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Releve Epidemiologique Hebdomadaire. 2013 Jul 12; 88(28):285-96.This epidemiologic record discusses recent data about yellow fever outbreaks and cases in Africa and South America between 2011 and 2012. During this period, major outbreaks were reported in Sudan and Uganda while significant clusters of cases were reported in Cameroon, Chad and Cote d’Ivoire, necessitating an extended vaccination response. In addition, some isolated cases occurred in districts reporting high yellow fever vaccination coverage (Burkina Faso, Central African Republic, Togo), for which no vaccination response was undertaken. In South America, the World Health Organization American Region reported 32 cases (2011-2012), including 9 deaths, in Brazil, Ecuador, Plurinational State of Bolivia and Peru. As of 2012, most countries in the Caribbean and Latin America with enzootic areas had introduced the yellow fever vaccine into their national routine immunization schedules. The 2008 outbreaks in the Southern Cone expanded the area considered at risk to include northern Argentina and Paraguay. Building upon the yellow fever investment case strategy, which has reduced the frequency and size of disruptive outbreaks, the Yellow Fever Strategic Framework 2012-2020 prioritizes endemic countries according to their epidemic risk. This framework will enable WHO and partners to identify the populations’ high priority needs through a systematic approach so that limited resources can be allocated most effective to reduce the burden of yellow fever in Africa. Following a request from the countries, a form of yellow fever experts met in Panama to discuss how countries can make scientific evidence-based risk assessments and suggested that endemic countries should strive to enhance yellow fever surveillance systems.
[Clinical, epidemiological and microbiological characteristics of a cohort of pulmonary tuberculosis patients in Cali, Colombia] Caracteristicas clinicas, epidemiologicas y microbiologicas de una cohorte de pacientes con tuberculosis pulmonar en Cali, Colombia.
Biomedica. 2010 Oct-Dec; 30(4):482-91.INTRODUCTION: The World Health Organization recommended strategy for global tuberculosis control is a short-course, clinically administered treatment, This approach has approximately 70% coverage in Colombia. OBJECTIVE: The clinical, epidemiological and microbiological characteristics along with drug therapy outcomes were described in newly diagnosed, pulmonary tuberculosis patients. MATERIALS AND METHODS: This was a descriptive study, conducted as part of a multicenter clinical trial of tuberculosis treatment. A cohort of 106 patients with pulmonary tuberculosis were recruited from several public health facilities in Cali between April 2005 and June 2006. Sputum smear microscopy, culture, drug susceptibility tests to first-line anti-tuberculosis drugs, chest X- ray and HIV-ELISA were performed. Clinical and epidemiological information was collected for each participant. Treatment was administered by the local tuberculosis health facility. Food and transportation incentives were provided during a 30 month follow-up period. RESULTS: The majority of patients were young males with a diagnostic delay longer than 9 weeks and a high sputum smear grade (2+ or 3+). The initial drug resistance was 7.5% for single drug treatment and 1.9% for multidrug treatments. The incidence of adverse events associated with treatment was 8.5%. HIV co-infection was present in 5.7% of the cases. Eighty-six percent of the patients completed the treatment and were considered cured. The radiographic presentation varied within a broad range and differed from the classic progression to cavity formation. CONCLUSION: Delay in tuberculosis diagnosis was identified as a risk factor for treatment compliance failure. The study population had similar baseline epidemiologic characteristics to those described in other cohort studies.
[Implementation of the Integrated Management of Childhood Illnesses strategy in Northeastern Brazil] Implementacao da estrategia Atencao Integrada as Doencas Prevalentes na Infancia no Nordeste, Brasil.
Revista De Saude Publica. 2008 Aug; 42(4):598-606.OBJECTIVE: The majority of child deaths are avoidable. The Integrated Management of Childhood Illnesses strategy, developed by the World Health Organization and the United Nations Children's Fund, aims to reduce child mortality by means of actions to improve performance of health professionals, the health system organization, and family and community practices. The article aimed to describe factors associated with the implementation of this strategy in three states of Northeastern Brazil. METHODS: Ecological study conducted in 443 municipalities in the states of Northeastern Brazil Ceara, Paraiba and Pernambuco, in 2006. The distribution of economic, geographic, environmental, nutritional, health service organization, and child mortality independent variables were compared between municipalities with and without the strategy. These factors were assessed by means of a hierarchical model, where Poisson regression was used to calculate the prevalence ratios, after adjustment of confounding factors. RESULTS: A total of 54% of the municipalities studied had the strategy: in the state of Ceara, 65 had it and 43 did not have it; in the state of Paraiba, 27 had it and 21 did not have it; and in the state of Pernambuco, 147 had it and 140 did not have it. After controlling for confounding factors, the following variables were found to be significantly associated with the absence of the strategy: lower human development index, smaller population, and greater distance from the capital. CONCLUSIONS: There was inequality in the development of the strategy, as municipalities with a higher risk to child health showed lower rates of implementation of actions. Health policies are necessary to help this strategy to be consolidated in the municipalities that are at a higher risk of child mortality.
