Border Binational Infectious Disease Conference - Mexico Border ...

2012 

Proceedings Report of the United States-México 

Border Binational Infectious Disease Conference 

May 22-24, 2012 

Austin, Texas 

Providing international leadership 

to optimize health and quality of 

life along the United States-México 

border 

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For additional information, please visit the BHC website at www.borderhealth.org. 

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ACKNOWLEDGEMENTS 

Special thanks is extended to the following entities and individuals for the invaluable time, expertise, and 

assistance provided to the United States-México Border Binational Infectious Disease Conference, sponsored by 

the U.S.-México Border Health Commission (BHC) and coordinated through the Texas Department of State 

Health Services’ (DSHS) Office of Border Health in partnership with the BHC Chihuahua Regional Office. 

Technical Organizing Committee: Dr. Allison Banicki (Chair), Dr. Elisa Aguilar, Dr. Ricardo Cortés Alcalá, 

Dr. Karen Ferran, Omar Contreras, Lori Navarrete, Katharine Perez-Lockett, Raul Sotomayor, Dr. Steve 

Waterman, and Dr. Enrique Flores-Pérez. 

Administrative and Logistics Planning: Kathie Martinez, Susan Ayala, Jorge Bacelis, Jose Moreira, Dr. 

Banicki, Dr. Aguilar, Carlos Ramón Arriaga Rangel, Fabiola Elena de la Torre, Rogelio Sánchez, and Eduardo 

Rangel. 

Conference Support: 

• Dr. Aguilar and Dr. Ronald J. Dutton, Masters of Ceremony. 

• All speakers, panelists, and poster presenters who provided technical content and stimulated discussion. 

• The following subject matter experts, facilitators, scribes, and note takers who assisted with registration, 

timekeeping, translations, and technical support: Lupita Mata, Lupita Guerrero, Ivonne Mendez, C. 

Arriaga, F. de la Torre, Aldo Carrasco, Edith de la Fuente, J. Bacelis, Elvia Ledezma, J. Moreira, Adriana 

Corona-Luevanos, Calixto Seca, K. Martinez, Linda Willer, S. Ayala, L. Navarrete, Avelina Acosta, 

Herminia Alva, O. Contreras, Maureen Fonseca-Ford, Orion McCotter, Dr. Aguilar, Dr. Miguel 

Escobedo, Dr. Norma Irene Luna Guzmán, Lupe González, Dr. Leticia Wong López, Dr. David Padilla, 

Dr. Max Zarate-Bermudez, Dr. Rachael Joseph, Irma Hernández Monroy, Dr. Lumumba Arriaga, Micaela 

Tapia, Andy Thornton, Alba Phippard, Dr. Eduardo Azziz-Baumgartner, Dr. Cortéz Alcalá, Irma López 

Martínez, K. Pérez-Lockett, Dr. José Luis Alomía, Jennifer Smith, Dr. Fernando González, Dr. Liz 

Hunsperger, Dr. Paul Cantey, Dr. Daniel Marquez Uscanga, Mauricio Gómez-Sierra, Veronica Bejarano, 

Laura Alvarez, Dr. Waterman, Dr. Banicki, Andres Velasco-Villa, Belinda Medrano, Dr. María 

Guadalupe González Martínez, Catherine Golenko, Sonia Montiel, Ricardo Morales Monroy, Dr. Dutton, 

Dr. Martha Alicia Bueno, Dr. K. Ferran, Dr. Alfonso Rodriguez-Lainz, Dr. Gudelia Rangel, Dr. María 

Teresa Zorrilla, Jorge Navarro, and Michael Welton. 

SharePoint Conference Site: Pan American Health Organization–U.S.-México Border Office 

Resource Provisions: The Center for Global Health, Centers for Disease Control and Prevention 

Contracted Support: 

• Venue—Sheraton Austin Hotel at the Capitol 

• Audio/Visual Support—Swank Audio Visuals 

• Interpretation Services—Maya Interpreting 

• Written Conference Recording and Draft Proceeding Report—The Global Good 

• Training in Epidemiology and Surveillance Data Visualization—The University of North Texas, School 

of Public Health, Department of Epidemiology, Health Science Center for Early Warning Infectious 

Disease 

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Finally, special thanks are extended to Luanne Southern, Deputy Commissioner, Texas DSHS, who hosted the 

Conference together with Dr. Beatriz A. Díaz Torres, Delegate to Dr. Sergio Piña Marshall, Chihuahua Secretariat 

of Health and BHC-Chihuahua Member. 

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TABLE OF CONTENTS 

ACKNOWLEDGEMENTS ........................................................................................................................ i 

EXECUTIVE SUMMARY ........................................................................................................................ 1 

OVERVIEW OF EVENT .......................................................................................................................... 3 

Purpose .................................................................................................................................................. 3 

Objectives and Methodology .............................................................................................................. 3 

Conference Structure ........................................................................................................................... 3 

OPENING REMARKS ............................................................................................................................. 4 

Review of 2011 Meeting and Objectives for the 2012 BBID Conference .................................... 5 

DAY 1: PANELS AND PRESENTATIONS .......................................................................................... 5 

Panel–Federal Updates on Border and Binational Preparedness, Surveillance, and 

Epidemiology ......................................................................................................................................... 5 

Panel–State Updates on Border and Binational Preparedness, Surveillance, and 

Epidemiology ......................................................................................................................................... 6 

Panel–Local Updates on Border and Binational Preparedness, Surveillance, and 

Epidemiology ......................................................................................................................................... 6 

Panel–Cross-Border Sharing of Public Health Items ...................................................................... 6 

Binational Technical Work Group and Sub-Groups’ Reports ........................................................ 7 

Plenary–Best Practices in Border Binational Surveillance ................................................................ 8 

Questions & Answers ......................................................................................................................... 10 

DAY 2: BREAKOUT GROUPS AND LIGHTENING TALKS ........................................................... 10 

Disease Breakout Group Reports .................................................................................................... 10 

TB, HIV, STDs, Hepatitis ............................................................................................................... 11 

Foodborne and Diarrheal Diseases ............................................................................................. 12 

Respiratory Diseases, including Pandemic Influenza and Coccidioidomycosis ................... 12 

Emerging Infectious Threats, including Vector-Borne Diseases ............................................. 13 

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Thematic Breakout Group Reports .................................................................................................. 13 

Laboratory Integration with Surveillance Systems .................................................................... 14 

Migrant Health ................................................................................................................................. 14 

Binational Communication and the Implementation of the Guidelines ................................... 15 

Cross-Border Sharing of Items for Public Health Purposes ..................................................... 15 

DAY 2 & 3: CONCURRENT TRACK SESSIONS ............................................................................. 16 

Best Practices and Lessons Learned from BIDS and EWIDS Projects ..................................... 16 

HPV, Cervical Cancer, and HIV: Epidemiology and Control Measures ..................................... 16 

Binational Outbreak Investigations .................................................................................................. 17 

Respiratory Conditions in the Border Region: Tuberculosis and Influenza............................... 17 

International Health Regulations and Their Impact on U.S.-México Bilateral Relations ......... 17 

Effective Methods for Outreach, including Innovative Film Documentary and Social Media 

Techniques .......................................................................................................................................... 18 

Training in Data Visualization for Epidemiology and Surveillance ............................................. 18 

CLOSING REMARKS ............................................................................................................................ 18 

SUMMARY OF PRIORITY ISSUES, OBJECTIVES, AND NEXT STEPS .................................... 19 

Priority Issues and Objectives .......................................................................................................... 19 

Recommendations and Next Steps ................................................................................................. 20 

APPENDIX A: PARTICIPANT DIRECTORY ................................................................................... A-1 

APPENDIX B: MEETING AGENDA .................................................................................................. B-1 

APPENDIX C: LIST OF POSTER PRESENTERS AND TITLES ................................................. C-1 

APPENDIX D: PANEL SUMMARIES ................................................................................................ D-1 


Epidemiology ..................................................................................................................................... D-1 



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Panel–Cross-Border Sharing of Public Health Items .................................................................. D-6 

APPENDIX E: CONCURRENT TRACK SESSION SUMMARIES ................................................ E-1 

Best Practices and Lessons Learned from BIDS and EWIDS Projects .................................... E-1 

HPV, Cervical Cancer, and HIV: Epidemiology and Control Measures .................................... E-2 

Binational Outbreak Investigations ................................................................................................. E-4 

Respiratory Conditions in the Border Region: Tuberculosis and Influenza.............................. E-7 

International Health Regulations and Their Impact on U.S.-México Bilateral Relations ........ E-9 

Effective Methods for Outreach, including Innovative Film Documentary and Social Media 

Techniques ....................................................................................................................................... E-12 

APPENDIX F: LIST OF ACRONYMS ................................................................................................ F-1 

APPENDIX G: LIGHTNING TALK SUMMARIES ............................................................................ G-1 

APPENDIX H: BREAKOUT GROUP PARTICIPANTS .................................................................. H-1 

APPENDIX I: BREAKOUT GROUP SUMMARY SLIDES ............................................................... I-1 

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EXECUTIVE SUMMARY 

The U.S.-México Border Health Commission (BHC) sponsored the United States-México Border Binational 

Infectious Disease (BBID) Conference, hosted by the Texas Department of State Health Services’ (DSHS) Office 

of Border Health (OBH) in partnership with the BHC Chihuahua Regional Office, on May 22-24, 2012, in Austin, 

Texas. 

The purpose of this three-day binational conference was to convene federal, state, and local partners from both 

sides of the U.S.-México border to address critical infectious disease and emergency preparedness issues 

impacting the region and to discuss potential solutions to those problems. 

To improve binational preparedness, surveillance, and epidemiology in border health, conference participants 

discussed several areas of concern, including the enhancement of cross-border and global partnerships, global 

health security, and international communication on public health events that address binational and/or 

international concerns. 

The conference addressed the following strategic objectives: 

• Enhance processes for cross-border epidemiologic information sharing. 

• Improve communication protocols for immediate, cross-border notification regarding public health events 

of binational and/or international concern. 

• Improve electronic information sharing and data exchange. 

• Establish enhanced regional surveillance networks. 

• Encourage binational surveillance, epidemiology, and preparedness training and exercises. 

• Assess the impact of migration on U.S. and México health systems. 

• Review insights and best practices gained from migrant experiences to better inform border and nonborder 

states. 

The following recommendations were identified: 

• Prioritize the implementation of the Guidelines for 2012-2014, including standardization where possible 

and protocol implementation for cross-border communication and collaboration. 

• Identify alternate funding sources and communicate the value of border health actions and initiatives to 

local, state, and federal policy- and decision-makers. 

• Increase cross-border data and information sharing, possibly leveraging enhanced electronic surveillance 

systems. 

• Include migrant populations in public health surveillance, prevention and control, and outreach activities. 

• Revise policies and practices that hinder the cross-border sharing of public health items; convene a small 

work group to advance specific action items proposed during the corresponding panel discussion. 

• Continue building relationships and strategic alliances that facilitate binational collaboration on infectious 

disease and emergency preparedness issues affecting the United States and México. 

In total, 150 participants attended the conference. Participants represented federal, state, and local health agencies 

and laboratories from all ten U.S. and Mexican border states—Arizona, Baja California, California, Chihuahua, 

Coahuila, New Mexico, Nuevo León, Sonora, Tamaulipas, and Texas. Also present were representatives from the 

BHC; Pan American Health Organization/World Health Organization; México Ministry of Health; México’s 

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National Institute of Epidemiological Diagnosis and Referral; México’s General Directorate of Epidemiology; 

U.S. Department of Health and Human Services; Centers for Disease Control and Prevention; Department of 

Global Migration and Quarantine; Assistant Secretary for Preparedness and Response; U.S. Customs and Border 

Protection; Texas A&M University; University of California, Los Angeles; University of California, San Diego; 

Texas Tech University; National Polytechnic Institute; and National Autonomous University of Tamaulipas. 

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OVERVIEW OF EVENT 

Purpose 

The purpose of the third annual United States-México Border Binational Infectious Disease (BBID) Conference 

was to convene federal, state, and local partners from both sides of the U.S.-México border to address critical 

infectious disease and emergency preparedness issues impacting the border region. This meeting built on 

outcomes of the 2011 BBID Conference held in El Paso, Texas. 

Objectives and Methodology 

Improved preparedness, surveillance, epidemiology, and cross-border information sharing were identified as key 

areas that lead to an enhanced binational public health emergency response. As such, the conference provided a 

forum for local, state, and federal stakeholders to address the following binational strategic objectives: 

• Enhance processes for cross-border epidemiologic information sharing. 

• Improve communication protocols for immediate, cross-border notification regarding public health events 

of binational and/or international concern. 

• Improve electronic information sharing and data exchange. 

• Establish enhanced regional and binational surveillance networks. 

• Encourage binational surveillance, epidemiology, and preparedness training/exercises. 

• Assess the impact of migration on U.S. and México health systems. 

• Review insights and best practices gained from migrant experiences to better inform border and nonborder 

states. 

Conference Structure 

Dr. Ronald J. Dutton, Director, Office of Border Health (OBH), Texas Department of State Health Services 

(DSHS), and Dr. Elisa Aguilar, Coordinator, BHC Chihuahua Regional Office, acted as masters of ceremony. 

The conference agenda (see Appendix B—note: some individuals referenced herein may not be listed on the 

agenda) was organized under the following structure: 

• Panels for federal, state, and local updates on border and binational preparedness, surveillance, and 

epidemiology. A fourth panel addressed the cross-border sharing of public health items (see Appendix D 

for summaries). 

• A presentation on the Binational Technical Work Group and sub-groups. 

• A plenary session on best practices for border binational surveillance. 

• Breakout groups organized by disease or thematic area (see Appendix H for participants and Appendix I 

for summary slides). 

‣ Disease breakout groups: 

1. Tuberculosis (TB), HIV, STDs, and hepatitis. 

2. Foodborne and diarrheal diseases. 

3. Respiratory diseases, including pandemic influenza and coccidioidomycosis. 

4. Emerging infectious threats, including vector-borne diseases. 

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‣ Thematic breakout groups: 

1. Laboratory integration with surveillance systems. 

2. Migrant health. 

3. Binational communication and implementation of the Technical Guidelines for United 

States-México Coordination on Public Health Events of Mutual Interest (Guidelines). 

4. Cross-border sharing of items for public health purposes. 

• Concurrent sessions with panel presentations organized by topic (see Appendix E for summaries). 

‣ Concurrent Session I: 

1. Best practices and lessons learned from Border Infectious Disease Surveillance (BIDS) 

and Early Warning Infectious Disease Surveillance (EWIDS) projects. 

2. Human papillomavirus (HPV), cervical cancer, and Human Immunodeficiency Virus 

(HIV): epidemiology and control measures. 

3. Binational outbreak investigations. 

4. Respiratory conditions in the border region: TB and influenza. 

‣ Concurrent Session II: 

1. International health regulations and their impact on U.S.-México bilateral relations. 

2. Effective methods for outreach, including innovative film documentary and social media 

techniques. 

3. Optional training in data visualization for epidemiology and surveillance. 

• Lightening talks (short talks) on infectious disease issues affecting the U.S.-México border region (see 

Appendix G for summaries). 

• Poster session on various U.S.-México border binational infectious diseases (see Appendix C for titles 

and presenters). 

OPENING REMARKS 

Luanne Southern, M.S.W., Deputy Commissioner, Texas DSHS 

Dr. Beatriz A. Díaz Torres, Delegate to Dr. Sergio Piña Marshall, Chihuahua Secretary of Health and BHC- 

Chihuahua Member 

L. Southern welcomed conference participants to Austin on behalf of Dr. David Lakey, Texas DSHS 

Commissioner and BHC-Texas Member, and acknowledged the BHC’s conference sponsorship as well as the 

Texas DSHS OBH in planning the event. In addition, L. Southern noted the attendance and support of BHC U.S. 

Section representatives—Dr. Dutton, Texas; Robert Guerrero, Arizona; Mauricio Leiva, California—and BHC 

México Section representatives—Dr. María Teresa Zorilla, Executive Secretary, and Dr. Gudelia Rangel, 

Delegate to the México Secretary of Health. L. Southern recognized the participation of the federal delegations 

led by Dr. Katrin Kohl, Office of the Director, Department of Global Migration and Quarantine (DGMQ), Centers 

for Disease Control and Prevention (CDC); and Dr. Ricardo Cortés Alcalá, Director, Inter-Institutional Liaison 

Office, General Directorate of Epidemiology (DGE), México Ministry of Health. 

L. Southern extended a special recognition to the universities and nongovernmental organizations, including the 

Pan American Health Organization (PAHO)-U.S.-México Border Office, for attending the 2012 BBID 

Conference. 

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L. Southern reiterated the conference objectives and concluded by acknowledging the BHC’s support of 

binational strategies impacting border health by providing a venue for discussion and action. 

Dr. Díaz reviewed Chihuahua’s demographics and provided a brief history of cross-border collaboration, 

emphasizing the need to address border health through coordinated local, state, and national actions. 

Dr. Díaz reviewed binational projects in Chihuahua, including BIDS, EWIDS, and pilots for TB and 

coccidioidomycosis prevention and control in collaboration with Texas and New Mexico. She noted Chihuahua’s 

ongoing commitments to border health include strengthening communication, coordination, and collaboration in 

surveillance; maintaining disease prevention and control; participating in laboratory trainings; and sharing 

epidemiological information with Texas, New Mexico, and Arizona to support cross-border decision making. 

Dr. Díaz concluded by asserting it was essential that the United States and México continue their collaboration to 

safeguard the health of border populations, as illnesses do not recognize political borders. 

Review of 2011 Meeting and Objectives for the 2012 BBID Conference 

Dr. Allison Abell Banicki, Epidemiologist, Texas DSHS OBH 

Dr. Banicki informed participants all 2012 BBID Conference documents were accessible in English and Spanish 

on the PAHO-U.S.-México Border Office SharePoint site (The site would remain active for a limited time). 

Dr. Banicki reviewed the 2011 BBID Conference outcomes and presented the 2012 meeting objectives. She 

encouraged BBID participants to focus on sustaining border and binational initiatives under severe funding 

restrictions brought about, in part, by the cessation of EWIDS funding in August 2012. She also reviewed the 

conference agenda, noting conference planners incorporated an optional, three-part data visualization training 

intended to help participants effectively prepare graphs and figures to communicate epidemiological and 

surveillance data. The training topic resulted from an EWIDS survey that identified epidemiology and 

surveillance needs in Texas, New Mexico, Chihuahua, Nuevo León, and Tamaulipas. 

Dr. Banicki announced the BHC would sponsor the first Border Obesity Prevention Summit in 2013 as well as a 

fourth BBID Conference in 2014. She concluded by thanking all conference participants for attending. 

DAY 1: PANELS AND PRESENTATIONS 

Federal, state, and local partners provided panel updates on border and binational preparedness; surveillance; 

epidemiology perspectives; and the cross-border sharing of specimens, reagents, supplies, and other items for 

public health use. Panel discussion abstracts are provided below (see Appendix D for more details on panel 

presentations). 


Epidemiology 

Dr. Ricardo Cortés Alcalá, Director, Inter-Institutional Liaison Office, DGE, México Ministry of Health 

Dr. Katrin Kohl, Ph.D., M.P.H., Deputy Director, DGMQ, CDC 

Dr. Jose Fernandez, Deputy Director, Division of International Health Security, Office of the Assistant 

Secretary for Preparedness and Response (ASPR), U.S. Department of Health and Human Services (HHS) 

The three panelists reviewed major global, trilateral, and binational health initiatives, such as the North American 

Plan for Pandemic and Animal Influenza (NAPAPI), the Global Health Security Initiative (GHSI), the 

International Health Regulations (IHR), EWIDS, and BIDS. They emphasized the recently signed Guidelines lay 

the framework for meaningful binational engagement, including notification of epidemiologic events. 

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Epidemiology 

Dr. Francisco Javier Navarro Gálvez, General Director, Community Health Services, Sonora Secretariat of 

Public Health 

David Selvage, M.H.S., PA-C, Epidemiologist, Infectious Disease Epidemiology Bureau, New Mexico 

Department of Health (NM DOH) 

Dr. Navarro Gálvez and D. Selvage described significant accomplishments in binational cooperation at the state 

level, including Sonora’s Epidemiologic Intelligence Unit for Health Emergencies (UIEES) and several enhanced 

surveillance projects. 


Epidemiology 

Dr. José Luis Aranda Lozano, Epidemiologist, Institute of Public Health Services for Baja California-Health 

Jurisdiction II, Tijuana 

Dr. Benito Lopez, Epidemiologist, Yuma County Public Health Services District 

Belinda Medrano, M.P.H., Epidemiologist, Hidalgo County Health and Human Services Department 

(HCHD) 

The three panelists described the challenges of disease surveillance and control in border communities with high 

levels of migration. Recommendations included improving routine vital statistics surveillance, using existing 

infrastructure to improve communication and collaboration, and maintaining frequent communication with 

colleagues in neighboring communities across the border. 

Panel–Cross-Border Sharing of Public Health Items 

Moderator: Sonia Montiel, BIDS Laboratory Coordinator, DGMQ, CDC 

Dr. Elisa Aguilar Jiménez, Coordinator, BHC Chihuahua Regional Office, “Evaluation of Transportation 

Procedures for Materials Used in Public Health on the U.S.-México Border” 

Trinidad Barreras, Supervisory Consumer Safety Officer, U.S. Food and Drug Administration (FDA), 

“Import Operations” 

Norman Bebon, Assistant Port Director-El Paso, U.S. Customs and Border Protection (CBP), “U.S.-México 

Transport of Public Health Material” 

Dr. Miguel Escobedo, Quarantine Medical Officer, DGMQ, CDC, “Evaluation of Pilot Procedures for 

Importing Public Health Specimens through Southern Land Border Ports of Entry” 

Dr. Aguilar presented recent survey results that evaluated transportation procedures for border public health 

materials. She noted respondents identified multiple challenges and barriers to compliance with import/export 

regulations and recognized cost as the most frequently identified barrier. Several recommendations emerged from 

the evaluation, most notably the development and implementation of a uniform, efficient import/export process. 

T. Barreras provided an overview of FDA import operations, including those implemented along the U.S.- 

México border. 

N. Bebon presented an evaluation of the Border Health Pilot Project for Cross-Border Transport of Public 

Health Material, in operation from September 30, 2009, to January 1, 2010. He concluded the pilot was unable to 

facilitate the movement of items for public health purposes and noted lessons learned can improve the process. 

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A discussion following the panel presentations allowed participants to share additional challenges they 

encountered with exporting and importing items for public health purposes. 

Dr. Cortés Alcalá suggested convening a small work group to analyze the situation and submit specific 

recommendations to the Mexican Federal Commission for Protection against Health Risks with a letter requesting 

a response. 

Raul Sotomayor, M.P.H., M.S.A., International Health Analyst, ASPR, HHS, recommended using the NAPAPI to 

support requests for further study and action, as the highest levels of all three North American nations approved it 

and requested protocols for rapidly sharing specimens be developed. 

Dr. Steve Waterman, Team Lead, U.S.-México Unit, DGMQ, CDC, and S. Montiel emphasized the need to 

consider globally-developed best practices, such as the Chinese electronic platform. 

Binational Technical Work Group and Sub-Groups’ Reports 

Dr. Steve Waterman, Team Lead, U.S.-México Unit, DGMQ, CDC 

Dr. Waterman explained the Binational Technical Work Group (BTWG) in Public Health met four times in 

plenary, most recently in December 2011. Established in 2010 to facilitate discussion on technical matters, the 

BTWG involved technical sections that addressed issues on (1) infectious diseases (an active section), (2) noncommunicable 

diseases (an envisioned section), and (3) health communication (in planning). In addition, a crosscutting 

team was identified to initiate the Guidelines implementation. 

Over 50 public health agency representatives participated in the fourth BTWG plenary meeting videoconference, 

including representation from the CDC, DGE, México’s National Institute of Epidemiological Diagnosis and 

Referral (InDRE), and the binational border states. The infectious disease section focused on science, data, and 

public health practice; addressed laboratory issues, including CDC-InDRE shipment protocol development; and 

provided updates on México’s National Epidemiological Surveillance System (SINAVE), as well as ongoing 

programs, infectious diseases, and event-based surveillance. Specific updates on surveillance activities included 

the following: 

• The CDC’s Global Disease Detection Program developed and strengthened global capacity to rapidly 

detect, identify, and contain international, emerging infectious disease and bioterrorist threats. 

• The European Commission, as part of the Global Health Security Action Group, funded a project for early 

alerting and reporting that utilized a single portal consisting of 40 languages, 10,000 informational 

sources, and 1.5 million scanned web pages. 

• BIDS expanded binational surveillance into a more comprehensive system that included event-based 

surveillance and connected with sentinel surveillance sites via SINAVE to form an epidemiologic 

intelligence network for risk detection and assessment. Although the border was a priority, surveillance 

was not limited to the region. 

