ABSTRACT Introduction: The first cases of COVID-19 were identified in Cuba on March 11, 2020. The peak of the curve occurred on April 24 with 849 active cases, decreasing in May. Three waves occurred, the first from March 11 to July 19, 2020, with a peak of 847 active cases. The second from the beginning of September until November 19 with a peak of 676 active cases and the third from that date and continues in July 2021. Objective: To explore the epidemiological and social conditions that occurred in Cuba in July 2021. Methods: Descriptive quantitative-qualitative research. The historical-logical method was followed, supported by the documentary review technique. The daily reports published by the Ministry of Public Health of Cuba, corresponding to the days between July 1 and 31, 2021, were reviewed. Tables and graphs were prepared. Results: All provinces presented infections, with a notable increase from January 2021 onwards. Surveillance with PCR of suspects and contacts was maintained. There was an increase in mortality and greater involvement of children and young people. Conclusions: July 2021 was the month with the worst indicators. Diagnostic tests and molecular biology laboratories increased significantly. Control measures were implemented according to the severity of the situation in each territory. Disease care protocols were periodically updated. Vaccination of the population was initiated.

RESUMEN Introducción: En Cuba se identificaron los primeros casos de COVID-19 el 11 de marzo del 2020. El acmé de la curva ocurrió el 24 de abril con 849 casos activos, cifra que descendió en mayo. Se presentaron tres olas, la primera desde el 11 de marzo hasta el 19 de julio del 2020, con un pico de 847 casos activos. La segunda desde principios de septiembre hasta el 19 de noviembre, con un pico de 676 casos activos y la tercera desde esa fecha y se mantuvo en julio del 2021. Objetivo: Explorar las condiciones epidemiológicas y sociales que ocurrieron en Cuba en el mes de julio del 2021. Métodos: Investigación descriptiva cuanti-cualitativa. Se siguió el método histórico-lógico, apoyados en la técnica de revisión documental. Se revisaron los partes diarios publicados por el Ministerio de Salud Pública de Cuba, correspondientes a los días entre el 1 y el 31 de julio de 2021. Se confeccionaron tablas y gráficos. Resultados: Todas las provincias presentaron contagios, con notable incremento a partir de enero 2021. Se mantuvo la vigilancia con PCR a sospechosos y contactos. Hubo un aumento de la mortalidad y mayor afectación de niños y jóvenes. Conclusiones: El mes de julio del 2021 fue el de peores indicadores. Se incrementaron notablemente los test diagnósticos y los laboratorios de biología molecular. Se implantaron medidas de control según la gravedad de la situación de cada territorio. Se actualizaron periódicamente los protocolos de atención a la enfermedad. Se inició la vacunación a la población.

Abstract Cuba has a long tradition of controlling epidemics. In Cuba, this occurred with covid-19 six months after it started. Different measures were taken to control the pandemic: various community interventions, the isolation of suspected cases and of people returning from overseas, the application of therapeutic strategies. The first phase of the epidemic peaked in late April and the highest number of cases was seen in May. The epidemic was under control in June and July. Cases began to de-escalate in mid-June. There was a rise in cases in the month of August, which was interpreted as another outbreak.

Resumen Cuba tiene una larga tradición en el control de epidemias. En Cuba, se presentó la situación de la covid-19 seis meses después de su comienzo. Se tomaron medidas diferentes para controlar la pandemia: diversas intervenciones comunitarias, el aislamiento de contactos de casos sospechosos y de personas regresando del extranjero, la aplicación de estrategias terapéuticas. La primera fase epidémica tuvo un pico a finales de abril y en mayo presentó el mayor número de casos acumulados. Hubo un control de la epidemia en junio y julio. Se inició la desescalada a mediados de junio. Se constató un aumento de casos en el mes de agosto, que se interpreta como un rebrote de la misma.

ABSTRACT The containment measures taken during the second month of the presence of COVID-19 in Cuba are presented in this work and their effectiveness is analyzed. For the study, the logical historical method was used, based on the technique of documentary review. The daily reports published by the Ministry of Public Health which are available on the official website of the National Center of Medical Sciences´ Information and Cubadebate (alternative information medium) from April 10 to May 9, 2020 were reviewed. It was concluded that the studied period corresponds to the most intense days of the epidemic in Cuba, until that date. It was managed to predict the peak of the epidemic, in almost a month, a fact that demonstrates the relevance of the epidemiological and social control measures that were implemented. The strategy of monitoring suspects and contacts, as well as the early admission and treatment of confirmed cases, favored the achievement of a high percentage of recovered cases, low mortality, and a 4.4% lethality.