How Brazil outpaced the United States when it came to AIDS: the politics of civic infiltration, reputation, and strategic internationalization.
Journal of Health Politics, Policy and Law. 2011 Apr; 36(2):317-52.Using a temporal approach dividing the reform process into two periods, this article explains how both Brazil and the United States were slow to respond to AIDS. However, Brazil eventually outpaced the United States in its response due to international rather than democratic pressures. Since the early 1990s, Brazil's success has been attributed to "strategic internationalization": the concomitant acceptance and rejection of global pressure for institutional change and antiretroviral treatment, respectively. The formation of tripartite partnerships among donors, AIDS officials, and nongovernmental organizations has allowed Brazil to avoid foreign aid dependency, while generating ongoing incentives for influential AIDS officials to incessantly pressure Congress for additional funding. Given the heightened international media attention, concern about Brazil's reputation has contributed to a high level of political commitment. By contrast, the United States' more isolationist relationship with the international community, its focus on leading the global financing of AIDS efforts, and the absence of tripartite partnerships have prevented political leaders from adequately responding to the ongoing urban AIDS crisis. Thus, Brazil shows that strategically working with the international health community for domestic rather than international influence is vital for a sustained and effective response to AIDS.
Reproductive health surveillance in the US-Mexico border region: beyond the border (and into the future) [editorial]
Preventing Chronic Disease. 2008 Oct; 5(4):A109.This editorial examines reproductive health surveillance in the US- Mexico border region. It offers improvements for reproductive health data system methods and recommendations for sustainability of the project. It also proposes revisions to the Brownsville-Matamoros Sister City Project for Women’s Health (BMSCP) in the following areas: maternal birthing experiences, women’s health over the life course, migration history, acculturation/cultural identity/border region identity, Latina reproductive health, and MCH policy relevance.
The past, present, and future of reproductive health surveillance in the US-Mexico border region [editorial]
Preventing Chronic Disease. 2008 Oct; 5(4):A110.This editorial discusses reproductive health surveillance in the US- Mexico border region. It touches on past, present and future projects for that area including the United States- Mexico Border Health Commission (USMBHC) and the Brownsville-Matamoros Sister City Project for Women’s Health (BMSCP).
Zhonghua Liu Xing Bing Xue Za Zhi / Chinese Journal of Epidemiology. 1997 Oct; 18(5):309-311.Global HIV infection and AIDS: according to WHO estimates, by mid 1996 there were 7 million cumulative AIDS cases. Today the number of people infected with HIV is even more alarming: roughly 21.8 million, of those 42% are women. By the year 2000 there will be between 40 and 50 million cases. Each day about 8,500 additional people are infected with AIDS; one can say the situation is grim. Currently, the AIDS and HIV epidemic regions are shifting, they have gradually moved from the original sites of North America and West Europe toward the mass populations of developing countries in Asia, Africa, and Latin America. In the Asian region which contains about 60% of the world's population, beginning in 1988, with Thailand and India at the center, an exploding epidemic has taken shape. Recent materials indicate, those infected with HIV in Thailand exceed 700,000, over 2 million in India, and the HIV epidemic has already spread to the near neighbors Burma, southern China, Cambodia, Malaysia and Vietnam. With the accumulation of molecular epidemiology research materials, the complete picture of the causes and characteristics of this massive epidemic happening in the Asian region is gradually becoming clear. (excerpt)
Inconsistencies between tuberculosis reporting by the Ministry of Health and the World Health Organization. Mexico, 1981-1998. Discrepancias entre los datos ofrecidos por la Secretaría de Salud y la Organización Mundial de la Salud sobre tuberculosis en México, 1981-1998.