As per the letter of intent to implement the Guidelines, Dr. Waterman affirmed the BTWG was tasked to oversee 

the development of protocols outlined within the Guidelines within 12 months of their signing and to provide 

periodic reviews and updates. 

Potential BTWG collaborations included partnerships with PAHO and HHS on HPV vaccination and cervical 

cancer prevention; affiliations concerning hepatitis C and cross-cutting health promotions; and the formation of a 

BTWG non-communicable diseases section. 

Dr. Waterman concluded by emphasizing the key roles border stakeholders play in the U.S.-México collaboration 

on public health and encouraged the continued cross-border convergence of public health activities. 

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Plenary–Best Practices in Border Binational Surveillance 

Dr. Nubia Astrid Hernández Santillan, Binational Epidemiological Surveillance Coordinator, Sonora 

Secretariat of Public Health, “Binational System for Real-Time Epidemiological Alerts” 

Omar A. Contreras, M.P.H., Epidemiologist, Arizona Department of Health Services (ADHS), 

“Campylobacter and Guillain-Barré Syndrome (GBS): A Multi-jurisdictional Approach to the First Binational 

Outbreak along the Arizona-México Border” 

Dr. Bertha P. Armendariz, Border Health Specialist, Migrant Clinicians Network, “Binational Tuberculosis 

Surveillance and Control Pilot Project in the New Mexico and Chihuahua Region” 

Orion McCotter, M.P.H., BIDS Epidemiologist, ADHS OBH, and Dr. José Alomía Zegarra, Epidemiologist, 

Sonora Secretariat of Public Health, “The Binational Project Improving the Diagnosis, Surveillance, and 

Treatment of Coccidioidomycosis in the Border Region of ‘Four Corners’ Arizona-Sonora and New Mexico- 

Chihuahua” 

Dr. Daniel Carmona Aguirre, Department of Epidemiology and Communicable Diseases, Tamaulipas 

Secretariat of Health, “Sustainability of Binational Epidemiological Surveillance” 

Dr. Hernández and her colleague, Marco Cázares, discussed the Four Corners Pilot Project: Binational Early 

Epidemiological Alert System. Focused on the binational Four Corners region of Arizona, Sonora, California, and 

Baja California, the pilot aimed to develop a binational platform based on an Early Epidemiologic Alert System 

that would standardize methods, processes, and technical tools for identification and early warning of public 

health events of binational interest. 

Dr. Hernández and M. Cázares defined binational cases, provided a list of diseases of binational interest, and 

developed a flow chart illustrating binational communication. In addition, they affirmed the pertinent state 

jurisdiction was notified when binational cases were confirmed in México, as only state-level authorities were 

authorized to disseminate information to other states. 

Dr. Hernández and M. Cázares reported the Binational Epidemiologic Network members’ objective was to 

collaborate, strengthen, and maintain epidemiologic surveillance under the Four Corners project. Furthermore, 

the Early Epidemiologic Alert System established an automatic communication channel that provided immediate 

notification. 

M. Cázares noted the system’s software monitored the database every fifteen minutes to identify probable cases 

and immediately alert the appropriate physicians to emerging cases by e-mail, etc. He noted doctors can alert the 

system by text or through an online portal and added the system also maintains videoconferencing capabilities. 

Dr. Hernández and M. Cázares affirmed the use of information technologies allowed for improved U.S.-México 

communication, better decision-making, and stronger responses to binational health cases. 

O. Contreras described the multi-jurisdictional approach to the first binational outbreak along the Arizona- 

México border, which occurred in June 2011 after Sonora and Baja California health authorities notified the 

ADHS and the California Department of Public Health (CDPH) that they detected cases of Acute Flaccid 

Paralysis (AFP)/suspected GBS. 

O. Contreras reported the Arizona criteria for reporting a binational case applies to Arizona residents diagnosed 

with reportable diseases in Sonora or Sonora residents who (1) recently travelled to Arizona or other U.S. states, 

(2) possibly contracted the illness from or shared it with Arizona residents or residents from other U.S. states, (3) 

and/or were part of a suspected binational outbreak. 

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In addition, O. Contreras shared information on Arizona’s Health Services Portal. Managed by the ADHS Bureau 

of Emergency Preparedness and Response, the portal allows for the exchange of secured information and houses 

the Medical Electronic Disease Surveillance Intelligence System (MEDSIS), a secured, web-based disease 

surveillance system that captures all reportable diseases, excluding HIV infection, sexually transmitted diseases, 

and TB. He noted the Sonora Secretary of Health retains access to the Health Services Portal as well. 

O. Contreras reported the AFP/GBS investigation was completed with the support of ADHS, CDC, DGMQ, 

Yuma County Public Health Services District, CDPH, Imperial County Health Department, San Luis Rio 

Colorado General Hospital, Sonora Secretary of Health, DGE, and InDRE. He affirmed a robust binational 

collaboration and multi-jurisdictional approach was essential to address the outbreak and noted the efforts also 

enhanced communication among the ADHS Office of Infectious Disease Services, the ADHS OBH, and the 

Sonora Secretary of Health. 

Dr. Armendariz reviewed the Binational Pilot Project: Tuberculosis Surveillance and Control in the New 

Mexico-Chihuahua Border Region, a three-year binational project established to decrease TB in the New Mexico- 

Chihuahua border region through enhanced surveillance and control. She explained that in 2007, the NM DOH 

OBH utilized BHC funding to develop a three-year public health plan for Luna County, New Mexico, and 

Palomas, Chihuahua, that specified nine priority health areas, including TB. This effort resulted in a bilateral 

agreement for health cooperation signed by the New Mexico and Chihuahua state governors and health 

authorities. 

Dr. Armendariz stated a binational TB committee composed of U.S. and México health administrators was 

created to develop the binational TB pilot project in the border region. Funded by the BHC through the Migrant 

Clinicians Network (MCN), the pilot objectives were to (1) improve TB surveillance; (2) train non-medical 

personnel on preventative measures; (3) diminish Multi-drug Resistant (MDR) TB; (4) establish a binational 

patient registry and functional patient database for use by participating health care providers on both sides of the 

border; and (5) implement protocols that improved binational communication. 

Dr. Armendariz reported pilot participants conducted an intensive investigation to identify active TB cases and 

continue treatment for existing cases, which included providing treatment during home visits. She noted access to 

rural communities and a lack of public health materials posed significant challenges, as did communication 

between the corresponding binational health, social security, and defense agencies with respect to these TB cases. 

Future goals included introducing TB education into prison systems, increasing access to rural areas, and securing 

further project funding. 

O. McCotter and Dr. Alomía presented their experience with an ongoing pilot project launched in February 2010 

entitled Four Corners: Improved Diagnosis, Surveillance and Treatment of Coccidioidomycosis in the Binational 

Border Region of Arizona-Sonora-New Mexico-Chihuahua. O. McCotter and Dr. Alomía explained the pilot’s 

goals were to improve the diagnostics, surveillance, and treatment of coccidioidomycosis, which is caused by the 

inhalation of spores endemic to the border region and often mis- or undiagnosed. 

O. McCotter noted that increased coccidioidomycosis cases declared in Arizona could be attributed to several 

factors, including changes in laboratory reporting and increased awareness among doctors. He also illustrated the 

rate of reported cases across borders, comparing 11,888 Arizona cases in 2010 to only 63 cases reported in Sonora 

over nine years. Possible causes for the variation included underreporting and a lack of specific processes for 

coccidioidomycosis detection and treatment in México. O. McCotter asserted the pilot project was developed as a 

collaborative, binational effort to acutely understand the burden of coccidioidomycosis in the border region. 

To enhance clinical awareness and laboratory capacity in México, O. McCotter and Dr. Alomía affirmed that in 

September 2011, project participants conducted laboratory trainings with Sonora and Chihuahua personnel to 

facilitate the exchange of InDRE and CDC technologies and provided financial support for laboratory equipment. 

9

The pilot project also sponsored binational continuing medical education sessions in New Mexico and Arizona, 

providing translated educational materials for medical personnel in addition to public education campaign 

materials. 

The presenters asserted U.S. and Mexican pilot participants learned to adapt existing resources for use by 

individual states. They concluded by emphasizing the declaration of cooperation signed at the Arizona-Sonora 

Commission meeting in June 2010 helped further advance the project. 

Dr. Carmona addressed the sustainability of binational epidemiologic surveillance and reported current 

challenges included the need for greater investment, training, and efficient strategies. He asserted stronger 

international alliances and permanent binational collaboration were necessary to sustain efforts and affirmed 

surveillance needed to become analytical, preventative, and accompanied by university research. 

Strengths in binational surveillance included existing strategic alliances, the Guidelines, information systems, the 

BHC, binational health councils, and other health institutions and organizations. Strategies for sustaining 

epidemiological surveillance potentially involved stronger political cohesion and project prioritization as well as a 

broader legal basis for collaboration. 

Questions & Answers 

O. Contreras elaborated on the GBS outbreak detection timeline and explained the first diarrheal illness case 

occurred in May. Cases increased in both Yuma and San Luis by June, and after an epidemiologic investigation, 

GBS was determined to be the cause of the one reported fatality. 

In response to a question regarding the Early Epidemiologic Alert System’s development costs, M. Cázares stated 

costs were attributed to software development, as the software was the property of Sonora and not intended to 

substitute other platforms. 

Dr. Cortés Alcalá reported the Sonora-Arizona collaboration regarding the health portal was a positive experience 

and could be utilized in other states, although it is important to clarify objectives. According to Dr. Cortés Alcalá, 

an outbreak study was not justifiable based on a single case or even a few. He noted GBS surveillance continued 

due to remaining cases. 

In response to Dr. Waterman’s question regarding the potential for the Guidelines to affect local communications, 

a Four Corners participant responded that the Guidelines could help build on existing relationships. 

DAY 2: BREAKOUT GROUPS AND LIGHTENING TALKS 

Conference attendees participated in breakout groups of their choice, all designed to facilitate further discussion 

on specific diseases and other thematically organized information (see Appendix H for a complete list of breakout 

group participants). 

Each breakout group also included up to three 5-minute lightening talks presented by subject matter experts (see 

Appendix G for lightning talk summaries). The breakout group reports below begin with a list of the lightning 

talks presented during each session. 

Disease Breakout Group Reports 

Within each of the four disease-specific breakout groups, participants received a one-page summary of 

discussions and conclusions reached by their respective 2011 BBID Conference breakout groups as well as a list 

of questions for discussion during the current session. 

10

Disease-specific breakout groups were asked to complete the following: 

• Review 2011 BBID Conference breakout group information i to address follow-up items. 

• Discuss the ways surveillance data are currently shared. 

• Identify ways to improve the exchange of surveillance information. 

• Identify ways to improve cooperation on disease control measures related to binational cases or 

outbreaks. 

• Develop a Group Activity Plan for 2012-14. 

Breakout group representatives reported the group discussion results on conference day three (see Appendix H for 

breakout group report slides). Summaries of the group reports are provided below, following the list of lightning 

talks within each session. 

TB, HIV, STDs, Hepatitis 

Dr. Miguel Escobedo, Quarantine Medical Officer, DGMQ, CDC, “Descriptive Analysis of Mexican 

Immigrants with Overseas Tuberculosis Conditions, October 1, 2010–September 30, 2011” 

Dr. Haoquan Wu, Assistant Professor, Center of Excellence for Infectious Diseases, Texas Tech University 

Health Sciences Center (TTUHSC), Paul L. Foster School of Medicine, “Design miRNA-based shRNA to 

Suppress HIV Infection” 

Dr. Escobedo reported TB work groups were formed to address specific issues per the established 2011-2012 

activity plan, especially binational case management, and worked in close coordination with other binational TB 

initiatives involving the BHC, CDC Division of TB Elimination, DGMQ, and Immigration and Customs 

Enforcement (ICE). The work groups planned to pursue better outreach and coordination with these groups. 

In addition, Dr. Escobedo affirmed the TB Work Groups established an HIV Continuity of Care Work Group, and 

a work plan regarding migrants in the United States was in development. As binational TB projects, such as 

Grupo Sin Fronteras (Group without Borders), encountered HIV and TB coinfection, the group indentified this 

issue as a priority in the forthcoming years. 

The group also recognized the lack of coordination regarding binational referrals and continuity of care for 

patients in U.S. federal custody as a gap in the process, noting these patients are continually repatriated to México 

without advance notification provided to U.S. and Mexican public health authorities. 

The group recognized the Tijuana Compañeros (Tijuana Partners) program as a best practice for using remote 

video and mobile phones to track patients. They recommended developing procedures to ensure prompt reporting 

to Mexican consulates throughout the United States and noted operational consular staff training would be 

required to assist with health repatriations. 

Dr. Escobedo reported a reliable information system that ensures prompt reporting of case referrals to U.S and 

México federal public health authorities does not exist. As such, the group made the following recommendations: 

(1) utilize established TB referral systems, such as TB-Net, to coordinate the flow of clinical information required 

to follow-up on referred patients; (2) identify uniform reporting procedures for México’s national TB program 

and the international relations section of México’s consular service to assist with patient and family relocations; 

and (3) establish clinical case follow-up calls, especially to address MDR patients. 

Dr. Escobedo indicated an established system to coordinate follow-up and response to difficult cases and 

outbreaks also does not exist. The group recommended expanding existing regional systems and developing 

11

protocols to define roles, responsibilities, and points of contact as well as developing a resource directory with 

contact information to include Mexican consular resources. 

Foodborne and Diarrheal Diseases 

Dr. Rachael Joseph, Epidemic Intelligence Service (EIS) Officer, CDC, “Investigation of a Shigella Sonnei 

Outbreak among U.S. Travelers to México, November 2011” 

Dr. Max Zarate-Bermudez, CDC epidemiologist, indicated InDRE continued to pursue Pulsed Field Gel 

Electrophoresis certification for various macro-organisms and bionumerics analysis training. Several binational 

training sessions were completed in 2011, including GBS Campylobacter training and coccidioidomycosis 

continuing education for healthcare providers as well as dust modeling training for coccidioidomycosis in New 

Mexico and Chihuahua. The binational notification pilot project also advanced the Guidelines implementation. 

Collaboration challenges included the loss of EWIDS funding, which presented obstacles to continuing 

surveillance activities. The group also surmised that public health workers utilized informal methods to convey 

binational surveillance information, rather than formal channels. Another challenge concerned the varying U.S. 

and México definitions for binational cases. With respect to these challenges, the group recommended binational 

partners take steps to clearly understand specific U.S. and Mexican public health interventions for enteric disease 

cases or outbreak reports. 

Dr. Joseph presented the group recommendations for 2012-2014 activities, including activities intended to 

increase the understanding of U.S. and México surveillance system attributes, such as varying case definitions and 

health interventions. The group recommended integrating environmental assessments into epidemiologic 

investigations and identifying strategies to link U.S. and Mexican information systems. As formal implementation 

of the Guidelines would improve the sustainability and stability of binational surveillance systems and 

communication, the group recommended increased pilot participation by Mexican border states and U.S. and 

Mexican non-border states as well as the development of criteria to guide time and resource investment in 

binational investigations. 

Respiratory Diseases, including Pandemic Influenza and Coccidioidomycosis 

Dr. Alberto Martínez Vázquez, Professor, Autonomous University of Ciudad Juárez, “Clinical Disorders and 

Risk Factors for the Development of Acute Respiratory Distress Syndrome in the Intensive Care Unit” 

Dr. Mingtao Zeng, Assistant Professor, Center of Excellence for Infectious Diseases, TTUHSC, Paul L. 

Foster School of Medicine, “New Mucosal Vaccine for Cross-Strain Protection against Influenza” 

Dr. Beatriz A. Díaz Torres, Delegate to Dr. Sergio Piña Marshall, Chihuahua Secretary of Health and BHC- 

Chihuahua Member, “Risk Factors Associated with Acquired Pneumonia in a Pediatric Patient at Ciudad 

Juárez General Hospital” 

Dr. Eduardo Azziz-Baumgartner, EIS Officer, CDC, reported NAPAPI was launched in 2011. The group 

planned to circulate annual reports on respiratory diseases and determined further migrant population outreach 

was required. 

Moreover, the group concluded additional measures to implement NAPAPI were necessary, including essential 

relationship building at the local, state, and federal levels. They identified the joint use of MEDSIS by Sonora, 

México, and Arizona, United States, as a best practice case for local collaboration due to the mutual trust and 

respect developed among binational partners. 

Dr. Azziz-Baumgartner noted the following as promising directions for binational collaborations: (1) use of a 

SharePoint website as a forum/receptacle for binational data; (2) the potential binational access to U.S and 

México surveillance systems; (3) development of linguistically and culturally appropriate health education 

12

materials for vulnerable populations; and (4) the proposal of a standardized border city report to facilitate a 

borderwide analysis of data. 

The group determined 2012-2014 activities would include formalizing binational communication protocols and 

disseminating the Guidelines. Members planned to continue building relationships while respecting differences in 

legal and cultural norms among stakeholders. 

Emerging Infectious Threats, including Vector-Borne Diseases 

Orion McCotter, M.P.H., BIDS Epidemiologist, ADHS OBH, “Establishing a System for Dengue Surveillance 

along the Arizona-Sonora Border” 

Omar Contreras, M.P.H., Epidemiologist, ADHS, “Detection of Rocky Mountain Spotted Fever (RMSF) 

Activity in Southern Arizona” 

Dr. Benjamin Park, Medical Officer, Mycotic Diseases Branch, CDC, “The Re-emergence and Changing 

Epidemiology of Coccidioidomycosis, United States, 1998–2010” 

Lieutenant (LTJG) David Cruz, Environmental Health Division Officer, Preventive Medicine, Naval Medical 

Center San Diego, reported on an electronic system for rabies surveillance, developed by CDC following the 2011 

BBID Conference. Additionally, CDC and PAHO/ World Health Organization (WHO) are also planning a March 

2013 training session on dengue, and the CDC and American Association of Public Health Labs developed and 

disseminated dengue testing guidelines. With respect to México, LTJG. Cruz affirmed that InDRE continued to 

the build capacity in laboratory immunohistochemistry within Mexican border states and held training sessions on 

coccidioidomycosis. He also asserted funding for border dengue surveillance required attention. 

LTJG Cruz emphasized the importance of a OneHealth perspective in helping improve communications. 

Improvements in the communication process may potentially require those involved in surveillance on both sides 

of the border to convene regular meetings and phone conferences as well as exchange contact information. The 

group plans to utilize lessons learned and standardize protocols for communication and cooperation on disease 

control measures related to binational cases and outbreaks. 

The 2012-2014 activity plan included continued monthly meetings. The group indicated they would solicit the 

CDC and the U.S. and México offices of border heath to facilitate meetings. They also anticipated their pilot 

program participation would improve binational communication and information sharing. 

Thematic Breakout Group Reports 

Conference participants pre-registered for two of eight thematic breakout groups according to their areas of 

expertise and professional interests. Themes identified for discussion included ongoing issues or new areas of 

interest raised during the 2011 BBID Conference. 

Thematic breakout group objectives included the following: 

• Review 2011 BBID Conference recommendations and action items. 

• Describe the current status of binational collaboration. 

• Identify promising future directions for binational collaboration. 

• Identify key areas not currently being addressed, i.e., the gaps. 

• Develop 2012-2014 Group Activity Plan. 

13

Laboratory Integration with Surveillance Systems 

No presentations were scheduled for this session. Discussion began immediately. 

Irma Hernández Monroy, InDRE, reported important advances in diagnostics occurred in México since 2011, 

including expanded laboratory capacity, increased training, and progress toward ensuring more timely 

surveillance by decentralizing diagnostics to the local level. She also highlighted examples of the strong federal 

and state-level collaboration that existed between the two countries and affirmed InDRE sought to continue 

reinforcing binational communication. 

In addition, I. Hernández Monroy reported that InDRE identified several opportunities for future collaboration, 

including a border region course on dengue in August/September 2012 and an international bilingual course on 

diagnostics for dengue in March 2013. Arizona, New Mexico, Chihuahua, and Sonora were also developing a 

working protocol for the diagnostics of coccidioidomycosis. 

With respect to challenges, I. Hernández Monroy affirmed the need to improve the process for cross-border 

sharing of public health materials and the communications between local laboratories with that of state and federal 

laboratories. She also noted funding for research and diagnostics implementation remained a concern. 

I. Hernández Monroy stated the InDRE 2012-2014 Activity Plan aimed to increase (1) communication among 

binational federal, state, and local laboratories; (2) diagnostics capacity and implementation protocols; and (3) 

regional laboratory resources. She reported InDRE planned to exchange diagnostic algorithms with the United 

States to detect illnesses transmitted between both countries, collaboratively define border-related diagnostic 

priorities, and integrate binational teams, including laboratories intended to rapidly respond to infectious disease 

outbreaks. 

Migrant Health 

Dr. Alfonso Rodriguez-Lainz, Epidemiologist, CDC, “Migration-related Information in U.S. National Data 

Sources” 

Dr. Gudelia Rangel, Coordinator, Comprehensive Strategy for Migrant Health, México Ministry of Health; 

BHC Delegate to Salomón Chertorivski Woldenberg, México Secretary of Health, “Comprehensive Strategy 

for Migrant Health” 

This was the first meeting of a thematic group on migrant health during a BBID Conference, as the topic was 

identified as an area of interest in 2011. 

Dr. Rodríguez reported the Ventanillas de Salud ([VDS]—Windows to Health) program, established in the 50 

Mexican consulates in the United States, increased the capacity to provide health information to vulnerable 

Hispanic communities living in the United States. He indicated a forthcoming telemedicine pilot would be 

implemented in certain VDS locations and a call center designed to provide health information to migrants was 

slated for June 2012. He also noted the increased collaboration between HHS and community health centers. 

Dr. Rodríguez reported México’s ongoing Northern Border Migration Survey provided information on migrant 

health issues and affirmed this data was shared with U.S. researchers. 

With respect to the United States, Dr. Rodríguez reported CDC was scheduled to release an HIV/AIDS 

surveillance guidance report for U.S. border states as well as an influenza health communication plan for 

migrants, both in 2012. He discussed improvements related to the addition of migration variables to surveillance 

systems and the increased emphasis on health communication with migrants in the United States. 

14

Opportunities for binational collaboration included (1) enhancing VDS services; (2) utilizing resources pledged 

for mobile health units serving migrants in the United States; (3) advancing a Mexican health communication 

campaign for migrants in the United States; and (4) increasing collaboration between México and CDC on 

migrant health surveillance and education. 

Priority areas of concern included (1) immigrants deported with health conditions that call for prior notification 

and continuity of care; (2) lack of insurance; (3) the need for better borderwide surveillance data, especially 

regarding HIV, to address deported persons with health conditions; and (4) the enrollment of more migrant 

workers into México’s Seguro Popular. 

The VDS 2012-2014 Activity Plan outlined efforts to enhance cross-border communication and disseminate 

migrant health information. VDS also intended to establish a binational work group to develop a collaborative 

work plan on migrant health communication and to jointly develop linguistically and culturally appropriate health 

education materials. In conclusion, VDS acknowledged the need to better educate U.S. healthcare providers on 

services available to migrants on both sides of the border, i.e., educating U.S. health workers on HIV resources 

available in México. 

Binational Communication and the Implementation of the Guidelines 

Dr. Steve Waterman, Team Lead, U.S.-México Unit, DGMQ, CDC, “Overview of Pilot Project to Implement 

the Technical Guidelines for United States-México Coordination on Public Health Events of Mutual Interest” 

Dr. Allison Abell Banicki, Epidemiologist, Texas DSHS OBH, "Pilot Project to Implement the Technical 

Guidelines for United States-México Coordination on Public Health Events of Mutual Interest: Perspectives 

from the U.S. Border States" 

D. Selvage stressed the importance of maintaining a strong presence in border health offices and highlighted the 

improved data exchange with policy makers since 2011. He affirmed the necessity for public health workers to 

effectively inform policy makers about the value of work along the border (i.e., information regarding the GBS 

outbreak) to continue to receive funding and maintain their presence. 

D. Selvage reported surveillance data was shared through various formats and forms, including during national 

and binational meetings and within standardized reports. He commended Arizona and Sonora’s ability to integrate 

for data exchange and identified web-based tracking systems, face-to-face meetings, and standardized 

communication, such as through binational case definitions, as opportunities to improve data exchange. 

The group affirmed that promising future directions for binational collaboration included implementation of the 

Guidelines and indicated the need to share pilot project results and information regarding noteworthy 

communication tools. They also emphasized the need to creatively identify different federal and state funding 

opportunities to offset the cessation of EWIDS funding. In addition, the group suggested they pursue uniformity 

in reporting across states when performing border region analyses and noted that a mechanism, such as 

SharePoint, could be established to make data available for inclusion in an annual report. 