RESUMEN Se presentan las medidas de contención tomadas durante el segundo mes de la presencia de la COVID-19 en Cuba y se analiza su efectividad. Para el estudio se aplicó el método histórico lógico, sustentado en la técnica de la revisión documental. Se revisaron los partes diarios publicados por el Ministerio de Salud Pública disponibles en el sitio web oficial del Centro Nacional de Información de Ciencias Médicas y Cubadebate (medio de información alternativo), entre el 10 de abril y el 9 de mayo del 2020. Se concluye que el periodo de estudio corresponde con los días de mayor intensidad de la epidemia en Cuba, hasta esa fecha. Se logró adelantar el pico de la epidemia, en casi un mes, hecho que demuestra la pertinencia de las medidas de control tanto epidemiológicas y sociales que se implementaron. La estrategia de vigilancia de los sospechosos y contactos, así como el ingreso precoz y tratamiento de los casos confirmados, permitieron el logro de un elevado porcentaje de casos recuperados y una escasa mortalidad, con cifras de letalidad de 4,4 %.

ABSTRACT Introduction: COVID-19 is a viral respiratory disease produced by SARS-CoV-2. The first cases were diagnosed in Wuhan, China in December 2019; then the disease became a pandemic. The WHO declared it a global emergency on January 30, 2020. General data on the epidemic in Cuba, Australia and New Zealand are presented. Objective: To present the evolution of the epidemic in these countries as well as the measures taken and their results. Material and Methods: A descriptive, quantitative and qualitative research used documentary review to compare information about the epidemic in the selected countries. The information was obtained from medical journals, periodical press, and official websites and it was analyzed before June 13. Results: Australia had 7,283 cases of which 6,888 (94.48%) patients recovered. They performed 1,782,651 diagnostic tests (69.91 per 10,000 inhabitants) and the positivity was 0.4%. They reported 102 deaths with higher rates in people aged 70 - 89 years, and a case fatality of 1.39%. New Zealand reported 1,515 cases, with 1,483 recovered (97.8%) and 22 deaths. They performed 310,297 (36 per 10,000 population) PCR tests, with 0.7% positive cases. The case fatality was 1.9%. Cuba accumulated 2,238 cases and 1,923 (86%) recovered. A total of 84 patients died, with a lethality of 3.75%. PCR tests (12.16 x 10,000 inhabitants) were performed reporting 1.7% of positive cases. Conclusions: The control resulted from the political will to confront and contain the epidemic with drastic measures of social distancing, closure of borders and isolation of territories, application of diagnostic tests, and the existence of robust and free public health systems.

RESUMEN Introducción: La COVID-19, enfermedad respiratoria viral, producida por el SARS- CoV- 2, los primeros casos aparecieron en Wuhan, China, en diciembre 2019, evolucionó a pandemia. La OMS declaró emergencia mundial el 30 de enero del 2020. Se presentan los datos generales de la epidemia en Cuba, Australia y Nueva Zelandia. Objetivo: Describir la evolución de la epidemia en dichos países, las medidas tomadas y sus resultados. Material y Métodos: Investigación descriptiva, cuanti - cualitativa, utilizó la revisión documental, para cotejar información publicada sobre la epidemia en los países seleccionados, en revistas médicas, prensa periódica, sitios web oficiales. Se analizó información hasta el 13 de junio. Resultados: Australia tuvo 7 283 casos, 6 888 (94,48 %) recuperados. Realizaron 1 782 651 test diagnósticos (69,91 por 10 000 habitantes) y positividad de 0.4 %. Reportaron 102 fallecidos, mayores tasas entre 70 - 89 años, letalidad de 1,39 %. Nueva Zelandia totalizó 1 515 casos, con 1 483 recuperados (97,8 %), fallecieron 22. Realizaron 310 297 (36 por 10 000 habitantes) pruebas de PCR, con 0,7 % de positivos. La letalidad fue de 1,9 %. Cuba, acumulaba 2 238 casos, recuperados 1 923 (86 %). Fallecieron 84 pacientes, con letalidad de 3,75 %. Realizaron PCR (12,16 x 10 000 hab.), con 1,7 % positivas. Conclusiones: El control resultó de la voluntad política de enfrentar y contener la epidemia con drásticas medidas de distanciamiento social, cierre de fronteras y aislamiento de territorios, aplicación de test diagnósticos, y la existencia de sistemas de salud públicos robustos y gratuitos.