Salud Pública de México. 2003 Mar-Apr; 45(2):78-83.The objective was to describe the tuberculosis morbidity and mortality trends in Mexico, by comparing the data reported by the Ministry of Health (MH) and the World Health Organization (WHO) between 1981 and 1998. The number of cases notified in the past few years, their rates, and the trends of the disease in Mexico were analyzed. The incidence of smear-positive pulmonary tuberculosis was estimated for 1997 and 1998 with the annual tuberculosis infection risk (ATIR), to estimate the percentage of bacilliferous cases in 1997-1998. WHO reported more tuberculosis cases for Mexico than the MH. However, this difference has decreased throughout the years. The notification of smear-positive cases remained stable during 1993-1998. The estimated percentages of detection were 66% for 1997 and 26% for 1998 (based on ATIR of 0.5%). Tuberculosis mortality decreased gradually (6.7% per year) between 1990 and 1998, whereas the number of new cases increased, suggesting the persistence of disease transmission in the population. Inconsistencies between case notifications from national data and WHO were considerable, but decreased progressively during the study period. According to ATIR estimations, a considerable number of infectious tuberculosis cases are not detected. (author's)
Perspectives in Health. 2004; 9(2):30-32.Think about a vacation in the Caribbean and what comes to your mind? Clean air, superb scenery, relaxation, reinvigoration, and renewal? Unfortunately, this is not the reality for many residents of the poorer Caribbean islands. In several Caribbean countries, from 15 percent to 30 percent of the population live below the poverty line. The region’s infant mortality rates vary from 10–12 per 1,000 live births in Barbados and St. Lucia to 24 in Jamaica and 52 in Guyana. Meanwhile, HIV/AIDS has taken a particularly heavy toll on the Caribbean, with prevalence rates that are second only to those of sub-Saharan Africa. In the wake of the United Nations Millennium Summit, prime ministers of the Caribbean Community (CARICOM) met in Nassau in 2001 to review the region’s health priorities and declared their conviction that “The health of the Nation is the wealth of the Nation.” Inspired by this—and by the spirit of the Millennium Development Goals—Caribbean governments have developed new strategic plans for health. How realistic are their goals in the current economic and political climate? How likely are these strategies to succeed in improving quality of life for the Caribbean poor? (excerpt)
Geneva, Switzerland, WHO, Division of Emerging and Other Communicable Diseases Surveillance and Control, 1998. 59 p. (WHO/EPI/GEN/98.09)Yellow fever is a viral haemorrhagic fever transmitted by mosquitos infected with the yellow fever virus. The disease is untreatable, and case fatality rates in severe cases can exceed 50%. Yellow fever can be prevented through immunization with the 17D yellow fever vaccine. The vaccine is safe, inexpensive and reliable. A single dose provides protection against the disease for at least 10 years and possibly life-long. There is high risk for an explosive outbreak in an unimmunized population—and children are especially vulnerable—if even one laboratory-confirmed case of yellow fever occurs in the population. Effective activities for disease surveillance remain the best tool for prompt detection and response to an outbreak of yellow fever especially in populations where coverage rates for yellow fever vaccine are not high enough to provide protection against yellow fever. The guidelines in this manual describe how to detect and confirm suspected cases of yellow fever. They also describe how to respond to an outbreak of yellow fever and prevent additional cases from occurring. The guidelines are intended for use at the district level. (excerpt)
Clinical Infectious Diseases. 2003 Jan 15; 36 Suppl 1:S24-S30.Resistance to antituberculosis drugs has been a problem since the era of chemotherapy began. After dramatic outbreaks of multidrug-resistant tuberculosis (MDR-TB) in the early 1990s, resistance became recognized as a global problem. MDR-TB now threatens the inhabitants of countries in Europe, Asia, Africa, and the Americas. An understanding of the molecular basis of drug resistance may contribute to the development of new drugs. Management of MDR-TB relies on prompt recognition and treatment with at least 3 drugs to which an isolate is susceptible. (author's)
Lancet. 2003 Sep 13; 362(9387):917.I find reassuring the fact that the Child survival series could constitute a renaissance in child-health matters, as suggested by Boniface Kalanda in the accompanying Debate section online. To remain quiet while 10 million children die every year, mostly in developing countries, is certainly unacceptable. (excerpt)
PHNFLASH. 1996 Feb 2; (103):1-2.An estimated 1.2-2.0 million people had been infected by 1995 in Latin America and the Caribbean, and more than 300,000 new HIV infections occur annually. The lack of seroprevalence studies, however, makes reliable estimates difficult. To date, there are 126,000 cumulative AIDS cases and 59,162 deaths recorded in Latin America, and 8065 AIDS cases and 4778 deaths recorded in the Caribbean. New infections are particularly evident among the most socially and economically marginalized populations in the region, as well as among people aged 15-25 years. Relative to other population age groups, these latter individuals are more likely to be highly mobile and involved in tourism and commercial sex, factors which may increase one's vulnerability to infection. The World Bank has sponsored a regional initiative on HIV/AIDS in Latin America and the Caribbean for the period 1996-98 designed to mobilize and unify national and international efforts against HIV and STDs by raising the awareness of regional government administrators, helping to develop a new generation of STD/AIDS control programs to follow the first generation of programs implemented in Brazil and Honduras, and helping the development of regional approaches to STD/AIDS control. The project will cost an estimated US$6.6 million, of which the World Bank will provide approximately US$1.0 million. The initiative will enable countries in the region to share the results of studies in different countries, to build upon the best practices of each others' programs, and to develop strategies for controlling AIDS and STDs across borders. The Bank has also financed projects or project components in Brazil, Haiti, and Honduras. These initiatives are briefly discussed.