Cross-Border Sharing of Items for Public Health Purposes 

No presentations were scheduled for this session. Discussion began immediately. 

Dr. Esteban Vlasich, Coordinator, Project JUNTOS, Texas DSHS, explained each port of entry encountered 

difficulties with importing medicines into México due to the process with México’s Federal Commission for the 

Protection against Sanitary Risks (COFEPRIS). As a result, permission to import/export needed materials was not 

always provided during emergency cases. Dr. Vlasich asserted a federal-level meeting between COFEPRIS, CDC, 

and the FDA was necessary to identify and implement solutions, such as offering a single permit to import/export 

public health materials. 

15

Dr. Aguilar emphasized the need for resolution and indicated a special permit for the importation of public health 

material into México was a possible solution. The group encouraged the BHC to convene a meeting to address the 

topic with federal agencies. 

DAY 2 & 3: CONCURRENT TRACK SESSIONS 

Participants took part in concurrent track sessions that focused on border health topics of interest, each containing 

up to six fifteen-minute presentations offered by area experts. A 30-minute question/discussion period succeeded 

each panel (see Appendix E for summaries of concurrent track session presentations). 

Best Practices and Lessons Learned from BIDS and EWIDS Projects 

Moderator: Jorge Bacelis 

Dr. Martha Alicia Bueno Rosas, Chief, Epidemiology Surveillance, Chihuahua Secretariat of Health, 

“Seroprevalence of Coccidioidomycosis in Chihuahua” 

Katharine Perez-Lockett, M.P.H., BIDS Officer-Epidemiologist, NM DOH, “Development and Dissemination 

of the Borderwide Regional Influenza Surveillance Network Report” 

Catherine Golenko, M.P.H., BIDS Epidemiologist, ADHS, “Enhancing Respiratory Infection Surveillance on 

the Arizona-Sonora Border–BIDS Program Sentinel Surveillance Data” 

Dr. Ricardo Cortés Alcalá, Director, Inter-Institutional Liaison Office, DGE, México Ministry of Health, 

“Epidemiologic Surveillance of Influenza in México, its Impact on the Northern Border, and the HHS- 

General Directorate of Epidemiology Cooperative Agreement” 

Dr. Steve Waterman, Team Lead, U.S.-México Unit, DGMQ, CDC, “U.S. Perspective on BIDS Best Practices 

and Lessons Learned” 

Raul Sotomayor, M.P.H., M.S.A., International Health Analyst, ASPR, HHS, “EWIDS Best Practices and 

Lessons Learned” 

Speakers described ways the BIDS and EWIDS projects have enhanced surveillance efforts along the U.S.- 

México border. 

HPV, Cervical Cancer, and HIV: Epidemiology and Control Measures 

Moderator: Dr. Allison Banicki 

Dr. Mona Saraiya, M.P.H., Medical Officer, Epidemiology and Applied Research Branch, Division of Cancer 

Prevention and Control, CDC, “Cervical Cancer Prevention” 

Dr. Allison Banicki, Epidemiologist, Texas DSHS OBH, “HPV Vaccination in Texas, 2010” 

Dr. Gudelia Rangel, Coordinator, Comprehensive Strategy for Migrant Health, México Ministry of Health; 

BHC Delegate to Salomón Chertorivski Woldenberg, México Secretary of Health, “Current Overview of HIV 

on the Northern Border of México” 

Emilio J. German, M.S.H.S.A., Public Health Analyst-Coordinator for Hispanic or Latino Health Equity 

Activities, CDC, “HIV and Health Equity among Hispanics/Latinos” 

Dr. María Luisa Zúñiga, Associate Professor and Behavioral Epidemiologist, Division of Global Public 

Health, University of California, San Diego (UCSD), “Gender Inequality and HIV Care Behavior among 

HIV-positive Latinos in the U.S.-México Border Region” 

Speakers reviewed recent work on HPV and HIV and identified areas for future collaborations between the United 

States and México. 

16

Binational Outbreak Investigations 

Moderator: Omar Contreras 

Maureen Fonseca-Ford, M.P.H., Public Health Prevention Specialist, DGMQ, CDC, “Cluster of Guillain- 

Barré Syndrome due to a Waterborne Outbreak of Campylobacter Jejuni Infection—Sonora, México, and 

Arizona, 2011” 

Dr. Max Zarate-Bermudez, CDC Epidemiologist, “Environmental Assessment of the Waterborne Outbreak of 

Campylobacter Infection in Sonora, México, and Arizona, United States, 2011” 

Dr. Miguel Escobedo, Quarantine Medical Officer, DGMQ, CDC, “Coordinated Response to a Binational 

Wound Botulism Outbreak” 

Dr. Gerardo H. Flores-Gutiérrez, Professor, Autonomous University of Tamaulipas, “Epidemiologic 

Surveillance on the U.S.-México Border from the Veterinary Perspective under the One Health Concept” 

Dr. Andres Velasco-Villa, Associate Service Fellow, CDC, “Rabies across Borders: Finding Emerging and 

Re-emerging RABV Variants with Public Health Impact” 

Dr. Mauricio Gómez-Sierra, InDRE, “Expanded Panel of 20 Anti-nucleocapsid Monoclonal Antibody as a 

Tool in the Differentiation of A-typical Antigenic of the Rabies Virus within the Mexican Territory” 

Speakers and participants discussed outbreaks and clusters with binational implications. 

Respiratory Conditions in the Border Region: Tuberculosis and Influenza 

Moderator: Dr. Elisa Aguilar 

Dr. Miguel Angel Reyes López, Professor/Researcher, Genomics and Biotechnology Center, National 

Polytechnic Institute, “Detection of M. Tuberculosis Mutations in Tamaulipas Isolates” 

Dr. Alberto Martínez Vázquez, Professor, Autonomous University of Ciudad Juárez, “Tuberculosis Analysis 

in Juárez, 2011” 

Dr. Roberto Alejandro Suárez Pérez, Epidemiologist, Juárez Jurisdictional Office, “Epidemiology of A- 

H1N1 and the Identification of Risk Factors Associated with Confirmed Cases during the 2009 Pandemic in 

Ciudad Juárez, Chihuahua, México” 

Laura Alvarez, M.P.H., Disease Surveillance Specialist, EWIDS, El Paso Department of Public Health 

(DPH), “Integrating Selected El Paso County School Districts into Public Health Surveillance” 

Aldo Carrasco, Disease Surveillance Specialist, Texas DSHS OBH Region 9/10, “Sustaining Syndromic 

Surveillance in Underserved Areas along the Border using Independent School Districts as Reporting Sites in 

Health Service Region 9/10 with the Texas Department of State Health Services” 

Dr. Eduardo Azziz-Baumgartner, EIS Officer, CDC, “Estimating the Disease and Economic Burden of Viral 

Respiratory Diseases at Sentinel Sites on the U.S.-México Border during 2010-2012” 

Speakers discussed recent research and innovations in surveillance of TB, influenza, and influenza-like illnesses 

along the U.S.-México border. 

International Health Regulations and Their Impact on U.S.-México Bilateral Relations 

Moderator: Linda Willer 

Dr. Katrin Kohl, Ph.D., M.P.H., Deputy Director, DGMQ, CDC, “Practical Aspects of the Binational 

Implementation of the International Health Regulations” 

17


“International Health Regulations and Their Impact on Binational and Border Relationships between México 

and the United States” 

Alicia Harvey Vera, M.P.H., Project Manager, Division of Global Public Health, Department of Medicine, 

UCSD, “Biological Sample Transport across the U.S.-México Border: It Takes Two Villages” 

Dr. Roberta Andraghetti, Adviser, International Health Regulations, PAHO/WHO, “Maximizing the Benefits 

of the International Health Regulations: The Example of México and the United States” 

Speakers discussed International Health Regulations as they pertained to bilateral relations. 

Effective Methods for Outreach, including Innovative Film Documentary and Social 

Media Techniques 


Michael Welton, M.P.H., M.A., Epidemiologist, California Office of Binational Border Health (COBBH), 

CDPH, “California Border Region Influenza-like Illness (ILI) Surveillance and Influenza Education in 

Migrant Farmworker Populations” 

Irma Ortiz Soto, Coordinator, BHC Baja California Regional Office, “Health Education for the Surveillance 

of Vaccine Preventable Diseases within Communities in Tijuana during 2011” 

Dr. Kimberly Shoaf, Associate Professor, UCLA School of Public Health; Assistant Director, UCLA Center 

for Public Health and Disasters, “Cross-border Public Health Communication during the 2009 H1N1 

Influenza Outbreak” 

Dr. Jacob Rosales Velázquez, Quality and Health Education, Tamaulipas Secretariat of Health, “Dengue 

Proof Hospital” 

Speakers presented innovative methods for health communication, surveillance, and disease control regarding 

influenza, influenza-like illness, TB, dengue, and other infectious diseases. 

Training in Data Visualization for Epidemiology and Surveillance 

In 2010, public health personnel in the Texas-México border region participated in a survey designed to assess 

surveillance and epidemiology training needs. The results indicated several needs and identified a focus for future 

trainings. As many primary training needs related to the visualization of epidemiologic and surveillance data, 

Texas EWIDS sponsored training in free, readily available software, such as Epi Info 7, that enables data 

collection, advanced statistical analyses, and geographic information system mapping capability. 

CLOSING REMARKS 

Dr. Gudelia Rangel, Coordinator, Comprehensive Strategy for Migrant Health, México Ministry of Health; BHC 

Delegate to Salomón Chertorivski Woldenberg, México Secretary of Health 

Dr. Craig Shapiro, Director, Office of the Americas, Office of Global Affairs; HHS Representative to the BHC 

Dr. Rangel affirmed the BBID Conference provided a critical opportunity to share information and experiences in 

advancement of improved collaborative binational efforts. To illustrate this, she noted her participation in the TB 

breakout group informed her that not all Mexican consulates actively participated when patients were deported 

from the United States. As a result, she planned to initiate consulate trainings through the BHC México Section. 

Furthermore, she noted certain practices were more successful than others and affirmed the necessity for 

improved procedures regarding the cross-border sharing of public health materials. 

18

Dr. Rangel commended the previous year’s conference participants for their work follow through on identified 

action items as well as their work on new activities and noted the results were substantial. She stated the 

conference allowed participants to appreciate the work of the border states and the challenges they encounter. She 

concluded by emphasizing the next step is to advance implementation of the Guidelines. 

Dr. Craig Shapiro agreed that the BBID Conference was a success, covering an impressive breadth and depth of 

topics. Participants provided important, compelling presentations and engaged in thoughtful discussions 

concerning communicable and non-communicable diseases. He noted many participants indicated the need for 

greater binational communication. He remarked that the BBID Conference was an example of binational 

communication and one the BHC was proud to support. 

Dr. Shapiro applauded the signing of the Guidelines by the U.S. and Mexican Secretaries of Health and noted they 

would provide binational public health workers the framework to continue their work in collaboration with their 

border counterpart. He affirmed the likelihood the Guidelines would serve as a distinctive example of binational 

collaboration as well as a best practice to share with WHO and its partners. 

With respect to a multi-sectorial food safety agreement signed by the U.S. Secretary of Health, the United States 

Department of Agriculture, and the Mexican Ministry of Agriculture, Dr. Shapiro noted that the stakeholders were 

made up of more than just public health agencies. He affirmed this U.S.-México food safety agreement was the 

first international food safety agreement signed by the United States since the Food Safety Modernization Act, 

which provides the U.S. FDA increased authority and funding to improve food safety through international 

engagement. 

Dr. Shapiro closed by emphasizing that the significance of these paper agreements could be attributed to the 

efforts made by border health professionals before and after the signatures. He congratulated those present for 

their contributions to improving people’s lives along the border. 

Dr. Dutton closed the conference by observing that the previous three conferences on border health progressively 

gained strength, both in technical and logistical aspects. He thanked all participants for traveling to participate in 

the conference as well as the BHC and Texas DSHS OBH staffs for making the conference possible. 

The 2010 and 2011 BBID Conferences proceedings are available on the U.S.-Mexico Border Health Commission 

website (http://www.borderhealth.org/reports.phpcurr=about_us). 

The 2012 BBID Conference proceedings will be available upon completion. 

SUMMARY OF PRIORITY ISSUES, OBJECTIVES, AND NEXT STEPS 

Priority Issues and Objectives 

Improvements in border health featured prominently at the 2012 BBID Conference. Common themes included 

implementation of the Guidelines and enhanced binational collaboration among U.S. and Mexican counterparts 

that was critical to successful binational surveillance, outbreak investigations, and the cross-border control and 

prevention of infectious diseases. Border health agencies and practitioners reported on protocols and pilot projects 

implemented to improve the cross-border transport of public health items, information and data sharing, and 

communication and indicated binational laboratory trainings advanced capacity building. 

In addition, participants discussed potential opportunities to offset challenges to successful collaboration, such as 

inefficient transport policies and procedures regarding public health materials as well as funding cuts and limited 

resources overall. Specific opportunities included the enhancement of surveillance and electronic data systems to 

stimulate greater information sharing and communication as well as the development of strategic alliances with 

19

non-health agencies, such as the Mexican consulate and the U.S. Department Agriculture, to strengthen public 

health initiatives for disease prevention and control. 

Recommendations and Next Steps 

The following recommendations were identified: 

• Prioritize the implementation of the Guidelines for 2012-2014, including standardization where possible 

and protocol implementation for cross-border communication and collaboration. 

• Identify alternate funding sources and communicate the value of border health actions and initiatives to 

local, state, and federal policy- and decision-makers. 

• Increase cross-border data and information sharing, possibly leveraging enhanced electronic surveillance 

systems. 

• Include migrant populations in public health surveillance, prevention and control, and outreach activities. 

• Revise policies and practices that hinder the cross-border sharing of public health items; convene a small 

work group to advance specific action items proposed during the corresponding panel discussion. 

• Continue building relationships and strategic alliances that facilitate binational collaboration on infectious 

disease and emergency preparedness issues affecting the United States and México. 

Conference participants were asked to outline a 2012-2014 activity plan and present it at the next BBID 

Conference, scheduled for 2014. 

20

APPENDIX A: PARTICIPANT DIRECTORY 

First Name 

Last Name 

Title 

Email 

Telephone 

Avelina Acosta Program Manager, CDPH COBBH avelina.acosta@cdph.ca.gov (619) 688-0178 

Elisa Aguilar J. Coordinator, BHC Chihuahua 

Regional Office 

José Alomía Zegarra Epidemiologist, Sonora Secretariat 

of Public Health 

Herminia Alva Regional Epidemiologist, Texas 

DSHS 

Laura Alvarez Disease Surveillance Specialist, 

EWIDS, El Paso DPH 

Roberta Andraghetti Regional Adviser, International 

Health Regulations, PAHO 

José Luis Aranda Lozano Epidemiological Surveillance 

Coordinator 

eaguilar@saludfronteriza.org.mx (01152-656) 639-0863 / 

64 

jalomia@saludsonora.gob.mx (662) 108-4502 

herminia.alva@dshs.state.tx.us (956) 421-5559 

AlvarezJL@elpasotexas.gov (915) 771-5708 

andragro@paho.org (202) 316-6126 

jlaranda5@hotmail.com (01152-664) 638-7311 

Jorge Luis Arellano Estrada Physician arestrad@hotmail.com (01152-664) 638-6877 

Ext. 2102 

Bertha Armendariz Border Health Specialist, MCN barmendariz@migrantclinician.org (915) 282-2537 

María Arevalo Postdoctoral Research Associate, 

Center of Excellence for Infectious 

Diseases, TTUHSC, Paul L. Foster 

School of Medicine 

maria.arevalo@ttuhsc.edu (915) 783-1241 

Lumumba Arriaga Epidemiologist lumumbarriaga@hotmail.com (01152-554) 062-4254 

A-1

Carlos Ramón Arriaga Rangel Institutional Relations Coordinator carriaga@saludfronteriza.org.mx (01152-656) 639-0863 

Susan Ayala Administrative Assistant, Texas 

DSHS 

susan.ayala@dshs.state.tx.us (512) 776-7675 

Eduardo Azziz-Baumgartner EIS Officer, CDC eha9@cdc.gov (404) 259-8831 

Jorge Bacelis Coordinator, Texas DSHS OBH jorge.bacelis@dshs.state.tx.us (512) 776-6569 

Allison Banicki Epidemiologist, Texas DSHS OBH allison.banicki@dshs.state.tx.us (512) 776-6705 

Trinidad Barreras Supervisory Consumer Safety 

Officer, FDA 

Norman Bebon Assistant Port Director-El Paso, 

CBP 

Veronica Bejarano Director, Baja California State 

Laboratory of Public Health 

Preeti Bharaj Physician, Center of Excellence for 

Infectious Diseases, TTUHSC, 

Paul L. Foster School of Medicine 

Martha Alicia Bueno Rosas Chief, Epidemiology Surveillance, 

Chihuahua Secretariat of Health 

trinidad.barreras@fda.hhs.gov (915) 771-7790 

Ext. 1101 

norman.bebon@dhs.gov (915) 588-8041 

veronica.bejarano.ramirez@gmail.com (01152-686) 248-2992 

p.bharaj@ttuhsc.edu (321) 332-2503 

maliciabueno@hotmail.com (01152-614) 439-9900 

Ext. 21656 

José Arturo Campos Physician jack01_1@hotmail.com (01152-1-877) 772-3535 

Paul Cantey Medical Epidemiologist, CDC gdn9@cdc.gov (404) 718-4735 

Gloria Cardenas Nurse gloriacdr@hotmail.com (01152-656) 616-7498 

Daniel Carmona Aguirre Chief, Department of 

Epidemiology and Communicable 

Diseases, Tamaulipas Secretariat 

of Health 

dr_daniel_carmona@hotmail.com (01152-1-834) 315-0301 

Aldo Carrasco Disease Surveillance Specialist, 

Texas DSHS OBH Region 9/10 

A-2 

aldo.carrasco@dshs.state.tx.us 

Not Available

Armando Carvajal Physician carvajalarmando@hotmail.com (01152-662) 104-0631 

Keila Castillo Epidemiologist Supervisor kcastillo@ci.laredo.tx.us (956) 795-4938 

Harendra Chahar Postdoctoral Research Assistant, 




Jang-Gi Choi Postdoctoral Research Assistant, 




harendra.chahar@ttuhsc.edu (915) 783-1241 

jang-gi.choi@ttuhsc.edu (915) 783-1241 

Ext. 319 

Omar Contreras Epidemiologist, ADHS contreo@azdhs.gov (602) 364-0246 

Ricardo Cortés Alcalá Director, Inter-Institutional Liaison 

Office, DGE, México Ministry of 

Health 

David Cruz Environmental Health Division 

Officer, Preventive Medicine, 

Naval Medical Center San Diego 

Ricardo.Cortes@salud.gob.mx (01552-55) 5337-1670 

david.cruzmestre@med.navy.mil (619) 799-8773 

Fabiola Elena de la Torre Binational Administrator fdelatorre@saludfronteriza.org.mx (01152-656) 639-0863 

Edith de la Fuente Program Specialist III, Texas 

DSHS 

Beatriz A. Díaz Torres Delegate to Dr. Sergio Piña 

Marshall, Chihuahua Secretary of 

Health and BHC-Chihuahua 

Member 

Gloria L. Doria Cobos Epidemiologist, Tamaulipas 

Secretariat of Health 

edith.delafuente@dshs.state.tx.us (956) 421-5595 

bdiaz@uacj.mx (01152-656) 688-1820 

gldoriac@hotmail.com (01152-899) 924-2037 

Paul Dulin Director, NM DOH OBH paul.dulin@state.nm.us (575) 528-5154 

Ronald Dutton Director, Texas DSHS OBH rj.dutton@dshs.state.tx.us (512)776-7675 

A-3

Paul Edelson Medical Officer, CDC dou9@cdc.gov (01152-1-718) 553-1685 

Thomas "Tate" Erlinger Epidemiologist, Texas DSHS thomas.erlinger@dshs.state.tx.us (512) 776-7198 

Miguel Escobedo Quarantine Medical Officer, 

DGMQ, CDC 

Rita Espinoza Communicable Disease Manager, 

Texas DSHS 

mxe8@cdc.gov (915) 834 5951 

rita.espinoza@dshs.state.tx.us (210) 949-2196 

Nicole Evert Epidemiologist, Texas DSHS nicole.evert@dshs.state.tx.us (512) 533-3122 

Lucia Fajardo Respiratory Coordinator Luciafajardo_2005@hotmail.com (619) 481-9164 

Edgar Alberto Farías Farías Physician fedgar_07@hotmail.com (01152-1-844) 438-8330 

Karen Ferran Program Manager, EWIDS, CDPH 

COBBH 

Maria Fierro BIDS Officer, Imperial County 

Public Health Department 

karen.ferran@cdph.ca.gov (619) 688-3187 

karlalopez@co.imperial.ca.us (760) 482 -4702 

María Flores Nurse juntos1922@prodigy.net.mx (915)834-5954 

Gerardo Humberto Flores-Gutiérrez Professor, Autonomous University 

of Tamaulipas 

Maureen Fonseca-Ford Public Health Prevention 

Specialist, DGMQ, CDC 

ghflores@uat.edu.mx (01152-834) 145-8070 

mrf5@cdc.gov (619) 692-5510 

Diana Fortune TB Nurse Consultant, NM DOH Diana.Fortune@state.nm.us (505) 827-2473 

Edgar Ivan Galindo State Laboratory Director egalindo@ssnl.gob.mx (01152-81) 8031-3569 

Lauren Garcia EWIDS Binational Coordinator, 

HCHD 

Emilio J. German Public Health Analyst-Coordinator 

for Hispanic or Latino Health 

Equity Activities, CDC 

lauren.garcia@hchd.org (956) 318-2426 

egerman@cdc.gov (404) 639-8468 

A-4

Catherine Golenko BIDS Epidemiologist, ADHS catherine.golenko@azdhs.gov (480) 323-5934 

Jose A. Gomes-Moreira Binational Coordinator, Texas 

DSHS OBH 

jose.moreira@dshs.state.tx.us (512) 837-9588 

Mario Gómez Linares Physician mayoglin@hotmail.com (0115-868) 822-5522 

Fernando González Lead Epidemiologist, El Paso DPH gonzalezfj2@elpasotexas.gov (915) 771-5808 

Mauricio Gómez-Sierra InDRE Not Available Not Available 

Guadalupe González Binational TB Project Manager, 

Texas DSHS 

Hector Gonzalez Director, Laredo Health 

Department 

lupe.gonzalez@dshs.state.tx.us (915) 834-7792 

hgonzalez@ci.laredo.tx.us (956) 795-4920 

María Guadalupe González Martínez Midwife mggonzalez@ssnl.gob.mx (01152-818) 014-5244 

María Eugenia Guerra Domínguez International Relations Coordinator mguerra@saludfronteriza.org.mx (01152-818) 345-3429 

Lupita Guerrero Public Health Technician I, Texas 

DSHS 

Janie Hamilton Public Health & Prevention 

Specialist, Texas DSHS 

Alicia Harvey Vera Project Manager, Division of 

Global Public Health, Department 

of Medicine, UCSD 

lupita.guerrero@dshs.state.tx.us (956) 794-6343 

janie.hamilton@dshs.state.tx.us (512) 776-6251 

alvera@ucsd.edu (858) 967-7521 

John Herbold Consultant johnherbold@johnherbold.org (210) 219-4771 

Salvadore Hernandez Epidemiologist, Texas DSHS sal.hernandez@dshs.state.tx.us (210) 949-2118 

Rafael Hernández Flores Director of Public Health rahernandez@ssnl.gob.mx (01152-81) 8130-7068 

Irma Hernández Monroy Chief, Department of Bacteriology irmahm57@gmail.com (01152-55) 5341-7859 

A-5

Nubia Astrid Hernández Santillan Binational Epidemiological 

Surveillance Coordinator 

epifrontera@saludsonora.gob.mx (01152-662) 180-3571 

Michael Hill Public Health Director Michael.Hill@ElPasoTexas.gov (915) 771-5702 

Elizabeth Hunsperger Chief, Serology Diagnostics and 

Research Laboratory, CDC 

Esmeralda Iniguez-Stevens Epidemiologist, EWIDS, CDPH 

COBBH 

enh4@cdc.gov (787) 706-2472 

einiguez@cdph.ca.gov (619) 688-0111 

Trinidad Jeronimo Midwife trinijero@hotmail.com (01152-626) 104-0656 

Barbara Jiménez Deputy Director, San Diego 

County Health And Human 

Services Agency 

barbara.Jiménez@sdcounty.ca.gov (619) 338-2722 

María Guadalupe Jiménez Fierro Physician dra_Jiménez00@hotmail.com Not Available 

Rachael Joseph EIS Officer, CDC vie5@cdc.gov (908) 310-0201 

Saleem Kamili Team Leader, CDC skamili@cdc.gov (404) 639-4431 

Katrin Kohl Deputy Director, DGMQ kkohl@cdc.gov (404) 639-8073 

Justine Kozo Chief, County of San Diego 

Border Health Program 

Paula Kriner Epidemiologist, Imperial County 

Public Health Department 

Grace Kubin Director, Texas DSHS Laboratory 

Services 

Justine.Kozo@sdcounty.ca.gov (619) 692-6656 

paulakriner@co.imperial.ca.us (760) 482 4904 

Grace.Kubin@dshs.state.tx.us (512) 776-2468 

Elvia Ledezma Coordinator, Texas DSHS OBH elvia.ledezma@dshs.state.tx.us (210) 949-2177 