ABSTRACT Introduction: At the end of the second decade of the 20th century, between the years 1918 and 1919, there was a global outbreak of influenza known as "Spanish flu". In Cuba, it caused a high morbidity and mortality, which led to a great concern in the population and the health authorities of the country. Objective: To characterize the 1918-1919´s influenza epidemic in Cuba by analysing the documents preserved on its evolution and preventive measures. Methods: A qualitative research was carried out by performing a documentary analysis as a procedure for the implementation of the historical-logical theoretical method. There were reviewed statistics, articles, guidelines and plans of confrontation to the epidemic, and also reports on its control issued by the Health´s Directorate. Results: The epidemic was intense until early 1919; then it had some outbreaks with a relative frequency, but in a most benign form, until 1920. The morbidity data have records from 1942, with higher figures in 1957 (rate of 1419,86 x 105 inhabitants); 1951 (6.92 x 105 inhabitants); 1947 (5.88 x 105 inhabitants). The higher mortality rate corresponded to the years 1918-1920 (193.92 x 105 inhabitants; 50.11 and 47.46, respectively). Conclusions: The 1918´s Influenza Epidemic caused in Cuba a high morbidity and mortality. Adequate contingency plans were developed to halt it, according to its nature and the development of scientific knowledge at the time.

RESUMEN Introducción: A finales de la segunda década del siglo XX, entre los años 1918 y 1919, a nivel mundial se propagó la pandemia de influenza que se conoce como “gripe española”. En Cuba causó una elevada morbilidad y mortalidad, lo que motivó una gran preocupación en la población y las autoridades sanitarias del país. Objetivos: Caracterizar la epidemia de gripe de 1918-1919 en Cuba a partir del análisis de los documentos que se conservan sobre su evolución y medidas preventivas. Método: Se realizó una investigación cualitativa a partir del análisis documental como procedimientos para la aplicación del método teórico histórico-lógico. Se revisaron estadísticas, artículos, directrices y planes de enfrentamiento a la epidemia, de la dirección de Sanidad, e informes sobre su control. Resultados: Entre 1918 y 1920, se reportó la mayor mortalidad en Cuba por gripe. La morbilidad se recoge desde 1942, con cifra mayor en 1957 (tasa de 1419.86 x 105 habitantes), 1951 (6.92 x 105 habitantes), 1947 (5.88 x 105 habitantes). La mortalidad más elevada correspondió a los años 1918- 1920 (193,92 x 105 habitantes; 50,11 y 47,46). Conclusiones: La epidemia de gripe de 1918, causó en Cuba una elevada morbilidad y mortalidad, se elaboraron planes adecuados de contingencia para frenarla, de acuerdo a su naturaleza y al desarrollo de los conocimientos científicos del momento.

ABSTRACT Introduction: At the end of the second decade of the 20th century, between the years 1918 and 1919, there was a global outbreak of influenza known as "Spanish flu". In Cuba, it caused a high morbidity and mortality, which led to a great concern in the population and the health authorities of the country. Objective: To characterize the 1918-1919´s influenza epidemic in Cuba by analysing the documents preserved on its evolution and preventive measures. Methods: A qualitative research was carried out by performing a documentary analysis as a procedure for the implementation of the historical-logical theoretical method. There were reviewed statistics, articles, guidelines and plans of confrontation to the epidemic, and also reports on its control issued by the Health´s Directorate. Results: The epidemic was intense until early 1919; then it had some outbreaks with a relative frequency, but in a most benign form, until 1920. The morbidity data have records from 1942, with higher figures in 1957 (rate of 1419,86 x 105 inhabitants); 1951 (6.92 x 105 inhabitants); 1947 (5.88 x 105 inhabitants). The higher mortality rate corresponded to the years 1918-1920 (193.92 x 105 inhabitants; 50.11 and 47.46, respectively). Conclusions: The 1918´s Influenza Epidemic caused in Cuba a high morbidity and mortality. Adequate contingency plans were developed to halt it, according to its nature and the development of scientific knowledge at the time.

