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PAN AMERICAN HEALTH ORGANIZATION WOL DnTEBAMBXOA OSTEAL PBEETBB9, AT BAHE \Mi RLBEVEL, WORLD HEALTH ORGANOIZATOON Washington, D.C., USA, 25-27 April 1995 Provisional Agenda Item 4 12 April 1995 ORIGINAL: SPANISH REPORT OF THE PROGRAM ON VETERINARY PUBLIC HEALTH: COMPLIANCE WITH THE STRATEGIC ORIENTATIONS AND PROGRAM PRIORITIES OF THE PAN AMERICAN HEALTH ORGANIZATION, 1991-1994

Page 2 CONTENTS Page 1. Introduction... 3 2. Establishment of a Center of Technical Excellence More Consonant with Subregional and Regional Integration Initiatives... 3 3. Development of the Strategic Orientations and Program Priorities and Compliance with the Mandates of RIMSA VII and VIm II... 4 3.1 Food Protection... 6 3.2 Foot-and Mouth Disease... 7 3.3 Zoonoses... 7 3.3.1 Rabies... 7 3.3.2 Taeniasis and Cysticercosis... 9 3.3.3 Bovine Tuberculosis... 10 3.3.4 Other Zoonoses... 11 3.4 Biomedical Models... 12 3.5 Strengthening of Veterinary Public Health Services... 13 3.6 Contribution to Other PAHO Program Priorities for 1991-1994... 14 e

Page 3 1. Introduction In September 1990 the XXII Pan American Sanitary Conference, in Resolution XII, adopted the Strategic Orientations and Program Priorities for the Pan American Health Organization for the Quadrennium 1991-1994. The strategic orientations were aimed at promoting a dynamic framework for modernization of the health sector and its interrelationships with other governmental sectors so that these relationships would lead to more efficient, effective, and equitable responses to the health needs of the peoples of the Americas. One of the most important orientations was the new, health-based approach to development, not solely by reason of the incorporation of health and human capital into economic production, but also in recognition of their far-reaching interdependence in achieving sustainable human development. Progress made in this direction also means redefining the social role of the State in consolidating democracy in the Americas. Intersectoral action is implicit in the strategic orientations, as in the use of mass communication, the integration of women into development as agents of change, the decentralization of sectoral power toward the local services and the community, the targeting of actions toward high-risk urban and rural populations, the promotion of health promotion as a social reality, the management of knowledge with due regard for appropriate technology, the mobilization of national resources, and, lastly, cooperation between countries. During the quadrennium, the VII and VIII Inter-American Meetings, at the Ministerial Level, on Animal Health (RIMSA) were held in 1991 and 1993, respectively, during which the ministers of agriculture or their representatives adopted significant resolutions. These resolutions have fulfilled the task of orienting the Pan American Health Organization's technical cooperation program toward the agricultural sector as a means of contributing to health promotion in development. 2. Establishment of a Center of Technical Excellence More Consonant with Subregional and Regional Integration Initiatives The economic processes and policies undertaken to substitute imports did not lead to the outcomes expected. To the contrary, compounded by other factors relating to the world economy, they served only to heighten the economic crisis in the Region of the Americas. In attempting to overcome the crisis, the countries made economic changes and adjustments, and they have continued to increase their regional ties as a means of bolstering their external integration.

Page 4 As a result, subregional initiatives have been intensified, since they provide the means for economic and social integration to overcome the crisis. This reality has been reflected in the requests received by the Organization from the countries for technical cooperation in formulating programs for food protection and food safety with a view to promoting international trade. Evaluation of the PAHO Regional Technical Cooperation Program on Food Protection, 1986-1990, concluded in general that notable progress had been made, in particular as regarded the vigorous efforts made by the countries in integrating food protection activities through national programs. With regard to strengthening of the laboratory services, significant advances were made, evidenced by the fact that all the countries now have national laboratories and are currently establishing and/or expanding their national networks of analytical services. Improvements were also observed in inspection systems, community participation, and epidemiological surveillance of food-borne diseases. In addition to these achievements, the evaluation also noted that there was a need to continue permanent international technical support and to establish a regional reference center to provide comprehensive technical cooperation in food protection. O The ministers of agriculture showed their concern for the decision to close the Pan American Zoonosis Center in April 1991 through unanimous approval of RIMSA VII Resolution V, requesting the Director of PAHO to see that comprehensive and permanent technical cooperation be provided to resolve problems related to food protection and the control of zoonoses. In response to this concern and the request made, the Governing Bodies of PAHO, accepting the generosity of the Argentine Government, approved establishment of the Pan American Institute for Food Protection and Zoonoses (INPPAZ) through an agreement signed on 15 November 1991 at the Organization of American States (OAS) in the presence of the President of Argentina, Dr. Carlos Saúl Menem. There is no need for further discussion of INPPAZ in the present report, since a specific item on the Institute has been included on the agenda of RIMSA IX. 3. Development of the Strategic Orientations and Program Priorities and Compliance with the Mandates of RIMSA VII and VIII The Veterinary Public Health Program (HCV) is part of the Division of Disease Prevention and Control. A regional office assists it in providing technical cooperation, supported by regional, intercountry, and country personnel, and two specialized centers: B