Mauricio Leiva Chief, CDPH COBBH Mleiva@cdph.ca.gov (916) 779-7202 

A-6

Waldo Lopez Associate Director, Healthy Texas 

Babies , City of Laredo Health 

Department 

wlopez@ci.laredo.tx.us (956) 795-4921 

Irma López Martínez MSc, InDRE lopezmi74@gmail.com (01152-55) 5341-1432 

Benito Lopez-Alvarez Epidemiologist, Yuma County 

Health Services District 

Adriana Corona Luevanos Program Manager, Texas DSHS 

OBH 

benito.lopez@yumacountyaz.gov (928) 317-4540 

Ext. 1724 

adriana.corona@dshs.state.tx.us (915) 834-7690 

Norma Alicia Lugo Guillén Biologist normalugog@hotmail.com Not Available 

Norma Irene Luna BIDS Technical Coordinator nluna@dgepi.salud.gob.mx (01152-55) 5337-1744 

Rufino Luna Director, Women’s Cancer rufino.luna@salud.gob.mx (01152-555) 263-9105 

Hongming Ma Postdoctoral Research Associate hongming.ma@ttuhsc.edu (915) 783-1241 

Ext. 297 

Sarah Marikos Senior Research Specialist, 

EWIDS, CDPH COBBH 

Maria Julia Marinissen Director, Division of International 

Health Security, ASPR, HHS 

Azi Maroufi Epidemiologist, San Diego County 

Department of Health 

sarah.marikos@cdph.ca.gov (619) 688-0158 

maria.marinissen@hhs.gov (202) 205-4214 

azarnoush.maroufi@sdcounty.ca.gov (619) 666-5168 

Daniel Márquez Epidemiologist dmarquezusc@hotmail.com (01152-229) 213-5649 

Kathie Martinez Program Coordinator, Texas 

DSHS OBH 

Alberto Martínez Vázquez Professor, Autonomous University 

of Ciudad Juárez 

Lupita Mata Administrative Assistant II, Texas 

DSHS 

kathie.martinez@dshs.state.tx.us (512) 776-3736 

alberto.martinez@uacj.mx (01152-656) 616-0087 

lupita.mata@dshs.state.tx.us (956) 421-5595 

A-7

Orion McCotter BIDS Epidemiologist, ADHS orion.mccotter@azdhs.gov (520) 770-3179 

Michelle McDonald Chief Medical Officer, Pima 

County Health Department 

michelle.mcdonald@pima.gov (520) 243-7797 

Belinda Medrano Epidemiologist, HCHD belinda.medrano@hchd.org (956) 318-2426 

Linda Meehan CBP Operations Specialist Linda.Meehan@dhs.gov (915) 633-7300 

Ext. 136 

Ivonne Mendez Public Health and Prevention 

Specialist, Texas DSHS 

ivonne.mendez@dshs.state.tx.us (915) 834-7746 

Sonia Montiel Binational Lab Coordinator, CDC hrm3@cdc.gov (619) 692-5787 

Ricardo Morales Laboratory Technician ric_mj@yahoo.com.mx 

(01152- 55) 5342-7550 

Ext. 283 

Julio Cesar Morales Rueda Epidemiologist Jurisdiccionldo@hotmail.com (01152-867) 712-1464 

Gale Morrow Deputy Regional Director, Deputy 

Regional Director, Texas DSHS 

Health Service Region 8 

Lorraine Navarrete Binational Operations Coordinator, 

BHC U.S. Section 

gale.morrow@dshs.state.tx.us (210) 949-2002 

lorraine.navarrete@hhs.gov (915) 532-1006 

Ext.107 

Francisco Javier Navarro Gálvez Physician navarro.fra@gmail.com (01152-662)108-4530 

Ernest (Skip) Oertli Director, Oral Rabies Vaccination 

Program, Texas DSHS 

Irma Ortiz Soto Coordinator, BHC Baja California 

Regional Office 

ernest.oertli@dshs.state.tx.us (512) 776-3306 

irma.ortiz.55@hotmail.com (01152-664) 634-6511 

David Padilla Program Manager, Texas DSHS david.padilla@dshs.state.tx.us (915) 834-7769 

Benjamin Park Medical Officer, Mycotic Diseases 

Branch, CDC 

bpark1@cdc.gov 

Not available 

Fermin Perez Physician fermon26@hotmail.com (01152-878) 782-9291 

A-8

Carlos Gabriel Perez Puente Chemist cgabriel40@hotmail.com (01152-1-834) 315-0301 

Enrique Perez-Flores Advisor/Epidemiologist, Health 

Surveillance and Disease 

Prevention and Control, 

PAHO/WHO 

Katharine Perez-Lockett BIDS Officer-Epidemiologist, NM 

DOH 

perezenr@paho.org (915) 845-5950 

Ext. 42531 

katharine.perez@state.nm.us (575) 528-5103 

Clelia Pezzi Public Health Advisor, CDC kpezzi@cdc.gov (619) 692-5667 

Rossanne Philen Medical Epidemiologist, CDC RPhilen@cdc.gov (404) 639-4350 

Alba Phippard BIDS Data Manager, CDC ign7@cdc.gov (619) 206-0461 

Barbara Quiram Director, Texas A&M USA Center 

for Rural Public Health 

Preparedness 

Pushker Raj Laboratory Services Section, 

Microbiological Services Branch, 

Texas DSHS 

quiram@srph.tamhsc.edu (979) 845-2387 

pushker.raj@dshs.state.tx.us (512) 776-7760 

Sara Ramirez Physician osraco06@hotmail.com (01152-868) 822-5522 

María Gudelia Rangel Coordinator, Comprehensive 

Strategy for Migrant Health, 

México Ministry of Health 

Miguel Angel Reyes López Professor/Researcher, Genomics 

and Biotechnology Center, 

National Polytechnic Institute 

Lizette Rodarte Medical Research Technician III, 




grangel2009@gmail.com (01152-664) 634-6511 

mreyesl@ipn.mx (01152-55) 729-6000 

Ext. 87751 

lizette.rodarte@ttuhsc.edu 915-783-1241 

Ext. 278 

Alfredo Rodríguez Trujillo Medical Epidemiologist alfredotrrd@hotmail.com (01-614) 439-99-00 

Ext. 21656 

A-9

Alfonso Rodriguez-Lainz Epidemiologist, CDC jqi3@cdc.gov (619) 692-8406 

Jacob Rosales Velázquez Quality and Health Education, 

Tamaulipas Secretariat of Health 

Mona Saraiya Medical Officer, Epidemiology 

and Applied Research Branch, 

Division of Cancer Prevention and 

Control, CDC 

jacobrosve@hotmail.com (01152-1-834) 315-0301 

msaraiya@bellsouth.net (770) 488-4293 

Alessio Scorza Public Health Professional dscorza@dgepi.salud.gob.mx (01152- 55) 5337-1647 

Calixto Seca Texas DSHS OBH-Laredo 

Regional Coordinator 

David Selvage Epidemiologist, Infectious Disease 

Epidemiology Bureau, NM DOH 

Premlata Shankar Professor and Co-director, Center 

of Excellence for Infectious 



Craig Shapiro Director, Office of the Americas, 

Office of Global Affairs, HHS 

Kimberley Shoaf Associate Professor, UCLA School 

of Public Health; Assistant 

Director, UCLA Center for Public 

Health and Disasters 

calixto.seca@dshs.state.tx.us (956) 764-6290 

walter.selvage@state.nm.us (505) 476-3563 

Premlata.shankar@ttuhsc.edu (915) 783-1241 

craig.shapiro@hhs.gov (202) 260-1733 

kshoaf@ucla.edu (310) 794-0840 

Jennifer Smith Surveillance Officer jennifer.smith@sdcounty.ca.gov (619) 692-8484 

Raul Sotomayor International Health Analyst, 

ASPR, HHS 

Luanne Southern Deputy Commissioner, Texas 

DSHS 

Raul.Sotomayor@hhs.gov (202) 401-5837 

luanne.southern@dshs.state.tx.us (512) 776-7792 

A-10

Roberto Alejandro Suárez Pérez Epidemiologist, Juárez 

Jurisdictional Office 

Manjunath Swamy Professor and Co-director, Center 

of Excellence for Infectious 



Cynthia Tafolla Binational TB Project Manager, 

Health Service Region 11, Texas 

DSHS 

rasuarez2000@yahoo.com.mx (01152- 656) 613-5510 

Ext. 115 

manjunath.swamy@ttuhsc.edu (915) 783-1245 

cynthia.tafolla@dshs.state.tx.us (956) 423-0130 

María Micaela Tapia Olea Chemical Biologist mika_tapia@hotmail.com (01152-662) 256-6384 

Ethel Taylor CDC Preventive Medicine Fellow etaylor@medicine.tamhsc.edu (979) 571-2492 

Andy Thornton Applied Epidemiology Fellow, 

Council of State and Territorial 

Epidemiologists 

andrew.thornton@sdcounty.ca.gov (619) 692-8052 

Silvia Estela Trevino Chemist qsilviaetrevino@yahoo.com.mx (01152- 656) 613-5248 

Rocio Uresti Professor, Autonomous University 

of Tamaulipas 

Adolfo M. Valadez Assistant Commissioner, 

Prevention and Preparedness 

Services Division, Texas DSHS 

Barbara Vassell Correctional TB Coordinator, TB 

Services Branch, Texas DSHS 

ruresti@uat.edu.mx (01152-899) 944-1761 

adolfo.valadez@dshs.state.tx.us (512) 776-7729 

barbara.vassell@dshs.state.tx.us (512) 776-2511 

Gilberto Vaughan AIDS Services Foundation GVaughan@cdc.gov (404) 639-0877 

Andres Velasco-Villa Associate Service Fellow, CDC DLY3@cdc.gov (404) 639-1055 

Esteban Vlasich Coordinator, Project JUNTOS, 

Texas DSHS 

evlasich@cdc.gov (915) 834-5954 

A-11

Steve Waterman Team Lead, U.S.-México Unit, 

DGMQ, CDC 

shw2@cdc.gov (619) 692-5659 

Michael Welton Epidemiologist, CDPH COBBH mwelton@cdph.ca.gov (619) 254-6582 

Linda Willer Program Manager, BHC U.S. 

Section 

linda.willer@hhs.gov (915) 532-1006 

Ext. 105 

Leticia Wong State Epidemiologist epidemiologia_bc@yahoo.com.mx (01152- 686) 559-5800 

Ext. 4241 / 4252 

Haoquan Wu Assistant Professor, Center of 

Excellence for Infectious Diseases, 

TTUHSC, Paul L. Foster School of 

Medicine 

haoquan.wu@ttuhsc.edu 

(915)7831241x284 

Chunting Ye Postdoctoral Research Associate chunting.ye@ttuhsc.edu (915) 783-1241 

Ext. 277 

Guohua Yi Postdoctoral Associate g.yi@ttuhsc.edu 

(915) 783-1241 

Ext. 261 

Carmen Rosa Zapata Holguin Technical Professional in Clinical 

Analysis 

cr.z.h@hotmail.com (01152-614) 411-3315 

Max Zarate-Bermudez Epidemiologist, CDC mcz4@cdc.gov (770) 488-7421 

Mingtao Zeng Assistant Professor, Center of 

Excellence for Infectious Diseases, 

TTUHSC, Paul L. Foster School of 

Medicine 

mt.zeng@ttuhsc.edu 

(915) 783-1241 

Ext. 253 

María Luisa Zúñiga Associate Professor and 

Behavioral Epidemiologist, 

Division of Global Public Health, 

UCSD 

mzuniga@ucsd.edu (619) 681-0689 

A-12

APPENDIX B: MEETING AGENDA 

Start 

End 

8:00 8:45 

Tuesday, May 22, 2012 

Registration 

Third Floor, Capitol View Terrace North-Foyer 

Inauguration and Opening Remarks 

Third Floor, Capitol Ballroom 

Luanne Southern, M.S.W., Deputy Commissioner, Texas Department of State Health Services (DSHS) 

9:00 9:30 

Dr. Beatriz A. Díaz Torres, Delegate to Dr. Sergio Piña Marshall, Chihuahua Secretary of Health and 

BHC-Chihuahua Member 

Master and Mistress of Ceremonies: 

Dr. Ronald J. Dutton, Director, Office of Border Health (OBH), Texas DSHS and BHC Delegate 

Dr. Elisa Aguilar Jiménez, Coordinator, BHC Chihuahua Regional Office 

9:30 9:45 

9:45 10:45 

Review of 2011 Meeting and Objectives for 2012 Meeting 


Dr. Allison Abell Banicki, Epidemiologist, Texas DSHS OBH 

Panel–Federal Updates on Border and Binational Preparedness, Surveillance and 

Epidemiology 


Dr. Ricardo Cortés Alcalá, Director, Inter-Institutional Liaison Office, General Directorate of Epidemiology, 

México Ministry of Health 

Dr. Katrin Kohl, Ph.D., M.P.H., Deputy Director, Division of Global Migration and Quarantine (DGMQ), 

Centers for Disease Control and Prevention (CDC) 

Dr. Jose Fernandez, Deputy Director, Division of International Health Security, Office of the Assistant 

Secretary for Preparedness and Response, U.S. Department of Health and Human Services (HHS) 

10:45 11:00 Break 

Panel–State Updates on Border and Binational Preparedness, Surveillance and 

Epidemiology 


11:00 11:45 

11:45 12:30 

Dr. Francisco Javier Navarro Gálvez, General Director, Community Health Services, Sonora Secretariat 

of Public Health 

David Selvage, M.H.S., PA-C, Epidemiologist, Infectious Disease Epidemiology Bureau, New Mexico 

Department of Health (NM DOH) 

Panel–Local Updates on Border and Binational Preparedness, Surveillance and 

Epidemiology 


Dr. José Luis Aranda Lozano, Epidemiologist, Institute of Public Health Services for Baja California– 

Health Jurisdiction II, Tijuana 

Dr. Fermín Pérez Ortiz, Epidemiologist, Coahuila Secretariat of Health, Jurisdiction I, Piedras Negras 


Belinda Medrano, M.P.H., Epidemiologist, Hidalgo County Health and Human Services Department 

12:30 2:00 No host Lunch 

B-1

Panel–Cross-border Sharing of Public Health Items 


Sonia Montiel, BIDS Laboratory Coordinator, DGMQ, CDC–Moderator 

2:00 3:15 

Dr. Elisa Aguilar Jiménez, Coordinator, BHC Chihuahua Regional Office–Review of experiences along 

the border 

Dr. Miguel Escobedo, Quarantine Medical Officer, DGMQ, CDC–Summary of pilot evaluation results 

Trinidad Barreras, Supervisory Consumer Safety Officer, U.S. Food and Drug Administration 

Representative, Federal government of México (pending) 

Norman Bebon, Assistant Port Director-El Paso, U.S. Customs and Border Protection 

3:15 3:45 Break and Poster Set-up 

3:45 4:45 

4:45 5:00 

Panel–Cross-border Sharing of Public Health Items, continued 


Questions and Discussion 

Binational Technical Work Group and Sub-Groups Reports 


Dr. Steve Waterman, Team Lead, U.S.-México Unit, DGMQ, CDC 

5:00 5:15 

Breakout Group Process 


Katharine Perez-Lockett, M.P.H., BIDS Officer-Epidemiologist, NM DOH 

5:15 5:20 

5:45 7:00 

Day 1Closing 


Poster Session and Social 

Second Floor, Creekside 

B-2

Start 

End 

7:30 8:00 

Wednesday, May 23, 2012 

Registration 

Third Floor, Capitol View Terrace North-Foyer 

Breakout groups will discuss border and binational initiatives. 

Each group may begin with up to three lightning talks (5 minutes each). 

8:00 9:30 

Group 1 

TB, HIV, STDs, 

Hepatitis 

Third Floor, Capitol D 

Dr. Miguel Escobedo, 

Descriptive Analysis of 

Mexican Immigrants with 

Overseas Tuberculosis 

Conditions, October 1, 

2010–September 30, 

2011 

Group 2 

Foodborne and 

Diarrheal Diseases 

Third Floor, Capitol View 

Terrace South 

Dr. Rachael Joseph, 

Investigation of a 

Shigella Sonnei 

Outbreak among U.S. 

Travelers to México, 

November 2011 

Group 3 

Respiratory Diseases, 

including Pandemic 

Influenza and 

Coccidioidomycosis 


Terrace North 

Dr. Alberto Martínez 

Vázquez, Clinical 

Disorders and Risk 

Factors for the 

Development of Acute 

Respiratory Distress 

Syndrome in the 

Intensive Care Unit 

Group 4 

Emerging Infectious 

Threats, including 

Vector-borne 

Diseases 

Third Floor, Capitol A-C 

Orion McCotter, 

M.P.H., Establishing a 

System for Dengue 

Surveillance along the 

Arizona-Sonora Border 

Dr. Haoquan Wu, 

Design miRNA-based 

shRNA to Suppress HIV 

Infection 

9:30 10:00 Break 

Dr. Mingtao Zeng, New 

Mucosal Vaccine for 

Cross-Strain Protection 

against Influenza 

Dr. Beatriz A. Díaz 

Torres, Risk Factors 

Associated with 

Acquired Pneumonia in 

a Pediatric Patient at 

Ciudad Juárez General 

Hospital 

Omar Contreras, 

M.P.H., Detection of 

Rocky Mountain 

Spotted Fever Activity in 

Southern Arizona 

Dr. Benjamin Park, 

The Re-emergence and 

Changing Epidemiology 

of Coccidioidomycosis, 

United States, 1998– 

2010 

Breakout groups will discuss border and binational initiatives. 

Each group may begin with up to three lightning talks (5 minutes each). 

Group 1 

Group 2 

Group 3 

Group 4 

10:00 11:30 

Laboratory Integration 

with Surveillance 

Systems 


Terrace North 



Terrace South 

Binational 

Communication and 

the Implementation of 

Guidelines 


Cross-border Sharing 

of Items for Public 

Health Purposes 


No presentations– 

discussion will begin 

immediately. 

Dr. Alfonso Rodriguez- 

Lainz, Migration-related 

Information in U.S. 

National Data Sources 

Dr. Steve Waterman, 

Overview of Pilot Project 

to Implement the 

Technical Guidelines for 

U.S.-México 

Coordination on Public 

Health Events of Mutual 

Interest 

No presentations– 

discussion will begin 

immediately. 

B-3

Dr. Gudelia Rangel, 

Comprehensive Strategy 

for Migrant Health 

Dr. Allison Abell 

Banicki, Pilot Project to 

Implement the 

Technical Guidelines for 

U.S.-México 

Coordination on Public 

Health Events of Mutual 

Interest : Perspectives 

from the U.S. Border 

States 

11:30 1:00 No Host Lunch 

Plenary Session–Best Practices in Border Binational Surveillance 

Third floor, Capitol Ballroom 

1:00 1:15 Dr. Nubia Astrid Hernández Santillan, Binational System for Real-Time Epidemiological Alerts 

1:15 1:30 

1:30 1:45 

1:45 2:00 

Omar A. Contreras, M.P.H., Campylobacter and Guillain-Barré Syndrome (GBS): A Multi-jurisdictional 

Approach to the First Binational Outbreak along the Arizona/México Border 

Dr. Bertha P. Armendariz, Binational Tuberculosis Surveillance and Control Pilot Project in the New 

Mexico and Chihuahua Region 

Orion McCotter, M.P.H., and Dr. José Alomía Zegarra, The Binational Project Improving the Diagnosis, 

Surveillance, and Treatment of Coccidioidomycosis in the Border Region of “Four Corners” Arizona- 

Sonora and New Mexico-Chihuahua 

2:00 2:15 Dr. Alfredo Rodríguez Trujillo, Sustainability of Binational Epidemiological Surveillance 

2:15 2:40 Questions and Discussion 

2:40 3:00 Break 

Track Session 1 

Each track will include up to six 15-minute talks followed by a 30-minute question/discussion 

period. 

3:00 5:00 

Track 1 

Best Practices and 

Lessons Learned from 

BIDS and EWIDS 

Projects 


Moderator: Jorge 

Bacelis 

Dr. Martha Alicia 

Bueno Rosas, 

Seroprevalence of 

Coccidioidomicosis in 

Chihuahua 

Track 2 

HPV, Cervical Cancer, 

and HIV: Epidemiology 

and Control Measures 


Terrace South 

Moderator: Dr. Allison 

Banicki 

Dr. Mona Saraiya, 

Cervical Cancer 

Prevention 

Track 3 

Binational Outbreak 

Investigations 


Terrace North 

Moderator: Omar 

Contreras 

Maureen Fonseca- 

Ford, M.P.H., Cluster of 

Guillain-Barré Syndrome 

Due to a Waterborne 

Outbreak of 

Campylobacter Jejuni 

Infection—Sonora, 

México and Arizona, 

2011 

Track 4 

Respiratory 

Conditions in the 

Border Region: 

Tuberculosis and 

Influenza 


Moderator: Dr. Elisa 

Aguilar Jiménez 

Dr. Miguel Angel 

Reyes López, 

Detection of M. 

Tuberculosis Mutations 

in Tamaulipas Isolates 

Katharine Perez- 

Lockett, M.P.H., 

Development and 

Dissemination of the 

Borderwide Regional 

Influenza Surveillance 

Dr. Allison Abell 

Banicki, HPV 

Vaccination in Texas, 

2010 

Dr. Max Zarate- 

Bermudez, 

Environmental 

Assessment of the 

Waterborne Outbreak of 

Campylobacter Infection 

Dr. Alberto Martínez 

Vázquez, Tuberculosis 

Analysis in Juárez, 

2011 

B-4

Network Report 

in Sonora, México, and 

Arizona, United States, 

2011 

Dr. Miguel Escobedo, 

Coordinated Response 

to a Binational Wound 

Botulism Outbreak 

Catherine Golenko, 

M.P.H., Enhancing 

Respiratory Infection 

Surveillance on the 

Arizona-Sonora 

Border—BIDS Program 

Sentinel Surveillance 

Data 

Dr. Gudelia Rangel, 

Current Overview of HIV 

on the Northern Border 

of México 

Dr. Roberto Alejandro 

Suárez Pérez, 

Epidemiology of A- 

H1N1 and the 

Identification of Risk 

Factors Associated with 

Confirmed Cases during 

the 2009 Pandemic in 

Ciudad Juárez, 

Chihuahua, México 

Dr. Ricardo Cortés 

Alcalá, Epidemiologic 

Surveillance of Influenza 

in México, its Impact on 

the Northern Border, and 

the HHS-General 

Directorate of 

Epidemiology 

Cooperative Agreement 

Emilio J. German, 

M.S.H.S.A., HIV and 

Health Equity among 

Hispanics/Latinos 

Dr. Gerardo H. Flores- 

Gutiérrez, 

Epidemiologic 

Surveillance on the U.S.- 

México Border from the 

Veterinary Perspective 

under the One Health 

Concept 

Laura Alvarez. M.P.H., 

Integrating Selected El 

Paso County School 

Districts into Public 

Health Surveillance 

Dr. Steve Waterman, 

U.S. Perspective on 

BIDS Best Practices and 

Lessons Learned 

Dr. María Luisa Zúñiga, 

Gender Inequality and 

HIV Care Behavior 

among HIV-positive 

Latinos in the U.S.- 

México Border Region 

Dr. Andres Velasco- 

Villa, Rabies across 

Borders: Finding 

Emerging and Reemerging 

RABV Variants 

with Public Health 

Impact 

Aldo Carrasco, 

Sustaining Syndromic 

Surveillance in 

Underserved Areas 

along the Border using 

Independent School 

Districts as Reporting 

Sites in Health Service 

Region 9/10 with the 

Texas Department of 

State Health Services 

Raul Sotomayor, 

M.P.H., M.S.A., EWIDS 

Best Practices and 

Lessons Learned 

Dr. Mauricio Gómez- 

Sierra, Expanded Panel 

of 20 Anti-nucleocapsid 

Monoclonal Antibody as 

a Tool in the 

Differentiation of A- 

Typical Antigenic of the 

Rabies Virus within the 

Mexican Territory 

Dr. Eduardo Azziz- 

Baumgartner, 

Estimating the Disease 

and Economic Burden 

of Viral Respiratory 

Diseases at Sentinel 

Sites on the U.S.- 

México Border during 

2010–2012 

Questions and 

discussion 

Questions and 

discussion 

Questions and 

discussion 

Questions and 

discussion 

6:00 8:30 

Evening Concurrent Session 

Working Dinner (Pre-registration Required) 

Second Floor, Creekside 

Training in Data Visualization for Epidemiology and Surveillance (Overview) 

Instructors: Dr. Raquel Qualls-Hampton and Dr. Martha Felini 

B-5

Start 

End 

8:00 8:30 

Thursday, May 24, 2012 

Registration 

Third Floor, Ballroom, Pre-Function Area 

Track Session 2 

Each track will include up to six 15-minute talks followed by a 30-minute question/discussion 

period. 

