conference participants for their work follow through on identified
action items as well as their work on new activities and noted the results were substantial. She stated the
conference allowed participants to appreciate the work of the border states and the challenges they encounter. She
concluded by emphasizing the next step is to advance implementation of the Guidelines.
Dr. Craig Shapiro agreed that the BBID Conference was a success, covering an impressive breadth and depth of
topics. Participants provided important, compelling presentations and engaged in thoughtful discussions
concerning communicable and non-communicable diseases. He noted many participants indicated the need for
greater binational communication. He remarked that the BBID Conference was an example of binational
communication and one the BHC was proud to support.
Dr. Shapiro applauded the signing of the Guidelines by the U.S. and Mexican Secretaries of Health and noted they
would provide binational public health workers the framework to continue their work in collaboration with their
border counterpart. He affirmed the likelihood the Guidelines would serve as a distinctive example of binational
collaboration as well as a best practice to share with WHO and its partners.
With respect to a multi-sectorial food safety agreement signed by the U.S. Secretary of Health, the United States
Department of Agriculture, and the Mexican Ministry of Agriculture, Dr. Shapiro noted that the stakeholders were
made up of more than just public health agencies. He affirmed this U.S.-México food safety agreement was the
first international food safety agreement signed by the United States since the Food Safety Modernization Act,
which provides the U.S. FDA increased authority and funding to improve food safety through international
engagement.
Dr. Shapiro closed by emphasizing that the significance of these paper agreements could be attributed to the
efforts made by border health professionals before and after the signatures. He congratulated those present for
their contributions to improving people’s lives along the border.
Dr. Dutton closed the conference by observing that the previous three conferences on border health progressively
gained strength, both in technical and logistical aspects. He thanked all participants for traveling to participate in
the conference as well as the BHC and Texas DSHS OBH staffs for making the conference possible.
The 2010 and 2011 BBID Conferences proceedings are available on the U.S.-Mexico Border Health Commission
website (http://www.borderhealth.org/reports.php?curr=about_us).
The 2012 BBID Conference proceedings will be available upon completion.
SUMMARY OF PRIORITY ISSUES, OBJECTIVES, AND NEXT STEPS
Priority Issues and Objectives
Improvements in border health featured prominently at the 2012 BBID Conference. Common themes included
implementation of the Guidelines and enhanced binational collaboration among U.S. and Mexican counterparts
that was critical to successful binational surveillance, outbreak investigations, and the cross-border control and
prevention of infectious diseases. Border health agencies and practitioners reported on protocols and pilot projects
implemented to improve the cross-border transport of public health items, information and data sharing, and
communication and indicated binational laboratory trainings advanced capacity building.
In addition, participants discussed potential opportunities to offset challenges to successful collaboration, such as
inefficient transport policies and procedures regarding public health materials as well as funding cuts and limited
resources overall. Specific opportunities included the enhancement of surveillance and electronic data systems to
stimulate greater information sharing and communication as well as the development of strategic alliances with
19
non-health agencies, such as the Mexican consulate and the U.S. Department Agriculture, to strengthen public
health initiatives for disease prevention and control.
Recommendations and Next Steps
The following recommendations were identified:
•
Prioritize the implementation of the Guidelines for 2012-2014, including standardization where possible
and protocol implementation for cross-border communication and collaboration.
•
Identify alternate funding sources and communicate the value of border health actions and initiatives to
local, state, and federal policy- and decision-makers.
•
Increase cross-border data and information sharing, possibly leveraging enhanced electronic surveillance
systems.
•
Include migrant populations in public health surveillance, prevention and control, and outreach activities.
•
Revise policies and practices that hinder the cross-border sharing of public health items; convene a small
work group to advance specific action items proposed during the corresponding panel discussion.
•
Continue building relationships and strategic alliances that facilitate binational collaboration on infectious
disease and emergency preparedness issues affecting the United States and México.
Conference participants were asked to outline a 2012-2014 activity plan and present it at the next BBID
Conference, scheduled for 2014.
20
Acosta
Program Manager, CDPH COBBH
avelina.acosta@cdph.ca.gov
(619) 688-0178
Elisa
Aguilar J.
Coordinator, BHC Chihuahua
Regional Office
eaguilar@saludfronteriza.org.mx
(01152-656) 639-0863 /
64
José
Alomía Zegarra
Epidemiologist, Sonora Secretariat
of Public Health
jalomia@saludsonora.gob.mx
(662) 108-4502
Herminia
Alva
Regional Epidemiologist, Texas
DSHS
herminia.alva@dshs.state.tx.us
(956) 421-5559
Laura
Alvarez
Disease Surveillance Specialist,
EWIDS, El Paso DPH
AlvarezJL@elpasotexas.gov
(915) 771-5708
Roberta
Andraghetti
Regional Adviser, International
Health Regulations, PAHO
andragro@paho.org
(202) 316-6126
José Luis
Aranda Lozano
Epidemiological Surveillance
Coordinator
jlaranda5@hotmail.com
(01152-664) 638-7311
Jorge Luis
Arellano Estrada
Physician
arestrad@hotmail.com
(01152-664) 638-6877
Ext. 2102
Bertha
Armendariz
Border Health Specialist, MCN
barmendariz@migrantclinician.org
(915) 282-2537
María
Arevalo
Postdoctoral Research Associate,
Center of Excellence for Infectious
Diseases, TTUHSC, Paul L. Foster
School of Medicine
maria.arevalo@ttuhsc.edu
(915) 783-1241
Lumumba
Arriaga
Epidemiologist
lumumbarriaga@hotmail.com
(01152-554) 062-4254
Title
A-1
Telephone
Last Name
Avelina
Email
First Name
APPENDIX A: PARTICIPANT DIRECTORY
Carlos Ramón
Arriaga Rangel
Institutional Relations Coordinator
carriaga@saludfronteriza.org.mx
(01152-656) 639-0863
Susan
Ayala
Administrative Assistant, Texas
DSHS
susan.ayala@dshs.state.tx.us
(512) 776-7675
Eduardo
Azziz-Baumgartner
EIS Officer, CDC
eha9@cdc.gov
(404) 259-8831
Jorge
Bacelis
Coordinator, Texas DSHS OBH
jorge.bacelis@dshs.state.tx.us
(512) 776-6569
Allison
Banicki
Epidemiologist, Texas DSHS OBH
allison.banicki@dshs.state.tx.us
(512) 776-6705
Trinidad
Barreras
Supervisory Consumer Safety
Officer, FDA
trinidad.barreras@fda.hhs.gov
(915) 771-7790
Ext. 1101
Norman
Bebon
Assistant Port Director-El Paso,
CBP
norman.bebon@dhs.gov
(915) 588-8041
Veronica
Bejarano
Director, Baja California State
Laboratory of Public Health
veronica.bejarano.ramirez@gmail.com
(01152-686) 248-2992
Preeti
Bharaj
Physician, Center of Excellence for
Infectious Diseases, TTUHSC,
Paul L. Foster School of Medicine
p.bharaj@ttuhsc.edu
(321) 332-2503
Martha Alicia
Bueno Rosas
Chief, Epidemiology Surveillance,
Chihuahua Secretariat of Health
maliciabueno@hotmail.com
(01152-614) 439-9900
Ext. 21656
José Arturo
Campos
Physician
jack01_1@hotmail.com
(01152-1-877) 772-3535
Paul
Cantey
Medical Epidemiologist, CDC
gdn9@cdc.gov
(404) 718-4735
Gloria
Cardenas
Nurse
gloriacdr@hotmail.com
(01152-656) 616-7498
Daniel
Carmona Aguirre
Chief, Department of
Epidemiology and Communicable
Diseases, Tamaulipas Secretariat
of Health
dr_daniel_carmona@hotmail.com
(01152-1-834) 315-0301
Aldo
Carrasco
Disease Surveillance Specialist,
Texas DSHS OBH Region 9/10
aldo.carrasco@dshs.state.tx.us
Not Available
A-2
Armando
Carvajal
Physician
carvajalarmando@hotmail.com
(01152-662) 104-0631
Keila
Castillo
Epidemiologist Supervisor
kcastillo@ci.laredo.tx.us
(956) 795-4938
Harendra
Chahar
Postdoctoral Research Assistant,
School of Medicine
harendra.chahar@ttuhsc.edu
(915) 783-1241
Jang-Gi
Choi
Postdoctoral Research Assistant,
School of Medicine
jang-gi.choi@ttuhsc.edu
(915) 783-1241
Ext. 319
Omar
Contreras
Epidemiologist, ADHS
contreo@azdhs.gov
(602) 364-0246
Ricardo
Cortés Alcalá
Director, Inter-Institutional Liaison
Office, DGE, México Ministry of
Health
Ricardo.Cortes@salud.gob.mx
(01552-55) 5337-1670
David
Cruz
Environmental Health Division
Officer, Preventive Medicine,
Naval Medical Center San Diego
david.cruzmestre@med.navy.mil
(619) 799-8773
Fabiola Elena
de la Torre
Binational Administrator
fdelatorre@saludfronteriza.org.mx
(01152-656) 639-0863
Edith
de la Fuente
Program Specialist III, Texas
DSHS
edith.delafuente@dshs.state.tx.us
(956) 421-5595
Beatriz A.
Díaz Torres
Delegate to Dr. Sergio Piña
Marshall, Chihuahua Secretary of
Health and BHC-Chihuahua
Member
bdiaz@uacj.mx
(01152-656) 688-1820
Gloria L.
Doria Cobos
Epidemiologist, Tamaulipas
Secretariat of Health
gldoriac@hotmail.com
(01152-899) 924-2037
Paul
Dulin
Director, NM DOH OBH
paul.dulin@state.nm.us
(575) 528-5154
Ronald
Dutton
Director, Texas DSHS OBH
rj.dutton@dshs.state.tx.us
(512)776-7675
A-3
Paul
Edelson
Medical Officer, CDC
dou9@cdc.gov
(01152-1-718) 553-1685
Thomas "Tate"
Erlinger
Epidemiologist, Texas DSHS
thomas.erlinger@dshs.state.tx.us
(512) 776-7198
Miguel
Escobedo
Quarantine Medical Officer,
DGMQ, CDC
mxe8@cdc.gov
(915) 834 5951
Rita
Espinoza
Communicable Disease Manager,
Texas DSHS
rita.espinoza@dshs.state.tx.us
(210) 949-2196
Nicole
Evert
nicole.evert@dshs.state.tx.us
(512) 533-3122
Lucia
Fajardo
Respiratory Coordinator
Luciafajardo_2005@hotmail.com
(619) 481-9164
Edgar Alberto
Farías Farías
Physician
fedgar_07@hotmail.com
(01152-1-844) 438-8330
Karen
Ferran
Program Manager, EWIDS, CDPH
COBBH
karen.ferran@cdph.ca.gov
(619) 688-3187
Maria
Fierro
BIDS Officer, Imperial County
Public Health Department
karlalopez@co.imperial.ca.us
(760) 482 -4702
María
Flores
Nurse
juntos1922@prodigy.net.mx
(915)834-5954
Gerardo Humberto
Flores-Gutiérrez
Professor, Autonomous University
of Tamaulipas
ghflores@uat.edu.mx
(01152-834) 145-8070
Maureen
Fonseca-Ford
Public Health Prevention
Specialist, DGMQ, CDC
mrf5@cdc.gov
(619) 692-5510
Diana
Fortune
TB Nurse Consultant, NM DOH
Diana.Fortune@state.nm.us
(505) 827-2473
Edgar Ivan
Galindo
State Laboratory Director
egalindo@ssnl.gob.mx
(01152-81) 8031-3569
Lauren
Garcia
EWIDS Binational Coordinator,
HCHD
lauren.garcia@hchd.org
(956) 318-2426
Emilio J.
German
Public Health Analyst-Coordinator
for Hispanic or Latino Health
Equity Activities, CDC
egerman@cdc.gov
(404) 639-8468
A-4
Catherine
Golenko
BIDS Epidemiologist, ADHS
catherine.golenko@azdhs.gov
(480) 323-5934
Jose A.