RESUMEN Introducción: A finales de la segunda década del siglo XX, entre los años 1918 y 1919, a nivel mundial se propagó la pandemia de influenza que se conoce como “gripe española”. En Cuba causó una elevada morbilidad y mortalidad, lo que motivó una gran preocupación en la población y las autoridades sanitarias del país. Objetivos: Caracterizar la epidemia de gripe de 1918-1919 en Cuba a partir del análisis de los documentos que se conservan sobre su evolución y medidas preventivas. Método: Se realizó una investigación cualitativa a partir del análisis documental como procedimientos para la aplicación del método teórico histórico-lógico. Se revisaron estadísticas, artículos, directrices y planes de enfrentamiento a la epidemia, de la dirección de Sanidad, e informes sobre su control. Resultados: Entre 1918 y 1920, se reportó la mayor mortalidad en Cuba por gripe. La morbilidad se recoge desde 1942, con cifra mayor en 1957 (tasa de 1419.86 x 105 habitantes), 1951 (6.92 x 105 habitantes), 1947 (5.88 x 105 habitantes). La mortalidad más elevada correspondió a los años 1918- 1920 (193,92 x 105 habitantes; 50,11 y 47,46). Conclusiones: La epidemia de gripe de 1918, causó en Cuba una elevada morbilidad y mortalidad, se elaboraron planes adecuados de contingencia para frenarla, de acuerdo a su naturaleza y al desarrollo de los conocimientos científicos del momento.

ABSTRACT Introduction: The bubonic plague affected much of the world in the first half of the twentieth century, causing from small outbreaks to large epidemics. In Cuba, it appeared twice in 1912 and in 1914 causing some morbidity and mortality. Objective: To rescue the history of bubonic plague’s epidemics in Cuba. Methodology: Qualitative, using as theoretical methods the historical- logic and the documentary analysis. Statistics were reviewed in the Department of Statistics and Medical Records of the Ministry of Public Health, in articles of the time, in guidelines and plans to confront the epidemic established by the National Department of Health of the Secretariat of Health and Charity, and also reports written by the health workers who participated in the control strategies of this disease. Results: In 1912, there were outbreaks in Havana, Santiago de Cuba and Pinar del Rio imported from the Canary Islands. In the second epidemic in 1914 that was eradicated in 1915, there were 68 cases and 23 deaths. A control strategy was designed, which included the entry and isolation of the suspects, surveillance of the residents in the area, collection of rats, disinfection, sanitation and deratization of the affected area. Conclusions: The measures taken were timely and efficient for controlling the epidemic. No more cases have occurred since July, 1915.

RESUMEN Introducción: La peste bubónica afectó a gran parte del mundo en la primera mitad del siglo xx, causando desde pequeños brotes a grandes epidemias. En Cuba se presentó en dos oportunidades, en 1912 y en 1914, causando alguna morbimortalidad. Objetivo: Rescatar la historia de las epidemias de peste bubónica en Cuba. Metodología: Cualitativa, utilizando como métodos teóricos el histórico-lógico y el análisis documental. Se revisaron estadísticas en el Departamento de Estadísticas y Registros Médicos del Ministerio de Salud Pública, artículos de la época, directrices y planes de enfrentamiento a la epidemia orientados por el Departamento Nacional de Sanidad, de la Secretearía de Sanidad y Beneficencia, e informes redactados por los sanitaristas que trabajaron en su control. Resultados: En 1912 existieron brotes en La Habana, Santiago de Cuba y Pinar del Río, importada de las Islas Canarias. Durante la segunda epidemia en 1914, erradicada al año siguiente, se produjeron 68 casos y 23 fallecidos. Se diseñó una estrategia de lucha que incluyó, desde el ingreso y aislamiento de los sospechosos, vigilancia de los residentes en la zona, recogida de ratas, hasta desinfección, saneamiento y desratización de la zona afectada. Conclusiones: Las medidas tomadas fueron oportunas y eficientes, controlando la epidemia. No se produjeron más casos desde julio de 1915.

