ABSTRACT. The objective of this study was to determine the etiology of febrile illnesses among patients from October 1, 1993 through September 30, 1999, in the urban community of Iquitos in the Amazon River Basin of Peru. Epidemiological and clinical data as well as blood samples were obtained from consenting patients at hospitals, health clinics and private residences. Samples were tested for arboviruses in cell cultures and for IgM and IgG antibodies by ELISA. Blood smears were examined for malaria, and sera were tested for antibodies to Leptospira spp. by ELISA and microscopic agglutination. Among 6,607 febrile patients studied, dengue viruses caused 14.6% of the cases, and Venezuelan equine encephalitis virus caused 2.5%, Oropouche virus 1.0%, Mayaro virus 0.4%, and other arboviruses caused 0.2% of the cases. Also, 22.9% of 4,844 patients tested were positive for malaria, and of 400 samples tested, 9% had evidence of acute leptospirosis. Although the study was not designed to assess the importance of these pathogens as a cause of human morbidity in the total population, these results indicate that arboviruses, leptospirosis, and malaria were the cause of approximately 50% of the febrile cases. Although the arboviruses that were diagnosed can produce asymptomatic infections, our findings increased the overall understanding of the relative health burden of these infections, as well as baseline knowledge needed for designing and implementing further studies to better assess the health impact and threat of these pathogens in the Amazon Basin of Peru.

Our understanding of the health effects of disasters and populations disrupted by war or civil strife and how to respond effectively and responsibly to them has expanded greatly in the last several decades and continues to grow. Most of the morbidity and mortality in disasters of all types result from population displacement. Displaced populations, especially those in resource-poor areas with little or no developed civil and public health infrastructure, almost always experience significantly higher morbidity and mortality than their pre-disaster status. Since the mid-1990s the international humanitarian community has developed scientifically based consensus standards (The Sphere Project and others) for providing water and sanitation, shelter, and primary health care to these populations, focused on meeting the highest-priority needs that include prevention and treatment of acute diarrhea and dehydration, measles, malnutrition, vitamin A deficiency, and several other conditions. Health care professionals responding to humanitarian crises must be prepared to adapt their practices to provide care that is appropriate to the type of disaster and the particular circumstances and resources available.

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