Gomes-Moreira
Binational Coordinator, Texas
DSHS OBH
jose.moreira@dshs.state.tx.us
(512) 837-9588
Mario
Gómez Linares
Physician
mayoglin@hotmail.com
(0115-868) 822-5522
Fernando
González
Lead Epidemiologist, El Paso DPH
gonzalezfj2@elpasotexas.gov
(915) 771-5808
Mauricio
Gómez-Sierra
InDRE
Not Available
Not Available
Guadalupe
González
Binational TB Project Manager,
Texas DSHS
lupe.gonzalez@dshs.state.tx.us
(915) 834-7792
Hector
Gonzalez
Director, Laredo Health
Department
hgonzalez@ci.laredo.tx.us
(956) 795-4920
María Guadalupe
González Martínez
Midwife
mggonzalez@ssnl.gob.mx
(01152-818) 014-5244
María Eugenia
Guerra Domínguez
International Relations Coordinator
mguerra@saludfronteriza.org.mx
(01152-818) 345-3429
Lupita
Guerrero
Public Health Technician I, Texas
DSHS
lupita.guerrero@dshs.state.tx.us
(956) 794-6343
Janie
Hamilton
Public Health & Prevention
Specialist, Texas DSHS
janie.hamilton@dshs.state.tx.us
(512) 776-6251
Alicia
Harvey Vera
Project Manager, Division of
Global Public Health, Department
of Medicine, UCSD
alvera@ucsd.edu
(858) 967-7521
John
Herbold
Consultant
johnherbold@johnherbold.org
(210) 219-4771
Salvadore
Hernandez
sal.hernandez@dshs.state.tx.us
(210) 949-2118
Rafael
Hernández Flores
Director of Public Health
rahernandez@ssnl.gob.mx
(01152-81) 8130-7068
Irma
Hernández Monroy
Chief, Department of Bacteriology
irmahm57@gmail.com
(01152-55) 5341-7859
A-5
Nubia Astrid
Hernández Santillan
Binational Epidemiological
Surveillance Coordinator
epifrontera@saludsonora.gob.mx
(01152-662) 180-3571
Michael
Hill
Public Health Director
Michael.Hill@ElPasoTexas.gov
(915) 771-5702
Elizabeth
Hunsperger
Chief, Serology Diagnostics and
Research Laboratory, CDC
enh4@cdc.gov
(787) 706-2472
Esmeralda
Iniguez-Stevens
Epidemiologist, EWIDS, CDPH
COBBH
einiguez@cdph.ca.gov
(619) 688-0111
Trinidad
Jeronimo
Midwife
trinijero@hotmail.com
(01152-626) 104-0656
Barbara
Jiménez
Deputy Director, San Diego
County Health And Human
Services Agency
barbara.Jiménez@sdcounty.ca.gov
(619) 338-2722
María Guadalupe
Jiménez Fierro
Physician
dra_Jiménez00@hotmail.com
Not Available
Rachael
Joseph
EIS Officer, CDC
vie5@cdc.gov
(908) 310-0201
Saleem
Kamili
Team Leader, CDC
skamili@cdc.gov
(404) 639-4431
Katrin
Kohl
Deputy Director, DGMQ
kkohl@cdc.gov
(404) 639-8073
Justine
Kozo
Chief, County of San Diego
Border Health Program
Justine.Kozo@sdcounty.ca.gov
(619) 692-6656
Paula
Kriner
Epidemiologist, Imperial County
Public Health Department
paulakriner@co.imperial.ca.us
(760) 482 4904
Grace
Kubin
Director, Texas DSHS Laboratory
Services
Grace.Kubin@dshs.state.tx.us
(512) 776-2468
Elvia
Ledezma
Coordinator, Texas DSHS OBH
elvia.ledezma@dshs.state.tx.us
(210) 949-2177
Mauricio
Leiva
Chief, CDPH COBBH
Mleiva@cdph.ca.gov
(916) 779-7202
A-6
Waldo
Lopez
Associate Director, Healthy Texas
Babies , City of Laredo Health
Department
wlopez@ci.laredo.tx.us
(956) 795-4921
Irma
López Martínez
MSc, InDRE
lopezmi74@gmail.com
(01152-55) 5341-1432
Benito
Lopez-Alvarez
Epidemiologist, Yuma County
Health Services District
benito.lopez@yumacountyaz.gov
(928) 317-4540
Ext. 1724
Adriana Corona
Luevanos
Program Manager, Texas DSHS
OBH
adriana.corona@dshs.state.tx.us
(915) 834-7690
Norma Alicia
Lugo Guillén
Biologist
normalugog@hotmail.com
Not Available
Norma Irene
Luna
BIDS Technical Coordinator
nluna@dgepi.salud.gob.mx
(01152-55) 5337-1744
Rufino
Luna
Director, Women’s Cancer
rufino.luna@salud.gob.mx
(01152-555) 263-9105
Hongming
Ma
Postdoctoral Research Associate
hongming.ma@ttuhsc.edu
(915) 783-1241
Ext. 297
Sarah
Marikos
Senior Research Specialist,
EWIDS, CDPH COBBH
sarah.marikos@cdph.ca.gov
(619) 688-0158
Maria Julia
Marinissen
Director, Division of International
Health Security, ASPR, HHS
maria.marinissen@hhs.gov
(202) 205-4214
Azi
Maroufi
Epidemiologist, San Diego County
Department of Health
azarnoush.maroufi@sdcounty.ca.gov
(619) 666-5168
Daniel
Márquez
Epidemiologist
dmarquezusc@hotmail.com
(01152-229) 213-5649
Kathie
Martinez
Program Coordinator, Texas
DSHS OBH
kathie.martinez@dshs.state.tx.us
(512) 776-3736
Alberto
Martínez Vázquez
of Ciudad Juárez
alberto.martinez@uacj.mx
(01152-656) 616-0087
Lupita
Mata
Administrative Assistant II, Texas
DSHS
lupita.mata@dshs.state.tx.us
(956) 421-5595
A-7
Orion
McCotter
BIDS Epidemiologist, ADHS
orion.mccotter@azdhs.gov
(520) 770-3179
Michelle
McDonald
Chief Medical Officer, Pima
County Health Department
michelle.mcdonald@pima.gov
(520) 243-7797
Belinda
Medrano
Epidemiologist, HCHD
belinda.medrano@hchd.org
(956) 318-2426
Linda
Meehan
CBP Operations Specialist
Linda.Meehan@dhs.gov
(915) 633-7300
Ext. 136
Ivonne
Mendez
Public Health and Prevention
Specialist, Texas DSHS
ivonne.mendez@dshs.state.tx.us
(915) 834-7746
Sonia
Montiel
Binational Lab Coordinator, CDC
hrm3@cdc.gov
(619) 692-5787
Ricardo
Morales
Laboratory Technician
ric_mj@yahoo.com.mx
(01152- 55) 5342-7550
Ext. 283
Julio Cesar
Morales Rueda
Epidemiologist
Jurisdiccionldo@hotmail.com
(01152-867) 712-1464
Gale
Morrow
Deputy Regional Director, Deputy
Regional Director, Texas DSHS
Health Service Region 8
gale.morrow@dshs.state.tx.us
(210) 949-2002
Lorraine
Navarrete
Binational Operations Coordinator,
BHC U.S. Section
lorraine.navarrete@hhs.gov
(915) 532-1006
Ext.107
Francisco Javier
Navarro Gálvez
Physician
navarro.fra@gmail.com
(01152-662)108-4530
Ernest (Skip)
Oertli
Director, Oral Rabies Vaccination
Program, Texas DSHS
ernest.oertli@dshs.state.tx.us
(512) 776-3306
Irma
Ortiz Soto
Coordinator, BHC Baja California
Regional Office
irma.ortiz.55@hotmail.com
(01152-664) 634-6511
David
Padilla
Program Manager, Texas DSHS
david.padilla@dshs.state.tx.us
(915) 834-7769
Benjamin
Park
Medical Officer, Mycotic Diseases
Branch, CDC
bpark1@cdc.gov
Not available
Fermin
Perez
Physician
fermon26@hotmail.com
(01152-878) 782-9291
A-8
Carlos Gabriel
Perez Puente
Chemist
cgabriel40@hotmail.com
(01152-1-834) 315-0301
Enrique
Perez-Flores
Advisor/Epidemiologist, Health
Surveillance and Disease
Prevention and Control,
PAHO/WHO
perezenr@paho.org
(915) 845-5950
Ext. 42531
Katharine
Perez-Lockett
BIDS Officer-Epidemiologist, NM
DOH
katharine.perez@state.nm.us
(575) 528-5103
Clelia
Pezzi
Public Health Advisor, CDC
kpezzi@cdc.gov
(619) 692-5667
Rossanne
Philen
Medical Epidemiologist, CDC
RPhilen@cdc.gov
(404) 639-4350
Alba
Phippard
BIDS Data Manager, CDC
ign7@cdc.gov
(619) 206-0461
Barbara
Quiram
Director, Texas A&M USA Center
for Rural Public Health
Preparedness
quiram@srph.tamhsc.edu
(979) 845-2387
Pushker
Raj
Laboratory Services Section,
Microbiological Services Branch,
Texas DSHS
pushker.raj@dshs.state.tx.us
(512) 776-7760
Sara
Ramirez
Physician
osraco06@hotmail.com
(01152-868) 822-5522
María Gudelia
Rangel
Coordinator, Comprehensive
Strategy for Migrant Health,
México Ministry of Health
grangel2009@gmail.com
(01152-664) 634-6511
Miguel Angel
Reyes López
Professor/Researcher, Genomics
and Biotechnology Center,
National Polytechnic Institute
mreyesl@ipn.mx
(01152-55) 729-6000
Ext. 87751
Lizette
Rodarte
Medical Research Technician III,
School of Medicine
lizette.rodarte@ttuhsc.edu
915-783-1241
Ext. 278
Alfredo
Rodríguez Trujillo
Medical Epidemiologist
alfredotrrd@hotmail.com
(01-614) 439-99-00
Ext. 21656
A-9
Alfonso
Rodriguez-Lainz
Epidemiologist, CDC
jqi3@cdc.gov
(619) 692-8406
Jacob
Rosales Velázquez
Quality and Health Education,
Tamaulipas Secretariat of Health
jacobrosve@hotmail.com
(01152-1-834) 315-0301
Mona
Saraiya
Medical Officer, Epidemiology
and Applied Research Branch,
Division of Cancer Prevention and
Control, CDC
msaraiya@bellsouth.net
(770) 488-4293
Alessio
Scorza
Public Health Professional
dscorza@dgepi.salud.gob.mx
(01152- 55) 5337-1647
Calixto
Seca
Texas DSHS OBH-Laredo
Regional Coordinator
calixto.seca@dshs.state.tx.us
(956) 764-6290
David
Selvage
Epidemiologist, Infectious Disease
Epidemiology Bureau, NM DOH
walter.selvage@state.nm.us
(505) 476-3563
Premlata
Shankar
Professor and Co-director, Center
of Excellence for Infectious
School of Medicine
Premlata.shankar@ttuhsc.edu
(915) 783-1241
Craig
Shapiro
Director, Office of the Americas,
Office of Global Affairs, HHS
craig.shapiro@hhs.gov
(202) 260-1733
Kimberley
Shoaf
Associate Professor, UCLA School
of Public Health; Assistant
Director, UCLA Center for Public
Health and Disasters
kshoaf@ucla.edu
(310) 794-0840
Jennifer
Smith
Surveillance Officer
jennifer.smith@sdcounty.ca.gov
(619) 692-8484
Raul
Sotomayor
International Health Analyst,
ASPR, HHS
Raul.Sotomayor@hhs.gov
(202) 401-5837
Luanne
Southern
Deputy Commissioner, Texas
DSHS
luanne.southern@dshs.state.tx.us
(512) 776-7792
A-10
Roberto Alejandro
Suárez Pérez
Epidemiologist, Juárez
Jurisdictional Office
rasuarez2000@yahoo.com.mx
(01152- 656) 613-5510
Ext. 115
Manjunath
Swamy
Professor and Co-director, Center
of Excellence for Infectious
School of Medicine
manjunath.swamy@ttuhsc.edu
(915) 783-1245
Cynthia
Tafolla
Binational TB Project Manager,
Health Service Region 11, Texas
DSHS
cynthia.tafolla@dshs.state.tx.us
(956) 423-0130
María Micaela
Tapia Olea
Chemical Biologist
mika_tapia@hotmail.com
(01152-662) 256-6384
Ethel
Taylor
CDC Preventive Medicine Fellow
etaylor@medicine.tamhsc.edu
(979) 571-2492
Andy
Thornton
Applied Epidemiology Fellow,
Council of State and Territorial
Epidemiologists
andrew.thornton@sdcounty.ca.gov
(619) 692-8052
Silvia Estela
Trevino
Chemist
qsilviaetrevino@yahoo.com.mx
(01152- 656) 613-5248
Rocio
Uresti
of Tamaulipas
ruresti@uat.edu.mx
(01152-899) 944-1761
Adolfo M.
Valadez
Assistant Commissioner,
Prevention and Preparedness
Services Division, Texas DSHS
adolfo.valadez@dshs.state.tx.us
(512) 776-7729
Barbara
Vassell
Correctional TB Coordinator, TB
Services Branch, Texas DSHS
barbara.vassell@dshs.state.tx.us
(512) 776-2511
Gilberto
Vaughan
AIDS Services Foundation
GVaughan@cdc.gov
(404) 639-0877
Andres
Velasco-Villa
Associate Service Fellow, CDC
DLY3@cdc.gov
(404) 639-1055
Esteban
Vlasich
Coordinator, Project JUNTOS,
Texas DSHS
evlasich@cdc.gov
(915) 834-5954
A-11
Steve
Waterman
Team Lead, U.S.-México Unit,
DGMQ, CDC
shw2@cdc.gov
(619) 692-5659
Michael
Welton
Epidemiologist, CDPH COBBH
mwelton@cdph.ca.gov
(619) 254-6582
Linda
Willer
Program Manager, BHC U.S.
Section
linda.willer@hhs.gov
(915) 532-1006
Ext. 105
Leticia
Wong
State Epidemiologist
epidemiologia_bc@yahoo.com.mx
(01152- 686) 559-5800
Ext. 4241 / 4252
Haoquan
Wu
Assistant Professor, Center of
Excellence for Infectious Diseases,
TTUHSC, Paul L. Foster School of
Medicine
haoquan.wu@ttuhsc.edu
(915)7831241x284
Chunting
Ye
Postdoctoral Research Associate
chunting.ye@ttuhsc.edu
Guohua
Yi
Postdoctoral Associate
g.yi@ttuhsc.edu
(915) 783-1241
Ext. 277
(915) 783-1241
Ext. 261
Carmen Rosa
Zapata Holguin
Technical Professional in Clinical
Analysis
cr.z.h@hotmail.com
(01152-614) 411-3315
Max
Zarate-Bermudez
Epidemiologist, CDC
mcz4@cdc.gov
(770) 488-7421
Mingtao
Zeng
Assistant Professor, Center of
Excellence for Infectious Diseases,
TTUHSC, Paul L. Foster School of
Medicine
mt.zeng@ttuhsc.edu
(915) 783-1241
Ext. 253
María Luisa
Zúñiga
Associate Professor and
Behavioral Epidemiologist,
Division of Global Public Health,
UCSD
mzuniga@ucsd.edu
(619) 681-0689
A-12
APPENDIX B: MEETING AGENDA
Start
End
Tuesday, May 22, 2012
8:00
8:45
Registration
Third Floor, Capitol View Terrace North-Foyer
Inauguration and Opening Remarks
Third Floor, Capitol Ballroom
Luanne Southern, M.S.W., Deputy Commissioner, Texas Department of State Health Services (DSHS)
9:00
9:30
Dr. Beatriz A. Díaz Torres, Delegate to Dr. Sergio Piña Marshall, Chihuahua Secretary of Health and
BHC-Chihuahua Member
Master and Mistress of Ceremonies:
Dr. Ronald J. Dutton, Director, Office of Border Health (OBH), Texas DSHS and BHC Delegate
Dr. Elisa Aguilar Jiménez, Coordinator, BHC Chihuahua Regional Office
Review of 2011 Meeting and Objectives for 2012 Meeting
9:30
9:45
Dr. Allison Abell Banicki, Epidemiologist, Texas DSHS OBH
Panel–Federal Updates on Border and Binational Preparedness, Surveillance and
Epidemiology
9:45 10:45
Dr. Ricardo Cortés Alcalá, Director, Inter-Institutional Liaison Office, General Directorate of Epidemiology,
México Ministry of Health
Dr. Katrin Kohl, Ph.D., M.P.H., Deputy Director, Division of Global Migration and Quarantine (DGMQ),
Centers for Disease Control and Prevention (CDC)
Dr. Jose Fernandez, Deputy Director, Division of International Health Security, Office of the Assistant
Secretary for Preparedness and Response, U.S. Department of Health and Human Services (HHS)
Break
10:45 11:00
Panel–State Updates on Border and Binational Preparedness, Surveillance and
Epidemiology
11:00 11:45
Dr. Francisco Javier Navarro Gálvez, General Director, Community Health Services, Sonora Secretariat
of Public Health
David Selvage, M.H.S., PA-C, Epidemiologist, Infectious Disease Epidemiology Bureau, New Mexico
Department of Health (NM DOH)
Panel–Local Updates on Border and Binational Preparedness, Surveillance and
Epidemiology
11:45 12:30
Dr. José Luis Aranda Lozano, Epidemiologist, Institute of Public Health Services for Baja California–
Health Jurisdiction II, Tijuana
Dr. Fermín Pérez Ortiz, Epidemiologist, Coahuila Secretariat of Health, Jurisdiction I, Piedras Negras
Belinda Medrano, M.P.H., Epidemiologist, Hidalgo County Health and Human Services Department
12:30
2:00
No host Lunch
B-1
Panel–Cross-border Sharing of Public Health Items
Sonia Montiel, BIDS Laboratory Coordinator, DGMQ, CDC–Moderator
2:00
3:15
Dr. Elisa Aguilar Jiménez, Coordinator, BHC Chihuahua Regional Office–Review of experiences along
the border
Dr. Miguel Escobedo, Quarantine Medical Officer, DGMQ, CDC–Summary of pilot evaluation results
Trinidad Barreras, Supervisory Consumer Safety Officer, U.S. Food and Drug Administration
Representative, Federal government of México (pending)
Norman Bebon, Assistant Port Director-El Paso, U.S. Customs and Border Protection
3:15
Break and Poster Set-up
3:45
Panel–Cross-border Sharing of Public Health Items, continued
3:45
4:45
Questions and Discussion
Binational Technical Work Group and Sub-Groups Reports
4:45
5:00
Dr. Steve Waterman, Team Lead, U.S.-México Unit, DGMQ, CDC
Breakout Group Process
5:00
5:15
Katharine Perez-Lockett, M.P.H., BIDS Officer-Epidemiologist, NM DOH
5:15
5:20
5:45
7:00
Day 1Closing
Poster Session and Social
Second Floor, Creekside
B-2
Start
End
Wednesday, May 23, 2012
7:30
Registration
8:00
Third Floor, Capitol View Terrace North-Foyer
Breakout groups will discuss border and binational initiatives.
Each group may begin with up to three lightning talks (5 minutes each).
8:00
9:30
Group 1
TB, HIV, STDs,
Hepatitis
Group 2
Foodborne and
Diarrheal Diseases
Third Floor, Capitol D
Third Floor, Capitol View
Terrace South
Dr. Miguel Escobedo,
Descriptive Analysis of
Mexican Immigrants with
Overseas Tuberculosis
Conditions, October 1,
2010–September 30,
2011
Dr. Rachael Joseph,
Investigation of a
Shigella Sonnei
Outbreak among U.S.
Travelers to México,
November 2011
Dr. Haoquan Wu,
Design miRNA-based
shRNA to Suppress HIV
Infection
Group 3
Respiratory Diseases,
including Pandemic
Influenza and
Coccidioidomycosis
Group 4
Emerging Infectious
Threats, including
Vector-borne
Diseases
Terrace North
Dr. Alberto Martínez
Vázquez, Clinical
Disorders and Risk
Factors for the
Development of Acute
Respiratory Distress
Syndrome in the
Intensive Care Unit
Third Floor, Capitol A-C
Dr. Mingtao Zeng, New
Mucosal Vaccine for
Cross-Strain Protection
against Influenza
Dr. Beatriz A. Díaz
Torres, Risk Factors
Associated with
Acquired Pneumonia in
a Pediatric Patient at
Ciudad Juárez General
Hospital
9:30
Orion McCotter,
M.P.H., Establishing a
System for Dengue
Surveillance along the
Arizona-Sonora Border
Omar Contreras,
M.P.H., Detection of
Rocky Mountain
Spotted Fever Activity in
Southern Arizona
Dr. Benjamin Park,
The Re-emergence and
Changing Epidemiology
of Coccidioidomycosis,
United States, 1998–
2010
Break
10:00
Breakout groups will discuss border and binational initiatives.
Each group may begin with up to three lightning talks (5 minutes each).
Group 1
Laboratory Integration
with Surveillance
Systems
10:00
11:30
Group 2
Migrant Health
Terrace South
Terrace North
No presentations–
discussion will begin
immediately.
Group 3
Binational
Communication and
the Implementation of
Guidelines
Group 4
Cross-border Sharing
of Items for Public
Health Purposes
Dr. Alfonso RodriguezLainz, Migration-related
Information in U.S.
National Data Sources
B-3
Dr. Steve Waterman,
Overview of Pilot Project
to Implement the
Technical Guidelines for
U.S.-México
Coordination on Public
Health Events of Mutual
Interest
No presentations–
discussion will begin
immediately.