Page 5 the Pan American Foot-and-Mouth Disease Center (PANAFTOSA), in Rio de Janeiro, and the Pan American Institute for Food Protection and Zoonoses (INPPAZ), in Argentina. As regards programming, technical cooperation is carried out in five projects: - Food Protection; - Foot-and-mouth Disease; - Zoonoses; - Development of Biomedical Models; - Strengthening of Veterinary Public Health Services; Most of the resources, however, have been allocated to focus on the priorities and strategic approaches formulated by the ministries of health and agriculture, namely, food protection, elimination of rabies, eradication of foot-and-mouth disease, and eradication of bovine tuberculosis. The Program has made efficient use of operational approaches in delivering the Organization's technical cooperation. In this regard, mention must be made of the mobilization of resources to support implementation of the country programs, which amounted to more than US$ 4 million in extrabudgetary funds over four years' time; enlisting the collaboration of various technical cooperation organizations, such as the Food and Agriculture Organization (FAO), the Inter-American Institute for Cooperation on Agriculture (IICA), the Regional International Organization for Plant Protection and Animal Health (RIOPPAH), the United States Agency for International Development (USAID), and the International Atomic Energy Agency (IAEA), in order to make optimum use of the resources in regional projects of mutual interest, such as food protection, elimination of rabies, biomedical models, prevention and eradication of foot-and-mouth disease, as well as of the collaboration of national organizations, particularly in the United States of America, such as the Food and Drug Administration (FDA), the United States Department of Agriculture (USDA), and the Centers for Disease Control (CDC). During the period, the cooperation mobilized in the countries was worthy of note. Bilateral and multilateral agreements were maintained active for coordinated application of foot-and-mouth disease and rabies control measures in border areas, RIMSA serving as a mechanism for the exchange of experiences and reaffirmation of commitments. In the subregional area, the South American Foot-and-Mouth Disease Control Commission

Page 6 (COSALFA) assisted in carrying out the activities of the Hemispheric Program for Eradication of Foot-and-mouth Disease by the Year 2000 (PHEFA) in the affected countries. Emphasis continued to be placed on the training of human resources, especially for the promotion and strengthening of the national programs for food protection, elimination of rabies, and eradication of foot-and-mouth disease. During the quadrennium 5,633 officials in 31 countries were trained. 3.1 Food Protection Pursuant to RIMSA VII resolutions Il on food protection, VII on cholera, and VIII on veterinary public health, and RIMSA VIII resolutions II on technical cooperation for the development of program priorities in veterinary public health, VII on food protection and harmonization of standards for subregional marketing of food, the following actions were carried out: The Veterinary Public Health Program responded rapidly and effectively to the appearance of the cholera epidemic in the Americas to meet the needs of the countries. Initially, a document was prepared for dissemination titled "Risks of Cholera Transmission in Food." Studies on contamination by Vibrio cholerae were carried out on foods commonly consumed in Peru and Bolivia. In conjunction with the FDA, four subregional courses on microbiological analysis of V. cholerae in food were held, training 85 persons from 22 countries. In April 1992 a FAO/PAHO/WHO technical consultation was held in Buenos Aires on food safety and commerce in connection with the cholera epidemic in which the barriers established to international trade of food products were discussed and technical recommendations were issued to promote the commerce and consumption of food without risk of cholera transmission. An inventory of public and private institutions was prepared on food protection activities with a view to ordering these activities in the Central American countries. This inventory is being used to set up integrated national food protection programs. Implementation of this intersectoral and interinstitutional integration was undertaken jointly by the Veterinary Public Health Program and the Institute of Nutrition of Central America and Panama (INCAP). The human resources of the Institute were trained in order to expand the technical cooperation at the household and consumer level in the subregion, and mechanisms for joint programming and coordination were established. In 1990 a proposal was developed for a Latin American network of food analysis laboratories to serve as reference for technical cooperation in food analysis. In 1992 a guide for carrying out epidemiological surveillance of food-borne diseases (FBD) was prepared and distributed to all the health services in charge of data collection and analysis

