A major challenge of infectious disease elimination is the need to interrupt pathogen transmission across all vulnerable populations. Ethnic minorities are among the key vulnerable groups deserving special attention in disease elimination initiatives, especially because their lifestyle might be intrinsically linked to locations with high transmission risk. There has been a renewed interest in malaria elimination, which has ignited a quest to understand factors necessary for sustainable malaria elimination, highlighting the need for diverse approaches to address epidemiological heterogeneity across malaria transmission settings. An analysis of malaria incidence among the Guna Amerindians of Panamá over the last 34 years showed that this ethnic minority was highly vulnerable to changes that were assumed to not impact malaria transmission. Epidemic outbreaks were linked with El Niño Southern Oscillations and were sensitive to political instability and policy changes that did not ensure adequate attention to the malaria control needs of the Gunas. Our results illustrate how the neglect of minorities poses a threat to the sustainable control and eventual elimination of malaria in Central America and other areas where ethnic minorities do not share the benefits of malaria control strategies intended for dominant ethnic groups.

Background: The present study provides a countrywide perspective of the malaria situation in Panamá over a longterm framework, with the purpose of identifying historical malaria resurgence events and their potential causes. Methods: A descriptive-ecological study was conducted by analysing demographic and epidemiological annual malaria time series data in Panamá (1884-2019) using several data sources. Malaria intensity indicators were calculated during the study period. The effects of El Niño Southern Oscillation on malaria transmission were also analysed using a retrospective analysis of malaria cases between 1957 and 2019. Results: Several factors were identified responsible for malaria resurgence in Panamá, mostly related with Malaria Control Programme weakening. During the past 20 years (2000-2019) malaria has progressively increased in prevalence within indigenous settlements, with a predominance of male cases and a high proportion (15% of total cases) in children less than 5 years old. During this period, a significant and increasing proportion of the Plasmodium falciparum cases were imported. Retrospective analysis (1957-2019) evidenced that ENSO had a significant impact on malaria transmission dynamics in Panamá. Conclusions: Data analysis confirmed that although authorities have been successful in focalizing malaria transmission in the country, there are still neglected issues to be solved and important intercultural barriers that need to be addressed in order to achieve elimination of the disease by 2022. This information will be useful for targeting strategies by the National Malaria Elimination Programme.

BackgroundMalaria has historically been entrenched in indigenous populations of the República de Panamá. This scenario occurs despite the fact that successful methods for malaria elimination were developed during the creation of the Panamá Canal. Today, most malaria cases in the República de Panamá affect the Gunas, an indigenous group, which mainly live in autonomous regions of eastern Panamá. Over recent decades several malaria outbreaks have affected the Gunas, and one hypothesis is that such outbreaks could have been exacerbated by climate change, especially by anomalous weather patterns driven by the EL Niño Southern Oscillation (ENSO).ResultsMonthly malaria cases in Guna Yala (1998–2016) were autocorrelated up to 2 months of lag, likely reflecting parasite transmission cycles between humans and mosquitoes, and cyclically for periods of 4 months that might reflect relapses of Plasmodium vivax, the dominant malaria parasite transmitted in Panamá. Moreover, malaria case number was positively associated (P < 0.05) with rainfall (7 months of lag), and negatively with the El Niño 4 index (15 months of lag) and the Normalized Difference Vegetation Index, NDVI (8 months of lag), the sign and magnitude of these associations likely related to the impacts of weather patterns and vegetation on the ecology of Anopheles albimanus, the main malaria vector in Guna Yala. Interannual cycles, of approximately 4-year periods, in monthly malaria case numbers were associated with the El Niño 4 index, a climatic index associated with weather and vegetation dynamics in Guna Yala at seasonal and interannual time scales.ConclusionThe results showed that ENSO, rainfall and NDVI were associated with the number of malaria cases in Guna Yala during the study period. These results highlight the vulnerability of Guna populations to malaria, an infection sensitive to climate change, and call for further studies about weather impacts on malaria vector ecology, as well as the association of malaria vectors with Gunas paying attention to their socio-economic conditions of poverty and cultural differences as an ethnic minority.Electronic supplementary materialThe online version of this article (10.1186/s12936-018-2235-3) contains supplementary material, which is available to authorized users.

SARS-COV-2 is the most recent from a series of emerging pathogens stressing national health systems. Initially restricted to Hubei province in China, COVID-19, the disease caused by SARS-COV-2 has become pandemic, reaching almost every nation on our planet. Here, we present an estimate of the Basic Reproduction Number (R0) for this disease based on confirmed cases recorded during the initial 30 days of transmission. Based on local transmission data for the six initial days of transmission, we estimated (mean ± SE) R0 = 2.58 ± 2.43. R0 was reduced by up to 56% to R0 = 1.12 ± 0.02 following suppression measures in place by April 4th, 2020. Independent estimates for the time-varying reproduction number (Rt) based on the serial interval distribution estimated for China showed that after 30 days, Rt decreased reaching a value of 0.914 ± 0.104 on April 4th, 2020. In this study, we also describe the suppression strategies in place in Costa Rica and compare their impacts with those implemented in Panamá and Uruguay, provided these three middle-income countries have similar demographic and economic indicators. However, these three countries have structurally different health systems and have resorted to different suppression measures against COVID-19. We compare the early epidemic growth curves in the three countries using an exponential deceleration model. We found the lowest epidemic growth rate in Costa Rica, followed by Panamá and then Uruguay, while the highest deceleration was observed in Uruguay, followed by Costa Rica and Panamá. We discuss how the unified, universal healthcare system of Costa Rica has been vital to successfully manage the early stage of the COVID-19 epidemic and call for the developments of precision public health tools to further improve epidemic health surveillance in Costa Rica.