ABSTRACT Introduction: The bubonic plague affected much of the world in the first half of the twentieth century, causing from small outbreaks to large epidemics. In Cuba, it appeared twice in 1912 and in 1914 causing some morbidity and mortality. Objective: To rescue the history of bubonic plague’s epidemics in Cuba. Methodology: Qualitative, using as theoretical methods the historical- logic and the documentary analysis. Statistics were reviewed in the Department of Statistics and Medical Records of the Ministry of Public Health, in articles of the time, in guidelines and plans to confront the epidemic established by the National Department of Health of the Secretariat of Health and Charity, and also reports written by the health workers who participated in the control strategies of this disease. Results: In 1912, there were outbreaks in Havana, Santiago de Cuba and Pinar del Rio imported from the Canary Islands. In the second epidemic in 1914 that was eradicated in 1915, there were 68 cases and 23 deaths. A control strategy was designed, which included the entry and isolation of the suspects, surveillance of the residents in the area, collection of rats, disinfection, sanitation and deratization of the affected area. Conclusions: The measures taken were timely and efficient for controlling the epidemic. No more cases have occurred since July, 1915.

RESUMEN Introducción: La peste bubónica afectó a gran parte del mundo en la primera mitad del siglo xx, causando desde pequeños brotes a grandes epidemias. En Cuba se presentó en dos oportunidades, en 1912 y en 1914, causando alguna morbimortalidad. Objetivo: Rescatar la historia de las epidemias de peste bubónica en Cuba. Metodología: Cualitativa, utilizando como métodos teóricos el histórico-lógico y el análisis documental. Se revisaron estadísticas en el Departamento de Estadísticas y Registros Médicos del Ministerio de Salud Pública, artículos de la época, directrices y planes de enfrentamiento a la epidemia orientados por el Departamento Nacional de Sanidad, de la Secretearía de Sanidad y Beneficencia, e informes redactados por los sanitaristas que trabajaron en su control. Resultados: En 1912 existieron brotes en La Habana, Santiago de Cuba y Pinar del Río, importada de las Islas Canarias. Durante la segunda epidemia en 1914, erradicada al año siguiente, se produjeron 68 casos y 23 fallecidos. Se diseñó una estrategia de lucha que incluyó, desde el ingreso y aislamiento de los sospechosos, vigilancia de los residentes en la zona, recogida de ratas, hasta desinfección, saneamiento y desratización de la zona afectada. Conclusiones: Las medidas tomadas fueron oportunas y eficientes, controlando la epidemia. No se produjeron más casos desde julio de 1915.

ABSTRAC Introduction: The main aspects of the professional work of Dr. Guiteras in relation to Cuban health are described. Objective: To present the hygienic-epidemiological situation during Juan Guiteras' work period and the main control activities carried out under his management. Method: The logical- historical method was followed and this was supported by the technique of documentary revision. Statistical analyzes of the major epidemics occurring in Cuba between 1900 and 1925 (in the National Statistics Office of MINSAP), documents of the Office of the Public Health’s Historian, and scientific articles of the time were reviewed. Results: It refers to the evolution of public health in that period. The main epidemics occurred: smallpox, malaria, yellow fever, poliomyelitis, bubonic plague, 1918-1919 influenza, and tuberculosis. These were characterized by high morbidity and mortality. The institutional response to the epidemics was successful and appropriate: it allowed the eradication of yellow fever (1908), bubonic plague (1915), smallpox (1923), and reduced morbidity and mortality of influenza, tuberculosis and typhoid fever, as well as polio and malaria. Conclusions: Guiteras has a decisive participation in the control of the epidemics, as well as in the control of the health of the Island from his high positions in the field. The institutional response to the epidemics are successful and appropriate taking into account the resources and scientific advances they has.

