Contents Abbreviations and Acronyms ..................................................................................................................................................... 11 ContentsExecutive Summary ............................................................................................................. ........................................................... 3 15 AbbreviationsFigures ....................................................................................................................... and Acronyms .......................................................................... 1120 ExecutiveTables ....................................................................................................................... Summary ........................................................................... 10 24 FiguresSection 1 Regional Health Overview ........................................................................................... ......................... 20 25 Tables1.1 Demographics .............................................................................................................. ............................................................. 23 27 Section 1.1.1 The1 Regional Caribbean Health Region Overview ................................................................................................... ............................................... 2527 1.1.1.1 Demographic overview of CARPHA Member States ............................................................................... 28 1.1 Demographics 27 1.1.2 Migration ........................................................................................................................................................................... 34 1.1.1 The Caribbean Region 27 1.2 Socio-Economic Profile .......................................................................................................................................................... 35 1.1.1.1 Demographic overview of CARPHA Member States 28 1.2.1 Gross Domestic Product (GDP) Per Capita ............................................................................................................ 35 1.2.2 Health 1.1.2Expenditure Migration Data for CARPHA Member States ....................................................................... ..............34 41 1.3 Mortality1.2 – LeadingSocio-Economic Causes Profileof Death ....................................................................................... ......................................... 4735 1.3.1Leading1.3 Mortality Causes of– Leading Death in Causes CARPHA of Death Member States (CMS) ................................................................... ........47 47 1.3.2 Conditions1.3.2 Causing Conditions Death Causing in the English Death in and the DutchEnglish -speak and Dutching Caribbean, -speaking Caribbean, 2000-2012 ...................... 47 47 1.3.3 Conditions Causing2000-2012 Death in Haiti ........................................................................................................................... 56 1.3.4 Challenges1.3.3 and Conditions Limitations Causing ............................................................................................. Death in Haiti ........................................... 5660 1.3.5 CARPHA’s1.3.4 Role .......................................................................................................... Challenges and Limitations ....................................................... 6060 References ....................................................................................................................1.3.5 CARPHA’s Role ..................................................................... 60 61 Section References 61 2 Communicabl e Diseases ........................................................................................................................ 63 Section2.1 Diseases 2 Communicable of Endemic Potential Diseases ............................................................................................. ............................................... 6365 2.1.1 Vector-borne Diseases ................................................................................................................................................. 65 2.1 Diseases of Endemic Potential 65 2.1.1.1Chikungunya ........................................................................................................................................................... 65 2.1.1 Vector-borne Diseases 65 2.1.1.2 Dengue .................................................................................................................................................................... 65 2.1.1.3 Malaria .............................................................................................................2.1.1.1 Chikungunya ......................................................... 6568 2.1.1.4 Leptospirosis 2.1.1.2 ....................................................................................................... Dengue ................................................... 6570 2.1.2 Vector-borne Disease2.1.1.3 ControlMalaria ........................................................................................... ........................................ 6870 2.1.3 CARPHA Recommendations2.1.1.4 Leptospirosis and Role in Controlling Vector-borne Diseases ......................................... 7071 2.2 Foodborne Dis2.1.2eases Vector-borne ........................................................................................................ Disease Control ........................................................ 7072 2.2.1 Food security,2.1.3 FoodCARPHA safety Recommendations and Foodborne and Di seasesRole in ......................................................................Controlling Vector-borne Diseases ................. 7172 2.2.22.2 Food safetyFoodborne and Foodborne Diseases Diseas es Surveillance in the Caribbe an ....................................................... .. 7273 2.2.3 Foodborne2.2.1 DiseaseFood Trsecurity,ends, Caribbea Food safetyn, 2005-2012and Foodborne ......................................................................... Diseases .................. 72 74 2.2.3.1 Salmonellosis2.2.2 Food in safety the Caribbean, and Foodborne 2005-2012 Diseases ........................................................................... Surveillance in the Caribbean .................... 7375 2.2.3.2 Salmonella2.2.3 Foodborne Serotypes Disease Trends Trends, ......................................................................................... Caribbean, 2005-2012 ................................. 7475 2.2.3.3 Ciguatera (fish toxin) Poisoning ..................................................................................................................... 77 2.2.3.1 Salmonellosis in the Caribbean, 2005-2012 75 2.2.3.4 Shigellosis and Campylobacteriosis .............................................................................................................. 77 2.2.3.2 Salmonella Serotypes Trends 75 2.2.3.5 Norovirus ................................................................................................................................................................. 78 2.2.4 Conclusions and2.2.3.3 Recommendations Ciguatera (fish ........................................................................................ toxin) poisoning .............................. 7877 2.2.5 Limits/ Challenges2.2.3.4 ..................................................................................................... Shigellosis and Campylobacteriosis .................................................... 77 79 2.2.6 CARPHA’s Role 2.2.3.5Going ForwardNorovirus ............................................................................................ ...................................... 78 79 2.3 Respiratory Viral2.2.4 IllnessConclusions ................................................................................................. and Recommendations ......................................................... 78 80 2.3.1 Background2.2.5 .............................................................................................................Limits/ Challenges ......................................................... 79 80 2.3.2 Data Trends2.2.6 ............................................................................................................CARPHA’s Role (Going Forward) .......................................................... 7980 2.3.2.12.3 AcuteRespiratory Respiratory Viral Illness Illness ........................................................................................... ........................................ 80 80 2.3.2.2 Severe2.3.1 AcuteBackground Respiratory Illness .................................................................................... ................................. 80 82 2.3.2.3 Respiratory2.3.2 Data Virus Trends Trends ............................................................................................ ........................................ 8084 2.3.2.4 Emerging 2.3.2.1Respiratory Acute Viruses Respiratory ........................................................................................ Illness .................................. 8087 3 3.2 Nutrition ...................................................................................................................................................................................... 139 2.3.3