Dr. Gudelia Rangel,
Comprehensive Strategy
for Migrant Health
11:30
Dr. Allison Abell
Banicki, Pilot Project to
Implement the
Technical Guidelines for
U.S.-México
Coordination on Public
Health Events of Mutual
Interest : Perspectives
from the U.S. Border
States
No Host Lunch
1:00
Plenary Session–Best Practices in Border Binational Surveillance
Third floor, Capitol Ballroom
1:00
1:15
Dr. Nubia Astrid Hernández Santillan, Binational System for Real-Time Epidemiological Alerts
1:15
1:30
Omar A. Contreras, M.P.H., Campylobacter and Guillain-Barré Syndrome (GBS): A Multi-jurisdictional
Approach to the First Binational Outbreak along the Arizona/México Border
1:30
1:45
1:45
2:00
2:00
2:15
Dr. Alfredo Rodríguez Trujillo, Sustainability of Binational Epidemiological Surveillance
2:15
2:40
Questions and Discussion
2:40
3:00
Dr. Bertha P. Armendariz, Binational Tuberculosis Surveillance and Control Pilot Project in the New
Mexico and Chihuahua Region
Orion McCotter, M.P.H., and Dr. José Alomía Zegarra, The Binational Project Improving the Diagnosis,
Surveillance, and Treatment of Coccidioidomycosis in the Border Region of “Four Corners” ArizonaSonora and New Mexico-Chihuahua
Break
Track Session 1
Each track will include up to six 15-minute talks followed by a 30-minute question/discussion
period.
Track 1
Best Practices and
Lessons Learned from
BIDS and EWIDS
Projects
3:00
5:00
Track 2
HPV, Cervical Cancer,
and HIV: Epidemiology
and Control Measures
Track 3
Binational Outbreak
Investigations
Terrace North
Track 4
Respiratory
Conditions in the
Border Region:
Tuberculosis and
Influenza
Moderator: Dr. Elisa
Aguilar Jiménez
Terrace South
Moderator: Jorge
Bacelis
Moderator: Dr. Allison
Banicki
Moderator: Omar
Contreras
Dr. Martha Alicia
Bueno Rosas,
Seroprevalence of
Coccidioidomicosis in
Chihuahua
Dr. Mona Saraiya,
Cervical Cancer
Prevention
Maureen FonsecaFord, M.P.H., Cluster of
Guillain-Barré Syndrome
Due to a Waterborne
Outbreak of
Campylobacter Jejuni
Infection—Sonora,
México and Arizona,
2011
Dr. Miguel Angel
Reyes López,
Detection of M.
Tuberculosis Mutations
in Tamaulipas Isolates
Katharine PerezLockett, M.P.H.,
Development and
Dissemination of the
Borderwide Regional
Influenza Surveillance
Dr. Allison Abell
Banicki, HPV
Vaccination in Texas,
2010
Dr. Max ZarateBermudez,
Environmental
Assessment of the
Waterborne Outbreak of
Campylobacter Infection
Dr. Alberto Martínez
Vázquez, Tuberculosis
Analysis in Juárez,
2011
B-4
Network Report
in Sonora, México, and
Arizona, United States,
2011
Catherine Golenko,
M.P.H., Enhancing
Respiratory Infection
Surveillance on the
Arizona-Sonora
Border—BIDS Program
Sentinel Surveillance
Data
Dr. Gudelia Rangel,
Current Overview of HIV
on the Northern Border
of México
Dr. Miguel Escobedo,
Coordinated Response
to a Binational Wound
Botulism Outbreak
Dr. Roberto Alejandro
Suárez Pérez,
Epidemiology of AH1N1 and the
Identification of Risk
Factors Associated with
Confirmed Cases during
the 2009 Pandemic in
Ciudad Juárez,
Chihuahua, México
Dr. Ricardo Cortés
Alcalá, Epidemiologic
Surveillance of Influenza
in México, its Impact on
the Northern Border, and
the HHS-General
Directorate of
Epidemiology
Cooperative Agreement
Emilio J. German,
M.S.H.S.A., HIV and
Health Equity among
Hispanics/Latinos
Dr. Gerardo H. FloresGutiérrez,
Epidemiologic
Surveillance on the U.S.México Border from the
Veterinary Perspective
under the One Health
Concept
Laura Alvarez. M.P.H.,
Integrating Selected El
Paso County School
Districts into Public
Health Surveillance
Dr. Steve Waterman,
U.S. Perspective on
BIDS Best Practices and
Lessons Learned
Dr. María Luisa Zúñiga,
Gender Inequality and
HIV Care Behavior
among HIV-positive
Latinos in the U.S.México Border Region
Dr. Andres VelascoVilla, Rabies across
Borders: Finding
Emerging and Reemerging RABV Variants
with Public Health
Impact
Aldo Carrasco,
Sustaining Syndromic
Surveillance in
Underserved Areas
along the Border using
Independent School
Districts as Reporting
Sites in Health Service
Region 9/10 with the
Texas Department of
State Health Services
Dr. Mauricio GómezSierra, Expanded Panel
of 20 Anti-nucleocapsid
Monoclonal Antibody as
a Tool in the
Differentiation of ATypical Antigenic of the
Rabies Virus within the
Mexican Territory
Dr. Eduardo AzzizBaumgartner,
Estimating the Disease
and Economic Burden
of Viral Respiratory
Diseases at Sentinel
Sites on the U.S.México Border during
2010–2012
Questions and
discussion
Questions and
discussion
Raul Sotomayor,
M.P.H., M.S.A., EWIDS
Best Practices and
Lessons Learned
Questions and
discussion
Questions and
discussion
Evening Concurrent Session
Working Dinner (Pre-registration Required)
6:00
8:30
Second Floor, Creekside
Training in Data Visualization for Epidemiology and Surveillance (Overview)
Instructors: Dr. Raquel Qualls-Hampton and Dr. Martha Felini
B-5
Start
End
Thursday, May 24, 2012
8:00
Registration
8:30
Third Floor, Ballroom, Pre-Function Area
Track Session 2
Each track will include up to six 15-minute talks followed by a 30-minute question/discussion
period.
Track 1
8:30
10:30
10:30
10:45
10:45
11:30
Track 2
Track 3
International Health
Regulations and Their Impact
on U.S.-México Bilateral
Relations
Effective Methods for Outreach,
including Innovative Film
Documentary and Social Media
Techniques
Training in Data
Visualization for
Epidemiology and
Surveillance
Terrace North
Dr. Katrin Kohl, Practical
Aspects of the Binational
Implementation of the
Regulations
Michael Welton, M.P.H., M.A.,
California Border Region ILI
Surveillance and Influenza
Education in Migrant Farmworker
Populations
Dr. Ricardo Cortés Alcalá,
Regulations and Their Impact
on Binational and Border
Relationships between México
and the United States
Irma Ortiz Soto, Health Education
for the Surveillance of Vaccine
Preventable Diseases within
Communities in Tijuana during 2011
Alicia Harvey Vera, Biological
Sample Transport across the
U.S.-México Border: It Takes
Two Villages
Dr. Kimberly Shoaf, Cross-border
Public Health Communication
during the 2009 H1N1 Influenza
Outbreak
Dr. Roberta Andraghetti,
Maximizing the Benefits of the
Regulations: The Example of
México and the United States
Questions and discussion
Dr. Jacob Rosales Velázquez,
Dengue Proof Hospital
Dr. Raquel Qualls-Hampton
and Dr. Martha Felini,
Exercises using Epi Info™ 7
Questions and discussion
Transition from fourth floor breakout rooms to third floor Capitol Ballroom
Reports from Breakout Groups
Closing
Dr. Gudelia Rangel, Coordinator, Comprehensive Strategy for Migrant Health, México Ministry of
Health; BHC Delegate to the Mexican Secretary of Health
Dr. Craig Shapiro, Director, Office of the Americas, Office of Global Affairs; HHS representative to the
BHC
11:30
11:45
11:45
12:10
Break
Training Session 3
12:15
2:15
Dr. Martha Felini, Dr. Raquel Qualls-Hampton, and Dr. Sumihiro Suzuki, Exercises Using R
Third Floor, Capitol View Terrace North
B-6
APPENDIX C: LIST OF POSTER PRESENTERS AND TITLES
Presenting author(s) underlined.
Authors
Title
Sojan Abraham, Rajendra Pahwa, Guohua Yi, Chunting Long-term Engraftment of Human Natural T
Ye, Shashidhar Jaggaiahgari, Sandesh Subramanya, N. Regulatory Cells in NOD/SCID IL2rγcnull Mice by
Manjunath, and Dr. Premlata Shankar
Expression of Human IL-2
Dr. Jorge Luis Arellano Estrada, Dr. José Luis Aranda
Lozano, and Irma Ortiz Soto.
Analysis of Patient Survival and Morbidity on ART
UPS and Tijuana CAPASITS, 1999-2011
Robyn Atadero, Karla Lopez, Paula Kriner, and Laura
Apodaca
Provider Knowledge, Attitudes, and Practices Survey
Regarding Coccidioidomycosis in Imperial County,
California
Veronica Bejarano, Esmeralda Iniquez-Stevens, Sarah
Marikos, Melanie Harris, Maggie Santibañez, Martha
Vázquez-Erlbeck, Karen Ferran, and Paula Kriner
Laboratory Bioterrorism Response Capabilities in
Select Areas along the California-Baja California
Border
Preeti Bharaj, Sojan Abraham, Lizette Rodarte,
Ogechika Alozie, Dr. Manjunath Swamy, and Dr.
Premlata Shankar
Expression of PD-1H: a Novel Ig Superfamily Ligand
on Hematopoietic Cells of Normal and HIV Infected
Subjects
Santos Daniel Carmona Aguirre, Dr. Jacob Rosales
Velázquez, and Javier García Luna Martínez
Current Dengue Classification
Harendra S. Chahar, Shuping Chen, and Chunting Ye
Recruitment of miRNA Effectors LSM1, GW182,
DDX3 and XRN1 by West Nile Virus to Replication
Complexes Leads to P Body Depletion and These
miRNA Effectors Positively Regulate WNV
Replication
Shuiping Chen, Harendra S. Chahar, Sojan Abraham,
Dr. Haoquan Wu, Theodore C. Pierson, Xiaozhong A.
Wang, and N. Manjunath
Ago-2-mediated Slicer Activity is Essential for Antiflaviviral Efficacy of RNAi
Adriana Corona Luevanos, Dr. Miguel Escobedo,
Alfonso Rodríguez, and Claudia Lozano
Use of the Community Health Worker Model to
Educate International Travelers at an El Paso, Texas,
Port of Entry about H1N1 Influenza Prevention
Dr. Gloria Leticia Doria Cobos and Dr. Pablo G. López
Rodríguez
Study of Dengue Outbreak in Rio Bravo, Tamaulipas
Dr. Miguel Escobedo, M.D., M.P.H.; Flor Puentes,
M.P.H.; Adriana Corona, MBA; and Michelle
Sandoval, M.P.H.
Bacteriologic Assessment of Imported Cheese from
México-El Paso, Texas, 2008
Nicole Evert, Anne Tyree, Cynthia Tafolla, Kenneth
Jost Jr., María Rodríguez, and Charles Wallace
Tuberculosis Transmission Knows No Borders:
Genotype Clusters along the Texas-México Border,
2005-2010
Maria Fierro, Karla Lopez, Lisa Smith, Paula Kriner,
Serosurvey of Coccidioidomycosis in Residents of
C-1
Holly Maag, Michael V. Lancaster, and Vatchara
Oubsuntia
Imperial County, California
Maureen Fonseca-Ford, M.P.H.; Clelia Pezzi; Timothy
Doyle, M.P.H.; and Dr. Steve Waterman
Infectious Disease Morbidity in the U.S. Region
Bordering México, 1999-2009
M.S.P. María Guadalupe González Martínez, Dr.
Francisco González Alanís, M. en C. Rafael Hernández
Flores, M.S.P. Norma Alicia Lugo Guillén, and M.S.P.
Argentina Argelia Garza Robledo
Rickettsiosis Types Reported in Nuevo León, México,
2011
Esmeralda Iniguez-Stevens, Karen Ferran, and Paula
Kriner
Evaluation of School Absenteeism Data for Enhanced
Detection of Influenza Activity in Imperial County,
California
M.S.P. Norma Alicia Lugo Guillén, M.S.P. María
Guadalupe González Martínez, and M.S.P. Nancy
Robledo Victoria Torres
Water Plant Breeding as Chief Breeding Ground in
Absence of Storm Water in Guadalupe, Nuevo León
Hongming Ma, Jessica Montoya, and Dr. Haoquan Wu
Optimization of PAR-CLIP Method for Identification
of microRNA Targets in Viral Genome
Belinda A. Medrano, M.P.H
Initial Mercury-tainted Product Investigation and
Outbreak Detection in Hidalgo County, Texas
Clelia Pezzi and Dr. Miguel Escobedo
TB and HIV Co-Infection in the Texas Border Region,
2000-2010
Rossanne Philen, Maureen Fonseca-Ford, M.P.H.;
Sonia Montiel; Dr. Miguel Escobedo; Jennifer Smith;
Karla Lopez; Orion McCotter, M.P.H.; Katherine
Pérez-Lockhart, M.P.H.; Herminia Alva; and Dr. Steve
Waterman
An Overview of Recent Border Infectious Disease
Surveillance (BIDS) Projects Funded through the CDC
Epidemiology and Laboratory Capacity Cooperative
Agreement with U.S. Border States
Lizette Rodarte and Dr. Premlata Shankar
Antibody Mediated Delivery of siRNA using a CD7Protamine Conjugate
Jennifer Smith, Catherine Golenko, M.P.H., Orion
McCotter, M.P.H., Paula Kriner, Karla Lopez, and
Lucia Fajardo
Enhanced Surveillance for Severe Acute Respiratory
Infections in the California-Arizona Border Region
Dr. Manjunath Swamy and Chunting Ye
SiRNA Treatment for Sepsis
María Micaela Tapia Olea
Vibrio Parahaemolyticus Outbreak in Sonora, México,
2011
Andy Thornton, M.P.H.; Dr. Michele Ginsberg; Dr.
Annie Kao; and Dr. Steve Waterman
Evaluation of Listeriosis Surveillance in San Diego
County, California, 2005–2010
Orion McCotter, M.P.H. (on behalf of Clarisse Tsang);
Corey Benedum; Dr. Rocío M. Uresti Marín
Coccidioidomycosis Surveillance in Arizona:
Comparison of 2007 and 2011 Data Comprehensive
Human Health
C-2
Dr. Rocío M. Uresti Marín
Comprehensive Human Health
Dr. Haoquan Wu, Hongming Ma, Chunting Ye, Jessica
Montoya, Dr. Premlata Shankar, and Dr. Manjunath
Swamy
Improved siRNA/shRNA Functionality by Mismatched
Duplex
Guohua Yi (on behalf of Chunting Ye), Sojan
Abraham, Dr. Haoquan Wu, Dr. Premlata Shankar, and
N. Manjunath
Targeted Delivery of siRNA to Macrophages and
Dendritic Cells to Suppress Flaviviruses Encephalitis
C-3
APPENDIX D: PANEL SUMMARIES
Epidemiology
Dr. Ricardo Cortés Alcalá, Director, Inter-Institutional Liaison Office, DGE, México Ministry of Health
Dr. Katrin Kohl, Ph.D., M.P.H., Deputy Director, DGMQ, CDC
Dr. Jose Fernandez, Deputy Director, Division of International Health Security, ASPR, HHS
Dr. Cortés Alcalá provided the Mexican federal perspective on preparedness and surveillance, noting it was
essential that present systems evolve from reactive to proactive and from fragmented to integrated. Possible
modifications included utilizing information from institutions not typically involved to improve epidemiologic
surveillance as well as integrating laboratories into surveillance systems. Moreover, he affirmed systems should
analyze and challenge rather than describe and corroborate; vertical movement should become horizontal; and
systems should be open rather than closed.
As international linkages fall under DGE’s purview, México collaborated with the Public Health Agency of
Canada, the CDC, PAHO, and the European Centre for Disease Control and Prevention. Epidemiologic
surveillance of infectious diseases on México’s northern border strengthened SINAVE, México’s national system
for epidemiologic surveillance. Specific collaborations between México and the United States included EWIDS;
binational outbreak investigations; Día de Norte América (Day of North America), a project for the automatic
exchange of public security and health information; and development of the AlertaMex system, a platform
utilizing SINAVE to analyze the state of health of all federal regions, particularly the six Mexican border states.