Page 7 in the countries. The system will be implemented by means of pilot projects in eight countries, including tourist cities. A consultation of experts on food irradiation for the control of bacteriological contaminants was held jointly with the IAEA in October 1991 in Washington, D.C. The recommendations of this meeting have served as a basis for implementing a coordinated research plan to perform studies on its applicability in various countries. 3.2 Foot-and-Mouth Disease The following resolutions were implemented: I, Program Budget of the Pan American Foot-and-Mouth Disease Center (PANAFTOSA); IV, Hemispheric Committee for the Eradication of Foot-and-mouth Disease; and XIII, Community Participation, with special reference to producers in the RIMSA national sanitary campaigns; II, Programs and Budget of the Pan American Foot-and-Mouth Disease Center; IV, Hemispheric Committee for the Eradication of Foot-and-Mouth Disease; and VIII, Health and Development in Subregional Initiatives for Integration of RIMSA VII in the technical cooperation activities that were developed through PANAFTOSA in compliance with the directives of the Organization and the demands of the countries of the Region in the framework of the Hemispheric Program for Eradication of Foot-and-mouth Disease (PHEFA). Technical cooperation was aimed at the establishment of disease-free areas and protection of those already existing. The principal achievements and impacts will be detailed in the specific item included in the Agenda of the present RIMSA IX. 3.3 Zoonoses 3.3.1 Rabies The rabies health problem was discussed in relation to implementation of RIMSA VII resolution II, on urban rabies, and X, on rabies transmitted by vampire bats; and RIMSA VIII resolution II, on technical cooperation for the development of program priorities in veterinary public health, and VI, on elimination of rabies, emphasizing the following achievements: Most of the countries have been successful in controlling urban rabies, in that 97% of the human cases occurred in communities of less than 50,000 population and 87% of the 416 cities registered in the program were shown to be free of canine rabies.

9 Page 8 During the quadrennium, Argentina, Belize, Canada, Costa Rica, Chile, Grenada, French Guiana, Guyana, Panama, Suriname, and Uruguay and the English-speaking Caribbean remained free of human rabies. Note should be made of the efforts carried out by Belize, which achieved rabies-free status in 1990 and has maintained it throughout this period. Human rabies has tended to diminish, thanks to improvement in the medical care provided to exposed persons as a result of the implementation of training programs and increased canine vaccination coverage, typified by the case of Mexico, which since 1990 has succeeded in reducing human rabies by 50%. However, the problem continues to be worrisome in Bolivia, El Salvador, Guatemala, Ecuador, and Peru. The cities of Guayaquil and Lima have again presented human rabies after having been free from the disease for 4 and 10 years, respectively. Dogs continued to be the principal transmitters of rabies to humans in the Americas. Of the cases reported in the period 1990-1993, dogs were identified as the source of infection in 84% of the 531 cases in which the attacking species was reported. While rabies transmitted by canines has decreased, wildlife rabies, especially that transmitted by vampire bats, appears to be increasing in the epidemiological surveillance systems monitoring the disease. Of the cases of human rabies in which the source of infection was known, 6.3% were caused by bat bites. Losses in the livestock industry are also growing, which has caused concern among the governments for organization of a regional program to combat rabies transmitted by vampire bats. Rabies in mongooses persists in Cuba, the Dominican Republic, Puerto Rico, and Grenada. The significant increase in reports of persons being bitten by animals and of rabies transmitted by vampire bats in the Region of the Americas prompted PAHO to convene a meeting of experts in Washington, 1-5 April 1991, jointly with the CDC and the Mérieux Foundation to analyze the situation and make recommendations for its prevention and control. Intervention of the ministries of agriculture and livestock owners in the countries has also been promoted to support programs for surveillance and control of rabies transmitted by vampire bats. The progress of the regional program for the elimination of rabies during the 1 9 80s led to the III Meeting of Directors of Rabies Control Programs in Latin America, held in Porto Alegre, Brazil, in October 1989, which established a final attack phase (1990 and 1991) for which the countries committed themselves to intensifying mass canine rabies vaccination campaigns, setting up weekly Regional Information System, and expanding medical care for people exposed to rabies in rural and marginalized areas.

