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1st LATIN AMERICA COUNTRIES MEETING - BRIEF REPORT INSTITUTO LATINOAMERICANO DE SEPSIS - ILAS

SÃO PAULO MAY 30^th 2018

Context

Sepsis is one of the major causes of death worldwide. Although recent data suggest that mortality rates are decreasing in developed countries, the current situation in low and middle-income countries is uncertain. There is a paucity of data and the few high-quality studies suggest that the sepsis burden is substantial and mortality rates are unacceptably high. In Latin America, most countries are middle-income and face common challenges tackling sepsis. Social inequality with no universal access to qualified public health, limitation in resources and ICU availability, shortage and limited qualification of healthcare workers and low awareness among lay people are common issues. Government policies to tackle the burden of sepsis are generally lacking.

At the Seventieth World Health Assembly in May 2017, Member States of the World Health Organization (WHO) adopted a resolution (WHA70.7) on improving the prevention, diagnosis and treatment of sepsis. The resolution requested WHO to develop guidance for the prevention and management of sepsis, to produce a report on the epidemiology and burden of sepsis, and to support countries to obtain the necessary infrastructure, laboratory capacity, strategies and tools to address sepsis

The Instituto Latinoamericano de Sepsis, ILAS, also known as the Latin America Sepsis Institute (LASI) convened a Latin America (LATAM) countries meeting. This meeting was a joint initiative with the Global Sepsis Alliance and supported by the Pan America Health Organization (PAHO). The main objectives of the meeting were to identify common problems and to move the agenda on sepsis in LATAM countries forward in accordance with the WHO resolution.

The meeting brief report

The participants were welcome by the ILAS president, Dr Luciano Azevedo who presented the proposed agenda (Appendix 1). Representatives of Argentina, Chile, Colombia, Mexico, Peru, Uruguay were present. A representative of the Consorcio Centroamericano y Del Caribe de Terapia Intensiva (COCECATI) was also present representing the following countries: Belize, Guatemala, El Salvador, Costa Rica, Nicaragua, Panama, Dominican Republic, Puerto Rico and Cuba. The Pan America Health Organization was represented by Pilar Ramon-Pardo from the Central Office in Washington and Romina Oliveira from PAHO office in Brazil. Simon Finfer and Niranjan Kissoon represented the Global Sepsis Alliance. The complete list of participants, including Brazilian members of ILAS, is available at the end of this document (Appendix 2).

After a brief introduction of the ILAS activities over the last 10 years, each of the participants presented data and the status of sepsis awareness and activities in their own country. A PDF version of all presentations is available at ILAS website. The main message was that our countries, regardless of their economic profile, share similar issues of absence of reliable data, low awareness among healthcare professionals and lay people, inadequacy of diagnosis and treatment, lack of preventative strategies and inadequate support for survivors and families. There are currently no national action policies available and quality improvement strategies are incipient in many of the countries.

The presentation of the WHO resolution clarified potential pathways and issues that need to be addressed to change the sepsis scenario in LATAM countries. This was followed by the Global Sepsis Alliance reinforcing the relevance of forming regional alliances through which individual countries can work together to seek common solutions and which provides stronger advocacy that single countries working alone. The participants acknowledged the importance of working as a supranational union and how this could facilitate their own local efforts.

The PAHO presentation clarified all the potential partnerships that could be explored between ILAS and PAHO. Potential projects would be training courses, awareness campaigns and endorsements of ILAS initiatives.

In open discussion an action plan including the following was agreed:

To approve the “Sao Paulo Declaration” with the main requests from the group directed to government authorities, policy makers, healthcare managers, healthcare professionals, and associated societies to support national and international commitments to improve the prevention, diagnosis, and treatment of sepsis and to dedicate human and financial resources to these goals.
To make the declaration available on the ILAS website to be endorsed by individuals and by the major societies in LATAM countries, including those from intensive care, pediatrics, emergency medicine, internal medicine, infections disease, nursing and other allied professionals.
To request Global Sepsis Alliance support to spread Sao Paulo Declaration in its network to enhance the numbers of endorsements by other countries.
In conjunction with the GSA to draft a press release to be distributed in all countries represented at the meeting.
To publish the declaration in all possible scientific journals in LATAM countries and in a major international journal if feasible, accompanied by a perspective-type article noting the gaps in knowledge and treatment and the high mortality rates documented in some LATAM countries.
To plan a training course in Spanish, under the umbrella of PAHO focused on the limited-resources settings of Latin America
To plan common strategies to raise awareness around the 2019 World Sepsis Day using ILAS materials, including to advertise the 2^nd World Sepsis Congress, a free web congress in September 2018 organized by GSA.
To have quarterly webex meetings in which the progress in each country would be reported and an annual meeting prior to the ILAS annual conference being the next on May 8^th – 9^th 2019 in Rio de Janeiro.

Closing

Dr Luciano Azevedo (ILAS president) thanked all participants for their active contributions to this meeting. Participants welcomed the fact that we will have the chance to work together, to share experiences, successes and remaining challenges. All participants acknowledge the importance of having GSA and PAHO as partners in this initiative and described the meeting as a major step forward in the fight against sepsis in LATAM countries.