Dr. Cortés Alcalá also reported on their participation in binational surveillance and multinational initiatives, such
as NAPAPI and the GHSI. NAPAPI facilitated trilateral and regular communication among Canadian, Mexican,
and U.S. health emergency centers, to include automatic notification of public health events of international
interest. He affirmed the U.S.-México agreement to enhance influenza surveillance resulted in a valuable network
of sentinel units and laboratories in México, to include México’s Intelligence Units for Health Emergencies,
established in U.S.-México border region states. He noted Sonora’s Sonora’s Epidemiologic Intelligence Unit for
Health Emergencies (UIEES) was designated as the regional Focal Point to alert the United States to cases and
outbreaks.
Dr. Cortés Alcalá concluded that transforming networks of transmission into networks of protection required
further U.S.-México collaboration.
Dr. Kohl announced the Guidelines laid the framework for enhanced binational engagement. She affirmed border
health agencies initiated implementation of the Guidelines’ principles, as demonstrated in the Binational
Technical Working Group (BTWG) in Public Health, established as a forum to facilitate discussions on technical
matters in public health, specifically infectious diseases, non-communicable diseases, and health communication.
In 2011-2012, the BTWG cross-cutting team created a binational list of notifiable diseases and developed
communication pathway protocols that were implemented in a Texas, New Mexico, Arizona, and Sonora pilot
project. A broad representation from federal, state, and local partners comprised the BTWG, including the CDC,
the Council of State and Territorial Epidemiologists, state and local U.S. border health offices, DGE, InDRE, and
the Sonora state representative. Partnership, formal and informal agreements, and frequent communication at all
governmental levels were essential to success in border public health.
Dr. Kohl reported several border binational surveillance reports were in various stages of completion or updates.
She noted border region influenza reports were issued regularly, and EWIDS supported ongoing surveillance
reports for border sister-states. As part of an ongoing effort to understand drug-resistant TB on the border, the
D-1
CDC published a BIDS surveillance report in December 2011. Additionally, the CDC planned to publish a
guideline to improve HIV surveillance in Hispanic/Latino border populations.
Dr. Kohl observed that challenges persisted in binational epidemiology and surveillance. Reporting timeliness
remained problematic, and the cross-border movement of laboratory specimens and reagents presented ongoing
challenges. Although U.S. public health budgets were decreasing, there was a sustained need for training and
information technology development.
Moreover, the CDC continued to help integrate existing binational efforts to eliminate redundancies and
inefficiencies, including the cross-population of surveillance studies with routine surveillance systems. Dr. Kohl
affirmed a recent effort to add “binational” and “foreign birth” variables to U.S. national health electronic disease
surveillance systems reflected progress toward understanding health in binational and foreign born populations
that would allow the United States to target health resources more effectively.
Dr. Kohl invited conference participants to attend a BIDS strategic planning session on Thursday, May 24. She
noted the considerable changes that occurred since the previous session, including changes in disease patterns and
border infrastructure; the development of SINAVE; the formal approval of the Guidelines; and current budget
limitations.
The CDC’s DGMQ in strategic planning identified the following main goals:
•
Implement a binational public health strategy—led by Dr. Waterman.
•
Strengthen understanding regarding the health needs of Spanish-speaking mobile populations—led by Dr.
Rodriguez-Lainz.
•
Maintain and improve a system for rapid response to illness and public health emergencies at ports of
entry—led by Dr. Escobedo.
•
Develop strategic partnerships.
Dr. Kohl considered TB surveillance and control demonstrated the need for binational communication and
collaboration. TB case management required immigrant screening, specimen and reagent import/export, travel
restrictions, and continuity of care. She noted that gaps identified in border preparedness during the H1N1
outbreak included limitations to reaching migrant populations in case of emergency. In response, the CDC
developed flu health communication materials in Spanish, compiled a directory of migrant-serving organizations,
and utilized public media to quickly reach mobile migrant populations.
The DGMQ planned to convene a stakeholder meeting in August 2012.
Dr. Fernandez emphasized the need to creatively identify alternate federal and state funding opportunities to
offset the cessation of EWIDS funding. He noted that federal, state, and local agencies shared the responsibility
for border health and suggested binational partners continue to collaborate, effectively leverage resources, and
build on existing initiatives, including the U.S.-México Agreement on Emergency Management Cooperation,
NAPAPI, IHR, and the BHC.
In addition, Dr. Fernandez reported the launch of the HHS National Health Security Strategy in December 2009
clearly indicated cross-border and global partnerships were integral to U.S. national security. He affirmed the U.S.
federal government participated in multilateral initiatives, including the GHSI, a ministerial-level initiative
intended to strengthen public health preparedness and response to biological, chemical, radio-nuclear threats and
pandemic influenza; and the IHR, the WHO-supported global health security framework that identified core
capacities for surveillance and response. The IHR established a rapid, 24-hour global communication network of
National Focal Points. He explained that when ASPR notified the international community of any event of
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interest, the community would automatically notify Canada and México. Canada, México, and the United States
established simultaneous notification agreement.
On a regional level, Dr. Fernandez contended HHS supported NAPAPI and EWIDS, noting the EWIDS-U.S.
project provided over $41.6 million in funding over nine years to enhance cross-border epidemiological
surveillance as well as laboratory and health alert notification abilities. EWIDs-México invested $5.6 million over
five years to enhance capabilities in northern border states and the México Ministry of Health.
Questions and Answers
In response to Dr. Dutton’s question regarding the availability of the Guidelines in English and Spanish, Dr.
Waterman reported CDC posted the Guidelines to the CDC website as of May 22, 2012.
Dr. Waterman asked Dr. Cortés Alcalá to further explain México’s Epidemiologic Intelligence Network (in
development).
Dr. Cortés Alcalá explained that the provisionally named Epidemiologic Intelligence Network was an information
system that allowed state and local epidemiologists to emit notifications as well as record and access information
online in real time. It facilitated México’s information exchange with Canada and the United States and
maintained an obligatory variable to identify binational cases. He noted the forthcoming integration of
laboratories into the network and affirmed the system was operational for specific diseases, such as dengue,
juvenile and adult cancers, and HIV.
Dr. Cortés Alcalá reported that although the system required some improvements, the pilot was successful overall.
It was introduced at the National Epidemiologic System’s Center-South Regional Meeting in addition to the
Regional Meeting in Querétaro, México. The DGE Director also expressed an interest in launching it nationally.
Epidemiology
Dr. Francisco Javier Navarro Gálvez, General Director, Community Health Services, Sonora Secretariat of
Public Health
David Selvage, M.H.S., PA-C, Epidemiologist, Infectious Disease Epidemiology Bureau, NM DOH
Dr. Navarro explained SINAVE was a national system that received input from the Epidemiological Surveillance
Committees; the National Laboratory and the National Network of Public Health Laboratories; epidemiology
personnel/staff; and Epidemiological Surveillance Units. The surveillance system tracked morbidity, mortality,
special concerns, health emergencies, and international health. Threats to public health included bioterrorism,
emerging and re-emerging diseases, and pandemics.
Dr. Navarro also reported on Sonora’s advancements, including the development of the Master Plan for Health
Infrastructure, the state UIEES, and the expansion of their automotive fleet for health services. He affirmed
México maintained a network of interconnected UIEES with videoconferencing capabilities, including border
situated units, although he noted communication and response times required improvement, as Units experienced
delays in receiving validation and information needed for decision-making.
Dr. Navarro discussed possible recommendations, including the need for public health workers to secure
permission from U.S. Homeland Security to binationally collaborate on cases of public health interest; the
Mexican consulate in Yuma, Arizona, to assent to temporary patient internment and medical personnel; and
advanced certificate training and graduate programs, to include epidemiology scholarships.
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D. Selvage reviewed health services programs, border surveillance, and epidemiology activities. He highlighted
the following U.S. border state accomplishments:
•
Arizona established a binational agreement with Sonora to facilitate information flow and exchange by
sharing their secured Health Services Portal; enhanced communication and binational reporting in
MEDSIS and trained Sonora Secretariat of Health members on its use; participated in the U.S.-México
Binational Communication Pathways Pilot Study (OBH); and planned enhanced arbovirus surveillance,
particularly in relation to dengue.
•
California’s 2011 One Border One Health Symposium launched an initiative to build more resilient and
healthy border communities through a binational and multidisciplinary network that included over 20
institutional partners in Baja California and over 30 in California. The network would identify, respond
to, and develop sustainable solutions to address health risks at the human-animal-environmental interface.
In addition, the California EWIDS Program aimed to enhance binational ILI surveillance, established a
surveillance network in the California/Baja California region, and facilitated bioterrorism preparedness
and response training for regional public health professionals.
•
The NM DOH OBH launched a coccidioidomycosis education/awareness campaign; participated in the
Four Corners initiative; formed a binational work group composed of federal and state agencies; and
participated in a project to increase the number and quality of submissions sent to the state laboratory for
testing. Future efforts included continuing to train health care providers and build laboratory capacity
with the Four Corners project; establishing binational case reporting procedures and protocols with the
NM DOH; and collaborating with the CDC and other U.S. and Mexican border states to develop a
borderwide influenza surveillance report.
•
The Texas DSHS OBH maintained regular two-way communication with Tamaulipas and Chihuahua,
which included participation in the binational case notification pilot program. The Texas and Coahuila
state health departments signed the joint statement of cooperation in TB. In addition, Texas and México
implemented tighter control measures following a case investigation associated with imported, mercurytainted beauty cream. Texas also planned to continue with binational case and outbreak notifications as
incidents occurred and to routinely exchange epidemiological information to the extent possible in a
reduced funding environment.
Epidemiology
Dr. José Luis Aranda Lozano, Epidemiologist, Institute of Public Health Services for Baja California-Health
Jurisdiction II, Tijuana
Belinda Medrano, M.P.H., Epidemiologist, HCHD
Dr. Aranda reported the five million inhabitants residing in the California/Baja California border region, which
included Tijuana, Rosarito, Tecate, and San Diego, hindered surveillance efforts due to high levels of migration
and internal movement, including continuous travel between Sinaloa and Tijuana. He noted substantial
immigration recorded from all Mexican states also presented a surveillance challenge, resulting in the introduction
of tropical illnesses, among other effects. Moreover, it was difficult to locate cases, as many Tijuana residents
worked and/or shopped in the United States.
With respect to Tijuana, Dr. Aranda affirmed diabetes and heart disease were the principal causes of mortality,
and respiratory infectious diseases were primary causes of illness. He also stated the Tijuana Office of
Epidemiological Surveillance increased its personnel and established an epidemiological surveillance committee.
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Dr. Lopez explained Yuma’s population influx, which doubled from 200,000 to 400,000 inhabitants during the
winter, related to situations similar to those caused by the H1N1 pandemic. He noted the Yuma County Public
Health Services District (Health District) acted quickly to provide permanent residents with influenza vaccines to
guard against transmission by visitors traveling from other states.
Dr. Lopez affirmed barriers to binational communication included the infrequent use of established pathways as
well as differences in laboratory testing methods and languages. Regional violence impeded cross-border
collaboration, and funding cuts threatened program continuity.
To address these barriers, the Health District worked closely with Sonora and Baja California to develop
binational communication protocols and procedures for timely information sharing, including the utilization of
formal communication pathways and participation in quarterly binational consultation meetings. Sonora also
provided Arizona with weekly morbidity reports.
Dr. Lopez suggested partners utilize existing infrastructure to improve communication and collaboration; exercise
real-time communication and networking to improve information sharing; and participate in practice exercises to
address non-emergency situations.
B. Medrano discussed surveillance in the Hidalgo-Tamaulipas border region. She affirmed the HCHD
maintained weekly communication with Mexican counterparts through the EWIDS program and planned to
implement syndromic surveillance, wherein hospitals would participate in an early warning surveillance system.
Moreover, B. Medrano indicated increased legal and illegal migration generated Hidalgo public health challenges.
She noted as many as 100 people were recently discovered inside “stash houses,” some of whom were illegal
immigrants with signs of chicken pox. The HCHD was working closely with first responders and hospitals to
coordinate responses to similar situations.
Unregulated products posed additional health concerns in Hidalgo. Food-borne illnesses transmitted through
illegally imported, unpasteurized cheese resulted in recent deaths. Others issues related to mercury-contaminated
beauty creams sold by private vendors, in which case the HCHD developed a poster campaign to raise awareness.
Mauricio Leiva, Chief, CDPH COBBH, inquired whether an awareness campaign was directed toward
unpasteurized cheese producers.
Dr. Aranda confirmed a campaign was developed. However, difficulties in reaching small, home-based Mexican
producers included their lack of regulation. As such, it was difficult to locate problems due to their mobility.
Armando Carvajal, Sonora State Laboratory of Public Heath, requested clarification with respect to mortality and
whether the epidemiology differentiated diabetes from cardiac diseases or AIDS as cause of death when these
diseases were present simultaneously.
Dr. Aranda stated they attempted to identify the basic cause of death and the period during which events occurred;
however, he indicated it was possible these diseases were co-morbidities. He noted properly completing the death
certificate was also important.
Dr. Dutton agreed reporting on death certificates was important. He noted some studies indicated the rise of
diabetes as the first cause of mortality in México, whereas diabetes held sixth place as the recorded cause of death
in Texas. He affirmed age-adjusted data was also important.
Maria Fierro, Imperial County Public Health Department, inquired whether cirrhosis as the cause of death was
related to alcoholism or hepatitis C.
Dr. Aranda stated he was unable to answer the question, as the death certificate would not indicate this. A review
of the clinical report would determine these linkages. He also suggested that rectifying the cause of death held
some importance, noting they frequently received reports erroneously indicating TB as cause of death. Dying
from TB was not the same as dying with TB.
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Dr. Aguilar stated that in México, doctors often received trainings on death certificate completion, as many were
unaware how to properly complete certificates.
Elizabeth Hunsperger, Chief, Serology Diagnostics and Research Laboratory, CDC–San Juan, Puerto Rico, asked
B. Medrano whether Hidalgo established policies for first responders and vaccination requirements based on
encounters with unvaccinated immigrants.
B. Medrano reported HCHD followed CDC guidelines. She indicated the U.S. Border Patrol required training on
standard precautions in case of encounters with infectious disease in illegal immigrants, as they were often the
first line and first exposed. She also noted hospitals aimed to enforce recommended vaccinations, including those
that guard against seasonal viruses and pertussis, although no definite policies existed.
Panel–Cross-Border Sharing of Public Health Items
Moderator: Sonia Montiel, BIDS Laboratory Coordinator, DGMQ, CDC
Dr. Elisa Aguilar Jiménez, Coordinator, BHC Chihuahua Regional Office, “Evaluation of Transportation
Procedures for Materials Used in Public Health on the U.S.-México Border”
Trinidad Barreras, Supervisory Consumer Safety Officer, FDA, “Import Operations”
Norman Bebon, Assistant Port Director-El Paso, CBP, “U.S.-México Transport of Public Health Material”
Dr. Miguel Escobedo, Quarantine Medical Officer, DGMQ, CDC, “Evaluation of Pilot Procedures for
Importing Public Health Specimens through Southern Land Border Ports of Entry”
Dr. Aguilar presented an evaluation of transportation procedures regarding border public health materials. To
improve transportation procedures, the BHC Chihuahua Regional Office developed a survey, in collaboration
with San Diego County and the DGMQ, to compile information on utilized practices that could be used to
formulate recommendations. They emailed the 70-question survey to 21 border, state, and federal health workers,
including epidemiologists and chemists, and received a 90 percent response rate. Of these, 65 percent had
participated in activities related to the exportation of biological samples and/or importation of reagents for rapid
testing, hospital equipment, anti-toxins, medical devices, etc.
Dr. Aguilar explained the documentation process involved when acquiring a permit to import public healthrelated material into México. Documentation was sent to COFEPRIS, which maintained a response time of at
least two weeks. Once a permit was obtained, the laboratory was required to send the tracking number in advance
of the package to enable the InDRE legal department and the customs agent to follow through appropriately. Dr.
Aguilar noted a similar process to export public health materials from México to the United States.
Although 78 percent of those surveyed indicated that U.S.-México coordination existed, over 40 percent indicated
there was room for improvement. The survey identified several barriers to compliance with import/export
regulations, including the following:
•
Lack of communication with the customs agent.
•
Lack of communication with COFEPRIS.
•
Difficulties in complying with each agency’s norms.
•
Limited budgets for covering each agency’s costs.
•
Prolonged permit procedures.
•
Inconsistent treatment of permits/documentation.
•
Lack of training in procedures.
•
Time limitations.
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Cost was the most frequently indicated barrier, particularly concerning customs/broker fees and the required
additional personnel time.
Dr. Aguilar reported one recommendation included developing a uniform import/export process, possibly using
an electronic portal to connect health services, COFEPRIS, and customs. This would allow for more efficient,
real-time procedures; reduce administrative steps; and minimize time and human error.
In addition, Dr. Aguilar affirmed other improvements included new binational agreements for scientific support to
permit the exchange of public health materials; flexibility in the use or designation of transportation lines
exclusively for importation to México; the provision of a single permit for the import/export of specific goods;
and the designation of a single federal agency to oversee import/export of public health materials.