Page 9 The IV Meeting of Directors of National Programs, held in Mexico City in October 1992, reviewed the situation of the national programs and made the decision to defer the elimination target to the year 2000, alternately emphasizing intensification of the national programs in Bolivia, Ecuador, Peru, El Salvador, and Guatemala and, in particular, improvement of the medical care provided to people exposed to rabies. In this respect it is important to note the extensive mobilization of resources for the training of health-post personnel in the treatment of people exposed to rabies. During the period 1990-1993, 49 courses were offered in 14 countries, training a total of 1,269 physicians and paramedical personnel. December 1991 saw the conclusion of project WING/86/25 on elimination of urban rabies in Central America, assisted with financing by the European Economic Community (EEC) in the amount of US$ 5 million, which contributed significantly to reducing the number of cases of human and canine rabies. In following up this effort, PAHO succeeded in mobilizing US$ 500,000 from the United Arab Gulf Program for United Nations Development Organizations (AGFUND) for the continued strengthening of rabies elimination programs in this subregion in 1993 and 1994. 3.3.2 Taeniasis and Cysticercosis Since 1990, when the Inter-American Workshop on Strategies and Policies for Control of the Taeniasis/Cysticercosis Complex in Latin America was held in Mexico City, the Veterinary Public Health Program has been advocating and collaborating with the countries for the implementation of local programs to control this zoonosis. "Epidemiology and Control of Taeniasis and Cysticercosis" was written and published as a guide to the organization of local programs. During the quadrennium, local control programs were organized in eight countries--bolivia, Brazil, Colombia, Ecuador, Guatemala, Honduras, Mexico, and Venezuela--in which interventions were carried out in 24 foci with a human population at risk estimated at 355,062. In 1991 a regional information system was set up to compile data on the incidence of human neurocysticercosis and animal cysticercosis; the system is still in need of additional support, since information from the countries is supplied only on an irregular basis. During the last two years, technical cooperation for the prevention and control of this zoonosis has been strengthened pursuant to RIMSA VII Resolution VIII, on veterinary public health; and Resolution XI, on community participation, especially participation by the producers in the national sanitary campaigns; and RIMSA VII Resolution IX, on agricultural workers' health.

RIMSA9/4 Page 10 (Eng.), 3.3.3 Bovine Tuberculosis In view of the public health hazard posed by bovine tuberculosis and the meat and milk production losses it causes in the countries of the Americas, at RIMSA VII, held in 1991, the ministers of agriculture requested the Director of PAHO to prepare a plan of action for the eradication of bovine tuberculosis. Pursuant to this mandate, an Inter-American Meeting for the Eradication of Bovine Tuberculosis was convened in Saltillo, Mexico, in November 1991, to review the situation and draw up a proposal for a regional plan of action. The table below shows the situation of bovine tuberculosis in the Americas. Current Situation Countries and Territories Number % of Bovine Tuberculosis a. Unverified or Anguilla, Antigua, Bahamas, Barbados, Bermuda, eliminated British Virgin Islands, Cuba, Dominica, Grenada, 22 55.0 St. Lucia, St. Vincent and the Grenadines, Trinidad & Tobago, Belize, Panama, United States of America, Canada, Suriname, Jamaica Guadeloupe, Haiti, Montserrat, St. Kitts & Nevis, b. Less than 1% Dominican Republic, Honduras, Costa Rica, 7 17.5 prevalence Colombia, Paraguay, Venezuela, Uruguay c. Prevalence of Argentina, Brazil, Bolivia, Chile, Ecuador, El 1% or more Salvador, Guatemala, Guyana, Mexico, Nicaragua, 11 27.5 Peru. TOTAL 40 100.0 0 The situation may generally be summarized by pointing out that of the 423 million heads of cattle in the Americas, 208 million are in countries and areas free from tuberculosis or with a low free prevalence of the disease. The remaining 255 million are in countries with prevalences higher than 1%. INPPAZ has acted as a reference laboratory for the production and standardization of reagents for laboratory and field diagnosis. INPPAZ was designated by the World Health Organization as an international reference laboratory for BCG vaccines used in o