Track 1 

Track 2 

Track 3 

International Health 

Regulations and Their Impact 

on U.S.-México Bilateral 

Relations 

Effective Methods for Outreach, 

including Innovative Film 

Documentary and Social Media 

Techniques 

Training in Data 

Visualization for 

Epidemiology and 

Surveillance 




Terrace North 

8:30 10:30 


Dr. Katrin Kohl, Practical 

Aspects of the Binational 

Implementation of the 


Regulations 


Michael Welton, M.P.H., M.A., 

California Border Region ILI 

Surveillance and Influenza 

Education in Migrant Farmworker 

Populations 

Dr. Raquel Qualls-Hampton 

and Dr. Martha Felini, 

Exercises using Epi Info 7 

Dr. Ricardo Cortés Alcalá, 


Regulations and Their Impact 

on Binational and Border 

Relationships between México 

and the United States 

Irma Ortiz Soto, Health Education 

for the Surveillance of Vaccine 

Preventable Diseases within 

Communities in Tijuana during 2011 

Alicia Harvey Vera, Biological 

Sample Transport across the 

U.S.-México Border: It Takes 

Two Villages 

Dr. Kimberly Shoaf, Cross-border 

Public Health Communication 

during the 2009 H1N1 Influenza 

Outbreak 

Dr. Roberta Andraghetti, 

Maximizing the Benefits of the 


Regulations: The Example of 

México and the United States 

Questions and discussion 

Dr. Jacob Rosales Velázquez, 

Dengue Proof Hospital 

Questions and discussion 

10:30 10:45 Transition from fourth floor breakout rooms to third floor Capitol Ballroom 

10:45 11:30 

Reports from Breakout Groups 


11:30 11:45 

Closing 


Dr. Gudelia Rangel, Coordinator, Comprehensive Strategy for Migrant Health, México Ministry of 

Health; BHC Delegate to the Mexican Secretary of Health 

Dr. Craig Shapiro, Director, Office of the Americas, Office of Global Affairs; HHS representative to the 

BHC 

11:45 12:10 Break 

12:15 2:15 

Training Session 3 

Dr. Martha Felini, Dr. Raquel Qualls-Hampton, and Dr. Sumihiro Suzuki, Exercises Using R 

Third Floor, Capitol View Terrace North 

B-6

APPENDIX C: LIST OF POSTER PRESENTERS AND TITLES 

Presenting author(s) underlined. 

Authors 

Sojan Abraham, Rajendra Pahwa, Guohua Yi, Chunting 

Ye, Shashidhar Jaggaiahgari, Sandesh Subramanya, N. 

Manjunath, and Dr. Premlata Shankar 

Dr. Jorge Luis Arellano Estrada, Dr. José Luis Aranda 

Lozano, and Irma Ortiz Soto. 

Title 

Long-term Engraftment of Human Natural T 

Regulatory Cells in NOD/SCID IL2rγcnull Mice by 

Expression of Human IL-2 

Analysis of Patient Survival and Morbidity on ART 

UPS and Tijuana CAPASITS, 1999-2011 

Robyn Atadero, Karla Lopez, Paula Kriner, and Laura 

Apodaca 

Veronica Bejarano, Esmeralda Iniquez-Stevens, Sarah 

Marikos, Melanie Harris, Maggie Santibañez, Martha 

Vázquez-Erlbeck, Karen Ferran, and Paula Kriner 

Preeti Bharaj, Sojan Abraham, Lizette Rodarte, 

Ogechika Alozie, Dr. Manjunath Swamy, and Dr. 

Premlata Shankar 

Santos Daniel Carmona Aguirre, Dr. Jacob Rosales 

Velázquez, and Javier García Luna Martínez 

Harendra S. Chahar, Shuping Chen, and Chunting Ye 

Shuiping Chen, Harendra S. Chahar, Sojan Abraham, 

Dr. Haoquan Wu, Theodore C. Pierson, Xiaozhong A. 

Wang, and N. Manjunath 

Adriana Corona Luevanos, Dr. Miguel Escobedo, 

Alfonso Rodríguez, and Claudia Lozano 

Dr. Gloria Leticia Doria Cobos and Dr. Pablo G. López 

Rodríguez 

Dr. Miguel Escobedo, M.D., M.P.H.; Flor Puentes, 

M.P.H.; Adriana Corona, MBA; and Michelle 

Sandoval, M.P.H. 

Nicole Evert, Anne Tyree, Cynthia Tafolla, Kenneth 

Jost Jr., María Rodríguez, and Charles Wallace 

Maria Fierro, Karla Lopez, Lisa Smith, Paula Kriner, 

Provider Knowledge, Attitudes, and Practices Survey 

Regarding Coccidioidomycosis in Imperial County, 

California 

Laboratory Bioterrorism Response Capabilities in 

Select Areas along the California-Baja California 

Border 

Expression of PD-1H: a Novel Ig Superfamily Ligand 

on Hematopoietic Cells of Normal and HIV Infected 

Subjects 

Current Dengue Classification 

Recruitment of miRNA Effectors LSM1, GW182, 

DDX3 and XRN1 by West Nile Virus to Replication 

Complexes Leads to P Body Depletion and These 

miRNA Effectors Positively Regulate WNV 

Replication 

Ago-2-mediated Slicer Activity is Essential for Antiflaviviral 

Efficacy of RNAi 

Use of the Community Health Worker Model to 

Educate International Travelers at an El Paso, Texas, 

Port of Entry about H1N1 Influenza Prevention 

Study of Dengue Outbreak in Rio Bravo, Tamaulipas 

Bacteriologic Assessment of Imported Cheese from 

México-El Paso, Texas, 2008 

Tuberculosis Transmission Knows No Borders: 

Genotype Clusters along the Texas-México Border, 

2005-2010 

Serosurvey of Coccidioidomycosis in Residents of 

C-1

Holly Maag, Michael V. Lancaster, and Vatchara 

Oubsuntia 

Maureen Fonseca-Ford, M.P.H.; Clelia Pezzi; Timothy 

Doyle, M.P.H.; and Dr. Steve Waterman 

M.S.P. María Guadalupe González Martínez, Dr. 

Francisco González Alanís, M. en C. Rafael Hernández 

Flores, M.S.P. Norma Alicia Lugo Guillén, and M.S.P. 

Argentina Argelia Garza Robledo 

Esmeralda Iniguez-Stevens, Karen Ferran, and Paula 

Kriner 

M.S.P. Norma Alicia Lugo Guillén, M.S.P. María 

Guadalupe González Martínez, and M.S.P. Nancy 

Robledo Victoria Torres 

Hongming Ma, Jessica Montoya, and Dr. Haoquan Wu 

Belinda A. Medrano, M.P.H 

Clelia Pezzi and Dr. Miguel Escobedo 

Rossanne Philen, Maureen Fonseca-Ford, M.P.H.; 

Sonia Montiel; Dr. Miguel Escobedo; Jennifer Smith; 

Karla Lopez; Orion McCotter, M.P.H.; Katherine 

Pérez-Lockhart, M.P.H.; Herminia Alva; and Dr. Steve 

Waterman 

Lizette Rodarte and Dr. Premlata Shankar 

Jennifer Smith, Catherine Golenko, M.P.H., Orion 

McCotter, M.P.H., Paula Kriner, Karla Lopez, and 

Lucia Fajardo 

Dr. Manjunath Swamy and Chunting Ye 

María Micaela Tapia Olea 

Andy Thornton, M.P.H.; Dr. Michele Ginsberg; Dr. 

Annie Kao; and Dr. Steve Waterman 

Imperial County, California 

Infectious Disease Morbidity in the U.S. Region 

Bordering México, 1999-2009 

Rickettsiosis Types Reported in Nuevo León, México, 

2011 

Evaluation of School Absenteeism Data for Enhanced 

Detection of Influenza Activity in Imperial County, 

California 

Water Plant Breeding as Chief Breeding Ground in 

Absence of Storm Water in Guadalupe, Nuevo León 

Optimization of PAR-CLIP Method for Identification 

of microRNA Targets in Viral Genome 

Initial Mercury-tainted Product Investigation and 

Outbreak Detection in Hidalgo County, Texas 

TB and HIV Co-Infection in the Texas Border Region, 

2000-2010 

An Overview of Recent Border Infectious Disease 

Surveillance (BIDS) Projects Funded through the CDC 

Epidemiology and Laboratory Capacity Cooperative 

Agreement with U.S. Border States 

Antibody Mediated Delivery of siRNA using a CD7- 

Protamine Conjugate 

Enhanced Surveillance for Severe Acute Respiratory 

Infections in the California-Arizona Border Region 

SiRNA Treatment for Sepsis 

Vibrio Parahaemolyticus Outbreak in Sonora, México, 

2011 

Evaluation of Listeriosis Surveillance in San Diego 

County, California, 2005–2010 

Orion McCotter, M.P.H. (on behalf of Clarisse Tsang); 

Corey Benedum; Dr. Rocío M. Uresti Marín 

Coccidioidomycosis Surveillance in Arizona: 

Comparison of 2007 and 2011 Data Comprehensive 

Human Health 

C-2

Dr. Rocío M. Uresti Marín 

Dr. Haoquan Wu, Hongming Ma, Chunting Ye, Jessica 

Montoya, Dr. Premlata Shankar, and Dr. Manjunath 

Swamy 

Guohua Yi (on behalf of Chunting Ye), Sojan 

Abraham, Dr. Haoquan Wu, Dr. Premlata Shankar, and 

N. Manjunath 

Comprehensive Human Health 

Improved siRNA/shRNA Functionality by Mismatched 

Duplex 

Targeted Delivery of siRNA to Macrophages and 

Dendritic Cells to Suppress Flaviviruses Encephalitis 

C-3

APPENDIX D: PANEL SUMMARIES 


Epidemiology 

Dr. Ricardo Cortés Alcalá, Director, Inter-Institutional Liaison Office, DGE, México Ministry of Health 

Dr. Katrin Kohl, Ph.D., M.P.H., Deputy Director, DGMQ, CDC 

Dr. Jose Fernandez, Deputy Director, Division of International Health Security, ASPR, HHS 

Dr. Cortés Alcalá provided the Mexican federal perspective on preparedness and surveillance, noting it was 

essential that present systems evolve from reactive to proactive and from fragmented to integrated. Possible 

modifications included utilizing information from institutions not typically involved to improve epidemiologic 

surveillance as well as integrating laboratories into surveillance systems. Moreover, he affirmed systems should 

analyze and challenge rather than describe and corroborate; vertical movement should become horizontal; and 

systems should be open rather than closed. 

As international linkages fall under DGE’s purview, México collaborated with the Public Health Agency of 

Canada, the CDC, PAHO, and the European Centre for Disease Control and Prevention. Epidemiologic 

surveillance of infectious diseases on México’s northern border strengthened SINAVE, México’s national system 

for epidemiologic surveillance. Specific collaborations between México and the United States included EWIDS; 

binational outbreak investigations; Día de Norte América (Day of North America), a project for the automatic 

exchange of public security and health information; and development of the AlertaMex system, a platform 

utilizing SINAVE to analyze the state of health of all federal regions, particularly the six Mexican border states. 

Dr. Cortés Alcalá also reported on their participation in binational surveillance and multinational initiatives, such 

as NAPAPI and the GHSI. NAPAPI facilitated trilateral and regular communication among Canadian, Mexican, 

and U.S. health emergency centers, to include automatic notification of public health events of international 

interest. He affirmed the U.S.-México agreement to enhance influenza surveillance resulted in a valuable network 

of sentinel units and laboratories in México, to include México’s Intelligence Units for Health Emergencies, 

established in U.S.-México border region states. He noted Sonora’s Sonora’s Epidemiologic Intelligence Unit for 

Health Emergencies (UIEES) was designated as the regional Focal Point to alert the United States to cases and 

outbreaks. 

Dr. Cortés Alcalá concluded that transforming networks of transmission into networks of protection required 

further U.S.-México collaboration. 

Dr. Kohl announced the Guidelines laid the framework for enhanced binational engagement. She affirmed border 

health agencies initiated implementation of the Guidelines’ principles, as demonstrated in the Binational 

Technical Working Group (BTWG) in Public Health, established as a forum to facilitate discussions on technical 

matters in public health, specifically infectious diseases, non-communicable diseases, and health communication. 

In 2011-2012, the BTWG cross-cutting team created a binational list of notifiable diseases and developed 

communication pathway protocols that were implemented in a Texas, New Mexico, Arizona, and Sonora pilot 

project. A broad representation from federal, state, and local partners comprised the BTWG, including the CDC, 

the Council of State and Territorial Epidemiologists, state and local U.S. border health offices, DGE, InDRE, and 

the Sonora state representative. Partnership, formal and informal agreements, and frequent communication at all 

governmental levels were essential to success in border public health. 

Dr. Kohl reported several border binational surveillance reports were in various stages of completion or updates. 

She noted border region influenza reports were issued regularly, and EWIDS supported ongoing surveillance 

reports for border sister-states. As part of an ongoing effort to understand drug-resistant TB on the border, the 

D-1

CDC published a BIDS surveillance report in December 2011. Additionally, the CDC planned to publish a 

guideline to improve HIV surveillance in Hispanic/Latino border populations. 

Dr. Kohl observed that challenges persisted in binational epidemiology and surveillance. Reporting timeliness 

remained problematic, and the cross-border movement of laboratory specimens and reagents presented ongoing 

challenges. Although U.S. public health budgets were decreasing, there was a sustained need for training and 

information technology development. 

Moreover, the CDC continued to help integrate existing binational efforts to eliminate redundancies and 

inefficiencies, including the cross-population of surveillance studies with routine surveillance systems. Dr. Kohl 

affirmed a recent effort to add “binational” and “foreign birth” variables to U.S. national health electronic disease 

surveillance systems reflected progress toward understanding health in binational and foreign born populations 

that would allow the United States to target health resources more effectively. 

Dr. Kohl invited conference participants to attend a BIDS strategic planning session on Thursday, May 24. She 

noted the considerable changes that occurred since the previous session, including changes in disease patterns and 

border infrastructure; the development of SINAVE; the formal approval of the Guidelines; and current budget 

limitations. 

The CDC’s DGMQ in strategic planning identified the following main goals: 

• Implement a binational public health strategy—led by Dr. Waterman. 

• Strengthen understanding regarding the health needs of Spanish-speaking mobile populations—led by Dr. 

Rodriguez-Lainz. 

• Maintain and improve a system for rapid response to illness and public health emergencies at ports of 

entry—led by Dr. Escobedo. 

• Develop strategic partnerships. 

Dr. Kohl considered TB surveillance and control demonstrated the need for binational communication and 

collaboration. TB case management required immigrant screening, specimen and reagent import/export, travel 

restrictions, and continuity of care. She noted that gaps identified in border preparedness during the H1N1 

outbreak included limitations to reaching migrant populations in case of emergency. In response, the CDC 

developed flu health communication materials in Spanish, compiled a directory of migrant-serving organizations, 

and utilized public media to quickly reach mobile migrant populations. 

The DGMQ planned to convene a stakeholder meeting in August 2012. 

Dr. Fernandez emphasized the need to creatively identify alternate federal and state funding opportunities to 

offset the cessation of EWIDS funding. He noted that federal, state, and local agencies shared the responsibility 

for border health and suggested binational partners continue to collaborate, effectively leverage resources, and 

build on existing initiatives, including the U.S.-México Agreement on Emergency Management Cooperation, 

NAPAPI, IHR, and the BHC. 

In addition, Dr. Fernandez reported the launch of the HHS National Health Security Strategy in December 2009 

clearly indicated cross-border and global partnerships were integral to U.S. national security. He affirmed the U.S. 

federal government participated in multilateral initiatives, including the GHSI, a ministerial-level initiative 

intended to strengthen public health preparedness and response to biological, chemical, radio-nuclear threats and 

pandemic influenza; and the IHR, the WHO-supported global health security framework that identified core 

capacities for surveillance and response. The IHR established a rapid, 24-hour global communication network of 

National Focal Points. He explained that when ASPR notified the international community of any event of 

D-2

interest, the community would automatically notify Canada and México. Canada, México, and the United States 

established simultaneous notification agreement. 

On a regional level, Dr. Fernandez contended HHS supported NAPAPI and EWIDS, noting the EWIDS-U.S. 

project provided over $41.6 million in funding over nine years to enhance cross-border epidemiological 

surveillance as well as laboratory and health alert notification abilities. EWIDs-México invested $5.6 million over 

five years to enhance capabilities in northern border states and the México Ministry of Health. 

Questions and Answers 

In response to Dr. Dutton’s question regarding the availability of the Guidelines in English and Spanish, Dr. 

Waterman reported CDC posted the Guidelines to the CDC website as of May 22, 2012. 

Dr. Waterman asked Dr. Cortés Alcalá to further explain México’s Epidemiologic Intelligence Network (in 

development). 

Dr. Cortés Alcalá explained that the provisionally named Epidemiologic Intelligence Network was an information 

system that allowed state and local epidemiologists to emit notifications as well as record and access information 

online in real time. It facilitated México’s information exchange with Canada and the United States and 

maintained an obligatory variable to identify binational cases. He noted the forthcoming integration of 

laboratories into the network and affirmed the system was operational for specific diseases, such as dengue, 

juvenile and adult cancers, and HIV. 

Dr. Cortés Alcalá reported that although the system required some improvements, the pilot was successful overall. 

It was introduced at the National Epidemiologic System’s Center-South Regional Meeting in addition to the 

Regional Meeting in Querétaro, México. The DGE Director also expressed an interest in launching it nationally. 


Epidemiology 

Dr. Francisco Javier Navarro Gálvez, General Director, Community Health Services, Sonora Secretariat of 

Public Health 

David Selvage, M.H.S., PA-C, Epidemiologist, Infectious Disease Epidemiology Bureau, NM DOH 

Dr. Navarro explained SINAVE was a national system that received input from the Epidemiological Surveillance 

Committees; the National Laboratory and the National Network of Public Health Laboratories; epidemiology 

personnel/staff; and Epidemiological Surveillance Units. The surveillance system tracked morbidity, mortality, 

special concerns, health emergencies, and international health. Threats to public health included bioterrorism, 

emerging and re-emerging diseases, and pandemics. 

Dr. Navarro also reported on Sonora’s advancements, including the development of the Master Plan for Health 

Infrastructure, the state UIEES, and the expansion of their automotive fleet for health services. He affirmed 

México maintained a network of interconnected UIEES with videoconferencing capabilities, including border 

situated units, although he noted communication and response times required improvement, as Units experienced 

delays in receiving validation and information needed for decision-making. 

Dr. Navarro discussed possible recommendations, including the need for public health workers to secure 

permission from U.S. Homeland Security to binationally collaborate on cases of public health interest; the 

Mexican consulate in Yuma, Arizona, to assent to temporary patient internment and medical personnel; and 

advanced certificate training and graduate programs, to include epidemiology scholarships. 

D-3

D. Selvage reviewed health services programs, border surveillance, and epidemiology activities. He highlighted 

the following U.S. border state accomplishments: 

• Arizona established a binational agreement with Sonora to facilitate information flow and exchange by 

sharing their secured Health Services Portal; enhanced communication and binational reporting in 

MEDSIS and trained Sonora Secretariat of Health members on its use; participated in the U.S.-México 

Binational Communication Pathways Pilot Study (OBH); and planned enhanced arbovirus surveillance, 

particularly in relation to dengue. 

• California’s 2011 One Border One Health Symposium launched an initiative to build more resilient and 

healthy border communities through a binational and multidisciplinary network that included over 20 

institutional partners in Baja California and over 30 in California. The network would identify, respond 

to, and develop sustainable solutions to address health risks at the human-animal-environmental interface. 

In addition, the California EWIDS Program aimed to enhance binational ILI surveillance, established a 

surveillance network in the California/Baja California region, and facilitated bioterrorism preparedness 

and response training for regional public health professionals. 

• The NM DOH OBH launched a coccidioidomycosis education/awareness campaign; participated in the 

Four Corners initiative; formed a binational work group composed of federal and state agencies; and 

participated in a project to increase the number and quality of submissions sent to the state laboratory for 

testing. Future efforts included continuing to train health care providers and build laboratory capacity 

with the Four Corners project; establishing binational case reporting procedures and protocols with the 

NM DOH; and collaborating with the CDC and other U.S. and Mexican border states to develop a 

borderwide influenza surveillance report. 

• The Texas DSHS OBH maintained regular two-way communication with Tamaulipas and Chihuahua, 

which included participation in the binational case notification pilot program. The Texas and Coahuila 

state health departments signed the joint statement of cooperation in TB. In addition, Texas and México 

implemented tighter control measures following a case investigation associated with imported, mercurytainted 

beauty cream. Texas also planned to continue with binational case and outbreak notifications as 

incidents occurred and to routinely exchange epidemiological information to the extent possible in a 

reduced funding environment. 


Epidemiology 

Dr. José Luis Aranda Lozano, Epidemiologist, Institute of Public Health Services for Baja California-Health 

Jurisdiction II, Tijuana 


Belinda Medrano, M.P.H., Epidemiologist, HCHD 

Dr. Aranda reported the five million inhabitants residing in the California/Baja California border region, which 

included Tijuana, Rosarito, Tecate, and San Diego, hindered surveillance efforts due to high levels of migration 

and internal movement, including continuous travel between Sinaloa and Tijuana. He noted substantial 

immigration recorded from all Mexican states also presented a surveillance challenge, resulting in the introduction 

of tropical illnesses, among other effects. Moreover, it was difficult to locate cases, as many Tijuana residents 

worked and/or shopped in the United States. 

With respect to Tijuana, Dr. Aranda affirmed diabetes and heart disease were the principal causes of mortality, 

and respiratory infectious diseases were primary causes of illness. He also stated the Tijuana Office of 

Epidemiological Surveillance increased its personnel and established an epidemiological surveillance committee. 

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Dr. Lopez explained Yuma’s population influx, which doubled from 200,000 to 400,000 inhabitants during the 

winter, related to situations similar to those caused by the H1N1 pandemic. He noted the Yuma County Public 

Health Services District (Health District) acted quickly to provide permanent residents with influenza vaccines to 

guard against transmission by visitors traveling from other states. 

Dr. Lopez affirmed barriers to binational communication included the infrequent use of established pathways as 

well as differences in laboratory testing methods and languages. Regional violence impeded cross-border 

collaboration, and funding cuts threatened program continuity. 

To address these barriers, the Health District worked closely with Sonora and Baja California to develop 

binational communication protocols and procedures for timely information sharing, including the utilization of 

formal communication pathways and participation in quarterly binational consultation meetings. Sonora also 

provided Arizona with weekly morbidity reports. 

Dr. Lopez suggested partners utilize existing infrastructure to improve communication and collaboration; exercise 

real-time communication and networking to improve information sharing; and participate in practice exercises to 

address non-emergency situations. 

B. Medrano discussed surveillance in the Hidalgo-Tamaulipas border region. She affirmed the HCHD 

maintained weekly communication with Mexican counterparts through the EWIDS program and planned to 

implement syndromic surveillance, wherein hospitals would participate in an early warning surveillance system. 

Moreover, B. Medrano indicated increased legal and illegal migration generated Hidalgo public health challenges. 

She noted as many as 100 people were recently discovered inside “stash houses,” some of whom were illegal 

immigrants with signs of chicken pox. The HCHD was working closely with first responders and hospitals to 

coordinate responses to similar situations. 

Unregulated products posed additional health concerns in Hidalgo. Food-borne illnesses transmitted through 

illegally imported, unpasteurized cheese resulted in recent deaths. Others issues related to mercury-contaminated 

beauty creams sold by private vendors, in which case the HCHD developed a poster campaign to raise awareness. 


Mauricio Leiva, Chief, CDPH COBBH, inquired whether an awareness campaign was directed toward 

unpasteurized cheese producers. 

Dr. Aranda confirmed a campaign was developed. However, difficulties in reaching small, home-based Mexican 

producers included their lack of regulation. As such, it was difficult to locate problems due to their mobility. 

Armando Carvajal, Sonora State Laboratory of Public Heath, requested clarification with respect to mortality and 

whether the epidemiology differentiated diabetes from cardiac diseases or AIDS as cause of death when these 

diseases were present simultaneously. 