Dr. Aguilar affirmed these improvements would have an enormous impact on the process required for
epidemiological surveillance as well as the control and prevention of diseases.
T. Barreras provided a general overview of FDA import operations on the Texas-México border. The FDA
worked in collaboration with U.S. Homeland Security, the CDC, and the Texas Office of Policy and
Governmental Affairs to ensure that imported products for human and animal use were safe and effective.
Referenced documents included the Federal Food, Drug, and Cosmetic (FD&C) Act, the Bioterrorism Act of
2002, and the Public Health Service Act.
T. Barreras reported the El Paso FDA field office was abile to perform product entry reviews and investigations,
including sample collections and analysis; compliance activities, such as detentions and hearings; post-refusal
activities, including export verification; and entry filer activities, such as filer evaluations and training.
T. Barreras noted an importer or designated representative was required to file an entry and bond with customs
pending a decision to admit goods into the United States in addition to filing a notice with the FDA. Investigators
evaluated the admissibility of a product electronically and entry reviewers evaluated whether to release the
product, request an examination, request additional information, or recommend detention of the product.
An import alert system prevented products in violation from distribution in the United States. Approximately 271
import alerts were active at the time, many of which concerned medicated and non-medicated animal feed.
T. Barreras reported importers were responsible for ensuring imported products were in compliance with U.S.
laws and regulations. They could be placed on the “detention without examination” list if they had a history of
violations, but could petition for removal if they provided evidence of non-violative shipments and assurance the
cause of violation was corrected.
Controls were maintained in an effort to protect the nation’s food supply against terrorism and other food-related
emergencies.
N. Bebon discussed CBP duties and activities and stated they defended the border from terrorists and smugglers
and enforced the laws of over forty different agencies.
In 2008, the U.S. and Mexican Secretaries of Health met to discuss difficulties in the cross-border transport of
medicines, biological specimens, materials, and equipment for public health. A pilot project was proposed to
identify barriers and to revise binational operating procedures in favor of a more consistent flow of public health
samples and medications. The CBP Office of Field Operations and the CBP Office of Trade met with HHS to
develop the pilot’s standard process.
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N. Bebon reported the Border Health Pilot Project for Cross-Border Transport of Public Health Material ran
from September 30, 2009, to January 1, 2010. It focused on biological specimen exchange to diagnose diseases of
public health interest and on pharmaceuticals to treat MDR TB.
Operating under this pilot, the “Juntos” Project, in collaboration with the Ciudad Juárez and El Paso health
departments, promoted TB control activities in both cities. Specimen transport from the Chihuahua Secretariat of
Health to the Texas DSHS was essential to improve cross-border transport.
As a condition of the pilot, items arriving by land entered as commercial shipments and were documented in the
Automated Commercial Environment (ACE) e-Manifest. All shipments were required to be clearly marked with
the appropriate placard, per International Air Transport Association Guidelines for the Safe Transport of
Infectious Substances and Diagnostic Specimens, and accompanied by a CDC permit. U.S. Customs brokers were
not required for informal entries, as CBP Agricultural Specialists or Hazmat-trained CBP officers sufficed to clear
shipments. Shipments were no longer referred to the FDA.
The Border Health Pilot Program was extended beyond January 2010. In February 2012, the CBP El Paso Field
Office and the El Paso CDC Quarantine Station agreed to jointly develop a local emergency protocol for rapid
importation of biological specimens from México during public health emergencies.
Dr. Escobedo reported on a survey developed by the San Diego County Office of Public Health, in collaboration
with the CDC, that evaluated pilot procedures for importing public health specimens through southern land border
ports of entry. The survey’s goal was to formulate recommendations for improving importation procedures.
Survey participants included stakeholders from the four U.S. border states. Of the 33 respondents, 58 percent
indicated awareness of the pilot project, and 15 percent reported their invitation to provide pilot design input. As a
result of the pilot project, one Texas and three San Diego public health workers were trained to use the CBP ACE
e-manifest.
Biological shipments reported by Laredo, Texas, doubled from 10 in the three-month period prior to the pilot to
20 during the pilot’s three-month period. Brownsville, Texas, reported an increase from 30 to 40 biological
shipments over the same duration.
However, respondents also reported problems during the pilot, such as an inability to pay customs broker fees or
lack of access to commercial trucking lanes. The costs per public health shipment more than doubled for San
Diego-based respondents, primarily due to customs brokers. El Paso TB programs lacked funding to pay broker
fees and imported no specimens during the pilot.
Thirty-seven percent of respondents did not recommend continuing the project, while 18 percent of those who did
recommend the pilot’s continuation were from San Diego. The rest were undecided.
Dr. Escobedo noted the pilot appeared to have insufficient input from public health stakeholders and training,
notification, and application was inconsistent at all Points of Entry. The pilot remained in operation in 2010,
although it was unable to facilitate the movement of biologic specimens for public health purposes.
Panel Moderator S. Montiel acknowledged various procedures existed for the transport of public health materials
and noted that local, state, and federal level efforts were made in response to these problems. In local sites,
regulations were not applied consistently. She affirmed the need for regulatory procedures, including
implementation of exceptions for health-related materials required to control and detect health emergencies that
threaten regional and global health.
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Dr. Reyes, National Polytechnic Institute–Reynosa, Tamaulipas, referenced their research center and explained
U.S.-based providers declined to accept Mexican credit cards, forcing them to purchase identical equipment from
Mexican distributors at three times the cost. The product was then delayed at Customs, resulting in the lab’s
inability to perform its analysis.
In response to Dr. Reyes, I. Hernández Monroy stated COFEPRIS and CBP affirmed they would expedite the
permit process for diagnostic use, not commercial, when notified in emergency cases. She indicated the
possibility for InDRE to provide a one-time exception letter declaring a reactive was required for a specific
purpose, but emphasized the importer would thereafter be required to undergo the regular process.
S. Montiel inquired whether a person could purchase and item in the United States and import it as a donation.
I. Hernández Monroy responded that the problem was not the purchase, but the permit to import the item.
Dr. Aguilar’s questioned why certain U.S. distributors declined to accept Mexican credit cards.
A participant responded that U.S. and México distributors are licensed to sell products in their respective
countries. A U.S. distributor will decline to sell a product when there are licensed dealers in México.
Dr. Cortés Alcalá noted that items purchased in the United States were subject to import fees and would
ultimately cost the same or more. Anyone living in the border region is subject to the same laws. It is likely that
U.S. providers would be required to purchase a distributor’s license to sell products in México and assume the
expenses of bringing products into the country. Mexican providers’ products are more expensive because they are
subject to customs fees.
Dr. Dutton affirmed solutions are required to address the concerns of public health and not commercial interests.
At a 2005 BHC conference, the U.S. and México Secretaries of Health expressed their willingness to assist;
however, he was unaware of any progress.
S. Montiel agreed specific recommendations are required, as is an agenda to resolve the problems.
Dr. Cortés Alcalá suggested they petition COFEPRIS and CBP by letter to perform a study that assessed the
number of public health material import-exports that encountered problems. With this specific data, they can
confirm a problem exists and demand change. He proposed convening a small work group to draft a letter.
Dr. Aguilar noted each country’s diverse import-export requirements and suggested decreasing the required
process time. The kinds of operations might be a question of education or to save time.
A participant from El Paso stated his agency adapted to the pilot project and was able to reach a solution. He
indicated a problem crossing medicines and affirmed a resolution was unattainable if COFEPRIS does not agree
to discuss the issue. El Paso public health workers go through the import process properly, but COFEPRIS has not
responded to their concerns.
Another participant indicated different activities take place along the border, and while problems may exist in El
Paso, the pilot was excellent in San Diego.
Dr. Cortés Alcalá affirmed importation involved federal laws and noted federal and state allowances existed in the
cases of a real emergency.
One public health worker agreed resolutions were needed. He reported on the Texas DSHS regional border offices
and their experience crossing medications into México. They attempted to follow time-consuming procedures
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regarding 45-50 MDR TB cases, and received a written response denying their efforts after approximately a year
and a half. They continued to treat patients, although not altogether legally, and worked with local agencies to
treat patients and cross medicines. Mexican customs oftentimes confiscated medicine. In addition, the Mexican
side was directed to pay fines and fees, regardless of established local agreements.
Dr. Waterman inquired about the WHO’s role, as this was not strictly a U.S.-México border issue and occurred
between countries on a global scale.
S. Montiel referenced a Chinese model that dealt with significant commerce and movement of people. She noted
China’s electronic platform could be applied on a smaller scale in México and affirmed preliminary steps, such as
transcription of the Articles, were required. Although strong collaboration existed with InDRE, this would be a
long process.
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APPENDIX E: CONCURRENT TRACK SESSION SUMMARIES
Best Practices and Lessons Learned from BIDS and EWIDS Projects
Dr. Martha Alicia Bueno Rosas, Chief, Epidemiology Surveillance, Chihuahua Secretariat of Health,
“Seroprevalence of Coccidioidomycosis in Chihuahua”
Katharine Perez-Lockett, M.P.H., BIDS Officer-Epidemiologist, NM DOH, “Development and Dissemination
of the Borderwide Regional Influenza Surveillance Network Report”
Catherine Golenko, M.P.H., BIDS Epidemiologist, ADHS, “Enhancing Respiratory Infection Surveillance on
the Arizona-Sonora Border–BIDS Program Sentinel Surveillance Data”
“Epidemiologic Surveillance of Influenza in México, its Impact on the Northern Border, and the HHSGeneral Directorate of Epidemiology Cooperative Agreement”
Dr. Steve Waterman, Team Lead, U.S.-México Unit, DGMQ, CDC, “U.S. Perspective on BIDS Best Practices
and Lessons Learned”
Raul Sotomayor, M.P.H., M.S.A., International Health Analyst, ASPR, HHS, “EWIDS Best practices and
Lessons Learned”
Dr. Bueno discussed the seroprevalance of coccidioidomycosis in Chihuahua, a member state in the Four
Corners project. She noted they confirmed 24 coccidioidomycosis cases during the pilot and compiled weekly
reports of aggregate syndromic and virologic data for distribution to binational partners.
Next steps included using data to establish a border region baseline and potentially establishing data sharing
agreements to formalize data collection and reporting. Four Corners was the result of established regional
relationships and a best practice model.
C. Golenko explained the ADHS OBH BIDS program aimed to enhance respiratory infection surveillance on the
Arizona-Sonora border by monitoring (1) infectious respiratory pathogens among hospitalized patients with
Severe Acute Respiratory Infection (SARI) during the 2010-2011 flu season; and (2) BIDS sentinel hospital site
patients with viral respiratory conditions in Pima County, Arizona. She affirmed the exercise benefitted public
health concerning outbreak detection and/or epidemics and concluded a better understanding of the limitations of
rapid flu diagnostics was needed. They were currently pursuing more effective cross-border collaboration for
SARI surveillance.
Dr. Cortés Alcalá presented the Mexican experience regarding influenza surveillance by reviewing 2012 data
taken from México’s northern border, noting the General Directorate of Health Services was responsible for
border health. To strengthen surveillance, the DGE planned to build capacity with border laboratories and to
acquire additional laboratory equipment for InDRE. He affirmed influenza surveillance required highly sensitive
diagnostics, real-time reporting and notifications, standardized procedures, and sustainability.
Dr. Waterman stated the project aimed to establish an enhanced binational surveillance system and network for
infectious diseases by promoting binational data exchange, enabling the development of binational prevention and
control strategies, and enhancing regional public health infrastructure. To this end, programs built capacity in
epidemiology, surveillance, and laboratory diagnostics.
Dr. Waterman reported at least one BIDS meeting took place each year since 1998, and from 2006-2010, eight
training sessions were convened in México and the United States. He noted BIDS produced several publications
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on U.S-México border infectious disease surveillance and was present in five sister city regions and
approximately 20 hospitals and clinics.
With respect to best practices, Dr. Waterman reported the project developed borderwide surveillance reports,
implemented harmonized case definitions and laboratory testing algorithms, established a network of
epidemiologists and laboratories, and performed trainings. Partnerships between CDC quarantine stations and
local/state health departments were also effective.
In addition, the CDC maintained a longstanding collaboration with the DGE that included the launch of the first
binational web-based surveillance information system in May 2012. The system permitted binational messaging
and data sharing. It represented a possible platform for expanding data sharing beyond the limited number of
diseases and syndromes that BIDS surveys.
R. Sotomayor discussed lessons learned from EWIDS projects and affirmed EWIDS supported several U.S.México border initiatives, including enhanced ILI surveillance, laboratory capacity building, binational outbreak
investigation and response, and secure electronic data exchange. All four U.S. border states participated in
EWIDS projects.
To advance borderwide and binational integration of preparedness and response activities, R. Sotomayor indicated
the need to identify and develop policy tools that could overcome barriers to surveillance data sharing and
communicating health alerts during a major public health event. The interoperability of emergency preparedness
and response systems also required improvement. He affirmed sharing lessons learned and best practices with
binational partners would help resolve policy and operational issues.
In response to Dr. Cortés Alcalá’s question concerning rapid testing for influenza and the accuracy of results, Dr.
Waterman affirmed it was well-recognized that the rapid test for influenza had low sensitivity. It was incorporated
in the United States because it engaged doctors in the surveillance process and doctors liked to use them.
Dr. Waterman also explained several BIDS sentinel sites fed into ILI-net, noting the recommendation was to
increase the number of border sites. México built a valuable data surveillance system in SINAVE, and although
the U.S system was different, he acknowledged they were able to develop a good impression of the data when
observing the Mexican system.
HPV, Cervical Cancer, and HIV: Epidemiology and Control Measures
Moderator: Dr. Allison Banicki
Dr. Mona Saraiya, Medical Officer, Epidemiology and Applied Research Branch, Division of Cancer Prevention
and Control, CDC, “Cervical Cancer Prevention”
Dr. Allison Banicki, Epidemiologist, Texas DSHS OBH, “HPV Vaccination in Texas, 2010”
Dr. Gudelia Rangel, Coordinator, Comprehensive Strategy for Migrant Health, México Ministry of Health; BHC
Delegate to Salomón Chertorivski Woldenberg, México Secretary of Health, “Current Overview of HIV on the
Northern Border of México” “Current Overview of HIV on the Northern Border of México”
Emilio J. German, M.S.H.S.A., Public Health Analyst-Coordinator for Hispanic or Latino Health Equity
Activities, CDC, “HIV and Health Equity among Hispanics/Latinos”
Dr. María Luisa Zúñiga, Associate Professor and Behavioral Epidemiologist, Division of Global Public Health,
UCSD “Gender Inequality and HIV Care Behavior among HIV-positive Latinos in the U.S.-México Border
Region”
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Dr. Saraiya provided an update on cervical cancer screening and HPV vaccination. From 2004-2008, the annual
average instances of HPV-associated cancer exceeded 21,000 cases in women and 12,000 in men. She noted new
U.S. guidelines advised cervical cancer screenings beginning at age 21. México established a cervical cancer
prevention and control policy in 2008, and since then, two million HPV vaccine doses were administered to girls
ages 9-16 and over six million HPV cytology tests were performed. As of January 1, 2012, the Mexican
government announced universal HPV vaccine coverage for girls between the ages of 9 and 10.
Dr. Saraiya reported HPV testing and vaccination was often ignored along the border. She affirmed a transient
population made surveillance and follow-up difficult. However, she indicated the United States possessed
considerable resources and México maintained considerable experience with the HPV vaccine and testing.
Dr. Banicki discussed HPV vaccination rates along the Texas border. She noted certain HPV types were known
causes of cervical cancer, and Texas sustained some of the highest cervical cancer incidence and mortality rates in
the United States.
Analysis of the Texas 2010 Behavior Risk Factor Surveillance System indicated a higher prevalence of HPV
vaccine series completion among 15-17-year-old girls and among those whose parents had some college
education. It was concluded that HPV immunization rates along the Texas border tended to be slightly higher than
elsewhere in Texas. The HPV series rate of completion remained low, less than 20 percent among girls ages 9-17.
Dr. Rangel provided an overview of HIV/AIDS in México’s northern border region. México reported nearly
150,000 AIDS cases nationally. AIDS-related death rates in border states were much higher than the national rate
of 4.8. Baja California’s rate was the highest at 8.7, followed by Tamaulipas at 5.9, Sonora at 5.1, Nuevo León at
4.3, and Coahuila at 3.1.
Dr. Rangel affirmed recent health services and education programs targeted migrants and mobile populations.
Several border region HIV research projects were in progress or completed, and priorities were to increase the
communication between HIV researchers and decision makers, thereby increasing research influence on public
policy as well as new research funding opportunities.
E. German addressed HIV and health equity among Latinos in the United States. He reported an estimated 1.2
million people were living with HIV in the United States, and approximately 20 percent were unaware of the
infection. Hispanics represented 22 percent of diagnosed U.S. HIV infections in 2010.