Page 11 human tuberculosis vaccination programs. At the present time it is the only laboratory in the world in which the quality and potency of this vaccine is certified by WHO. 3.3.4 Other Zoonoses In compliance with specific requests from the countries, technical cooperation was provided on other zoonoses of economic and public health importance, such as bovine and caprine brucellosis, leptospirosis, hydatidosis, and the equine encephalitides. Collaboration was provided in reference activities for diagnosis, production, and standardization of biologicals and reagents, and a regional plan for epidemiological surveillance of equine encephalitides is being planned jointly with CDC and the United States Army Research Institute of Infectious Diseases (USAMRIID). Technical cooperation was also provided in emerging situations, namely: Plague. As a result of an outbreak of plague in Peru in October 1992, collaboration was provided in epidemiological characterization of this zoonosis,_ identification of the risk indicators, and strengthening the information and notification and laboratory diagnosis systems. Anthrax. As part of the technical cooperation program to strengthen the animal health service in Haiti, a program was set up jointly with the United States Government to expand livestock vaccination coverage for this zoonosis and provide health education regarding this problem. At the beginning of January 1995 an outbreak of cutaneous anthrax occurred in Callao, Peru, that affected 32 people who had eaten meat from cattle stricken with this disease. PAHO cooperated with epidemiological research and the formulation of a program to control the emergency. Malta Fever. This disease is concentrated in certain areas of Argentina, Mexico, and Peru. In Mexico and Peru, nomadic herds of goats are the cause of epidemic outbreaks caused by human ingestion of unpasteurized milk and fresh cheeses. The Organization has been cooperating in the distribution of diagnostic reagents and reference vaccines produced by INPPAZ. As a result of the increase in cases in Peru in 1993, a technical cooperation program was established emphasizing epidemiological surveillance, strengthening of the national and regional diagnostic reference laboratory, and the production of vaccine to control the disease in goats.

Page 12 report: Two important meetings were held at the end of the period covered by the present The Meeting of the Scientific Working Group on Progress in the Prevention, Control, and Treatment of Hydatidosis, convened at the request of Dr. Luis Alberto Lacalle, former President of Uruguay, and held in Montevideo 26-28 October 1994. The Meeting of the Working Group on the Prevention, Control, and Eradication of Brucellosis in Latin America and the Caribbean, held at INPPAZ headquarters in Buenos Aires 14-16 November 1994. - The conclusions and recommendations of these two meetings are included as special reports on the agenda of the present RIMSA IX. 3.4 Biomedical Models During the period the regional program on the conservation and rational use of nonhuman primates was continued, which is funded by USAID and the National Institutes of Health and based on the Peruvian Primatology Project (PPP) that has been in execution since 1976 under an agreement between the Government of Peru and PAHO. External evaluations of the Peruvian Primatology Project and the Regional Program carried out in 1992 and 1993 have pointed to significant results and impact, which may be summarized as follows: Reduction of exports from an annual average of 30,000 specimens prior to the project to an annual average of 585, now subject to express authorization by the Peruvian Ministry of Agriculture and solely when earmarked for use in priority biomedical research. In the period 1990-1993 the average number of annual transfers was 240. The Project has permitted the identification of species and subspecies of Amazonian primate fauna, its geographical distribution, and knowledge of the principal characteristics of its population dynamics. Captive-breeding under natural conditions on Amazonian islands controlled by the Project is contributing to a better understanding of the anatomy, physiology, nutrition, and pathology of these species and to the development of methods for the sustainable harvest of these primates. This experience is susceptible of being extended to other species of Amazon fauna and facilitates the active participation of local communities.