RESUMEN Introducción: Se describen los principales aspectos de la labor profesional del doctor Guiteras en relación con la sanidad cubana. Objetivo: Presentar la situación higiénico-epidemiológica durante la época de trabajo de Juan Guiteras y las principales actividades de control realizadas bajo su dirección. Método: Se siguió el método histórico lógico, apoyado en la técnica de la revisión documental. Se revisaron estadísticas de las principales epidemias ocurridas en Cuba entre 1900 y 1925 existentes en la Dirección Nacional de Estadísticas del Ministerio de Salud Pública, documentos de la Oficina del Historiador de la Salud Pública, y artículos científicos del período. Resultados: Se refiere la evolución de la salud pública la época. Las principales epidemias ocurridas: viruela, paludismo, fiebre amarilla, poliomielitis, peste bubónica, la gripe de 1918-1919 y la tuberculosis. Estas enfermedades se caracterizaron por una alta morbilidad y mortalidad. La respuesta institucional ante las epidemias fue acertada y oportuna: permitió erradicar la fiebre amarilla (1908), la peste bubónica (1915), la viruela (1923) y disminuir la morbilidad y mortalidad de la gripe, la tuberculosis y la fiebre tifoidea, la poliomielitis y el paludismo. Conclusiones: Guiteras tiene una participación decisiva en el control de las epidemias, y en el control de la sanidad de la Isla, desde sus altos cargos en el ramo. La respuesta institucional ante las epidemias es acertada y oportuna a partir de los recursos y avances científicos con los que contaban.

ABSTRAC Introduction: The main aspects of the professional work of Dr. Guiteras in relation to Cuban health are described. Objective: To present the hygienic-epidemiological situation during Juan Guiteras' work period and the main control activities carried out under his management. Method: The logical- historical method was followed and this was supported by the technique of documentary revision. Statistical analyzes of the major epidemics occurring in Cuba between 1900 and 1925 (in the National Statistics Office of MINSAP), documents of the Office of the Public Health’s Historian, and scientific articles of the time were reviewed. Results: It refers to the evolution of public health in that period. The main epidemics occurred: smallpox, malaria, yellow fever, poliomyelitis, bubonic plague, 1918-1919 influenza, and tuberculosis. These were characterized by high morbidity and mortality. The institutional response to the epidemics was successful and appropriate: it allowed the eradication of yellow fever (1908), bubonic plague (1915), smallpox (1923), and reduced morbidity and mortality of influenza, tuberculosis and typhoid fever, as well as polio and malaria. Conclusions: Guiteras has a decisive participation in the control of the epidemics, as well as in the control of the health of the Island from his high positions in the field. The institutional response to the epidemics are successful and appropriate taking into account the resources and scientific advances they has.

RESUMEN Introducción: Se describen los principales aspectos de la labor profesional del doctor Guiteras en relación con la sanidad cubana. Objetivo: Presentar la situación higiénico-epidemiológica durante la época de trabajo de Juan Guiteras y las principales actividades de control realizadas bajo su dirección. Método: Se siguió el método histórico lógico, apoyado en la técnica de la revisión documental. Se revisaron estadísticas de las principales epidemias ocurridas en Cuba entre 1900 y 1925 existentes en la Dirección Nacional de Estadísticas del Ministerio de Salud Pública, documentos de la Oficina del Historiador de la Salud Pública, y artículos científicos del período. Resultados: Se refiere la evolución de la salud pública la época. Las principales epidemias ocurridas: viruela, paludismo, fiebre amarilla, poliomielitis, peste bubónica, la gripe de 1918-1919 y la tuberculosis. Estas enfermedades se caracterizaron por una alta morbilidad y mortalidad. La respuesta institucional ante las epidemias fue acertada y oportuna: permitió erradicar la fiebre amarilla (1908), la peste bubónica (1915), la viruela (1923) y disminuir la morbilidad y mortalidad de la gripe, la tuberculosis y la fiebre tifoidea, la poliomielitis y el paludismo. Conclusiones: Guiteras tiene una participación decisiva en el control de las epidemias, y en el control de la sanidad de la Isla, desde sus altos cargos en el ramo. La respuesta institucional ante las epidemias es acertada y oportuna a partir de los recursos y avances científicos con los que contaban.