Dr. Aranda stated they attempted to identify the basic cause of death and the period during which events occurred; 

however, he indicated it was possible these diseases were co-morbidities. He noted properly completing the death 

certificate was also important. 

Dr. Dutton agreed reporting on death certificates was important. He noted some studies indicated the rise of 

diabetes as the first cause of mortality in México, whereas diabetes held sixth place as the recorded cause of death 

in Texas. He affirmed age-adjusted data was also important. 

Maria Fierro, Imperial County Public Health Department, inquired whether cirrhosis as the cause of death was 

related to alcoholism or hepatitis C. 

Dr. Aranda stated he was unable to answer the question, as the death certificate would not indicate this. A review 

of the clinical report would determine these linkages. He also suggested that rectifying the cause of death held 

some importance, noting they frequently received reports erroneously indicating TB as cause of death. Dying 

from TB was not the same as dying with TB. 

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Dr. Aguilar stated that in México, doctors often received trainings on death certificate completion, as many were 

unaware how to properly complete certificates. 

Elizabeth Hunsperger, Chief, Serology Diagnostics and Research Laboratory, CDC–San Juan, Puerto Rico, asked 

B. Medrano whether Hidalgo established policies for first responders and vaccination requirements based on 

encounters with unvaccinated immigrants. 

B. Medrano reported HCHD followed CDC guidelines. She indicated the U.S. Border Patrol required training on 

standard precautions in case of encounters with infectious disease in illegal immigrants, as they were often the 

first line and first exposed. She also noted hospitals aimed to enforce recommended vaccinations, including those 

that guard against seasonal viruses and pertussis, although no definite policies existed. 

Panel–Cross-Border Sharing of Public Health Items 

Moderator: Sonia Montiel, BIDS Laboratory Coordinator, DGMQ, CDC 

Dr. Elisa Aguilar Jiménez, Coordinator, BHC Chihuahua Regional Office, “Evaluation of Transportation 

Procedures for Materials Used in Public Health on the U.S.-México Border” 

Trinidad Barreras, Supervisory Consumer Safety Officer, FDA, “Import Operations” 

Norman Bebon, Assistant Port Director-El Paso, CBP, “U.S.-México Transport of Public Health Material” 

Dr. Miguel Escobedo, Quarantine Medical Officer, DGMQ, CDC, “Evaluation of Pilot Procedures for 

Importing Public Health Specimens through Southern Land Border Ports of Entry” 

Dr. Aguilar presented an evaluation of transportation procedures regarding border public health materials. To 

improve transportation procedures, the BHC Chihuahua Regional Office developed a survey, in collaboration 

with San Diego County and the DGMQ, to compile information on utilized practices that could be used to 

formulate recommendations. They emailed the 70-question survey to 21 border, state, and federal health workers, 

including epidemiologists and chemists, and received a 90 percent response rate. Of these, 65 percent had 

participated in activities related to the exportation of biological samples and/or importation of reagents for rapid 

testing, hospital equipment, anti-toxins, medical devices, etc. 

Dr. Aguilar explained the documentation process involved when acquiring a permit to import public healthrelated 

material into México. Documentation was sent to COFEPRIS, which maintained a response time of at 

least two weeks. Once a permit was obtained, the laboratory was required to send the tracking number in advance 

of the package to enable the InDRE legal department and the customs agent to follow through appropriately. Dr. 

Aguilar noted a similar process to export public health materials from México to the United States. 

Although 78 percent of those surveyed indicated that U.S.-México coordination existed, over 40 percent indicated 

there was room for improvement. The survey identified several barriers to compliance with import/export 

regulations, including the following: 

• Lack of communication with the customs agent. 

• Lack of communication with COFEPRIS. 

• Difficulties in complying with each agency’s norms. 

• Limited budgets for covering each agency’s costs. 

• Prolonged permit procedures. 

• Inconsistent treatment of permits/documentation. 

• Lack of training in procedures. 

• Time limitations. 

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Cost was the most frequently indicated barrier, particularly concerning customs/broker fees and the required 

additional personnel time. 

Dr. Aguilar reported one recommendation included developing a uniform import/export process, possibly using 

an electronic portal to connect health services, COFEPRIS, and customs. This would allow for more efficient, 

real-time procedures; reduce administrative steps; and minimize time and human error. 

In addition, Dr. Aguilar affirmed other improvements included new binational agreements for scientific support to 

permit the exchange of public health materials; flexibility in the use or designation of transportation lines 

exclusively for importation to México; the provision of a single permit for the import/export of specific goods; 

and the designation of a single federal agency to oversee import/export of public health materials. 

Dr. Aguilar affirmed these improvements would have an enormous impact on the process required for 

epidemiological surveillance as well as the control and prevention of diseases. 

T. Barreras provided a general overview of FDA import operations on the Texas-México border. The FDA 

worked in collaboration with U.S. Homeland Security, the CDC, and the Texas Office of Policy and 

Governmental Affairs to ensure that imported products for human and animal use were safe and effective. 

Referenced documents included the Federal Food, Drug, and Cosmetic (FD&C) Act, the Bioterrorism Act of 

2002, and the Public Health Service Act. 

T. Barreras reported the El Paso FDA field office was abile to perform product entry reviews and investigations, 

including sample collections and analysis; compliance activities, such as detentions and hearings; post-refusal 

activities, including export verification; and entry filer activities, such as filer evaluations and training. 

T. Barreras noted an importer or designated representative was required to file an entry and bond with customs 

pending a decision to admit goods into the United States in addition to filing a notice with the FDA. Investigators 

evaluated the admissibility of a product electronically and entry reviewers evaluated whether to release the 

product, request an examination, request additional information, or recommend detention of the product. 

An import alert system prevented products in violation from distribution in the United States. Approximately 271 

import alerts were active at the time, many of which concerned medicated and non-medicated animal feed. 

T. Barreras reported importers were responsible for ensuring imported products were in compliance with U.S. 

laws and regulations. They could be placed on the “detention without examination” list if they had a history of 

violations, but could petition for removal if they provided evidence of non-violative shipments and assurance the 

cause of violation was corrected. 

Controls were maintained in an effort to protect the nation’s food supply against terrorism and other food-related 

emergencies. 

N. Bebon discussed CBP duties and activities and stated they defended the border from terrorists and smugglers 

and enforced the laws of over forty different agencies. 

In 2008, the U.S. and Mexican Secretaries of Health met to discuss difficulties in the cross-border transport of 

medicines, biological specimens, materials, and equipment for public health. A pilot project was proposed to 

identify barriers and to revise binational operating procedures in favor of a more consistent flow of public health 

samples and medications. The CBP Office of Field Operations and the CBP Office of Trade met with HHS to 

develop the pilot’s standard process. 

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N. Bebon reported the Border Health Pilot Project for Cross-Border Transport of Public Health Material ran 

from September 30, 2009, to January 1, 2010. It focused on biological specimen exchange to diagnose diseases of 

public health interest and on pharmaceuticals to treat MDR TB. 

Operating under this pilot, the “Juntos” Project, in collaboration with the Ciudad Juárez and El Paso health 

departments, promoted TB control activities in both cities. Specimen transport from the Chihuahua Secretariat of 

Health to the Texas DSHS was essential to improve cross-border transport. 

As a condition of the pilot, items arriving by land entered as commercial shipments and were documented in the 

Automated Commercial Environment (ACE) e-Manifest. All shipments were required to be clearly marked with 

the appropriate placard, per International Air Transport Association Guidelines for the Safe Transport of 

Infectious Substances and Diagnostic Specimens, and accompanied by a CDC permit. U.S. Customs brokers were 

not required for informal entries, as CBP Agricultural Specialists or Hazmat-trained CBP officers sufficed to clear 

shipments. Shipments were no longer referred to the FDA. 

The Border Health Pilot Program was extended beyond January 2010. In February 2012, the CBP El Paso Field 

Office and the El Paso CDC Quarantine Station agreed to jointly develop a local emergency protocol for rapid 

importation of biological specimens from México during public health emergencies. 

Dr. Escobedo reported on a survey developed by the San Diego County Office of Public Health, in collaboration 

with the CDC, that evaluated pilot procedures for importing public health specimens through southern land border 

ports of entry. The survey’s goal was to formulate recommendations for improving importation procedures. 

Survey participants included stakeholders from the four U.S. border states. Of the 33 respondents, 58 percent 

indicated awareness of the pilot project, and 15 percent reported their invitation to provide pilot design input. As a 

result of the pilot project, one Texas and three San Diego public health workers were trained to use the CBP ACE 

e-manifest. 

Biological shipments reported by Laredo, Texas, doubled from 10 in the three-month period prior to the pilot to 

20 during the pilot’s three-month period. Brownsville, Texas, reported an increase from 30 to 40 biological 

shipments over the same duration. 

However, respondents also reported problems during the pilot, such as an inability to pay customs broker fees or 

lack of access to commercial trucking lanes. The costs per public health shipment more than doubled for San 

Diego-based respondents, primarily due to customs brokers. El Paso TB programs lacked funding to pay broker 

fees and imported no specimens during the pilot. 

Thirty-seven percent of respondents did not recommend continuing the project, while 18 percent of those who did 

recommend the pilot’s continuation were from San Diego. The rest were undecided. 

Dr. Escobedo noted the pilot appeared to have insufficient input from public health stakeholders and training, 

notification, and application was inconsistent at all Points of Entry. The pilot remained in operation in 2010, 

although it was unable to facilitate the movement of biologic specimens for public health purposes. 


Panel Moderator S. Montiel acknowledged various procedures existed for the transport of public health materials 

and noted that local, state, and federal level efforts were made in response to these problems. In local sites, 

regulations were not applied consistently. She affirmed the need for regulatory procedures, including 

implementation of exceptions for health-related materials required to control and detect health emergencies that 

threaten regional and global health. 

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Dr. Reyes, National Polytechnic Institute–Reynosa, Tamaulipas, referenced their research center and explained 

U.S.-based providers declined to accept Mexican credit cards, forcing them to purchase identical equipment from 

Mexican distributors at three times the cost. The product was then delayed at Customs, resulting in the lab’s 

inability to perform its analysis. 

In response to Dr. Reyes, I. Hernández Monroy stated COFEPRIS and CBP affirmed they would expedite the 

permit process for diagnostic use, not commercial, when notified in emergency cases. She indicated the 

possibility for InDRE to provide a one-time exception letter declaring a reactive was required for a specific 

purpose, but emphasized the importer would thereafter be required to undergo the regular process. 

S. Montiel inquired whether a person could purchase and item in the United States and import it as a donation. 

I. Hernández Monroy responded that the problem was not the purchase, but the permit to import the item. 

Dr. Aguilar’s questioned why certain U.S. distributors declined to accept Mexican credit cards. 

A participant responded that U.S. and México distributors are licensed to sell products in their respective 

countries. A U.S. distributor will decline to sell a product when there are licensed dealers in México. 

Dr. Cortés Alcalá noted that items purchased in the United States were subject to import fees and would 

ultimately cost the same or more. Anyone living in the border region is subject to the same laws. It is likely that 

U.S. providers would be required to purchase a distributor’s license to sell products in México and assume the 

expenses of bringing products into the country. Mexican providers’ products are more expensive because they are 

subject to customs fees. 

Dr. Dutton affirmed solutions are required to address the concerns of public health and not commercial interests. 

At a 2005 BHC conference, the U.S. and México Secretaries of Health expressed their willingness to assist; 

however, he was unaware of any progress. 

S. Montiel agreed specific recommendations are required, as is an agenda to resolve the problems. 

Dr. Cortés Alcalá suggested they petition COFEPRIS and CBP by letter to perform a study that assessed the 

number of public health material import-exports that encountered problems. With this specific data, they can 

confirm a problem exists and demand change. He proposed convening a small work group to draft a letter. 

Dr. Aguilar noted each country’s diverse import-export requirements and suggested decreasing the required 

process time. The kinds of operations might be a question of education or to save time. 

A participant from El Paso stated his agency adapted to the pilot project and was able to reach a solution. He 

indicated a problem crossing medicines and affirmed a resolution was unattainable if COFEPRIS does not agree 

to discuss the issue. El Paso public health workers go through the import process properly, but COFEPRIS has not 

responded to their concerns. 

Another participant indicated different activities take place along the border, and while problems may exist in El 

Paso, the pilot was excellent in San Diego. 

Dr. Cortés Alcalá affirmed importation involved federal laws and noted federal and state allowances existed in the 

cases of a real emergency. 

One public health worker agreed resolutions were needed. He reported on the Texas DSHS regional border offices 

and their experience crossing medications into México. They attempted to follow time-consuming procedures 

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egarding 45-50 MDR TB cases, and received a written response denying their efforts after approximately a year 

and a half. They continued to treat patients, although not altogether legally, and worked with local agencies to 

treat patients and cross medicines. Mexican customs oftentimes confiscated medicine. In addition, the Mexican 

side was directed to pay fines and fees, regardless of established local agreements. 

Dr. Waterman inquired about the WHO’s role, as this was not strictly a U.S.-México border issue and occurred 

between countries on a global scale. 

S. Montiel referenced a Chinese model that dealt with significant commerce and movement of people. She noted 

China’s electronic platform could be applied on a smaller scale in México and affirmed preliminary steps, such as 

transcription of the Articles, were required. Although strong collaboration existed with InDRE, this would be a 

long process. 

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APPENDIX E: CONCURRENT TRACK SESSION SUMMARIES 

Best Practices and Lessons Learned from BIDS and EWIDS Projects 


Dr. Martha Alicia Bueno Rosas, Chief, Epidemiology Surveillance, Chihuahua Secretariat of Health, 

“Seroprevalence of Coccidioidomycosis in Chihuahua” 

Katharine Perez-Lockett, M.P.H., BIDS Officer-Epidemiologist, NM DOH, “Development and Dissemination 

of the Borderwide Regional Influenza Surveillance Network Report” 

Catherine Golenko, M.P.H., BIDS Epidemiologist, ADHS, “Enhancing Respiratory Infection Surveillance on 

the Arizona-Sonora Border–BIDS Program Sentinel Surveillance Data” 


“Epidemiologic Surveillance of Influenza in México, its Impact on the Northern Border, and the HHS- 

General Directorate of Epidemiology Cooperative Agreement” 

Dr. Steve Waterman, Team Lead, U.S.-México Unit, DGMQ, CDC, “U.S. Perspective on BIDS Best Practices 

and Lessons Learned” 

Raul Sotomayor, M.P.H., M.S.A., International Health Analyst, ASPR, HHS, “EWIDS Best practices and 

Lessons Learned” 

Dr. Bueno discussed the seroprevalance of coccidioidomycosis in Chihuahua, a member state in the Four 

Corners project. She noted they confirmed 24 coccidioidomycosis cases during the pilot and compiled weekly 

reports of aggregate syndromic and virologic data for distribution to binational partners. 

Next steps included using data to establish a border region baseline and potentially establishing data sharing 

agreements to formalize data collection and reporting. Four Corners was the result of established regional 

relationships and a best practice model. 

C. Golenko explained the ADHS OBH BIDS program aimed to enhance respiratory infection surveillance on the 

Arizona-Sonora border by monitoring (1) infectious respiratory pathogens among hospitalized patients with 

Severe Acute Respiratory Infection (SARI) during the 2010-2011 flu season; and (2) BIDS sentinel hospital site 

patients with viral respiratory conditions in Pima County, Arizona. She affirmed the exercise benefitted public 

health concerning outbreak detection and/or epidemics and concluded a better understanding of the limitations of 

rapid flu diagnostics was needed. They were currently pursuing more effective cross-border collaboration for 

SARI surveillance. 

Dr. Cortés Alcalá presented the Mexican experience regarding influenza surveillance by reviewing 2012 data 

taken from México’s northern border, noting the General Directorate of Health Services was responsible for 

border health. To strengthen surveillance, the DGE planned to build capacity with border laboratories and to 

acquire additional laboratory equipment for InDRE. He affirmed influenza surveillance required highly sensitive 

diagnostics, real-time reporting and notifications, standardized procedures, and sustainability. 

Dr. Waterman stated the project aimed to establish an enhanced binational surveillance system and network for 

infectious diseases by promoting binational data exchange, enabling the development of binational prevention and 

control strategies, and enhancing regional public health infrastructure. To this end, programs built capacity in 

epidemiology, surveillance, and laboratory diagnostics. 

Dr. Waterman reported at least one BIDS meeting took place each year since 1998, and from 2006-2010, eight 

training sessions were convened in México and the United States. He noted BIDS produced several publications 

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on U.S-México border infectious disease surveillance and was present in five sister city regions and 

approximately 20 hospitals and clinics. 

With respect to best practices, Dr. Waterman reported the project developed borderwide surveillance reports, 

implemented harmonized case definitions and laboratory testing algorithms, established a network of 

epidemiologists and laboratories, and performed trainings. Partnerships between CDC quarantine stations and 

local/state health departments were also effective. 

In addition, the CDC maintained a longstanding collaboration with the DGE that included the launch of the first 

binational web-based surveillance information system in May 2012. The system permitted binational messaging 

and data sharing. It represented a possible platform for expanding data sharing beyond the limited number of 

diseases and syndromes that BIDS surveys. 

R. Sotomayor discussed lessons learned from EWIDS projects and affirmed EWIDS supported several U.S.- 

México border initiatives, including enhanced ILI surveillance, laboratory capacity building, binational outbreak 

investigation and response, and secure electronic data exchange. All four U.S. border states participated in 

EWIDS projects. 

To advance borderwide and binational integration of preparedness and response activities, R. Sotomayor indicated 

the need to identify and develop policy tools that could overcome barriers to surveillance data sharing and 

communicating health alerts during a major public health event. The interoperability of emergency preparedness 

and response systems also required improvement. He affirmed sharing lessons learned and best practices with 

binational partners would help resolve policy and operational issues. 


In response to Dr. Cortés Alcalá’s question concerning rapid testing for influenza and the accuracy of results, Dr. 

Waterman affirmed it was well-recognized that the rapid test for influenza had low sensitivity. It was incorporated 

in the United States because it engaged doctors in the surveillance process and doctors liked to use them. 

Dr. Waterman also explained several BIDS sentinel sites fed into ILI-net, noting the recommendation was to 

increase the number of border sites. México built a valuable data surveillance system in SINAVE, and although 

the U.S system was different, he acknowledged they were able to develop a good impression of the data when 

observing the Mexican system. 

HPV, Cervical Cancer, and HIV: Epidemiology and Control Measures 

Moderator: Dr. Allison Banicki 

Dr. Mona Saraiya, Medical Officer, Epidemiology and Applied Research Branch, Division of Cancer Prevention 

and Control, CDC, “Cervical Cancer Prevention” 

Dr. Allison Banicki, Epidemiologist, Texas DSHS OBH, “HPV Vaccination in Texas, 2010” 

Dr. Gudelia Rangel, Coordinator, Comprehensive Strategy for Migrant Health, México Ministry of Health; BHC 

Delegate to Salomón Chertorivski Woldenberg, México Secretary of Health, “Current Overview of HIV on the 

Northern Border of México” “Current Overview of HIV on the Northern Border of México” 

Emilio J. German, M.S.H.S.A., Public Health Analyst-Coordinator for Hispanic or Latino Health Equity 

Activities, CDC, “HIV and Health Equity among Hispanics/Latinos” 

Dr. María Luisa Zúñiga, Associate Professor and Behavioral Epidemiologist, Division of Global Public Health, 

UCSD “Gender Inequality and HIV Care Behavior among HIV-positive Latinos in the U.S.-México Border 

Region” 

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Dr. Saraiya provided an update on cervical cancer screening and HPV vaccination. From 2004-2008, the annual 

average instances of HPV-associated cancer exceeded 21,000 cases in women and 12,000 in men. She noted new 

U.S. guidelines advised cervical cancer screenings beginning at age 21. México established a cervical cancer 

prevention and control policy in 2008, and since then, two million HPV vaccine doses were administered to girls 

ages 9-16 and over six million HPV cytology tests were performed. As of January 1, 2012, the Mexican 

government announced universal HPV vaccine coverage for girls between the ages of 9 and 10. 

Dr. Saraiya reported HPV testing and vaccination was often ignored along the border. She affirmed a transient 

population made surveillance and follow-up difficult. However, she indicated the United States possessed 

considerable resources and México maintained considerable experience with the HPV vaccine and testing. 

Dr. Banicki discussed HPV vaccination rates along the Texas border. She noted certain HPV types were known 

causes of cervical cancer, and Texas sustained some of the highest cervical cancer incidence and mortality rates in 

the United States. 

Analysis of the Texas 2010 Behavior Risk Factor Surveillance System indicated a higher prevalence of HPV 

vaccine series completion among 15-17-year-old girls and among those whose parents had some college 

education. It was concluded that HPV immunization rates along the Texas border tended to be slightly higher than 

elsewhere in Texas. The HPV series rate of completion remained low, less than 20 percent among girls ages 9-17. 

Dr. Rangel provided an overview of HIV/AIDS in México’s northern border region. México reported nearly 

150,000 AIDS cases nationally. AIDS-related death rates in border states were much higher than the national rate 

of 4.8. Baja California’s rate was the highest at 8.7, followed by Tamaulipas at 5.9, Sonora at 5.1, Nuevo León at 

4.3, and Coahuila at 3.1. 

Dr. Rangel affirmed recent health services and education programs targeted migrants and mobile populations. 

Several border region HIV research projects were in progress or completed, and priorities were to increase the 

communication between HIV researchers and decision makers, thereby increasing research influence on public 

policy as well as new research funding opportunities. 

E. German addressed HIV and health equity among Latinos in the United States. He reported an estimated 1.2 

million people were living with HIV in the United States, and approximately 20 percent were unaware of the 

infection. Hispanics represented 22 percent of diagnosed U.S. HIV infections in 2010. 

Also in 2010, the United States released the National HIV/AIDS Strategy (NHAS), a comprehensive plan for 

prevention, care, and HIV research aimed at reducing HIV incidence and HIV-related disparities as well as 

increasing access to care. 

E. German concluded Latinos were disproportionately affected by HIV and affirmed the NHAS would succeed 

by targeting resources to maximize impact on incidence and health equity, recognizing the importance of 

prevention, developing supportive policies, and garnering collective commitment. 

Dr. Zúñiga spoke on gender inequality and HIV among Latinas in the U.S.-México border region. She reported 

Latinos in San Diego’s southern region accounted for 59 percent of HIV cases; women comprised 25 percent of 

new HIV diagnoses; and women along México’s northern border were at increased risk for HIV. Dr. Zúñiga and 

her colleagues conducted a binational study that revealed HIV-positive Latino women were significantly more 

likely to make unsupervised changes to their Antiretroviral Therapy (ART) than were HIV-positive Latino men. 

From the research, Dr. Zúñiga concluded female Latino study participants were more likely to report HIV-related 

social isolation and maintained poorer ART adherence than did men. The profile suggested women might be more 

vulnerable to poor health outcomes. She noted the border region required longitudinal studies of HIV-positive 

women and barriers to health care. 

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A. Carvajal inquired about HPV transmission and the types associated with cervical cancer. 

Dr. Saraiya responded that U.S. studies indicated increased HPV in young white women, and HPV 18 was the 

most common genotype associated with adenocarcinoma. She did not have data on México. 

Dr. Banicki asked Dr. Rangel to explain the increase in Sonora AIDS rates and the relatively low numbers of 

people receiving ART. 

Dr. Rangel cited a lack of information on death records as a possible explanation for the difference in Sonora’s 

AIDS rates compared to other states. Sonora, Tamaulipas, and Coahuila did not indicate decreases in AIDS 

deaths, although this could be attributed to reporting. She noted the investment in universal treatment for people 

with AIDS was producing results in México. 

In Baja California, 1,350 patients were in treatment, which was less than the number of cases reported. This was 

possibly attributable to follow-up issues, changes in state of residence, or lack of access. In Tijuana, it was 

difficult for patients to travel to CAPASITS for treatment. In other cases, patients who began treatment in 

advanced stages died soon after, which may explain why they were not yet detecting a reduction in AIDS-related 

deaths. 

E. German affirmed the CDC’s Office of Health Equity partnered with federal and nonfederal partners focused on 

addressing HIV among all populations most disproportionately impacted. He noted the term “social determinants 

of health” was absent from conference discussions and reported social determinants driving the HIV epidemic 

among Latinos included unemployment, lack of insurance, and homelessness. CDC included social determinant 

language in all the Funding Opportunity Announcements. 

A participant stated her area was not highly populated and noted difficulties in attracting funding. She inquired 

about ways to identify support, as HIV-AIDS funding is generally distributed to larger cities. 

E. German responded that the CDC funded all 50 states, six territories, as well as six to eight additional cities with 

the highest impact of HIV in January 2012. He recommended she work with her local city and state health 

departments to acquire funding. CDC was committed to reducing HIV incidence and inequities. 