Page 13 Monkeys have been used largely for research on malaria, hepatitis A, ophthalmology, neurology, nutrition, and pharmacology. The hepatitis A vaccine, developed through the use of primates provided by the PPP, will be available very soon on the market. Administrative and legal arrangements were concluded for initiation of the Bolivian Primatology Project within the framework of the Regional Program. In order to transfer the technology generated by the Regional Program and exchange information on programs for conservation of primates and their rational use in biomedical research, the first meeting of the Regional Committee on Primatology for the Americas (CORP) was held in Seattle, 29-31 October 1990, which led to the publication of the meeting's proceedings, Primates of the Americas: Strategies for Their Conservation and Sustained Use in Biomedical Research. 3.5 Strengthening of Veterinary Public Health Services Pursuant to RIMSA VII resolution VIII on veterinary public health, and with a view to seeking continuity in veterinary public health activities in the national area, a meeting of experts was held in January 1992 in Blacksburg, Virginia, to enhance public health teaching in Latin American schools of veterinary medicine. The participants agreed to conduct a prospective study that would orient higher education according to the countries' social, political, and economic context; the study began in August 1992 and was completed in 24 schools. During RIMSA VIII, the ministers (Resolution VIII on Health and Development in the Subregional Integration Initiatives) discussed modernization of the public services and its possible impact on both animal production and health and the production and distribution of food, requesting the Director of PAHO to carry out case studies in various countries. The studies were initiated in six countries: Argentina, Colombia, Costa Rica, Mexico, Jamaica and Peru. Pursuant to the request of the ministers, a Regional Seminar on Alternative Models for the Organization of Official Veterinary Services was organized jointly with FAO in Acapulco, Mexico, in October 1994, during which nondelegable and delegable functions of the State were defined with regard to animal health programs. Support continued to be provided for laboratories involved in diagnosis, production, and quality control of biologicals in the Region. In particular, a project was prepared for development of the Central Veterinary Laboratory of the Dominican Republic through coordination between the ministries of health and agriculture and the livestock producers. In similar manner, the laboratory services of the General Department of Livestock Services (DIGESEPE) of Guatemala were enhanced.

Page 14 In response to a request by the ministers of agriculture and public health of the English-speaking Caribbean countries, (RIMSA VII and VIII Resolutions IX and X, respectively) a Five-year Strategic Plan for the Strengthening and Development of Veterinary Public Health was formulated in the Caribbean. Meetings for scientific updating were held, reference biologicals and reagents were supplied, and technical cooperation in food protection was expanded to fulfill the unique and special needs of the Caribbean. Jointly with CARICOM, the Five-year Strategic Plan is being finalized to mobilize the resources necessary for its implementation. 3.6 Contribution to Other PAHO Program Priorities for 1991-1994 The HCV Program has organized its technical cooperation activities in accordance with to the priorities of the Organization and the countries. A contribution has been made to health and the environment through the promotion of policies and the dissemination of information on veterinary public health problems with regard to urbanization and agricultural and livestock production. A workshop for the Caribbean countries was held to study the problem of contamination caused by animal production. In conjunction with the Division of Environmental Sanitation, a proposal was prepared for a regional plan for control of the use of pesticides in the Americas, which has been promoted at the political level in the countries. Through the Regional Program on Primatology, policies are being promoted and methodologies developed for comprehensive conservation of wilderness areas. Programming integration has been achieved in food and nutrition with the Institute of Nutrition of Central America and Panama (INCAP) for the delivery of technical cooperation in food protection in the subregion of Central America and Panama. The activities carried out by the Regional Food Protection Program to develop the countries' capacity to guarantee basic food quality and hygiene to the population already constitute a significant contribution. Support of the Program was significant in reducing the risks of transmission of cholera in food sold by street vendors and promoting international trade of food. The programs for elimination of rabies, eradication of foot-and-mouth disease and the initiative to eradicate bovine tuberculosis in the Americas are a credit to the experience and achievements of the HCV Program in controlling and eliminating preventable diseases. The method developed by PANAFTOSA to characterize livestock production ecosystems and stratify risks for the implementation of programs for the eradication and prevention of foot-and-mouth disease have served as models for other diseases. Community organization and participation of the producers in animal health activities in

Page 15 the locality of San Patricio, Paraguay, have been put to good use in the installation of an electric power and sewerage network to improve the living conditions of the population. The activities carried out to prevent diarrheal diseases of food origin and the efforts to combat toxoplasmosis are examples of the contribution made to maternal and child health. With regard to workers' health, the HCV Program has taken significant initiatives. A forum was presented in RIMSA VmI on the health of agricultural and livestock workers in which various risks were studied and specific recommendations made to enlist the health and agriculture sectors in the search for solutions. Surveillance and control have continued of the principal occupational zoonoses, such as brucellosis and leptospirosis. Similarly, by recommendation of the ministers in RIMSA VIII, a proposal has been prepared for a regional plan for the prevention of accidents caused by venomous animals, which occur most frequently among agricultural and livestock workers. INPPAZ continued its study on tuberculosis and other mycobacterial infections in immunocompromised individuals, such as AIDS patients. The Program's activities in developing biomedical models for research and quality control of biologicals and drugs has helped significantly by providing animal models for behavioral studies in addiction to certain drugs.