Also in 2010, the United States released the National HIV/AIDS Strategy (NHAS), a comprehensive plan for
prevention, care, and HIV research aimed at reducing HIV incidence and HIV-related disparities as well as
increasing access to care.
E. German concluded Latinos were disproportionately affected by HIV and affirmed the NHAS would succeed
by targeting resources to maximize impact on incidence and health equity, recognizing the importance of
prevention, developing supportive policies, and garnering collective commitment.
Dr. Zúñiga spoke on gender inequality and HIV among Latinas in the U.S.-México border region. She reported
Latinos in San Diego’s southern region accounted for 59 percent of HIV cases; women comprised 25 percent of
new HIV diagnoses; and women along México’s northern border were at increased risk for HIV. Dr. Zúñiga and
her colleagues conducted a binational study that revealed HIV-positive Latino women were significantly more
likely to make unsupervised changes to their Antiretroviral Therapy (ART) than were HIV-positive Latino men.
From the research, Dr. Zúñiga concluded female Latino study participants were more likely to report HIV-related
social isolation and maintained poorer ART adherence than did men. The profile suggested women might be more
vulnerable to poor health outcomes. She noted the border region required longitudinal studies of HIV-positive
women and barriers to health care.
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A. Carvajal inquired about HPV transmission and the types associated with cervical cancer.
Dr. Saraiya responded that U.S. studies indicated increased HPV in young white women, and HPV 18 was the
most common genotype associated with adenocarcinoma. She did not have data on México.
Dr. Banicki asked Dr. Rangel to explain the increase in Sonora AIDS rates and the relatively low numbers of
people receiving ART.
Dr. Rangel cited a lack of information on death records as a possible explanation for the difference in Sonora’s
AIDS rates compared to other states. Sonora, Tamaulipas, and Coahuila did not indicate decreases in AIDS
deaths, although this could be attributed to reporting. She noted the investment in universal treatment for people
with AIDS was producing results in México.
In Baja California, 1,350 patients were in treatment, which was less than the number of cases reported. This was
possibly attributable to follow-up issues, changes in state of residence, or lack of access. In Tijuana, it was
difficult for patients to travel to CAPASITS for treatment. In other cases, patients who began treatment in
advanced stages died soon after, which may explain why they were not yet detecting a reduction in AIDS-related
deaths.
E. German affirmed the CDC’s Office of Health Equity partnered with federal and nonfederal partners focused on
addressing HIV among all populations most disproportionately impacted. He noted the term “social determinants
of health” was absent from conference discussions and reported social determinants driving the HIV epidemic
among Latinos included unemployment, lack of insurance, and homelessness. CDC included social determinant
language in all the Funding Opportunity Announcements.
A participant stated her area was not highly populated and noted difficulties in attracting funding. She inquired
about ways to identify support, as HIV-AIDS funding is generally distributed to larger cities.
E. German responded that the CDC funded all 50 states, six territories, as well as six to eight additional cities with
the highest impact of HIV in January 2012. He recommended she work with her local city and state health
departments to acquire funding. CDC was committed to reducing HIV incidence and inequities.
Juan Ruiz, from Baja California, emphasized the reality of AIDS within border populations, noting the high
percentage of women contracting AIDS from their male partners/spouses and the lack of access. He also affirmed
medicines would become less accessible with reduced budgets, and patients would be placed on waiting lists or be
required to assume part of the cost. In addition, as many people did not test for AIDS, they were unable to
determine an accurate number of those unaware of their HIV status who were infecting others.
E. German replied by restating parts of his earlier discussion. Stigma and discrimination resulted in unwillingness
among married men to admit to same-sex relations. Diminishing the infection in communities required
collaboration at local, state, and federal levels. As funding was problematic, they needed to be creative.
Dr. Rangel noted BBID objectives included identifying areas that lacked development and recommended they
develop proposals to collaborate on specific areas, such as the possible expansion of HIV screening. To illustrate,
she reported a study of migrants crossing the Tijuana-San Diego border detected HIV with a prevalence of 1.23,
much higher than the national HIV incidence in adult men. She emphasized the study reflected only one border
crossing.
Binational Outbreak Investigations
Moderator: Omar Contreras
Maureen Fonseca-Ford, M.P.H., Public Health Prevention Specialist, DGMQ, CDC, “Cluster of GuillanBarré Syndrome due to a Waterborne Outbreak of Campylobacter Jejuni Infection—Sonora, México, and
Arizona, 2011”
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Dr. Max Zarate-Bermudez, CDC Epidemiologist, “Environmental Assessment of the Waterborne Outbreak of
Campylobacter Infection in Sonora, México, and Arizona, United States, 2011”
Dr. Miguel Escobedo, Quarantine Medical Officer, DGMQ, CDC, “Coordinated Response to a Binational
Wound Botulism Outbreak”
Dr. Gerardo H. Flores-Gutiérrez, Professor, Autonomous University of Tamaulipas, “Epidemiologic
Surveillance on the U.S.-México Border from the Veterinary Perspective under the One Health Concept”
Dr. Andres Velasco-Villa, Associate Service Fellow, CDC, “Rabies across Borders: Finding Emerging and
Re-emerging RABV Variants with Public Health Impact”
Dr. Mauricio Gómez-Sierra, InDRE, “Expanded Panel of 20 Anti-nucleocapsid Monoclonal Antibody as a
Tool in the Differentiation of A-typical Antigenic of the Rabies Virus within the Mexican Territory”
M. Fonseca-Ford discussed the 2011 Arizona-Sonora binational investigation of a GBS outbreak due to a
waterborne Campylobacter jejuni. M. Fonseca-Ford reported an initial review of an Arizona GBS patient
determined that a full outbreak investigation required a coordinated response with México. On June 29, federal,
state, and local epidemiologists met in San Luis, Arizona, and agreed to establish the first fully-integrated
binational outbreak response through shared field work, databases, and reports.
M. Fonseca-Ford stated they confirmed an unprecedented GBS cluster with an incidence 26 times the expected
rate. They identified the precipitant as Campylobacter jejuni infection and available evidence suggested a large
bacterial outbreak had occurred.
This investigation represented a landmark in binational collaboration and strengthened ties between local, state,
and federal counterparts. Multiple disciplines, including epidemiology, lab, and environmental health were
essential to the response. Lasting outcomes included the establishment of Campylobacter diagnostics in México.
In addition, the Cajeme Operating Agency for Municipal Water and Wastewater collaborated with Yuma County
water authorities to share information on improved practices for iron and manganese removal and water
disinfection in San Luis.
Dr. Zarate-Bermudez spoke on the environmental assessment of the waterborne outbreak of campylobacter
jejuni. As part of the GBS outbreak investigation, an environmental team assessed the potential sources and
pathways of water contamination.
The team examined the regional drinking and wastewater treatment systems and analyzed samples taken from
selected points. No C. jejuni were isolated in any of the environmental samples. However, Dr. Zarate-Bermudez
explained this was not unusual.
Dr. Zarate-Bermudez recommended environmental scientists enter into investigations earlier. He observed diverse
land uses in the border region with no evaluation of the impact on groundwater. He also noted differences in
drinking water treatment technologies. Integrating groundwater quality with human health could enhance
sustainable management of water resources.
Dr. Escobedo discussed the coordinated response to a binational outbreak of wound botulism. In August 2011,
the El Paso public health authorities were notified of four hospitalized cases of acute descending paralysis. The
response required a coordinated and multi-jurisdictional outbreak investigation. The CDC facilitated binational
coordination among subject matter experts, an epidemiology response team, and a field team. Upon identifying
the disease as botulism, public health workers secured the anti-toxin drug, hospitals and other relevant agencies
and institutions were alerted, and México was officially notified. Subsequently, three confirmed cases of botulism
occurred in El Paso. The CDC and Texas DSHS experts provided valuable consultation expertise and guidance.
Dr. Escobedo affirmed this experience revealed that specific international response protocols were needed to deal
with a DGE request for assistance. Procedures were also required to manage emergency requests for securing,
transporting, and exporting public health materials
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Dr. Flores provided the veterinary perspective on border epidemiologic surveillance. One Health recognized the
link between human, animal, and environmental health and considered human and veterinary medicines to be
similar, as they shared a common knowledge of anatomy, physiology, and pathology. Dr. Flores affirmed
surveillance and control of diseases should take place under one international, interdisciplinary, and multisectorial focus. As examples, he cited transmission of brucellosis and rabies from animals to humans, due perhaps
to a lack of awareness of the disease.
Dr. Velasco discussed border rabies surveillance and the considerable economic impact of rabies prevention and
control efforts on the United States and México. He reported the United States spent $118 million in one year to
provide post-exposure rabies prophylaxis; México spent $2 million.
He concluded by stating a new resolution for the global elimination of rabies associated with dogs was introduced
at the World Health Assembly.
Dr. Gómez-Sierra explained the epidemiology of the rabies virus in México and presented data on the
characteristics of classic and atypical rabies antigens. From 2007 to 2011, 373 rabies cases were reported in
Tamaulipas and 316 cases in San Luis Potosí.
A participant inquired which binational measures could be initiated to control rabies outbreaks. He identified a
Texas aerial program dropped vaccine-laden food into the wild for foxes to consume, although he was unaware of
the program’s effectiveness. He also asked about factors for transmission among species.
Dr. Velasco reported the vaccine was encased in a polymer-coated biscuit, similar to dog food. The Texas
program was active and did eliminate a variant present in foxes and coyotes in 2004. Mexican efforts have not
been comparable.
The virus was detected in dogs in México, and the oral vaccination intervention cost $27 million. A massive
vaccination took place in México, but included only domesticated dogs and not wild animals. The United States
and Canada collaborated with México under a tri-national treaty for rabies control to implement the oral
vaccination in hard-to-reach areas.
Dr. Velasco affirmed the virus had high mutation, and there was potential for the virus to become established.
They detected a mutation in coyotes and were concerned with possible transmission back to dogs. Spikes in rabies
transmission were found in the spring and fall.
In the case of bovines, they found greater rabies prevalence in rainy seasons. As rabies transmission occurred
from animal to human, and not the reverse, it was important to include veterinarians and environmentalists in
surveillance and control efforts.
With respect to the types of botulism treatment available to Mexican residents, Dr. Escobedo replied the antitoxin
to botulism was under experimental protocol release in the United States. Although, it could be acquired
commercially, it would require a special initiative, as it was seldom used. The antitoxin could be available if
Mexican health authorities promoted the acquisition of a drug depot. In the United States, the antitoxin was
available only through the strategic national stockpile and required legal consultation.
Dr. Escobedo indicated the CDC’s willingness to work with private industry to increase the antitoxin’s
availability and noted that establishing access to the drug was important.
Dr. Escobedo was asked to compare the costs associated with lack of access to the antitoxin and those attributed
to establishing a depot. He stated patients invariably experienced extensive stays in the intensive care unit,
followed by months of rehabilitative therapy, all of which would be very expensive. Better results developed from
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early administration of the antitoxin. In terms of costs, establishing depots or a binational accord to share the drug
was sensible. The transportation of the antitoxin also needed to be addressed.
Respiratory Conditions in the Border Region: Tuberculosis and Influenza
Moderator: Dr. Elisa AguilarJiménez
Dr. Miguel Angel Reyes López, Professor/Researcher, Genomics and Biotechnology Center, National
Polytechnic Institute, “Detection of M. Tuberculosis Mutations in Tamaulipas Isolates”
Dr. Alberto Martínez Vázquez, Professor, Autonomous University of Ciudad Juárez, “Tuberculosis Analysis
in Juárez 2011”
Dr. Roberto Alejandro Suárez Pérez, Epidemiologist, Juárez Jurisdictional Office, “Epidemiology of AH1N1 and the Identification of Risk Factors Associated with Confirmed Cases during the 2009 Pandemic in
Ciudad Juárez, Chihuahua, México”
Laura Alvarez, M.P.H., Disease Surveillance Specialist, EWIDS, El Paso DPH, “Integrating Selected El Paso
County School Districts into Public Health Surveillance”
Aldo Carrasco, Disease Surveillance Specialist, Texas DSHS OBH Region 9/10, “Sustaining Syndromic
Surveillance in Underserved Areas along the Border using Independent School Districts as Reporting Sites in
Health Service Region 9/10 with the Texas Department of State Health Services”
Dr. Eduardo Azziz-Baumgartner, EIS Officer, CDC, “Estimating the Disease and Economic Burden of Viral
Respiratory Diseases at Sentinel Sites on the U.S.-México Border during 2010-2012”
Dr. Reyes provided information on the detection of Mycrobacterium Tuberculosis (M. TB) mutations in
Tamaulipas. México’s Northern border region accounted for more than 33 percent of the 15,384 national TB
cases. Tamaulipas alone accounted for 6.9 percent.
TB was resistant to antibiotics due to its lipid structure in the cellular wall. The general objective of Dr. Reyes’
research was to molecularly analyze the mycobacteria isolates of potential TB patients. He mapped the
relationship between the bacterium under study and the Tamaulipas health districts from which they originated.
He also identified drug resistance in the bacterium.
Dr. Martínez Vázquez discussed clinical disorders and risk factors for the development of Acute Respiratory
Distress Syndrome in the Intensive Care Unit of Ciudad Juárez hospitals. The main objective was to characterize
intensive care unit cases to show which clinical disorders were prevalent. The results showed the prevalence of
non-specific pneumonia, non-specific sepsis, females, 44 years of age, and degenerative chronic diseases.
Dr. Suárez discussed the epidemiology and risk factors for A-H1N1 influenza associated with the 2009 Ciudad
Juárez pandemic, identifying obesity and diabetes as relevant risk factors. Surveillance of H1N1 continued after
the outbreak. The presence of co-morbidities resulted in a poorer prognosis.
L. Alvarez spoke on integrating El Paso County school districts into public health surveillance. The El Paso
DPH, in collaboration with the Texas Association of Local Health Officials, implemented an electronic system in
county school districts to capture information related to absenteeism and symptoms associated to influenza. The
system could be used in the future to detect enteric diseases and vaccine preventable conditions.
The project’s main objective and expected outcome was to obtain timely and accurate school health indicators for
use in emergency preparedness activities. They expected that system automation would reduce the labor required
for data collection. They planned to expand the project to sites in Southwestern New Mexico school districts.
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A. Carrasco presented on maintaining syndromic surveillance in underserved border areas by using independent
school districts as reporting sites. This project launched in 2007 in Health Service Region 9/10, an underserved
border area. In the 2010-2011 school year, eight schools participated with a combined population of 2,812
students. The school ILI and Gastrointestinal-like Illness surveillance project was an extension of a pilot project
headed by the DSHS Preparedness Program.
A. Carrasco concluded that schools were an excellent venue for syndromic surveillance activities, particularly
when located in an area of limited health infrastructure. The data collected allowed DSHS Health Services Region
9/10 to monitor disease activity and alert epidemiologists in advance to initiate a public response if needed.
Dr. Azziz-Baumgartner demonstrated how to leverage influenza surveillance to estimate disease and economic
burden in Imperial County, California. Although a preventable infection, influenza was tied to approximately
100,000 deaths per year in the Americas. Two sentinel hospitals in Imperial County with PAHO/CDC
surveillance provided data used to estimate the incidence of influenza-associated hospitalizations.
Data collected for analysis included patient demographics, SARI case-status/survival, viral data by epidemiology,
etc. Preliminary findings indicated that Imperial County sustained a substantial rate of influenza-associated
hospitalizations, potentially higher than the national incidence rate. They hoped to replicate this analysis in
Arizona, New Mexico, and Texas and also wanted to add migrant case status to the recorded information.
In reference to Dr. Reyes’ earlier disclosure that he was not in possession of border specimens, an epidemiologist
participating in the Reynosa-Matamoros binational project reported she studied TB DNA genotyping and
submitted the results to the Mexican side. She inquired why he had not received the report and whether she could
assist him to obtain the results.
Dr. Reyes stated they did not have the samples because patients were sent to the United States where they
collected samples and kept the DNA.
Dr. Restrepo had more than 14,000 samples.
Dr. Reyes affirmed he was not acquainted with the full scope for the distribution of his work and required the
samples to understand how many strains existed statewide. With that information, he would be able to collaborate
with the United States to determine whether people on both sides of the border were sharing TB strains. He also
wanted to understand the origin of MDR strains. He hypothesized that a number of those taking antibiotics were
spreading the strain throughout his state. He noted that as México did not have those antibiotics, they were unable
to understand how the drug resistant mutations were circulating.
A state laboratory employee representative informed Dr. Reyes those samples were sent to Dr. Restrepo;
however, she is no longer working with TB diagnosis.
Dr. Aguilar inquired whether Dr. Reyes had trouble importing the TB samples and whether the National
Polytechnic Institute had the resources to do so. She suggested Dr. Reyes speak with the U.S. side to obtain half
the samples and perform the research collaboratively.