Juan Ruiz, from Baja California, emphasized the reality of AIDS within border populations, noting the high 

percentage of women contracting AIDS from their male partners/spouses and the lack of access. He also affirmed 

medicines would become less accessible with reduced budgets, and patients would be placed on waiting lists or be 

required to assume part of the cost. In addition, as many people did not test for AIDS, they were unable to 

determine an accurate number of those unaware of their HIV status who were infecting others. 

E. German replied by restating parts of his earlier discussion. Stigma and discrimination resulted in unwillingness 

among married men to admit to same-sex relations. Diminishing the infection in communities required 

collaboration at local, state, and federal levels. As funding was problematic, they needed to be creative. 

Dr. Rangel noted BBID objectives included identifying areas that lacked development and recommended they 

develop proposals to collaborate on specific areas, such as the possible expansion of HIV screening. To illustrate, 

she reported a study of migrants crossing the Tijuana-San Diego border detected HIV with a prevalence of 1.23, 

much higher than the national HIV incidence in adult men. She emphasized the study reflected only one border 

crossing. 

Binational Outbreak Investigations 

Moderator: Omar Contreras 

Maureen Fonseca-Ford, M.P.H., Public Health Prevention Specialist, DGMQ, CDC, “Cluster of Guillan- 

Barré Syndrome due to a Waterborne Outbreak of Campylobacter Jejuni Infection—Sonora, México, and 

Arizona, 2011” 

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Dr. Max Zarate-Bermudez, CDC Epidemiologist, “Environmental Assessment of the Waterborne Outbreak of 

Campylobacter Infection in Sonora, México, and Arizona, United States, 2011” 

Dr. Miguel Escobedo, Quarantine Medical Officer, DGMQ, CDC, “Coordinated Response to a Binational 

Wound Botulism Outbreak” 

Dr. Gerardo H. Flores-Gutiérrez, Professor, Autonomous University of Tamaulipas, “Epidemiologic 

Surveillance on the U.S.-México Border from the Veterinary Perspective under the One Health Concept” 

Dr. Andres Velasco-Villa, Associate Service Fellow, CDC, “Rabies across Borders: Finding Emerging and 

Re-emerging RABV Variants with Public Health Impact” 

Dr. Mauricio Gómez-Sierra, InDRE, “Expanded Panel of 20 Anti-nucleocapsid Monoclonal Antibody as a 

Tool in the Differentiation of A-typical Antigenic of the Rabies Virus within the Mexican Territory” 

M. Fonseca-Ford discussed the 2011 Arizona-Sonora binational investigation of a GBS outbreak due to a 

waterborne Campylobacter jejuni. M. Fonseca-Ford reported an initial review of an Arizona GBS patient 

determined that a full outbreak investigation required a coordinated response with México. On June 29, federal, 

state, and local epidemiologists met in San Luis, Arizona, and agreed to establish the first fully-integrated 

binational outbreak response through shared field work, databases, and reports. 

M. Fonseca-Ford stated they confirmed an unprecedented GBS cluster with an incidence 26 times the expected 

rate. They identified the precipitant as Campylobacter jejuni infection and available evidence suggested a large 

bacterial outbreak had occurred. 

This investigation represented a landmark in binational collaboration and strengthened ties between local, state, 

and federal counterparts. Multiple disciplines, including epidemiology, lab, and environmental health were 

essential to the response. Lasting outcomes included the establishment of Campylobacter diagnostics in México. 

In addition, the Cajeme Operating Agency for Municipal Water and Wastewater collaborated with Yuma County 

water authorities to share information on improved practices for iron and manganese removal and water 

disinfection in San Luis. 

Dr. Zarate-Bermudez spoke on the environmental assessment of the waterborne outbreak of campylobacter 

jejuni. As part of the GBS outbreak investigation, an environmental team assessed the potential sources and 

pathways of water contamination. 

The team examined the regional drinking and wastewater treatment systems and analyzed samples taken from 

selected points. No C. jejuni were isolated in any of the environmental samples. However, Dr. Zarate-Bermudez 

explained this was not unusual. 

Dr. Zarate-Bermudez recommended environmental scientists enter into investigations earlier. He observed diverse 

land uses in the border region with no evaluation of the impact on groundwater. He also noted differences in 

drinking water treatment technologies. Integrating groundwater quality with human health could enhance 

sustainable management of water resources. 

Dr. Escobedo discussed the coordinated response to a binational outbreak of wound botulism. In August 2011, 

the El Paso public health authorities were notified of four hospitalized cases of acute descending paralysis. The 

response required a coordinated and multi-jurisdictional outbreak investigation. The CDC facilitated binational 

coordination among subject matter experts, an epidemiology response team, and a field team. Upon identifying 

the disease as botulism, public health workers secured the anti-toxin drug, hospitals and other relevant agencies 

and institutions were alerted, and México was officially notified. Subsequently, three confirmed cases of botulism 

occurred in El Paso. The CDC and Texas DSHS experts provided valuable consultation expertise and guidance. 

Dr. Escobedo affirmed this experience revealed that specific international response protocols were needed to deal 

with a DGE request for assistance. Procedures were also required to manage emergency requests for securing, 

transporting, and exporting public health materials 

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Dr. Flores provided the veterinary perspective on border epidemiologic surveillance. One Health recognized the 

link between human, animal, and environmental health and considered human and veterinary medicines to be 

similar, as they shared a common knowledge of anatomy, physiology, and pathology. Dr. Flores affirmed 

surveillance and control of diseases should take place under one international, interdisciplinary, and multisectorial 

focus. As examples, he cited transmission of brucellosis and rabies from animals to humans, due perhaps 

to a lack of awareness of the disease. 

Dr. Velasco discussed border rabies surveillance and the considerable economic impact of rabies prevention and 

control efforts on the United States and México. He reported the United States spent $118 million in one year to 

provide post-exposure rabies prophylaxis; México spent $2 million. 

He concluded by stating a new resolution for the global elimination of rabies associated with dogs was introduced 

at the World Health Assembly. 

Dr. Gómez-Sierra explained the epidemiology of the rabies virus in México and presented data on the 

characteristics of classic and atypical rabies antigens. From 2007 to 2011, 373 rabies cases were reported in 

Tamaulipas and 316 cases in San Luis Potosí. 


A participant inquired which binational measures could be initiated to control rabies outbreaks. He identified a 

Texas aerial program dropped vaccine-laden food into the wild for foxes to consume, although he was unaware of 

the program’s effectiveness. He also asked about factors for transmission among species. 

Dr. Velasco reported the vaccine was encased in a polymer-coated biscuit, similar to dog food. The Texas 

program was active and did eliminate a variant present in foxes and coyotes in 2004. Mexican efforts have not 

been comparable. 

The virus was detected in dogs in México, and the oral vaccination intervention cost $27 million. A massive 

vaccination took place in México, but included only domesticated dogs and not wild animals. The United States 

and Canada collaborated with México under a tri-national treaty for rabies control to implement the oral 

vaccination in hard-to-reach areas. 

Dr. Velasco affirmed the virus had high mutation, and there was potential for the virus to become established. 

They detected a mutation in coyotes and were concerned with possible transmission back to dogs. Spikes in rabies 

transmission were found in the spring and fall. 

In the case of bovines, they found greater rabies prevalence in rainy seasons. As rabies transmission occurred 

from animal to human, and not the reverse, it was important to include veterinarians and environmentalists in 

surveillance and control efforts. 

With respect to the types of botulism treatment available to Mexican residents, Dr. Escobedo replied the antitoxin 

to botulism was under experimental protocol release in the United States. Although, it could be acquired 

commercially, it would require a special initiative, as it was seldom used. The antitoxin could be available if 

Mexican health authorities promoted the acquisition of a drug depot. In the United States, the antitoxin was 

available only through the strategic national stockpile and required legal consultation. 

Dr. Escobedo indicated the CDC’s willingness to work with private industry to increase the antitoxin’s 

availability and noted that establishing access to the drug was important. 

Dr. Escobedo was asked to compare the costs associated with lack of access to the antitoxin and those attributed 

to establishing a depot. He stated patients invariably experienced extensive stays in the intensive care unit, 

followed by months of rehabilitative therapy, all of which would be very expensive. Better results developed from 

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early administration of the antitoxin. In terms of costs, establishing depots or a binational accord to share the drug 

was sensible. The transportation of the antitoxin also needed to be addressed. 

Respiratory Conditions in the Border Region: Tuberculosis and Influenza 

Moderator: Dr. Elisa AguilarJiménez 

Dr. Miguel Angel Reyes López, Professor/Researcher, Genomics and Biotechnology Center, National 

Polytechnic Institute, “Detection of M. Tuberculosis Mutations in Tamaulipas Isolates” 

Dr. Alberto Martínez Vázquez, Professor, Autonomous University of Ciudad Juárez, “Tuberculosis Analysis 

in Juárez 2011” 

Dr. Roberto Alejandro Suárez Pérez, Epidemiologist, Juárez Jurisdictional Office, “Epidemiology of A- 

H1N1 and the Identification of Risk Factors Associated with Confirmed Cases during the 2009 Pandemic in 

Ciudad Juárez, Chihuahua, México” 

Laura Alvarez, M.P.H., Disease Surveillance Specialist, EWIDS, El Paso DPH, “Integrating Selected El Paso 

County School Districts into Public Health Surveillance” 

Aldo Carrasco, Disease Surveillance Specialist, Texas DSHS OBH Region 9/10, “Sustaining Syndromic 

Surveillance in Underserved Areas along the Border using Independent School Districts as Reporting Sites in 

Health Service Region 9/10 with the Texas Department of State Health Services” 

Dr. Eduardo Azziz-Baumgartner, EIS Officer, CDC, “Estimating the Disease and Economic Burden of Viral 

Respiratory Diseases at Sentinel Sites on the U.S.-México Border during 2010-2012” 

Dr. Reyes provided information on the detection of Mycrobacterium Tuberculosis (M. TB) mutations in 

Tamaulipas. México’s Northern border region accounted for more than 33 percent of the 15,384 national TB 

cases. Tamaulipas alone accounted for 6.9 percent. 

TB was resistant to antibiotics due to its lipid structure in the cellular wall. The general objective of Dr. Reyes’ 

research was to molecularly analyze the mycobacteria isolates of potential TB patients. He mapped the 

relationship between the bacterium under study and the Tamaulipas health districts from which they originated. 

He also identified drug resistance in the bacterium. 

Dr. Martínez Vázquez discussed clinical disorders and risk factors for the development of Acute Respiratory 

Distress Syndrome in the Intensive Care Unit of Ciudad Juárez hospitals. The main objective was to characterize 

intensive care unit cases to show which clinical disorders were prevalent. The results showed the prevalence of 

non-specific pneumonia, non-specific sepsis, females, 44 years of age, and degenerative chronic diseases. 

Dr. Suárez discussed the epidemiology and risk factors for A-H1N1 influenza associated with the 2009 Ciudad 

Juárez pandemic, identifying obesity and diabetes as relevant risk factors. Surveillance of H1N1 continued after 

the outbreak. The presence of co-morbidities resulted in a poorer prognosis. 

L. Alvarez spoke on integrating El Paso County school districts into public health surveillance. The El Paso 

DPH, in collaboration with the Texas Association of Local Health Officials, implemented an electronic system in 

county school districts to capture information related to absenteeism and symptoms associated to influenza. The 

system could be used in the future to detect enteric diseases and vaccine preventable conditions. 

The project’s main objective and expected outcome was to obtain timely and accurate school health indicators for 

use in emergency preparedness activities. They expected that system automation would reduce the labor required 

for data collection. They planned to expand the project to sites in Southwestern New Mexico school districts. 

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A. Carrasco presented on maintaining syndromic surveillance in underserved border areas by using independent 

school districts as reporting sites. This project launched in 2007 in Health Service Region 9/10, an underserved 

border area. In the 2010-2011 school year, eight schools participated with a combined population of 2,812 

students. The school ILI and Gastrointestinal-like Illness surveillance project was an extension of a pilot project 

headed by the DSHS Preparedness Program. 

A. Carrasco concluded that schools were an excellent venue for syndromic surveillance activities, particularly 

when located in an area of limited health infrastructure. The data collected allowed DSHS Health Services Region 

9/10 to monitor disease activity and alert epidemiologists in advance to initiate a public response if needed. 

Dr. Azziz-Baumgartner demonstrated how to leverage influenza surveillance to estimate disease and economic 

burden in Imperial County, California. Although a preventable infection, influenza was tied to approximately 

100,000 deaths per year in the Americas. Two sentinel hospitals in Imperial County with PAHO/CDC 

surveillance provided data used to estimate the incidence of influenza-associated hospitalizations. 

Data collected for analysis included patient demographics, SARI case-status/survival, viral data by epidemiology, 

etc. Preliminary findings indicated that Imperial County sustained a substantial rate of influenza-associated 

hospitalizations, potentially higher than the national incidence rate. They hoped to replicate this analysis in 

Arizona, New Mexico, and Texas and also wanted to add migrant case status to the recorded information. 


In reference to Dr. Reyes’ earlier disclosure that he was not in possession of border specimens, an epidemiologist 

participating in the Reynosa-Matamoros binational project reported she studied TB DNA genotyping and 

submitted the results to the Mexican side. She inquired why he had not received the report and whether she could 

assist him to obtain the results. 

Dr. Reyes stated they did not have the samples because patients were sent to the United States where they 

collected samples and kept the DNA. 

Dr. Restrepo had more than 14,000 samples. 

Dr. Reyes affirmed he was not acquainted with the full scope for the distribution of his work and required the 

samples to understand how many strains existed statewide. With that information, he would be able to collaborate 

with the United States to determine whether people on both sides of the border were sharing TB strains. He also 

wanted to understand the origin of MDR strains. He hypothesized that a number of those taking antibiotics were 

spreading the strain throughout his state. He noted that as México did not have those antibiotics, they were unable 

to understand how the drug resistant mutations were circulating. 

A state laboratory employee representative informed Dr. Reyes those samples were sent to Dr. Restrepo; 

however, she is no longer working with TB diagnosis. 

Dr. Aguilar inquired whether Dr. Reyes had trouble importing the TB samples and whether the National 

Polytechnic Institute had the resources to do so. She suggested Dr. Reyes speak with the U.S. side to obtain half 

the samples and perform the research collaboratively. 

Dr. Aguilar observed that two presentations concerned the incorporation of public school systems into the 

surveillance process. She inquired whether they used this information to develop heath education for the 

community. 

The panelists replied interventions were related to handwashing and influenza prevention activities. 

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International Health Regulations and Their Impact on U.S.-México Bilateral Relations 


Dr. Katrin Kohl, Ph.D., M.P.H., Deputy Director, DGMQ, CDC, “Practical Aspects of the Binational 

Implementation of the International Health Regulations” 


“International Health Regulations and Their Impact on Binational and Border Relationships between México 

and the United States” 

Alicia Harvey Vera, M.P.H., Project Manager, Division of Global Public Health, Department of Medicine, 

UCSD, “Biological Sample Transport across the U.S.-México Border: It Takes Two Villages” 

Dr. Roberta Andraghetti, Adviser, International Health Regulations, PAHO/WHO, “Maximizing the Benefits 

of the International Health Regulations: The Example of México and the United States” 

Dr. Kohl discussed practical aspects of binational IHR implementation and noted several articles within the IHR 

support binational collaboration. In addition, she stated the United States would not require an extension for the 

implementation of IHR capacities. The Guidelines were broader in scope but complementary and consistent with 

the IHR. She affirmed public health workers’ efforts in border health fit into a larger international agreement and 

praised them representing a model of collaboration for other countries. 

ASPR managed the National IHR Focal Point (NFP) and coordination among agencies. ASPR served as the 

authorizing official and retained the ultimate authority to authorize any notification of potential public health 

emergency of international concern to WHO. A by-product of the IHR infrastructure and process, countries used 

NFPs to rapidly exchange information on a variety of public health events in a trusted environment. 

Dr. Kohl reported the CDC had a very low threshold for notification, noting the CDC would report the event to 

WHO if two of the four notification criteria were met. One reported event was a GBS cluster in neighboring 

counties of the United States and México. 

In the spirit of the IHR, U.S. and México have collaborated to build laboratory and epidemiologic capacity, 

facilitate the import-export of public health materials, and cooperate on the binational treatment of cases. The 

United States and México met the IHR recommendations for binational collaboration and could do much more. 

Dr. Cortés Alcalá presented on the IHR’s impact on binational and border relationships between México and the 

United States. He agreed they are a useful tool. With respect to the WHO’s provision of five years to implement 

the basic IHR capacities, Dr. Cortés Alcalá clarified this was the time limit the member states had outlined for 

themselves. He affirmed México would request an extension on IHR basic capacities and developed a 2012 plan 

for their implementation. InDRE already surpassed the requirements for surveillance capacity. What remained 

was to fulfill the basic capacities for intersectoral coordination. The Regulations marked an important change in 

the paradigm for analysis of infectious disease as well as environmental and radio-nuclear risks. 

Dr. Vera described the methods developed and implemented to transport biological samples across the U.S.- 

México border. This exercise involved the UCSD Division of Global Public Health, the San Diego Public Health 

Lab, the CDC Quarantine Station, CBP, México’s Customs, Baja California Secretary of Health, and municipal 

health authorities. The process accounted for field team training, driver and vehicle, appropriate times of day, etc., 

and reduced the cost per sample transport from $500 to $270. The model represented the most cost-effective and 

efficient means to date for public health studies. 

Dr. Andraghetti reported México and the United States were among WHO member states recognizing the need 

to collectively respond to public health emergencies of international concern. The current IHR entered into force 

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in June 2007 and was a legal tool describing procedures, rights, and legal obligations for State Parties and the 

WHO. 

Article 2 of the IHR stated that “the purpose and scope of these Regulations are to prevent, protect against, 

control, and provide a public health response to the international spread of disease in ways that are commensurate 

with and restricted to public health risks, and which avoid unnecessary interference with international traffic and 

trade.” 

Dr. Andraghetti reported WHO and its member states were learning how to implement the IHR, and certain 

countries were not using them to support public health preparedness. She noted the regulations were not new, but 

guidance member countries decided to offer themselves to support public health. There was a need for continuity 

on the local, national, and international levels. 

IHRs introduced NFPs as a new function. NFPs gathered relevant information from across sectors within their 

government, have communication visibility with the WHO, and were overseen by HHS and DGE. 

Dr. Andraghetti affirmed the IHR allowed them to be better prepared to cope with public health emergencies, but 

the core capacities for surveillance, response, and preparedness were not yet fully operational. WHO expected 70 

percent of state parties to request an extension for implementation of the core capacities. 

Subregional collaborations in the Americas, such as the Central America Integration System, supported the 

implementation of the Regulations. The Regulations promoted any form of collaboration between countries 

through subregional and regional networks. 

Dr. Andraghetti noted the way the United States and México embraced the Regulations was exemplary. Their 

binational collaboration and information sharing signaled transparency. 

Challenges to IHR implementation and WHO action included limited financial and technical resources. WHO 

aimed to strengthen country ownership and development of the IHR, possibly by leveraging existing regional 

networks. They also needed to increase advocacy and improve communication to characterize the benefits of IHR 

implementation. 


Dr. Waterman noted Luis Castellano, PAHO, had indicated the Guidelines might be included in a WHO 

document as a model of collaboration for other countries and inquired whether this was possible. 

Dr. Andraghetti responded that it had been difficult to continue using the IHR framework because minimal 

experience sharing had taken place. She asked which channels were best to share best practices. They usually 

shared information through (1) e-mail dissemination to members worldwide; (2) the IHR information, adding a 

best practices section; or (3) the PAHO website. 

Dr. Andraghetti stated that although WHO could identify the lack of adequate mechanisms to share best practices 

as an issue, member input was also important. She suggested members recommend including mechanisms for best 

practices and noted WHO received a recommendation to redesign the EIS website. 

Dr. Kohl stated the IHR were a kind of description of a functional public health program. The only additional step 

the United States needed to take was to devise communication processes. She indicated the NFP intranet site was 

not yet used to understand what was occurring worldwide. Formerly held IHR implementation courses and 

regional meetings would be a good forum for sharing best practices. She agreed the Guidelines were an 

appropriate tool to share with IHR. 

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Dr. Waterman indicated the CDC discussed writing an article concerning the Guidelines process for publication in 

the PAHO bulletin or elsewhere. He noted that many people consider the border as one epidemiological zone and 

inquired whether localized, sister city outbreaks met the threshold for reporting to WHO. 

Dr. Kohl noted a binational event involving a food product not likely to be exported, for instance, might not be 

considered an event of international concern. The fact that an event took place on both sides of the border was not 

a default determination for international reporting. With respect to the GBS outbreak, however, they initially did 

not know what caused the spread. 

Dr. Cortés Alcalá indicated his impression was protocols were meant to be used as designed. Events meeting the 

criteria of a WHO notifiable case should be reported internationally, even if individuals were aware it was not 

likely to spread. He considered it a learning exercise and an opportunity for México to inform NFPs of their 

actions, as they could then implement their own risk assessments. They should always assess an event with Annex 

II and share information with WHO through PAHO. 

Dr. Andraghetti replied a fundamental issue persisted with determining a notifiable case despite having Annex II. 

An intense discussion took place within the organization with certain member states regarding the threshold for 

reporting. After approximately five years, they concluded it was impossible to determine a threshold, and they 

could only be guided by Annex II criteria to internationally communicate. 

A second considerable discussion that occurred within WHO concerned the occasions when they identified 

information through the media, i.e., newspapers, and subsequently requested verification from the NFP. Although 

the WHO was aware the event would not likely escalate to a H1N1 outbreak, they aimed to maintain open 

communication channels between the organization and the NFPs, as they could not afford to initiate contact in the 

midst of the next severe acute respiratory syndrome, otherwise known as SARS. 

Dr. Andraghetti reported a third WHO discussion focused on defining the role of the IHR event information site. 

It was necessary that WHO determine whether its purpose was to provide early warning or to inform decisionmaking 

related to travel. Resolving how the information posted on the site trickled down to the local level was 

also important. She noted suggestions from member states were most welcome. 

Dr. Kohl indicated a benefit of this decision-making instrument was they were motivated to determine an event’s 

scope and potential impact when in the midst of it. At CDC, neither the group nor the center that investigated the 

outbreak made the decision to report. The associate directors for science from the different centers who were 

presented with the information made the decisions, often for the first time, during the assessment call. They were 

able gain a fresh perspective from which to judge the criteria and determine whether the event was important 

enough to report to WHO. 

R. Sotomayor commented that they had a collaboration agreement for pandemic influenza at the trilateral level; 

the Guidelines at the binational level; and BIDS at the cross-border level. EWIDS-U.S. and EWIDS-México 

would end. She asked panelists to comment on how frameworks that endured could be used to support the 

continuance of cross-border health programs. 

Dr. Kohl replied that the entire BBID Conference addressed this question. All binational activities met the spirit of 

the IHR, and conference discussions would further aspects of the IHR requirements in the international context. 

Dr. Cortés Alcalá added that written documents should be revised and updated regularly. Taking into account 

U.S. laws, Mexican laws, and state laws, they would write useful plans and guidelines. 

Dr. Andraghetti stated IHR-Article 3 stipulated that member states, in view of their health policies, would seek 

compliance with the IHR. The Regulations went back to strong national systems. Noting the conference 

E-11

discussion regarding sustainability in the border region, she expressed her surprise by the end of EWIDS funding. 

She affirmed the world looked to the United States when it came to resource mobilization. 

Dr. Charles Wallace, Manager, Texas DSHS Tuberculosis Services Branch, and President, U.S. National TB 

Controllers Association, stated he was unaware of TB’s connection to the IHR. He noted the CDC supported four 

binational projects along the U.S.-México border but affirmed insufficient binational cooperation regarding TB 

took place. He was unaware of any regulations that managed MDR TB patients who crossed into México and 

inquired when IHR regulations would be built into the system to manage these complicated TB cases. Dr. Wallace 

asked panel members to consider the complexity and how they could binationally address diseases like TB. He 

affirmed the four binational border projects received inadequate funding and needed more collaboration, 

surveillance, and regulation. 

Dr. Kohl responded that, from her perspective, the IHR did not get to that level of continuity of care. What they 

accomplished with respect to preventing cross-border TB transmission met the spirit of the IHR, but the IHR were 

not written in a granular fashion. TB was a problem worldwide, although not in terms of outbreaks, which 

possibly explained why an explicit statement had not been made within the IHR to address TB as a global 

problem. The CDC did report to WHO under the IHR any individuals they were aware of who travelled while 

infected with MDR or Extremely Drug-resistant (XDR) TB. This never made it to the event information site 

shared with NFP, possibly because it was not deemed enough of a crisis for other countries. 