During the period extending from the 70th to the 80th anniversary of the founding of Pedro Kouri Tropical Medicine Institute, researchers, professionals and technicians from the center, in joint cooperation with a variety of Cuban academic and health care institutions, have integrated into multidisciplinary teams engaged in tasks related to scientific development, technological innovation and capacity building. The paper summarizes the main research studies about tuberculosis conducted from 2008 to 2017 as contributions to the National Tuberculosis Control and Elimination Program, with a view to enhancing the quality, effectiveness and efficiency of actions, swiftly finding a solution to tuberculosis incidence and mortality, and fostering tuberculosis research, surveillance and control. Evidence is presented which substantiates innovations in the clinical therapeutic management of both immunocompetent and immunocompromised patients, children and adolescents, and indications are provided for latent tuberculosis infection control, surveillance of anti-tuberculosis treatment outcomes, investigation of case contacts, changes in the record and information system, quality monitoring and evaluation of the detection of tuberculosis cases, and impact on morbidity and mortality.

Desde el 70 al 80 Aniversario de la fundación del Instituto de Medicina Tropical "Pedro Kourí", los investigadores, profesionales y técnicos de este centro, han laborado en cooperación con diversas instituciones académicas y de los servicios de salud de Cuba (en equipos multidisciplinarios) en las tareas de desarrollo científico, innovación tecnológica y construcción de capacidades. Este artículo resume las principales investigaciones realizadas sobre la tuberculosis desde 2008-2017; como contribuciones al Programa Nacional de Control y Eliminación de la Tuberculosis con la perspectiva de aumentar la calidad, efectividad y eficiencia de las acciones y acelerar la solución de la incidencia y la mortalidad por tuberculosis, para la investigación, la vigilancia y control de la tuberculosis. Se presentan evidencias que fundamentan las innovaciones en el manejo clínico terapéutico de pacientes inmunocompetentes e inmunocomprometidos, en niños y adolescentes, sobre las indicaciones para el control de la infección tuberculosa latente, la vigilancia de los desenlaces del tratamiento anti-tuberculosis, la investigación de contactos de casos, los cambios en el sistema de registro e información, el monitoreo y evaluación de la calidad de la detección de casos de tuberculosis, el impacto sobre la morbilidad y la mortalidad.

ABSTRACT INTRODUCTION Leprosy, an infectious disease caused by Mycobacterium leprae, affects the nervous system, skin, internal organs, extremities and mucous membranes. Biological, social and environmental factors influence its occurrence and transmission. The first effective treatments appeared in 1930 with the development of dapsone, a sulfone. The main components of a control and elimination strategy are early case detection and timely administration of multidrug therapy. OBJECTIVES Review the history of leprosy control in Cuba, emphasizing particularly results of the National Leprosy Control Program, its modifications and influence on leprosy control. EVIDENCE ACQUISITION The historiological method was applied using document review, complemented by interviews with experts on leprosy and its control. Archived documents, medical records, disease prevalence censuses conducted since 1942, and incidence and prevalence statistics for 1960–2015 from the Ministry of Public Health’s National Statistics Division were reviewed. Reports and scientific literature published on the Program and the history of leprosy in Cuba were also reviewed. DEVELOPMENT Leprosy has been documented in Cuba since 1613. In 1938, the Leprosy Foundation was created with ten dispensaries nationwide for diagnosis and treatment. The first National Leprosy Control Program was established in 1962, implemented in 1963 and revised five times. In 1972, leper colonies were closed and treatment became ambulatory. In 1977, rifampicin was introduced. In 1988, the Program instituted controlled, decentralized, community-based multidrug treatment and established the criteria for considering a patient cured. In 2003, it included actions aimed at early diagnosis and prophylactic treatment of contacts. Since 2008, it prioritizes actions directed toward the population at risk, maintaining five-year followup with dermatological and neurological examination. Primary health care carries out diagnostic and treatment activities. The lowest leprosy incidence of 1.6 per 100,000 population was achieved in 2006. Since 2002, prevalence has remained steady at 0.2 per 10,000 population. Leprosy ceased to be considered a public health problem in Cuba as of 1993. In 1990–2015, 1.6% of new leprosy patients were aged <15 years. At present, late diagnosis of cases exceeds 20%, which leads to a high percentage of grade 2 disability in such patients. Spontaneous physician visits by already symptomatic patients surpassed 70% of cases diagnosed in 2010–2015. CONCLUSIONS Actions undertaken after initial detection of leprosy in Cuba failed to control it. Effective control began in 1963, with the implementation of the National Leprosy Control Program, whose systematic actions have had an impact on trends in leprosy, reflected in WHO’s 1993 declaration that leprosy was no longer a public health problem in Cuba.