Dr. Aguilar observed that two presentations concerned the incorporation of public school systems into the
surveillance process. She inquired whether they used this information to develop heath education for the
community.
The panelists replied interventions were related to handwashing and influenza prevention activities.
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International Health Regulations and Their Impact on U.S.-México Bilateral Relations
Dr. Katrin Kohl, Ph.D., M.P.H., Deputy Director, DGMQ, CDC, “Practical Aspects of the Binational
Implementation of the International Health Regulations”
“International Health Regulations and Their Impact on Binational and Border Relationships between México
and the United States”
Alicia Harvey Vera, M.P.H., Project Manager, Division of Global Public Health, Department of Medicine,
UCSD, “Biological Sample Transport across the U.S.-México Border: It Takes Two Villages”
Dr. Roberta Andraghetti, Adviser, International Health Regulations, PAHO/WHO, “Maximizing the Benefits
of the International Health Regulations: The Example of México and the United States”
Dr. Kohl discussed practical aspects of binational IHR implementation and noted several articles within the IHR
support binational collaboration. In addition, she stated the United States would not require an extension for the
implementation of IHR capacities. The Guidelines were broader in scope but complementary and consistent with
the IHR. She affirmed public health workers’ efforts in border health fit into a larger international agreement and
praised them representing a model of collaboration for other countries.
ASPR managed the National IHR Focal Point (NFP) and coordination among agencies. ASPR served as the
authorizing official and retained the ultimate authority to authorize any notification of potential public health
emergency of international concern to WHO. A by-product of the IHR infrastructure and process, countries used
NFPs to rapidly exchange information on a variety of public health events in a trusted environment.
Dr. Kohl reported the CDC had a very low threshold for notification, noting the CDC would report the event to
WHO if two of the four notification criteria were met. One reported event was a GBS cluster in neighboring
counties of the United States and México.
In the spirit of the IHR, U.S. and México have collaborated to build laboratory and epidemiologic capacity,
facilitate the import-export of public health materials, and cooperate on the binational treatment of cases. The
United States and México met the IHR recommendations for binational collaboration and could do much more.
Dr. Cortés Alcalá presented on the IHR’s impact on binational and border relationships between México and the
United States. He agreed they are a useful tool. With respect to the WHO’s provision of five years to implement
the basic IHR capacities, Dr. Cortés Alcalá clarified this was the time limit the member states had outlined for
themselves. He affirmed México would request an extension on IHR basic capacities and developed a 2012 plan
for their implementation. InDRE already surpassed the requirements for surveillance capacity. What remained
was to fulfill the basic capacities for intersectoral coordination. The Regulations marked an important change in
the paradigm for analysis of infectious disease as well as environmental and radio-nuclear risks.
Dr. Vera described the methods developed and implemented to transport biological samples across the U.S.México border. This exercise involved the UCSD Division of Global Public Health, the San Diego Public Health
Lab, the CDC Quarantine Station, CBP, México’s Customs, Baja California Secretary of Health, and municipal
health authorities. The process accounted for field team training, driver and vehicle, appropriate times of day, etc.,
and reduced the cost per sample transport from $500 to $270. The model represented the most cost-effective and
efficient means to date for public health studies.
Dr. Andraghetti reported México and the United States were among WHO member states recognizing the need
to collectively respond to public health emergencies of international concern. The current IHR entered into force
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in June 2007 and was a legal tool describing procedures, rights, and legal obligations for State Parties and the
WHO.
Article 2 of the IHR stated that “the purpose and scope of these Regulations are to prevent, protect against,
control, and provide a public health response to the international spread of disease in ways that are commensurate
with and restricted to public health risks, and which avoid unnecessary interference with international traffic and
trade.”
Dr. Andraghetti reported WHO and its member states were learning how to implement the IHR, and certain
countries were not using them to support public health preparedness. She noted the regulations were not new, but
guidance member countries decided to offer themselves to support public health. There was a need for continuity
on the local, national, and international levels.
IHRs introduced NFPs as a new function. NFPs gathered relevant information from across sectors within their
government, have communication visibility with the WHO, and were overseen by HHS and DGE.
Dr. Andraghetti affirmed the IHR allowed them to be better prepared to cope with public health emergencies, but
the core capacities for surveillance, response, and preparedness were not yet fully operational. WHO expected 70
percent of state parties to request an extension for implementation of the core capacities.
Subregional collaborations in the Americas, such as the Central America Integration System, supported the
implementation of the Regulations. The Regulations promoted any form of collaboration between countries
through subregional and regional networks.
Dr. Andraghetti noted the way the United States and México embraced the Regulations was exemplary. Their
binational collaboration and information sharing signaled transparency.
Challenges to IHR implementation and WHO action included limited financial and technical resources. WHO
aimed to strengthen country ownership and development of the IHR, possibly by leveraging existing regional
networks. They also needed to increase advocacy and improve communication to characterize the benefits of IHR
implementation.
Dr. Waterman noted Luis Castellano, PAHO, had indicated the Guidelines might be included in a WHO
document as a model of collaboration for other countries and inquired whether this was possible.
Dr. Andraghetti responded that it had been difficult to continue using the IHR framework because minimal
experience sharing had taken place. She asked which channels were best to share best practices. They usually
shared information through (1) e-mail dissemination to members worldwide; (2) the IHR information, adding a
best practices section; or (3) the PAHO website.
Dr. Andraghetti stated that although WHO could identify the lack of adequate mechanisms to share best practices
as an issue, member input was also important. She suggested members recommend including mechanisms for best
practices and noted WHO received a recommendation to redesign the EIS website.
Dr. Kohl stated the IHR were a kind of description of a functional public health program. The only additional step
the United States needed to take was to devise communication processes. She indicated the NFP intranet site was
not yet used to understand what was occurring worldwide. Formerly held IHR implementation courses and
regional meetings would be a good forum for sharing best practices. She agreed the Guidelines were an
appropriate tool to share with IHR.
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Dr. Waterman indicated the CDC discussed writing an article concerning the Guidelines process for publication in
the PAHO bulletin or elsewhere. He noted that many people consider the border as one epidemiological zone and
inquired whether localized, sister city outbreaks met the threshold for reporting to WHO.
Dr. Kohl noted a binational event involving a food product not likely to be exported, for instance, might not be
considered an event of international concern. The fact that an event took place on both sides of the border was not
a default determination for international reporting. With respect to the GBS outbreak, however, they initially did
not know what caused the spread.
Dr. Cortés Alcalá indicated his impression was protocols were meant to be used as designed. Events meeting the
criteria of a WHO notifiable case should be reported internationally, even if individuals were aware it was not
likely to spread. He considered it a learning exercise and an opportunity for México to inform NFPs of their
actions, as they could then implement their own risk assessments. They should always assess an event with Annex
II and share information with WHO through PAHO.
Dr. Andraghetti replied a fundamental issue persisted with determining a notifiable case despite having Annex II.
An intense discussion took place within the organization with certain member states regarding the threshold for
reporting. After approximately five years, they concluded it was impossible to determine a threshold, and they
could only be guided by Annex II criteria to internationally communicate.
A second considerable discussion that occurred within WHO concerned the occasions when they identified
information through the media, i.e., newspapers, and subsequently requested verification from the NFP. Although
the WHO was aware the event would not likely escalate to a H1N1 outbreak, they aimed to maintain open
communication channels between the organization and the NFPs, as they could not afford to initiate contact in the
midst of the next severe acute respiratory syndrome, otherwise known as SARS.
Dr. Andraghetti reported a third WHO discussion focused on defining the role of the IHR event information site.
It was necessary that WHO determine whether its purpose was to provide early warning or to inform decisionmaking related to travel. Resolving how the information posted on the site trickled down to the local level was
also important. She noted suggestions from member states were most welcome.
Dr. Kohl indicated a benefit of this decision-making instrument was they were motivated to determine an event’s
scope and potential impact when in the midst of it. At CDC, neither the group nor the center that investigated the
outbreak made the decision to report. The associate directors for science from the different centers who were
presented with the information made the decisions, often for the first time, during the assessment call. They were
able gain a fresh perspective from which to judge the criteria and determine whether the event was important
enough to report to WHO.
R. Sotomayor commented that they had a collaboration agreement for pandemic influenza at the trilateral level;
the Guidelines at the binational level; and BIDS at the cross-border level. EWIDS-U.S. and EWIDS-México
would end. She asked panelists to comment on how frameworks that endured could be used to support the
continuance of cross-border health programs.
Dr. Kohl replied that the entire BBID Conference addressed this question. All binational activities met the spirit of
the IHR, and conference discussions would further aspects of the IHR requirements in the international context.
Dr. Cortés Alcalá added that written documents should be revised and updated regularly. Taking into account
U.S. laws, Mexican laws, and state laws, they would write useful plans and guidelines.
Dr. Andraghetti stated IHR-Article 3 stipulated that member states, in view of their health policies, would seek
compliance with the IHR. The Regulations went back to strong national systems. Noting the conference
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discussion regarding sustainability in the border region, she expressed her surprise by the end of EWIDS funding.
She affirmed the world looked to the United States when it came to resource mobilization.
Dr. Charles Wallace, Manager, Texas DSHS Tuberculosis Services Branch, and President, U.S. National TB
Controllers Association, stated he was unaware of TB’s connection to the IHR. He noted the CDC supported four
binational projects along the U.S.-México border but affirmed insufficient binational cooperation regarding TB
took place. He was unaware of any regulations that managed MDR TB patients who crossed into México and
inquired when IHR regulations would be built into the system to manage these complicated TB cases. Dr. Wallace
asked panel members to consider the complexity and how they could binationally address diseases like TB. He
affirmed the four binational border projects received inadequate funding and needed more collaboration,
surveillance, and regulation.
Dr. Kohl responded that, from her perspective, the IHR did not get to that level of continuity of care. What they
accomplished with respect to preventing cross-border TB transmission met the spirit of the IHR, but the IHR were
not written in a granular fashion. TB was a problem worldwide, although not in terms of outbreaks, which
possibly explained why an explicit statement had not been made within the IHR to address TB as a global
problem. The CDC did report to WHO under the IHR any individuals they were aware of who travelled while
infected with MDR or Extremely Drug-resistant (XDR) TB. This never made it to the event information site
shared with NFP, possibly because it was not deemed enough of a crisis for other countries.
Tools were established to work with colleagues in the Department of Homeland Security to prevent TB patients
from travelling via airplane. In order to prevent spread of the disease, they also attempted to assure continuity of
care in other countries for TB patients who wanted to return to the United States.
Dr. Kohl noted TB was one of the primary diseases of concern in her division at CDC, and she agreed there was
more to be done.
In response to Dr. Waterman’s request for more information on the U.S. state-level involvement in the IHR
review process, Dr. Kohl explained state health departments were consulted as part of the assessment process for
WHO notifiable events. They invited the CDC representative and a state epidemiologist to an assessment call
coordinated by CDC. In addition, all state epidemiologists received information on events shared through the
CDC’s Epidemic Information Exchange.
Dr. Andraghetti affirmed WHO was attuned to TB. She indicated acute events, such as MDR or XDR cases
related to air travel, would make it on the information site. The IHR channels to the NFPs were used for
international contact tracing of TB cases among focal points. It was possible to apply IHR provisions in travel
medicine to travelers at departure or upon arrival. How these provisions could support the development and
enforcement of TB protocols needed to be considered.
Dr. Cortés Alcalá expressed concern that too many initiatives were treating the same thing. Possible resolutions
included managing programs and processes more efficiently; merging the various initiatives spending limited
resources for similar purposes; and leveraging resources better.
Effective Methods for Outreach, including Innovative Film Documentary and Social
Media Techniques
Michael Welton, M.P.H., M.A., Epidemiologist, CDPH COBBH, “California Border Region ILI Surveillance
and Influenza Education in Migrant Farmworker Populations”
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Irma Ortiz Soto, Coordinator, BHC Baja California Regional Office, “Health Education for the Surveillance
of Vaccine Preventable Diseases within Communities in Tijuana during 2011”
Dr. Kimberly Shoaf, Associate Professor, UCLA School of Public Health; Assistant Director, UCLA Center
for Public Health and Disasters, “Cross-border Public Health Communication during the 2009 H1N1
Influenza Outbreak”
Dr. Jacob Rosales Velázquez, Quality and Health Education, Tamaulipas Secretariat of Health, “Dengue
Proof Hospital”
M. Welton discussed challenges in reaching migrant populations. The H1N1 pandemic identified the need for
increased infectious disease surveillance. The enhanced ILI surveillance initiative included migrant farm workers
in San Diego and Imperial Counties, and the Vista Community Clinic as well as the Clínicas de Salud del Pueblo
partnered in the effort.
The project established outreach promotora (health promotion worker) teams that worked within farmworker
communities as well as surveillance and communication protocols. Over 11,000 face-to-face encounters took
place and 20,000 flyers were distributed. They determined ILI was present in the farmworker community, and atrisk workers often did not have health insurance vaccinations. Challenges to the project included difficulties
reaching the population and unfamiliarity with the practice.
I. Ortiz spoke about community health education and surveillance of vaccine-preventable diseases in Tijuana.
The principal preventable diseases studied in 2011 were polio, whooping cough, tetanus, and measles.
Community activities included testing, diagnosis, and vaccinations. TB surveillance activities included
conducting epidemiologic and contacts studies, performing home visits to ensure 100 percent completion of
treatments, and distributing prophylaxes to all children under the age of five. In addition, I. Ortiz described ILI
surveillance and outreach using health outposts, information collection, and community flyer distribution.
I. Ortiz concluded that improved epidemiologic surveillance required greater community participation for both
notification and information collection in coordination with public health services. Health promotion and
education on the ground were important factors in raising awareness and improving health.
Dr. Shoaf presented her research on cross-border communication during the 2009 H1N1 outbreak. The study
aimed to better understand the experiences and perceptions of California border residents during the outbreak.
Dr. Shoaf surveyed California residents to collect data on information sources, protective actions, information
availability, communication strategies, and demographic characteristics. The responses indicated California
residents received abundant information during the H1N1 outbreak from both domestic and international sources.
Participants perceived the information from domestic sources to be more accurate, trustworthy, and useful.
Dr. Rosales discussed activities of Hospital Seguro to combat dengue, including hospital accreditation, Clinical
Practice Guide, intensive training, and activities to form a multidisciplinary, inter-institutional team of evaluators.
The Tamaulipas Secretariat of Health developed a contingency plan for surveillance and response in case of
dengue outbreak.
In response to a question regarding whether migrant workers involved in the ILI surveillance project were
questioned about their states of origin and levels of education, M. Welton responded that this information was not
collected due to limited space on the form. He agreed, however, that these were good questions to consider.
Dr. Aranda inquired about farm worker perceptions of the influenza vaccine.
E-13
M. Welton reported a lack of acceptance of the vaccine by Tijuana farm workers, and they observed that many
people did not seek the vaccine although it was available. M. Welton was unaware of the level of acceptance of
the vaccine among the farm workers in his project, but he concluded acceptance would be more likely with
promotora participation.
Dr. Gloria Leticia Doria Cobos, Epidemiologist, Tamaulipas Secretariat of Health, reported people in Tamaulipas
also did not seek the influenza vaccination even when available. However, once H1N1 cases were announced via
television, people began to seek the vaccine. In order to identify more effective ways to disseminate information
to the public, Dr. Doria asserted the need to evaluate the kinds of information the population received to
determine their impact.
Avelina Acosta, BHC California Outreach Office Coordinator, asked M. Welton if there were plans to continue
his initiative or to train health promotion workers to respond to questions and provide information.
Although he was interested in continuing the project, M. Welton related no immediate plans existed.
Noting Vista Community Clinic was possibly one of the first to use health promotion workers in the early 1980s,
Dr. Shoaf inquired whether the promotores used were already part of the clinic’s process or new to the project.
M. Welton responded that they used existing promotores who worked for the clinics. He noted they would be able
to continue promoting work identified by the project, to an extent, but not to the same degree.
I. Ortiz noted these outreach projects primarily served Spanish-speaking, Mexican immigrants. She suggested
working with Mexican teams of health workers and employing the same promotion methods/materials used in
México might generate more trust and achieve greater impact.
M. Welton agreed that binational collaboration has advantageous increased their output. His office has increased
its collaboration with mobile clinics that travel to the more rural Mexican areas, such as Valle de Guadalupe.
Through EWIDS, he noted, they also work with some Baja California binational sites within the ILI network.
I. Ortiz was asked about the effects of violence on the groups that went into the communities. She responded that
nothing occurred when they went into the communities. They went house to house, and, if there were gangs, they
never bothered the health workers. They always tried to find leaders and ask permission to go into the
communities. In the future, they wanted to organize and return the information collected to the communities, so
that they could become decision makers about the health characteristics presenting in their areas.