Tools were established to work with colleagues in the Department of Homeland Security to prevent TB patients 

from travelling via airplane. In order to prevent spread of the disease, they also attempted to assure continuity of 

care in other countries for TB patients who wanted to return to the United States. 

Dr. Kohl noted TB was one of the primary diseases of concern in her division at CDC, and she agreed there was 

more to be done. 

In response to Dr. Waterman’s request for more information on the U.S. state-level involvement in the IHR 

review process, Dr. Kohl explained state health departments were consulted as part of the assessment process for 

WHO notifiable events. They invited the CDC representative and a state epidemiologist to an assessment call 

coordinated by CDC. In addition, all state epidemiologists received information on events shared through the 

CDC’s Epidemic Information Exchange. 

Dr. Andraghetti affirmed WHO was attuned to TB. She indicated acute events, such as MDR or XDR cases 

related to air travel, would make it on the information site. The IHR channels to the NFPs were used for 

international contact tracing of TB cases among focal points. It was possible to apply IHR provisions in travel 

medicine to travelers at departure or upon arrival. How these provisions could support the development and 

enforcement of TB protocols needed to be considered. 

Dr. Cortés Alcalá expressed concern that too many initiatives were treating the same thing. Possible resolutions 

included managing programs and processes more efficiently; merging the various initiatives spending limited 

resources for similar purposes; and leveraging resources better. 

Effective Methods for Outreach, including Innovative Film Documentary and Social 

Media Techniques 


Michael Welton, M.P.H., M.A., Epidemiologist, CDPH COBBH, “California Border Region ILI Surveillance 

and Influenza Education in Migrant Farmworker Populations” 

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Irma Ortiz Soto, Coordinator, BHC Baja California Regional Office, “Health Education for the Surveillance 

of Vaccine Preventable Diseases within Communities in Tijuana during 2011” 

Dr. Kimberly Shoaf, Associate Professor, UCLA School of Public Health; Assistant Director, UCLA Center 

for Public Health and Disasters, “Cross-border Public Health Communication during the 2009 H1N1 

Influenza Outbreak” 

Dr. Jacob Rosales Velázquez, Quality and Health Education, Tamaulipas Secretariat of Health, “Dengue 

Proof Hospital” 

M. Welton discussed challenges in reaching migrant populations. The H1N1 pandemic identified the need for 

increased infectious disease surveillance. The enhanced ILI surveillance initiative included migrant farm workers 

in San Diego and Imperial Counties, and the Vista Community Clinic as well as the Clínicas de Salud del Pueblo 

partnered in the effort. 

The project established outreach promotora (health promotion worker) teams that worked within farmworker 

communities as well as surveillance and communication protocols. Over 11,000 face-to-face encounters took 

place and 20,000 flyers were distributed. They determined ILI was present in the farmworker community, and atrisk 

workers often did not have health insurance vaccinations. Challenges to the project included difficulties 

reaching the population and unfamiliarity with the practice. 

I. Ortiz spoke about community health education and surveillance of vaccine-preventable diseases in Tijuana. 

The principal preventable diseases studied in 2011 were polio, whooping cough, tetanus, and measles. 

Community activities included testing, diagnosis, and vaccinations. TB surveillance activities included 

conducting epidemiologic and contacts studies, performing home visits to ensure 100 percent completion of 

treatments, and distributing prophylaxes to all children under the age of five. In addition, I. Ortiz described ILI 

surveillance and outreach using health outposts, information collection, and community flyer distribution. 

I. Ortiz concluded that improved epidemiologic surveillance required greater community participation for both 

notification and information collection in coordination with public health services. Health promotion and 

education on the ground were important factors in raising awareness and improving health. 

Dr. Shoaf presented her research on cross-border communication during the 2009 H1N1 outbreak. The study 

aimed to better understand the experiences and perceptions of California border residents during the outbreak. 

Dr. Shoaf surveyed California residents to collect data on information sources, protective actions, information 

availability, communication strategies, and demographic characteristics. The responses indicated California 

residents received abundant information during the H1N1 outbreak from both domestic and international sources. 

Participants perceived the information from domestic sources to be more accurate, trustworthy, and useful. 

Dr. Rosales discussed activities of Hospital Seguro to combat dengue, including hospital accreditation, Clinical 

Practice Guide, intensive training, and activities to form a multidisciplinary, inter-institutional team of evaluators. 

The Tamaulipas Secretariat of Health developed a contingency plan for surveillance and response in case of 

dengue outbreak. 


In response to a question regarding whether migrant workers involved in the ILI surveillance project were 

questioned about their states of origin and levels of education, M. Welton responded that this information was not 

collected due to limited space on the form. He agreed, however, that these were good questions to consider. 

Dr. Aranda inquired about farm worker perceptions of the influenza vaccine. 

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M. Welton reported a lack of acceptance of the vaccine by Tijuana farm workers, and they observed that many 

people did not seek the vaccine although it was available. M. Welton was unaware of the level of acceptance of 

the vaccine among the farm workers in his project, but he concluded acceptance would be more likely with 

promotora participation. 

Dr. Gloria Leticia Doria Cobos, Epidemiologist, Tamaulipas Secretariat of Health, reported people in Tamaulipas 

also did not seek the influenza vaccination even when available. However, once H1N1 cases were announced via 

television, people began to seek the vaccine. In order to identify more effective ways to disseminate information 

to the public, Dr. Doria asserted the need to evaluate the kinds of information the population received to 

determine their impact. 

Avelina Acosta, BHC California Outreach Office Coordinator, asked M. Welton if there were plans to continue 

his initiative or to train health promotion workers to respond to questions and provide information. 

Although he was interested in continuing the project, M. Welton related no immediate plans existed. 

Noting Vista Community Clinic was possibly one of the first to use health promotion workers in the early 1980s, 

Dr. Shoaf inquired whether the promotores used were already part of the clinic’s process or new to the project. 

M. Welton responded that they used existing promotores who worked for the clinics. He noted they would be able 

to continue promoting work identified by the project, to an extent, but not to the same degree. 

I. Ortiz noted these outreach projects primarily served Spanish-speaking, Mexican immigrants. She suggested 

working with Mexican teams of health workers and employing the same promotion methods/materials used in 

México might generate more trust and achieve greater impact. 

M. Welton agreed that binational collaboration has advantageous increased their output. His office has increased 

its collaboration with mobile clinics that travel to the more rural Mexican areas, such as Valle de Guadalupe. 

Through EWIDS, he noted, they also work with some Baja California binational sites within the ILI network. 

I. Ortiz was asked about the effects of violence on the groups that went into the communities. She responded that 

nothing occurred when they went into the communities. They went house to house, and, if there were gangs, they 

never bothered the health workers. They always tried to find leaders and ask permission to go into the 

communities. In the future, they wanted to organize and return the information collected to the communities, so 

that they could become decision makers about the health characteristics presenting in their areas. 

With respect to a question regarding the methods used for dengue surveillance and treatment, Dr. Rosales stated 

his was an innovative, new model created in the Under-Secretariat with various colleagues. PAHO invited them to 

provide training in almost all Mexican states. Lessons learned included that the doctors did not possess the 

knowledge necessary to manage severe cases of dengue. In the General Hospital, ten patients arrived the first day, 

and in one week, they had 300 patients. They instructed a group to recognize the dengue symptoms and conducted 

a training program on clinical management. 

In response to whether she inquired about the survey participants’ countries of origin and whether she planned to 

extend her research to include online sources of information, Dr. Shoaf replied she did not inquire about country 

of origin. She also observed that the Latino community did not seek “official information” on health from online 

sources, but preferred face-to-face interaction or other primary sources of information. 

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APPENDIX F: LIST OF ACRONYMS 

ACE 

ADHS 

AFP 

AIDS 

ART 

ASPR 

BBID 

BIDS 

BTWG 

CDC 

CBP 

CDPH 

COBBH 

COFEPRIS 

DGE 

DGMQ 

DPH 

EIS 

EWIDS 

FDA 

GBS 

GHSI 

Guidelines 

HCHD 

HHS 

HIV 

HPV 

ICE 

Automated Commercial Environment e-Manifest 

Arizona Department of Health Services 

Acute Flaccid Paralysis 

Acquired Immune Deficiency Syndrome 

Antiretroviral Therapy 

Assistant Secretary for Preparedness and Response 

Border Binational Infectious Disease 

Border Infectious Disease Surveillance 

Binational Technical Work Group 

Centers for Disease Control and Prevention 

U.S. Customs and Border Protection 

California Department of Public Health 

California Office of Binational Border Health 

México Federal Commission for the Protection against Sanitary Risks (Comisión 

Federal para la Protección contra Riesgos Sanitarios) 

General Directorate of Epidemiology/ Dirección General de Epidemiología 

Division of Global Migration and Quarantine 

El Paso Department of Public Health 

CDC Epidemic Intelligence Service 

Early Warning Infectious Disease Surveillance 

U.S. Food and Drug Administration 

Guillain-Barré Syndrome 

Global Health Security Initiative 

Technical Guidelines for United States-México Coordination on Public Health 

Events of Mutual Interest 

Hidalgo County Health and Human Services Department 

U.S. Department of Health and Human Services 

Human Immunodeficiency Virus 

Human Papillomavirus 

Immigration and Customs Enforcement 

F-1

IHR 

ILI 

InDRE 

LTJG 

MCN 

MDR 

MEDSIS 

NAPAPI 

NFP 

NHAS 

NM DOH 

OBH 

PAHO 

RMSF 

SARI 

SINAVE 

TB 

Texas DSHS 

TTUHSC 

UCSD 

UIEES 

VDS 

WHO 

XDR 

International Health Regulations 

Influenza-like Illness 

National Institute of Epidemiological Diagnosis and Referral/ Instituto de 

Diagnóstico y Referencia Epidemiológicos 

Lieutenant (junior grade) 

Migrant Clinicians Network 

Multi-drug Resistant 

Medical Electronic Disease Surveillance Intelligence System 

North American Plan for Pandemic and Animal Influenza 

National IHR Focal Points 

National HIV/AIDS Strategy 

New Mexico Department of Health 

Office of Border Health 

Pan American Health Organization 

Rocky Mountain Spotted Fever 

Severe Acute Respiratory Infection 

México National Epidemiological Surveillance System/Sistema Nacional de 

Vigilancia Epidemiológica 

Tuberculosis 

Texas Department of State Health Services 

Texas Tech University Health Sciences Center 

University of California, San Diego 

Sonora Epidemiologic Intelligence and Health Emergencies Unit/Unidad de 

Inteligencia para Emergencias en Salud de Sonora 

Ventanillas de Salud 

World Health Organization 

Extensively Drug-Resistant 

F-2

APPENDIX G: LIGHTNING TALK SUMMARIES 

Dr. Miguel Escobedo, “Descriptive Analysis of Mexican Immigrants with Overseas Tuberculosis Conditions, 

October 1, 2010–September 30, 2011” 

Dr. Escobedo indicated a CDC analysis of medical information regarding Mexican immigrants with TB 

conditions revealed a significant percentage of Class B cases. The analysis also identified well-defined relocation 

patterns, including California and Texas as leading destinations. He concluded Class B TB tracking may be a 

useful surveillance and referral tool. 

Dr. Haoquan Wu, “Design miRNA-based shRNA to Suppress HIV Infection” 

Dr. Wu discussed laboratory research he conducted at Texas Tech University to design a genetic suppression of 

HIV infection. Although results were promising, he will conduct further research. 

Dr. Rachel Joseph, “Investigation of a Shigella Sonnei Outbreak among U.S. Travelers to México, November 

2011” 

Dr. Joseph reported a San Diego patient diagnosed with Shigellosis, a notifiable, foodborne illness, launched an 

outbreak investigation, which tracked the outbreak to U.S. tourists who ledged at the same Puerto Vallarta hotel. 

Dr. Alberto Martínez Vázquez, “Clinical Disorders and Risk Factors for the Development of Acute Respiratory 

Distress Syndrome in the Intensive Care Unit” 

Dr. Martínez Vázquez noted the study determined hospitalized patients run the risk of acute respiratory distress at 

the rate of 1.5 to 8.4 cases per 100,000. The two highest risk factors include non-specific pneumonia and sepsis. 

Dr. Mingtao Zeng, “New Mucosal Vaccine for Cross-Strain Protection against Influenza” 

Laboratory research at Texas Tech University tested the use of detoxified anthrax to deliver antigens for crossstrain 

protection against influenza. Preliminary data from testing on mice indicated the feasibility of developing a 

new universal influenza vaccine. 

Dr. Beatriz A. Díaz Torres, “Risk Factors Associated with Acquired Pneumonia in a Pediatric Patient at Ciudad 

Juárez General Hospital” 

This study identified risk factors linked to deaths due to acquired pneumonia in patients four-years-old and 

younger who were admitted to the Ciudad Juárez General Hospital. Tobacco exposure was identified as a risk 

factor for contracting pneumonia. Risk factors for mortality included incomplete vaccination, absence of breast 

feeding, premature/low birth weight, and malnutrition. 

Orion McCotter, M.P.H., “Establishing a System for Dengue Surveillance along the Arizona-Sonora Border” 

O. McCotter reported the border mosquito vector was widespread and thriving despite the lack of reported dengue 

cases in Arizona. He noted that raising clinical awareness was necessary, as travelers and immigrants annually 

import cases to the United States. The University of Arizona Department of Entomology planned to study the age 

structure of wild, trapped Ae. egypti mosquitos to determine whether longevity limits dengue transmission and to 

establish a baseline that would allow public health officials to refine the vector surveillance program. Arizona 

health services would also perform a serosurvey of dengue symptomatic patients and conduct a 

Knowledge/Attitudes/Practices survey of health care providers. 

G-1

Omar Contreras, M.P.H., “Detection of Rocky Mountain Spotted Fever (RMSF) Activity in Southern Arizona” 

In November 2011, an outbreak of RMSF, a zoonotic disease caused by bacterium transmitted by the brown dog 

tick, was identified in the Arizona border region. O. Contreras reported a high potential for an RMSF emergency 

in new areas, due to the extensive range of the tick, which has a year-round breeding cycle in similar climates. 

Dr. Benjamin Park, “The Re-emergence and Changing Epidemiology of Coccidioidomycosis, United States, 

1998–2010” 

Dr. Park and other CDC experts analyzed the U.S. National Notifiable Disease Surveillance System to 

characterize cases of Coccidioidomycosis, a fungal respiratory infection caused by inhaling spores, and describe 

trends. 

Dr. Alfonso Rodriguez-Lainz, “Migration-related Information in U.S. National Data Sources” 

Dr. Rodriguez-Lainz and other DGMQ colleagues surveyed U.S. national data sources for available migrationrelated 

information, including online databases such as PubMed, WorldCAT, Google Scholar, and federal 

government web pages. They identified incomplete migrant coverage and inconsistencies in database information, 

but acknowledged health surveys can potentially limit the study of migrant health. 

Dr. Gudelia Rangel, “Comprehensive Strategy for Migrant Health” 

Dr. Rangel affirmed the Mexican government aimed to guarantee the constitutional right to health services for the 

estimated 12 million Mexican migrants in the United States and their families in México. As part of the 

comprehensive strategy, the VDS program, located in all Mexican consulates in the United States since 2002, 

offered medical assistance and health insurance enrollment. In addition, México planned to establish community 

centers, call centers, and educational kiosks for migrant health education. 

Dr. Steve Waterman, “Evaluation of the Binational Communication Pathways Protocol Pilot” 

Launched in November 2011, this six-month pilot was intended to systematize timely communications of 

binational illness among U.S. and Mexican public health entities at all governmental levels. A survey showed that 

participants valued the communication benefits and found the methodology highly acceptable. They planned to 

expand the pilot to additional U.S. and Mexican border and non-border states. 

Dr. Allison Banicki, “Pilot Project to Implement the Technical Guidelines for United States-México Coordination 

on Public Health Events of Mutual Interest: Perspectives from the U.S. Border States” 

The participating U.S. states in the U.S.-México Binational Communications Pathway Protocol project included 

Arizona, New Mexico, and Texas. An evaluation revealed inconsistencies in binational case identification and 

reporting. Recommendations included strengthening communication pathways and raising awareness of the 

importance of binational reporting. 

G-2

APPENDIX H: BREAKOUT GROUP PARTICIPANTS 

Place/Room: 

Floor: 

TB, HIV, STD, Hepatitis 

Participant Directory 

Capitol D 

3rd Floor 

Date: 05/23/2012 

Time: 

8:00 a.m.-9:30 a.m. 

Last Name 

First Name 

1 Aguilar Elisa 

2 Campos José Arturo 

3 Cardenas Gloria 

4 Carrasco Aldo 

5 Choi Jang-Gi 

6 Escobedo Miguel 

7 Evert Nicole 

8 Flores Maria 

9 Fortune Diana 

10 Gomes-Moreira Jose A. 

11 Jeronimo Trinidad 

12 Jiménez Barbara 

13 Kohl Katrin 

14 Kozo Justine 

15 Lopez Waldo 

16 Luna Norma Irene 

17 Padilla David 

18 Perez-Flores Enrique 

19 Pezzi Clelia 

20 Rangel María Gudelia 

21 Reyes López Miguel Angel 

22 Reyes-Ruvalcaba David 

23 Salazar Lilia 

24 Saraiya Mona 

25 Tafolla Cynthia 

26 Vassell Barbara 

27 Welton Michael 

28 Wu Haoquan 

29 Yi Guohua 

30 Zúñiga María Luisa 

H-1

Place/Room: 

Floor: 

Foodborne and Diarrheal Diseases 


Capitol View Terrace South 

3rd Floor 

Date: 05/23/2012 

Time: 

8:00 a.m.-9:30 a.m. 

Last Name 

First Name 

1 Alva Herminia 

2 Arriaga Lumumba 

3 Banicki Allison 

4 Carmona Daniel 

5 Dutton Ronald J. 

6 Hernández Monroy Irma 

7 Jiménez María Guadalupe 

8 Joseph Rachael 

9 Ledezma Elvia 

10 Maroufi Azi 

11 Montiel Sonia 

12 Phippard Alba 

13 Seca Calixto 

14 Selvage David 

15 Tapia Micaela 

16 Taylor Ethel 

17 Thornton Andy 

18 Trevino Silvia Estela 

19 Waterman Steve 

20 Zarate-Bermudez Max 

H-2

Respiratory Diseases 


Place/Room: 

Capitol View Terrace North 

Floor: 

3rd Floor 

Date: 05/23/2012 

Time: 

8:00 a.m.-9:30 a.m. 

Last Name 

First Name 

1 Acosta Avelina 

2 Alomía Zegarra José 

3 Arevalo Maria 

4 Cázares Marco 

5 Cortés Alcalá Ricardo 

6 de Lafuente Edith 

7 Díaz Beatriz 

8 Fajardo Lucia 

9 Farías Farías Edgar Alberto 

10 Fernandez Jose 

11 Fierro Maria 

12 Golenko Catherine 

13 González Fernando 

14 Guerrero Robert 

15 Hernández Nubia 

16 Kriner Paula 

17 Martínez Vázquez Alberto 

18 Mata Lupita 

19 Medrano Belinda 

20 Pérez-Lockett Katharine 

21 Philen Rossanne 

22 Rodriguez-Lainz Alfonso 

23 Scorza Alessio 

24 Shankar Premlata 

H-3

Emerging Infectious Threats 

(including Vector-Borne Diseases) 


Place/Room: 

Capitol A-C 

Floor: 

3rd Floor 

Date: 05/23/2012 

Time: 

8:00 a.m.-9:30 a.m. 

Last Name 

First Name 

1 Alvarez Laura 

2 Bejarano Veronica 

3 Cantey Paul 

4 Contreras Omar 

5 Cruz David 

6 Doria Cobos Gloria L. 

7 Fonseca-Ford Maureen 

8 Gómez-Sierra Mauricio 

9 Garcia Lauren 

10 González Martínez María Guadalupe 

11 Guerra María Eugenia 

12 Guerra Marta 

13 Hernandez Salvadore 

14 Hunsperger Elizabeth 

15 Leiva Mauricio 

16 Lugo Guillén Norma Alicia 

17 Marikos Sarah 

18 McCotter Orion 

19 Morales Ricardo 

20 Navarrete Lorraine 

21 Navarro Gálvez Francisco Javier 

22 Park Benjamin 

23 Rosales Jacob 

24 Velasco-Villa Andres 

25 Willer Linda 

H-4

Place/Room: 

Floor: 

Laboratory Integration with Surveillance Systems 


Capitol View Terrace North 

3rd Floor 

Date: 5/23/2012 

Time: 

Last Name 

10:00 a.m.-11:30 a.m. 

First Name 

1 Arriaga Lumumba 

2 Arriaga Rangel Carlos 

3 Bacelis Jorge 

4 Bejarano Veronica 

5 Carvajal Armando 

6 Galindo Galindo Edgar 

7 Golenko Catherine 

8 González Martínez María G. 

9 Guerra Marta 

10 Hernández Monroy Irma 

11 Hunsperger Elizabeth 

12 Lopez Waldo 

13 López Martínez Irma 

14 Marikos Sarah 

15 Medrano Belinda 

16 Tapia Olea María Micaela 

17 Velasco-Villa Andres 

18 Willer Linda 

H-5



Place/Room: 

Capitol View Terrace South 

Floor: 

3rd Floor 

Date: 05/23/2012 

Time: 

10:00 a.m.-11:30 a.m. 

Last Name 

First Name 

1 Acosta Avelina 

2 Cantey Paul 

3 Carrasco Aldo 

4 Corona-Luevanos Adriana 

5 German Emilio 

6 Gomes-Moreira Jose A. 

7 Jiménez Barbara 

8 Pezzi Clelia 

9 Rangel Gudelia 

10 Rodriguez-Lainz Alfonso 

11 Welton Michael 

H-6

Binational Communication and Implementation of the Guidelines 


Place/Room: 

Capitol D 

Floor: 

3rd Floor 

Date: 05/23/2012 

Time: 

10:00 a.m.-11:30 a.m. 

Last Name 

First Name 

1 Alomía Zegarra José 

2 Alva Herminia 

3 Aranda Lozano José Luis 

4 Armendariz Bertha 

5 Banicki Allison 

6 Cardenas Gloria 

7 Cázares Marco 

8 Contreras Omar 

9 Cortés Alcalá Ricardo 

10 Cruz David 

11 Doria Cobos Gloria L. 

12 Evert Nicole 

13 Fajardo Lucia 

14 Fierro Maria 

15 Flores Maria 

16 Fonseca-Ford Maureen 

17 Fortune Diana 

18 Garcia Lauren 

19 Gómez Linares Mario 

20 González Fernando 

21 González Madrigal Luis 

22 Guerrero Lupita 

23 Guerrero Robert 


25 Jiménez Fierro María Guadalupe 

26 Joseph Rachael 

27 Ledezma Elvia 

28 López-Alvarez Benito 

29 Maroufi Azi 

30 Marquez Uscanga Daniel 

31 Martínez Vázquez Alberto 

H-7

32 Mata Lupita 

33 Morales Julio 

34 Morales Ricardo 

35 Navarro Gálvez Francisco Javier 

36 Ortiz Soto Irma 

37 Perez-Flores Enrique 

38 Philen Rossanne 

39 Phippard Alba 

40 Ramirez Sara 

41 Reyes López Miguel A. 

42 Romo Jaime 

43 Rosales Jacob 

44 Saraiya Mona 

45 Savage Kimberly 

46 Seca Calixto 

47 Selvage David 

48 Smith Jennifer 

49 Taylor Ethel 

50 Thornton Andy 

51 Treviño Silvia Estela 

52 Vassell Barbara 

53 Waterman Steve 

54 Wong Leticia 

H-8

Cross-Border Sharing of Items for Public Health Purposes 


Place/Room: 

Capitol A-C 

Floor: 

3rd Floor 

Date: 05/23/2012 

Time: 

10:00 a.m.-11:30 a.m. 

Last Name 

First Name 

1 Aguilar J. Elisa 

2 Barreras Trinidad 

3 Bueno Martha A. 

4 Campos José Arturo 

5 Carmona Daniel 

6 de la Torre Fabiola 

7 de Lafuente Edith 

8 Dutton Ronald J. 

9 Escobedo Miguel 

10 Ferran Karen 

11 González Guadalupe 


13 Iniguez-Stevens Esmeralda 

14 Kriner Paula 

15 Leiva Mauricio 

16 Luna Guzmán Norma I. 

17 Monroy Ricardo M. 

18 Montiel Sonia 

19 Navarrete Lorraine 

20 Padilla David 

21 Tafolla Cynthia 

H-9

APPENDIX I: BREAKOUT GROUP SUMMARY SLIDES 

I-1

I-2

I-3

I-4

I-5

I-6

I-7

I-8

I-9

I-10

I-11

I-12

I-13

I-14

I-15

I-16

I-17

I-18

I-19

I-20

I-21

I-22

I-23

I-24

I-25

Border Binational Infectious Disease Conference - Mexico Border ...

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