With respect to a question regarding the methods used for dengue surveillance and treatment, Dr. Rosales stated
his was an innovative, new model created in the Under-Secretariat with various colleagues. PAHO invited them to
provide training in almost all Mexican states. Lessons learned included that the doctors did not possess the
knowledge necessary to manage severe cases of dengue. In the General Hospital, ten patients arrived the first day,
and in one week, they had 300 patients. They instructed a group to recognize the dengue symptoms and conducted
a training program on clinical management.
In response to whether she inquired about the survey participants’ countries of origin and whether she planned to
extend her research to include online sources of information, Dr. Shoaf replied she did not inquire about country
of origin. She also observed that the Latino community did not seek “official information” on health from online
sources, but preferred face-to-face interaction or other primary sources of information.
E-14
APPENDIX F: LIST OF ACRONYMS
ACE
Automated Commercial Environment e-Manifest
ADHS
Arizona Department of Health Services
AFP
Acute Flaccid Paralysis
AIDS
Acquired Immune Deficiency Syndrome
ART
Antiretroviral Therapy
ASPR
Assistant Secretary for Preparedness and Response
BBID
Border Binational Infectious Disease
BIDS
Border Infectious Disease Surveillance
BTWG
Binational Technical Work Group
CDC
Centers for Disease Control and Prevention
CBP
U.S. Customs and Border Protection
CDPH
California Department of Public Health
COBBH
California Office of Binational Border Health
COFEPRIS
México Federal Commission for the Protection against Sanitary Risks (Comisión
Federal para la Protección contra Riesgos Sanitarios)
DGE
General Directorate of Epidemiology/ Dirección General de Epidemiología
DGMQ
Division of Global Migration and Quarantine
DPH
El Paso Department of Public Health
EIS
CDC Epidemic Intelligence Service
EWIDS
Early Warning Infectious Disease Surveillance
FDA
U.S. Food and Drug Administration
GBS
Guillain-Barré Syndrome
GHSI
Global Health Security Initiative
Guidelines
Technical Guidelines for United States-México Coordination on Public Health
Events of Mutual Interest
HCHD
Hidalgo County Health and Human Services Department
HHS
U.S. Department of Health and Human Services
HIV
Human Immunodeficiency Virus
HPV
Human Papillomavirus
ICE
Immigration and Customs Enforcement
F-1
IHR
International Health Regulations
ILI
Influenza-like Illness
InDRE
National Institute of Epidemiological Diagnosis and Referral/ Instituto de
Diagnóstico y Referencia Epidemiológicos
LTJG
Lieutenant (junior grade)
MCN
Migrant Clinicians Network
MDR
Multi-drug Resistant
MEDSIS
Medical Electronic Disease Surveillance Intelligence System
NAPAPI
North American Plan for Pandemic and Animal Influenza
NFP
National IHR Focal Points
NHAS
National HIV/AIDS Strategy
NM DOH
New Mexico Department of Health
OBH
Office of Border Health
PAHO
Pan American Health Organization
RMSF
Rocky Mountain Spotted Fever
SARI
Severe Acute Respiratory Infection
SINAVE
México National Epidemiological Surveillance System/Sistema Nacional de
Vigilancia Epidemiológica
TB
Tuberculosis
Texas DSHS
Texas Department of State Health Services
TTUHSC
Texas Tech University Health Sciences Center
UCSD
University of California, San Diego
UIEES
Sonora Epidemiologic Intelligence and Health Emergencies Unit/Unidad de
Inteligencia para Emergencias en Salud de Sonora
VDS
Ventanillas de Salud
WHO
World Health Organization
XDR
Extensively Drug-Resistant
F-2
APPENDIX G: LIGHTNING TALK SUMMARIES
Dr. Miguel Escobedo, “Descriptive Analysis of Mexican Immigrants with Overseas Tuberculosis Conditions,
October 1, 2010–September 30, 2011”
Dr. Escobedo indicated a CDC analysis of medical information regarding Mexican immigrants with TB
conditions revealed a significant percentage of Class B cases. The analysis also identified well-defined relocation
patterns, including California and Texas as leading destinations. He concluded Class B TB tracking may be a
useful surveillance and referral tool.
Dr. Haoquan Wu, “Design miRNA-based shRNA to Suppress HIV Infection”
Dr. Wu discussed laboratory research he conducted at Texas Tech University to design a genetic suppression of
HIV infection. Although results were promising, he will conduct further research.
Dr. Rachel Joseph, “Investigation of a Shigella Sonnei Outbreak among U.S. Travelers to México, November
2011”
Dr. Joseph reported a San Diego patient diagnosed with Shigellosis, a notifiable, foodborne illness, launched an
outbreak investigation, which tracked the outbreak to U.S. tourists who ledged at the same Puerto Vallarta hotel.
Dr. Alberto Martínez Vázquez, “Clinical Disorders and Risk Factors for the Development of Acute Respiratory
Distress Syndrome in the Intensive Care Unit”
Dr. Martínez Vázquez noted the study determined hospitalized patients run the risk of acute respiratory distress at
the rate of 1.5 to 8.4 cases per 100,000. The two highest risk factors include non-specific pneumonia and sepsis.
Dr. Mingtao Zeng, “New Mucosal Vaccine for Cross-Strain Protection against Influenza”
Laboratory research at Texas Tech University tested the use of detoxified anthrax to deliver antigens for crossstrain protection against influenza. Preliminary data from testing on mice indicated the feasibility of developing a
new universal influenza vaccine.
Dr. Beatriz A. Díaz Torres, “Risk Factors Associated with Acquired Pneumonia in a Pediatric Patient at Ciudad
Juárez General Hospital”
This study identified risk factors linked to deaths due to acquired pneumonia in patients four-years-old and
younger who were admitted to the Ciudad Juárez General Hospital. Tobacco exposure was identified as a risk
factor for contracting pneumonia. Risk factors for mortality included incomplete vaccination, absence of breast
feeding, premature/low birth weight, and malnutrition.
Orion McCotter, M.P.H., “Establishing a System for Dengue Surveillance along the Arizona-Sonora Border”
O. McCotter reported the border mosquito vector was widespread and thriving despite the lack of reported dengue
cases in Arizona. He noted that raising clinical awareness was necessary, as travelers and immigrants annually
import cases to the United States. The University of Arizona Department of Entomology planned to study the age
structure of wild, trapped Ae. egypti mosquitos to determine whether longevity limits dengue transmission and to
establish a baseline that would allow public health officials to refine the vector surveillance program. Arizona
health services would also perform a serosurvey of dengue symptomatic patients and conduct a
Knowledge/Attitudes/Practices survey of health care providers.
G-1
Omar Contreras, M.P.H., “Detection of Rocky Mountain Spotted Fever (RMSF) Activity in Southern Arizona”
In November 2011, an outbreak of RMSF, a zoonotic disease caused by bacterium transmitted by the brown dog
tick, was identified in the Arizona border region. O. Contreras reported a high potential for an RMSF emergency
in new areas, due to the extensive range of the tick, which has a year-round breeding cycle in similar climates.
Dr. Benjamin Park, “The Re-emergence and Changing Epidemiology of Coccidioidomycosis, United States,
1998–2010”
Dr. Park and other CDC experts analyzed the U.S. National Notifiable Disease Surveillance System to
characterize cases of Coccidioidomycosis, a fungal respiratory infection caused by inhaling spores, and describe
trends.
Dr. Alfonso Rodriguez-Lainz, “Migration-related Information in U.S. National Data Sources”
Dr. Rodriguez-Lainz and other DGMQ colleagues surveyed U.S. national data sources for available migrationrelated information, including online databases such as PubMed, WorldCAT, Google Scholar, and federal
government web pages. They identified incomplete migrant coverage and inconsistencies in database information,
but acknowledged health surveys can potentially limit the study of migrant health.
Dr. Gudelia Rangel, “Comprehensive Strategy for Migrant Health”
Dr. Rangel affirmed the Mexican government aimed to guarantee the constitutional right to health services for the
estimated 12 million Mexican migrants in the United States and their families in México. As part of the
comprehensive strategy, the VDS program, located in all Mexican consulates in the United States since 2002,
offered medical assistance and health insurance enrollment. In addition, México planned to establish community
centers, call centers, and educational kiosks for migrant health education.
Dr. Steve Waterman, “Evaluation of the Binational Communication Pathways Protocol Pilot”
Launched in November 2011, this six-month pilot was intended to systematize timely communications of
binational illness among U.S. and Mexican public health entities at all governmental levels. A survey showed that
participants valued the communication benefits and found the methodology highly acceptable. They planned to
expand the pilot to additional U.S. and Mexican border and non-border states.
Dr. Allison Banicki, “Pilot Project to Implement the Technical Guidelines for United States-México Coordination
on Public Health Events of Mutual Interest: Perspectives from the U.S. Border States”
The participating U.S. states in the U.S.-México Binational Communications Pathway Protocol project included
Arizona, New Mexico, and Texas. An evaluation revealed inconsistencies in binational case identification and
reporting. Recommendations included strengthening communication pathways and raising awareness of the
importance of binational reporting.
G-2
APPENDIX H: BREAKOUT GROUP PARTICIPANTS
TB, HIV, STD, Hepatitis
Participant Directory
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Place/Room:
Capitol D
Floor:
3rd Floor
Date:
05/23/2012
Time:
8:00 a.m.-9:30 a.m.
Last Name
Aguilar
Campos
Cardenas
Carrasco
Choi
Escobedo
Evert
Flores
Fortune
Gomes-Moreira
Jeronimo
Jiménez
Kohl
Kozo
Lopez
Luna
Padilla
Perez-Flores
Pezzi
Rangel
Reyes López
Reyes-Ruvalcaba
Salazar
Saraiya
Tafolla
Vassell
Welton
Wu
Yi
Zúñiga
First Name
Elisa
José Arturo
Gloria
Aldo
Jang-Gi
Miguel
Nicole
Maria
Diana
Jose A.
Trinidad
Barbara
Katrin
Justine
Waldo
Norma Irene
David
Enrique
Clelia
María Gudelia
Miguel Angel
David
Lilia
Mona
Cynthia
Barbara
Michael
Haoquan
Guohua
María Luisa
H-1
Foodborne and Diarrheal Diseases
Place/Room:
Capitol View Terrace South
Floor:
3rd Floor
Date:
05/23/2012
Time:
8:00 a.m.-9:30 a.m.
1
2
3
4
5
6
7
8
9
10
11
Last Name
Alva
Arriaga
Banicki
Carmona
Dutton
Hernández Monroy
Jiménez
Joseph
Ledezma
Maroufi
Montiel
First Name
Herminia
Lumumba
Allison
Daniel
Ronald J.
Irma
María Guadalupe
Rachael
Elvia
Azi
Sonia
12
13
14
15
16
17
18
19
20
Phippard
Seca
Selvage
Tapia
Taylor
Thornton
Trevino
Waterman
Zarate-Bermudez
Alba
Calixto
David
Micaela
Ethel
Andy
Silvia Estela
Steve
Max
H-2
Respiratory Diseases
Capitol View Terrace North
3rd Floor
05/23/2012
8:00 a.m.-9:30 a.m.
First Name
Avelina
José
Maria
Marco
Ricardo
Edith
Beatriz
Lucia
Edgar Alberto
Jose
Maria
Catherine
Fernando
Robert
Nubia
Paula
Alberto
Lupita
Belinda
Katharine
Rossanne
Alfonso
Alessio
Premlata
Place/Room:
Floor:
Date:
Time:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Last Name
Acosta
Alomía Zegarra
Arevalo
Cázares
Cortés Alcalá
de Lafuente
Díaz
Fajardo
Farías Farías
Fernandez
Fierro
Golenko
González
Guerrero
Hernández
Kriner
Martínez Vázquez
Mata
Medrano
Pérez-Lockett
Philen
Rodriguez-Lainz
Scorza
Shankar
H-3
Emerging Infectious Threats
(including Vector-Borne Diseases)
Capitol A-C
3rd Floor
05/23/2012
8:00 a.m.-9:30 a.m.
Place/Room:
Floor:
Date:
Time:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Last Name
Alvarez
Bejarano
Cantey
Contreras
Cruz
Doria Cobos
Fonseca-Ford
Gómez-Sierra
Garcia
González Martínez
Guerra
Guerra
Hernandez
Hunsperger
Leiva
Lugo Guillén
Marikos
McCotter
Morales
Navarrete
Navarro Gálvez
Park
Rosales
Velasco-Villa
Willer
First Name
Laura
Veronica
Paul
Omar
David
Gloria L.
Maureen
Mauricio
Lauren
María Guadalupe
María Eugenia
Marta
Salvadore
Elizabeth
Mauricio
Norma Alicia
Sarah
Orion
Ricardo
Lorraine
Francisco Javier
Benjamin
Jacob
Andres
Linda
H-4
Laboratory Integration with Surveillance Systems
Place/Room:
Capitol View Terrace North
Floor:
3rd Floor
Date:
5/23/2012
Time:
10:00 a.m.-11:30 a.m.
Last Name
First Name
1
Arriaga
Lumumba
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Arriaga Rangel
Bacelis
Bejarano
Carvajal
Galindo Galindo
Golenko
González Martínez
Guerra
Hernández Monroy
Hunsperger
Lopez
López Martínez
Marikos
Medrano
Tapia Olea
Velasco-Villa
Willer
Carlos
Jorge
Veronica
Armando
Edgar
Catherine
María G.
Marta
Irma
Elizabeth
Waldo
Irma
Sarah
Belinda
María Micaela
Andres
Linda
H-5
Migrant Health
Place/Room:
Capitol View Terrace South
Floor:
3rd Floor
Date:
05/23/2012
Time:
10:00 a.m.-11:30 a.m.
Last Name
First Name
1
Acosta
Avelina
2
Cantey
Paul
3
Carrasco
Aldo
4
Corona-Luevanos
Adriana
5
German
Emilio
6
Gomes-Moreira
Jose A.
7
Jiménez
Barbara
8
Pezzi
Clelia
9
Rangel
Gudelia
10
Rodriguez-Lainz
Alfonso
11
Welton
Michael
H-6
Binational Communication and Implementation of the Guidelines
Capitol D
3rd Floor
05/23/2012
10:00 a.m.-11:30 a.m.
Place/Room:
Floor:
Date:
Time:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Last Name
Alomía Zegarra
Alva
Aranda Lozano
Armendariz
Banicki
Cardenas
Cázares
Contreras
Cortés Alcalá
Cruz
Doria Cobos
Evert
Fajardo
Fierro
Flores
Fonseca-Ford
Fortune
Garcia
Gómez Linares
González
González Madrigal
Guerrero
Guerrero
Hernandez
Jiménez Fierro
Joseph
Ledezma
López-Alvarez
Maroufi
Marquez Uscanga
Martínez Vázquez
First Name
José
Herminia
José Luis
Bertha
Allison
Gloria
Marco
Omar
Ricardo
David
Gloria L.
Nicole
Lucia
Maria
Maria
Maureen
Diana
Lauren
Mario
Fernando
Luis
Lupita
Robert
Salvadore
María Guadalupe
Rachael
Elvia
Benito
Azi
Daniel
Alberto
H-7
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
Mata
Morales
Morales
Navarro Gálvez
Ortiz Soto
Perez-Flores
Philen
Phippard
Ramirez
Reyes López
Romo
Rosales
Saraiya
Savage
Seca
Selvage
Smith
Taylor
Thornton
Treviño
Vassell
Waterman
Wong
Lupita
Julio
Ricardo
Francisco Javier
Irma
Enrique
Rossanne
Alba
Sara
Miguel A.
Jaime
Jacob
Mona
Kimberly
Calixto
David
Jennifer
Ethel
Andy
Silvia Estela
Barbara
Steve
Leticia
H-8
Place/Room:
Floor:
Date:
Time:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
Cross-Border Sharing of Items for Public Health Purposes
Capitol A-C
3rd Floor
05/23/2012
10:00 a.m.-11:30 a.m.
Last Name
First Name
Aguilar J.
Elisa
Barreras
Trinidad
Bueno
Martha A.
Campos
José Arturo
Carmona
Daniel
de la Torre
Fabiola
de Lafuente
Edith
Dutton
Ronald J.
Escobedo
Miguel
Ferran
Karen
González
Guadalupe
Hernandez
Salvadore
Iniguez-Stevens
Esmeralda
Kriner
Paula
Leiva
Mauricio
Luna Guzmán
Norma I.
Monroy
Ricardo M.
Montiel
Sonia
Navarrete
Lorraine
Padilla
David
Tafolla
Cynthia
H-9
APPENDIX I: BREAKOUT GROUP SUMMARY SLIDES
I-1
I-2
I-3
I-4
I-5
I-6
I-7
I-8
I-9
I-10
I-11
I-12
I-13
I-14
I-15
I-16
I-17
I-18
I-19
I-20
I-21
I-22
I-23
I-24
I-25

Border Binational Infectious Disease Conference

Transcription

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